Abstract
Purpose:To evaluate the clinical characteristics and ocular features of patients with acute secondary angle closure, associated with lens subluxation (ASAC-LS).Methods:We performed a retrospective study at the EENT Hospital of Fudan University, Shanghai, China. A total of 41 affected eyes from 41 patients were enrolled in this study. Furthermore, 20 affected eyes were part of the ASAC-LS cohort and 21 affected eyes were included in the acute primary angle closure (APAC) cohort. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), axial length (AL), minimum corneal curvature (K1), maximum corneal curvature (K2), and anterior chamber depth (ACD) were measured and compared between the 2 cohorts. In addition, inter-eye (intraindividual) comparison was performed.Results:The ASAC-LS cohort exhibited younger ages, more frequent trauma history (35%), lower IOP (27.43 ± 13.86 mmHg vs. 41.27 ± 10.36 mmHg), longer AL (23.96 ± 2.60 vs. 22.49 ± 0.77 mm), shallower ACD (1.28 ± 0.38 vs. 1.58 ± 0.23 mm), and bigger ACD differences (0.99 ± 0.52 vs. 0.15 ± 0.19 mm), as compared with the APAC cohort (all p < 0.05). Moreover, eyes from the lens subluxation cohort experienced worse BCVA, higher IOP, and shallower ACD than their matched unaffected eyes (all p < 0.05). Although longer AL, shallower ACD, and bigger ACD differences were strongly correlated with lens subluxation in a univariate logistic regression analysis, only the ACD difference remained significant in the multivariate model (p = 0.004, OR = 1,510.50). Additionally, according to the receiver operating characteristic (ROC) curve analysis, both ACD and ACD differences had greater value in the differential diagnosis of ASAC-LS and APAC, with a cut-off value of 1.4 and 0.63 mm, respectively.Conclusions:Shallower ACD and larger ACD differences provide the promising diagnostic potential for patients with ASAC-LS.
Highlights
Lens subluxation has multi-factorial etiology, including congenital or developmental conditions, comorbidities of eye diseases, associated with zonular disease, and a history of ocular blunt trauma or previous intraocular surgery [1–7]
Longer axial length (AL), shallower anterior chamber depth (ACD), and bigger ACD differences were strongly correlated with lens subluxation in a univariate logistic regression analysis, only the ACD difference remained significant in the multivariate model (p = 0.004, OR = 1,510.50)
A total of 41 affected eyes were included in this study; of the affected eyes belonged to the ASACLS cohort and affected eyes belonged to the acute primary angle closure (APAC) cohort
Summary
Lens subluxation has multi-factorial etiology, including congenital or developmental conditions (such as Marfan syndrome, Weill–Marchesani syndrome, and homocystinuria), comorbidities of eye diseases, associated with zonular disease (such as high myopia, retinitis pigmentosa, pseudoexfoliation syndrome, and uveitis), and a history of ocular blunt trauma or previous intraocular surgery [1–7]. This condition can sometimes induce acute secondary angle closure (ASAC) that presents with non-specific signs and symptoms, similar to acute primary angle closure (APAC), such as blurred vision, elevated intraocular pressure (IOP), shallow anterior chamber, severe ocular pain, headache, nausea, and vomiting. We delineated the clinical and ocular characteristics of patients with ASAC-LS and APAC, which may benefit the future diagnosis and differential diagnosis of these patients
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