PENDEKATAN KLASIFIKASI GLAUKOMA
KLASIFIKASI BERDASARKAN ETIOLOGI
The glaucomas have traditionally been divided on the basis of primary and secondary forms. This division is arbitrary and artificial, however, in that all glaucomas are secondary to some abnormality, whether inherited or environmental. The historical basis for this division was the assumption that the initial events leading to outflow obstruction and IOP elevation in those glaucomas called primary (e.g., open-angle, angle-closure, and congenital) are confined to the anterior chamber angle or conventional outflow pathway, with no apparent contribution from other ocular or systemic disorders. These conditions typically are bilateral and probably have a genetic basis. In contrast, other glaucomas have been classified as secondary because of a partial understanding of underlying, predisposing ocular or systemic events. These latter glaucomas may be unilateral or bilateral, and some may have a genetic basis, whereas others are acquired.
In reality, the concept of primary and secondary glaucomas largely reflects our incomplete understanding of the pathophysiologic events that ultimately lead to glaucomatous optic atrophy and visual field loss. As our knowledge of the mechanisms underlying the causes of the glaucomas continues to expand, the primary and secondary classifications become increasingly artificial and inadequate. Furthermore, glaucomas caused by developmental anomalies of the anterior chamber angle do not fit neatly into either category. For these reasons, we recommend replacing traditional concepts with a new scheme that provides a better working foundation for the concepts of mechanism, diagnosis, and therapy that will shape the management of the glaucomas for the foreseeable future. This classification is used in this text for the discussion of the various forms of glaucoma.