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СОСУДИСТАЯ ОБОЛОЧКА ГЛАЗНОГО ЯБЛОКА [ vascular layer of the eyeball ] Сосудистая оболочка глазного яблока, или увеальный тракт, или увеа - это средняя оболочка глазного яблока. (Лат.: uveo - быть влажным, водянистым). В сосудистой оболочке выделяют три части: радужка, ресничное (цилиарное) тело и собственно сосудистая часть, или хороидеа.
Сосудистая оболочка обеспечивает гемациркуляцию в глазном яблоке и его метаболизм.
Глазное яблоко представляет собой сфероидную эластическую структуру, состоящую из ядра и окружающих ядро оболочек. Ядро глазного яблока включает следующие взаимодействующие части: переднюю и заднюю камеры глаза, заполненные внутриглазной жидкостью (внутриглазная жидкость), хрусталик и стекловидное тело. Оболочки глазного яблока расположены тремя концентрическими слоями: наружная - фиброзная оболочка глазного яблока, средняя - сосудистая оболочка глазного яблока и внутренняя - чувствительная оболочка глазного яблока, или сетчатка.
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Схема. Внутренняя структура левого глазного яблока. Вид сверху.
Модификация: Gray H., (1821–1865), Standring S., Ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 39th ed., Churchill Livingstone, 2008, 1600 p.
см.: Анатомия человека: Литература. Иллюстрации |
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Примечание:
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The organization of the eye, viewed from above. In this illustration the left eye and part of the lower eyelid are depicted in horizontal section and also cut away to show internal structure. |
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Схема. Кровеносные сосуды увеального тракта.
Модификация: Gray H., (1821–1865), Standring S., Ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 39th ed., Churchill Livingstone, 2008, 1600 p.
см.: Анатомия человека: Литература. Иллюстрации |
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Примечание:
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The vascular arrangements of the uveal tract. The long posterior ciliary arteries, one of which is visible (A), branch at the ora serrata (b) and feed the capillaries of the anterior part of the choroid. Short posterior ciliary arteries (C) divide rapidly to form the posterior part of the choriocapillaris. Anterior ciliary arteries (D) send recurrent branches to the choriocapillaris (e) and anterior rami to the major arterial circle (f). Branches from the circle extend into the iris (g) and to the limbus. Branches of the short posterior ciliary arteries (C) form an anastomotic circle (h) (of Zinn) round the optic disc, and twigs (i) from this join an arterial network on the optic nerve. The vorticose veins (J) are formed by the junctions (k) of suprachoroidal tributaries (l). Smaller tributaries are also shown (m, n). The veins draining the scleral venous sinus (o) join anterior ciliary veins and vorticose tributaries. |
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Схема. Сагиттальное сечение глаза и его ресничной области.
Модификация: Levin L.A., Nilsson Siv F.E., Ver Hoeve J., Wu S., Kaufman P.L., Alm A., Eds. Adler's Physiology of the Eye, 11th ed., Elsevier, 2011, 820 p.
см.: Физиология человека: Литература. Иллюстрации.
Примечание:
Schematic representation of a sagittal section of
the anatomy of the accommodative apparatus at the ciliary
region of the eye, A, in relation to a mid-sagittal section of the
eye as a whole, B.
The schematic shows that the lens capsule,
zonule, ciliary muscle and choroid constitute a single elastic
“sling” anchored at the posterior scleral canal where the optic
nerve leaves the globe, and anteriorly at the scleral spur.
The action of accommodation results in a movement of the
ciliary body forward and towards the axis of the eye against
the elasticity of the posterior attachment of the ciliary
muscle and the posterior zonular fibers. With a cessation
of an accommodative effort, the ciliary muscle is returned
to its unaccommodated configuration through the elasticity
of choroid and posterior zonular fibers. |
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Схема. Артерии (A) и вены (B) глазницы и глазного яблока = A. Arterial supply to the orbit and eyeball. B. Venous drainage of the orbit and eyeball.
Модификация: Gray H., (1821–1865), Drake R., Vogl W., Mitchell A., Eds. Gray's Anatomy for Students. Churchill Livingstone, 2007, 1150 p.
