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La Revue Du Praticien May 2016Glaucomas treatment. Glaucoma is the first cause of blindness in Europe. The purposes of its treatment are lowering intraocular pressure (IOP), but also getting a good...
Glaucomas treatment. Glaucoma is the first cause of blindness in Europe. The purposes of its treatment are lowering intraocular pressure (IOP), but also getting a good patient compliance with a good tolerance and a good ratio cost/effectiveness. Glaucoma treatment should stop optic nerve fiber layer loss and stabilize visual field defects. Medical topic treatment is the first line of treatment, with possible association of drops and absence of benzalkonium chloride for some of them. Four therapeutic classes are available: beta blockers, prostaglandins , alpha-2 agonists and carbonic anhydrase inhibitors. Laser peripheral iridotomy (LPI) can treat occludable angles or angle closure when there is no or only localized peripheral anterior synechia. Laser iridoplasty is indicated in plateau iris when remains an appositional angle closure after LPI. Selective laser trabeculoplasty is an effective tool in lowering IOP and decrease IOP fluctuation. It can be successfully used as primary or adjunctive therapy for the management of both early and advanced glaucoma in primary open angle glaucoma or in angle closure glaucoma after LPI. Surgical approach should be considered after medical and/or laser treatment when glaucomatous visual field defects still progress. Filtering surgeries (non penetrating deep sclerectomy or trabeculectomy) or glaucoma valve implantation are well known for their effectiveness but bleb complications lead to develop blebless procedures called MIGS (mini invasive glaucoma surgery) or, in refractory glaucoma, non invasive surgery devices such as High-intensity focused ultrasound which consist in ultrasonic circular cyclo-coagulation of ciliary body, leading to less long term complication than diode transscleral cyclocoagulation.
Topics: Europe; Glaucoma; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Treatment Outcome
PubMed: 30512573
DOI: No ID Found -
Revue Medicale de Liege Sep 2022Acute angle closure glaucoma is an ophthalmic emergency that can lead to blindness in some cases. The presenting signs are often suggestive, like ocular pain and blurred...
Acute angle closure glaucoma is an ophthalmic emergency that can lead to blindness in some cases. The presenting signs are often suggestive, like ocular pain and blurred vision accompanied by headache, nausea and vomiting. These symptoms must be recognized as soon as possible, and the patient must be addressed, urgently, to an ophthalmologist for treatment. Many drugs may lead to an acute angle closure glaucoma in patients with risk factors. This article aims to remind the anatomical risk factors as well as the drugs that may induce an acute angle closure glaucoma. For a better understanding, this article will provide a brief reminder of the pathophysiological mechanism of acute angle closure glaucoma.
Topics: Acute Disease; Glaucoma, Angle-Closure; Humans
PubMed: 36082598
DOI: No ID Found -
Indian Journal of Ophthalmology Jun 2024Glaucoma, the silent thief of sight, is one of the most common vision-threatening conditions. Even though POAG (primary open angle glaucoma) is more common, PACG... (Review)
Review
BACKGROUND
Glaucoma, the silent thief of sight, is one of the most common vision-threatening conditions. Even though POAG (primary open angle glaucoma) is more common, PACG (primary angle closure glaucoma) is the dreaded variant. ISGEO (International Society for Geographical and Epidemiological Ophthalmology) has classified primary angle closure as PACS (primary angle closure suspect), PAC (primary angle closure), and PACG (primary angle closure glaucoma. The inconspicuous nature of PACS makes its diagnosis and treatment very tricky.
PURPOSE
To determine which cases are best suited for laser peripheral iridotomy.
SYNOPSIS
Laser peripheral iridotomy is the gold standard for acute primary angle closure glaucoma treatment. But there is a lot of confusion regarding its use in PACS as a prophylactic measure. We have tried to throw light on laser peripheral iridotomy, a much debatable topic. The video focuses on various trials regarding laser peripheral iridotomy, the indications, side effects, and contraindications. We have also discussed its use as a therapeutic and prophylactic procedure.
HIGHLIGHTS
The video highlights that the approach of laser peripheral iridotomy should be on a case-by-case basis.
VIDEO LINK
https://youtu.be/kiEYI9ct2Oo.
