Attack Of Acute Angle-closure Glaucoma Research Articles

Acute glaucoma attack in a patient recovered from coronavirus infection (case report)

The prevalence of ophthalmic manifestations in COVID-19 ranges from 2 to 32%. The most common ophthalmic disease associated with COVID-19 is viral conjunctivitis, but there are also reports of cases with episcleritis, uveitis, occlusions of the central retinal artery and vein, retinopathy, glaucoma, dry eye syndrome, as well as rare neuroophthalmological manifestations such as diplopia, ophthalmoplegia and nystagmus. This study reports a case of bilateral acute angle-closure glaucoma attack in a patient recovered from severe COVID-19 pneumonia.PURPOSE. To determine the causes of bilateral acute angle-closure glaucoma attack associated with COVID-19 pneumonia, and to evaluate the effectiveness of laser iridotomy and transciliary drainage of the posterior chamber of the eye.METHODS. Bilateral acute angle closure glaucoma attack was observed in a female patient recovered from COVID-19 pneumonia. Low hypermetropia and co-existing cataract were diagnosed in both eyes. In order to normalize the IOP and restore visual acuity, laser iridotomy was performed in both eyes, followed by surgical treatment of glaucoma with transciliary drainage of the posterior chamber in both eyes. After that the patient underwent phacoemulsification with implantation of intraocular lenses (IOL) in both eyes.RESULTS. Laser iridotomy and transciliary drainage of the posterior chamber was performed in both eyes. The target IOP without topical therapy and stabilization of glaucoma were achieved in both eyes. The second step was phacoemulsification with implantation of IOL, which significantly improved visual acuity of both eyes.CONCLUSION. COVID-19 can lead to vision loss and disability, therefore IOP should be monitored in patients that remain in prone position for ventilation for extended periods of time and receive systemic steroid medications. This is especially relevant for patients with a predisposition to glaucoma or with diagnosed glaucoma.

Клинический случай сочетания острого приступа закрытоугольной глаукомы с острым увеитом: конкуренция или синергизм

An atypical clinical case of a combination of an acute attack of angle-closure glaucoma with acute anterior uveitis with the simultaneous development of both diseases is represented. Keywords: acute attack of angle-closure glaucoma, acute anterior uveitis, differential diagnosis, therapy

Оценка коэффициента LAF в качестве критерия риска острого приступа закрытоугольной глаукомы

Purpose. To study the possibility of using the LAF coefficient in predicting an acute attack of angle-closure glaucoma (AACG) in anatomically short eyes of Europoids. Material and methods. In total, 4 groups of patients were formed: healthy individuals with hyperopia, patients with primary angle closure (PCA) of the anterior chamber, patients with primary angle-closure glaucoma (PACG), and patients with an acute attack of angle-closure glaucoma. The anteroposterior axis of the eye (APA), lens thickness (LT) were studied, and the LAF coefficient was calculated based on the results of these studies. Results. For each of the three factors studied (LT, APA, and LAF), an ROC analysis was performed to identify the cut-off points that best separate the hyperopic and acute attack groups. Cut-off points, sensitivity, specificity, areas under the ROC-curves (AUC) were found. Conclusion. Comparative analysis of LT and LAF parameters in the groups of hypermetropes, patients with PCA and with the initial stage of PACG did not reveal significant differences. In the acute attack group, LT and LAF were statistically significantly higher than the other groups. It was revealed that the LAF coefficient provides a better separation of the group of hypermetropes and the group of acute attack of the primary angle-closure, in comparison with the indicators of LT and especially the APA of the eyes. Our data showed that a high risk of an acute attack of glaucoma in eyes with a short APA occurs at LAF values greater than 2.332. This is confirmed by the high sensitivity, specificity and AUC of this indicator. Keywords: LAF coefficient, acute attack of angle-closure glaucoma, hypermetropia, primary closure of the anterior chamber angle

Анатомо-морфометрические факторы риска первичной закрытоугольной глаукомы в глазах с короткой ПЗО

