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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 -
The American Journal of Case Reports Nov 2021BACKGROUND Drug-induced acute angle closure glaucoma is an uncommon ocular emergency that may follow the administration of certain topical and systemic medications....
BACKGROUND Drug-induced acute angle closure glaucoma is an uncommon ocular emergency that may follow the administration of certain topical and systemic medications. Acute angle closure can be triggered by various classes of drugs, including adrenergic agonists, anticholinergics, and serotonergic medications. Here, we report a rare case of drug-induced acute angle closure glaucoma secondary to olanzapine. CASE REPORT A 59-year-old male patient of Arabian Peninsula descent, known to have schizophrenia, presented to our Emergency Department with a 3-day history of right ocular pain and decrease in vision. He was started recently on olanzapine 5 mg once daily by his psychiatrist 1 week prior to the onset of his symptoms. The diagnosis of drug-induced pupillary block was made based on clinical and radiological findings. The patient was started on topical and systemic IOP-lowering agents. A therapeutic Nd: YAG laser peripheral iridotomy for the right eye was performed. On follow-up, his symptoms alleviated and clinical examination showed significant improvement. CONCLUSIONS The reported case highlights the importance of systemic medical history in secondary acute angle closure glaucoma. Physicians from other specialties should be aware of drugs triggering pupillary block and therefore be able to educate patients about symptoms of acute angle closure glaucoma.
Topics: Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Laser Therapy; Male; Middle Aged; Olanzapine
PubMed: 34803156
DOI: 10.12659/AJCR.934432 -
Acta Ophthalmologica Feb 2022To determine the association between plasma free fatty acid (FFA) levels and primary angle-closure glaucoma (PACG). (Comparative Study)
Comparative Study
PURPOSE
To determine the association between plasma free fatty acid (FFA) levels and primary angle-closure glaucoma (PACG).
METHODS
Free fatty acid (FFA) levels in patients with PACG (n = 181) and people without glaucoma (n = 340) were compared. Twenty-two FFAs and six lipid classes were measured using metabolomics analysis. Odds ratio (OR) of these metabolites and their 95% confidence intervals (95%CI) for PACG were obtained by logistic regression. Stepwise forward selection was performed to identify FFAs that influenced PACG risk. Areas under the curve (AUC) were applied to assess the predictive performance. Spearman's rank correlation was used to assess the relationship between ocular parameters and FFAs.
RESULTS
Most FFAs in the PACG group were lower than those in the non-glaucoma group. Docosahexaenoic acid (DHA; OR for fourth quartile (Q4) vs. first quartile (Q1): 0.32 (0.16-0.66); per standard deviation (SD) increase: 0.64 (0.49-0.83); p for trend: 0.0007) and total saturated fatty acids (SFAs; OR for Q4 versus Q1: 0.27 (0.13-0.56); per SD increase: 0.65 (0.50-0.87); p for trend: 0.0004) were associated with decreased PACG risk. The AUC of the model that included DHA, total SFAs, demographic and ophthalmic factors increased from 0.8230 (0.7811-0.8649) to 0.8512 (0.8133-0.8891) (increased AUC: 0.0282 (0.0112-0.0453); p for increased AUC: 0.0012). Additionally, the cup-disc ratio had a weak negative correlation with DHA and total SFAs (DHA: r = -0.12085, p = 0.0065; total SFAs: r = -0.13318, p = 0.0024).
CONCLUSIONS
Decrease in FFA levels may be related to lipid peroxidation. Docosahexaenoic acid (DHA) and total SFAs may be screening indices for PACG patients.
Topics: Aged; Biomarkers; Fatty Acids, Nonesterified; Female; Follow-Up Studies; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Mass Spectrometry; Metabolomics; Middle Aged; Retrospective Studies; Slit Lamp Microscopy; Visual Fields
PubMed: 33829654
DOI: 10.1111/aos.14874 -
Eye (London, England) Jan 2020Angle-closure glaucoma is an aggressive condition that causes millions to become blind worldwide. This review explores the use of prophylactic laser peripheral iridotomy... (Review)
Review
Angle-closure glaucoma is an aggressive condition that causes millions to become blind worldwide. This review explores the use of prophylactic laser peripheral iridotomy (PI) in patients classified as primary angle-closure suspects (PACS), and additionally, the use of clear lens exchange as a primary treatment option in established angle-closure disease with or without glaucoma. As PI has a strong prophylactic effect in fellow eyes of patients who have had an acute attack, its use has been widely adopted in those patients classified as PACS, but with limited evidence to support this. A large randomised trial conducted in China has demonstrated that although PI reduces the risk of incident angle-closure disease, the incidence of disease that would threaten vision was much lower than anticipated. This suggests that the benefit of prophylactic PI is very limited. Health services data shows an association between rising cataract surgical rates and of decreasing rates of acute angle-closure. Age-related growth of the lens is a major component of angle-closure disease. Several studies have shown that clear lens extraction (CLE) effectively lowers IOP in angle-closure. The use of CLE as a primary treatment option has been tested against LPI in the EAGLE study, a large RCT that enroled people with angle-closure and an IOP > 30 mmHg, and those with angle-closure glaucoma. The trial showed CLE to be superior to PI both for IOP control and patient reported quality of life. On these grounds, CLE should be considered for first-line treatment of more advanced angle-closure disease.
