Secondary Acute Angle-closure Glaucoma Research Articles

Unilateral acute secondary angle-closure glaucoma in active thyroid eye disease

<br>Thyroid eye disease (TED) is the most common and disfiguring orbital disease in adults. This complex condition is characterized by autoimmune-mediated inflammation of the orbital soft tissues, extraocular muscles, and eyelids. Majority of those with TED have autoimmune hyperthyroidism (Graves disease), but rarely patients can have hypothyroidism or normal thyroid function. Association of TED with open-angle glaucoma has been reported widely, whereas its association with angle-closure glaucoma has been sparsely reported as case reports. We report two instances of secondary angle-closure glaucoma (SACG) in patients with active TED, with focus on clinical presentation, diagnostic challenges, and presumed mechanisms of angle closure.<br>

Letter. Topiramate‐induced acute angle closure glaucoma

Sir, I read with interest your ‘Drug notes’ article about topiramate and its use for weight reduction in patients with obesity.1 I note that the other uses of the drug are as an anti-epileptic and for the prevention of migraine. Among the many side effects of the drug, visual disturbances, diplopia and eye pain are frequently mentioned in the literature. I would like to draw the attention of readers to a more serious side effect: acute secondary angle closure glaucoma, which is often bilateral.2, 3 The British National Formulary documents this.4 Many cases have previously been reported by ophthalmologists.2, 3, 5, 6 Now that weight reduction is being considered as an indication1 in addition to the other established uses (epilepsy and migraine), it is possible that the incidence of acute angle closure glaucoma could soon rise. Therefore, primary care practitioners and eye emergency doctors should be alert to the possibility of this occurring, and the presentation and management of these patients. The cases presented seem to be between 30–60 years of age, occur in both sexes, and seem to arise a few weeks after starting topiramate treatment. Patients present with acute onset of myopia with reduction of visual acuity. Acute angle closure glaucoma often occurs bilaterally with very high intra-ocular pressures. Ophthalmologists should be aware that management of these secondary angle closure cases is completely different from the management of the primary acute angle closure glaucomas. Box 1 (above) summarises acute secondary angle closure glaucoma presentation, signs, mechanism of onset, and management. Presentation5-7 • Acute onset of myopia, often bilateral • Reduction in visual acuity • Moderate to severe eye pain, sometimes with halos • History of starting topiramate within a month or so Signs • Possible red eye with corneal oedema • Shallow anterior chambers • Pupils may be fixed or mobile; pressures often high • Lens swollen, anteriorly displaced • B-scan examination showing shallow anterior chamber, angle closure and generalised swelling of ciliary body and choroid Mechanism of onset The onset seems to be due to cilio-choroidal effusion, which tends to push the lens forward due to ciliary and vitreous pressure inducing myopia and angle closure5-7 Management In cases of bilateral angle closures, always ask about topiramate • Stop the medication immediately • Start oral or intravenous carbonic anhydrase inhibitors such as Diamox and topical treatment with brinzolamide or dorzolamide • Do not use pilocarpine; instead use cycloplegia (cyclophentolate) • Some have used laser peripheral iridotomy • Topical steroids to promote decongestion • Iopidine and beta blockers could be useful I hope your readers would appreciate this information. There are no conflicts of interests declared.

Primary Iris Stromal Cyst Presenting As Acute Secondary Angle Closure Glaucoma Treated with ND:YAG LASER Peripheral Iridotomy — A Rare Occurrence

Primary Iris Stromal Cyst Presenting As Acute Secondary Angle Closure Glaucoma Treated with ND:YAG LASER Peripheral Iridotomy — A Rare Occurrence

Uveal effusion induced by escitalopram

Case reportA 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DiscussionThe uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology.

Efusión uveal inducido por escitalopram

Case reporTA 73 year-old woman with depression treated with escitalopram developed acute secondary angle closure glaucoma related to uveal effusion after duplicating the drug dose 3 days before. She evolved favorably once the antidepressant treatment was suspended and a new treatment with topical hypotensive therapy and oral prednisone was used. DiscussionThe uveal effusion syndrome associated to medicines is rare; it may be associated with acute myopic shift and acute angle closure glaucoma. The correct diagnosis and discontinuation of the drug lead to the resolution of this nosology.

