Page 153 - วารสารกรมการแพทย์แผนไทยฯ ปีที่ 16 ฉบับที่ 1

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Õ¿‘ª√“¬º≈ disc cupping °≈‰°‡À¡◊Õπ∑’Ëæ∫„π case optic

ªí®®ÿ∫—π ®—°…ÿ·æ∑¬å à«π„À≠àÀ√◊Õ‡°◊Õ∫∑—ÈßÀ¡¥ atrophy ·≈–¬—ß “¡“√∂Õ∏‘∫“¬°≈‰°°“√‡°‘¥ normal
√—°…“ºŸâªÉ«¬‚√§μâÕÀ‘π‚¥¬Õ‘ß∑ƒ…Æ’§«“¡¥—π≈Ÿ°μ“ tension glaucoma ‰¥âÕ’°¥â«¬ ‚¥¬¡’ enhanced

‚¥¬‡™◊ËÕ«à“ ocular pressure ¡’ direct injury μàÕ pressure in the central retinal artery ∑’ˇ°‘¥
ganglion cells ‡¡◊ËÕ cells 쓬 °Á‡°‘¥ retrograde ®“°°“√√—¥μ—«‡°‘πæÕ¥’À√◊Õ¢“¥§«“¡¬◊¥À¬ÿàπ¢Õß·ºàπ
degeneration ¢Õß optic nerve fibers ‰ª¬—ß op- lamina cribrosa ∑’Ë°√–∑”μàÕ central retinal ar-

tic disc ‡°‘¥‡ªìπ pathognomonic sign §◊Õ optic tery „π∫√‘‡«≥ optic nerve head àߺ≈„Àâ perfu-
disc cupping ®“°§«“¡‡™◊ËÕπ’È ®÷ß𔉪 Ÿà°√–∫«π sion pressure in the prelaminar region of the

°“√√—°…“¥â«¬«‘∏’≈¥§«“¡¥—π≈Ÿ°μ“ ‰¡à«à“§«“¡¥—π optic nerve head ≈¥≈ß ·≈–∑”„À⇰‘¥ optic disc
[8-10,12]
≈Ÿ°μ“∑’Ëμ√«®æ∫§√—Èß·√°®– ŸßÀ√◊ÕμË”°Áμ“¡ Õ¬à“߉√ cupping ‰¥â‡™àπ°—π Palm pressure therapy
°Áμ“¡ ‡π◊ËÕß®“°∑ƒ…Æ’π’È ¬—߉¡à “¡“√∂μÕ∫‚®∑¬å„π (PPT) ‡ªìππ«—μ°√√¡∑’˧‘¥§âπ¢÷Èπ¡“„À¡à ‚¥¬¡’®ÿ¥

2 ª√–‡¥ÁπÀ≈—° §◊Õ (1) ‡¡◊ËÕ control ocular pres- ª√– ߧå‡æ◊Ëՙ૬ à߇ √‘¡°“√‰À≈‡«’¬π‡≈◊Õ¥„π≈Ÿ°μ“
sure ‰¥â¥’·≈â« ∑”‰¡ºŸâªÉ«¬¬—ßμ“∫Õ¥ (2) ®√‘ßÀ√◊Õ∑’Ë Õ“»—¬À≈—°°≈‰° mechanics ‡¡◊ËÕ apply pressure

§«“¡¥—π≈Ÿ°μ“∑’ËμË” ®– “¡“√∂°àÕ„À⇰‘¥ direct in- ∑’Ë∫√‘‡«≥ anterior surface of cornea ®–¡’·√ß àß
jury μàÕ ganglion cells ®÷ß¡’π—°«‘∑¬“»“ μ√å„𠉪¥â“πÀ≈—߬◊¥·ºàπ lamina cribrosa ∑”„Àâ¡’§«“¡
»Ÿπ¬å«‘®—¬‚√§μâÕÀ‘π„πμà“ߪ√–‡∑»§âπ§«â“‰ª„π·π« ¬◊¥À¬ÿàπ¥’¢÷Èπ ‡≈◊Õ¥·¥ß°Á®– “¡“√∂·À«°ºà“π‡¢â“‰ª