Purpose. To study the features of t anatomical and morphometric parameters of structures of the anterior segment of the eyes in young patients with moderate and high hyperopia to identify signs of an increased risk of developing primary angle-closure glaucoma (PACG) and its acute attack. Material and methods. Clinical material is presented by 58 patients (116 eyes) with the anteroposterior axis of the eyes less than 23 mm. The main group consisted of 33 patients (66 eyes) with moderate and high hyperopia. The comparison group included 25 patients (50 eyes) with PACG. Results. The study made it possible to identify a group with an increased risk of developing PACG from a selected total population of young patients with moderate and high degrees of hypermetropia, which included 19 people (58 %). Conclusion. Comparative analysis of the morphometric parameters of the structures of the anterior segment of anatomically «short» eyes in young patients with moderate and high hypermetropic refraction, on the one hand, and in patients with PACG, on the other, revealed statistically significant differences between them in the depth of the anterior chamber in the central zone, thickness of the lens, the volume of the anterior chamber, the depth of the anterior chamber at the periphery, the angle of the anterior chamber. But, given the 1.5-fold statistically significant difference in age between the groups, it can be assumed that in some young hypermetropes, due to the continuous increase in the volume of the lens, when they reach the appropriate age, a number of indicators can become comparable to the PACG group. Keywords: hyperopia, refractive surgery, primary angle-closure glaucoma, acute attack of angle-closure glaucoma

Wolf in sheep’s clothing: Cough syrup-induced synergistic idiosyncratic mydriatic reaction precipitating a bilateral acute angle-closure attack in a predisposed hypermetropic patient

ABSTRACT An uncommon ophthalmic emergency condition, bilateral acute angle-closure glaucoma (AACG), is a potentially sight-threatening adverse effect of several local and systemic drugs in high-risk individuals. The majority of cases with drug-induced pupillary block closed-angle glaucoma are preventable, if high-risk patients are recognized and treated prophylactically. We report one such case that highlights the risk factors and rare pathophysiological mechanism of developing bilateral AACG attack after consumption of an antitussive drug orally.

Diagnosis and treatment of angle-closure glaucoma

Glaucoma is a polyetiological disease, which is based on increased intraocular pressure, leading to impaired visual fields and pathology of the optic nerve. As a result of increased pressure, there is an increase in the hydrodynamic load on the optic disc, gradually leading to its atrophy. Progressive narrowing of visual fields is another classic sign of glaucoma. This disease is one of the main causes of vision loss and related disability of the population. There are three main forms of glaucoma: primary open-angle, primary closed-angle, and secondary glaucoma, which develops against the background of the existing pathology of the organs of vision (diabetic retinopathy, acute iridocyclitis, post-thrombotic oculopathy). Primary open-angle glaucoma is the most common form of the disease, usually affecting the elderly. Angle-closure glaucoma is less common, but it is more dangerous. This form of the disease is often observed against the background of existing hypermetropia. This type of primary glaucoma develops as a result of a violation of the outflow in the drainage system of the eye due to the occlusion of the internal scleral sinus. In this case, the anterior chamber is significantly reduced in size or even disappears, and the lens is close to the cornea. Angle-closure glaucoma is characterized by a paroxysmal course, rapid progression, and a less favorable prognosis. In some cases, an acute attack of angle-closure glaucoma requires immediate hospitalization with subsequent surgical intervention.

Выявление случаев повышенного риска первичной закрытоугольной глаукомы у молодых пациентов с высокой степенью гиперметропии

Purpose. Evaluation of the incidence of risk of primary angle-closure glaucoma (PACG) in young patients with a high hyperopia. Material and methods. The main group consisted of 58 healthy patients (116 eyes) with high hyperopia. Their age ranged from 32 to 40 years. Selection criteria: the anteroposterior axis (APA) of the eye is less than 22 mm, the absence of ophthalmic and systemic somatic pathology. The comparison group was formed by 52 patients (104 eyes) with high hyperopia (APA less than 22 mm) and the initial stage of PACG, as well as the presence of a functional block of the front camera angle. Their age ranged from 45 to 50 years with a median of 47 years. The morphometric parameters of the anterior segment of the eyes were evaluated in groups. Results. We determined statistically significant differences in all studied parameters of the compared groups: the depth of the anterior chamber in the central zone, the thickness of the lens, the volume of the anterior chamber. However, when comparing these indicators with the comparison group, it was found that in 15 patients in the main group, most of them were comparable. Conclusion. Comparative analysis of the topographic and anatomical parameters of the anterior segment of the eyes of young healthy hypermetropes made it possible to identify 15 people. (26 %) with an increased risk of developing PACG and an acute attack. Keywords: acute attack of angle-closure glaucoma, hyperopic refraction, anteroposterior axis of the eye, lens thickness, anterior chamber depth, anterior chamber volume.

