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Disease Markers 2022Recent resting-state functional magnetic resonance imaging (fMRI) studies have focused on glaucoma-related neuronal degeneration in structural and spontaneous functional...
OBJECTIVES
Recent resting-state functional magnetic resonance imaging (fMRI) studies have focused on glaucoma-related neuronal degeneration in structural and spontaneous functional brain activity. However, there are limited studies regarding the differences in the topological organization of the functional brain network in patients with glaucoma. In this study, we aimed to assess both potential alterations and the network efficiency in the functional brain networks of patients with primary angle-closure glaucoma (PACG).
METHODS
We applied resting-state fMRI data to construct the functional connectivity network of 33 patients with PACG (54.21 ± 7.21 years) and 33 gender- and age-matched healthy controls (52.42 ± 7.80 years). The differences in the global and regional topological brain network properties between the two groups were assessed using graph theoretical analysis. Partial correlations between the altered regional values and clinical parameters were computed for patients with PACG.
RESULTS
No significant differences in global topological measures were identified between the two groups. However, significant regional alterations were identified in the patients with PACG, including differences within visual and nonvisual (somatomotor and cognition-emotion) regions. The normalized clustering coefficient and normalized local efficiency of the right superior parietal gyrus were significantly correlated with the retinal fiber layer thickness (RNFLT) and the vertical cup to disk ratio (V C/D). In addition, the normalized node betweenness of the left middle frontal gyrus (orbital portion) was significantly correlated with the V C/D in the patients with PACG.
CONCLUSIONS
Our results suggest that regional inefficiency with decrease and compensatory increase in local functional properties of visual and nonvisual nodes preserved the brain network of the PACG at the global level.
Topics: Brain; Female; Glaucoma, Angle-Closure; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Net
PubMed: 35035609
DOI: 10.1155/2022/2731007 -
Journal of Current Glaucoma Practice 2022To evaluate the efficacy of selective laser trabeculoplasty (SLT) in Southeast Asian eyes with primary open-angle glaucoma (POAG) vs primary angle-closure glaucoma after...
AIM
To evaluate the efficacy of selective laser trabeculoplasty (SLT) in Southeast Asian eyes with primary open-angle glaucoma (POAG) vs primary angle-closure glaucoma after peripheral iridotomy (PACG-PI).
MATERIALS AND METHODS
Records of glaucoma patients who underwent SLT and had a 24-month follow-up were reviewed. Pre- and post-treatment intraocular pressure (IOP), percentage of IOP reduction in POAG, and PACG-PI groups, and probability of failure were analyzed. SLT failure was defined as any eye that did not have IOP lower than 20% compared to the baseline or had an IOP higher than the baseline on two consecutive visits. Adding medication, repeating SLT, or surgical intervention to control IOP was also considered a failure.
RESULTS
Sixty-three POAG and 12 PACG-PI eyes were eligible. The mean (standard deviation [SD]) age was 62.9 (10.2) years in POAG and 60.3 (6.2) years in PACG-PI. Mean (SD) prelaser IOP in POAG was 19.0 (4.4) mm Hg and 20.7 (4.7) mm Hg in PACG-PI. At 24 months post-SLT, mean (SD) IOP was 14.1 (4.7) mm Hg and 13.6 (2.0) mm Hg in POAG and PACG-PI, respectively. There was no significant difference in percentage of IOP reduction (22.8 ± 23.0% for POAG and 30.7 ± 19.5% for PACG-PI, = 0.96), or failure probability ( = 0.10) between both groups.
CONCLUSION
The efficacy of SLT at 24 months was comparable between POAG and PACG-PI.
CLINICAL SIGNIFICANCE
Selective laser trabeculoplasty may be an option to further lower IOP in eyes with angle closure with visible trabecular meshwork (TM) after iridotomy, especially in highly pigmented eyes of Southeast Asians.
HOW TO CITE THIS ARTICLE
Wongwuticomjon T, Chansangpetch S, Inobhas A, Efficacy of Selective Laser Trabeculoplasty in Primary Angle-closure Glaucoma after Peripheral Iridotomy. J Curr Glaucoma Pract 2022;16(2):124-127.
