Aetiogenesis of Primary Glaucoma

Abstract

The work concerned vvith the aetiology of primary glaucoma and the investigations made demonstrate that the concept of a Central and cerebral regulation of intra-ocular pressure has received considerable attention. Numerous recent studies go to prove that there is a grovving tendency to adopt the concept of this aetiologic relationship. In his study about the primary glaucoma, and vvith reference to changes in the brain, the author was able to establish the following:

1) Pneumo-encephalographic findings in 21 cases with various forms of primary glaucoma proved positive in ali the cases but one, that is, there vvere 9 cases vvith cortico-subcortical atrophy of the brain, and 8 cases vvith frontal-parietal atrophy; in addition, 12 cases revealed an englargement of the ventricular system i. e. the presence of the Hydrocephalus internus vvhile the Cysterne chiasmatic and the Cysterna peduncularis were found enlarged in 10 and 5 cases respectively. Besides the frontal-parietal cortical atrophy of the brain, the diencephalo-mesencephalic atrophy was noted as as vvell.

2) Albumino-globulin reaction after Pandy vvas positive in 14 cases with glaucoma.

3) Audiogram was positive in 6 cases, pointing to a bilateral of the Nervus acusticus.

4) Resudial symptoms of encephalitis, chronic or larval, were also established in glaucomatous cases.

5) In 6 surgical cases — where bilateral transfrontal lobectomy was performed in 5 cases, and unilateral frontal lobectomy in 1 case — intraocular tonus, tensio art. brachialis-art- radialis, retinal pressure and art. ophthalmicae respectively had been examined before and after the operation.

The findings thus obtained point to a regulating centre the frontal part of the brain concerned vvith the intra-ocular and blood pressure, where a synchronic rise and fali in the pressure could often be established in cases after operation.

In ocnclusion, the author argues in support of the cerebral theory or hypothesis about the origin of primary glaucoma: this eye-condition is primarily due to inflammation or intoxication vvhich brings about an atrophy of the diencephalofrontal-parietal part of the brain, and chiefly in the entire neuro-vegetative area, vvith resultatn symptoms of a cerebrovegetative disfunction, vvhich eventually reveals itself in the eye, too, in the form of a glaucomatous condition.