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Scientific Reports Oct 2023To examine the size of the ciliary body stroma (CBS) in dependence of the morphology of the anterior chamber angle in enucleated human eyes, we histomorphometrically...
To examine the size of the ciliary body stroma (CBS) in dependence of the morphology of the anterior chamber angle in enucleated human eyes, we histomorphometrically examined human enucleated eyes. The study included 107 eyes (with a mean axial length of 25.1 ± 2.8 mm (range 21.0-36.0 mm). The anterior chamber angle was open in 68 eyes and it was closed and endothelialized in 39 eyes. The maximal CBS width (541 ± 210 µm versus 59 ± 179 µm; P < 0.001) and the minimal CBS width (214 ± 107 µm versus 17 ± 55 µm; P < 0.001) and maximal ciliary muscle height (593 ± 557 µm versus 293 ± 111 µm; P = 0.001) were significantly smaller in the angle-closure group than in the open-angle group. Maximal CBS width increased with presence of an open anterior chamber angle (beta: 0.82; B: 517; 95% CI 435, 599; P < 0.001) and longer axial length (beta: 0.17; B: 18.2; 95% CI 4.2, 32.2; P = 0.01). Minimal CBS width increased with the presence of an open anterior chamber angle (beta: 0.48; B: 131; 95% CI 80.4, 181; P < 0.001) and a larger maximal ciliary muscle height (beta: 0.33; B: 0.28; 95% CI 0.12, 0.44; P = 0.001). Maximal ciliary muscle height correlated with the maximal CBS height (beta: 0.35; B: 0.53; 95% CI 0.25, 0.81; P < 0.001). The findings suggest that the CBS size is markedly smaller in eyes with a chronically closed endothelialized anterior chamber angle than in eyes with open angles. The tightening of the angle in eyes with angle-closure may prevent the access of aqueous humor not only to the trabecular meshwork but also to the ciliary body and may reduce the uveoscleral or uveovortex outflow pathway.
Topics: Humans; Ciliary Body; Glaucoma, Angle-Closure; Microscopy, Acoustic; Anterior Chamber; Trabecular Meshwork; Intraocular Pressure
PubMed: 37805618
DOI: 10.1038/s41598-023-44085-8 -
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 -
Indian Journal of Ophthalmology May 2023With ultrasound biomicroscopy (UBM), radial scans are taken by using a typical ciliary process, to show the details of the iridocorneal angle, the anterior surface of...
BACKGROUND
With ultrasound biomicroscopy (UBM), radial scans are taken by using a typical ciliary process, to show the details of the iridocorneal angle, the anterior surface of the ciliary body, and its relation to the posterior iris. Appositional closure represents potentially reversible contact between the peripheral iris and trabecular meshwork. The appositional closure can further be classified according to the configuration of iridotrabecular contact (ITC). UBM can be performed in dark and light conditions, which has been shown to be useful for detecting changes in iridocorneal angle configuration associated with dark and light.
PURPOSE
To image ITC configuration in appositional angle closure and also image iridocorneal angle in dark and bright light room illumination. Synopsis: UBM demonstrates two types of ITC configuration in appositional closure which are, B-type and S-type. It can also demonstrate the presence of sinus of Mapstone in S-type of ITC.
HIGHLIGHTS
UBM allows imaging of dynamic changes in the iris and shows that the degree of appositional angle closure is a dynamic process that can change rapidly depending on the lighting conditions.
VIDEO LINK
https://youtu.be/tgN4SLyx6wQ.
Topics: Humans; Glaucoma, Angle-Closure; Iris; Anterior Chamber; Trabecular Meshwork; Ciliary Body; Microscopy, Acoustic; Gonioscopy
PubMed: 37203009
DOI: 10.4103/IJO.IJO_74_23 -
BMJ Open Apr 2023Primary angle-closure glaucoma (PACG) is a leading cause of irreversible blindness globally, and the number of patients with PACG rises every year. Yet, there is a lack... (Observational Study)
Observational Study
INTRODUCTION
Primary angle-closure glaucoma (PACG) is a leading cause of irreversible blindness globally, and the number of patients with PACG rises every year. Yet, there is a lack of knowledge about the clinical characteristics, therapeutic options and profile of patients with PACG in China. Hence, we design the China Glaucoma Treatment Pattern Study Ⅰ-Primary Angle-Closure Glaucoma (Ch-GTPⅠ). The objective of this paper is to describe the design and methodology of Ch-GTP. The aim of this study is to characterise the profile and trend associated with initial PACG treatment for the last 10 years in China.
