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Ugeskrift For Laeger Sep 2021Glaucoma is the most common cause of irreversible blindness globally with a significant contribution from angle-closure glaucoma. Over the past 20 years, the terminology... (Review)
Review
Glaucoma is the most common cause of irreversible blindness globally with a significant contribution from angle-closure glaucoma. Over the past 20 years, the terminology has been standardised with the term glaucoma being used exclusively for patients with signs of glaucomatous damage to the optic nerve. Prospective randomised clinical trials have changed treatment algorithms as summarised in this review. Prophylactic iridotomy is now only offered to selected at-risk patients, while removal of the lens with phacoemulsification is more often used as the primary treatment of patients with angle closure.
Topics: Cataract Extraction; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Phacoemulsification; Prospective Studies
PubMed: 34498583
DOI: No ID Found -
Eye (London, England) Dec 2022
Topics: Humans; Glaucoma, Angle-Closure; Intraocular Pressure
PubMed: 35725765
DOI: 10.1038/s41433-021-01881-8 -
Romanian Journal of Ophthalmology 2021Ultrasound biomicroscopy (UBM) is an important tool in the diagnosis, evaluation and follow up of glaucoma patients. Even if we are dealing with a primary angle closure... (Review)
Review
Ultrasound biomicroscopy (UBM) is an important tool in the diagnosis, evaluation and follow up of glaucoma patients. Even if we are dealing with a primary angle closure glaucoma (PACG) or a primary open angle glaucoma (POAG) patient, the mechanism of angle closure can be revealed by performing an UBM. The device can help differentiate between the two types of glaucoma even in patients with opaque corneas when gonioscopy cannot be performed. Knowing the type of glaucoma is vital, especially regarding an individualized treatment, since each patient is unique and needs to be treated accordingly, in order to prevent glaucomatous optic neuropathy and visual field loss. : AC = anterior chamber, ICE = iridocorneal endothelial syndrome, IOP = intraocular pressure, NTG = normal tension glaucoma, PACG = primary angle closure glaucoma, PC = posterior chamber, PEX = pseudoexfoliation syndrome, POAG = primary open angle glaucoma, UBM = ultrasound biomicroscopy.
Topics: Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Microscopy, Acoustic; Tonometry, Ocular; Visual Fields
PubMed: 34179574
DOI: 10.22336/rjo.2021.24 -
Journal of Current Glaucoma Practice 2019Our goal is to review current literature regarding drug-induced acute angle-closure glaucoma (AACG) and provide ophthalmologists and general practitioners with a... (Review)
Review
AIM
Our goal is to review current literature regarding drug-induced acute angle-closure glaucoma (AACG) and provide ophthalmologists and general practitioners with a thorough understanding of inciting medications and treatment pitfalls to be avoided.
BACKGROUND
Drug-induced AACG is an ophthalmological emergency that ophthalmologists and general practitioners should be familiar with, given its potentially blinding consequences. Common anatomical risk factors for AACG include a shallow anterior chamber depth, short axial length, plateau iris configuration, thick lens, anteriorly positioned lens, and rarely, intraocular tumor. Demographic risk factors include female sex, Asian ethnicity, family history, and advanced age. In patients with predisposing factors, acute angle closure can be triggered by various classes of medications including adrenergic agonists, anticholinergics, cholinergics, sulfonamides, supplements, and serotonergic medications. Physicians prescribing such inciting medications should be aware of their potentially sight-threatening adverse effects and to inform patients of the warning symptoms. Patients typically present with elevated intraocular pressure (IOP), headache, nausea, blurry vision, and halos around lights.
REVIEW RESULTS
There are two main mechanisms of drug-induced AACG, both with different treatment strategies. The first mechanism of drug-induced AACG is pupillary block and iridocorneal angle closure secondary to thickening of iris base with mydriasis. The second mechanism of drug-induced AACG is anterior displacement of the lens-iris diaphragm due to mass effect (e.g., blood, misdirected aqueous humor, and tumors), uveal effusion, or weakened zonules.
CONCLUSION
This paper reviews drug-induced AACG, high-risk anatomical features, underlying mechanisms, inciting medications, and options for treatment and prevention.
CLINICAL SIGNIFICANCE
With proper understanding of the underlying mechanism of drug-induced AACG, physicians can respond promptly to save their patients' vision by employing the correct treatment strategy.
HOW TO CITE THIS ARTICLE
Yang MC, Lin KY. Drug-induced Acute Angle-closure Glaucoma: A Review. J Curr Glaucoma Pract 2019;13(3):104-109.
