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Eye (London, England) Nov 2022To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary open-angle glaucoma (POAG) in those population-based studies that... (Meta-Analysis)
Meta-Analysis
AIM
To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary open-angle glaucoma (POAG) in those population-based studies that reported blindness rates for both PACG and POAG.
METHOD
A systematic search was performed in PubMed for articles published in English between 2000 and 2020 reporting the prevalence of POAG as well as PACG among various ethnic populations. A study was included if it was (1) population-based (2) had published prevalence and blindness rates for both PACG and POAG in the same cohort. (3) Glaucoma was defined as per the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) criteria. The proportion of blindness for both POAG and PACG for each study and the cumulative proportion taking all the studies were calculated.
RESULTS
We included 23 studies with 78,434 participants. POAG was diagnosed in 1702 persons with 151 (8.9%) blind. There were 724 cases of PACG with 196 (27.0%) blind. The risk ratio of blindness in PACG to POAG varied from 0.73 to 10.6 among the studies. The cumulative risk ratio was 2.39 (95% confidence interval (CI); 1.99, 2.87). Risk ratios for studies including visual field restriction while defining blindness were similar to studies that did not (1.92 vs 2.64, P = 0.11). Risk ratios were also similar for studies that used greater than 2 instead of 3 or more quadrants of iridotrabecular contact to define angle closure (2.79 vs 2.25).
CONCLUSION
Primary angle-closure disease is more likely to be associated with blindness.
Topics: Humans; Blindness; Glaucoma; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Intraocular Pressure; Visual Field Tests
PubMed: 34645961
DOI: 10.1038/s41433-021-01802-9 -
Acta Ophthalmologica Feb 2022To investigate the development of angle closure from baseline open angle and associated risk factors in a rural Chinese population through a longitudinal study over a... (Comparative Study)
Comparative Study
PURPOSE
To investigate the development of angle closure from baseline open angle and associated risk factors in a rural Chinese population through a longitudinal study over a 5-year period.
METHODS
Subjects aged ≥30 years and older with bilateral open angles at baseline of the Handan Eye Study who participated in the follow-up and had undergone both baseline and follow-up gonioscopic examinations were included. Subjects with any form of angle closure, glaucoma, incisional ocular surgery or other conditions that could influence the results were excluded. The development of angle closure was defined as the presence of primary angle closure suspect (PACS) or primary angle closure (PAC)/primary angle closure glaucoma (PACG) during the follow-up in normal subjects with baseline bilateral open angles. Logistic regression was performed to identify the baseline risk factors for the development of angle closure.
RESULTS
A total of 457 subjects with bilateral open angles at baseline aged 53.0 (45.5, 58.0) years were enrolled. 94.7% of the included cases developed PACS, 5.3% developed PAC and no one developed PACG after 5 years. In logistic regression, significant risk factors for the development of angle closure were shallower central anterior chamber depth (ACD) (p = 0.002) and narrower mean angle width (p < 0.001).
CONCLUSIONS
This study reports the development from baseline open angle to angle closure after a 5-year follow-up. We confirm that the mean angle width and central ACD were independent predictive risk factors for the development of any form of angle closure.
Topics: China; Female; Follow-Up Studies; Glaucoma, Angle-Closure; Gonioscopy; Humans; Incidence; Intraocular Pressure; Male; Middle Aged; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Rural Population; Time Factors
PubMed: 33960669
DOI: 10.1111/aos.14887 -
Middle East African Journal of... 2020The purpose of the study was to report a small case series of patients with iridoschisis seen at our hospital over a period of 5 years.
PURPOSE
The purpose of the study was to report a small case series of patients with iridoschisis seen at our hospital over a period of 5 years.
METHODS
Retrospective review of all those files over the past 5 years whereby the diagnosis of iridoschisis/iris atrophy/iris fibrils in anterior chamber (AC) was made.
