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Progress in Brain Research 2015Glaucoma is the second cause of blindness worldwide. In the next years, approximately one-fourth of all glaucoma cases will be angle-closure types. Older age, female... (Review)
Review
Glaucoma is the second cause of blindness worldwide. In the next years, approximately one-fourth of all glaucoma cases will be angle-closure types. Older age, female sex, and Asian ethnicities are described risk factors as well as shorter axial length, shallow anterior chamber depth, lens position, and thickness. New findings suggest iris volume and choroidal thickness to have a key role in the mechanisms of angle closure. Classical clinical conditions are acute, intermittent, and chronic forms. Ultrasound biomicroscopy and anterior segment optical coherence tomography contribute to a better understanding of the mechanisms of angle closure, helping the ophthalmologists in the diagnosis and treatment. The therapy includes laser iridotomy, argon laser peripheral iridoplasty, lens extraction, goniosynechialysis, filtering surgery, drainage implant, and cyclodestruction.
Topics: Glaucoma, Angle-Closure; Humans; Ophthalmologic Surgical Procedures
PubMed: 26518079
DOI: 10.1016/bs.pbr.2015.05.001 -
International Ophthalmology Clinics 1990
Review
Topics: Acute Disease; Aqueous Humor; Chronic Disease; Eye; Glaucoma, Angle-Closure; Gonioscopy; Humans; Laser Therapy; Racial Groups
PubMed: 2199387
DOI: 10.1097/00004397-199030030-00005 -
BMC Veterinary Research Mar 2019Open angle glaucoma is the only type of primary glaucoma reported in Beagles. This case report describes a primary angle-closure glaucoma in a Beagle and its diagnostic...
BACKGROUND
Open angle glaucoma is the only type of primary glaucoma reported in Beagles. This case report describes a primary angle-closure glaucoma in a Beagle and its diagnostic and prognostic relevance.
CASE PRESENTATION
A 12-year-old, neutered male Beagle presented to the Michigan State University (MSU) Comparative Ophthalmology Service for evaluation of suspected visual impairment. Complete ophthalmic examination of the left eye (OS) revealed: blepharospasm, absent menace response, moderate episcleral congestion, mild diffuse corneal edema, mydriasis, asteroid hyalosis, decreased myelination and cupping of the optic nerve head, and mild retinal vascular attenuation. Examinations of the right eye (OD) were within normal limits. Intraocular Pressure (IOP) were 24 mmHg OD and 49 mmHg OS. Gonioscopy OD revealed a narrow iridocorneal angle with moderate pectinate ligament dysplasia characterized by broad-based pectinate ligament strands (fibrae latae) and solid sheets (laminae) throughout all 4 quadrants. DNA testing revealed that the dog did not carry the Gly661Arg ADAMTS10 mutation responsible for primary open angle glaucoma (POAG) in Beagles. The OS was medically managed with latanoprost 0.005% and dorzolamide HCl 2% /timolol malate 0.5% ophthalmic solutions for 7 months and then enucleated due to uncontrolled IOP. Histopathologic evaluation was consistent with goniodysgenesis with a broad, non-perforate, sheet-like band of uveal stroma bridging from the base of the iris to the terminal arborization of Descemet's membrane. Approximately 14 months from the initial diagnosis of glaucoma OS, OD also developed glaucoma and was enucleated. Histopathologic findings were consistent with goniodysgenesis OD.
CONCLUSIONS
To our knowledge, this is the first reported case of PACG with goniodysgenesis in a Beagle supported by clinical, genetic, and histopathologic data. It highlights the importance of gonioscopy in Beagles with glaucoma. Further studies with a larger number of dogs are warranted to characterize clinical manifestations and inheritance of PACG in this breed.
Topics: Animals; Dog Diseases; Dogs; Eye Abnormalities; Glaucoma, Angle-Closure; Gonioscopy; Intraocular Pressure; Male; Treatment Outcome
PubMed: 30832652
DOI: 10.1186/s12917-019-1812-1 -
Seminars in Ophthalmology Jun 2002Angle closure glaucoma remains a major challenge for ophthalmologists. The three main challenges in the treatment of angle closure glaucoma are, firstly, to achieve... (Review)
Review
Angle closure glaucoma remains a major challenge for ophthalmologists. The three main challenges in the treatment of angle closure glaucoma are, firstly, to achieve rapid reduction of intraocular pressure in acute angle closure glaucoma, secondly, to prevent progression to chronic angle closure glaucoma, and thirdly, to manage established chronic angle closure glaucoma. Incisional surgery for angle closure glaucoma is typically required when laser surgery and/or medical therapy fail to control the intraocular pressure or control progressive synechial closure. The role for surgical iridectomy and emergency trabeculectomy in the modern management of acute angle closure glaucoma is diminishing. Trabeculectomy, goniosynechialysis, cyclodestructive procedures, and glaucoma implant are effective surgical options for chronic angle closure glaucoma, but none of them have been shown to be more effective than the others with proper comparative clinical trials. Trabeculectomy and goniosynechialysis are often combined with cataract extraction, which appears to offer additional pressure-control benefits to patients with chronic angle closure glaucoma.