Secondary glaucoma in a 76 year old male following couching by a traditional healer: A case report

Any opacity or loss of transparency of the lens that caused diminution or impairment of vision is called cataract. Treatment of cataract is by surgical extraction. Couching is the earliest form of cataract surgery, traced to Assyria in 1700 BC. Couching procedures result on lens luxation, or subluxation or dislodgement, not an extraction. Lens luxation may be associated with many complications, some of which are vision threatening. Forward dislodgement of the lens into the anterior chamber can cause damage to the corneal endothelium and induce acute secondary angle-closure glaucoma. Obstruction to aqueous outflow can also result as a direct consequence of damage to the trabecular meshwork. This is a case report of a 76 year-old black male who developed acute secondary angle-closure glaucoma, 8 months after undergoing couching by a traditional healer. Key words: Cataract, couching, Secondary glaucoma lens dislodgement.

Typical migraine or ophthalmologic emergency?

We describe the case of a 47-year-old woman who came to the emergency department (ED) complaining of worse than typical migraine headache and blurry vision after recently doubling the dose of topiramate earlier that day. After complete neurologic and ophthalmologic evaluation, she was found to have elevated intraocular pressures and was diagnosed with topiramate-induced bilateral acute angleclosure glaucoma, which is a rare side effect of this commonly prescribed medication. She was treated with timolol, brimonide, and prednisolone drops to reduce intraocular pressure as well as cessation of topiramate and was discharged home. This report briefly discusses the clinical history, appropriate evaluation, differential diagnosis, and approach to secondary acute angle-closure glaucoma in the ED.

Secondary Bilateral Angle Closure Glaucoma due to Topiramate

We examined a 39-year-old female with severe headache and blurred vision. She was on topiramate, 50 mg once a day for one week because of migraine. Periorbital edema, chemosis, myopia, high intraocular pressures, and shallow anterior chambers were present at the initial examination. Iridocorneal angles were closed, ultrasound showed choroidal effusions. We stopped topiramate and started antiglaucoma treatment. After one week the intraocular pressure was 10 mm Hg in both eyes without treatment. A new ultrasound showed no choroidal effusions. Topiramate has been associated with acute secondary angle closure glaucoma as an idiosyncratic reaction to the drug. Physicians prescribing topiramate need to alert patients of this potential sight-threatening idiosyncratic reaction.

Topiramate Induced Acute Secondary Angle Closure Glaucoma And Myopic Shift : A Case Review

Introduction : Acute myopia and secondary acute angle-closure glaucoma are serious adverse effects of topiramate use, both of which are reversible with immediate discontinuation of the drug. Topiramate is an oral sulfamate medication used primarily for epilepsy and migraine1. Other uses of topiramate include use in management of peripheral neuropathies and radiculopathies, idiopathic intracranial hypertension, adjunctive therapy in alcohol dependence and nicotine cessation2• Case presentation: A 40 year old man, on oral topiramate for alcohol dependence, presented with complaints of severe pain, redness and sudden loss of vision in both eyes since two days. Best corrected visual acuity was 20/20 in both eyes with minus three diopters sphere. A diagnosis of secondary angle closure glaucoma with myopic shift was made.• Conclusion : Topiramate was discontinued immediately and anti glaucoma therapy initiated along with topical steroids. Unaided visual acuity returned to 20/20 in both eyes with normal anterior segment and intraocular pressure within one week of treatment.

The explore of management of secondary acute angle-closure glaucoma associated with lens subluxation by microsurgical operation

目的 探讨晶状体不全脱位致急性闭角型青光眼的临床诊治经验.方法 回顾性分析我院确诊为晶状体不全脱位致急性闭角型青光眼的患者资料.本组病例共20例(21眼),临床表现均为急性闭角型青光眼;所有病例皆已根据患者晶状体移位程度及视力情况给予相应手术治疗.结果 患者出院后平均随访(16.95±15.69)个月.1例患者经保守治疗后出院.余患者术后最佳矫正视力3眼0.01～0.10,7眼0.10～0.30,4眼0.30～0.50,7眼＞0.50,眼压均控制在正常范围.经保守治疗的患者眼压控制在正常范围,无晶状体移位加重的情况出现;手术后患者无一例严重并发症,无再次手术者,眼压控制及视力恢复良好.结论 晶状体不全脱位致急性闭角型青光眼的临床特点与原发性急性闭角型青光眼类似,易误诊.细致的眼科检查将有助于提高正确诊断率.正确诊断是有效治疗的基础。