RESULTS
In our case series, the average age at presentation was 49 years (range: 23-85 years). The pathology was bilateral in 57% of patients in our series. Our most common presentations were angle closure glaucoma and cataract. Younger individuals can also manifest iridoschisis.
CONCLUSION
The iridoschisis can be an incidental finding, and gonioscopy should be performed in all the cases, as occludable or synechiael angle closure may be present in these cases.
Topics: Adult; Aged; Aged, 80 and over; Anterior Chamber; Atrophy; Cataract; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Iris; Iris Diseases; Male; Middle Aged; Retrospective Studies; Slit Lamp Microscopy; Young Adult
PubMed: 33814819
DOI: 10.4103/meajo.MEAJO_120_19 -
JAMA Ophthalmology Jun 2023Laser peripheral iridotomy (LPI) is the most common primary treatment for primary angle closure disease (PACD). However, there are sparse data guiding the longitudinal...
IMPORTANCE
Laser peripheral iridotomy (LPI) is the most common primary treatment for primary angle closure disease (PACD). However, there are sparse data guiding the longitudinal care of PAC suspect (PACS) eyes after LPI.
OBJECTIVE
To elucidate the anatomic effects of LPI that are associated with a protective outcome against progression from PACS to PAC and acute angle closure (AAC) and to identify biometric factors that predict progression after LPI.
DESIGN, SETTING, AND PARTICIPANTS
This was a retrospective analysis of data from the Zhongshan Angle Closure Prevention (ZAP) trial, a study of mainland Chinese people aged 50 to 70 years with bilateral PACS who received LPI in 1 randomly selected eye. Gonioscopy and anterior-segment optical coherence tomography (AS-OCT) imaging were performed 2 weeks after LPI. Progression was defined as the development of PAC or an acute angle closure (AAC) attack. Cohort A included a random mix of treated and untreated eyes, and cohort B included only eyes treated with LPI. Univariable and multivariable Cox regression models were developed to assess biometric risk factors for progression in cohorts A and B. Data were analyzed from January 4 to December 22, 2022.
MAIN OUTCOME AND MEASURE
Six-year progression to PAC or AAC.
RESULTS
Cohort A included 878 eyes from 878 participants (mean [SD] age, 58.9 [5.0] years; 726 female [82.7%]) of whom 44 experienced progressive disease. In a multivariable analysis, treatment (hazard ratio [HR], 0.67; 95% CI, 0.34-1.33; P = .25) was no longer associated with progression after adjusting for age and trabecular iris space area at 500 μm (TISA at 500 μm) at the 2-week visit. Cohort B included 869 treated eyes from 869 participants (mean [SD] age, 58.9 [5.0] years; 717 female [82.5%]) of whom 19 experienced progressive disease. In multivariable analysis, TISA at 500 μm (HR, 1.33 per 0.01 mm2 smaller; 95% CI, 1.12-1.56; P = .001) and cumulative gonioscopy score (HR, 1.25 per grade smaller; 95% CI, 1.03-1.52; P = .02) at the 2-week visit were associated with progression. Persistent angle narrowing on AS-OCT (TISA at 500 μm ≤0.05 mm2; HR, 9.41; 95% CI, 3.39-26.08; P <.001) or gonioscopy (cumulative score ≤6; HR, 2.80; 95% CI, 1.13-6.93; P =.04) conferred higher risk of progression.
CONCLUSIONS AND RELEVANCE
Study results suggest that persistent angle narrowing detected by AS-OCT or cumulative gonioscopy score was predictive of disease progression in PACS eyes after LPI. These findings suggest that AS-OCT and gonioscopy may be performed to identify patients at high risk of developing angle closure who may benefit from closer monitoring despite patent LPI.
Topics: Humans; Female; Middle Aged; Iridectomy; Retrospective Studies; Glaucoma, Angle-Closure; Intraocular Pressure; Prospective Studies; Iris; Laser Therapy; Tomography, Optical Coherence; Acute Disease; Gonioscopy; Biometry; Lasers
PubMed: 37103926
DOI: 10.1001/jamaophthalmol.2023.0937 -
Ophthalmology Aug 2023This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to... (Randomized Controlled Trial)
Randomized Controlled Trial
Fourteen-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle-Closure Prevention Study: Extended Follow-up of a Randomized Controlled Trial.
