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Clinical & Experimental Ophthalmology 2023
Topics: Humans; Glaucoma, Angle-Closure; Retinoblastoma; Treatment Outcome; Iris; Retinal Neoplasms; Intraocular Pressure; Phacoemulsification
PubMed: 37350374
DOI: 10.1111/ceo.14271 -
Journal of Glaucoma Jun 2003To report the occurrence of angle-closure glaucoma in 2 teenagers.
OBJECTIVE
To report the occurrence of angle-closure glaucoma in 2 teenagers.
DESIGN
Observational case reports, review of literature.
METHODS
Review of case histories, examinations, biometries, visual fields, and ultrasound biomicroscopy findings in 2 teenagers with angle-closure glaucoma.
MAIN OUTCOME MEASURES
Intraocular pressure, gonioscopy, Humphrey 24-2 visual field (SITA Standard), and ultrasound biomicroscopy.
RESULTS
The first case involved a 15-year-old white male who presented with an intraocular pressure of 60 mm Hg in the right eye and 24 mm Hg in the left eye and 360-degree appositional closure in both eyes. Ultrasound biomicroscopy revealed prominent bilateral ciliary pigment epithelial cysts pushing the iris anteriorly towards the angle. The second case involved a 14-year-old white male with a strong family history of primary angle-closure glaucoma. The patient had pupillary block and an intraocular pressure of 24 mm Hg in the right eye and 40 mm Hg in the left eye on routine eye examination. Gonioscopy and ultrasound biomicroscopy revealed appositional closure of the angle in all 4 quadrants bilaterally.
CONCLUSION
Primary angle-closure glaucoma is uncommon in younger individuals. Therefore, the finding of angle-closure glaucoma in a young individual should alert the physician to the possibility of a secondary cause of angle closure, such as iris pigment epithelial cysts. In addition, special attention to family history is important as the configuration of an occludable anterior chamber angle may, in some instances, be inherited.
Topics: Adolescent; Ciliary Body; Cysts; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Male; Pigment Epithelium of Eye; Ultrasonography; Uveal Diseases
PubMed: 12782835
DOI: 10.1097/00061198-200306000-00003 -
International Ophthalmology Clinics 2004
Review
Topics: Aqueous Humor; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Lens, Crystalline; Ophthalmologic Surgical Procedures
PubMed: 14704532
DOI: 10.1097/00004397-200404410-00019 -
Seminars in Ophthalmology Jun 2002Primary angle closure is a condition characterized by obstruction to aqueous humor outflow by the peripheral iris, and results in changes in the iridocorneal angle that... (Review)
Review
Primary angle closure is a condition characterized by obstruction to aqueous humor outflow by the peripheral iris, and results in changes in the iridocorneal angle that are visible through gonioscopic examination. Gonioscopy in these eyes, however, can be difficult. This chapter discusses techniques that might help in the examination. These include beginning the examination with the inferior angle, methods to help in looking over the iris, cycloplegia, locating the corneal wedge, indentation, van Herick estimation, examining the other eye, and topical glycerin. Finally, there is a discussion about the pathology associated with the closed angle, with emphasis on the appearance of iris bombé, plateau iris, and the distinction between iris processes and peripheral anterior synechiae.
Topics: Glaucoma, Angle-Closure; Gonioscopy; Humans
PubMed: 15513458
DOI: 10.1076/soph.17.2.59.14721 -
Journal of Glaucoma Mar 2022We used anterior segment optical coherence tomography to investigate anterior chamber angle in primary angle-closure glaucoma (PACG) eyes following phacoemulsification... (Randomized Controlled Trial)
Randomized Controlled Trial
PRCIS
We used anterior segment optical coherence tomography to investigate anterior chamber angle in primary angle-closure glaucoma (PACG) eyes following phacoemulsification and phacotrabeculectomy. Angle widening was significantly greater after phacoemulsification up to 6 months after the surgery.
PURPOSE
To compare anterior chamber angle following 2 common surgeries for PACG.
