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BMJ Case Reports Dec 2020Iris melanocytoma (IM) is a rare variant of iris nevus with distinctive clinical and histopathological features. A 66-year-old woman, with a history of right eye...
Iris melanocytoma (IM) is a rare variant of iris nevus with distinctive clinical and histopathological features. A 66-year-old woman, with a history of right eye pigmented iris nevus, presented to us with a recent onset of visual acuity decrease in that eye. She had a melanocytic iris lesion with iridocorneal angle invasion, peripheral corneal adhesion, pupil corectopia, sectorial cataract and high intraocular pressure. Ultrasound biomicroscopy did not exclude malignant transformation, so excisional biopsy was performed revealing the presence of IM without signs of atypia. Subsequently, the patient underwent cataract surgery combined with iridoplasty and later an trabeculectomy. Most cases of IM remain stable and require no intervention, but in cases of unusual clinical course, with rapid growth or secondary glaucoma, surgical treatment is indicated as a diagnostic and therapeutic measure. This case report highlights the importance of a timely and multidisciplinary ophthalmological approach for a better visual outcome.
Topics: Aged; Cataract Extraction; Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris Neoplasms; Melanocytes; Microscopy, Acoustic; Nevus, Pigmented; Trabeculectomy
PubMed: 33318246
DOI: 10.1136/bcr-2020-237269 -
Experimental and Therapeutic Medicine Mar 2021The present study aimed to explore the clinical role of heat shock protein 70 (HSP70) in patients with acute angle-closure glaucoma (AACG). Seventy-four AACG patients...
The present study aimed to explore the clinical role of heat shock protein 70 (HSP70) in patients with acute angle-closure glaucoma (AACG). Seventy-four AACG patients who were admitted to our hospital from April 2017 to April 2019 were enrolled as a study group (SG). A further 70 healthy people undergoing physical examinations during the same period were enrolled as a control group (CG). HSP70 concentration was compared between the two groups, and the clinical value of this protein in AACG was analyzed. HSP70 concentration in SG was significantly lower than that in CG (P<0.050). The sensitivity and specificity of HSP70 for diagnosing AACG were 79.73 and 74.29%, respectively (P<0.001). HSP70 concentration was positively correlated with central anterior chamber depth and peripheral anterior chamber depth, but negatively correlated with anterior angle and intraocular pressure (P<0.001). HSP70 had a relatively satisfactory predictive value for adverse reactions during the treatment (P<0.001). HSP70 concentration was markedly reduced in AACG patients, and its detection had a relatively satisfactory predictive value for AACG. Thus, HSP70 may be a potential and notable indicator for diagnosing and treating glaucoma in the future.
PubMed: 33603860
DOI: 10.3892/etm.2021.9683 -
Clinical & Experimental Ophthalmology Dec 2021To determine the prevalence of zonulopathy in a large cohort of eyes with primary angle closure disease (PACD) that underwent cataract surgery.
BACKGROUND
To determine the prevalence of zonulopathy in a large cohort of eyes with primary angle closure disease (PACD) that underwent cataract surgery.
METHODS
Retrospective consecutive case series of PACD eyes (including primary angle closure suspect, primary angle closure, and primary angle closure glaucoma) that underwent phacoemulsification cataract surgery or clear lens extraction between 2009 and 2020 at a single ophthalmology centre. Those with risk factors for zonulopathy such as history of trauma, pseudoexfoliation syndrome, intraocular surgery, retinitis pigmentosa or connective tissue disorders were excluded. The primary outcomes included the prevalence of zonulopathy assessed intraoperatively and secondary pigment dispersion syndrome.
RESULTS
In our cohort of 806 consecutive PACD eyes, the prevalence of zonulopathy was 7.3% (59 of 806 eyes) - significantly greater than the 0.46%-2.6% range reported for the general population (p < 0.001). Intraoperative signs of zonular weakness included floppy capsular bag (29 eyes, 3.6%), zonular laxity (25 eyes, 3.1%) and zonular dehiscence (11 eyes, 1.4%). Among these eyes, capsular tension ring was used in 23 eyes (39.0%), six eyes (10.2%) experienced vitreous prolapse intraoperatively and underwent anterior vitrectomy, and two eyes (3.4%) experienced posterior capsular rupture, one of which required a scleral-fixated intraocular lens. Secondary pigment dispersion syndrome was observed in 141 eyes (17.5%).
