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International Ophthalmology Dec 2022To determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in Vogt-Koyanagi-Harada (VKH) disease. (Observational Study)
Observational Study
PURPOSE
To determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in Vogt-Koyanagi-Harada (VKH) disease.
METHODS
This retrospective, longitudinal observational study analyzed the demographic data, disease stage, glaucoma development, intraocular pressure, best-corrected visual acuity, lens status, optic nerve, gonioscopy, management, and visual outcomes of VKH disease. Clinical features were used to categorize the stage of VKH disease. VKH eyes were divided into two groups, with or without glaucoma, undergoing further analysis, including statistical analysis.
RESULTS
305 eyes of 155 patients with VKH disease with a median follow-up of 22 months were included. Secondary glaucoma developed in 67 (22%) eyes, most of which (64.2%) had chronic recurrent VKH at presentation. Angle-closure was present in 55 (82.1%) of glaucoma eyes. Peripheral anterior and posterior synechiae were present in 58 (86.6%) and 51 (76.1%) eyes, respectively. Pupillary block and posterior synechiae resulted in iris bombé in 17 (25.4%) eyes with glaucoma. At the last visit, visual acuity was worse in eyes with glaucoma (p < 0.001).
CONCLUSION
We found that angle-closure disease is a significant cause of secondary glaucoma in VKH. Eyes with glaucoma were more likely to present in the chronic recurrent stage of the disease.
Topics: Humans; Uveomeningoencephalitic Syndrome; Glaucoma, Angle-Closure; Retrospective Studies; Prevalence; Glaucoma
PubMed: 35789316
DOI: 10.1007/s10792-022-02412-4 -
Current Opinion in Ophthalmology Mar 2018Angle closure glaucoma is a leading cause of blindness globally and trends of how best to treat this disease are evolving. The advent of anterior segment imaging aids... (Review)
Review
PURPOSE OF REVIEW
Angle closure glaucoma is a leading cause of blindness globally and trends of how best to treat this disease are evolving. The advent of anterior segment imaging aids our understanding of pathogenesis and allows more robust and objective measurement of treatment modalities. We will also review recent literature regarding the role of laser and surgical interventions for the treatment of primary angle closure disease.
RECENT FINDINGS
Recent studies evaluating the efficacy of laser peripheral iridotomy (LPI) in primary angle closure suspects (PACs) show that while it is a safe intervention and initially anterior chamber angle widens following the laser treatment, the effect is lost with time. Only a small minority of PACs patients develop primary angle closure (PAC) or primary angle closure glaucoma (PACG). Trials evaluating argon laser peripheral iridoplasty (ALPI) have failed to show a substantial clinical benefit. In patients with early or moderate PACG and those with PAC with IOP over 30 mmHg, clear lens extraction is associated with better clinical and quality of life outcomes than LPI.
SUMMARY
Recent evidence supports initial clear lens extraction in the context of PACG or primary angle closure with IOP more than 30 mmHg.
Topics: Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Laser Therapy
PubMed: 29194069
DOI: 10.1097/ICU.0000000000000453 -
Clinical & Experimental Ophthalmology Apr 2018
Topics: Acute Disease; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Tonometry, Ocular
PubMed: 29665201
DOI: 10.1111/ceo.13189 -
Current Opinion in Ophthalmology Mar 2011With recent advances in imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, there is a better understanding of... (Review)
Review
PURPOSE OF REVIEW
With recent advances in imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, there is a better understanding of nonpupil block mechanisms and novel risk factors contributing to the pathogenesis of angle closure glaucoma.
RECENT FINDINGS
Recent studies suggest that multiple anatomical and physiological factors interplay in the pathogenesis of angle closure glaucoma. The association of greater iris convexity, area and thickness with narrow angles could result in a more anterior bowing and crowding of the peripheral iris. Other novel anatomic parameters such as greater lens vault, smaller anterior chamber width, area and volume, independently increase the risk of having angle closure. Dynamic increase or lesser reduction in iris volume during dilation supports the theory of physiological predisposition to the disease process. Choroidal expansion has been demonstrated in untreated and treated, acute and chronic primary angle closure eyes. It remains unknown whether this finding is a cause or effect in this condition.