Topiramate, Pseudotumor Cerebri, Weight-Loss and Glaucoma: An Ophthalmologic Perspective

Approved for the treatment of epilepsy and migraine prophylaxis, topiramate also acts as a carbonic anhydrase inhibitor implying a potential role in the treatment of pseudotumor cerebri (PTC). Topiramate has a propensity to cause anorexia with consequent weight loss, which alone may be curative in PTC. Prescribers must be aware of several reported cases of acute secondary angle-closure glaucoma reported in patients treated with topiramate.

Akutes Winkelblockglaukom nach massiver intraokularer Blutung bei exsudativer altersbedingter Makuladegeneration unter gerinnungshemmender Therapie

Acute secondary angle closure glaucoma after massive vitreous and subretinal hemorrhage from exudative age related macular degeneration is a seldom, but devastating complication of an anticoagulative therapy. Four patients (age range 70-76 years) developed unilateral acute angle closure glaucoma after massive intraocular bleeding due to exudative age-related macular degeneration and anticoagulative therapy. Three patients received Phenprocomoun and one patient thrombolytic therapy with heparin. One eye had led to blindness at initial investigation. Pars plana vitrectomy was performed in the remaining three eyes. Within a few months, 2 of these 3 eyes were blind, one eye had light perception and all three eyes developed hypotonia. Acute angle closure glaucoma after intraocular bleeding may be the initial clinical manifestation of overtreatment with anticoagulants. Early pars plana vitrectomy probably will increase the surveillance rate of the eye but not the visual prognosis.

Clinical study on the management of angle-closure glaucoma by phacoemulsification

目的 评价白内障超声乳化吸出后房人工晶状体植入术治疗合并白内障的闭角型青光眼的疗效.方法回顾分析2003年4月至2004年11月收住院的闭角型青光眼25例(26眼),其中14眼为原发性急性闭角型青光眼,7眼为原发性慢性闭角型青光眼,5眼为继发性急性闭角型青光眼.均有不同程度的晶状体浑浊,行透明角膜切口超声乳化吸出后房硬性人工晶状体植入术.随访6月～1年(平均9.40月).结果术后随访平均眼压(10.28±2.48)mmHg(1 mmHg=0.133kPa),比术前用药后眼压(18.36±3.23)mmHg明显降低,差异有统计学意义(P＜0.05),中央前房深度由术前的(1.56±0.45)mm,增加到术后的(2.23±0.34)mm,两者比较差异有统计学意义(P＜0.05).术后22眼(84.60%)最佳矫正视力有不同程度提高.结论透明角膜切口超声乳化白内障吸出联合后房型硬性人工晶状体植入术,可有效治疗合并白内障的闭角型青光眼。

Secondary acute angle-closure glaucoma associated with vitreous hemorrhage after ruptured retinal arterial macroaneurysm

To report acute angle-closure glaucoma in a patient with dense vitreous hemorrhage due to a ruptured retinal arterial macroaneurysm. Interventional case report. A male patient presented with severe pain and decreased vision in his right eye, nausea, and vomiting. Visual acuity was hand motions, intraocular pressure was 64 mm Hg, and light reflex was not detected in the right eye. The patient underwent comprehensive ophthalmologic examination and appropriate medical and surgical management. Examination of the right eye revealed a shallow anterior chamber and closed angle; ultrasound confirmed the presence of vitreous hemorrhage. After intensive medical treatment and subsequent pars plana vitrectomy with laser treatment to the ruptured retinal macroaneurysm, pain in the right eye subsided, visual acuity improved to 20/25, and intraocular pressure decreased to 20 mm Hg. We are unaware of previous clinical reports of this finding and could find no reference to it in a computerized search utilizing MEDLINE. In our patient the pressure stabilized and the vision improved after medical and surgical management.

