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Indian Journal of Ophthalmology Mar 2024To analyze primary congenital glaucoma (PCG) anterior chamber and angle anomalies over 360° as possible biomarkers of severity and prognosis. (Observational Study)
Observational Study
PURPOSE
To analyze primary congenital glaucoma (PCG) anterior chamber and angle anomalies over 360° as possible biomarkers of severity and prognosis.
METHODS
A cross-sectional observational study was conducted analyzing anterior segment anomalies of PCG patients over 4 years of age who underwent trabeculectomy combined with trabeculotomy and age-matched controls using anterior segment optical coherence tomography (ASOCT), CASIA-2. Anterior iridotrabecular adhesions or anterior iris insertion was identified and quantified from the scleral spur using the iridotrabecular contact (ITC) index parameter as a surrogate.
RESULTS
There was a variable but significantly increased anterior iridotrabecular adhesion on ITC index, ITC area, corneal volume, anterior chamber volume, iris volume, anterior chamber depth, and small/absent trabecular meshwork in PCG eyes compared to control eyes. In PCG eyes, anterior iridotrabecular adhesion had a positive correlation with pre-operative central corneal thickness (CCT) (r = 0.53, P = 0.02), review iris thickness (r = 0.4, P = 0.04), and ITC area (r = 0.85, P < 0.001). Review iris thickness had a negative correlation with pre-operative vertical cup-disc ratio (r = -0.51, P = 0.008). Iris hypoplasia with fewer or absent folds, collarette, pupillary ruff, and pupillary ruff to collarette distance was significantly different from controls.
CONCLUSION
ASOCT in PCG eyes has shown that they have variable anterior iridotrabecular tissue adhesions, anomalous tissue/membranes in the angle, and iris hypoplasia correlating with pre-operative cup-disc ratio. These features could be used as gonioscopic and clinical biomarkers to assess the severity and prognosis of the disease. The presence of abnormal iris morphology and iridotrabecular tissue anomalies in PCG suggests that it is more than just isolated trabeculodysgenesis and is probably best considered as part of the anterior segment dysgenesis spectrum.
Topics: Humans; Cross-Sectional Studies; Intraocular Pressure; Glaucoma, Angle-Closure; Iris; Iris Diseases; Tomography, Optical Coherence; Gonioscopy; Biomarkers; Anterior Eye Segment; Eye Abnormalities
PubMed: 38099353
DOI: 10.4103/IJO.IJO_370_23 -
Irish Journal of Medical Science Feb 2024The privatization of space travel is opening civilian spaceflight to an unprecedented number of individuals now and in the immediate future. The increase in the number... (Review)
Review
PURPOSE
The privatization of space travel is opening civilian spaceflight to an unprecedented number of individuals now and in the immediate future. The increase in the number and diversity of space travelers will mean increased exposure to both physiologic and pathologic changes observed during acute and prolonged microgravity.
AIMS
In this paper, we describe the anatomic, physiologic, and pharmacologic factors to consider that impact acute angle-closure glaucoma risk during spaceflight.
CONCLUSIONS
Based on these factors, we elaborate upon areas of medical considerations and provide future recommendations that may aid in reducing the risk of acute angle-closure glaucoma in the next era of spaceflight.
Topics: Humans; Glaucoma, Angle-Closure; Emergencies; Space Flight; Weightlessness
PubMed: 37243845
DOI: 10.1007/s11845-023-03407-5 -
Graefe's Archive For Clinical and... Sep 2023Since December 2022, China has eliminated the compulsory nucleic acid screening, which led to a new pandemic of Omicron. We observed a surge of primary angle-closure...
BACKGROUND
Since December 2022, China has eliminated the compulsory nucleic acid screening, which led to a new pandemic of Omicron. We observed a surge of primary angle-closure glaucoma (PACG) at a largest tertiary hospital in Shanghai. We evaluated the potential relationship between the infection of Omicron and the occurrence of PACG.
