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Journal of Glaucoma Aug 2015China has a large burden of primary angle-closure glaucoma (PACG) and the approach to treatment is different from that in most parts of the world. In China,... (Review)
Review
China has a large burden of primary angle-closure glaucoma (PACG) and the approach to treatment is different from that in most parts of the world. In China, trabeculectomy is a mainstay of initial treatment for PACG and laser peripheral iridotomy is reserved for PAC and PACG with peripheral angle synechiae ≤180 degrees. The greater reduction of and more stable IOP, lower frequency of acute angle closure, decreased progression of peripheral anterior synechia and glaucoma, and the reduction of ocular complications associated with long-term use of glaucoma medications support the use of initial trabeculectomy in PACG without significant lens opacities. Further study is required to determine the indications and effectiveness of initial trabeculectomy for PACG in a developing country setting.
Topics: Asian People; China; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Laser Therapy; Practice Patterns, Physicians'; Trabeculectomy
PubMed: 24786102
DOI: 10.1097/IJG.0000000000000075 -
The Pan African Medical Journal 2022An early and correct diagnosis improves the prognosis of post-operative Acute angle closure glaucoma (AACG). A 65 years-old monophtalmus man was operated for a total... (Review)
Review
An early and correct diagnosis improves the prognosis of post-operative Acute angle closure glaucoma (AACG). A 65 years-old monophtalmus man was operated for a total knee replacement surgery, under general anaesthesia without any adverse events. The day after, the patient described recurrent periorbital pain in his eye, with ocular hyperaemia, and reduced visual acuity. A diagnosis of AACG was made and conservative treatment was started to reduce the intraocular pressure. In the post-operative AACG, several predisposing local factors including genetic predisposition, female gender, hypermetropia, increased lens thickness and small corneal diameter, can be added to a pupillary block induced by adrenergic and anticholinergic drugs used in anaesthetic procedures as risk factors. An acute and intensive periorbital or ocular pain, with or without visual disturbance, must aware the physician.
Topics: Acute Disease; Aged; Arthroplasty, Replacement, Knee; Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Lens, Crystalline; Male
PubMed: 35371375
DOI: 10.11604/pamj.2022.41.68.31888 -
Revue Medicale de Liege Sep 2022Acute angle closure glaucoma is an ophthalmic emergency that can lead to blindness in some cases. The presenting signs are often suggestive, like ocular pain and blurred...
Acute angle closure glaucoma is an ophthalmic emergency that can lead to blindness in some cases. The presenting signs are often suggestive, like ocular pain and blurred vision accompanied by headache, nausea and vomiting. These symptoms must be recognized as soon as possible, and the patient must be addressed, urgently, to an ophthalmologist for treatment. Many drugs may lead to an acute angle closure glaucoma in patients with risk factors. This article aims to remind the anatomical risk factors as well as the drugs that may induce an acute angle closure glaucoma. For a better understanding, this article will provide a brief reminder of the pathophysiological mechanism of acute angle closure glaucoma.
Topics: Acute Disease; Glaucoma, Angle-Closure; Humans
PubMed: 36082598
DOI: No ID Found -
Ophthalmology. Glaucoma 2022
Topics: Glaucoma, Angle-Closure; Humans; Hypertension, Malignant; Intraocular Pressure
PubMed: 35398455
DOI: 10.1016/j.ogla.2022.03.009 -
Ophthalmology Jan 2002
Topics: Acute Disease; Chronic Disease; Disease Progression; Filtering Surgery; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Laser Therapy
PubMed: 11772559
DOI: 10.1016/s0161-6420(01)00921-6 -
European Journal of Ophthalmology Jul 2023To report the presentation and management of a 65-year-old female who presented with chronic angle closure glaucoma and an atypical iris membrane.
PURPOSE
To report the presentation and management of a 65-year-old female who presented with chronic angle closure glaucoma and an atypical iris membrane.
CASE REPORT
A 65-year-old healthy female with no significant past medical history presented to the emergency room with a 2-day history of headache, blurry vision, and right ocular pain. She denied any such prior episodes, any prior ocular history including ocular trauma, or a family history of glaucoma. She was diagnosed with bilateral, severe chronic angle closure glaucoma with an atypical, pigmented iris-pupillary membrane in the right eye. Given the appearance of the membrane, ocular oncology consultation and anterior segment imaging were unremarkable. Surgical management included complex cataract extraction, limited pars plana anterior vitrectomy, iris membrane removal, and placement of a sulcus tube shunt.
CONCLUSIONS
This complex case of chronic angle closure glaucoma with an atypical pupillary membrane highlights the importance of maintaining a broad differential and ruling out secondary pathologies such as iris melanoma. Additionally, it highlights the complexities of cataract extraction with a shallow anterior chamber.
Topics: Humans; Female; Aged; Glaucoma, Angle-Closure; Intraocular Pressure; Glaucoma; Iris; Cataract Extraction
PubMed: 35775108
DOI: 10.1177/11206721221111700 -
Survey of Ophthalmology 2020The crystalline lens plays an important role in the pathophysiology of primary angle closure and primary angle-closure glaucoma. The aging process is associated with a... (Review)
Review
The crystalline lens plays an important role in the pathophysiology of primary angle closure and primary angle-closure glaucoma. The aging process is associated with a progressive enlargement of the lens, resulting in greater iridolenticular and iridotrabecular contact, which exacerbates both pupillary block and appositional angle closure, irrespective of the cataract status of the lens. Cataract surgery has been shown to widen the angle and reduce intraocular pressure in eyes with primary angle closure or primary angle-closure glaucoma. Recently, clear lens phacoemulsification has been suggested as a treatment modality in such eyes. We review the literature on clear lens extraction in eyes with angle closure and discuss its efficacy, safety, and indications. Although it is evident that clear lens extraction is beneficial in eyes with primary angle closure and primary angle-closure glaucoma, it is technically challenging and should be performed by experienced surgeons who not only master the procedure but are also able to deal with potential complications. Since the follow-up of the reviewed studies is relatively short, long-term follow-up (>10 years) of patients who undergo this procedure is needed to evaluate the safety and confirm the early benefits reported.
Topics: Glaucoma, Angle-Closure; Humans; Lens, Crystalline; Phacoemulsification; Visual Acuity
PubMed: 32339525
DOI: 10.1016/j.survophthal.2020.04.003 -
Indian Journal of Ophthalmology Jul 2022
Topics: Eye Abnormalities; Eye Diseases, Hereditary; Glaucoma, Angle-Closure; Humans; Retinal Diseases; Retinal Dystrophies
PubMed: 35791192
DOI: 10.4103/ijo.IJO_2411_21 -
Lancet (London, England) Apr 2019Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects.
METHODS
In this randomised controlled trial, bilateral primary angle closure suspects aged 50-70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099.
FINDINGS
Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95% CI 0·30-0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up.
INTERPRETATION
Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended.
FUNDING
Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China.
Topics: Aged; China; Female; Glaucoma, Angle-Closure; Humans; Intention to Treat Analysis; Intraocular Pressure; Iridectomy; Kaplan-Meier Estimate; Lasers, Solid-State; Male; Middle Aged; Prophylactic Surgical Procedures
PubMed: 30878226
DOI: 10.1016/S0140-6736(18)32607-2 -
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