Changes In Anterior Chamber Angle Research Articles

A study of mydriatic effect on intraocular pressure and anterior chamber angle morphology by anterior segment optical coherence tomography

Context Pharmacological mydriasis possibly is associated with intraocular pressure (IOP) rise and anterior chamber angle changes. Hence, this study is focused on pressure analysis with anterior segment optical coherence tomography measurements of angle parameters during various dilation phases. Aims Purpose is to investigate IOP variations during dilation phases and to discover association of anterior segment optical coherence tomography measurements. Settings and design Observational study. Patients and methods Thirty-two participants were recruited and IOP measured by rebound tonometer in pre, mid, and full pupillary dilation phases. Lens vault (LV at horizontal and vertical), angle opening distance (AOD at 500 and 750 μm) and trabecular iris space area (TISA at 500 and 750 μm) in temporal and nasal scans were quantified. Paired t test performed to establish a statistical significance P value less than or equal to 0.05. Statistical analysis used MS Excel. Results A total of 32 participants with mean age of 47.5±10.94 years consisting of 17 (53.13%) males and 15 (46.87%) females with 20 (62.5%) right and 12 (37.5%) left eyes were investigated. Mean IOP in pre, mid, and full-dilation phases were 14.86±2.87, 15.94±2.72, and 15.63±2.69 mmHg. Predilation IOP with IOP in mid and full dilation showed statistical significance (P=0.0001, 95% confidence interval 0.56–1.56) and 0.88 and 0.85 Pearson’s coefficients, respectively. IOP analysis with LV, AOD, and TISA in pre, mid, and full-dilation phases exhibited a significant difference (P<0.0001). Conclusion This research highlights an increase in IOP alongside a noteworthy decrease in the average LV by 30.94 μm during mid-dilation compared to the predilation phase. Likewise, the AOD at 750 μm demonstrated a significant reduction by 0.40 and 0.45 μm in temporal scans during mid and full dilation, respectively, while TISA remained unchanged.

Incidence and predisposing factors of intraocular Lens tilt following secondary ciliary sulcus implantation in children: An ultrasound biomicroscopic study.

To evaluate the incidence and causes of intraocular lens (IOL) tilt and changes in anterior chamber angle after secondary IOL sulcus implantation following congenital cataract removal. A retrospective observational study was conducted on children who underwent secondary sulcus IOL implantation following pediatric cataract removal in the period from 2017-2020 in Cairo university Hospitals. Children were examined for IOL position, centration, and tilt. Intraocular pressure (IOP) measurement, fundus and gonioscopic examination was performed. Ultrasound biomicroscopy (UBM) was performed on both eyes in children with clinically detected tilt. Ciliary sulcus secondary IOL implantation was performed in 102 eyes (57 children). IOL tilt was detected clinically in 16 eyes of 14 children (15.7%). UBM showed clinically undetected tilt in the fellow eye in additional 4 eyes. The mean angle of tilt was 12.8 ± 3.9° in clinically detected tilt compared to 7.5 ± 1.2° in UBM detected tilt. Mean anterior chamber depth (ACD) was 2.4 ± 0.5 mm IOP was >21 mmHg in 1.9% of eyes. Narrowing of the anterior chamber angle (ACA) after sulcus implantation occurred in 40% of eyes with open angle. Sulcus proliferations and obliterated sulcus were detected in all 20 eyes. Sommering's ring was found in 7 eyes (35%). Axial length, corneal diameter, and presence of persistent fetal vasculature did not affect IOL position. The presence of residual lens matter or an obliterated ciliary sulcus is associated with a higher incidence of IOL malposition following ciliary sulcus implantation.

Changes in Anterior Chamber Angle and Choroidal Thickness in Patients with Primary Angle-Closure Glaucoma after Phaco-Goniosynechialysis.

We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) complicated by cataracts. This prospective cohort study included 60 patients with PACG complicated by cataracts from the Department of Ophthalmology of Shaoxing People’s Hospital, China. Patients underwent PEI combined with GSL (PEI-GSL group) or laser peripheral iridotomy (LPI) followed by PEI (PEI group). Intraocular pressure (IOP) and endothelial counts were significantly decreased in both groups after surgery, while best-corrected visual acuity and central anterior chamber depth were significantly increased. However, there were no significant differences between the two groups. The opening degrees of room corners at 12, 3, 6, and 9 o’clock were recorded as AA12, AA3, AA6, and AA9, respectively. Anterior chamber depth was significantly increased postoperatively compared to preoperatively in both groups, with no significant between-group differences (all ps > 0.05). At 1, 3, and 6 months postoperatively, the width at AA12, AA3, and AA9 points was higher in the PEI-GSL group than in the PEI group (all ps < 0.05). Significant between-group differences at AA6 were observed preoperatively (p = 0.023) and at 1 (p = 0.027) and 3 (p = 0.033) months postoperatively but not at 6 months postoperatively (p = 0.055). CT was smaller postoperatively than preoperatively (all ps < 0.001). The present study suggests that patients with PACG who underwent PEI with or without GSL had reduced IOP and CT after surgery.