METHODS
In this retrospective cross-sectional study, we identified 41 patients diagnosed with PACG from 523 individuals registered in ophthalmic emergency from December 2022 to January 2023. We compared the proportion of PACG patients in all the patients registered at the ophthalmic emergency department in the corresponding period (December and January) from 2018 to 2023.
RESULTS
The proportion of PACG patients rose to 6.74% and 9.13%, nearly a five-fold increase compared to the previous 1.90%. The proportion of PACG patients throughout 2022 also increased in the recent 2 months. All PACG patients in our center from Dec. 21st 2022 to Jan. 27th 2023 had positive nucleic acid tests at their initial visits. The peak of glaucoma came around Dec. 27th 2022, while the peak of the internal medicine emergency came around Jan. 5th 2023.
CONCLUSIONS
The behavior pattern of the infected people and anxiety mood would induce the PACG attack. Some ophthalmic advice should be added to the Chinese treatment guidelines for COVID-19. Also, a shallow anterior chamber and narrow angle need to be ruled out when necessary. Further studies on larger populations are needed to explore the relationship between PACG and Covid.
Topics: Humans; Glaucoma, Angle-Closure; Retrospective Studies; Cross-Sectional Studies; Tertiary Care Centers; China; COVID-19; Acute Disease; Disease Outbreaks; Intraocular Pressure
PubMed: 37103623
DOI: 10.1007/s00417-023-06077-2 -
Journal of Cataract and Refractive... Nov 2023To evaluate the safety and efficacy of phacoemulsification as a first line treatment of acute angle closure glaucoma (AACG) and to evaluate the preoperative and...
PURPOSE
To evaluate the safety and efficacy of phacoemulsification as a first line treatment of acute angle closure glaucoma (AACG) and to evaluate the preoperative and postoperative anterior chamber angle width and anterior chamber parameters using anterior segment OCT(AS-OCT) and Pentacam.
SITTINGS
Sohag University Hospital, Sohag city, Egypt.
DESIGN
Prospective comparative interventional case series study.
METHODS
Patients presented with AACG. After control of high intraocular pressure (IOP), all participants were scheduled for phacoemulsification within a week after the attack. Preoperative and postoperative angle width, anterior chamber volume and anterior chamber depth was measured by AS-OCT and Pentacam to evaluate angle changes.
RESULTS
Fifty eyes with AACG were enrolled in the study. The mean IOP was lowered significantly from 40.23 ± 10.4 mmHg preoperatively to 11.4 ± 3.3 mmHg 3 months after surgery. The mean preoperative temporal angle widened from 18.13 ± 3.65 degree to 36.16 ± 4.46 3 months after phacoemulsification. Also, the mean preoperative nasal angle widened from 17.80 ± 3.45 preoperatively to 36.18 ± 4.47 3-month postoperative. The mean preoperative AC volume was 49.4 ± 5.73 μL. After surgery the AC volume increased significantly to 138.2 ± 29.78 μL. The mean preoperative ACD was 1.58 ± 0.12 mm that deepened significantly after surgery to 3.19 ± 0.43 mm.
CONCLUSION
Early phacoemulsification is very effective in treatment of AACG cases immediately after medical control of high IOP and resolution of corneal oedema. This was proved by imaging and measuring the angle width, anterior chamber volume and anterior chamber depth using AS- OCT and Pentacam.
Topics: Humans; Intraocular Pressure; Phacoemulsification; Glaucoma, Angle-Closure; Prospective Studies; Lens Implantation, Intraocular; Anterior Chamber; Glaucoma; Acute Disease
PubMed: 37586101
DOI: 10.1097/j.jcrs.0000000000001287 -
European Review For Medical and... Aug 2023The aim of the study was to investigate the clinical effectiveness and safety of sclerotonyxis in acute angle-closure glaucoma (ACG) with persistent high intraocular...
