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Heliyon Nov 2023To investigate the normative data of anterior chamber depth (ACD) and angle (ACA) and their associations in multiethnic cohorts spanning three generations in Russia.
PURPOSE
To investigate the normative data of anterior chamber depth (ACD) and angle (ACA) and their associations in multiethnic cohorts spanning three generations in Russia.
METHODS
The study cohort included the participants of three population-based studies performed in urban and rural Bashkortostan/Russia: The Ural Eye and Medical Study (UEMS; age:40+ years), Ural Children Eye Study (UCES; age:6-18 years), and Ural Very Old Study (UVOS; age:85+ years). Using Scheimflug camera-based anterior chamber imaging, we measured ACD and ACA as part of a comprehensive ophthalmological and systemic examination. Exclusion criterion was previous cataract surgery.
RESULTS
The study included 4869 (98.7 %) children out of 4933 children of the UCES, 5426 (92.0 %) out of 5899 UEMS participants, and 268 (16.3 %) out of 1526 UVOS participants. In the UEMS, shallower ACD (mean:3.14 ± 0.37 mm) correlated (multivariable analysis; r[2] = 0.57) with older age (beta: 0.08; < 0.001), shorter body height (beta:0.03; = 0.003), shorter axial length (beta:0.34; < 0.001), lower corneal volume (beta:0.06; < 0.001) and corneal refractive power (beta:0.12; < 0.001), thicker lens (beta: 0.09; < 0.001), higher IOP (beta: 0.03; = 0.02), higher prevalence of angle-closure glaucoma (beta: 0.03; = 0.003) and lower prevalence of open-angle glaucoma (beta:0.03; = 0.007). Similar associations were found in the UCES (ACD mean:3.70 ± 0.27 mm) and UVOS (ACD mean:2.96 ± 0.56 mm).
CONCLUSIONS
In this population-based cohort of three generations from rural and urban Bashkortostan, ACD decreased from the children cohort (mean:3.70 ± 0.27 mm) to the adult cohort (mean:3.14 ± 0.37 mm) and to the very old cohort (2.96 ± 0.56 mm). Determinants of shallow ACD were older age and lower body height, in addition to the ocular biometric parameters of shorter axial length, lower corneal volume, corneal refractive power, and thinner lens thickness.
PubMed: 38074889
DOI: 10.1016/j.heliyon.2023.e22394 -
Journal of Critical Care Medicine... Jul 2023Acute angle closure glaucoma (AACG) is an ophthalmological emergency, and can lead to the devastating consequence of permanent vision loss if not detected and treated...
INTRODUCTION
Acute angle closure glaucoma (AACG) is an ophthalmological emergency, and can lead to the devastating consequence of permanent vision loss if not detected and treated promptly. We present a case of an atypical presentation of unilateral AACG on post operative day (POD) 1, after a prolonged operation under general anaesthesia (GA).
CASE PRESENTATION
A 65-year-old female underwent a 16 hour long operation for breast cancer and developed an altered mental status with a left fixed dilated pupil on POD 1. She was intubated to secure her airway in view of a depressed consciousness level and admitted to the intensive care unit. Initial blood investigations and brain imaging were unremarkable. On subsequent review by the ophthalmologist, a raised intraocular pressure was noted and she was diagnosed with acute angle closure glaucoma. She was promptly started on intravenous acetazolamide and pressure-lowering ophthalmic drops. Her intraocular pressure normalized in the next 24 hours with improvement in her mental status to baseline.
CONCLUSION
AACG needs to be consistently thought of as one of the top differentials in any post-operative patient with eye discomfort or abnormal ocular signs on examination. A referral to the ophthalmologist should be made promptly once AACG is suspected.
PubMed: 37588183
DOI: 10.2478/jccm-2023-0016 -
Indian Journal of Ophthalmology Jul 2023This article describes 1-year outcomes of a new intra-ocular implant, "Glauco-Claw," in refractory chronic angle-closure glaucoma (ACG). Glauco-Claw is a novice...
