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Indian Journal of Ophthalmology Jul 2022
Topics: Choroid Diseases; Choroidal Effusions; Glaucoma, Angle-Closure; Humans; Lupus Erythematosus, Systemic
PubMed: 35791193
DOI: 10.4103/ijo.IJO_299_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 -
Ceska a Slovenska Oftalmologie :... 2022Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma...
INTRODUCTION
Topamax (topiramate) is a drug used in the treatment of epilepsy or migraine. Its use may rarely be associated with the occurrence of secondary angle-closure glaucoma due to supraciliary effusion. Although the ocular finding resembles primary angle-closure glaucoma, bilateral infliction should always raise the suspicion that it is drug-induced glaucoma.
CASE REPORT
The authors present a case of a 51-year-old patient on Topamax therapy with sudden vertigo, headache and blurred vision. Ophthalmic examination revealed bilateral angle-closure glaucoma, which was initially treated in the classical manner by administration of local antiglaucoma drugs and pilocarpine, followed by administration of osmotically active substances and laser iridotomy. Only the subsequent discontinuation of Topamax and the use of local cycloplegics and corticosteroids led to the release of the anterior segment angle closure and normalization of intraocular pressure.
CONCLUSION
The indicating physician and ophthalmologist must be aware of the possible side effects of Topamax therapy to determine the correct diagnosis and to administer treatment appropriately.
Topics: Fructose; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Middle Aged; Tonometry, Ocular; Topiramate
PubMed: 35760585
DOI: 10.31348/2022/16 -
Der Ophthalmologe : Zeitschrift Der... Aug 2021A 72-year-old female patient developed bilateral secondary iridocorneal angle-closure glaucoma with uveal effusion syndrome after uncomplicated cataract surgery. The...
A 72-year-old female patient developed bilateral secondary iridocorneal angle-closure glaucoma with uveal effusion syndrome after uncomplicated cataract surgery. The postoperative intake of acetazolamide was identified as causative for the development of the effusion syndrome. Taking a sulfonamide-free systemic and local intraocular pressure lowering and anti-inflammatory treatment into account, a rapid improvement of the ocular manifestation was achieved. The case illustrates a rare but clinically severe adverse effect of acetazolamide and outlines efficient treatment options.
Topics: Aged; Cataract; Cataract Extraction; Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Phacoemulsification; Tonometry, Ocular
PubMed: 32803274
DOI: 10.1007/s00347-020-01202-6 -
Asia-Pacific Journal of Ophthalmology... Oct 2020The aim of this study was to describe changes in intraocular pressure (IOP) and IOP medications after phacoemulsification with Kahook Dual Blade-assisted...
PURPOSE
The aim of this study was to describe changes in intraocular pressure (IOP) and IOP medications after phacoemulsification with Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy in eyes with angle-closure glaucoma and cataract.
DESIGN
Retrospective case series.
METHODS
Data were collected retrospectively through 24 months of follow-up in 42 eyes of 24 subjects.
RESULTS
Preoperative mean (SE) IOP was 25.5 (0.7) mm Hg using a mean of 2.3 (0.1) medications per eye. At month 24, mean IOP had decreased to 13.5 (0.4) mm Hg [a reduction of 12.0 mm Hg (47.1%); P < 0.0001]. Medication use declined to a mean of 0.6 (0.2) medications per eye [a reduction of 1.7 medications per eye (76%); P < 0.0001]. At month 24, 40 of 42 eyes (95.2%) achieved IOP ≤18 mm Hg, 42 of 42 eyes (100%) achieved IOP reduction of ≥20%, 36 of 42 eyes (85.7%) required ≥1 fewer medications for IOP control, and 29 of 42 (69.0%) were medication-free. No eyes required additional glaucoma surgery throughout 24 months of follow-up.
CONCLUSIONS
Phaco plus Kahook Dual Blade-assisted goniosynechialysis/excisional goniotomy provides statistically and clinically meaningful reductions in both IOP and medications in eyes with angle-closure glaucoma throughout 2 years of follow-up. These findings are consistent with our previously reported outcomes in this cohort at months 6 and 12 postoperatively, demonstrating a significant and sustained benefit of this procedure in eyes with angle-closure glaucoma and cataract.
Topics: Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Phacoemulsification; Retrospective Studies; Trabecular Meshwork; Trabeculectomy; Treatment Outcome
PubMed: 33031110
DOI: 10.1097/APO.0000000000000321 -
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 -
Veterinary Ophthalmology May 2022Angle closure glaucoma (PACG) is highly prevalent in dogs and is often refractory to medical therapy. We hypothesized that pathology affecting the post-trabecular...
PURPOSE
Angle closure glaucoma (PACG) is highly prevalent in dogs and is often refractory to medical therapy. We hypothesized that pathology affecting the post-trabecular conventional aqueous outflow pathway contributes to persistent intraocular pressure (IOP) elevation in dogs with PACG. The goal of this study was to determine the potential for aqueous angiography (AA) and optical coherence tomography (OCT) to identify abnormalities in post-trabecular aqueous outflow pathways in canine PACG.
METHODS
AA and anterior segment OCT (Spectralis HRA + OCT) were performed ex vivo in 19 enucleated canine eyes (10 normal eyes and 9 irreversibly blind eyes from canine patients enucleated for management of refractory PACG). Eyes were cannulated and maintained at physiologic IOP (10-20 mmHg) prior to intracameral infusion of fluorescent tracer. OCT scleral line scans were acquired in regions of high and low perilimbal AA signal. Eyes were then perfusion fixed and cryosections prepared from 10/10 normal and 7/9 PACG eyes and immunolabeled for a vascular endothelial marker.
