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Ophthalmology Mar 2022To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC). (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC).
DESIGN
Prospective, observational study.
PARTICIPANTS
Six hundred forty-three mainland Chinese with untreated PACS.
METHODS
Participants underwent baseline clinical examinations, including gonioscopy, anterior segment OCT (AS-OCT) imaging, and A-scan ultrasound biometry as part of the Zhongshan Angle Closure Prevention (ZAP) Trial. Primary angle closure suspect was defined as an inability to visualize pigmented trabecular meshwork in 2 or more quadrants based on static gonioscopy. Primary angle closure was defined as development of intraocular pressure above 24 mmHg or peripheral anterior synechiae. Progression was defined as development of PAC or an AAC attack. Multivariable logistic regression models were developed to assess biometric risk factors for progression.
MAIN OUTCOME MEASURES
Six-year progression from PACS to PAC or AAC.
RESULTS
Six hundred forty-three untreated eyes (609 nonprogressors, 34 progressors) of 643 participants were analyzed. In a multivariable model with continuous parameters, narrower horizontal angle opening distance of 500 μm from the scleral spur (AOD; odds ratio [OR], 1.10 per 0.01-mm decrease; P = 0.03), flatter horizontal iris curvature (IC; OR, 1.96 per 0.1-mm decrease; P = 0.01), and older age (OR, 1.11 per 1-year increase; P = 0.01) at baseline were associated significantly with progression (area under the receiver operating characteristic curve [AUC], 0.73). Smaller cumulative gonioscopy score was not associated with progression (OR, 1.03 per 1-modified Shaffer grade decrease; P = 0.85) when replacing horizontal AOD in the multivariable model. In a separate multivariable model with categorical parameters, participants in the lowest quartile of horizontal AOD (OR, 3.10; P = 0.002) and IC (OR, 2.48; P = 0.014) measurements and 59 years of age or older (OR, 2.68; P = 0.01) at baseline showed higher odds of progression (AUC, 0.72).
CONCLUSIONS
Ocular biometric measurements can help to risk-stratify patients with early angle closure for more severe disease. Anterior segment OCT measurements of biometric parameters describing the angle and iris are predictive of progression from PACS to PAC or AAC, whereas gonioscopy grades are not.
Topics: Aged; Anterior Eye Segment; Asian People; Biometry; China; Disease Progression; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Male; Middle Aged; Prospective Studies; Risk Factors; Tomography, Optical Coherence; Tonometry, Ocular; Ultrasonography
PubMed: 34634364
DOI: 10.1016/j.ophtha.2021.10.003 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Apr 2014To compare the ocular parameters of acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG). (Comparative Study)
Comparative Study
OBJECTIVE
To compare the ocular parameters of acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG).
METHODS
Totally 106 patients with primary angle closure glaucoma were recruited: 58 patients with AACG and 48 with CACG. All patients were divided into 3 groups: AACG attack eyes group, AACG uninvolved fellow eyes group and CACG group and underwent the same ophthalmic examinations, comprising optometry, keratometry, and A-scan ultrasonography. The lens/axial length factor (LAF) and relative lens position (RLP) were calculated.
RESULTS
The AACG attack eyes had a significant shallow anterior chamber depth, thick lens, short axial length and larger LAF. There tended to be a reduction in the percentage of LAF>0.20 in AACG attack eyes, CACG eyes and AACG uninvolved fellow eyes, though there were no statistically significant difference in all groups (P>0.05).
CONCLUSION
The eyes with AACG attack have a more crowded anterior chamber structure compared with uninvolved fellow eyes and eyes with CACG.
Topics: Acute Disease; Anterior Chamber; Biometry; Chronic Disease; Glaucoma, Angle-Closure; Humans; Lens, Crystalline
PubMed: 24820267
DOI: 10.3969/j.issn.1672-7347.2014.04.002 -
Acta Ophthalmologica Nov 2020To compare the morphological characteristics of the nailfold capillaries in glaucoma patients with those in healthy subjects. To evaluate the relationship of nailfold...
PURPOSE
To compare the morphological characteristics of the nailfold capillaries in glaucoma patients with those in healthy subjects. To evaluate the relationship of nailfold capillary morphology with retinal thickness and retinal vessel density in patients with primary open-angle (POAG) and primary angle-closure glaucoma (PACG).
