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Irish Journal of Medical Science Feb 2024The privatization of space travel is opening civilian spaceflight to an unprecedented number of individuals now and in the immediate future. The increase in the number... (Review)
Review
PURPOSE
The privatization of space travel is opening civilian spaceflight to an unprecedented number of individuals now and in the immediate future. The increase in the number and diversity of space travelers will mean increased exposure to both physiologic and pathologic changes observed during acute and prolonged microgravity.
AIMS
In this paper, we describe the anatomic, physiologic, and pharmacologic factors to consider that impact acute angle-closure glaucoma risk during spaceflight.
CONCLUSIONS
Based on these factors, we elaborate upon areas of medical considerations and provide future recommendations that may aid in reducing the risk of acute angle-closure glaucoma in the next era of spaceflight.
Topics: Humans; Glaucoma, Angle-Closure; Emergencies; Space Flight; Weightlessness
PubMed: 37243845
DOI: 10.1007/s11845-023-03407-5 -
European Review For Medical and... Aug 2023The aim of the study was to investigate the clinical effectiveness and safety of sclerotonyxis in acute angle-closure glaucoma (ACG) with persistent high intraocular...
OBJECTIVE
The aim of the study was to investigate the clinical effectiveness and safety of sclerotonyxis in acute angle-closure glaucoma (ACG) with persistent high intraocular pressure (IOP).
PATIENTS AND METHODS
The clinical data of 50 eyes from 50 patients (mean age: 68.9±7.19 years) with acute ACG and persistently high IOP who were admitted to our department between January 2012 and January 2022 were retrospectively analyzed. Patients who were administered the maximum dose of systemic and topical anti-glaucoma drugs and still had an IOP of >40 mmHg 24 hours after admission underwent sclerotonyxis. After the IOP control, an individualized phase II treatment plan was designed according to the patient's ocular condition.
RESULTS
Forty-eight patients showed improvement in their visual acuity 6 months postoperatively compared to their preoperative values. The mean IOPs were 54.84±7.82 mmHg and 21.34±7.81 mmHg 24 hours pre and postoperatively, respectively. The mean anterior chamber depth showed statistically significant differences pre and postoperatively (1.75±0.16 mm and 1.84±0.17 mm, respectively) (p<0.05). After IOP stabilized, four patients underwent YAG laser peripheral iridectomy, 18 underwent simple cataract phacoemulsification combined with intraocular lens (IOL) implantation, 21 underwent cataract phacoemulsification combined with IOL implantation and goniosynechialysis under a gonioscope, and 7 patients underwent combined surgery of glaucoma and cataract. The mean IOPs were 15.94±3.3 mmHg and 15.64±2.99 mmHg 1 week and 6 months after stage II surgery, respectively. Moreover, 42 eyes (84%) attained complete success and 8 eyes (16%) attained conditional success 6 months postoperatively. No serious complications, such as corneal endothelial decompensation, malignant glaucoma, vitreous or eruptive choroidal hemorrhage, and retinal detachment, were observed intraoperatively or postoperatively in both procedures.
CONCLUSIONS
Sclerotonyxis can rapidly lower IOP, release the pupillary blockage, reconstruct the anterior chamber, and reduce systemic complications caused by long-term high-dose antiglaucoma drugs. Thus, it normalizes the IOP and provides a safe operating space for stage II surgery, effectively reducing complications in patients in a persistent high IOP state.
Topics: Humans; Middle Aged; Aged; Glaucoma, Angle-Closure; Intraocular Pressure; Retrospective Studies; Glaucoma; Treatment Outcome; Cataract; Acute Disease
PubMed: 37667925
DOI: 10.26355/eurrev_202308_33400 -
Asia-Pacific Journal of Ophthalmology... 2024
Topics: Humans; Glaucoma, Angle-Closure; Cataract; Cataract Extraction; Intraocular Pressure; Phacoemulsification
PubMed: 38278701
DOI: 10.1016/j.apjo.2024.100034 -
Ophthalmology Jan 2023To investigate the extent of iris trabecular contact (ITC) measured by anterior segment OCT (AS-OCT) and its association with primary angle-closure (PAC) and PAC...
PURPOSE
To investigate the extent of iris trabecular contact (ITC) measured by anterior segment OCT (AS-OCT) and its association with primary angle-closure (PAC) and PAC glaucoma (PACG) in eyes with gonioscopic angle-closure and to determine the diagnostic performance of ITC for detection of gonioscopic angle-closure.