Topics: Humans; Glaucoma, Angle-Closure; Iridectomy; Intraocular Pressure; Laser Therapy; Iris; Gonioscopy
PubMed: 38804805
DOI: 10.4103/IJO.IJO_1362_23 -
Indian Journal of Ophthalmology Jun 2023UBM is a high-resolution ultrasound technique which allows non-invasive, in vivo imaging of the anterior segment and iridocorneal angle.
BACKGROUND
UBM is a high-resolution ultrasound technique which allows non-invasive, in vivo imaging of the anterior segment and iridocorneal angle.
PURPOSE
This video is compilation of short video clips and images which gives description on identification of angle closure due to pupillary block, peripheral anterior synechiae, iris bombe, plateau iris, supra ciliary effusion, and malignant glaucoma. It also shows video demonstrating partially and fully patent iridotomy and features of trabeculectomy bleb. Synopsis: This video summarizes importance of UBM application in angle closure glaucoma to understand its pathophysiology by showing the relationship between the peripheral iris, trabecular meshwork and ciliary processes.
HIGHLIGHTS
UBM provides two-dimensional, grayscale images of the angle structures and allows identification of non-pupillary block mechanism in angle closure glaucoma, which can be recorded for qualitative and quantitative analyses.
VIDEO LINK
https://youtu.be/prsmGnR8jYc.
Topics: Humans; Ciliary Body; Eye Abnormalities; Glaucoma; Glaucoma, Angle-Closure; Iris; Iris Diseases; Microscopy, Acoustic; Pupil Disorders
PubMed: 37322722
DOI: 10.4103/IJO.IJO_153_23 -
The American Journal of Case Reports Nov 2021BACKGROUND Drug-induced acute angle closure glaucoma is an uncommon ocular emergency that may follow the administration of certain topical and systemic medications....
BACKGROUND Drug-induced acute angle closure glaucoma is an uncommon ocular emergency that may follow the administration of certain topical and systemic medications. Acute angle closure can be triggered by various classes of drugs, including adrenergic agonists, anticholinergics, and serotonergic medications. Here, we report a rare case of drug-induced acute angle closure glaucoma secondary to olanzapine. CASE REPORT A 59-year-old male patient of Arabian Peninsula descent, known to have schizophrenia, presented to our Emergency Department with a 3-day history of right ocular pain and decrease in vision. He was started recently on olanzapine 5 mg once daily by his psychiatrist 1 week prior to the onset of his symptoms. The diagnosis of drug-induced pupillary block was made based on clinical and radiological findings. The patient was started on topical and systemic IOP-lowering agents. A therapeutic Nd: YAG laser peripheral iridotomy for the right eye was performed. On follow-up, his symptoms alleviated and clinical examination showed significant improvement. CONCLUSIONS The reported case highlights the importance of systemic medical history in secondary acute angle closure glaucoma. Physicians from other specialties should be aware of drugs triggering pupillary block and therefore be able to educate patients about symptoms of acute angle closure glaucoma.
Topics: Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Laser Therapy; Male; Middle Aged; Olanzapine
PubMed: 34803156
DOI: 10.12659/AJCR.934432 -
Ophthalmology. Glaucoma 2018
Topics: Anterior Eye Segment; Anticonvulsants; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Microscopy, Acoustic; Middle Aged; Topiramate
PubMed: 32672649
DOI: 10.1016/j.ogla.2018.10.001 -
Survey of Ophthalmology 2015Primary angle closure disease (PACD), prevalent in Asian countries, is generally associated with a shallower anterior chamber, a shorter axial length, thicker lens,... (Review)
Review
Primary angle closure disease (PACD), prevalent in Asian countries, is generally associated with a shallower anterior chamber, a shorter axial length, thicker lens, hyperopia, and female sex. Other physiologic factors, however, may be important, especially with regard to triggering acute primary angle closure. Thickening of the choroid has been demonstrated in untreated and treated, acute and chronic PACD eyes. Recently, there has been growing interest in studying the role of the choroid in the pathophysiology of PACD. The emergence of new imaging technology such as the enhanced depth imaging mode of spectral-domain optical coherence tomography and swept-source optical coherence tomography has contributed to understanding PACD pathologies. We summarize the functions of the choroid and choroidal changes in the pathogenesis of PACD, and discuss potential future developments.