PubMed: 36128080
DOI: 10.5005/jp-journals-10078-1377 -
Taiwan Journal of Ophthalmology 2022Primary angle closure glaucoma is a leading cause of irreversible blindness, particularly in Asia. Its pathophysiology is based in the closure of the anterior chamber... (Review)
Review
Primary angle closure glaucoma is a leading cause of irreversible blindness, particularly in Asia. Its pathophysiology is based in the closure of the anterior chamber angle (ACA). In addition to gonioscopy (current reference standard), in the past decade, anterior segment optical coherence tomography (AS-OCT) has been incorporated in routine ophthalmic practice to help assess the configuration of the ACA. Especially in nonspecialist ophthalmology practice, gonioscopy may be less frequently performed and AS-OCT may not be available, leading to the need of other anterior segment evaluation methods. Evaluating the anterior chamber depth (ACD) has long been recognized as screening tool for primary angle-closure glaucoma. It can be measured with several devices, such as Scheimpflug photography and the scanning peripheral ACD analyzer. It can also be estimated with the oblique flashlight test and van Herick technique (limbal ACD assessment). More recently, goniophotographic systems have been developed to produce images of the ACA similar to those seen with manual gonioscopy. NGS-1 automated gonioscope (NIDEK Co, Gamagori, Japan) and the RetCam (Natus Medical Incorporated, Pleasanton, CA) are commercially available. However, NGS-1 is the only one with a specialized software for ACA imaging. Several prototype devices are currently being developed, such as the GonioPEN and axicon lens assisted gonioscopy. This article aims to review different modalities of ACA assessment, beyond AS-OCT, and compare their relative advantages and disadvantages.
PubMed: 36660111
DOI: 10.4103/tjo.tjo_41_21 -
International Journal of Ophthalmology 2020To assess the changes in the anterior chamber parameters using Pentacam following four different lines of treatment of primary angle-closure glaucoma (PACG).
AIM
To assess the changes in the anterior chamber parameters using Pentacam following four different lines of treatment of primary angle-closure glaucoma (PACG).
METHODS
A retrospective comparative study included 126 patients (126 eye) presented within 24-48h after acute angle-closure glaucoma (AACG). Patients were divided into 2 groups: group A (68 eyes) with controlled intraocular pressure (IOP) ≤21 mm Hg, which included subgroup A1 (34 eyes) with clear lens underwent Nd:YAG laser peripheral iridotomy (LPI) and subgroup A2 (34 eyes) with cataract underwent standard phacoemulsification; and group B (58 eyes) with uncontrolled IOP, which included subgroup B1 (30 eyes) with clear lens underwent trabeculectomy and subgroup B2 (28 eyes) with cataract underwent combined phacoemulsification and trabeculectomy. Patients were followed up for at least 3mo. Primary outcomes were Pentacam anterior segment measurements [anterior chamber angle (ACA) and depth (ACD)]. Secondary outcomes were changes in IOP, visual acuity (VA) and recorded complications.
RESULTS
At the 3 month, there was significant increase in the ACA values in all studied groups compared to preoperative values (<0.001). The highest percent of increase in ACA was recorded in phacotrabeculectomy group B2 (128.40%). There was significant increase in ACD values at 3 month compared with baseline values (<0.001) for groups A1, A2, and B2; without change in B1 trabeculectomy group. The maximum deepening of ACD was noticed in group B2 with 94.27% increase. Significant decrease in postoperative IOP in groups A2, B1 and B2 (<0.001, =0.014, and <0.001 respectively). In group A1 there was significant increase in 3 month postoperative IOP from baseline values (<0.001). The maximum decrease in IOP was noticed in group B2 with 59.54% decrease. VA improvement in 3 month postoperative was recorded in all studied groups, maximum VA improvement was observed in group B2 up to 0.2 logMAR.
CONCLUSION
Pentacam can be a helpful tool in studying and comparing the effect of the different lines of management of PACG on the anterior chamber measures. Phacotrabeculectomy was proved to be an effective line for managing PACG with resultant significant increase in the anterior chamber parameters, IOP reduction as well as maximum VA improvement. LPI has only temporary effect on IOP with significant changes in ACA and ACD. Phacoemuslification alone can be an option in treating PACG. Trabeculectomy resulted in temporary increase in the anterior chamber parameter which subsequently returned to baseline values.
PubMed: 32399410
DOI: 10.18240/ijo.2020.04.10 -
Indian Journal of Ophthalmology Jan 2022To study the correlation between choroidal thickness (CT) and IOP control in primary angle-closure glaucoma (PACG).
PURPOSE
To study the correlation between choroidal thickness (CT) and IOP control in primary angle-closure glaucoma (PACG).