OBJECTIVE
The aim of the study was to investigate the clinical effectiveness and safety of sclerotonyxis in acute angle-closure glaucoma (ACG) with persistent high intraocular pressure (IOP).
PATIENTS AND METHODS
The clinical data of 50 eyes from 50 patients (mean age: 68.9±7.19 years) with acute ACG and persistently high IOP who were admitted to our department between January 2012 and January 2022 were retrospectively analyzed. Patients who were administered the maximum dose of systemic and topical anti-glaucoma drugs and still had an IOP of >40 mmHg 24 hours after admission underwent sclerotonyxis. After the IOP control, an individualized phase II treatment plan was designed according to the patient's ocular condition.
RESULTS
Forty-eight patients showed improvement in their visual acuity 6 months postoperatively compared to their preoperative values. The mean IOPs were 54.84±7.82 mmHg and 21.34±7.81 mmHg 24 hours pre and postoperatively, respectively. The mean anterior chamber depth showed statistically significant differences pre and postoperatively (1.75±0.16 mm and 1.84±0.17 mm, respectively) (p<0.05). After IOP stabilized, four patients underwent YAG laser peripheral iridectomy, 18 underwent simple cataract phacoemulsification combined with intraocular lens (IOL) implantation, 21 underwent cataract phacoemulsification combined with IOL implantation and goniosynechialysis under a gonioscope, and 7 patients underwent combined surgery of glaucoma and cataract. The mean IOPs were 15.94±3.3 mmHg and 15.64±2.99 mmHg 1 week and 6 months after stage II surgery, respectively. Moreover, 42 eyes (84%) attained complete success and 8 eyes (16%) attained conditional success 6 months postoperatively. No serious complications, such as corneal endothelial decompensation, malignant glaucoma, vitreous or eruptive choroidal hemorrhage, and retinal detachment, were observed intraoperatively or postoperatively in both procedures.
CONCLUSIONS
Sclerotonyxis can rapidly lower IOP, release the pupillary blockage, reconstruct the anterior chamber, and reduce systemic complications caused by long-term high-dose antiglaucoma drugs. Thus, it normalizes the IOP and provides a safe operating space for stage II surgery, effectively reducing complications in patients in a persistent high IOP state.
Topics: Humans; Middle Aged; Aged; Glaucoma, Angle-Closure; Intraocular Pressure; Retrospective Studies; Glaucoma; Treatment Outcome; Cataract; Acute Disease
PubMed: 37667925
DOI: 10.26355/eurrev_202308_33400 -
Asia-Pacific Journal of Ophthalmology... 2024
Topics: Humans; Glaucoma, Angle-Closure; Cataract; Cataract Extraction; Intraocular Pressure; Phacoemulsification
PubMed: 38278701
DOI: 10.1016/j.apjo.2024.100034 -
European Journal of Ophthalmology Jul 2023To report the presentation and management of a 65-year-old female who presented with chronic angle closure glaucoma and an atypical iris membrane.
PURPOSE
To report the presentation and management of a 65-year-old female who presented with chronic angle closure glaucoma and an atypical iris membrane.
CASE REPORT
A 65-year-old healthy female with no significant past medical history presented to the emergency room with a 2-day history of headache, blurry vision, and right ocular pain. She denied any such prior episodes, any prior ocular history including ocular trauma, or a family history of glaucoma. She was diagnosed with bilateral, severe chronic angle closure glaucoma with an atypical, pigmented iris-pupillary membrane in the right eye. Given the appearance of the membrane, ocular oncology consultation and anterior segment imaging were unremarkable. Surgical management included complex cataract extraction, limited pars plana anterior vitrectomy, iris membrane removal, and placement of a sulcus tube shunt.
CONCLUSIONS
This complex case of chronic angle closure glaucoma with an atypical pupillary membrane highlights the importance of maintaining a broad differential and ruling out secondary pathologies such as iris melanoma. Additionally, it highlights the complexities of cataract extraction with a shallow anterior chamber.