METHODS
One hundred ten glaucoma patients were evaluated in this single center, prospective, randomized clinical trial. Those with concomitant PACG and senile cataract and without a history of ocular surgery, trauma, or chronic miotic use were recruited. Monocular patients were also excluded. Finally, 52 eligible subjects were randomly assigned to phacoemulsification ("Phaco" group, 25 eyes) or phacotrabeculectomy ("Combined" group, 27 eyes) surgeries. A swept-source, anterior segment optical coherence tomography device (CASIA SS-1000 OCT) was used to image the anterior segment. Mask graders used the images to measure the following parameters before and 1 week, 1 month, and 6 months after surgery: angle opening distance at 500 µm, trabecular iris surface area at 500 µm, and trabecular iris angle at 500 µm.
RESULTS
There was no significant difference between study groups regarding best-corrected visual acuity, intraocular pressure (IOP), and the number of glaucoma medications in preoperative or postoperative visits (P>0.076). Also, the measured angle parameters were not statistically significantly different between the 2 groups before surgery (P>0.123). After surgery, all measured parameters were significantly increased in both groups (P<0.0001). At the 6-month follow-up, nasal angle opening distance at 500 µm was 0.383±0.027 vs. 0.349±0.017, trabecular iris surface area at 500 µm was 0.141±0.007 vs. 0.125±0.005, and trabecular iris angle at 500 µm was 40.1±12.9 vs. 34.6±3.1 in Phaco and Combined groups, respectively (P<0.0001 for all).
CONCLUSIONS
Anterior chamber angle widening by anterior segment optical coherence tomography was observed in PACG patients following surgery and was significantly greater after phacoemulsification compared with combined phacotrabeculectomy at all time points. Similar IOP and medication burden were noted for up to 6 months as secondary outcomes. The contribution of angle changes to the IOP-lowering effect of phacoemulsification in PACG eyes needs further study.
Topics: Anterior Chamber; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Phacoemulsification; Prospective Studies
PubMed: 35210384
DOI: 10.1097/IJG.0000000000001977 -
Indian Journal of Ophthalmology Jul 2023This article describes 1-year outcomes of a new intra-ocular implant, "Glauco-Claw," in refractory chronic angle-closure glaucoma (ACG). Glauco-Claw is a novice...
This article describes 1-year outcomes of a new intra-ocular implant, "Glauco-Claw," in refractory chronic angle-closure glaucoma (ACG). Glauco-Claw is a novice polymethylmethacrylate implant with a central ring and five claws placed circumferentially. It was placed in the anterior chamber and the peripheral iris was tucked into the claws, thus causing goniosynechialysis and preventing the reformation of goniosynechiae. It was implanted in five eyes of five patients, and they were followed up for 1 year. Target intra-ocular pressure was achieved and maintained in all the patients till the last follow-up. Two patients did not require any anti-glaucoma medication. No significant complications were observed in any patient. Glauco-Claw could be another armamentarium in the management of refractory chronic ACG.
Topics: Humans; Glaucoma, Angle-Closure; Iris; Glaucoma; Intraocular Pressure; Iris Diseases
PubMed: 37417139
DOI: 10.4103/IJO.IJO_2678_22 -
Eye (London, England) Nov 2022To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary open-angle glaucoma (POAG) in those population-based studies that... (Meta-Analysis)
Meta-Analysis
AIM
To estimate the risk of blindness with primary angle-closure glaucoma (PACG) compared to primary open-angle glaucoma (POAG) in those population-based studies that reported blindness rates for both PACG and POAG.
METHOD
A systematic search was performed in PubMed for articles published in English between 2000 and 2020 reporting the prevalence of POAG as well as PACG among various ethnic populations. A study was included if it was (1) population-based (2) had published prevalence and blindness rates for both PACG and POAG in the same cohort. (3) Glaucoma was defined as per the International Society for Geographical and Epidemiological Ophthalmology (ISGEO) criteria. The proportion of blindness for both POAG and PACG for each study and the cumulative proportion taking all the studies were calculated.