METHODS
In total, 61 patients (102 eyes) with PACG underwent subfoveal CT (SFCT) scanning using enhanced depth imaging-optical coherence tomography. The subjects with PACG were further grouped as controlled IOP (≤21 mm Hg on maximal medical therapy) and uncontrolled IOP (>21 mm Hg on maximal medical therapy). The average CT of the PACG eyes was calculated and compared between both groups. A correlation analysis was done between CT and intereye difference in CT with the disease parameters.
RESULTS
The mean CT was 274.38 ± 42.10 μm in 102 PACG eyes. SFCT was significantly increased in the uncontrolled IOP group as compared with the controlled IOP group. The mean SFCT was 245.57 ± 62.10 μm in the controlled group and 294.46 ± 51.05 μm in the uncontrolled group (P < 0.01). Factors associated with a thicker choroid were younger age, high IOP, and higher optic nerve head cupping (P < 0.001). Neither the visual field-mean deviation (VF-MD) nor pattern standard deviation (PSD) was found to be associated with overall CT. The intereye asymmetry between CT was significantly associated with poor VF-MD and PSD.
CONCLUSION
PACG eyes with thicker choroid may be a risk factor for poor IOP control on medical anti-glaucoma therapy. Thicker choroid as compared to the fellow eye is a poor prognostic sign and these eyes should be monitored closely.
Topics: Choroid; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Optic Disk; Tomography, Optical Coherence; Tonometry, Ocular
PubMed: 34937227
DOI: 10.4103/ijo.IJO_824_21 -
The Journal of International Medical... Jan 2023To investigate the pathogenesis of primary angle-closure disease (PACG) by measuring the anatomical structures of the anterior and posterior segments of the eye and...
OBJECTIVE
To investigate the pathogenesis of primary angle-closure disease (PACG) by measuring the anatomical structures of the anterior and posterior segments of the eye and inflammatory markers in the peripheral blood.
METHODS
This case-control study enrolled patients diagnosed with acute PACG (APACG) and chronic PACG (CPACG). It also enrolled control subjects without PACG. The anterior and posterior anatomical features were measured in all study participants. The levels of interleukin (IL)-6, tumour necrosis factor-α and the neutrophil-to-lymphocyte ratio (NLR) in the peripheral blood were measured.
RESULTS
This study analysed a total of 99 eyes: 34 eyes from 34 patients with APACG, 28 eyes from 28 patients with CPACG and 37 eyes from 37 control patients with senile cataract. The axis length, corneal diameter, anterior chamber depth and anterior chamber volume were significantly smaller in the APACG and CPACG groups compared with the controls. The level of IL-6 in the peripheral blood of patients with PACG was significantly lower than that of the controls. The NLR in the peripheral blood of patients with PACG was significantly greater than that of the controls.
CONCLUSIONS
Changes in the ocular anatomy and some inflammatory markers might be involved in the pathogenesis of PACG.
Topics: Humans; Anterior Chamber; Biometry; Case-Control Studies; Glaucoma, Angle-Closure; Intraocular Pressure; Interleukin-6; Tumor Necrosis Factor-alpha; Neutrophils; Lymphocytes; Leukocyte Count
PubMed: 36631983
DOI: 10.1177/03000605221147434 -
American Journal of Ophthalmology Case... Mar 2022To present a case of progressive ectropion uveae and secondary angle-closure glaucoma in association with type 1 neurofibromatosis (NF-1).
PURPOSE
To present a case of progressive ectropion uveae and secondary angle-closure glaucoma in association with type 1 neurofibromatosis (NF-1).
OBSERVATION
An 11-year-old-Hispanic-male with a known history of NF-1 who was followed for the ocular manifestations of NF-1 developed an irregular pupil and ectropion uveae in the right eye at the age of 3 years that gradually increased in severity. The area of ectropion uveae increased in size and extended superiorly with concurrent superior synechial angle closure and intraocular pressure (IOP) elevation. The patient subsequently developed chronic angle-closure glaucoma that could not be controlled with medical therapy. He underwent successful implantation of an aqueous drainage device which resulted in excellent intraocular pressure reduction.
CONCLUSIONS AND IMPORTANCE
Ectropion uveae can be progressive and lead to the development of extensive angle closure in patients with NF-1. Despite the low incidence of glaucoma in patients with NF-1, the presence of ectropion uveae in this condition necessitates careful observation of the anterior segment, including the anterior chamber angle and close monitoring of the IOP.