см.: Анатомия человека: Литература. Иллюстрации |
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Примечание:
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Arteries
The arterial supply to the structures in the orbit, including the eyeball, is by the ophthalmic artery (Fig. 8.90). This vessel is a branch of the internal carotid artery, given off immediately after the internal carotid artery leaves the cavernous sinus. The ophthalmic artery passes into the orbit through the optic canal with the optic nerve.
In the orbit the ophthalmic artery initially lies inferior and lateral to the optic nerve (Fig. 8.92). As it passes forward in the orbit it crosses superior to the optic nerve and proceeds anteriorly on the medial side of the orbit.
In the orbit the ophthalmic artery gives off numerous branches as follows:
• the lacrimal artery, which arises from the ophthalmic artery on the lateral side of the optic nerve, and passes anteriorly on the lateral side of the orbit, supplying the lacrimal gland, muscles, the anterior ciliary branch to the eyeball, and the lateral sides of the eyelid;
• the central retinal artery, which enters the optic nerve, proceeds down the center of the nerve to the retina, and is clearly seen when viewing the retina with an ophthalmoscope-occlusion of this vessel or of the parent artery leads to blindness;
• the long and short posterior ciliary arteries, which are branches that enter the eyeball posteriorly, piercing the sclera, and supplying structures inside the eyeball;
• the muscular arteries, which are branches supplying the intrinsic muscles of the eyeball;
• the supra-orbital artery, which usually arises from the ophthalmic artery immediately after it has crossed the optic nerve, proceeds anteriorly, and exits the orbit through the supra-orbital foramen with the supra-orbital nerve-it supplies the forehead and scalp as it passes across these areas to the vertex of the skull;
• the posterior ethmoidal artery, which exits the orbit through the posterior ethmoidal foramen to supply the ethmoidal air cells and nasal cavity;
• the anterior ethmoidal artery, which exits the orbit through the anterior ethmoidal foramen, enters the cranial cavity giving off the anterior meningeal branch, and continues into the nasal cavity supplying the septum and lateral wall, and ending as the dorsal nasal artery;
• the medial palpebral arteries, which are small branches supplying the medial area of the upper and lower eyelids;
• the dorsal nasal artery, which is one of the two terminal branches of the ophthalmic artery, leaves the orbit to supply the upper surface of the nose;
• the supratrochlear artery, which is the other terminal branch of the ophthalmic artery and leaves the orbit with the supratrochlear nerve, supplying the forehead as it passes across it in a superior direction.
Veins
There are two venous channels in the orbit, the superior and inferior ophthalmic veins.
The superior ophthalmic vein begins in the anterior area of the orbit as connecting veins from the supra-orbital vein and the angular vein join together. It passes across the superior part of the orbit, receiving tributaries from the companion veins to the branches of the ophthalmic artery and veins draining the posterior part of the eyeball. Posteriorly, it leaves the orbit through the superior orbital fissure and enters the cavernous sinus.
The inferior ophthalmic vein is smaller than the superior ophthalmic vein, begins anteriorly, and passes across the inferior part of the orbit. It receives various tributaries from muscles and the posterior part of the eyeball as it crosses the orbit.
The inferior ophthalmic vein leaves the orbit posteriorly by:
• joining with the superior ophthalmic vein;
• passing through the superior orbital fissure on its own to join the cavernous sinus; or
• passing through the inferior orbital fissure to join with the pterygoid plexus of veins in the infratemporal fossa. |
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Примечание:
Ciliary body
Extending from the anterior border of the choroid is the ciliary body (Fig. 8.101). This triangular-shaped structure, between the choroid and the iris, forms a complete ring around the eyeball. Its components include the ciliary muscle and the ciliary processes.
The ciliary muscle consists of smooth muscle fibers arranged longitudinally, circularly, and radially. Controlled by parasympathetics traveling to the orbit in the oculomotor nerve [III], these muscle fibers, on contraction, decrease the size of the ring formed by the ciliary body. The ciliary processes are longitudinal ridges projecting from the inner surface of the ciliary body. |
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Extending from them are zonular fibers attached to the lens of the eyeball, which suspend the lens in its proper position and collectively form the suspensory ligament of the lens.