Topics: China; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iridectomy; Iris; Laser Therapy; Lens Implantation, Intraocular; Quality of Life
PubMed: 31649349
DOI: 10.1038/s41433-019-0634-5 -
Eye (London, England) Jan 2019Acute primary angle closure requires emergency management that involves a rapid lowering of the intraocular pressure and resolution of relative pupil block - the most... (Review)
Review
Acute primary angle closure requires emergency management that involves a rapid lowering of the intraocular pressure and resolution of relative pupil block - the most common mechanism of angle closure. Emergency strategies for lowering intraocular pressure include medical treatment and argon laser peripheral iridoplasty. Anterior chamber paracentesis and diode laser transcleral cyclophotocoagulation may be considered in special situations. Relative pupil block can be relieved by peripheral laser iridotomy and primary lens extraction; the latter is a more effective treatment according to the results of clinical trials. However, primary lens extraction can be technically demanding in the acute setting. Peripheral laser iridotomy has a role in relieving pupil block and should also be considered in most cases. Lens extraction may be combined with procedures such as goniosynechialysis, trabeculectomy or endoscopic cyclophotocoagulation. In this review, we aim to discuss the available evidence regarding the different treatment modalities. We also discuss the economic consideration, including cost-effectiveness and life expectancy, in the management of acute primary angle closure.
Topics: Acute Disease; Disease Management; Filtering Surgery; Glaucoma, Angle-Closure; Health Care Costs; Humans; Intraocular Pressure; Practice Guidelines as Topic
PubMed: 30467424
DOI: 10.1038/s41433-018-0278-x -
Indian Journal of Ophthalmology Jan 2011To present an overview of the recent observations and research that shed light on the understanding of open and closed angle glaucoma. (Review)
Review
PURPOSE
To present an overview of the recent observations and research that shed light on the understanding of open and closed angle glaucoma.
METHODS
Literature review.
RESULTS
Glaucoma is a major eye problem afflicting millions of people worldwide. As the population increases, the number of people with glaucoma also increases, with glaucoma becoming an increasing public health concern. This paper presents the natural history of open angle and angle closure glaucoma. We examine the glaucomatous progression in terms of changes in optic disk morphology and visual fields as well as the risk factors for progression.
CONCLUSIONS
This present review highlights the magnitude of glaucoma globally and the need for a greater understanding of this disease and its natural progression.
Topics: Asia; Blindness; Disease Progression; Glaucoma, Angle-Closure; Glaucoma, Open-Angle; Global Health; Humans; Incidence; Optic Disk; Optic Nerve; Prevalence; Visual Fields
PubMed: 21150029
DOI: 10.4103/0301-4738.73682 -
PloS One 2022Psychotropic medications have been reported as a risk factor for angle closure disease. However, the interaction between background genetic risk for primary angle... (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIMS
Psychotropic medications have been reported as a risk factor for angle closure disease. However, the interaction between background genetic risk for primary angle closure glaucoma (PACG) and susceptibility to angle closure disease among psychotropic medication users has not been investigated. Here we demonstrate the utility of a genome-wide polygenic risk score (PRS) in identifying and risk-stratifying subjects with PACG and investigate the association between PACG genetic burden and exposure to psychotropic medications on prevalent angle closure.
METHODS
This analysis used the UK Biobank dataset, a prospective cohort study of 502,506 UK residents. We constructed a PACG PRS for participants using genome-wide association study summary statistics from a multiethnic meta-analysis using the Lassosum method.
RESULTS
Among the 441,054 participants, 959 (0.22%) were identified as PACG cases. Individuals with PACG had higher PRS compared to those without PACG (0.24±1.03 SD vs. 0.00±1.00 SD, p<0.001) and PACG prevalence increased with each decile of higher PRS. Among individuals using psychotropic medication, those with PACG had higher average PRS (0.31±1.00 SD vs. 0.00±1.00 SD, p<0.001) and were more likely to have a PRS in upper deciles of polygenic risk (p = 0.04). At each decile of PRS, psychotropic medication use was associated with increased risk of PACG. These effects were more pronounced and significant in higher deciles.