PubMed: 35169657
DOI: 10.1016/j.ajoc.2022.101345 -
Acta Ophthalmologica Feb 2022To report the efficacy and safety of bleb-independent penetrating canaloplasty in the management of primary angle-closure glaucoma (PACG). (Clinical Trial)
Clinical Trial
PURPOSE
To report the efficacy and safety of bleb-independent penetrating canaloplasty in the management of primary angle-closure glaucoma (PACG).
METHODS
This single-centre prospective interventional case series enrolled 57 eyes from 53 PACG patients with medically uncontrolled intraocular pressure (IOP) and peripheral anterior synechiae of over 270°. Penetrating canaloplasty, mainly consisted of tensioning suture-aided Schlemm's canal dilation and a trabeculectomy, was performed to create a direct communication between the anterior chamber and the Schlemm's canal. Postoperative IOP, number of glaucoma medications and procedure-related complications were evaluated. Rate of success was defined as IOP ≤ 21, ≤18 and ≤15 mmHg, and a ≥30% IOP reduction without (complete) or with/without (qualified) IOP-lowering medications.
RESULTS
A total of 45 eyes had 360° catheterization successfully completed. The mean preoperative IOP was 33.9 ± 11.7 mmHg (range, 13-59.6 mmHg), on 3.2 ± 0.8 glaucoma medications (range 2-5), which was decreased to 15.4 ± 3.7 mmHg (range, 8.6-22.5) and 0.2 ± 0.6 (range, 0-3) medications at 6 months and 14.8 ± 3.5 mmHg (range, 9-24) and 0.1 ± 0.3 (range, 0-1) medications at 12 months postoperatively. Complete success at 12 months were achieved in 78.9% (95% CI: 0.65-0.93), 71.1% (0.56-0.86) and 50.0% (0.33-0.67) eyes at IOP ≤ 21, ≤18 and ≤15 mmHg, respectively. Transient IOP elevation (>30 mmHg, 26.7%) and hyphema (11.1%) were the most common early surgical complications.
CONCLUSION
Penetrating canaloplasty in PACG appeared to have good efficacy and safety profiles in this pilot study. Further studies are justified.
Topics: Female; Follow-Up Studies; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Middle Aged; Pilot Projects; Prospective Studies; Trabeculectomy; Treatment Outcome; Visual Acuity
PubMed: 33880864
DOI: 10.1111/aos.14869 -
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 -
Journal of Ophthalmology 2021The purpose of this study was to evaluate the safety and efficacy of cyclophotocoagulation under microscopy combined with phacoemulsification in patients with primary...
The purpose of this study was to evaluate the safety and efficacy of cyclophotocoagulation under microscopy combined with phacoemulsification in patients with primary chronic angle-closure glaucoma. We retrospectively reviewed the results of cyclophotocoagulation under microscopic direct vision combined with phacoemulsification in 35 eyes (35 patients) with primary chronic angle-closure glaucoma and coexisting visually significant cataracts, treated between January 2017 and April 2020 at the glaucoma unit of the affiliated Changshu Hospital of Xuzhou Medical University. All patients were followed up for at least 12 months postoperatively. The preoperative to postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications, and surgery-associated complications were recorded. The BCVA improved from 1.15 ± 0.91 logMAR preoperatively to 0.86 ± 0.82 logMAR at the final postoperative examination ( = -3.62, < 0.0001). The mean IOP was 36.63 ± 13.50 mmHg preoperatively and 15.14 ± 3.19 mmHg at the final examination ( = -5.16, < 0.0001). The number of antiglaucoma drugs was significantly reduced from 2.23 ± 0.55 preoperatively to 0.54 ± 0.86 at the final postoperative examination ( = -5.26, < 0.0001). The absolute value of the mean defect and retinal nerve fiber layer thickness at the last follow-up postoperatively were significantly reduced compared to preoperative values ( = -3.35, =0.001; = -4.56, < 0.001, respectively). One patient experienced an explosive suprachoroidal hemorrhage during the operation. The sclera was incised at the corresponding site of the intraoperative hemorrhage. The operation was continued once there was no active bleeding, and the outcome was satisfactory. None of the patients required additional surgery to treat complications. Thus, cyclophotocoagulation under microscopic direct vision combined with phacoemulsification can be performed safely for the management of primary angle-closure glaucoma.
PubMed: 34721898
DOI: 10.1155/2021/6915656