Contraction of the ciliary muscle decreases the size of the ring formed by the ciliary body. This reduces tension on the suspensory ligament of the lens. The lens therefore becomes more rounded (relaxed) resulting in accommodation of the lens for near vision.
Ciliary processes also contribute to the formation of aqueous humor.
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Схема. Кровообращение и лимфаобращение переднего сегмента глаза.
Модификация: Levin L.A., Nilsson Siv F.E., Ver Hoeve J., Wu S., Kaufman P.L., Alm A., Eds. Adler's Physiology of the Eye, 11th ed., Elsevier, 2011, 820 p.
см.: Физиология человека: Литература. Иллюстрации. |
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Примечание:
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A. The arterial supply of the anterior segment comes from the anterior ciliary arteries (ACA) and from the terminal branches of the long
posterior ciliary arteries (LPCA). These vessels form two sagittal arterial circles (between superior or inferior ACA and LPCA arteries) and also anastomose
together superficially and deeply to form two coronal arterial circles, called the episclera arterial circle (EAC) superficially and the greater circle of the iris (GCI)
deeply. In the anterior episclera (inset), the deep perforating branches of the LPCA anastomose with the ACA, together forming the EAC. The blood flow in
the EAC typically comes from LPCA (inside outwards) rather than from ACA. The EAC supplies both a superficial and a deep episcleral plexus (deep plexus
not shown). The conjunctival artery derives from the EAC, passing posteriorly, while also giving off an anteriorly directed branch called the limbal artery,
which subsequently forms the limbal arcade. Blood flow in the EAC (inset) is continuous near the rectus muscle insertion sites, but oscillates rather than
flows between the rectus muscle insertion sites.
B. Diagram shows a schematic of the arterial circulation of the episclera and conjunctival, which both have superficial and deep
components that supply capillary plexi.
C. Schematic diagram showing the distribution of lymphatics (green) in
relation to the blood vessels in the conjunctiva. Centripetal branches collect into a larger circular lymphatic ring, called the pericorneal lymphatic ring, which
then drains medially or laterally into regional lymph nodes.
D. A cross-sectional representation of the conjunctiva, episclera, and sclera shows that episclera
and sclera are devoid of lymphatic networks, while the conjunctiva has two lymphatic plexi – a superficial plexus (below the epithelium) and a deep plexus
(within Tenon’s fascia, but just above the episclera). Blood vessel plexi are found in the superficial and deep conjunctiva and episclera.
E. Exponential approximations of trilinear stress–strain curves for sclera, cornea (stroma), and lamina cribosa (optic nerve). |
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Схема. Кровоснабжение ресничного тела = Vascular architecture in the human ciliary body.
Модификация: Levin L.A., Nilsson Siv F.E., Ver Hoeve J., Wu S., Kaufman P.L., Alm A., Eds. Adler's Physiology of the Eye, 11th ed., Elsevier, 2011, 820 p.
см.: Физиология человека: Литература. Иллюстрации.
Примечание:
A. Blood supply to the ciliary
processes. CCM, Circular ciliary muscle; LCM,
longitudinal ciliary muscle; RCM, radial ciliary muscle.
A. Vascular architecture in the human ciliary body.
1, Perforating branches of the anterior ciliary arteries;
2, major arterial circle of iris; 3, first vascular territory.
The second vascular territory is depicted in 4a,
marginal route, and 4b, capillary network in the
center of this territory. 5, Third vascular territory; 6
and 7, arterioles to the ciliary muscle; 8, recurrent
choroidal arteries. |
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Схема. Передняя камера глаза, радужно-роговичный сегмент = Аnterior ocular segment.
Модификация: Levin L.A., Nilsson Siv F.E., Ver Hoeve J., Wu S., Kaufman P.L., Alm A., Eds. Adler's Physiology of the Eye, 11th ed., Elsevier, 2011, 820 p.
см.: Физиология человека: Литература. Иллюстрации. |
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Примечание:
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Arrows indicate aqueous humor flow pathways. Aqueous humor is formed by the ciliary processes, enters the posterior chamber, flows through the pupil into the anterior chamber, and exits at the chamber angle via the trabecular and
uveoscleral routes. |
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Таблица.
Эмбриональные источники развития отдельных структур глаза.