PURPOSE
This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC).
DESIGN
Extended follow-up of the Zhongshan Angle-Closure Prevention Study.
PARTICIPANTS
Eight hundred eighty-nine Chinese patients 50 to 70 years of age with bilateral PACS.
METHODS
Each patient received LPI in 1 randomly selected eye, with the fellow untreated eye serving as a control. Because the risk of glaucoma was low and acute angle closure (AAC) occurred only rarely, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit.
MAIN OUTCOME MEASURES
Incidence of PAC, a composite end point including peripheral anterior synechiae, intraocular pressure (IOP) of > 24 mmHg, or AAC.
RESULTS
During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary end points (P < 0.01). Within them, 1 LPI-treated eye and 5 control eyes progressed to AAC. Primary angle-closure glaucoma was found in 2 LPI-treated eyes and 4 control eyes. The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21-0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes showed more severe nuclear cataract, higher IOP, and larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and greater central anterior chamber depth (CACD) were associated with an increased risk of end points developing in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after the darkroom prone provocative test (DRPPT) were more likely to demonstrate PAC after LPI.
CONCLUIONS
Despite a two-third decrease in PAC occurrence after LPI, the cumulative risk of progression was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and to guide clinical practice.
FINANCIAL DISCLOSURE(S)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Topics: Humans; Iris; Iridectomy; Follow-Up Studies; Glaucoma, Angle-Closure; Treatment Outcome; Intraocular Pressure; Acute Disease; Glaucoma; Laser Therapy; Eye Abnormalities; Lasers; Gonioscopy
PubMed: 37030454
DOI: 10.1016/j.ophtha.2023.03.024 -
Ceska a Slovenska Oftalmologie :... 2022Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma...
INTRODUCTION
Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma due to supraciliary effusion. Although the ocular finding resembles primary angle-closure glaucoma, bilateral infliction should always raise the suspicion that it is drug-induced glaucoma.
CASE REPORT
The authors present a case of a 51-year-old patient on Topamax therapy with sudden vertigo, headache and blurred vision. Ophthalmic examination revealed bilateral angle-closure glaucoma, which was initially treated in the classical manner by administration of local antiglaucoma drugs and pilocarpine, followed by administration of osmotically active substances and laser iridotomy. Only the subsequent discontinuation of Topamax and the use of local cycloplegics and corticosteroids led to the release of the anterior segment angle closure and normalization of intraocular pressure.
CONCLUSION
The indicating physician and ophthalmologist must be aware of the possible side effects of Topamax therapy to determine the correct diagnosis and to administer treatment appropriately.
Topics: Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Middle Aged; Tonometry, Ocular; Topiramate
PubMed: 35760585
DOI: 10.31348/2022/16 -
The Application of Clinical Genetics 2021Primary angle-closure glaucoma (PACG) is estimated to affect over 30 million people worldwide by 2040 and is highly prevalent in the Asian population. PACG is more... (Review)
Review
Primary angle-closure glaucoma (PACG) is estimated to affect over 30 million people worldwide by 2040 and is highly prevalent in the Asian population. PACG is more severe and carries three times the higher risk of blindness than primary open-angle glaucoma, thus representing a significant public health concern. High heritability and ethnic-specific predisposition to PACG suggest the involvement of genetic factors in disease development. In the recent past, genetic studies have led to the successful identification of several genes and loci associated with PACG across different ethnicities. The precise cellular and molecular roles of these multiple loci in the development and progression of PACG remains to be elucidated. Nonetheless, these studies have significantly increased our understanding of the emerging cellular processes and biological pathways that might provide more significant insights into the disease's genetic etiology and may be valuable for future clinical applications. This review aims to summarize and update the current knowledge of PACG genetics analysis research.