Surgical Outcomes of Trabeculectomy Alone versus Trabeculectomy with Manual Small Incision Cataract Surgery Following Acute Angle Closure Glaucoma: A Comparative Study

Introduction: Acute Angle Closure Glaucoma (AACG) is an ophthalmic emergency and is managed medically. Therapeutic options for the management of the post congestive phase are varied and no procedure has a documented therapeutic superiority over the other. Two established procedures were therefore chosen and compared to determine their therapeutic efficacy. Aim: To compare the surgical results of combined manual Small Incision Cataract Surgery (SICS) and trabeculectomy with standalone trabeculectomy in patients following an attack of AACG, with a final aim to decide which would be the better therapeutic approach in such a situation. Materials and Methods: This was a prospective observational study done in Bankura Sammilani Medical College located in West Bengal, India. Sixteen patients presenting with AACG in a 19 months study period from October 2019-April 2021 and having 50% or more synechial angle closure on indentation gonioscopy were selected for this study after obtaining necessary ethical clearance. Eight of them underwent trabeculectomy alone (Group A) and the rest underwent a combined procedure of trabeculectomy and SICS (Group B). They were followed-up for a six-months period and compared on the basis of Intraocular Pressure (IOP) control, Anterior Chamber (AC) depth and the requirement for further surgery. Results: Mean IOP following surgery at the end of six weeks in Group A was 15.98±1.56 mmHg whereas in Group B it was 12.01±1.18 mmHg. Results were compared by unpaired t-test, and the difference was statistically significant (p<0.001). Three out of eight patients (37%) in Group A developed cataract which caused a reduction in visual acuity and needed cataract surgery within the six months follow-up period but none of the patients in Group B needed any additional surgery. One patient in Group A needed additional medications due to uncontrolled IOP after surgery but no such event was noted in Group B. Seventy five percent patients in Group A had Grade 2 angles whereas 87% patients in Group B had Grade 4 angles as estimated by Van Herrick’s method. Conclusion: Combined trabeculectomy and SICS offers a better level of postoperative IOP control than trabeculectomy alone, and perhaps offers a better therapeutic option following AACG. Also, the chances of postoperative cataract formation and associated visual debility are eliminated.

Phacoemulsification in prevention of acute angle-closure glaucoma attack

To study the changes in morphometric parameters of the anterior segment of anatomically short eyes with an increased risk of acute glaucoma attack before and after preventative PE. The study included 70 patients (70 eyes) with a high risk of acute glaucoma attack in short anatomical axial length and thickened lens, with posterior and middle positions of the ciliary body. They were divided into 2 groups: the main group consisted of 45 patients who agreed to undergo PE; the comparison group consisted of 25 patients who refused to undergo PE due to good visual functions and no complaints about vision. B-mode ultrasound examination of the anterior segment of the eye was used to evaluate the cross-sectional surface area of the lens (CSAL) and the cross-sectional surface area of the anterior chamber (CSAAC). In the main group, on day 2-3 after PE the anterior chamber depth increased in all eyes, the CSAAC index increased, the anterior chamber angle (ACA) widened to Schaffer grade to II-III. After 1-3 years and 4-5 years, the anterior chamber depth, the CSAAC index and the width of the ACA remained stable. In the comparison group, after 1-3 years the anterior chamber depth and the CSAAC index significantly decreased, the ACA narrowed, and the intraocular pressure increased; after 4-5 years, there was a progressive increase in the CSAL index, the ACA was completely closed (0°). In all cases of timely performed preventative PE, already on days 2-3 after surgery there was a statistically significant improvement in the main morphometric parameters of the eye, which remained stable for 4-5 years.

Выяснение наличия повышенного риска формирования первичной закрытоугольной глаукомы среди пациентов с гиперметропической рефракцией в отделении рефракционной хирургии

Important physiological feature of the anatomically «short» eye is the disproportionately large volume of the lens relative to the volume of the eye. A gradual and continuous increase in the volume of the lens contributes to the anterior displacement of the irido-lenticular diaphragm, causing the functional block of the anterior chamber angle. This leads to persistent disorders of the hydrodynamics of the eye, up to the development of an acute attack of angle-closure glaucoma. Purpose. To study incidence of increased risk formation of primary angle-closure glaucoma (PACG) and its acute attack in young patients with moderate and high hyperopia (Hm). Material and methods. Clinical material was presented by 58 patients (116 eyes) with indicators of axial length of the eyes less than 23 mm. The main group consisted of 33 patients (66 eyes) with moderate and high Hm. The comparison group was represented by 25 patients (50 eyes) with PACG. Results. The study made it possible to identify group of increased risk of the formation of PACG, which included 19 people (58%), from selected general population of young patients with moderate and high Hm. Conclusion. Comparative analysis of morphometric parameters of structures of the anterior segment of the anatomically «short» eyes in young patients with moderate and high Hm, on the one hand, and in patients with PACG, on the other, revealed statistically significant differences between them in the anterior chamber depth in the central zone, the thickness of the lens, the anterior chamber volume, the peripheral anterior chamber depth, of the anterior chamber angle. Key words: primary angle-closure glaucoma, acute attack of angle-closure glaucoma, hyperopia, refractive surgery.