SUMMARY
With a wider availability of imaging tools and a better understanding of risk factors and mechanisms, clinicians maybe able to more accurately identify those at greater risk of developing angle closure disease and tailor their treatment according to the predominant factor(s) involved.
Topics: Anterior Eye Segment; Diagnostic Imaging; Diagnostic Techniques, Ophthalmological; Glaucoma, Angle-Closure; Humans; Risk Factors
PubMed: 21252671
DOI: 10.1097/ICU.0b013e32834372b9 -
The New England Journal of Medicine Mar 2018
Topics: Acute Disease; Eye; Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Middle Aged
PubMed: 29514027
DOI: 10.1056/NEJMicm1712742 -
Survey of Ophthalmology 2009Primary angle-closure glaucoma is a major cause of blindness worldwide. It is a disease of ocular anatomy that is related to pupillary-block and angle-crowding... (Review)
Review
Primary angle-closure glaucoma is a major cause of blindness worldwide. It is a disease of ocular anatomy that is related to pupillary-block and angle-crowding mechanisms of filtration angle closure. Eyes at increased risk for primary angle-closure are small with decreased axial length, anterior chamber depth, and filtration angle width, associated with a proportionately large lens. Angle-closure glaucoma afflicts Asian and Eskimo eyes more frequently than eyes in other races with similar predisposing dimensions. The treatment of primary angle closure addresses its causal mechanisms. Laser peripheral iridotomy equalizes the anterior and posterior pressures and widens the filtration angle by reducing the effect of pupillary block. Argon laser peripheral iridoplasty contracts the iris stroma to reduce angle crowding and is helpful for some affected eyes. Lensectomy dramatically widens the angle and eliminates pupillary block. Clinical reports of lensectomy with posterior chamber intraocular lens implantation in the treatment of acute, chronic, and secondary angle-closure glaucoma describe very favorable results. The appropriate role for lensectomy in the management of primary angle closure, however, remains unproven. Prospective, randomized clinical trials are ongoing to determine the value and comparative risks and efficacy of lensectomy versus medical therapy, laser peripheral iridotomy, laser iridoplasty, and filtration procedures for the treatment of acute and chronic primary angle closure and for the prevention of chronic angle-closure glaucoma, both after and in place of laser peripheral iridotomy.
Topics: Glaucoma, Angle-Closure; Humans; Iridectomy; Iris; Lens, Crystalline
PubMed: 19298900
DOI: 10.1016/j.survophthal.2008.12.002 -
Current Opinion in Ophthalmology Apr 2003Recent studies underscore the importance of angle-closure glaucoma (ACG) as a cause of world blindness. A major contribution in assessing the true impact of this disease... (Review)
Review
PURPOSE OF REVIEW
Recent studies underscore the importance of angle-closure glaucoma (ACG) as a cause of world blindness. A major contribution in assessing the true impact of this disease has been an article estimating the number of persons with occludable angles, angle closure, and blindness from ACG in China as 28.2 million, 9.1 million, and 1.7 million, respectively. Although these numbers are based on data from Singapore and Mongolia, which may be applied to China only with caution, they emphasize the blinding potential of ACG, which is three times as likely to be associated with blindness as open-angle glaucoma (OAG).
RECENT FINDINGS
Recent reports in the Chinese literature on ACG prevalence suffer from definitional problems that would appear to lead to systematic overestimates of ACG prevalence and underestimates of OAG prevalence. Nonetheless, data from studies by Chinese investigators further emphasize the strong association between ACG and blindness, with fully 16% of subjects with ACG blind in one report-a far higher proportion than for OAG in China and elsewhere. The importance of topiramate as a cause of secondary angle closure has recently been understood, in part, because of a series of 19 such cases reported by investigators at the Food and Drug Administration.