CONCLUSIONS
This study evidenced a high prevalence of zonulopathy among a large cohort of PACD eyes and suggests zonulopathy as a possible under-recognised cause of angle closure. Until more sophisticated imaging modalities become available, awareness about the prevalence of zonulopathy in angle closure disease coupled with careful preoperative examinations can help minimise or prevent the complications of zonulopathy.
Topics: Cataract; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Phacoemulsification; Prevalence; Retrospective Studies
PubMed: 34382734
DOI: 10.1111/ceo.13983 -
Journal of Clinical Medicine Jan 2023We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with...
We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) complicated by cataracts. This prospective cohort study included 60 patients with PACG complicated by cataracts from the Department of Ophthalmology of Shaoxing People’s Hospital, China. Patients underwent PEI combined with GSL (PEI-GSL group) or laser peripheral iridotomy (LPI) followed by PEI (PEI group). Intraocular pressure (IOP) and endothelial counts were significantly decreased in both groups after surgery, while best-corrected visual acuity and central anterior chamber depth were significantly increased. However, there were no significant differences between the two groups. The opening degrees of room corners at 12, 3, 6, and 9 o’clock were recorded as AA12, AA3, AA6, and AA9, respectively. Anterior chamber depth was significantly increased postoperatively compared to preoperatively in both groups, with no significant between-group differences (all ps > 0.05). At 1, 3, and 6 months postoperatively, the width at AA12, AA3, and AA9 points was higher in the PEI-GSL group than in the PEI group (all ps < 0.05). Significant between-group differences at AA6 were observed preoperatively (p = 0.023) and at 1 (p = 0.027) and 3 (p = 0.033) months postoperatively but not at 6 months postoperatively (p = 0.055). CT was smaller postoperatively than preoperatively (all ps < 0.001). The present study suggests that patients with PACG who underwent PEI with or without GSL had reduced IOP and CT after surgery.
PubMed: 36675335
DOI: 10.3390/jcm12020406 -
Translational Vision Science &... Oct 2022To characterize the corneal biomechanical properties of primary angle closure glaucoma (PACG) and to investigate the diagnostic performance of combining corneal...
PURPOSE
To characterize the corneal biomechanical properties of primary angle closure glaucoma (PACG) and to investigate the diagnostic performance of combining corneal biomechanical parameters and anterior segment parameters in detecting PACG.
METHODS
This retrospective cross-sectional study evaluated 79 and 81 eyes of normal controls and patients with PACG, respectively. Corvis Biomechanical Factor (CBiF) and anterior chamber volume (ACV) were measured using the Corvis ST and Pentacam, respectively. We performed multivariable logistic regression, adjusted for age, sex, central corneal thickness, intraocular pressure, and ACV to evaluate the effect of CBiF on PACG. The area under the receiver operating curve (AUC) was calculated to compare the diagnostic performance of ACV, CBiF, and ACV-CBiF combination for detecting PACG.
RESULTS
The median CBiF of the control and PACG groups was 6.61 (interquartile range [IQR], 6.39-6.88) and 6.20 (IQR, 5.93-6.48), respectively (P < 0.001). A lower CBiF, suggestive of decreased corneal biomechanical stability, increased the odds of PACG (odds ratio, 0.029; 95% confidence interval [CI], 0.003-0.266; P = 0.002) in the multivariable logistic regression model. The ACV-CBiF combination yielded the highest AUC (0.934; 95% CI, 0.882-0.968) compared with ACV alone (0.878; 95% CI, 0.823-0.928). The ACV-CBiF combination had significantly higher discriminatory ability than that of ACV alone (DeLong test, P = 0.004).
CONCLUSIONS
Lower CBiF and ACV may act as independent predictors for PACG. Combining ACV and CBiF may enhance detection of PACG.
TRANSLATIONAL RELEVANCE
The combination of corneal biomechanical parameters and anterior segment parameters enhances the detection of PACG.
Topics: Cross-Sectional Studies; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Retrospective Studies; Tonometry, Ocular
PubMed: 36180025
DOI: 10.1167/tvst.11.10.7 -
Heliyon May 2024To evaluate abnormalities in serum and aqueous humor uric acid (UA) levels in primary angle closure glaucoma (PACG).
PURPOSE
To evaluate abnormalities in serum and aqueous humor uric acid (UA) levels in primary angle closure glaucoma (PACG).