Course features of angle-closure glaucoma

Glaucoma is a disease with multiple etiologies, which is based on increased intraocular pressure, leading to impaired visual fields and pathology of the optic nerve. Increase in the hydrodynamic load on the optic nerve disk occurs as a result of increased pressure, this is gradually leads to its atrophy. Progressive narrowing of the visual fields is another classic sign of glaucoma. This disease is one of the main causes of vision loss and related disability in the population. There are three main forms of glaucoma – primary open-angle, primary angle-closure, and secondary glaucoma, which develops against the background of existing eye pathology (diabetic retinopathy, acute iridocyclitis, post-thrombotic ophthalmopathy). Primary open-angle glaucoma is the most common form of the disease, which usually affects older people. The angle-closure form of glaucoma is less common, but it poses a great danger. Often this form of the disease is observed against the background of existing hypermetropia. This type of primary glaucoma develops as a result of impaired outflow in the drainage system of the eye due to the collapse of Schlemm's canal. Anterior chamber is significantly reduced in size or even disappears, and the lens is closely adjacent to the cornea. Angle-closure glaucoma has a paroxysmal form, rapid progression, and a less favorable prognosis. An acute attack of angle-closure glaucoma in some cases requires immediate hospitalization with subsequent surgical intervention.

Effectiveness of the system for predicting the risk of developing an acute angle closure glaucoma attack

To assess the effectiveness of predicting the development of PACG in eyes with short anterior-posterior axis. The study included 69 patients (90 eyes) aged 46 to 80 years with short anterior-posterior axis. We used our own mathematical formulas for calculating the risk of PACG development. According to these formulas, two groups of patients with high risk of PACG were selected. Patients of the main group underwent cataract phacoemulsification for preventive purposes, while patients of the comparison group did not undergo any operative treatment. In the long-term, PACG did not develop in the patients of the main group. Patients of the comparison group refused to undergo cataract phacoemulsification, and had PACG develop in 38% of cases in the long-term follow-up. The high efficiency of the developed screening model for estimating the risk of PACG developing in eyes with short anterior-posterior axis has been proved. Preventive cataract phacoemulsification in the eyes with a high risk of PACG development in all cases helped to avoid it, retaining and even improving visual functions.

Acute Glaucoma Attack Following Microvascular Decompression Surgery for Trigeminal Neuralgia

Microvascular decompression (MVD) is widely accepted as an effective surgical method to treat trigeminal neuralgia (TN), but the risks of morbidity and mortality must be considered. We experienced a case of acute angle-closure glaucoma attack following MVD for TN in an elderly patient, considered to be caused by lateral positioning during and after the surgery. A 79-year-old female underwent MVD for right TN in the left lateral decubitus position, and TN disappeared after the surgery. Postoperatively, the patient tended to maintain the left lateral decubitus position to prevent wound contact with the pillow, even after ambulation. Two days after the surgery, she complained of persistent left ocular pain with visual disturbance. The left pupil was dilated with only light perception, and the intraocular pressure (IOP) was 44 mmHg. Acute angle-closure glaucoma attack was diagnosed. After drip infusion of mannitol, emergent laser iridotomy was performed. The corrected visual acuity recovered with normalization of IOP (14 mmHg). The subsequent clinical course was uneventful and she was discharged from our hospital. The left lateral positioning during and after the surgery was considered to have contributed to increase IOP of the eye on the dependent side, which resulted in acute angle-closure glaucoma attack. The potential pathology is difficult to assess preoperatively, but patient management should always consider the increased possibility of this condition with age.

Precipitation of acute angle closure glaucoma following withdrawal of donepezil hydrochloride

Drug induced bilateral acute angle closure glaucoma (AACG) is well known entity reported but accidental withdrawal of a drug precipitating an attack of AACG is rare. Abrupt termination of donepezil, an FDA approved acetylcholinesterase inhibitor to treat mild to moderate Alzheimer’s disease, is often attributed to occurrence of side effects. In this case, incidence of bilateral AACG following discontinuation of donepezil hydrochloride in a 76-year-old female patient with Alzheimer’s disease is presented.

Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature

Posterior chamber intraocular lens (PC-IOL) subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.