SUMMARY
Angle closure in this setting appears to be caused by uveal effusion and anterior rotation of the ciliary body with resultant closure of the angle. The condition is not always responsive to laser iridectomy, and elimination of the causative agent appears to be critical. Ultrasonic biomicroscopy is a potential new diagnostic modality for ACG, allowing the measurement of novel parameters, such as the angle opening distance (AOD) at 500 microm (AOD 500). The efficacy of such parameters in improving screening for ACG can only be established by prospective studies of potentially at-risk eyes. A number of novel treatments for AC and angle closure have recently been proposed, including cataract extraction, paracentesis, and argon laser iridoplasty. As with proposed new diagnostic modalities, the efficacy of these treatments remains to be demonstrated with prospective studies, ideally organized in a controlled, randomized fashion.
Topics: Blindness; Ciliary Body; Drug Therapy; Glaucoma, Angle-Closure; Humans; Ophthalmologic Surgical Procedures; Uvea
PubMed: 12698044
DOI: 10.1097/00055735-200304000-00002 -
Developments in Ophthalmology 2012The main objective of surgical treatment in angle closure is to quickly decrease the intraocular pressure and therefore reduce the risk of further glaucomatous optic... (Review)
Review
The main objective of surgical treatment in angle closure is to quickly decrease the intraocular pressure and therefore reduce the risk of further glaucomatous optic nerve damage. Surgical treatment of angle-closure glaucoma also helps to ensure that progressive angle closure does not occur, and that the risk of acute angle closure is abolished. The surgical options are diverse and include laser surgery, filtering surgery, lens extraction, combined lens extraction and filtering surgery, angle widening procedures such as goniosynechialysis, lens extraction combined with goniosynechialysis or a combination of procedures.
Topics: Filtering Surgery; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Optic Nerve Diseases; Treatment Outcome
PubMed: 22517180
DOI: 10.1159/000334795 -
Seminars in Ophthalmology 2017To review the old and existing classification systems for primary angle closure disease. (Review)
Review
PURPOSE
To review the old and existing classification systems for primary angle closure disease.
METHODS
Literature review and new proposed classification system.
RESULTS
Existing classification systems have several shortcomings which cannot be applied in a clinical setting. This can be addressed by a proposed scoring system.
CONCLUSION
A scoring system would be most appropriate for any clinical setting as well as for prognosticating primary angle closure disease.
Topics: Anterior Chamber; Glaucoma, Angle-Closure; Gonioscopy; Humans; Narrow Band Imaging
PubMed: 26292158
DOI: 10.3109/08820538.2015.1053620 -
Current Opinion in Ophthalmology Mar 2014To review the classification of primary angle closure (PAC) and discuss the evidence-based management of each type. (Review)
Review
PURPOSE OF REVIEW
To review the classification of primary angle closure (PAC) and discuss the evidence-based management of each type.
RECENT FINDINGS
There is limited evidence to support the prophylactic treatment of primary angle closure suspects. Cataract and clear lens extraction may be more effective than traditional therapy in controlling intraocular pressure (IOP) in patients with PAC, primary angle closure glaucoma, and acute angle closure crisis.
SUMMARY
Treatment of angle closure depends on the signs of chronic angle damage and glaucomatous optic neuropathy. In the absence of such evidence, serial gonioscopy may be the preferred therapy. If signs or symptoms are present, medical therapy and laser peripheral iridotomy are beneficial. However, recent data suggest that cataract extraction may be more effective at controlling the IOP than laser or incisional glaucoma procedures.
Topics: Cataract Extraction; Evidence-Based Medicine; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Iridectomy; Iris; Laser Therapy; Lens, Crystalline; Tonometry, Ocular
PubMed: 24463418
DOI: 10.1097/ICU.0000000000000028