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Romanian Journal of Ophthalmology 2024Several ocular adverse effects have been attributed to Topiramate, a sulfonamide derivative. It can cause problems in the eye such as choroidal effusion syndrome, acute...
UNLABELLED
Several ocular adverse effects have been attributed to Topiramate, a sulfonamide derivative. It can cause problems in the eye such as choroidal effusion syndrome, acute angle closure glaucoma, myopic shift, visual field defects, and Myokymia. If not identified early, it can be vision-threatening. It is commonly used for migraine prophylaxis, partial onset, and generalized tonic-clonic seizures. It has also been prescribed for bipolar disorder and alcoholism. The risk of adverse reactions with this drug is 3%. The prognosis is favorable if it is discontinued early and prompt therapy is initiated.
OBJECTIVE
This article reported a case series of topiramate-induced ocular complications.
MATERIALS AND METHODS
The patients presented with high intraocular pressure and blurred vision following a topiramate prescription for headache.
CONCLUSION
Timely recognition and intervention can prevent potential visual loss in such cases.
Topics: Humans; Topiramate; Glaucoma, Angle-Closure; Myopia
PubMed: 38617722
DOI: 10.22336/rjo.2024.14 -
European Journal of Ophthalmology Apr 2024To compare the levels of endocannabinoids (EC) in plasma, aqueous humor and tears, cortisol in plasma and aqueous, in primary angle closure glaucoma (PACG) and controls,...
PURPOSE
To compare the levels of endocannabinoids (EC) in plasma, aqueous humor and tears, cortisol in plasma and aqueous, in primary angle closure glaucoma (PACG) and controls, while comparing the quality of life in both groups.
METHODS
A total of 60 patients, ≥40years of age, with a diagnosis of PACG or cataract, 30 in each group were recruited. They were subjected to a detailed ophthalmic evaluation, a WHO Quality of Life Brief Version (WHOQOL-BREF) questionnaire answering and collection of tear, aqueous and blood samples. The levels of endocannabinoids-anandamide (AEA), 2-arachidonoylglycerol (2AG) in plasma, aqueous humor and tears; cortisol in plasma and aqueous humor; and WHO-QOL score in each group were noted.
RESULTS
Plasma AEA ( = 0.01) and plasma 2-AG, ( = 0.002) levels were significantly higher in the control group as compared to the PACG group. WHO-QOL score was better in controls ( < 0.001). The EC were in undetectable levels in aqueous. Plasma and aqueous cortisol were significantly higher in PACG and both had the highest Area under the receiver operating characteristics (AUROC) curve value for differentiating PACG from controls. Tear 2AG and tear AEA had a moderately strong positive correlation with plasma 2-AG. Females had insignificantly higher levels of plasma and tear endocannabinoids.
CONCLUSIONS
Tear endocannabinoids were determined for the first time in PACG and normal with no difference between the two groups. Plasma and aqueous cortisol levels are a differentiating factor between normal and glaucoma patients with plasma endocannabinoids being remarkably higher in normals. Quality of life in glaucoma patients with high cortisol levels is poorer.
PubMed: 38613316
DOI: 10.1177/11206721241247419 -
European Journal of Ophthalmology Apr 2024There have been a number of clinical trials in glaucoma research published in the past two decades. Most of these trials were designed to evaluate very specific issues...
AIM
There have been a number of clinical trials in glaucoma research published in the past two decades. Most of these trials were designed to evaluate very specific issues in selected populations placing them in the explanatory end of the pragmatic-explanatory continuum. The purpose of this study was to assess the level of pragmatism of published randomized controlled trials in glaucoma.
METHODS
A PubMed search using 'glaucoma' from 1995 to 2022 and randomized controlled trial (RCT) article type was done. Each study was assessed by three independent examiners using the Pragmatic-Explanatory Continuum Indicator Summary version 2 (PRECIS-2) toolkit. Scores were calculated for each study to determine the level of pragmatism. A summed score ≥36 was indicative of a very pragmatic study.
RESULTS
Thirty-two different articles were included in the analysis. These papers represented 13 different landmark trials. The median PRECIS-2 score was 32 (range, 25 for the Early Manifest Glaucoma Trial (EMGT) to 34 to the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Ocular Hypertension Treatment Study). The Treatment of Advanced Glaucoma Study (TAGS), was considered very pragmatic and scored 33 points.