Topics: Algorithms; Glaucoma, Angle-Closure; Humans; Ophthalmologic Surgical Procedures
PubMed: 15513462
DOI: 10.1076/soph.17.2.92.14716 -
Eye (London, England) Jan 2006In contrast to the pattern of disease in Europeans, primary angle closure has a higher prevalence and tends to be asymptomatic in East Asians. The higher prevalence is... (Comparative Study)
Comparative Study Review
In contrast to the pattern of disease in Europeans, primary angle closure has a higher prevalence and tends to be asymptomatic in East Asians. The higher prevalence is attributed to differences in anterior chamber and angle anatomy. Several studies suggest that central anterior chamber depth is shallower in East Asians than in Europeans, although this is not universally accepted. It is debated whether pupil block is the predominant mechanism of angle closure in Asian people. Meaningful comparison between studies is currently hindered by differences in patient selection, examination technique, and case definition; however, the major scientific deficiency is the paucity of prospective followup data to give an insight into natural history of the disease. This review examines the data on prevalence, risk factors, and mechanism of angle closure. Special consideration is given to limitations of methodology in research to date, with the intention of developing more robust data in future studies.
Topics: Anterior Chamber; Asian People; Glaucoma, Angle-Closure; Gonioscopy; Humans; Iris; Iris Diseases; Laser Therapy; Prevalence; White People
PubMed: 15688051
DOI: 10.1038/sj.eye.6701797 -
The American Journal of Emergency... Apr 2022Acute angle closure glaucoma is a sight-threatening condition that may lead to blindness. This is a case report of a woman who presented to the emergency department (ED)...
Acute angle closure glaucoma is a sight-threatening condition that may lead to blindness. This is a case report of a woman who presented to the emergency department (ED) with acute angle closure glaucoma following use of an over-the-counter (OTC) homeopathic eye drop containing atropa belladonna (deadly nightshade). A 55-year-old woman presented to the ED with a 5-day history of left eye redness, swelling, tearing, and foreign-body sensation that had acutely worsened in the last two days. Her exam revealed mild left conjunctival injection with watery tearing and a hazy appearance of her left cornea. Fluorescein staining was negative, while tonometry revealed elevated intraocular pressure on the left, suggestive of acute angle closure glaucoma. She was urgently referred to ophthalmology. The etiology of the acute angle closure glaucoma was initially unclear however, with additional prompting, she revealed that two days prior she had started using homeopathic OTC eye drops. Inspection of the eyedrop's ingredients revealed that atropa belladonna was the primary ingredient and likely precipitated her isolated episode of acute angle closure glaucoma. A high level of clinical suspicion and focused ophthalmic exam including tonometry is essential to identify acute angle closure glaucoma in the ED. We present a case report of acute angle closure glaucoma associated with the use of homeopathic belladonna-containing eyedrops. Our report reinforces the necessity to perform thorough medication and supplement history given the prevalence of physiologically active substances available in OTC medications.
Topics: Atropa belladonna; Female; Glaucoma; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Middle Aged; Ophthalmic Solutions
PubMed: 34776281
DOI: 10.1016/j.ajem.2021.10.057 -
Progress in Retinal and Eye Research Jan 1999Chronic angle-closure glaucoma is the commonest form of glaucoma in Sino Mongaloid populations. It is an anatomical disorder of the anterior segment of the eye... (Review)
Review
Chronic angle-closure glaucoma is the commonest form of glaucoma in Sino Mongaloid populations. It is an anatomical disorder of the anterior segment of the eye characterised by permanent closure of part of the filtration angle as a result of iris apposition to the trabecular meshwork. Two pathways lead to this condition: recurrent pupillary block and "creeping" angle closure. East or Southeast Asian ethnic background is an important risk factor for the development of chronic angle-closure glaucoma. Other demographical risk factors include ageing, female gender and a familial tendency. Eyes with chronic angle-closure glaucoma have different anterior segment anatomical relationships when compared to normals. Those eyes at risk tend to be hypermetropic with a shallow anterior chamber, a relatively anteriorly positioned lens and a short axial length. The role of the ciliary body anatomy and ciliary processes in the pathogenesis of this condition requires further investigation.