METHODS
Patients with PACG and age-similar and gender-similar controls (patients scheduled for cataract extraction) were enrolled prospectively. Serum UA levels were determined by enzymatic colorimetry; aqueous humor UA levels by Enzyme-Linked ImmunoSorbent Assay. A -test was used to compare UA levels between PACG patients and controls, with one-way ANOVA used to compare levels across PACG subgroups with differing disease severity. Comparisons between PACG patients and controls were adjusted for systemic and ocular confounding factors using binary logistic regression.
RESULTS
In all, 131 PACG patients and 112 controls were included. The serum UA level was 266 ± 69 μmol/L in the PACG group and 269 ± 73 μmol/L in the control group (p = 0.71). The aqueous humor UA level was 35.4 ± 8.2 μmol/L in the PACG group and 53.9 ± 18.6 μmol/L in the control group (p < 0.001). This difference remained significant after adjusting for age, gender, systolic blood pressure, diastolic blood pressure, body mass index, axial length, central corneal thickness, anterior chamber depth, lens thickness, white-to-white distance, corneal endothelial cell density, and serum UA level (odds ratio: 0.88, 95 % confidence interval: 0.83-0.93, p < 0.001).
CONCLUSION
Aqueous humor UA levels differ between PACG patients and controls, but serum UA levels do not. This indicates that local UA plays a role in the pathogenesis of PACG, but systemic UA does not.
PubMed: 38742075
DOI: 10.1016/j.heliyon.2024.e30721 -
Acta Ophthalmologica Feb 2022To determine the association between plasma free fatty acid (FFA) levels and primary angle-closure glaucoma (PACG). (Comparative Study)
Comparative Study
PURPOSE
To determine the association between plasma free fatty acid (FFA) levels and primary angle-closure glaucoma (PACG).
METHODS
Free fatty acid (FFA) levels in patients with PACG (n = 181) and people without glaucoma (n = 340) were compared. Twenty-two FFAs and six lipid classes were measured using metabolomics analysis. Odds ratio (OR) of these metabolites and their 95% confidence intervals (95%CI) for PACG were obtained by logistic regression. Stepwise forward selection was performed to identify FFAs that influenced PACG risk. Areas under the curve (AUC) were applied to assess the predictive performance. Spearman's rank correlation was used to assess the relationship between ocular parameters and FFAs.
RESULTS
Most FFAs in the PACG group were lower than those in the non-glaucoma group. Docosahexaenoic acid (DHA; OR for fourth quartile (Q4) vs. first quartile (Q1): 0.32 (0.16-0.66); per standard deviation (SD) increase: 0.64 (0.49-0.83); p for trend: 0.0007) and total saturated fatty acids (SFAs; OR for Q4 versus Q1: 0.27 (0.13-0.56); per SD increase: 0.65 (0.50-0.87); p for trend: 0.0004) were associated with decreased PACG risk. The AUC of the model that included DHA, total SFAs, demographic and ophthalmic factors increased from 0.8230 (0.7811-0.8649) to 0.8512 (0.8133-0.8891) (increased AUC: 0.0282 (0.0112-0.0453); p for increased AUC: 0.0012). Additionally, the cup-disc ratio had a weak negative correlation with DHA and total SFAs (DHA: r = -0.12085, p = 0.0065; total SFAs: r = -0.13318, p = 0.0024).
CONCLUSIONS
Decrease in FFA levels may be related to lipid peroxidation. Docosahexaenoic acid (DHA) and total SFAs may be screening indices for PACG patients.
Topics: Aged; Biomarkers; Fatty Acids, Nonesterified; Female; Follow-Up Studies; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Mass Spectrometry; Metabolomics; Middle Aged; Retrospective Studies; Slit Lamp Microscopy; Visual Fields
PubMed: 33829654
DOI: 10.1111/aos.14874 -
Cureus May 2024To evaluate the outcomes of combined canaloplasty and trabeculotomy with phacoemulsification for primary angle-closure glaucoma (PACG).
PURPOSE
To evaluate the outcomes of combined canaloplasty and trabeculotomy with phacoemulsification for primary angle-closure glaucoma (PACG).
METHODS
In this retrospective, consecutive, single-surgeon case series, we analyzed the pre- and postoperative measurements of PACG patients who had the procedure. Adverse events were recorded. The main outcomes were mean intraocular pressure (IOP) in each quartile of the follow-up year and the number of IOP-lowering medications the patients were on by the end of each quartile compared to their baseline values.