CONCLUSION
Despite the number of RCTs in glaucoma, there is still a need for more pragmatic studies.
PubMed: 38602016
DOI: 10.1177/11206721241247428 -
Clinical Case Reports Apr 2024
PubMed: 38601169
DOI: 10.1002/ccr3.8755 -
Case Reports in Ophthalmology 2024Pupillary block, a concerning complication of cataract surgery, is heightened when a single-piece acrylic (SPA) intraocular lens (IOL) is implanted in the ciliary...
INTRODUCTION
Pupillary block, a concerning complication of cataract surgery, is heightened when a single-piece acrylic (SPA) intraocular lens (IOL) is implanted in the ciliary sulcus. We report an unusual occurrence of relative pupillary block and chronic angle-closure glaucoma (ACG) identified in the late postoperative period due to unintentional SPA IOL implantation in the sulcus.
CASE PRESENTATION
An 82-year-old woman presented with a history of chronic ACG 5 years after bilateral cataract extraction. Postoperatively, she experienced anterior chamber shallowing, elevated intraocular pressure (IOP), and two acute angle-closure attacks in the left eye, successfully managed with laser peripheral iridotomies (LPIs). Despite neodymium:YAG capsulotomy, elevated IOP persisted. Maximal medical therapy effectively controlled IOP; however, a shallow anterior chamber remained, prompting referral to our glaucoma service. Slit-lamp examination revealed a shallow peripheral anterior chamber, patent LPIs, and an Alcon SA60WF SPA IOL situated posteriorly with the optic against the pupil margin OS. Gonioscopy indicated a closed angle with peripheral anterior synechiae (PAS). Ultrasound biomicroscopy (UBM) confirmed haptics in the sulcus, with the lens optic and haptics anterior to the bag. These findings suggest relative pupillary block as the cause of her chronic ACG. The SPA IOL's bulky haptics in the sulcus likely induced iris bowing, leading to prolonged appositional angle-closure and chronic PAS formation.
CONCLUSION
IOLs designed for the capsular bag should not be placed in the sulcus. Therefore, IOLs of varying dimensions should be taken to the operating room in the event of complicated cataract extraction. Finally, UBM proves valuable in identifying causes of pupillary block.
PubMed: 38600916
DOI: 10.1159/000538343 -
Clinical Ophthalmology (Auckland, N.Z.) 2024Primary Angle Closure Glaucoma (PACG), is caused by narrowing the iridocorneal angle and increases the risk of blockage in the trabecular meshwork. Phacoemulsification... (Review)
Review
BACKGROUND
Primary Angle Closure Glaucoma (PACG), is caused by narrowing the iridocorneal angle and increases the risk of blockage in the trabecular meshwork. Phacoemulsification and laser peripheral iridotomy (LPI) effectively control IOP elevation and widen the angle. This systematic review and meta-analysis compared Phacoemulsification and LPI Effectiveness for PACG.
METHODS
We searched Medline, Embase, and CENTRAL. We included randomized controlled trials (RCTs) that compared Phacoemulsification and LPI for individuals with PACG. We sought to evaluate the following outcomes: mean IOP, number of glaucoma medications, visual acuity (VA), visual field (VF) progression, peripheral anterior synechiae (PAS), Shaffer gonioscopy grading, central corneal thickness (CCT), central endothelial cell density (CECD), and poor response to surgery. The standardized mean difference (SMD) was used to represent continuous outcomes, while the risk ratio (RR) was used to represent dichotomous outcomes.
RESULTS
5 RCTs that enrolled 917 participants were deemed eligible. The phacoemulsification group showed statistically significance lower mean CCT and CECD and lower risk of poor response to surgery compared to LPI (SMD = -1.10; 95% -1.50, -0.70; P<0.001, SMD -366.12; 95% -652.59, -79.65; P=0.01, and RR 0.35; 95% 0.23, 0.54; P<0.001 respectively). There were no significant improvement in IOP and number of medications between both groups (SMD = -0.74; 95% CI = -2.26, 0.78; P=0.34, and SMD -17.58; 95% CI = -50.28, 15.12; P=0.29 respectively). Finally, there were also no significant differences in VA, VF progression, PAS, and mean Shaffer gonioscopy grading between both groups.