CONCLUSION
We demonstrate the utility of a PRS for identifying individuals at higher risk of PACG. Additionally, we demonstrate an important relationship where the association between psychotropic medications use and PACG diagnosis varies across the polygenic risk spectrum.
Topics: Biological Specimen Banks; Genome-Wide Association Study; Glaucoma, Angle-Closure; Humans; Prospective Studies; Psychotropic Drugs; Risk Factors; United Kingdom
PubMed: 35763501
DOI: 10.1371/journal.pone.0270530 -
Acta Ophthalmologica Feb 2022To investigate the development of angle closure from baseline open angle and associated risk factors in a rural Chinese population through a longitudinal study over a... (Comparative Study)
Comparative Study
PURPOSE
To investigate the development of angle closure from baseline open angle and associated risk factors in a rural Chinese population through a longitudinal study over a 5-year period.
METHODS
Subjects aged ≥30 years and older with bilateral open angles at baseline of the Handan Eye Study who participated in the follow-up and had undergone both baseline and follow-up gonioscopic examinations were included. Subjects with any form of angle closure, glaucoma, incisional ocular surgery or other conditions that could influence the results were excluded. The development of angle closure was defined as the presence of primary angle closure suspect (PACS) or primary angle closure (PAC)/primary angle closure glaucoma (PACG) during the follow-up in normal subjects with baseline bilateral open angles. Logistic regression was performed to identify the baseline risk factors for the development of angle closure.
RESULTS
A total of 457 subjects with bilateral open angles at baseline aged 53.0 (45.5, 58.0) years were enrolled. 94.7% of the included cases developed PACS, 5.3% developed PAC and no one developed PACG after 5 years. In logistic regression, significant risk factors for the development of angle closure were shallower central anterior chamber depth (ACD) (p = 0.002) and narrower mean angle width (p < 0.001).
CONCLUSIONS
This study reports the development from baseline open angle to angle closure after a 5-year follow-up. We confirm that the mean angle width and central ACD were independent predictive risk factors for the development of any form of angle closure.
Topics: China; Female; Follow-Up Studies; Glaucoma, Angle-Closure; Gonioscopy; Humans; Incidence; Intraocular Pressure; Male; Middle Aged; Registries; Retrospective Studies; Risk Assessment; Risk Factors; Rural Population; Time Factors
PubMed: 33960669
DOI: 10.1111/aos.14887 -
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 -
BMC Ophthalmology May 2023Cataract is commonly observed in patients with primary angle-closure glaucoma; however, its underlying pathological mechanisms remain unclear. This study aimed to...
BACKGROUND
Cataract is commonly observed in patients with primary angle-closure glaucoma; however, its underlying pathological mechanisms remain unclear. This study aimed to improve our knowledge on the pathological processes involved in primary angle-closure glaucoma (PACG) by identifying potential prognostic genes associated with cataract progression.
METHODS
Thirty anterior capsular membrane samples were collected from PACG patients with cataracts and age-related cataracts. Differentially expressed genes (DEGs) between these two cohorts were analyzed using high-throughput sequencing. Gene ontology and Kyoto Encyclopedia of Genes and Genomes analyses were performed to screen the DEGs, and potential prognostic markers and their coexpression network were then predicted by bioinformatic analyses. The DEGs were further validated by reverse transcription-quantitative polymerase chain reaction.
RESULTS
A total of 399 DEGs were found to be specifically associated with cataracts development in PACG patients, among which 177 and 221 DEGs were upregulated and downregulated, respectively. STRING and Cytoscape network analyses revealed seven genes-CTGF, FOS, CAV1, CYR61, ICAM1, EGR1, and NR4A1-that were remarkably enriched and mainly involved in the MAPK, PI3K/Akt, Toll-like receptor, and TNF signaling pathways. RT-qPCR-based validation further confirmed that the sequencing results were accurate and reliable.
CONCLUSIONS
Herein, we identified seven genes and their signaling pathways that may contribute to cataract progression in patients with high intraocular pressure. Taken together, our findings highlight new molecular mechanisms that may explain the high incidence of cataracts in PACG patients. In addition, the genes identified herein may represent new foundations for the development of therapeutic strategies for PACG with cataract.
Topics: Humans; RNA-Seq; Glaucoma, Angle-Closure; Phosphatidylinositol 3-Kinases; Cataract; Prognosis
PubMed: 37131205
DOI: 10.1186/s12886-023-02950-0