Y HOC VIET NAM THANG 3 - SO 2/2012 S.Thdl gian nam vien
Thdi gian nam vien trung binh: 6,77 ± 4,63 ngay (ngan nhat: 2 ngay; dai nhat: 19 ngay). So vdi cac nghien ciTu khac ket qua cung tu'dng ty', cdn so vdi phau thuat md byng la ngan hdn han.
Dieu nay cung phii hdp vdi nhieu nghien ciru khac da cho thay tinh u'u viet cua PTNS so vdi phau thuat md byng la thdi gian binh phuc nhanh hdn, thdi gian nam vien ngan hdn va kinh te hdn.
V. KET LUAN
• Tud'i thai khi phau thuat trong ke hoach tir 13-16 tuan chiem 8 5 , 1 %
• Phau thuat cap ciru da so tren phu nii' cd thai < 12 tuan chiem 87,5%
• U nang bi chiem da so (55,3%), tiep den nang thanh djch 23,2%. Khdng cd trydng hdp nao bi ung thu'
• Thdi gian phau thuat trung binh bdc UBT: 51 ± 22,44 phut ( 20 - 140 phut)
• Thdi gian phau thuat trung binh cat phan phu: 72 ± 41 phut (35- 210 phiit)
• Thdi gian nam vien trung binh: 5,77 ± 4,63 ngay (2 - 1 9 ngay)
Chi djnh phau t h u a t Theo ke hoach la: 74,6%
• Phau thuat cap ciru: 25,4%
Phu'dng phap p h l u t h u a t
• Trong phau thuat ke hoach, ty le bdc u bao tdn buong trirng la: 97,9%
• Trong phau thuat cap ciru, ty le bdc u bao ton budng trimg la: 55,3%
TAI LIEU THAM KHAO
i . Pham Dinh Dung (2002), "Nghien ciTu tinh hinh khoi u buong trilhg trong qua trinh thai nghen tai BVPSTW 1996-2001", Luan van thac sy Y hoc, Oai hgc Y Ha Npi.
2. Hoang Thj Hfen (2006), "Tinh hinh phau thuat khoi u buong trirng 6 phu nu' c6 thai tai BVPSTW tir nam 2001-6/2006". Luan van tot nghiep bac sy cliuyen khoa cap I I , Oai hpc Y Ha Npi J, Do Thj Ngpc Lan (2003), "Nghien ciiU ap dung
phau thuat npi soi cat u nang buong trirng lanh tinh tai Vien BVBM&TSS". Luan van tot nghiep bac sy chuyen khoa cap I I , Oai hgc Y Ha Ngi 4. Pham Thanh Nga (2008), "Xi^ tri u buong trirng
trong thai ky bang phau thuat npi soi tai BVPSTW tir 1/2005- 6/2008". Luan van tot ngiiiep ac sy chuyen khoa cap I I , Dai hgc Y Ha Ngi 5 Nguyen Quoc Tuan (1998), "Oanh gia tinh hinh
dieu tri khoi u buong tru'ng tai khoa phu I Vien BVBM&TSS". Cong trinh nghien CLTU khoa hoc, Vien BVBM&TSS
6. Nguyen Thu Trang (2009), "Xac dinh gia tn dydoan ac fe'nh khoi u buong truhg ciia lam sang - Sieu am - CA125 tai BVPSTW nam 2008", Luan van tot nghiep bac sy noi tnj, ToTdng Oai hoc Y Ha Noi.
7. Cristalli B, Carol A, Izarad V, Levardon M (1991),
"Value of coeliosoopic surgical tieatement of ovarian tumors at the beginning of pregnane/', J Gynecol ObstEt Biol Reprod, 20 (5): 665-8
NGHIEN Cl)U DAC DIEM LAM SANG MAT CO HOI CHllNG NOI MO GIAC MAG - MONG MAT TANG NHAN AP
D a o Thj Lam Hudng*
T 6 M TAT
Muc tiiu: Md ta dSc diem lam sang cCia mat cd hpi chimg npi mo giac mac-mdng mat (ICE) tang nhan ap. Ddi tugng: 30 mat {28 ngifdi benh) tang NA tren mat cd hpi chirng ICE. PhUdng phap nghien ciru mo ta hoi ciru c l t ngang. Ket qua: Hgi chimg ICE hay gap d tuoi tren 40, 92,9% benh mgt mat. Benh cd trieu chifng chii quan kin dao dudi 3 hinh thai hoi chimg teo mong mat tien then, hgi chiing Cogan-Reese va hpi chifng Chandler, tien
* B§nh vien Ivlit trung i/Ong
Phan bien khoa hgc: PGS.TS. Vu Thi Bich Thuy 30
trien am i nen thudng dUdc phat hien va dieu In mugn. 86,7% mat c6 NA cao d mifc 25-32mmHg.