Topiramate-associated acute, bilateral, secondary angle-closure glaucoma

Purpose To evaluate spontaneous reports of ocular side effects associated with topiramate use. Design Retrospective case series. Methods One hundred fifteen case reports, primarily of a specific ocular syndrome (acute secondary angle-closure glaucoma), were collected from spontaneous reporting systems: the Drug Safety section of Ortho-McNeil Pharmaceuticals, Inc. (Raritan, NJ), the Food and Drug Administration (Rockville, MD), the World Health Organization (Uppsala, Sweden), the National Registry of Drug-Induced Side Effects (Casey Eye Institute, Oregon Health & Science University, Portland, Oregon), and the world literature. Main outcome measures The data were evaluated using the World Health Organization Causality Assessment Guide to the certainty of a suspected adverse drug reaction. Results Eighty-six cases of acute-onset glaucoma (83 bilateral and 3 unilateral), 17 cases of acute bilateral myopia (up to 8.75 diopters), 9 cases of suprachoroidal effusions, 3 cases of periorbital edema, and 4 cases of scleritis were reported. In those cases for which management was reported, 38% had laser or surgical peripheral iridectomy (21 cases). Conclusions In the “certain” category of the World Health Organization classification system, the following are caused by topiramate therapy: abnormal vision, acute secondary angle-closure glaucoma, acute myopia, and suprachoroidal effusions. All findings are reversible if recognized early and if the drug is discontinued. The first presenting symptom of acute secondary angle-closure glaucoma in many patients was blurring of vision. Peripheral iridectomy is ineffective for this type of angle-closure glaucoma.

Traumatic anterior lens dislocation: A case report

A 45-year-old man presented to the emergency department complaining of decreased vision and pain in the left eye after blunt trauma to the eye. On evaluation, the vision was limited to detecting hand motions, and the intraocular pressure was 37 mmHg. Secondary acute angle-closure glaucoma, with pupillary block due to anterior dislocation of the lens, was diagnosed. The intraocular pressure remained elevated after medical therapy, and the patient underwent intracapsular cataract extraction and anterior vitrectomy. The possibility of elevated intraocular pressure due to lens dislocation or other types of secondary glaucoma should be considered after blunt ocular trauma.

Hemorrhagic ocular complications associated with the use of systemic thrombolytic agents

Objective This study aimed to report three patients with hemorrhagic ocular and orbital complications associated with the use of systemic thrombolytic agents. Design The study design was a retrospective small case series. Participants Three eyes of three patients were studied. Intervention Surgical procedures to reduce intraocular pressure or relieve optic nerve compression were performed. Main outcome measures Visual acuity and intraocular pressure were measured. Results Three patients received an intravenous thrombolytic agent on diagnosis of an acute myocardial infarction. One patient had a spontaneous suprachoroidal hemorrhage develop with secondary acute angle closure glaucoma shortly after receiving tissue plasminogen activator. Another patient had an orbital hemorrhage develop on receiving tissue plasminogen activator 4 days after an uncomplicated cataract extraction. The third patient experienced an orbital hemorrhage while receiving streptokinase 1 day after undergoing an external levator resection. Two patients suffered significant visual loss due to glaucoma or compressive optic neuropathy. Conclusions The onset of eye pain or visual loss after the administration of a systemic thrombolytic agent should alert the physician to the possibility of an ocular or adnexal hemorrhage. Prompt diagnosis and treatment can improve the likelihood of a favorable visual outcome.

Secondary acute angle closure glaucoma: A complication of aids

A 58-year-old man with advanced AIDS presented to the emergency department complaining of headache and decreased vision bilaterally. On evaluation, he was found to have intraocular pressures of 69 and 65 mm Hg. After topical treatment with miotics and apraclonidine, he was given intravenous acetazolamide (Diamox) and peripheral iridotomy was performed. The pressures did not improve significantly. Secondary acute angle closure glaucoma was diagnosed. Emergency physicians should consider this diagnosis when evaluating AIDS patients with visual complaints.