RESULTS
We included 23 studies with 78,434 participants. POAG was diagnosed in 1702 persons with 151 (8.9%) blind. There were 724 cases of PACG with 196 (27.0%) blind. The risk ratio of blindness in PACG to POAG varied from 0.73 to 10.6 among the studies. The cumulative risk ratio was 2.39 (95% confidence interval (CI); 1.99, 2.87). Risk ratios for studies including visual field restriction while defining blindness were similar to studies that did not (1.92 vs 2.64, P = 0.11). Risk ratios were also similar for studies that used greater than 2 instead of 3 or more quadrants of iridotrabecular contact to define angle closure (2.79 vs 2.25).
CONCLUSION
Primary angle-closure disease is more likely to be associated with blindness.
Topics: Humans; Blindness; Glaucoma; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Intraocular Pressure; Visual Field Tests
PubMed: 34645961
DOI: 10.1038/s41433-021-01802-9 -
Canadian Journal of Ophthalmology.... Dec 2014This is a case-based approach to the diagnosis and management of angle closure glaucoma of a variety of causative factors, with a special emphasis on the use of advanced... (Review)
Review
This is a case-based approach to the diagnosis and management of angle closure glaucoma of a variety of causative factors, with a special emphasis on the use of advanced anterior segment imaging including ultrasound biomicroscopy and anterior segment optical coherence tomography. Although all angle closure is caused by iridotrabecular contact, the cause of angle closure glaucoma is classified based on the site of primary blockage of aqueous movement from anterior to posterior: pupillary block, plateau iris, lens-related, and posterior causative factors. Although gonioscopy is traditionally used to visualize the angle structures and estimate the angle width, objective and reproducible measurement of the anterior chamber angle can best be obtained with advanced anterior segment imaging. In this review article, we demonstrate the utility of anterior advanced imaging to identify underlying mechanisms in cases of angle closure glaucoma in guiding directed management.
Topics: Aged; Anterior Eye Segment; Antihypertensive Agents; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Iridectomy; Microscopy, Acoustic; Risk Factors; Tomography, Optical Coherence
PubMed: 25433740
DOI: 10.1016/j.jcjo.2014.10.004 -
British Medical Bulletin 2010A large number of drug classes have now been reported to provoke angle closure in high-risk individuals. The mechanism of action can be generalized into three main... (Review)
Review
INTRODUCTION OR BACKGROUND
A large number of drug classes have now been reported to provoke angle closure in high-risk individuals. The mechanism of action can be generalized into three main categories: sympathomimetic, parasympatholytic and idiosyndratic reactions.
SOURCES OF DATA
This review of the ophthalmic literature provides a clinical summary of primary angle-closure glaucoma (PACG) and its management.
AREAS OF AGREEMENT
External stimuli (pharmacological and environmental) may induce acute, and more often, asymptomatic angle closure, which carries a significant risk of glaucoma.
GROWING POINTS
Whenever in doubt, patients at risk of PACG who are starting on drug therapy known to provoke angle closure or aggravate the condition should be referred for detailed gonioscopic examination of the anterior chamber by an ophthalmologist. AREAS FOR DEVELOPING RESEARCH: The use of new imaging methods such as anterior segment optical coherence tomography to assess the presence or risk of angle closure is gaining popularity, and may offer a more rapid method of identifying people who are at risk of sight loss from angle-closure glaucoma precipitated by non-ophthalmological medication.
Topics: Glaucoma, Angle-Closure; Humans; Risk Factors; Tomography, Optical Coherence; Visual Fields
PubMed: 19933218
DOI: 10.1093/bmb/ldp042 -
Indian Journal of Ophthalmology Jan 2018Angle-closure glaucoma is characterized by appositional or synechial closure of the anterior chamber angle with glaucomatous field defects that may or may not be...
Angle-closure glaucoma is characterized by appositional or synechial closure of the anterior chamber angle with glaucomatous field defects that may or may not be associated with a pupillary block. Surgical pupilloplasty with single-pass four-throw technique helps to alleviate the appositional closure along with the breakage of peripheral anterior synechia, thereby increasing the aqueous outflow and decreasing intraocular pressure.
Topics: Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Iris; Laser Therapy; Male; Middle Aged; Ophthalmologic Surgical Procedures; Pupil; Plastic Surgery Procedures
PubMed: 29283136
DOI: 10.4103/ijo.IJO_559_17