-
British Journal of Hospital Medicine... Dec 2019Acute angle closure is an emergent ophthalmic condition that develops as a result of an obstructed outflow of aqueous humour between the anterior and posterior chambers... (Review)
Review
Acute angle closure is an emergent ophthalmic condition that develops as a result of an obstructed outflow of aqueous humour between the anterior and posterior chambers of the eye, leading to a sudden rise in intraocular pressure and secondary optic neuropathy if left untreated. The most common primary cause is a pupillary block in patients with pre-existing narrow angles, such as those who are long-sighted. However, awareness should be raised to identify secondary causes of angle closure, including the use of commonly prescribed medications. A detailed interrogation is essential to exclude other possible confounding disorders that present similarly, especially those originating in the CNS. Angle closure should be excluded in all patients presenting with sudden onset of red eye associated with pupillary dilation, dull pain and headache. Basic examination of the eye should include assessment of the anterior segment with a bright light, measurement of intraocular pressure and a full neurological exam. Immediate treatment must be initiated whenever there is high clinical suspicion of acute angle closure, with the administration of systemic ocular hypotensive therapy to prevent damage to the optic nerve and limit visual loss. An urgent referral to the ophthalmologist is mandatory to dictate definitive management.
Topics: Acute Disease; Age Factors; Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Risk Factors; Sex Factors
PubMed: 31822188
DOI: 10.12968/hmed.2019.80.12.C174 -
Progress in Retinal and Eye Research Mar 2017Primary angle-closure glaucoma (PACG) is a common cause of blindness. Angle closure is a fundamental pathologic process in PAGC. With the development of imaging devices... (Review)
Review
Primary angle-closure glaucoma (PACG) is a common cause of blindness. Angle closure is a fundamental pathologic process in PAGC. With the development of imaging devices for the anterior segment of the eye, a better understanding of the pathogenesis of angle closure has been reached. Aside from pupillary block and plateau iris, multiple-mechanisms are more common contributors for closure of the angle such as choroidal thickness and uveal expansion, which may be responsible for the presenting features of PACG. Recent Genome Wide Association Studies identified several new PACG loci and genes, which may shed light on the molecular mechanisms of PACG. The current classification systems of PACG remain controversial. Focusing the anterior chamber angle is a principal management strategy for PACG. Treatments to open the angle or halt the angle closure process such as laser peripheral iridotomy and/or iridoplasty, as well as cataract extraction, are proving their effectiveness. PACG may be preventable in the early stages if future research can identify which kind of angles and/or persons are more likely to benefit from prophylactic treatment. New treatment strategies like adjusting the psychological status and balancing the sympathetic-parasympathetic nerve activity, and innovative medicines are needed to improve the prognosis of PACG. In this review, we intend to describe current understanding and unknown aspects of PACG, and to share the clinical experience and viewpoints of the authors.
Topics: Diagnostic Techniques, Ophthalmological; Disease Management; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Sympathetic Nervous System
PubMed: 28039061
DOI: 10.1016/j.preteyeres.2016.12.003 -
JAMA May 2014Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A... (Review)
Review
IMPORTANCE
Glaucoma is a worldwide leading cause of irreversible vision loss. Because it may be asymptomatic until a relatively late stage, diagnosis is frequently delayed. A general understanding of the disease pathophysiology, diagnosis, and treatment may assist primary care physicians in referring high-risk patients for comprehensive ophthalmologic examination and in more actively participating in the care of patients affected by this condition.
OBJECTIVE
To describe current evidence regarding the pathophysiology and treatment of open-angle glaucoma and angle-closure glaucoma.
EVIDENCE REVIEW
A literature search was conducted using MEDLINE, the Cochrane Library, and manuscript references for studies published in English between January 2000 and September 2013 on the topics open-angle glaucoma and angle-closure glaucoma. From the 4334 abstracts screened, 210 articles were selected that contained information on pathophysiology and treatment with relevance to primary care physicians.
FINDINGS
The glaucomas are a group of progressive optic neuropathies characterized by degeneration of retinal ganglion cells and resulting changes in the optic nerve head. Loss of ganglion cells is related to the level of intraocular pressure, but other factors may also play a role. Reduction of intraocular pressure is the only proven method to treat the disease. Although treatment is usually initiated with ocular hypotensive drops, laser trabeculoplasty and surgery may also be used to slow disease progression.
CONCLUSIONS AND RELEVANCE
Primary care physicians can play an important role in the diagnosis of glaucoma by referring patients with positive family history or with suspicious optic nerve head findings for complete ophthalmologic examination. They can improve treatment outcomes by reinforcing the importance of medication adherence and persistence and by recognizing adverse reactions from glaucoma medications and surgeries.
Topics: Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Primary Health Care
PubMed: 24825645
DOI: 10.1001/jama.2014.3192 -
Disease-a-month : DM Jun 2014
Review
Topics: Aged; Blindness; Disease Progression; Female; Follow-Up Studies; Glaucoma, Angle-Closure; Humans; Incidence; Male; Middle Aged; Ocular Hypertension; Ophthalmologic Surgical Procedures; Risk Assessment; Severity of Illness Index; Tonometry, Ocular; Treatment Outcome
PubMed: 24906670
DOI: 10.1016/j.disamonth.2014.03.005 -
Current Opinion in Ophthalmology Mar 2020The genetic basis of primary angle closure (PAC) glaucoma is slowly being elucidated. In recent years, genome-wide association studies have identified eight new... (Review)
Review
PURPOSE OF REVIEW
The genetic basis of primary angle closure (PAC) glaucoma is slowly being elucidated. In recent years, genome-wide association studies have identified eight new susceptibility loci for PAC. Our purpose in this review is to summarize our current knowledge of genetics in angle closure, to take a closer look at the eight novel loci and what we have learned about their function, and consider what they might teach us about angle closure disease.