METHODS
Ch-GTPⅠ is a national multicentre retrospective observational study that will randomly sample from 50 hospitals throughout China. Over 7000 patient records hospitalised for initial PACG treatment from 2011 to 2020 will be selected randomly. The data from electronic medical records will be uploaded to an encrypted online platform that will receive and collate data from all collaborating hospitals. Data abstraction and monitoring will be performed in a standardised manner by trained statisticians to ensure consistency. Systematic data cleaning will also be conducted by statisticians to ensure data integrity before final data storage. The outcomes will include four broad categories: (1) demographics, (2) clinical characteristics, (3) therapeutic strategies and procedures and (4) early outcomes at discharge. The demographic characteristics and early outcomes will be summarised using descriptive statistics. Comparative analyses of characteristics and treatment pattern changing trends for different regions and years will be used to test for significant differences (t-test or Mann-Whitney U test).
ETHICS AND DISSEMINATION
The collaborating hospitals obtained local approval based on a standard ethics application from internal ethics committees or acknowledged an existent ethics approval of the leading institution with approval from internal ethics committees. Due to the retrospective nature, written informed consent from patients was waived by the ethics committee. The results will be published in academic journals and presented at national and international academic conferences.
TRIAL REGISTRATION NUMBER
ChiCTR2100054643.
Topics: Humans; Blindness; China; Glaucoma; Glaucoma, Angle-Closure; Intraocular Pressure; Retrospective Studies
PubMed: 37015785
DOI: 10.1136/bmjopen-2022-068048 -
Genes Sep 2021Monogenic syndromic disorders frequently feature ocular manifestations, one of which is glaucoma. In many cases, glaucoma in children may go undetected, especially in... (Review)
Review
Monogenic syndromic disorders frequently feature ocular manifestations, one of which is glaucoma. In many cases, glaucoma in children may go undetected, especially in those that have other severe systemic conditions that affect other parts of the eye and the body. Similarly, glaucoma may be the first presenting sign of a systemic syndrome. Awareness of syndromes associated with glaucoma is thus critical both for medical geneticists and ophthalmologists. In this review, we highlight six categories of disorders that feature glaucoma and other ocular or systemic manifestations: anterior segment dysgenesis syndromes, aniridia, metabolic disorders, collagen/vascular disorders, immunogenetic disorders, and nanophthalmos. The genetics, ocular and systemic features, and current and future treatment strategies are discussed. Findings from rare diseases also uncover important genes and pathways that may be involved in more common forms of glaucoma, and potential novel therapeutic strategies to target these pathways.
Topics: Aniridia; Collagen Diseases; Eye Abnormalities; Eye Diseases, Hereditary; Glaucoma; Glaucoma, Angle-Closure; Humans; Hyperopia; Immune System Diseases; Metabolic Diseases; Microphthalmos; Syndrome; Vascular Diseases
PubMed: 34573386
DOI: 10.3390/genes12091403 -
Eye (London, England) Jan 2020Differentiating the two main forms of primary glaucoma (open-angle and closed-angle glaucoma) depends on the correct assessment of the anterior chamber angle (ACA). This... (Review)
Review
Differentiating the two main forms of primary glaucoma (open-angle and closed-angle glaucoma) depends on the correct assessment of the anterior chamber angle (ACA). This assessment will determine the management plan and prognosis for the disease. The standard method of examining the angle has been, for many years, slit-lamp gonioscopy. This method, although clinically still useful, is less robust for patient follow up and clinical research, given its low reproducibility. Several imaging technologies have been developed in recent years to improve the evaluation of the ACA and overcome the shortcomings of gonioscopy. These recent advances include three-dimensional and 360° analysis by Swept-Source OCT (SS-OCT, CASIA, Tomey, Nagoya, Japan), the introduction of deep learning algorithms for automatic imaging classification and new goniophotographic systems. SS-OCT allows for the first time the assessment of the circumferential extension of angle closure with moderate to good diagnostic performance compared with gonioscopy. Deep learning algorithms are showing promising results for the automation of imaging analysis, and may potentially save physicians' time in regards of the interpretation of the images. Lastly, goniophotograph systems have the distinct advantage of recordability of gonioscopic findings and are most closely matched to the findings of slit-lamp gonioscopy.
Topics: Anterior Chamber; Anterior Eye Segment; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Japan; Prospective Studies; Reproducibility of Results; Tomography, Optical Coherence
PubMed: 31666710
DOI: 10.1038/s41433-019-0655-0 -
Journal of Ophthalmic & Vision Research 2020To evaluate the association of five different polymorphisms from a genome-wide-associated study with susceptibility to glaucoma in the northeast Iranian population. (Review)
Review
PURPOSE
To evaluate the association of five different polymorphisms from a genome-wide-associated study with susceptibility to glaucoma in the northeast Iranian population.
METHODS
Hundred and thirty patients with primary angle closure glaucoma (PACG) and 130 healthy controls were genotyped for the polymorphic regions with the aid of tetra-amplification refractory mutation system-polymerase chain reaction. The association of these variants with the disease susceptibility was measured statistically with the logistic regression method.