DESIGN
Multicenter, prospective study.
PARTICIPANTS
A total of 119 healthy participants with gonioscopic open-angle and 170 patients with gonioscopic angle-closure (94 with PAC suspect and 76 with PAC/PACG) were included.
METHODS
One eye of each subject was randomly selected for AS-OCT imaging. Angle-opening distance (AOD500) and trabecular iris space area (TISA500) were measured every 10° for 360°. Two criteria of ITC500 were examined: (1) AOD500 = 0 mm and (2) TISA500 = 0 mm. The association between the extent of ITC500 and PAC/PACG in eyes with gonioscopic angle-closure was analyzed with logistic regression analysis.
MAIN OUTCOME MEASURES
Sensitivity and specificity of ITC500 for detection of gonioscopic angle-closure; odds ratio (OR) of PAC/PACG.
RESULTS
The sensitivity of ITC500 ≥ 10° for detection of gonioscopic angle-closure ranged from 82.4% (AOD500 = 0 mm) to 84.7% (TISA500 = 0 mm), and the specificity was 85.7% (for both AOD500 = 0 mm and TISA500 = 0 mm). The extent of ITC500 determined by AS-OCT, not cumulative gonioscopy score (i.e., the sum of the modified Shaffer grades over 4 quadrants), was associated with the odds of PAC/PACG in eyes with gonioscopic angle-closure; the odds of PAC/PACG increased by 5% for every 10° increase in ITC500 (OR, 1.051, 95% confidence interval [CI], 1.022-1.080 for AOD500 = 0 mm; OR, 1.049, 95% CI, 1.022-1.078 for TISA500 = 0 mm). Axial length and anterior chamber depth were not associated with PAC/PACG in eyes with gonioscopic angle-closure (P ≥ 0.574).
CONCLUSIONS
A greater extent of ITC measured by AS-OCT, not angle-closure determined by gonioscopy, was associated with a greater odds of PAC/PACG in eyes with gonioscopic angle-closure.
Topics: Humans; Anterior Eye Segment; Gonioscopy; Prospective Studies; Intraocular Pressure; Tomography, Optical Coherence; Iris; Glaucoma, Angle-Closure
PubMed: 36652194
DOI: 10.1016/j.ophtha.2022.08.017 -
Clinical implication of recent randomized control trial in primary angle-closure disease management.Indian Journal of Ophthalmology Aug 2022Blindness due to primary angle-closure glaucoma (PACG) can be reduced significantly if the ongoing angle-closure process is arrested at an early stage. Various... (Review)
Review
Blindness due to primary angle-closure glaucoma (PACG) can be reduced significantly if the ongoing angle-closure process is arrested at an early stage. Various treatments such as laser peripheral iridotomy (LPI), iridoplasty, and clear lens extraction (CLE) have been advocated as first-line therapy for primary angle-closure (PAC), PACG, and high-risk cases of primary angle-closure suspect (PACS). EAGLE study, propagated the effectiveness of CLE over LPI for the management of primary angle closure and have sparked controversy regarding the role of LPI as a first line procedure. Randomized controlled trials (RCT), systematic reviews, and meta-analyses of RCTs done on the same question provide us with a solid base for creating guidelines/modules for our day-to-day clinical practice. A systematic review was conducted, searching several databases, including PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov, for the last 16 years (January 2005-December 2021) for RCTs with data published related to primary angle-closure disease (PACD). The search strategy included the following terms: "Primary Angle Closure disease," "Primary Angle Closure Glaucoma," "Primary Angle Closure," "Primary Angle Closure Suspect," "clear lens extraction," "laser iridotomy," "laser peripheral iridotomy," "argon laser peripheral iridoplasty," "selective laser trabeculoplasty," "trabeculectomy," "randomized control trial," and "meta-analysis of randomized control trial." In this review, we will discuss recently published RCTs (within the last 16 years) for the management of PACD and their clinical implications in day-to-day practice.
Topics: Disease Management; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Laser Therapy; Trabeculectomy
PubMed: 35918922
DOI: 10.4103/ijo.IJO_1807_21 -
BMC Ophthalmology Apr 2022Although primary angle-closure glaucoma (PACG) mainly occurs in elderly people, diagnosis of PACG in young patients is not uncommon. So far, there is no article...
BACKGROUND
Although primary angle-closure glaucoma (PACG) mainly occurs in elderly people, diagnosis of PACG in young patients is not uncommon. So far, there is no article specialized on the ocular anatomical characteristics in these patients.In this study, ocular anatomical characteristics in young PACG patients are analyzed.