METHODS
Fifty-one patients with normal-tension glaucoma, thirty-two patients with hypertension glaucoma, thirty-two PACG patients and sixty-one healthy subjects were included in this cross-sectional study. Patients with connective tissue diseases or taking anticoagulation or antiplatelet agents were excluded. Nailfold capillaroscopy, spectral-domain optical coherence tomography and optical coherence tomography angiography were used to evaluate the nailfold capillary morphology, retinal thickness and retinal vessel density, respectively.
RESULTS
Nailfold capillary morphological features, including lower capillary density, greater tortuosity, more dilated capillaries >50 μm and more avascular zones >100 μm, were more common in POAG and PACG patients than in control subjects (all p < 0.001). In the POAG group, nailfold vessel density was negatively correlated with ganglion cell complex (GCC) thickness (odds ratio [OR] = 0.908, p = 0.010) and radial peripapillary capillary (RPC) density (OR = 0.787, p = 0.025). Tortuosity degree was negatively associated with RPC density (OR = 0.804, p = 0.016). In the PACG group, no evident relationship between nailfold capillary morphology and retinal thickness or retinal vessel density was detected (all p > 0.05).
CONCLUSIONS
Nailfold capillary bed abnormalities were observed in both POAG and PACG patients. The nailfold capillary features, especially microvascular density and tortuosity degree, had a significant association with GCC thickness and RPC density in subjects with POAG but not in those with PACG.
Topics: Aged; Capillaries; Cross-Sectional Studies; Female; Follow-Up Studies; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Male; Microvascular Density; Middle Aged; Nerve Fibers; Optic Disk; Retrospective Studies; Tomography, Optical Coherence; Visual Fields
PubMed: 32243735
DOI: 10.1111/aos.14416 -
Medicine Jun 2017Drug-induced bilateral angle-closure glaucoma is a rare event and should be treated correctly and promptly to prevent visual loss.
RATIONALE
Drug-induced bilateral angle-closure glaucoma is a rare event and should be treated correctly and promptly to prevent visual loss.
PATIENT CONCERNS
We report a rare case of sumatriptan-induced bilateral angle-closure glaucoma in a young woman with migraine, and explore the possible mechanism.
DIAGNOSES
We describe the clinical outcome of a patient with sumatriptan-induced bilateral angle-closure glaucoma. The patient presented with bilateral acute elevation of intraocular pressure (IOP) and myopic shift.
INTERVENTIONS
The clinical symptoms and signs resolved rapidly after treatment with a topical cycloplegic agent, topical steroid, and aqueous suppressant.
OUTCOMES
Based on the suspicious of malignant glaucoma, we prescribed topical phenylephrine, whose application immediately lowered the IOP. All symptoms resolved after treatment with a long-acting cycloplegic agent, topical steroid, and aqueous suppressant for 3 days.
LESSONS
We presume that the mechanism underlying sumatriptan-induced bilateral angle-closure glaucoma may be correlated to the malignant glaucoma. Timely diagnosis and appropriate treatment are essential for resolving this ophthalmic emergency.
Topics: Adult; Diagnosis, Differential; Female; Glaucoma, Angle-Closure; Humans; Migraine Disorders; Sumatriptan; Vasoconstrictor Agents
PubMed: 28562545
DOI: 10.1097/MD.0000000000006953 -
The British Journal of Ophthalmology Jul 2007Focused research is needed to reduce the prevalence of glaucoma in Asia
Focused research is needed to reduce the prevalence of glaucoma in Asia
Topics: Asia; Disease Progression; Glaucoma, Angle-Closure; Humans; Iris; Prevalence
PubMed: 17576702
DOI: 10.1136/bjo.2006.111435 -
The Cochrane Database of Systematic... Jul 2008Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with... (Review)
Review
BACKGROUND
Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.
OBJECTIVES
To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles, PAC and PACG.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library), MEDLINE, EMBASE and LILACS (Latin American and Caribbean Literature on Health Sciences). The databases were last searched on 11 February 2008.
SELECTION CRITERIA
Only randomised controlled trials (RCTs) were eligible for inclusion in this review. Patients with narrow angles, PAC or PACG were eligible. Studies that included only patients with acute presentations, using laser peripheral iridoplasty to break acute crisis were excluded.
DATA COLLECTION AND ANALYSIS
No analysis was carried out due to lack of trials.
MAIN RESULTS
There were no RCTs assessing laser peripheral iridoplasty in the non-acute setting of angle-closure.