Модификация: Ross M.H., Kaye G.I., Pawlina K.W., Eds. Histology: A Text and Atlas. 4th ed., Lippincott Williams & Wilkins, 2002, 864 p., см.: Гистология человека: Литература. Иллюстрации.
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№ |
Источник |
№ |
Производное |
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I |
Поверхностный эктодерм |
1 |
Хрусталик |
| 2 |
Эпителий роговицы, конъюнктива, слёзные железы и их вспомогательные структуры
структуры |
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II |
Нейроэктодерм |
1 |
Стекловидное тело (развивается частично из нейроэктодерма чаши глазного
яблока, а частично из мезенхимы) |
| 2 |
Эпителий сетчатки, радужки и ресничного тела |
| 3 |
Мышцы сфинктера зрачка и дилататора зрачка |
| 4 |
Зрительный нерв |
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III |
Мезодерм |
1 |
Склера |
| 2 |
Строма роговицы, ресничное тело, радужка, хороидеа |
| 3 |
Внешние мышцы глазного яблока |
| 4 |
Веки (за исключением их эпителия и конъюнктивы) |
| 5 |
Гиалоидные структуры (большая часть дегенерирует до рождения) |
| 6 |
Оболочки зрительного
нерва |
| 7 |
Соединительные ткани и кровеносные сосуды глаза, костная орбита глаза,
стекловидное тело |
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Схема. Пути доставки медикаментов при местном их применении.
Модификация: Levin L.A., Nilsson Siv F.E., Ver Hoeve J., Wu S., Kaufman P.L., Alm A., Eds. Adler's Physiology of the Eye, 11th ed., Elsevier, 2011, 820 p.
см.: Физиология человека: Литература. Иллюстрации. |
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Примечание:
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A. Diagram of the eye with common drug delivery routes (solid arrows) and clearance pathways (dotted arrows) illustrated. The numbers refer
to the following processes: (1) transcorneal route from the tear film across the cornea into the anterior chamber, (2) transconjunctival route across the
conjunctiva, sclera, and anterior uvea into the posterior chamber, (3) intrastromal route directly into corneal stroma, (4) intracameral route directly into
anterior chamber, (5) subconjunctival route from the anterior subconjunctival space across the sclera and anterior uvea into the posterior chamber or across
the sclera, choroid, RPE, and retina into the anterior vitreous, (6) intravitreal drug injection directly into the vitreous, (7) sub-Tenon route from the posterior
sub-Tenon space across the sclera, choroid, RPE, and retina into the posterior vitreous, (8) elimination of drug in the aqueous humor across the trabecular
meshwork and Schlemm’s canal into the systemic vascular circulation, (9) elimination of drug in the aqueous humor across the uvea into the systemic
vascular circulation, (10) elimination of drug in the vitreous humor across the blood-retinal barrier to the systemic vascular circulation, (11) drug elimination
from the vitreous across anterior hyaloid face to the posterior chamber or vice versa , (12) drug elimination from subconjunctival and/or episcleral space to
systemic lymphatic or vascular circulation.
B. Pharmacokinetics of topical eye drop drug delivery. |
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«Я У Ч Е Н Ы Й И Л И . . . Н Е Д О У Ч К А ?»
Т Е С Т В А Ш Е Г О И Н Т Е Л Л Е К Т А
Предпосылка:
Эффективность развития любой отрасли знаний определяется степенью соответствия методологии познания - познаваемой сущности.
Реальность:
Живые структуры от биохимического и субклеточного уровня, до целого организма являются вероятностными структурами. Функции вероятностных структур являются вероятностными функциями.
Необходимое условие:
Эффективное исследование вероятностных структур и функций должно основываться на вероятностной методологии (Трифонов Е.В., 1978,..., ..., 2015, …).
Критерий: Степень развития морфологии, физиологии, психологии человека и медицины, объём индивидуальных и социальных знаний в этих областях определяется степенью использования вероятностной методологии.
Актуальные знания: В соответствии с предпосылкой, реальностью, необходимым условием и критерием...
...
о ц е н и т е с а м о с т о я т е л ь н о:
— с т е п е н ь р а з в и т и я с о в р е м е н н о й н а у к и,
— о б ъ е м В а ш и х з н а н и й и
— В а ш и н т е л л е к т !
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