CONCLUSION
Phacoemulsification showed statistically significant lower mean corneal thickness, central endothelial cell density, and lower risk of poor response to surgery compared to LPI. However, there were no significant differences in mean IOP, number of medications, VA, VF progression, PAS, and mean Shaffer gonioscopy grading between Phacoemulsification and LPI.
PubMed: 38596663
DOI: 10.2147/OPTH.S446285 -
The British Journal of Ophthalmology Apr 2024To compare the diagnostic performance of 360° anterior segment optical coherence tomography assessment by applying normative percentile cut-offs versus iris trabecular...
AIMS
To compare the diagnostic performance of 360° anterior segment optical coherence tomography assessment by applying normative percentile cut-offs versus iris trabecular contact (ITC) for detecting gonioscopic angle closure.
METHODS
In this multicentre study, 394 healthy individuals were included in the normative dataset to derive the age-specific and angle location-specific normative percentiles of angle open distance (AOD500) and trabecular iris space area (TISA500) which were measured every 10° for 360°. 119 healthy participants and 170 patients with angle closure by gonioscopy were included in the test dataset to investigate the diagnostic performance of three sets of criteria for detection of gonioscopic angle closure: (1) the 10th and (2) the 5th percentiles of AOD500/TISA500, and (3) ITC (ie, AOD500/TISA500=0 mm/mm). The number of angle locations with angle closure defined by each set of the criteria for each eye was used to generate the receiver operating characteristic (ROC) curve for the discrimination between gonioscopic angle closure and open angle.
RESULTS
Of the three sets of diagnostic criteria examined, the area under the ROC curve was greatest for the 10th percentile of AOD500 (0.933), whereas the ITC criterion AOD500=0 mm showed the smallest area under the ROC (0.852) and the difference was statistically significant with or without adjusting for age and axial length (p<0.001). The criterion ≥90° of AOD500 below the 10th percentile attained the best sensitivity 87.6% and specificity 84.9% combination for detecting gonioscopic angle closure.
CONCLUSIONS
Applying the normative percentiles of angle measurements yielded a higher diagnostic performance than ITC for detecting angle closure on gonioscopy.
PubMed: 38594062
DOI: 10.1136/bjo-2023-323860 -
Journal of Clinical Medicine Feb 2024To investigate the relationship between glaucoma, pseudoexfoliation and hearing loss (HL). : A systematic literature search following PRISMA guidelines was conducted... (Review)
Review
To investigate the relationship between glaucoma, pseudoexfoliation and hearing loss (HL). : A systematic literature search following PRISMA guidelines was conducted using the PubMed, Embase, Scopus and Cochrane databases from 1995 up to 28 August 2023. : Thirty studies out of the 520 records screened met the inclusion criteria and were included. Most articles (n = 20) analysed the association between pseudoexfoliation syndrome (XFS) and HL, showing XFS patients to have higher prevalence of sensorineural hearing loss (SNHL) at both speech frequencies (0.25, 0.5, 1 and 2 kHz), and higher frequencies (4 and 8 kHz) compared to controls in most cases. No significant differences in prevalence or level of HL between XFS and pseudoexfoliative glaucoma (XFG) were detected in most studies. Eight articles analysed the relationship between primary open-angle glaucoma (POAG) and HL. Overall, a positive association between the two conditions was highlighted across all studies except for two cases. Similarly, articles focusing on NTG and HL (n = 4) showed a positive association in most cases. The role of autoimmunity and, in particular, the presence of antiphosphatidylserine antibodies (APSA) in patients with NTG and HL suggested an underlying autoimmune or vascular mechanism contributing to their pathogenesis. Only one study analysed the relationship between angle-closure glaucoma (ACG) and HL, showing higher incidence of ACG in patients with SNHL compared to normal hearing controls. : Most studies detected an association between XFS and HL as well as POAG/NTG/ACG and HL, suggesting the presence of a similar pathophysiology of neurodegeneration. However, given the strength of the association of XFS with HL, it remains unclear whether the presence of XFG is further associated with SNHL. Further research specifically targeted to assess the correlation between glaucoma, XFS and HL is warranted to provide a more comprehensive understanding of this association.