Topics: Chronic Disease; Demography; Ethnicity; Eye Diseases; Glaucoma, Angle-Closure; Humans; Risk Factors
PubMed: 9920501
DOI: 10.1016/s1350-9462(98)00007-x -
Medicina (Kaunas, Lithuania) Dec 2022Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and... (Review)
Review
Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic balance between the angiogenic and antiangiogenic factors. High concentrations of vasogenic substances such as vascular endothelial growth factor (VEGF) induce neovascularization of the iris (NVI) and neovascularization of the angle (NVA) that limits the outflow of aqueous humor from the anterior chamber and increases the IOP. NVG clinical, if untreated, progresses from secondary open-angle glaucoma to angle-closure glaucoma, leading to irreversible blindness. It is an urgent ophthalmic condition; early diagnosis and treatment are necessary to preserve vision and prevent eye loss. The management of NVG requires the cooperation of retinal and glaucoma specialists. The treatment of NVG includes both control of the underlying disease and management of IOP. The main goal is the prevention of angle-closure glaucoma by combining panretinal photocoagulation (PRP) and antiangiogenic therapy. The aim of this review is to summarize the current available knowledge about the etiology, pathogenesis, and symptoms of NVG and determine the most effective treatment methods.
Topics: Humans; Glaucoma, Neovascular; Vascular Endothelial Growth Factor A; Glaucoma, Open-Angle; Glaucoma, Angle-Closure; Intraocular Pressure
PubMed: 36557072
DOI: 10.3390/medicina58121870 -
European Journal of Ophthalmology Jul 2023To report three cases that developed acute angle-closure glaucoma on the background of hyponatremia due to COVID 19 infection.
INTRODUCTION
To report three cases that developed acute angle-closure glaucoma on the background of hyponatremia due to COVID 19 infection.
METHODS
Data of patients with positive PCR result for COVID 19 infection and concurrent findings of acute angle-closure glaucoma were analysed retrospectively.
RESULTS
The common characteristic of all cases was positive PCR test for COVID 19 infection taken from the nasopharyngeal swab 4 or 5 days ago. Their serum sodium levels were lower than 135 mmol / L. At the initial ophthalmic examination, all cases had diffuse corneal edema with shallow anterior chambers and mid-dilated non-reacting pupils.The choroid was evaluated as normal by ocular ultrasonography. Intraocular pressures (IOP) of the first, second, and third cases were 35 mmHg, 44 mmHg, and 40 mm Hg, respectively. 5-10 cc/kg mannitol was given to all patients intravenously within 30 min. Simultaneously, they began to use oral acetazolamide, topical pilocarpine, beta-blocker, and prednisolone acetate drops.After stabilization of IOP, Neodymium-doped yttrium aluminum garnet;(ND: YAG) Laser iridotomy was performed on all patients. No additional fluid therapy was given to the patients other than mannitol, and it was determined that the blood sodium level remained at normal levels after diuresis.
DISCUSSION
Hyponatremia is the most common electrolyte disorder in COVID 19 infection. Hyponatremia may cause an angle-closure attack in patients with shallow anterior chamber angles.Therefore, one should be aware of the possibility of angle-closure glaucoma in patients who develop hyponatremia due to COVID 19 disease. Suspected patients should be referred to the ophthalmology department.
Topics: Humans; Glaucoma, Angle-Closure; Hyponatremia; Retrospective Studies; COVID-19; Iris; Intraocular Pressure; Laser Therapy; Acute Disease; Sodium
PubMed: 35815850
DOI: 10.1177/11206721221113201 -
BMC Ophthalmology Apr 2023X-linked retinoschisis (XLRS), due to mutations in the RS1 gene, is a common genetically determined form of macular degeneration. This report describes an unusual case...
BACKGROUND
X-linked retinoschisis (XLRS), due to mutations in the RS1 gene, is a common genetically determined form of macular degeneration. This report describes an unusual case of angle-closure glaucoma (ACG) with XLRS and discusses the treatment.
CASE PRESENTATION
A 39-year-old Chinese man with an X chromosome-recessive inherited c.489G > A variant in the RS1 gene was diagnosed as XLRS and ACG, presenting with cystic macular lesions, shallow anterior chamber depth (ACD), and angle-closure with uncontrolled intraocular pressure (IOP). Malignant glaucoma occurred following trabeculectomy combining phacoemulsification with intraocular lens (IOL) implantation and goniosynechialysis. Subsequent anterior vitrectomy and irido-zonulo-hyaloid-vitrectomy (IZHV) effectively lowered IOP and deepened ACD, but the cystic cavity became larger.
CONCLUSIONS
There is a potential risk of malignant glaucoma in ACG patients with XLRS after filtering surgery. Although anterior vitrectomy can effectively resolve aqueous misdirection, the macular retinoschisis may get worse. Awareness of this risk may aid in surgical planning and postoperative management in these patients.
Topics: Male; Humans; Adult; Glaucoma, Angle-Closure; Retinoschisis; Lens Implantation, Intraocular; Glaucoma; Cataract Extraction; Intraocular Pressure; Phacoemulsification
PubMed: 37069516
DOI: 10.1186/s12886-023-02903-7