METHODS
In this retrospective, comparative study, patients diagnosed with PACG and received ultrasound biomicroscopy (UBM) examination in our department were included. Patients were divided into two groups: a young group composed of patients ≤ 45 years and an old group composed of patients > 45 years. A-scan ultrasonography and ultrasound biomicroscopy (UBM) were used to measure ocular biometric parameters of patients in the two groups including axial length (AL), lens thickness (LT), central anterior chamber depth (ACD), anterior chamber width (ACW), angle opening distance 500 (AOD500), anterior chamber angle 500 (ACA500), iris thickness 1000 μm from the iris root (IT1000), iris thickness 500 μm from the iris root (IT500), trabecular-ciliary process angle (TCPA), trabecular-ciliary process distance (TCPD), scleral- ciliary process angle (SCPA), lens vault (LV), and pupil diameter (PD). Plateau iris (PI) and basal iris insertion were determined from UBM images, and the prevalence of PI and basal iris insertion were compared between the two groups. The incidence of postoperative malignant glaucoma (MG) was also determined in both groups and ocular anatomical predictors for the development of MG were evaluated in young PACG patients.
RESULTS
One hundred fifteen patients were included into young group and 480 patients were included into old group. The young group had shorter TCPD, shorter AL, narrower TCPA, narrower SCPA thinner Lens compared to the old group. There were no significant differences in ACD, AOD 500, ACA500, LV, IT500, IT1000, PD or ACW between the two groups. The prevalence of PI was 22.6% in old group and 66.1% in young group (P < 0.001). More young PACG patients displayed basal iris insertion compared to old PACG patients (P < 0.001). 87 patients in the young group and 201 patients in the old group underwent trabeculectomy in our study. Among these patients, 21 young patients and 11 old patients developed MG after trabeculectomy (P < 0.001).
CONCLUSIONS
Shorter AL, more anteriorly positioned ciliary body, higher prevalence of PI may be responsible for the etiology of young PACG patients. Our results suggest that shorter AL, shorter TCPD and narrower TCPA may be predictors for development of MG in young PACG patients after trabeculectomy.
Topics: Aged; Biometry; Ciliary Body; Glaucoma, Angle-Closure; Humans; Iris; Retrospective Studies
PubMed: 35365113
DOI: 10.1186/s12886-022-02374-2 -
Case Reports in Ophthalmology 2022Nail-patella syndrome (NPS) is a rare autosomal dominant disease characterized by nail dysplasia, aplastic or hypoplastic patellae, elbow dysplasia, and presence of...
Nail-patella syndrome (NPS) is a rare autosomal dominant disease characterized by nail dysplasia, aplastic or hypoplastic patellae, elbow dysplasia, and presence of iliac horns. Renal or ocular abnormalities are also associated with the disease. We report the case of a 57-year-old woman affected by NPS and having haploinsufficiency of the LMX1B gene who experienced severe bilateral chronic angle-closure glaucoma in both eyes and that was successfully managed with a flap-express procedure in the right eye. The left eye had no light perception, and medical treatment was considered. Glaucoma is the most frequent ocular abnormalities observed in association with NPS and usually presents with an open angle. Glaucoma associated with NPS typically has an early onset open-angle phenotype. In fewer cases, it may present with an angle-closure phenotype. Therefore, we emphasize the need for glaucoma case-finding protocols comprehensive of gonioscopy in NPS patients and their relatives.
PubMed: 36605036
DOI: 10.1159/000527234 -
Indian Journal of Ophthalmology May 2023To evaluate the refractive status and ocular biometric parameters in primary angle-closure glaucoma (PACG) eyes with different axial lengths (ALs).
PURPOSE
To evaluate the refractive status and ocular biometric parameters in primary angle-closure glaucoma (PACG) eyes with different axial lengths (ALs).
METHODS
In total, 742 Chinese PACG subjects with complete ophthalmic examinations were enrolled. The refractive status was categorized as myopia (spherical equivalent [SE] ≤-0.5 D), emmetropia (-0.5 D < SE < +0.5 D), and hyperopia (SE ≥+0.5 D), whereas the AL was divided into short (AL <22.5 mm), regular (22.5 ≤ AL <23.5 mm), and long (AL ≥23.5 mm). The refractive status and ocular biometric parameters were compared among different AL groups.