PubMed: 38592217
DOI: 10.3390/jcm13051379 -
Cureus Mar 2024Acute angle closure glaucoma (AACG) is characterized by narrowing or closure of the anterior chamber angle of the eye. AACG typically presents in older, hyperopic...
Acute angle closure glaucoma (AACG) is characterized by narrowing or closure of the anterior chamber angle of the eye. AACG typically presents in older, hyperopic patients who complain of blurred vision, ocular pain, halos around lights, headache, nausea, and vomiting. Optic disc swelling is known to be associated with intracranial hypertension, optic neuritis, anterior ischemic optic neuropathy, retinal vascular occlusion, and toxic optic neuropathy. There have been few reports of temporal relationships between laser iridotomy and optic disc swelling in patients with AACG. In this case report, we present a case of AACG where optic disc swelling was developed after sudden lowering of the intraocular pressure (IOP) by laser iridotomy. A 65-year-old woman presented with left eye pain and poor vision for one day. Slit-lamp examination revealed conjunctival injection, corneal edema, and a nonreactive and mid-dilated pupil in the left eye. Her best corrected visual acuity (BCVA) was 20/20 in the right eye and counting fingers in the left eye. IOP was 10 mmHg in the right eye and 54 mmHg in the left eye. A diagnosis of left AACG was made. A peripheral laser iridotomy was performed. The details of the optic disc were difficult to observe due to corneal edema, but there were no obvious abnormalities. The next day, the BCVA was 20/60 and the IOP had decreased to 9 mmHg in the left eye. Fundus examination demonstrated optic disc swelling in the left eye. Spectral-domain optical coherence tomography (SD-OCT) scanning revealed optic disc swelling in the left eye. One week after treatment, the BCVA was 20/50 and the IOP was 10 mmHg in the left eye. Fundus examination and SD-OCT scanning revealed mild improvement of optic disc swelling in the left eye. Four weeks after treatment, the BCVA was 20/50 and the IOP was 10 mmHg in the left eye. Fundus examination and SD-OCT scanning revealed an improvement in optic disc swelling in the left eye. After performing laser iridotomy, it is necessary to pay attention to changes in the optic disc as well as the IOP.
PubMed: 38586752
DOI: 10.7759/cureus.55765 -
Cureus Mar 2024Previous studies have reported that patients with retinitis pigmentosa (RP) may develop open-angle and angle-closure glaucoma. We conducted a chart review of patients...
Previous studies have reported that patients with retinitis pigmentosa (RP) may develop open-angle and angle-closure glaucoma. We conducted a chart review of patients with RP. Two siblings with RP associated with a mutation in the gene (c. 1540del, p.Leu514Trpfs*61) developed cystoid macular edema (CME) as part of the disease. For this reason, they both underwent intravitreal steroid injections. Both brothers developed steroid-induced glaucoma (SIG). Despite undergoing maximal medical therapy, they underwent seton implants to control their intraocular pressure. A third female patient with RP due to a mutation in the gene underwent cataract surgery. Topical steroids were prescribed and developed SIG. Increased intraocular pressure remains a complication of topical, injected, and systemic steroids. However, steroids may be needed to treat post-operatively and patients with CME. This case series unveils a complex association between RP and key comorbidities in these patients, with a focus on cataracts, glaucoma, and macular edema. Cataract surgery in patients with RP shows a link to the emergence of glaucoma, particularly in those with and gene mutations, revealing a novel association with mutations not previously documented. Furthermore, the paper explores a unique parallel with Schwartz-Matsuo syndrome, suggesting that patients with RP undergoing cataract surgery may develop increased intraocular pressure due to an outflow disturbance akin to Schwartz syndrome. This novel perspective deepens our understanding of the pathophysiological mechanisms governing intraocular pressure dynamics in patients with RP. To our knowledge, this is the first report of steroid-induced glaucoma in patients with RP due to mutations in the gene Intraocular pressure evaluation remains of utmost importance in the follow-up of patients with the disease.
PubMed: 38586746
DOI: 10.7759/cureus.55632