86,6% mat CO sd luong te bao npi mo giac mac giam du6i 1500 le bao/mm^ Ket lu$n: Hpi chimg ICE thudng gap d tuoi trung nien, tren mgt mat vdi cac mirc dg ton thuong giac mac, mo'ng mat khac nhau va NA cao vi/a phai.
T(f khoa: hoi chimg noi mo giac mac-mong mat, tang nhan ap.
Y HOC VIET NAM THANG 3 - SO 2/2012 SUAAMARY
STUDY ON CLtNICAL FEATURES OF IRIDOCORNEAL ENDOTHELIAL (ICE)
SYNDROME WITH HIGH lOP Purpose: To descnbe the clinical features of eyes with elevated IGP and diagnosed with iridocorneal endothelial (ICE) syndrome. Subject:
30 eyes with elevated IGP and diagnosed with ICE syndrome of 28 patients were recruited. !\ilethod:
Observation, retrospective study. Resu/(: ICE syndrome usually diagnosed over the age of 40.
92,9% of patients is unilateral. This disease is asymptomatic at the early stage, it progresse slowly and can cause severe visual loss if left untreated, 86,7% of eyes has moderate elevated IGP (25- 32mmHg), the number of endothelial cell is decresed, less than 1500 cell/mm^ in 86,6% of eyes. ICE syndrome has three mam features, progressive ins atrophy, Cogan-Reese syndrome and Chandler's syndrome. Conclusion: ICE is usually diagnosed over the age of 40, unilateral with a variable injured level of cornea, iris and moderate elevated IGP.
Keywords: iridocorneal endothelial (ICE) syndrome, elevated lOP,
I. DAT VAN of
Hdi chimg npi md giac mac-mong mat (Iridocorneal Endothelial syndrome-ICE) du'dc Harms de cap lan dau tien nam 1903. Trong hdi chuTig nay, cac te bao ndi md giac mac (GM) bien doi bat thu'dng, sinh san va di cir vao cac md lan can, lan rong den goc tien phdng (TP) va tren be mat cOa mdng mat, lam tang nhan ap (NA) dSn den td'n hai thj than kinh va thi tru'dng.
Tren lam sang benti du'dc bieu hien dudi 3 hinh thai; hoi chu'ng Chandler, hpi chirng Cogan- Reese va teo mdng mat tien trien. Can nguyen gay benh cdn chu'a dupe biet rd, nhung co the cd lien quan vdi nhidm virus nhU virus Herpes simplex hoSc virus Epstein-Barr. Do cac trieu chiifng chCi quan thudng kin dao, benh tien trien am I nen hau het ngudi benh den kham khi benh da d giai doan rat mudn vdi tinh trang NA cao, dinh goc TP nhieu, ton thUdng dTa thj giac va thi trUdng nang. O Viet Nam benh canh lam sang, phifdng phap dieu trj cung nhutien lUdng benh cua hpi chimg ICE chua that sududc hieu het rpng rai, Vdi mong mudn dong gdp them mdt sd dC^ Heu ve benh canh lam sang cua hdi chimg ICI d Viet Nam chung tdi tien hanh de tai nay vdi muc tieu "Mo ta dac diem lam sang
mat cd hgi chiing ndi mo giac mac-mdng mat tang nhan ap".
II. 06l TUONG VA PHL/ONG PHAP NGHIEN COU 2.1. ed'i tu'dng nghien ciiu; 30 mat (28
ngudi benh) da dupe dieu tri tai khoa Gidcdm benh vien Mat tmng Udng tU 5/2007- 3/2010 vdi Chan doan tang NA tren mat cd hdi chdng ICE.
Tieu chuan loai trU: mat cd kem cac benh ly khac gay khd khan cho viec danh gia can nguyen gay ton hai thUc the ndi nhan.
2.2. Phuong phap nghien ctjru: Nghien
cdu md ta hdi cUu cat ngang.