Topics: Humans; Female; Aged; Glaucoma, Angle-Closure; Intraocular Pressure; Glaucoma; Iris; Cataract Extraction
PubMed: 35775108
DOI: 10.1177/11206721221111700 -
European Journal of Ophthalmology Jul 2023To conduct a review of glaucoma management in France.
PURPOSE
To conduct a review of glaucoma management in France.
METHOD
A 15-question survey was sent to ophthalmologists listed in the journal Réalités Ophtalmologiques and the Syndicat National des Ophtalmologues de France.
RESULTS
459/471 responses were analyzed. Gonioscopy was performed by 64.7% of respondents with a Goldmann three-mirror lens, by 51.4% with a four-mirror lens, and 8.2% preferred to perform the procedure with anterior segment imaging. The visual field was reported to be interpreted without difficulty by 87.8% of the practitioners, and 54.0% utilize a progression software. Ultrasound biomicroscopy was reported to be interpreted without difficulty by 20.0% of practitioners. In cases of severe ocular hypertonia with flat bleb in early postoperative trabeculectomy, 61.7% chose ocular massage as a first-line treatment, 52.9% chose laser suture lysis, 50.5% utilized needling, and 24.8% employed hypotonizing eyedrops. In case of severe ocular hypertonia with flat bleb in early postoperative deep sclerectomy, 53.2% chose goniopuncture as their first treatment, 34.4% employed needling, 31.8% utilized ocular massage, and 23.3% chose hypotonizing eyedrops. The selective laser trabeculoplasty is used as soon as the diagnosis is made by 37.5%, in association with a mono or dual therapy by 93.2%, after trying different combinations of eyedrops by 45.5%, when the visual field deteriorates despite a normalized intraocular pressure by 46.6%, and in cases of hypertonia after filtering surgery by 19.2%. Concerning management for primary angle-closure glaucoma, 80.8% considered peripheral iridotomy, and 18.7% utilized cataract surgery.
CONCLUSION
The diversity of responses concerning glaucoma management should draw attention to the need for standardized practices.
Topics: Humans; Cataract Extraction; Filtering Surgery; Glaucoma; Glaucoma, Angle-Closure; Intraocular Pressure; Trabeculectomy
PubMed: 36597670
DOI: 10.1177/11206721221149757 -
Ophthalmology. Glaucoma 2024To report the contributing factors to the successful long-term treatment outcomes of a large series of patients with malignant glaucoma (MG).
PURPOSE
To report the contributing factors to the successful long-term treatment outcomes of a large series of patients with malignant glaucoma (MG).
DESIGN
Retrospective, interventional, consecutive case series.
PARTICIPANTS
This study used data collected from 1997 to 2022 from the Glaucoma Division of the Stein Eye Institute, University of California, Los Angeles (UCLA). All patients with MG who underwent treatment at UCLA were enrolled.
METHODS
The following demographic and clinical data were collected and analyzed for their relevance to successful treatment: age, gender, ethnicity, glaucoma family history, visual acuity (VA), intraocular pressure (IOP), lens status, prior glaucoma diagnosis, prior ocular surgery, prior use of antiglaucoma agents, ultrasonic axial length, qualitative anterior chamber (AC) depth, and treatment methods and outcomes.
MAIN OUTCOME MEASURES
Anatomical success was defined as restoration of normal AC depth, indicating relief of the MG episode. Complete success was defined as anatomical success and the reduction of IOP to < 21 mmHg without further surgery, with or without medications.