RESULTS
Hundred and thirty patients with PACG (53 males, 77 females) with a mean age of 64.5 6.2 years and 130 healthy control subjects (51 males, 79 females) with a mean age of 64.0 5.7 years were selected for evaluation. There was a significant association between rs3816415 ( = 0.005), rs736893 ( 0.001), rs7494379 ( 0.001), and rs1258267 ( = 0.02) with PACG susceptibility. This association could not be shown for rs3739821.
CONCLUSION
It was revealed that studied variants in and genes can contribute to the incidence of PACG. Additional studies in other populations are needed to evaluate .
PubMed: 32095208
DOI: 10.18502/jovr.v15i1.5942 -
Clinical Ophthalmology (Auckland, N.Z.) 2021To evaluate surgical outcomes of the four common procedures utilized for primary angle-closure glaucoma (PACG).
PURPOSE
To evaluate surgical outcomes of the four common procedures utilized for primary angle-closure glaucoma (PACG).
METHODS
A retrospective study of survival rate in surgical management of PACG was conducted in a referral eye center. One hundred and ninety-nine eyes from 173 PACG patients were collected for chart review. The procedures used were phacoemulsification (PE), combined PE with goniosynechialysis (PE-GSL), combined PE with trabeculectomy (PE-Trab), and trabeculectomy alone. Failure was defined as postoperative IOP >21 mmHg in patients who needed second surgical intervention or those who had IOP <5 mmHg with loss of light perception. Cumulative survival rates, risk of surgical failure, and complications were analyzed.
RESULTS
PE, PE-GSL, PE-Trab, and trabeculectomy were performed in 84 eyes (42.2%), 76 eyes (38.2%), 21 eyes (10.6%), and 18 eyes (9%), respectively. Cumulative survival rates at 60 months were 13%, 55%, 42% and 43%, respectively. Cox regression analysis indicated that each mmHg IOP increased, the risk of surgical failure decreased by 13% (adjusted hazard ratio (HR) 0.87; 95%CI: 0.84-0.93, <0.001).
CONCLUSION
Real-world surgical outcomes of PACG showed that PE alone had a low survival rate of 13% in 60-month follow-up whereas PE-GSL achieved the highest rate of 55%. PE-GSL should be initially considered for management of PACG, since it can restore and sustain the physiologic aqueous pathway and preserve the conjunctiva for future filtering surgery if needed.
PubMed: 34234405
DOI: 10.2147/OPTH.S315747 -
JAMA Ophthalmology Nov 2022Acute angle-closure (AAC) glaucoma is a sight-threatening disease and can reportedly occur in association with various drugs.
IMPORTANCE
Acute angle-closure (AAC) glaucoma is a sight-threatening disease and can reportedly occur in association with various drugs.
OBJECTIVE
To identify drugs that are associated with AAC glaucoma occurrence and evaluate the risk of AAC associated with each drug.
DESIGN, SETTING, AND PARTICIPANTS
A case-crossover study was conducted using the Health Insurance Review and Assessment Service database, which contains medical information of the entire Korean population. Patients who were first diagnosed with AAC and treated between 2013 and 2019 were identified using diagnostic and procedure codes. All drugs that the study participants were prescribed as well as prescription dates during the period of 1 to 180 days before the onset of AAC were extracted from the database. For each patient, 1 to 30 days before onset was considered the hazard period, and 91 to 180 days before AAC onset was considered the control period.
MAIN OUTCOMES AND MEASURES
Drugs associated with AAC and odds (calculated as odds ratios [ORs] with 95% CIs) of AAC development associated with each identified drug.
RESULTS
A total of 949 drugs that were prescribed to 13 531 patients with AAC (mean [SD] age, 66.8 [10.6] years; 9585 [70.8%] female) during the period of 1 to 180 days before the onset of AAC were analyzed. A total of 61 drugs were found to be associated with AAC, among which sumatriptan (OR, 12.60 [95% CI, 4.13-38.44]) was associated with the highest odds of AAC development, followed by topiramate (OR, 5.10 [95% CI, 2.22-11.70]) and duloxetine (OR, 4.04 [95% CI, 2.95-5.54]). The median (IQR) period from prescription of the drug to the onset of AAC for the 61 drugs was 11.9 days (10.9-12.8). A number of drugs not previously considered to be associated with AAC, including lactulose (OR, 2.81 [95% CI, 1.72-4.61]) and metoclopramide (OR, 2.52 [95% CI, 1.95-3.25]), were identified.
CONCLUSIONS AND RELEVANCE
Results of this case-crossover study suggest a need to consider AAC risk in patients taking any of the 61 drugs found to be associated with AAC.
Topics: Humans; Female; Aged; Male; Cross-Over Studies; Glaucoma, Angle-Closure; Acute Disease; Odds Ratio
PubMed: 36136326
DOI: 10.1001/jamaophthalmol.2022.3723