Vi day la mpt benh ly kha hiem gSp nen chiing tdi lay vao nghien ciru tat ca nhiing ngudi benh cd hpi chiing ICE tang NA dap Ung tieu chuan lUa chpn vao dieu trj tai khoa trong thdi gian nghien ciru.
Lay so lieu tU benh an luu trCr va ket qua kham mat ngudi benh den kham lai theo giay mdi. Ghi nhan cac thdng tin ve tien su", benh sii, cac trieu chUng co nang cua mat, thj luc (bang TL L^andolt), nhan ap (NA ke Maclakov, qua can lOg), tinh trang ket, giac mac, mdng mat, dong tu' (sinh hien vi Inami), gde tien phdng (kinh soi gde Goldmann mdt mat gUdng), day mat (kmh Volk), te bao ndi md giac mac (may hien vi npi md), thi trudng (may TT ke Goldmann),
2.3. Xi> ly so' lieu: bang phan mem Epi- info 6.04.
III. KET QUA VA BAN LUAN
Trong gan 3 nam tU 5/2007 den 3/2010 tai khoa Gidcdm Benh vien mat TW da tiep nhan va dieu trj cho 28 ngudi benh (30 mat) vdi chan doan tang NA tren mat cd hoi chirng ICE, Tren thuc te lam sang mdt sd ngirdi benh da dupc gij'i tu cac phong kham vao hdi ciian vdi chan doan khac nhu viem mang bo dao tang NA hoac gidcdm goc ddng. Rat cd the lUpng ngudi benh cd hpi chu'ng ICE la nhieu hdn nhuYig chi dUdc chuyen vao khoa Gidcdm khi da cd tang NA.
Tudi cua ddi tUpng nghien ciru tU 18 den
65, tudi trung binh 47,5 11,9, trong dd nhdm
tuoi tren 40 chiem da sd (71,5 %), nhdm tU 30
40 tudi it hon (21,4%), dudi 30 tuoi chi cd 2
tru'dng hpp (7,1%). Tudng tu nhU ket qua cCia
chiing tdi nhieu tac gia khac cung nhan thay
Y HOC VIET NAM THANG 3 - SO 2/2012
hdi chirng ICE thudng gap d nhdm tuoi tren 40 vdi ty le t U 7 2 % den 8 1 % [3,6,7].
S d ngudi benh nam chiem t^ le 42,9% (12 ngudi), nir chiem 5 7 , 1 % (16 ngudi). S u khac biet ve gidi khdng cd cd y nghla thdng ke vdi p>0,05.
ICE la mdt benh ly hiem gap nen so lupng dd'i tupng nghien cUu cua cac tac gia nudc ngoai cdn kha khiem tdn, vi vay ty le giira nam va nu' la rat khac nhau giua cac nghien ciru [3].
Dai da sd ngUdi benh bj benh mdt mat trong dd mSt trai gap d 17 ngudi (60,7%), mat phai d 9 ngUdi (32,1%). SU khac biet nay cd y nghla thdng ke vdi p < 0.05. 2 ngUdi (7,2%) mac benh d ca hai m l t deu la nam gidi, dieu nay khac so vdi nhan xet cija mot sd tac gia tren the gidi la hdi chimg ICE bao gid cung chi xay ra d mpt ben mat va su phan bo giCra hai mat khdng cd sU khac biet cd y nghTa thdng ke [3,4,7].
Ve hinh thai lam sang cd 26 mat (86,7%) the teo mo'ng mat tie'n trien, 3 mat (10 %) hdi chifng Cogan-Reese va 1 mat (3,3%) hdi chCfng Chandler. Trong khi dd theo cac tac gia Martha C,Yuan-Kuei Liu thudng gap nhat la hdi chifng Chandler [3,6]. Teekhasaenee C va cs
[4] lai gap nhieu hon hdi chimg Cogan-Reese.
Oieu nay cho thay cd tiie cd s u khac biet ve ty le cac hinh thai benh giii'a cac vung dja ly, chiing too khac nhau. Chiing tdi cung khdng loai trU kha nang nhiJTig ngudi benh cd hdi chCmg Chandler vdi nhurig ton thUdng nang tren GM da dUdc gu"! den dieu tri tai chuyen khoa Giac mac.