RESULTS
A total of 74 eyes of 73 patients were identified with a diagnosis of MG. The median (interquartile range) age of the patients at the time of MG presentation was 70 years (19.5) and 49 (75.4%) patients were female. The most common prior diagnosis before MG was primary angle closure glaucoma (PACG) (34 eyes, 51.5%). The initiating event for 30 eyes (45.5%) was glaucoma surgery and for 21 eyes (31.8%) was cataract surgery. Most eyes were pseudophakic (57, 86.4%). Fifty-six eyes underwent medical treatment; MG resolved in 2 eyes with medical treatment alone. Nine eyes (7 eyes = treatment naïve; 2 eyes = failed medical treatment) underwent laser treatment and MG resolved in 5 eyes. Among the 55 eyes which had surgical treatment, 52 eyes failed medical treatment and 3 eyes were treatment naïve. The anatomical success rate with surgical treatment was 96.4% and the most commonly performed surgical procedure was combined pars plana antero-central vitrectomy, hyaloido-zonulectomy, and iridectomy.
CONCLUSIONS
Female gender, PACG, and glaucoma surgery were predisposing factors for the development of MG. Medical treatment alone for MG was inadequate in the vast majority of cases. A surgical technique consisting of combined pars plana antero-central vitrectomy, hyaloido-zonulectomy and iridectomy consistently produced high long-term success.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Humans; Female; Male; Retrospective Studies; Intraocular Pressure; Aged; Middle Aged; Visual Acuity; Follow-Up Studies; Glaucoma; Treatment Outcome; Time Factors; Aged, 80 and over; Antihypertensive Agents; Adult; Trabeculectomy
PubMed: 38158080
DOI: 10.1016/j.ogla.2023.12.005 -
Seminars in Ophthalmology Jan 2024To compare the intraocular pressure (IOP)-lowering effect of different types of surgery available in the literature using a network meta-analysis (NMA) based on a... (Meta-Analysis)
Meta-Analysis Review
Efficacy and Safety of Different Types of Intraocular Pressure-Lowering Surgeries in Patients with Primary Angle Closure (PAC) or PAC Glaucoma: Systematic Review and Network Meta-Analysis of Randomized Clinical Trials.
OBJECTIVE
To compare the intraocular pressure (IOP)-lowering effect of different types of surgery available in the literature using a network meta-analysis (NMA) based on a systematic review.
METHODS
PubMed and the Cochrane database were searched. Randomized clinical trials involving surgical interventions for high IOP for PAC (primary angle closure) or PACG (primary angle closure glaucoma) were included. Descriptive statistics and outcomes were extracted. Bayesian NMA was performed to compare the IOP-lowering effect and the change in the number of antiglaucoma drugs required between baseline and endpoint, as well as success rates.
RESULTS
This NMA included 21 articles with 1237 eyes with PAC or PACG. Interventions were characterised as phacoemulsification (phaco), trabeculectomy, goniosynechialysis (GSL) with viscoelastic or blunt device, goniosurgery (GS) (trabeculotomy or goniotomy), micro-bypass stent (Istent®), endocyclophotocoagulation (ECPL) or various combinations of these procedures. Phaco+GSL [-1.73 (95%CrI: -3.53 to -0.13)] and phaco+GSL+GS [-3.92 (95%CrI: -6.91 to -1.31)] provided better IOP lowering effects than phaco alone. Phaco+trabeculectomy [-3.11 (95%CrI: -5.82 to -0.44)] was inferior to phaco+GSL+GS. Phaco+trabeculectomy [-0.45 (95%CrI: -0.81 to -0.13)] provided a better outcome in terms of reducing the need for antiglaucoma drug compared to phaco alone. There were no differences between the other surgeries in terms of reduction of antiglaucoma drug number and IOP lowering effect. Success rates were similar for all surgical procedures.
CONCLUSIONS
Phaco+GSL+GS showed the most promising results for lowering IOP. Phaco+trabeculectomy resulted in a significant reduction in the number of antiglaucoma drugs compared to phaco alone.
Topics: Humans; Intraocular Pressure; Antiglaucoma Agents; Bayes Theorem; Network Meta-Analysis; Glaucoma, Angle-Closure; Randomized Controlled Trials as Topic; Trabeculectomy; Glaucoma; Phacoemulsification; Treatment Outcome; Retrospective Studies
PubMed: 37296113
DOI: 10.1080/08820538.2023.2223292