RESULTS
Normal canine eyes showed segmental, circumferential limbal AA signal, whereas PACG eyes showed minimal or no AA signal. AA signal correlated with scleral lumens on OCT in normal dogs, but lumens were generally absent or flattened in PACG eyes. Collapsed vascular profiles were identified in tissue sections from PACG eyes, including those in which no lumens were identified on AA and OCT.
CONCLUSIONS
In canine eyes with PACG, distal aqueous outflow channels are not identifiable by AA, despite normalization of their IOP, and intra-scleral vascular profiles are collapsed on OCT and histopathology.
Topics: Animals; Dog Diseases; Dogs; Glaucoma, Angle-Closure; Intraocular Pressure; Tomography, Optical Coherence; Tonometry, Ocular
PubMed: 34581493
DOI: 10.1111/vop.12943 -
Indian Journal of Ophthalmology Jun 2023UBM is a high-resolution ultrasound technique which allows non-invasive, in vivo imaging of the anterior segment and iridocorneal angle.
BACKGROUND
UBM is a high-resolution ultrasound technique which allows non-invasive, in vivo imaging of the anterior segment and iridocorneal angle.
PURPOSE
This video is compilation of short video clips and images which gives description on identification of angle closure due to pupillary block, peripheral anterior synechiae, iris bombe, plateau iris, supra ciliary effusion, and malignant glaucoma. It also shows video demonstrating partially and fully patent iridotomy and features of trabeculectomy bleb. Synopsis: This video summarizes importance of UBM application in angle closure glaucoma to understand its pathophysiology by showing the relationship between the peripheral iris, trabecular meshwork and ciliary processes.
HIGHLIGHTS
UBM provides two-dimensional, grayscale images of the angle structures and allows identification of non-pupillary block mechanism in angle closure glaucoma, which can be recorded for qualitative and quantitative analyses.
VIDEO LINK
https://youtu.be/prsmGnR8jYc.
Topics: Humans; Ciliary Body; Eye Abnormalities; Glaucoma; Glaucoma, Angle-Closure; Iris; Iris Diseases; Microscopy, Acoustic; Pupil Disorders
PubMed: 37322722
DOI: 10.4103/IJO.IJO_153_23 -
Eye (London, England) Aug 2020To assess the ability of teleophthalmoscopic grading of peripheral anterior chamber depth (PACD) using the van Herick (vH) technique in detecting gonioscopically...
OBJECTIVES
To assess the ability of teleophthalmoscopic grading of peripheral anterior chamber depth (PACD) using the van Herick (vH) technique in detecting gonioscopically occludable angle; and to determine whether combining results from vH grading and ocular biometry can improve the accuracy to diagnose gonioscopically occludable angle METHODS: This cross-sectional study was an offshoot of a rural population-based study, Glaucoma Epidemiology and Molecular Genetic Study (GLEAMS). A masked urban ophthalmologist graded digital slit lamp photographs of PACD by vH technique. Sussman four-mirror lens was used to perform dark room indentation gonioscopy. Cutoff values of the tests were, vH technique: grade ≤ 2, central anterior chamber depth (ACD), as well as axial length: ≤ 25th percentile and lens thickness ≥ 75th percentile value of the study population.
RESULTS
We studied 1965 eyes of 1029 adult participants. The vH grade was ≤2 in 188 (9.5%) eyes. The angle was occludable by gonioscopy in 101 (5.1%) eyes. The performance of the vH test to rule out gonioscopically occludable angle was good [negative predictive value (NPV): 97.3%], despite low sensitivity (52.5%), while its efficacy to rule in the condition was low [positive predictive value (PPV): 28.2%] despite high specificity (92.8%). However, test combination strategy increased the PPV nearly twofold (53.8%). The calculated PPV at 10% prevalence of gonioscopically occludable angle was even higher (70.5%).
CONCLUSIONS
Van Herick technique can be incorporated into a teleophthalmology program by means of slit lamp photographs of PACD. Combined vH grading and ocular biometry improved the predictability of a gonioscopically occludable angle.
Topics: Adult; Anterior Chamber; Cross-Sectional Studies; Glaucoma; Glaucoma, Angle-Closure; Gonioscopy; Humans; Molecular Biology; Ophthalmology; Telemedicine
PubMed: 31695161
DOI: 10.1038/s41433-019-0666-x -
Romanian Journal of Ophthalmology 2017Clear lens extraction can be considered a therapeutic option in angle closure glaucoma (ACG). Even if it does not represent the first choice of treatment, it can be... (Review)
Review
Clear lens extraction can be considered a therapeutic option in angle closure glaucoma (ACG). Even if it does not represent the first choice of treatment, it can be taken into consideration when the topical treatment does not control the intraocular pressure (IOP) and iridotomy does not have a positive effect on the angle closure, especially in appositional angle closure when biometry or ultrabiomicroscopy (UBM) show lens involvement. In angle closure glaucoma, clear lens extraction represents an etiological treatment that takes into account the role of the lens in the pathogenesis of the disease. If we ignore it and we choose a filtrating surgery as therapeutic option we can end up with complications such as prolonged athalamia, corneal damage and lens opacification that will eventually require cataract surgery, but performed late and with higher risks. Before performing a filtrating surgery in ACG, we should take an UBM. We also need to choose the best moment to perform surgery, after topical treatment and iridotomy have been tested, but before trabecular damage appears.
Topics: Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Lens Implantation, Intraocular; Phacoemulsification; Tonometry, Ocular
PubMed: 29516042
DOI: No ID Found