This article describes 1-year outcomes of a new intra-ocular implant, "Glauco-Claw," in refractory chronic angle-closure glaucoma (ACG). Glauco-Claw is a novice polymethylmethacrylate implant with a central ring and five claws placed circumferentially. It was placed in the anterior chamber and the peripheral iris was tucked into the claws, thus causing goniosynechialysis and preventing the reformation of goniosynechiae. It was implanted in five eyes of five patients, and they were followed up for 1 year. Target intra-ocular pressure was achieved and maintained in all the patients till the last follow-up. Two patients did not require any anti-glaucoma medication. No significant complications were observed in any patient. Glauco-Claw could be another armamentarium in the management of refractory chronic ACG.
Topics: Humans; Glaucoma, Angle-Closure; Iris; Glaucoma; Intraocular Pressure; Iris Diseases
PubMed: 37417139
DOI: 10.4103/IJO.IJO_2678_22 -
Oman Journal of Ophthalmology 2023Plateau iris syndrome (PIS) was first coined in 1958 to describe the iris configuration of a patient, 2 years later; the concept of plateau iris was published. In 1992,... (Review)
Review
Plateau iris syndrome (PIS) was first coined in 1958 to describe the iris configuration of a patient, 2 years later; the concept of plateau iris was published. In 1992, the anatomic aspects of plateau iris were studied using ultrasound biomicroscopy (UBM) determining it as a form of primary angle-closure glaucoma caused by a large or anteriorly positioned ciliary body that leads to mechanical obstruction of the trabecular meshwork, this condition is most often found in young patients. We aim to review the current literature and knowledge on the diagnosis and treatment options of PIS; the search was conducted in PubMed, LILACS, and BIREME internet search sites using keywords and snowball search strategy of articles published until 2022, focusing on PIS history, epidemiology, clinical diagnosis, UBM feature, and treatment.
PubMed: 38059089
DOI: 10.4103/ojo.ojo_238_22 -
Asia-Pacific Journal of Ophthalmology... 2024To investigate the effectiveness and safety of phacogoniotomy versus phacotrabeculectomy (PVP) among patients with advanced primary angle-closure glaucoma (PACG) and... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To investigate the effectiveness and safety of phacogoniotomy versus phacotrabeculectomy (PVP) among patients with advanced primary angle-closure glaucoma (PACG) and cataracts.
DESIGN
Multicenter, randomized controlled, non-inferiority trial.
METHODS
A total of 124 patients (124 eyes) with advanced PACG and cataracts were enrolled, with 65 in the phacogoniotomy group and 59 in the phacotrabeculectomy group. Patients were followed up for 12 months with standardized evaluations. The primary outcome was the reduction in intraocular pressure (IOP) from baseline to 12 months postoperatively, of which a non-inferiority margin of 4 mmHg was evaluated. Secondary outcomes included the cumulative surgical success rate, postoperative complications, and changes in the number of glaucoma medications.
RESULTS
After 12 months, phacogoniotomy demonstrated non-inferiority to phacotrabeculectomy in terms of IOP reduction, with mean IOP reductions of - 26.1 mmHg and - 25.7 mmHg (P = 0.383), respectively, from baseline values of around 40 mmHg. Both groups experienced a significant reduction in the mean number of medications used postoperatively (P < 0.001). The cumulative success rate was comparable between the groups (P = 0.890). However, phacogoniotomy had a lower rate of postoperative complications and interventions (12.3% and 4.6%) compared to phacotrabeculectomy (23.7% and 20.3% respectively). The phacogoniotomy group reported shorter surgery time (22.1 ± 6.5 vs. 38.8 ± 11.1 min; P = 0.030) and higher quality of life (EQ-5D-5 L) improvement at 12 months (7.0 ± 11.5 vs. 3.0 ± 12.9, P = 0.010) than the phacotrabeculectomy group.
CONCLUSIONS
Phacogoniotomy was non-inferior to phacotrabeculectomy in terms of IOP reduction for advanced PACG and cataracts. Additionally, phacogoniotomy provided a shorter surgical time, lower postoperative complication rate, fewer postoperative interventions, and better postoperative quality of life.
Topics: Humans; Cataract; Glaucoma, Angle-Closure; Intraocular Pressure; Phacoemulsification; Postoperative Complications; Quality of Life; Trabeculectomy; Treatment Outcome
PubMed: 38383075
DOI: 10.1016/j.apjo.2023.100033 -
BMJ Open Ophthalmology Mar 2024To delineate the epidemiological landscape of glaucoma using a population-based sample representative of Bangladesh.