PubMed: 32435123
DOI: 10.5005/jp-journals-10078-1261 -
Indian Journal of Ophthalmology Aug 2022Surgeons often notice unexplained dilation of the pupil following an uncomplicated intra-ocular surgery. No definite line of treatment has been proposed for managing...
BACKGROUND
Surgeons often notice unexplained dilation of the pupil following an uncomplicated intra-ocular surgery. No definite line of treatment has been proposed for managing Urrets-Zavalia syndrome (UZS). The authors have previously documented the results of surgical pupilloplasty and have outlined this modality of treatment for cases with UZS.
PURPOSE
To highlight the aspect of development of UZS post-operatively in the eyes following an intra-ocular surgery.
SYNOPSIS
The video highlights the aspect of prevalence of the persistently dilated pupil that is non-responsive to topical miotics. Apart from associated glare, these cases often have raised intra-ocular pressure because of appositional closure of the anterior chamber angle. Surgical pupilloplasty pulls the iris tissue centrally, eventually releasing the mechanical blockage and often breakage of the peripheral anterior synechias as demonstrated by intra-operative gonioscopy and anterior segment optical coherence tomography.
HIGHLIGHTS
Performing a surgical pupilloplasty can resolve the UZS, and timely intervention can also prevent the development of secondary glaucoma because of fallback of the iris tissue on the structures of the anterior chamber angle.
ONLINE VIDEO LINK
https://youtu.be/IF_w8dVk5_w.
Topics: Glaucoma; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Iris; Iris Diseases; Pupil Disorders; Tomography, Optical Coherence
PubMed: 35919013
DOI: 10.4103/ijo.IJO_896_22 -
The Cochrane Database of Systematic... Mar 2021Primary angle-closure glaucoma (PACG) is characterized by a rise in intraocular pressure (IOP) secondary to aqueous outflow obstruction, with relative pupillary block...
BACKGROUND
Primary angle-closure glaucoma (PACG) is characterized by a rise in intraocular pressure (IOP) secondary to aqueous outflow obstruction, with relative pupillary block being the most common underlying mechanism. There is increasing evidence that lens extraction may relieve pupillary block and thereby improve IOP control. As such, comparing the effectiveness of lens extraction against other commonly used treatment modalities can help inform the decision-making process.
OBJECTIVES
To assess the effectiveness of lens extraction compared with other interventions in the treatment of chronic PACG in people without previous acute angle-closure attacks.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, one other database, and two trials registers (December 2019). We also screened the reference lists of included studies and the Science Citation Index database. We had no date or language restrictions.
SELECTION CRITERIA
We included randomized controlled trials (RCTs) comparing lens extraction with other treatment modalities for chronic PACG.
DATA COLLECTION AND ANALYSIS
We followed standard Cochrane methodology.
MAIN RESULTS
We identified eight RCTs with 914 eyes. We obtained data for participants meeting our inclusion criteria for these studies (PACG only, no previous acute angle-closure attacks), resulting in 513 eyes included in this review. The participants were recruited from a diverse range of countries. We were unable to conduct meta-analyses due to different follow-up periods and insufficient data. One study compared phacoemulsification with laser peripheral iridotomy (LPI) as standard care. Participants in the phacoemulsification group were less likely to experience progression of visual field loss (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.13 to 0.91; 216 eyes; moderate certainty evidence), and required fewer IOP-lowering medications (mean difference [MD] -0.70, 95% CI -0.89 to -0.51; 263 eyes; moderate certainty evidence) compared with standard care at 12 months. Moderate certainty evidence also suggested that phacoemulsification improved gonioscopic findings at 12 months or later (MD -84.93, 95% CI -131.25 to -38.61; 106 eyes). There was little to no difference in health-related quality of life measures (MD 0.04, 95% CI -0.16 to 0.24; 254 eyes; moderate certainty evidence), and visual acuity (VA) (MD 2.03 ETDRS letter, 95% CI -0.77 to 4.84; 242 eyes) at 12 months, and no observable difference in mean IOP (MD -0.03mmHg, 95% CI -2.34 to 2.32; 257 eyes; moderate certainty evidence) compared to standard care. Irreversible loss of vision was observed in one participant in the phacoemulsification group, and three participants in standard care at 36 months (moderate-certainty evidence). One study (91 eyes) compared phacoemulsification with phaco-viscogonioplasty (phaco-VGP). Low-certainty evidence suggested that fewer IOP-lowering medications were needed at 12 months with phacoemulsification (MD -0.30, 95% CI -0.55 to -0.05). Low-certainty evidence also suggested that phacoemulsification may have improved gonioscopic findings at 12 months or later compared to phaco-VGP (angle grading MD -0.60, 95% CI -0.91 to -0.29; TISA500 MD -0.03, 95% CI -0.06 to -0.01; TISA750 MD -0.03, 95% CI -0.06 to -0.01; 91 eyes). Phacoemulsification may result in little to no difference in best corrected VA at 12 months (MD -0.01 log MAR units, 95% CI -0.10 to 0.08; low certainty evidence), and the evidence is very uncertain about its effect on IOP at 12 months (MD 0.50 mmHg, 95% CI -2.64 to 3.64; very low certainty evidence). Postoperative fibrin reaction was observed in two participants in the phacoemulsification group and four in the phaco-VGP group. Three participants in the phaco-VGP group experienced hyphema. No data were available for progression of visual field loss and quality of life measurements at 12 months. Two studies compared phacoemulsification with phaco-goniosynechialysis (phaco-GSL). Low-certainty evidence suggested that there may be little to no difference in mean IOP at 12 months (MD -0.12 mmHg, 95% CI -4.72 to 4.48; 1 study, 32 eyes) between the interventions. Phacoemulsification did not reduce the number of IOP-lowering medications compared to phaco-GSL at 12 months (MD -0.38, 95% CI -1.23 to 0.47; 1 study, 32 eyes; moderate certainty evidence). Three eyes in the phaco-GSL group developed hyphemas. No data were available at 12 months for progression of visual field loss, gonioscopic findings, visual acuity, and quality of life measures. Three studies compared phacoemulsification with combined phaco-trabeculectomy, but the data were only available for one study (63 eyes). In this study, low-certainty evidence suggested that there was little to no difference between groups in mean change in IOP from baseline (MD -0.60 mmHg, 95% CI -1.99 to 0.79), number of IOP-lowering medications at 12 months (MD 0.00, 95% CI -0.42 to 0.42), and VA measured by the Snellen chart (MD -0.03, 95% CI -0.18 to 0.12). Participants in the phacoemulsification group had fewer complications (risk ratio [RR] 0.59, 95% CI 0.34 to 1.04), and the phaco-trabeculectomy group required more IOP-lowering procedures (RR 5.81, 95% CI 1.41 to 23.88), but the evidence was very uncertain. No data were available for other outcomes.
AUTHORS' CONCLUSIONS
Moderate certainty evidence showed that lens extraction has an advantage over LPI in treating chronic PACG with clear crystalline lenses over three years of follow-up; ultimately, the decision for intervention should be part of a shared decision-making process between the clinician and the patient. For people with chronic PACG and visually significant cataracts, low certainty evidence suggested that combining phacoemulsification with either viscogonioplasty or goniosynechialysis does not confer any additional benefit over phacoemulsification alone. There was insufficient evidence to draw any meaningful conclusions regarding phacoemulsification versus trabeculectomy. Low certainty evidence suggested that combining phacoemulsification with trabeculectomy does not confer any additional benefit over phacoemulsification alone, and may cause more complications instead. These conclusions only apply to short- to medium-term outcomes; studies with longer follow-up periods can help assess whether these effects persist in the long term.
Topics: Chronic Disease; Disease Progression; Glaucoma, Angle-Closure; Humans; Lens, Crystalline; Phacoemulsification; Quality of Life; Randomized Controlled Trials as Topic; Visual Acuity
PubMed: 33759192
DOI: 10.1002/14651858.CD005555.pub3 -
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 -
Asia-Pacific Journal of Ophthalmology... Sep 2022Primary angle-closure glaucoma (PACG) is responsible for half of the glaucoma-related blindness worldwide. Cataract surgery with or without trabeculectomy has been... (Review)
Review
Primary angle-closure glaucoma (PACG) is responsible for half of the glaucoma-related blindness worldwide. Cataract surgery with or without trabeculectomy has been considered to be the first-line treatment in eyes with medically uncontrolled PACG. While minimally invasive glaucoma surgery has become an important surgical approach for primary open-angle glaucoma, its indications and benefits in PACG are less clear. This review summarizes the efficacy and safety profile of minimally invasive glaucoma surgery in PACG to unfold new insights into the surgical management of PACG.
Topics: Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Phacoemulsification; Trabeculectomy
PubMed: 36179337
DOI: 10.1097/APO.0000000000000561