Topics: Choroid; Glaucoma, Angle-Closure; Humans; Tomography, Optical Coherence
PubMed: 26164737
DOI: 10.1016/j.survophthal.2015.06.005 -
Current Opinion in Ophthalmology Mar 2018Angle closure glaucoma is a leading cause of blindness globally and trends of how best to treat this disease are evolving. The advent of anterior segment imaging aids... (Review)
Review
PURPOSE OF REVIEW
Angle closure glaucoma is a leading cause of blindness globally and trends of how best to treat this disease are evolving. The advent of anterior segment imaging aids our understanding of pathogenesis and allows more robust and objective measurement of treatment modalities. We will also review recent literature regarding the role of laser and surgical interventions for the treatment of primary angle closure disease.
RECENT FINDINGS
Recent studies evaluating the efficacy of laser peripheral iridotomy (LPI) in primary angle closure suspects (PACs) show that while it is a safe intervention and initially anterior chamber angle widens following the laser treatment, the effect is lost with time. Only a small minority of PACs patients develop primary angle closure (PAC) or primary angle closure glaucoma (PACG). Trials evaluating argon laser peripheral iridoplasty (ALPI) have failed to show a substantial clinical benefit. In patients with early or moderate PACG and those with PAC with IOP over 30 mmHg, clear lens extraction is associated with better clinical and quality of life outcomes than LPI.
SUMMARY
Recent evidence supports initial clear lens extraction in the context of PACG or primary angle closure with IOP more than 30 mmHg.
Topics: Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Laser Therapy
PubMed: 29194069
DOI: 10.1097/ICU.0000000000000453 -
International Ophthalmology Dec 2022To determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in Vogt-Koyanagi-Harada (VKH) disease. (Observational Study)
Observational Study
PURPOSE
To determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in Vogt-Koyanagi-Harada (VKH) disease.
METHODS
This retrospective, longitudinal observational study analyzed the demographic data, disease stage, glaucoma development, intraocular pressure, best-corrected visual acuity, lens status, optic nerve, gonioscopy, management, and visual outcomes of VKH disease. Clinical features were used to categorize the stage of VKH disease. VKH eyes were divided into two groups, with or without glaucoma, undergoing further analysis, including statistical analysis.
RESULTS
305 eyes of 155 patients with VKH disease with a median follow-up of 22 months were included. Secondary glaucoma developed in 67 (22%) eyes, most of which (64.2%) had chronic recurrent VKH at presentation. Angle-closure was present in 55 (82.1%) of glaucoma eyes. Peripheral anterior and posterior synechiae were present in 58 (86.6%) and 51 (76.1%) eyes, respectively. Pupillary block and posterior synechiae resulted in iris bombé in 17 (25.4%) eyes with glaucoma. At the last visit, visual acuity was worse in eyes with glaucoma (p < 0.001).
CONCLUSION
We found that angle-closure disease is a significant cause of secondary glaucoma in VKH. Eyes with glaucoma were more likely to present in the chronic recurrent stage of the disease.
Topics: Humans; Uveomeningoencephalitic Syndrome; Glaucoma, Angle-Closure; Retrospective Studies; Prevalence; Glaucoma
PubMed: 35789316
DOI: 10.1007/s10792-022-02412-4 -
Journal of Glaucoma Aug 2015China has a large burden of primary angle-closure glaucoma (PACG) and the approach to treatment is different from that in most parts of the world. In China,... (Review)
Review
China has a large burden of primary angle-closure glaucoma (PACG) and the approach to treatment is different from that in most parts of the world. In China, trabeculectomy is a mainstay of initial treatment for PACG and laser peripheral iridotomy is reserved for PAC and PACG with peripheral angle synechiae ≤180 degrees. The greater reduction of and more stable IOP, lower frequency of acute angle closure, decreased progression of peripheral anterior synechia and glaucoma, and the reduction of ocular complications associated with long-term use of glaucoma medications support the use of initial trabeculectomy in PACG without significant lens opacities. Further study is required to determine the indications and effectiveness of initial trabeculectomy for PACG in a developing country setting.
Topics: Asian People; China; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Laser Therapy; Practice Patterns, Physicians'; Trabeculectomy
PubMed: 24786102
DOI: 10.1097/IJG.0000000000000075