∑ƒ…Æ’√–∫∫‰À≈‡«’¬π‡≈◊Õ¥ (ocular blood flow) „π≈Ÿ°μ“‰¥â¥’¢÷Èπ ¢≥–‡¥’¬«°—π ‡≈◊Õ¥¥”°Á “¡“√∂
·≈–∑’Ë¡’™◊ËÕ‡ ’¬ß¡“°∑’Ë ÿ¥§πÀπ÷Ëߧ◊Õ Professor Josef √–∫“¬ÕÕ°‰¥â¥’‡™àπ°—π ¥Ÿ°≈‰°°“√‰À≈‡«’¬π‡≈◊Õ¥
Flammer ∑’Ë∑ÿࡇ∑„Àâ°—∫ß“π«‘®—¬‡√◊ËÕß Glaucoma and ¢≥–∑” PPT
[1-4,11]
ocular blood flow ¡“°«à“ 40 ªï √“°∞“π¢Õß
¢âÕ √ÿª
[5-7]
·π«§‘¥π’È ®–¡Õß„π¡‘μ‘¢Õß°“√‰À≈‡«’¬π‡≈◊Õ¥
‚¥¬Õ∏‘∫“¬«à“ ºπ—߇ âπ‡≈◊Õ¥¢Õß retinal vein ®– ºŸâªÉ«¬∑—Èß 3 √“¬ ¡’°“√¡Õ߇ÀÁπ¥’¢÷Èπ ®“°°“√

∫“ß°«à“ retinal artery ©–π—È𠧫“¡¥—π≈Ÿ°μ“ ∂â“ √—°…“‚¥¬„™â¡ÿ¡¡Õß·≈–°“√·°âªí≠À“μ“¡∑ƒ…Æ’
Ÿß‡°‘π‰ª ®–§àÕ¬ Ê °¥∑—∫ retinal vein ∫π®Õ √–∫∫‰À≈‡«’¬π‡≈◊Õ¥ ´÷ËßÕ“®®–‡ªìπ‡√◊ËÕß„À¡à„π

ª√– “∑μ“ (enhanced pressure on the central «ß°“√®—°…ÿ«‘∑¬“ ‚¥¬‡©æ“–„πª√–‡∑»‰∑¬ À“°‰¥â
retinal vein) ‡°‘¥·√ßμâ“π Intra-ocular blood flow ¡’°“√»÷°…“ √à«¡¡◊Õ°—π √–¥¡ ¡Õß ¡“æ—≤π“„π
‡°‘¥ chronic ischemia ∑”„Àâ ganglion cells ·π«∑“ßπ’È Õ“®π”‰ª Ÿà°“√§âπæ∫«‘∏’μàÕ Ÿâ°—∫‚√§

∑¬Õ¬μ“¬‰ª‡√◊ËÕ¬ Ê πÕ°®“°π’È ∑ƒ…Æ’π’Ȭ—ß “¡“√∂ μ“∫Õ¥‰¥â¥’¢÷Èπ„πÕπ“§μ
Õ∏‘∫“¬„π°√≥’∑’ˇªìπ acute glaucoma ‰¥â‡ªìπÕ¬à“ߥ’

‡¡◊ËÕ§«“¡¥—π≈Ÿ°μ“ Ÿß¡“° Ê ®–°¥ retinal vein
‡Õ° “√Õâ“ßÕ‘ß
∫π®Õª√– “∑μ“ ®π collapse ‡°‘¥ acute circu-
1. Flammer J. Glaucoma. 2nd rev ed. Boston, MA: Hogrefe
latory failure ¢—È«ª√– “∑μ“®÷ß´’¥¢“« ‰¡à¡’ optic & Huber Publishers; 2003. p. 270-331.