RESULTS
A total of 46 eyes from 39 PACG patients were included. The preoperative IOP and glaucoma medications taken were 19.33±6.03 mm Hg and 1.80±1.39, respectively (N=46). Postoperative IOP means (mm Hg) in the subsequent four quartiles were 14.00±3.33 (N=44), 13.44±2.83 (N=32), 14.38±2.39 (N=16), and 14.92±2.90 (N=13) (p<0.0001). The mean number of meds was 0.32±0.80, 0.22±0.42, 0.59±0.80, and 0.08±0.28 in each respective quartile (p<0.0001), while the median was 0 across all quartiles.
CONCLUSIONS
Combining the OMNI surgical system with phacoemulsification led to substantial reductions in mean IOP and the number of IOP-lowering medications when compared to baseline measurements.
PubMed: 38887363
DOI: 10.7759/cureus.60549 -
Indian Journal of Ophthalmology Nov 2023Microspherophakia is a rare developmental lens anomaly with increased anteroposterior and reduced equatorial diameter. It presents with refractive myopia, shallow...
BACKGROUND
Microspherophakia is a rare developmental lens anomaly with increased anteroposterior and reduced equatorial diameter. It presents with refractive myopia, shallow anterior chamber, and angle closure glaucoma. It is associated with subluxated or dislocated lens, progressive myopia, defective accommodation, and glaucoma. Glaucoma is the most common vision-threatening complication and mostly requires surgical management that includes trabeculectomy, lensectomy, and drainage implant. A staged or combined procedure can be performed. The purpose of this video is to highlight the advantages of combining parsplana vitrectomy (PPV) with parsplana lensectomy (PPL), scleral fixated intraocular lens (SFIOL), and Aurolab aqueous drainage implant (AADI) in a young patient with advanced glaucoma and gross subluxation. Drainage implants are preferred over filtering surgeries in eyes undergoing vitreoretinal procedures due to the risk of bleb fibrosis and hypotony seen in the latter. The combined procedures should be tailored according to the lens status and severity of glaucoma in each patient.
PURPOSE
The purpose of this video is to illustrate a combined quadruple procedure (PPL, PPV, SFIOL, and AADI) in microspherophakic patients with unstable glaucoma and video-based skill transfer to a novice surgeon.
SYNOPSIS
This video illustrates quadruple surgery in a microspherophakic patient with secondary angle closure glaucoma. The authors also emphasize the advantages of a combined quadruple procedure over staged procedure or combined PPL with filtering procedure.
HIGHLIGHTS
Quadruple procedure can be performed in young microspherophakic patients with advanced glaucoma or at risk of progression and losing central vision along with gross subluxation of lens. It eliminates the need for multiple procedures, the risk of hypotony, and bleb-related complications.
VIDEO LINK
https://youtu.be/KdFjb7acXCI.
Topics: Humans; Glaucoma, Angle-Closure; Intraocular Pressure; Visual Acuity; Glaucoma; Retrospective Studies
PubMed: 37870033
DOI: 10.4103/IJO.IJO_733_23 -
Clinical Ophthalmology (Auckland, N.Z.) 2022To determine the distribution and the anatomical characteristics of plateau iris (PI) in primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM).
PURPOSE
To determine the distribution and the anatomical characteristics of plateau iris (PI) in primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM).
METHODS
Fifty UBM images of PACG cases were studied over one year by retrospective analysis. The data from UBM images including angle opening distance at 500 and 750 μm (AOD500 and AOD750), trabecular-iris angle (TIA), angle recess area at 750 μm (ARA750), maximum ciliary body thickness (CBTmax), anterior placement of ciliary processes (APCP), central anterior chamber depth (CACD), axial lens thickness (ALT), and ciliary sulcus status were analyzed and compared between the PI and non-PI cases.
RESULTS
Eighteen cases had PI (36%). The mean AOD500, AOD750, and TIA were significantly smaller in PI than in non-PI eyes ( = 0.01; = 0.046; and = 0.026). Values of the ARA750 and CBTmax were not significantly different between the two groups ( = 0.208 and = 0.368). CACD was deeper in the PI group ( = 0.011). ALT was higher in the non-PI group ( = 0.001). The mean APCP of the PI group was more than those of the non-PI group ( < 0.001). The number of cases with obliterated ciliary sulcus in more than two quadrants was significantly more in the PI group ( < 0.001).
CONCLUSION
Around one-third of PACG eyes were found to have PI on UBM imaging. The number of obliterated ciliary sulcus and APCP were important UBM parameters that help in PI diagnosis.
PubMed: 35241909
DOI: 10.2147/OPTH.S356106