AUTHORS' CONCLUSIONS
There is currently no strong evidence for laser peripheral iridoplasty's use in treating angle-closure.
Topics: Glaucoma, Angle-Closure; Humans; Iris; Laser Therapy
PubMed: 18646165
DOI: 10.1002/14651858.CD006746.pub2 -
PloS One 2022Retinitis pigmentosa (RP) is the most frequent retinal hereditary dystrophy and result in blindness if progresses. Several case reports have revealed the possible...
BACKGROUND
Retinitis pigmentosa (RP) is the most frequent retinal hereditary dystrophy and result in blindness if progresses. Several case reports have revealed the possible association between RP and primary angle-closure glaucoma (PACG). We conducted a population-based study to explore whether RP significantly increased the risk of PACG development.
METHODS
Using the Taiwan National Health Insurance Research Database, we enrolled patients with RP into the RP group from 2001 to 2013 and included a comparison group of 1:4 age- and sex-matched individuals without RP. We performed a Cox regression analysis to estimate the crude and adjusted hazard ratios (HRs) of RP for PACG after adjustment for hypertension, diabetes, hyperlipidaemia, chronic kidney disease, and lens subluxation.
RESULTS
We enrolled 6223 subjects with RP and 24892 subjects for comparison. The mean age of the cohort was 49.0 ± 18.1 years. The RP group had significantly higher percentages of diabetes mellitus, hypertension, and hyperlipidaemia. The cumulative incidence of PACG in patients with RP was 1.61%, which was significantly higher than that in the comparison group (0.81%, p < 0.0001). According to the univariate Cox regression analysis, the hazard of PACG development was significantly greater in the RP group, with an unadjusted HR of 2.09 (95% confidence interval [CI], 1.64-2.65). The increased risk persisted after adjusting for confounders (adjusted HR = 2.18; 95% CI, 1.76-2.72).
CONCLUSION
This nationwide population-based cohort study showed that people with RP are at a significantly greater risk of developing PACG than individuals without RP.
Topics: Adult; Aged; Cohort Studies; Diabetes Mellitus; Glaucoma, Angle-Closure; Humans; Hyperlipidemias; Hypertension; Middle Aged; Retinitis Pigmentosa
PubMed: 36083972
DOI: 10.1371/journal.pone.0274066 -
Distribution and characteristics of peripheral anterior synechiae in primary angle-closure glaucoma.Korean Journal of Ophthalmology : KJO Jun 2006To evaluate the characteristics of peripheral anterior synechiae (PAS) in primary angle-closure glaucoma (PACG). (Comparative Study)
Comparative Study
PURPOSE
To evaluate the characteristics of peripheral anterior synechiae (PAS) in primary angle-closure glaucoma (PACG).
METHODS
We reviewed the charts of 155 patients (244 eyes) with PACG. We divided these patients into one of four clinical subtypes: acute angle-closure glaucoma (ACG), chronic ACG, angle-closure hypertension, and ACG suspect. The prevalence, extent, and location of PAS were evaluated according to PACG subtypes. Correlation analysis was used to evaluate relationships between the highest IOP level without treatment and the extent of PAS.
RESULT
The average degree of angle-closure with PAS was 14.6 +/- 9.1 in eyes that were classified as ACG suspect, 83.8 +/- 48.3 in angle-closure hypertension, 140.5 +/- 31.3 in acute ACG, and 180.3 +/- 31.9 in chronic ACG (ANOVA test, P < 0.05). PAS was most frequently found in the superior part of the eye, especially from 12 to 1 o' clock. The incidence of broad PAS (PAS over 30 degrees in width) was highest in superior part, but the medium and narrow PAS (PAS limited to within 30 degrees in width) was distributed throughout all 12 sectors relatively equally. Prior to a laser iridotomy (LI) and other medical treatments, a positive correlation was found between the highest IOP (intraocular pressure) levels and the extent of PAS in chronic ACG (r = 0.423, P < 0.0001). However, statistically significant relationships were not found between the highest IOP levels before treatment and the extent of PAS in any of the other clinical subtypes.
CONCLUSIONS
Our results suggest that acute and chronic ACG patients are most likely to have a greater extent of PAS than patients in the angle-closure hypertension or ACG suspect subtypes. PAS may be narrower in earlier stages and broader in later stages. PAS was also found most frequently in the superior part of the eye. The extent of synechial closure of the angle may play a role in raising IOP levels in later stages of the disease rather than early on.