Tat ca 28 ngudi vdi 30 mat benh (100%) deu den kham vi thay nhin m d tang dan vao budi sang. Cam giac nhUc mat xuat hien vdi mirc do khac nhau nhung thudng nhifc nhe (21 mat -70%). 8 m l t (26,7%) nhin den cd quang va dien nhin bj thu hep. Trieu chUng nhin md la do dong tu' bj lech tam, giac mac phu, dac biet hay gap 6 hinh thai teo mong mat tien trien. Ket qua nay tUOng tU nhU trong nghien cUu cua Martha C [3]. Da sd cac nha nghien ciru cho rang tren mat cd hpi chimg ICE, te bao npi m d bj ton tht/Ong nhieu nen dd gay phii giac mac. Sau mdt giac ngu keo dai, tinh trang phii giac mac cang tang len va gay giam thj luc vao buoi sang.
Bang 1, Tinh trang giac mac
Giac macPhil bong bieu mo (n = 9 m^t)
So li/dng te bao noi mo G[W/mm^
(n = 30 mat)
IVIong mat dinh vao chu bien GU (n = 30 mat)
Trung tam Can trung tam
Ngoai bien Khong dem dUdc
<700 700-1500
>1500-2000
>2000
<1/4 1/4 - < 2/4 2/4 - < 3/4
> 3 / 4
So mat 9 0 0 7 7 12 3 1 5 1 4 20
%
100 0 0 23,3 23,3 40,0 10,0 3.3 16,7 3,3 13,3 66,7
Mdt trong cac ton thUdng thuc the ciia giac mac trong hpi chimg ICE la phu giac mac.
Trong nghien cifu nay phu giac mac gap d 9 mat, trong dd 1 mat vdi hpi chimg Chandler, 2 mat vdi hdi chimg Cogan-Reese, 6 mat vdi hdi chimg teo mdng mat tien then. Tat ca 9 mat cd phii bong bieu md deu d viing trung tam giac mac nen anh hi/dng nhieu den thj lUc, Tinh 32
trang phu giac mac tren mat hdi chimg Chandler thudng rat nang, trong khi dd tren mat vdi hdi chimg teo mdng mat va hdi chdng Cogan-Reese thi phiJ giac mac thudng d mUc trung binh, Phu giac mac giam di sau khi dieu trj ha NA.Theo Wilson MC khdng cd mdi tUPng quan giQa NA va tinh trang phii giac mac [5].
Y HQC VIET NAM THANG 3 - SO 2/2Q12
Nhieu tac gia cho rang phii giac mac la do te bao npi md bj tdn thuong va tang NA, Trong hpi chimg ICE so lupng te bao ndi md giam nhieu, khi so lupng te' bao npi md giam cdn 400-700 te bao /mm^ hoac thap hPn giac mac se bj ngam nudc va trd nen phu khdng cd kha nang hoi phuc [3,5], Tren 7/30 mat cda nghien cUu nay khdng dem dupc te bao ndi md do giac mac phii nhieu. Ty le mat cd sd lupng te bao ndi md giam den m(fc mat kha nang bu trU chiem 23,3% (7 mat). Da sd mat cd sd lUdng te bao ndi md chi cdn 700-1500/mm^
(12mat-40%J,'
Khi soi hien vi npi md chung tdi nhan thay ngoai su giam sut ve so lupng te bao ndi md thi hinh the cOa cac te bao npi mo cung thay doi, mSc dii van cd the thay cac te bao hinh sau canh, dac biet 6 giai doan sdm cua benh, Nhung d vao giai doan sau ciia benh thi sU thay ddi da rat rd ret trong do mot so te bao da mang hinh the tam giac, tU giac hoac cac hinh the khdng binh thudng khac, Oieu nay phiJ hpp vdi nhan xet cCia Jorge A. Tac gia da ghi nhan dupc iiinh anh cac te bao npi md bat thudng vdi khdng gian rdng Idn giu'a cac te bao. tinh di ddng thap, mau sac cCia cac te bao dao ngupe vdi mau den bao quanh bdi mpt dudng vien mau trang [2].
