The essence of the physiological intraocular pressure. Part 2. The role of scleral fluctuations in maintaining the continuity of the aqueous humor daily volume

Purposes: 1. To reveal the morphophysiological features of the elastic structures of the fibrous tunic of the eye in age-related ophthalmohypertension (AOH) and openangle glaucoma (OAG). 2. Show new features of dynamic differential diagnosis by means of modernized techniques of pnevmomagistral ORA and Corvis ST for accurate and objective differentiation between AOH and OAG.

Methods: Theoretical analysis and clinical trials results of the author’s method of differential Express-diagnostics between AOH and OAG based on the criteria of «rigidity» and «fluctuation of the sclera».

Results: There is a practical possibility of using the upgraded rapid diagnosis with the help of pneumatic analyzers ORA and Corvis ST in the conditions of polyclinic network for a reasonable and objective choice of the method of AOH prevention and OAG treatment, as well as their differential diagnostics,. This allows you to instantly, accurately and numerically identify the elderly patient abnormality of the current IOP level according to the level of IOP in his youth and belonging to the corresponding IOP zone. Also, according to the measured current levels of rigidity and fluctuation of sclera, it is possible to reliably differentiate AOH from OAG, as well as identify the level of decrease in the functional ability of the fibrous membrane of the eye (FME) to the fluctuation necessary to maintain the normal circulation of watery moisture and eye volume.

Conclusion: The principal role in the mechanisms of IOP level formation is played by rigidity and micro fluctuation of the sclera. With age, IOP increases due to the fact that the rigidity of the FME gradually increases. From the standpoint of physiology, AOH is useful and necessary for the eye to maintain normal metabolic processes, even in old age. Not knowing patient’s IOP level in his youth, the doctor often cannot reliably determine the abnormality or normality of the current IOP value. But the pathological level of rigidity of FME in OAG is always significantly higher than the normal level of its rigidity in AOH, and the level of fluctuation of the sclera on the contrary, respectively, falls markedly. This allows you to objectively separate the AOH from the OAG. In case of AOH or OAG, it is necessary to restore the functions of sclera, which will be physiologically and pathogenetically justified preventive or therapeutic effect.

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