BACKGROUND
To delineate the epidemiological landscape of glaucoma using a population-based sample representative of Bangladesh.
METHODS
Using multistage stratified cluster random sampling, households were selected to identify individuals ≥35 years across all 8 divisions of Bangladesh. Sampling frames were derived from the 2011 national census. Fifty-eight study examination sites were set up for comprehensive eye evaluations, including intraocular pressure, gonioscopy and visual field testing when indicated. International Society for Geographic and Epidemiological Ophthalmology definitions were used to define glaucoma and glaucoma suspect cases.
RESULTS
One hundred forty clusters (89 rural and 51 urban) were randomly selected, and 13 791 residential households were visited. We invited 17 002 individuals ≥35 years for on-site examination, of which 12 000 (71%) complied, with a male-to-female ratio of 1:1. The prevalence of glaucoma was 3.2% (95% CI 2.79% to 3.64%), and glaucoma suspect was 10.1% (95% CI 9.05% to 11.12%). The majority (78%) had primary open-angle glaucoma (POAG), while angle closure was seen in 16%. Of the POAG, 83% (n=251) were normal-tension glaucoma. Multivariable logistic regression showed increasing age (OR=1.01 for every 5-year increment, 95% CI 1 to 1.01) and male gender (OR=1.43, 95% CI 1.15 to 1.77) to be associated with an increased risk of glaucoma.
CONCLUSIONS
The prevalence of glaucoma in Bangladesh is 3.2% in ≥35-year-old individuals with older men most at risk. Extrapolating the results, we estimate about 2 million patients with glaucoma. Though normal-tension variety was the most common type, caution should be exercised in generalising these results to other populations.
Topics: Adult; Aged; Female; Humans; Male; Bangladesh; Cross-Sectional Studies; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Ocular Hypertension; Prevalence
PubMed: 38538147
DOI: 10.1136/bmjophth-2023-001609 -
Lasers in Medical Science Oct 2023To compare the microvasculature of the optic disc in open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) after trabeculectomy. This study included 34 patients...
To compare the microvasculature of the optic disc in open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) after trabeculectomy. This study included 34 patients divided into two groups based on the angle: (1) the OAG Group, which included 24 eyes from 24 patients, and (2) the ACG Group, which included ten eyes from 10 patients. All patients were subjected to comprehensive ophthalmic examinations. It included best-corrected visual acuity (BCVA), Goldmann applanation tonometry, gonioscopy, slit-lamp biomicroscopy, dilated fundus examination, and stereoscopic examination of the optic disc. The central corneal thickness was measured using a Nidek AL scan optical biometer. The visual field was evaluated by standard automated perimetry using Humphrey Field Analyzer (24-2 Swedish interactive threshold algorithm; Carl-Zeiss Meditec, Dublin, CA). Moreover, optical coherence tomography angiography (OCT-A) was performed utilizing the RTVue XR Avanti scanner (Optovue Inc., Fremont, CA, USA) preoperatively as well as 1 month after surgery. There was a statistically significant increase in optic disc vessel density (VD) in the whole image, radial peripapillary, inferior, superior, temporal, and nasal quadrant in OAG after surgery. Regarding the change in VD after surgery in ACG patients, there was a statistically significant increase in optic disc VD in the whole image, radial peripapillary, inferior, superior, temporal, and nasal quadrant in ACG after surgery.Regarding the percentage of VD change following trabeculectomy surgery, there were highly significant differences between the two groups for the whole image, radial peripapillary, inferior quadrant, and temporal quadrant VD. Statistically significant changes were also observed in the superior and nasal quadrants of VD. However, no significant change in VD was detected within the disc. In conclusion, the optic disc VD improved after the reduction of intraocular pressure (IOP) by surgery in both OAG and ACG. However, ACG demonstrated a significant improvement than the OAG.
Topics: Humans; Optic Disk; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Trabeculectomy; Visual Field Tests; Intraocular Pressure; Tomography, Optical Coherence
PubMed: 37897567
DOI: 10.1007/s10103-023-03907-x -
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