Topics: Aged; Anterior Chamber; Female; Follow-Up Studies; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Iris; Laser Therapy; Male; Retrospective Studies; Severity of Illness Index
PubMed: 16892646
DOI: 10.3341/kjo.2006.20.2.104 -
Graefe's Archive For Clinical and... Sep 2023Since December 2022, China has eliminated the compulsory nucleic acid screening, which led to a new pandemic of Omicron. We observed a surge of primary angle-closure...
BACKGROUND
Since December 2022, China has eliminated the compulsory nucleic acid screening, which led to a new pandemic of Omicron. We observed a surge of primary angle-closure glaucoma (PACG) at a largest tertiary hospital in Shanghai. We evaluated the potential relationship between the infection of Omicron and the occurrence of PACG.
METHODS
In this retrospective cross-sectional study, we identified 41 patients diagnosed with PACG from 523 individuals registered in ophthalmic emergency from December 2022 to January 2023. We compared the proportion of PACG patients in all the patients registered at the ophthalmic emergency department in the corresponding period (December and January) from 2018 to 2023.
RESULTS
The proportion of PACG patients rose to 6.74% and 9.13%, nearly a five-fold increase compared to the previous 1.90%. The proportion of PACG patients throughout 2022 also increased in the recent 2 months. All PACG patients in our center from Dec. 21st 2022 to Jan. 27th 2023 had positive nucleic acid tests at their initial visits. The peak of glaucoma came around Dec. 27th 2022, while the peak of the internal medicine emergency came around Jan. 5th 2023.
CONCLUSIONS
The behavior pattern of the infected people and anxiety mood would induce the PACG attack. Some ophthalmic advice should be added to the Chinese treatment guidelines for COVID-19. Also, a shallow anterior chamber and narrow angle need to be ruled out when necessary. Further studies on larger populations are needed to explore the relationship between PACG and Covid.
Topics: Humans; Glaucoma, Angle-Closure; Retrospective Studies; Cross-Sectional Studies; Tertiary Care Centers; China; COVID-19; Acute Disease; Disease Outbreaks; Intraocular Pressure
PubMed: 37103623
DOI: 10.1007/s00417-023-06077-2 -
Korean Journal of Ophthalmology : KJO Aug 2019To compare the effects of cataract surgery on intraocular pressure (IOP) according to preoperative factor in primary open-angle glaucoma (POAG) and primary angle-closure...
PURPOSE
To compare the effects of cataract surgery on intraocular pressure (IOP) according to preoperative factor in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).
METHODS
The medical records of 75 POAG and 95 PACG patients who underwent cataract surgery were reviewed. We classified POAG patients with a preoperative peak IOP of less than 31 mmHg and less than three medications used before surgery and PACG patients with a peak IOP of less than 42 mmHg, less than three medications used, and peripheral anterior synechiae of less than four clock hours into group 1. Patients with levels exceeding these thresholds were classified into group 2. The IOP, numbers of medications, and success rates were compared between two groups.
RESULTS
At 36 months after surgery, IOP reduction in group 1 was significantly greater than that in group 2 among POAG patients (-1.7 ± 2.1 vs. -0.6 ± 2.0 mmHg, = 0.021); however, there was no significant difference between the two groups for PACG patients (-2.5 ± 2.0 vs. -2.2 ± 3.3 mmHg, = 0.755). The medication changes were similar between the two groups for both POAG and PACG patients. The success rate at 36 months was significantly higher in group 1 than in group 2 for POAG patients (66.7% vs. 35.7%, = 0.009), but there was no significant difference between the two groups for PACG patients (79.1% vs. 69.2%, = 0.264).
CONCLUSIONS
For patients with relatively low peak IOP who used fewer medications before surgery, cataract surgery alone was effective for IOP control in both POAG and PACG patients. Conversely, For POAG patients with a history of higher peak IOP and who used more medications, cataract surgery was not effective in lowering IOP, whereas it resulted in relatively good IOP values in PACG patients.
Topics: Aged; Aged, 80 and over; Antihypertensive Agents; Cataract; Female; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Male; Middle Aged; Phacoemulsification; Preoperative Period; Prognosis; Retrospective Studies; Tonometry, Ocular; Treatment Outcome
PubMed: 31389206
DOI: 10.3341/kjo.2018.0135