RESULTS
The mean AL of the PACG eyes was 22.53 ± 0.84 mm (range: 19.68-25.57 mm). The refractive status was significantly different among different AL groups (P < 0.001). Also, 92.6% of hyperopic PACG eyes showed AL <23.5 mm, and 19.0% of myopic PACG eyes showed AL ≥23.5 mm. The SE showed significant differences among different AL groups only in the hyperopic subjects (P = 0.012). The AL was significantly longer in myopic eyes (P < 0.001). The PACG eyes with longer AL exhibited lower keratometry, longer central anterior chamber depth and corneal diameter, and lens position and relative lens position closer to the anterior (P < 0.001).
CONCLUSION
Axial hyperopia was common in PACG eyes, and axial myopia was not uncommon. Relatively anterior lens position could explain the occurrence of PACG in the eyes with long AL.
Topics: Humans; Hyperopia; Glaucoma, Angle-Closure; Refraction, Ocular; Lens, Crystalline; Myopia; Cornea; Biometry; Anterior Chamber
PubMed: 37203062
DOI: 10.4103/ijo.IJO_1890_22 -
International Ophthalmology Dec 2022We assessed the relationship between acute primary angle closure glaucoma (APACG) severity and macular microcirculation, as well as the diagnostic ability of blood flow...
PURPOSE
We assessed the relationship between acute primary angle closure glaucoma (APACG) severity and macular microcirculation, as well as the diagnostic ability of blood flow and macular structural parameters on optical coherence tomography angiography (OCTA) for APACG.
METHODS
APACG patients were assigned to mild, moderate, and severe groups in this cross-sectional study. Age-matched primary angle closure suspect (PACS) and healthy control groups were also recruited. The vessel density (VD) and foveal avascular zone (FAZ) in each macular superficial area were measured using OCTA. The retinal nerve fiber layer thickness (RNFLT) and ganglion cell complex thickness (GCCT) of the corresponding regions were measured using OCT.
RESULTS
All parameters in the control, PACS, and mild APACG groups differed significantly from those in the moderate and severe APACG groups (all P < 0.05). VD and RNFLT showed high and moderate diagnostic ability, respectively, to distinguish moderate APACG from PACS, with significant differences (P < 0.05) in areas under the receiver operating characteristic curve (AUCs) for VD and RNFLT in six macular areas. The diagnostic abilities of VD and RNFLT for distinguishing severe APACG from PACS were increased, with significant differences in the AUCs for VD and RNFLT in five macular areas (P < 0.05). All macular VDs and GCCTs were similar among the three APACG groups (P > 0.05).
CONCLUSIONS
Damage to the VD and FAZ in the macula increased with APACG severity. VD in the macular superficial layer showed a higher diagnostic ability than RNFLT, which was equivalent to that of GCCT.
Topics: Humans; Fluorescein Angiography; Retinal Vessels; Glaucoma, Open-Angle; Visual Field Tests; Glaucoma, Angle-Closure; Cross-Sectional Studies; Intraocular Pressure; Glaucoma; Macula Lutea; Tomography, Optical Coherence
PubMed: 35781598
DOI: 10.1007/s10792-022-02399-y -
European Review For Medical and... Aug 2019To explore the association between human leukocyte antigen (HLA)-DPA1 gene polymorphism and primary glaucoma.
OBJECTIVE
To explore the association between human leukocyte antigen (HLA)-DPA1 gene polymorphism and primary glaucoma.
PATIENTS AND METHODS
Six single nucleotide polymorphisms (SNPs) were genotyped in 51 patients and 51 healthy controls through Polymerase Chain Reaction (PCR). The possible association between HLA-DPA1 gene mutation and primary glaucoma was detected using the t-test and the Chi-square test.
RESULTS
Rs1676486 genotype had a significant genetic correlation. Rs3753841 and rs12138977 genotypes had a higher minor-allele frequency in control group. The CT + CC genotype frequency of rs12138977 showed a significant genetic correlation in both case group and control group. Moreover, the rs12138977 polymorphism and corneal thickness had little influence on the occurrence of primary angle-closure glaucoma (PACG). Also, the main risk factors for PACG were intraocular hypertension and short axial length.
CONCLUSIONS
The HLA-DPA1 gene polymorphism may be related to the severity of PACG.
Topics: Aged; Case-Control Studies; Female; Genetic Association Studies; Genetic Predisposition to Disease; Glaucoma, Angle-Closure; HLA-DP alpha-Chains; Humans; Male; Middle Aged; Polymorphism, Single Nucleotide
PubMed: 31389567
DOI: 10.26355/eurrev_201908_18623