PubMed: 33727852
DOI: 10.2147/TACG.S274884 -
Journal of Ophthalmic & Vision Research 2020
PubMed: 32095201
DOI: 10.18502/jovr.v15i1.5930 -
Genes Dec 2020Glaucoma, the world's leading cause of irreversible blindness, is a complex disease, with differential presentation as well as ethnic and geographic disparities. The... (Review)
Review
Glaucoma, the world's leading cause of irreversible blindness, is a complex disease, with differential presentation as well as ethnic and geographic disparities. The multifactorial nature of glaucoma complicates the study of genetics and genetic involvement in the disease process. This review synthesizes the current literature on glaucoma and genetics, as stratified by glaucoma subtype and ethnicity. Primary open-angle glaucoma (POAG) is the most common cause of glaucoma worldwide, with the only treatable risk factor (RF) being the reduction of intraocular pressure (IOP). Genes associated with elevated IOP or POAG risk include: , , , , -, , , , /, , and . However, there are variations in RF and genetic factors based on ethnic and geographic differences; it is clear that unified molecular pathways accounting for POAG pathogenesis remain uncertain, although inflammation and senescence likely play an important role. There are similar ethnic and geographic complexities in primary angle closure glaucoma (PACG), but several genes have been associated with this disorder, including , , , , and . In exfoliation glaucoma (XFG), genes implicated include , , and . Despite tremendous progress, major gaps remain in resolving the genetic architecture for the various glaucoma subtypes across ancestries. Large scale carefully designed studies are required to advance understanding of genetic loci as RF in glaucoma pathophysiology and to improve diagnosis and treatment options.
Topics: Adult; Aged; Asian People; Black People; Exfoliation Syndrome; Eye Proteins; Female; Genetic Predisposition to Disease; Genome-Wide Association Study; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Hispanic or Latino; Humans; Intraocular Pressure; Male; Multifactorial Inheritance; Nerve Tissue Proteins; Polymorphism, Genetic; Risk Factors; White People
PubMed: 33396423
DOI: 10.3390/genes12010055 -
International Journal of Ophthalmology 2022To investigate the surgical outcomes of patients with chronic angle-closure glaucoma (CACG) treated with phacoemulsification (phaco)/endocyclophotocoagulation (ECP) with...
AIM
To investigate the surgical outcomes of patients with chronic angle-closure glaucoma (CACG) treated with phacoemulsification (phaco)/endocyclophotocoagulation (ECP) with and without endoscopic goniosynechialysis (E-GSL).
METHODS
A retrospective, nonrandomized, comparative case series was conducted. Patients with CACG who underwent phaco in combination with either ECP alone (ECP group) or GSL with ECP (E-GSL group) from 2018 to 2019 were followed for 12mo and reviewed. Clinical features and outcomes were identified and analyzed. The ECP and E-GSL groups were matched in age and baseline intraocular pressure (IOP). Changes in IOP, mean of visual acuity (VA), peripheral anterior synechiae (PAS) formation, and the number of glaucoma medications was examined.
RESULTS
The ECP group included 32 eyes of 27 patients, and the E-GSL group included 32 eyes of 26 patients. The preoperative baseline IOP was 22.18±6.48 mm Hg in the ECP group and 22.95±6.71 mm Hg in the E-GSL group (=0.644). The mean IOP reduction was 26.2% in the ECP group and 41.6% in the E-GSL group at 12mo. The mean postoperative VA (logMAR units) at 12mo was 0.47 in the ECP group and 0.36 in the E-GSL group. The reduction in PAS formation and the number of glaucoma medications was also higher in the ECP group than E-GSL group at 12mo.
CONCLUSION
The phaco/ECP and phaco/E-GSL groups both achieve a significant reduction in IOP without complications associated with traditional glaucoma filtration surgeries.
PubMed: 36017042
DOI: 10.18240/ijo.2022.08.08