RECENT FINDINGS
Multiple novel loci associated with PAC glaucoma have been identified in large genome-wide association studies. Moreover, primary open angle glaucoma and PAC glaucoma are found to have partly overlapping genetic features.
SUMMARY
The genetic basis of PAC glaucoma is being deciphered. Even though there is still much more to be uncovered, this process has already provided new insights in the pathogenesis of this blinding disease. A better understanding of the pathogenic mechanisms through genomics may be valuable for the development of novel therapies.
Topics: Genome-Wide Association Study; Genomics; Glaucoma, Angle-Closure; Humans
PubMed: 31895154
DOI: 10.1097/ICU.0000000000000645 -
Indian Journal of Ophthalmology Apr 2018Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering... (Review)
Review
Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target" IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having - mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. "Target" IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a "Target" IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.
Topics: Antihypertensive Agents; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Iridectomy
PubMed: 29582808
DOI: 10.4103/ijo.IJO_1130_17 -
Experimental Eye Research Dec 2019Glaucoma, the leading cause of irreversible blindness worldwide, can be divided into two major types: primary open angle glaucoma (POAG) and primary angle closure... (Review)
Review
Glaucoma, the leading cause of irreversible blindness worldwide, can be divided into two major types: primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG). PACG could lead to severe vision loss and has a high prevalence among Asian populations. The worldwide population affected by PACG is estimated to exceed 20 million by 2020. Recent studies have shown that there are at least eight genetic loci significantly associated with risk of PACG, possibly contributing to the phenotype by interacting with environmental factors. This review presents the progress that has been achieved in the genetics of PACG and its future perspectives. This article should be considered as a memorial article to honor Dr. R. Rand Allingham's remarkable contribution to genetic association studies in glaucoma. We are deeply saddened by the loss of Dr. Allingham, not only a huge loss for ophthalmology, but also loss of a dear friend. Looking back to his extraordinary career, Dr. Allingham devoted his whole life and passion into establishing the genetic basis of different forms of glaucoma such as open angle, angle closure, and exfoliation glaucoma. He had a special interest in analyses of populations from African ancestry, which greatly boosted the understanding of glaucoma genetics.
Topics: Genetic Predisposition to Disease; Glaucoma, Angle-Closure; Global Health; Humans; Intraocular Pressure; Prevalence; Visual Fields
PubMed: 31634478
DOI: 10.1016/j.exer.2019.107835 -
Klinische Monatsblatter Fur... Aug 2023Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can...
Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can lead to severe visual disturbances and even blindness within a short time. It is divided into primary and secondary forms and can be further categorized depending on the presence of a pupillary block. In all cases, therapy is initially based on resolving the cause of the angle-closure and treating any underlying disease that may be present. In addition, intraocular pressure reduction must be achieved. This can be effectuated conservatively or surgically. Depending on the specific subtype of angle-closure, different treatments are promising.
Topics: Humans; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Blindness; Pupil Disorders; Europe; Intraocular Pressure
PubMed: 37236235
DOI: 10.1055/a-1812-4381 -
Developments in Ophthalmology 2017Advances in anterior segment imaging modalities have contributed new insights towards a better understanding of the various mechanisms of angle-closure glaucoma (ACG).... (Review)
Review
Advances in anterior segment imaging modalities have contributed new insights towards a better understanding of the various mechanisms of angle-closure glaucoma (ACG). This development is key to good decision making when confronted with angle-closure patients needing appropriate therapy. Surgical management of ACG remains an integral part of glaucoma patient care. The distinctive anatomy of angle-closure eyes and the few objective lines of evidence to support the effectiveness of the different surgical treatment options present a challenge to glaucoma surgeons.
Topics: Anterior Eye Segment; Filtering Surgery; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Treatment Outcome
PubMed: 28442694
DOI: 10.1159/000458493 -
Klinische Monatsblatter Fur... Nov 2021Secondary angle closure glaucoma is a very heterogeneous subtype of glaucoma with a variety of possible causes leading to a blockade of the regular aqueous humour flow...
Secondary angle closure glaucoma is a very heterogeneous subtype of glaucoma with a variety of possible causes leading to a blockade of the regular aqueous humour flow or outflow. A distinction is made between secondary pupillary block, angle closure with "pulling" or angle closure with "pushing" mechanisms. For each of these three subgroups, there are different causes, which in turn require individual therapy. Treatment of the underlying cause should always take priority whenever possible. Reduction of the intraocular pressure is often a symptomatic therapy with surgical, pressure lowering procedures showing a limited success rate in many forms of secondary angle closure glaucoma. This article intends to provide an overview of the different causes of secondary angle closure, diagnostic approaches and targeted therapies of exemplary causes of each subgroup.From the group of secondary pupillary block, mechanical causes, iris bombé, and intraoperative air or oil input are addressed, from the group of "pulling" causes, angle neovascularization, post-inflammatory angle changes, and iridocorneal endothelial syndrome and for the group of "pushing" mechanisms, gas endotamponade, retroiridal neoplasms and aqueous misdirection syndrome.While secondary angle closure is one of the most challenging glaucoma subgroups for treatment it is crucial to know the different subgroups and their development to choose the right treatment.
Topics: Glaucoma; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Iris Diseases; Tonometry, Ocular
PubMed: 34380157
DOI: 10.1055/a-1545-9983