Chung tdi nhan thay tren hau het mat nghien cifu mdng mat dinh vao chu bien giac mac > 3/4 chu vi cua giac mac, tham chi tren 20 mat (66,7%) mdng mat dinh vao toan bd chu bien giac mac. Ket qua nay cung phii hpp vdi ket luan cOa Denis P la tinh trang mong mat dinh vao chu bien giao mac phd bien trong ca ba the lam sang cija hpi chirng ICE va dinh
phat trien 6 khap eae gde phan tU cija toan bd chu vi mong mat [7]. Theo Martha C hien tUpng dinh nay la do mang te bao npi md giac mac bat thudng phat trien tdi goc TP gay dinh mdng mat vao viing be, vdng Schwalbe va vao mat sau giac mac. Vung dinh nay se ehe lap viing be, han che su luu thdng thijy djch va dan tdi tang NA. Dien dinh mong mat cang Idn thi mirc dp tang NA cang cao [3],
Tat ca ngudi benh den vien khi da cd bieu hien tdn thuong mdng mat rat rd ret. Trong 30 mat nghien ciru teo nhu md mdng mat mirc dp tir nhe den nang gap tren 26 mat (86,7%), 15 mat (50%) c_d teo toan bd chieu day mong mat, tao thanh Id thOng thudng nam doi dien vdi hudng dong tif lech tam, Dong til lech tam mifc dp tu nhe den nang gap tren 21 mat (70%), dac biet ddng ttr tren mat teo mo'ng mat tie'n trien thudng lech rat nhieu. Ldn mang bo dao thay d 5 mat (16,7%), trong dd cd 1 mat hdi chimg Cogan-Reese, 4 mat cdn lai la teo mong mat tien trien, Vj tri xay ra ldn mang bd dao thudng nam d gde phan tU tuong dng vdi hudng dong ti!f lech tam. Tren be mat cOa mdng mat xuat hien cac ndt nho dien hinh cd sac to va od eudng gap tren 3 mat (10%). Day la nhiing mat dilcic chan doan la hdi chUng Cogan-Reese. Theo cac tac gia khae tren the gidi d giai doan khdi dau ciia benh, dong ttf dan dan trd thanh hinh bau due, rdi thanh hinh qua le ma true dpc hudng ve phia cd dinh mong mat nang nhat, Ddng tCf lech tam cdn ket hpp vdi lpn_ mang bo dao lan rdng theo thdi gian. Cac Id thiing d mdng mat phat trien cham hon va bat nguon tif hai cP che do mang spi te bao co keo va do tan ra md eua mdng mat [3,7].
Bang 2. Dac diem lam sang Hinh thai
Teo mo'ng mat tien trien (n=26)
Hoi chutig Chandler (n=1) Hoi chiiTig Cogan-Reese
(n=3)
cOa tUnq hinh thai
Oac diem lam sang Bonq iLf lech tam, Lon manq bd dao Cac l5 thunq d mdng mat Dinh mdnq mat ra phia trade
Phil qiac mac Tang nhan ap Bat thudnq d mdnq mat
Phil qiac mac nanq Tang nhan ap Cac ndt nhd sac td tren mdng mat Cac bat thudng phdi hdp d mdng mat va GM
Tang nhan ap
So mat 21
4 15 26 6 26 0 1 1 3 3 3
Y HOC VIET NAM THANG 3 - SO 2/2012
Trong 26 mat hdi c h i m g teo mdng mat tie'n trien 21 mat (80,8%) ed dong ti!f bj keo lech ra khdi true thi giac, 15 mat (57,7%) cd teo toan bd chieu day cOa mdng mat tao thanh Id thiing nam ddi dien vdi hUdng ddng tif lech tam. Dinh mong mat vao chu bien giac mac xay ra d tat ca 26 mat (100%), vi vay cac mat nay deu cd tang NA. Phii giae mae gap tren 6 mat (23%).
Tren ea 3 mat hdi chdng Cogan-Reese dSc diem lam sang noi bat nhat la cac hat sae t d tren be mat cua mdng mat, thudng di kem eae tdn thUdng phdi hpp d mong mat, giac mac nhu ldn mang t>6 dao, phii giac mac va tang NA.
Chiing tdi chi gap 1 mat cd hpi chCmg Chandler vdi dac diem lam sang phii giac mac nang va tang NA, it cd tdn thUdng tren mdng mat.
Hau het mat nghien cifu cd thi lue giam dudi 3/10 (23 mat - 76,7%), trong dd 8 mat cd thj luc dudi ONT 3m (26,7%) va dupc xem la mil theo dinh nghTa eOa To ohUc Y te The gidi. Chi cd 7 mat dat thi luc > 3/10, TUdng t u nhu vay da sd mat trong nghien ciru ciia Martha C, Teekhasaenee C cd thj lUc giam dudi 3/10 [3,4].
Nguyen nhan ehi!i yeu la do benh dupc phat hien va dieu tri d giai doan mucin, Ngoai ra mdt s d mat CO thj Juc thap la do NA tang cao, mdi trudng trong sud't bj phu due.