Ocular biometric characteristics of acute and chronic primary angle-closure glaucoma in Chinese patients.

To compare the ocular parameters of acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG). 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. 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). The eyes with AACG attack have a more crowded anterior chamber structure compared with uninvolved fellow eyes and eyes with CACG.

The effect of anterior chamber paracentesis for treating acute attack of angle-closure glaucoma in different period

Objective To evaluate the effect of anterior chamber paracentesis for treating acute attack of angle-closure glaucoma in different period.Methods The 60 cases of primary angle-closure glaucoma in the first acute attacking period were divided into three groups:group A,n =20,operation time within 24 hours after the onset,group B,n =20,operation time in one to three days after the onset,group C,n =20,operation time in four to seven days after the onset.After paracentesis of anterior chamber,medications were applied to control intraocular pressure (IOP).The medical records of pain,IOP,vision,anterior chamber angle in three groups were comparatively analyzed.Results Tne decrease of IOP had significant different between the three groups.The IOP drop value in group A was larger than that in group B (t =3.77,P =0.000),which was higher than that in group C (t =2.85,P =0.01).The differences were statistically significant in degrees of pain relief,vision improvement,opening of anterior chamber angle among the three groups.The results of group A were better than group B (x2 =5.63,P =0.03 ;x2 =13.08,P =0.00 ;x2=10.99,P =0.00).The results of group B were better than group C (x2 =3.87,P =0.04 ;x2 =6.05,P =0.04 ;x2 =4.80,P =0.03).The differences were statistically significant in the number of the patients who underwent YAG laser peripheral iridotomy in those three groups,the number in group A was larger than group B (x2 =10.99,P=0.00),the number in group B was larger than group C (x2 =4.80,P =0.03).Conclusion Paracentesis of anterior chamber on acute attack of angle closure glaucoma can effectively relieve pain in early period,control intraocular pressure,restore visual function and can decrease or even avoid the possibilities of glaucoma filtering operation.Anterior chamber paracentesis at more than 3 days after attack will not reduce the possibility of filtering operation. Key words: Glaucoma, angle-closure ; Attack, acute ; Pressure, intraocular; Paracentesis, anterior chamber

Clinical study on the therapeutic alliance of acute angle-closure glaucoma with cataract

Objective To investigate the clinical significance of phacoemulsification combining initial iridoplasty by krypton and iridectomy by Nd:YAG laser treatment for cataract with acute angle closure glaucoma. Methods twenty-five eyes of 25 cases with first attack of acute angle-closure glaucoma with cataract were treated by initial laser iridoplasty and iridectomy after intraocular pressure controlled equability,followed by phacoemulsification and intraocular lens implantation after 3-14 days. The intraocular pressure,anterior chamber depth, visual acuity were observed, and the appearance of anterior chamber angle were found by Stratus OCT. Results From initial condition to after-operation, Intraocular pressure was decreased obviously from 62.17 ± 14. 12 mmHg to 14.32 ± 3. 17 mmHg. Anterior chamber depth changed from 1.67 ± 0.32 mm to 2.86 ± 0.40 mm, and the anterior chamber angle open widely. All patients had improved visual acuity. Conclusions To attack of acute angle-closure glaucoma combined with cataract, laser iridoplasty and iridectomy with followed phacoemulsification can effectively control the intraocular pressure,open the angle of anterior chamber, and improve visual acuity. It can reduce complications of glaucoma filtrating surgery, reduce the probability of trauma, improve vision, and improve quality of life. Key words: cataracts; glaucoma; surgery

Argon Laser Peripheral Iridoplasty (ALPI): An Update

Argon laser peripheral iridoplasty is a useful procedure to eliminate appositional angle closure resulting from mechanisms other than pupillary block. For those eyes with angle closure originating at an anatomic level posterior to the iris, such as plateau iris, lens-induced angle closure, or posterior segment processes (malignant glaucoma, central retinal vein occlusion, etc.), laser iridotomy by itself may be insufficient to treat the underlying disease mechanism. Argon laser peripheral iridoplasty is often useful in these cases to further open the angle. It can be used to break an acute attack of angle-closure glaucoma and relieve appositional angle closure secondary to plateau iris syndrome, or lens-related angle closure, and to widen the angle prior to argon laser trabeculoplasty. Peripheral location of long-duration, low-power, large spot size laser burns is essential for optimal success.

Two Cases of Acute Angle Closure Glaucoma Attack which were Triggered by Scoporamine Hydrobromide

Two Cases of Acute Angle Closure Glaucoma Attack which were Triggered by Scoporamine Hydrobromide