NA trung binh eua nhdm mat nghien cifu 1^ 28,7 ± 4,0 m m H g , thap nhat la 25mmHg, eao nhat la 39 m m H g , Mifc NA tU 25 - 32 mmHg chiem ty le eao nhat (26 mat - 86,7%).
Cdn lai 13,3% mat nghien eCfu cd NA tren 32 mmHg, NA trung binh trong nhdm mat nghien cCfu ei!ia Yuan-Kuei liu la 27,6 ± 4,5 m m H g [6], cda Erin A. la 26,8 ± 5,7 m m H g [1], NhU vay nhin chung tren nhCmg mat cd hpi chimg ICE, NA thudng khdng qua cao,
Tat ca 30 mat nghien cUu deu ed ton thUdng dSc hieu cOa dTa thj giac do gidcdm, trong dd 10 mat (33,3%) da ed tdn thuong lom dia tren 7/10, 20 mat (66,7%) ed Idm dia glocom tir 4/10 - 7/10. Ket qua nghien ciru cua Martha C cung eho thay da sd mat d mirc lom <^a rdng, thap nhat la 5/10 va eao nhat la 10/10 [3]. Nguyen nhan chu yeu van la do ngUdi benh di kham va dieu tri khi benh da d giai doan rat muon.
Hau het mat nghien ciJfu da 6 giai doan tien trien (23/30 mat-76,7%), cd 4 mat d giai doan tram trpng (13,3%) va 3 mat d giai doan gan mil va mil tjt (10%), khdng cd mat nao dupe phat hien va dieu trj d giai doan sdm. Do cac trieu chimg chd
quan tn^ng hdi ehimg ICE thudng kin dao, benh tien trien am i, thudng thi NB ehi thay dau nhifc nhe, md mat thoang qua vao budi sang. Chi de'n khi thi lUc giam sut nhieu. cd dau nhCfc, thj trudng thu hep thi NB mdi di kham va dieu tri. DSe diem ve giai doan benh trong nghien cifu ciia chiing tdi cung tuong t u nhu trong nghien ciiU cua cae tac gia khac [1,3,4].
IV. KET LUAN
ICE la mpt benh thudng gap d lUa tudi trung nien tren 40 tuoi, khdng ed s u khac biet ve ty ie mac benh giufa nam va nijr (p>0,05), Benh thudng xuat hien d mdt mat (92,9%) nhung han hCfu cung cd the xua't hien 6 ca hai mat (7,2%). Tren lam sang benh bieu hien dudi 3 hinh thai: hpi chUng teo mong mat tien trien, hdi chUng Cogan-Reese va hdi chutig Chandler. NA thudng khdng qua cao, it gay dau nhUe. Do trieu ehimg chCi quan thudng kin dao nen benh t h u d n g dUpc phat hien va dieu tn d giai doan mudn,
TAI LIEU T H A M K H A O
1. Erin A. Doe, Budenz DL, Gedde S3, Imami NR, (2001), "Long-tenn surgical outcomes of patients witii glaucoma secondary to the iridocomea! endothelial syndrome". Ophthalmology, 108:1789-95,
^. Jorge A. Alvarado, Collin G. Murphy, Maria Maglio, John Hetherington (1986),
"Pathogennesis of Chandler syndrome, essential irris atrophy and the Cogan-Reese syndrome. I.
Alterations of the corneal endothelium".
Investigative Ophthalmology; 27(6): 853-872.
3. Martha C. Wilson, Shields Bruce M. (1989), "A comparison of the clinical vanations of the iridocorneal endothelial syndrome". Arch Ophthalmol; 107: 1465-1468.
4. Teekhasaenee C, Ritch R.(2000), "Iridocorneal endothelial syndrome in Thai patients: clinical vanations". Arch Ophthalmol, 118:187-92 5. Wilson MC, Shields MB. (1989), "A comparison
of the clinical variations of the indocornea!
endothelial syndrome". Arch Ophthalmol, 107:1465-8.
6. Yuan-Kuei Liu, I-Jong Wang, Fung-Rong Hu, Por-Tying Hung, Huai-Wen Chang, (2001),
"Clinical and specular microscopic manifestations of indocorneal endothelial syndrome". Jpn. 1 Ophthalmol; 45: 281-287.
7. Denis P. (2007), "Le glaucome du syndrome indo- comDc^endothelial" J.Fr. Ophtalmol, 30(2): 189-195.