Changes in Anterior Chamber Volume, Depth and Angle After Prophylactic Laser Peripheral Iridotomy in Patients With Primary Angle-closure Suspect

Background and Objectives This study aims to assess changes in anterior chamber parameters after prophylactic laser peripheral iridotomy (LPI) in patients with primary angle-closure suspect (PACS). Subjects and Methods In this study, 43 patients (86 eyes) with PACS (Mean age: 55.16±9.14 years) participated. The anterior chamber parameters including anterior chamber volume (ACV), anterior chamber angle (ACA) and central anterior chamber depth (CACD) were extracted from the Pentacam map at 0-180° meridian before and one month after prophylactic LPI. Results The only parameter that had a significant increase after LPI was ACV, which increased from 99.26±19.57 mm3 to 113.09±19.712 mm3 after LPI (P&lt;0.001). The relationship between age and ACV changes after LPI was statistically significant (P=0.014), indicating that the increase of age is associated with the increased of ACV after LPI. The relationship of ACV and ACD with their initial values was statistically significant, such that with the increase of the initial values of ACV and ACD, their changes decrease. Due to the lack of significant increase in CACD after LPI, the relationship between its changes after LPI and its initial value cannot be relied upon. Conclusion ACV is the only anterior chamber parameter that changes significantly after prophylactic LPI. This parameter can be used as a measurable scale to evaluate and monitor the eyes of patients with PACS. Among the PACS cases, older patients and patients with lower initial ACV have greater increase of ACV after LPI

Correlation between corneal refractive power and anterior chamber morphology in age-related cataract patients with shallow anterior chambers

Objective: To investigate the relationship between corneal refractive power and anterior chamber parameters in age-related cataract patients with normal axial lengths and shallow anterior chambers. Methods: Retrospective case series study. Clinical data of 627 age-related cataract patients (627 eyes) with axial lengths between 22 mm and 24 mm and anterior chamber depths less than 2.20 mm treated in the Department of Ophthalmology of Peking University International Hospital from June 2018 to October 2021 were selected. There were 215 male patients and 412 female patients, with an average age of (75±10) years. According to the average corneal refractive power, eyes were divided into groups of keratometry (K)<42 diopters (D) (50 eyes), 42 D ≤K<45 D (398 eyes) and K ≥45 D (179 eyes). Axial length, anterior chamber depth, corneal diameter, anterior chamber volume and anterior chamber angle of 3 groups were recorded, and Spearman correlation analysis was used to analyze the correlation between parameters. The differences of parameters among different groups were compared by one-way analysis of variance or Kruskal-Wallis test, and multiple or pairwise comparisons using LSD-t test or Mann-Whitney U test. Results: There was a negative correlation between axial length and corneal refractive power in 627 eyes (r=-0.62, P<0.001). Corneal refractive power was positively correlated with anterior chamber depth (r=0.26, P=0.006), while in the K≥45 D group, corneal refractive power was also positively correlated with anterior chamber depth (r=0.23, P=0.025). Anterior chamber depth [M (Q1,Q3)] was 1.77 (1.64, 1.90) mm in the K<42 D group, 1.85 (1.70, 2.14) mm in the 42 D≤K<45 D group and 2.02 (1.81, 2.18) mm in the K≥45 D group. Multiple comparisons showed that there were significant differences in anterior chamber depth between the K<42 D group and the K≥45 D group, between the 42 D≤K<45 D group and the K≥45 D group (U=14 372.00, 18 226.00; both P<0.05). There was a negative correlation between corneal refractive power and corneal diameter in 627 eyes (r=-0.52,P<0.001), while in the 42 D≤K<45 D group and the K≥45 D group, corneal refractive power were also negatively correlated with corneal diameter (r=-0.20, -0.28; both P<0.05). Corneal diameter was (11.77±0.43) mm in the K<42 D group, (11.24±0.35) mm in the 42 D≤K<45 D group and (10.90±0.33) mm in the K≥45 D group, while there were significant differences in multiple comparisons (t=1.92, 2.96, 2.01; all P<0.05). There was no correlation between corneal refractive power and anterior chamber volume, or between corneal refractive power and anterior chamber angle in 627 eyes (all P>0.05). There was no significant difference both in anterior chamber volume and in anterior chamber angle among 3 groups (all P>0.05). Conclusion: For age-related cataract patients with normal axial lengths and shallow anterior chambers, the anterior chamber depth increase and the corneal diameter decrease with the increase of corneal refractive power, but there is no significant change in anterior chamber volume and anterior chamber angle.

Comparison of Anterior Chamber Depth with Posture Change Between Primary and lens-induced Angle Closure Glaucomas

Purpose: To compare the changes in central anterior chamber depth between supine and sitting positions using an ultrasound biomicroscope among acute angle closure glaucoma, lens-induced angle closure glaucoma, and normal groups.Methods: This study included 18, 13, and 29 individuals with acute angle closure glaucoma, lens-induced angle closure glaucoma, and control, respectively. The central anterior chamber depth, trabecular iris angle, corneal curvature, and axial length were measured in the sitting and supine positions.Results: The central anterior chamber depth in the supine and sitting positions were 1.61 ± 0.47 mm and 1.55 ± 0.46 mm in the acute angle closure glaucoma, which were significantly smaller than those in the normal group (2.48 ± 0.49 mm and 2.47 ± 0.50 mm) (p = 0.01 and p = 0.009, respectively). In lens-induced angle closure glaucoma, the central anterior chamber depth in the supine and sitting positions were 1.65 ± 0.84 mm and 1.52 ± 0.82 mm, respectively, which were significantly smaller than those in the normal group (p &lt; 0.001 for both). The absolute change in central anterior chamber depth with posture alteration was significantly larger in both acute angle closure glaucoma (0.15 ± 0.09 mm) and lens-induced angle closure glaucoma (0.25 ± 0.11 mm) than in the normal control (0.09 ± 0.08 mm) (p = 0.011, p &lt; 0.001, respectively). The largest amount of change was shown in the lens-induced angle closure glaucoma (p = 0.012). The absolute change in anterior chamber angle with posture change wa not significantly different between the groups (p = 0.165).Conclusions: Compared to the control group, the central anterior chamber depth was smaller in both glaucoma groups. The absolute change in the anterior chamber depth with posture was significantly larger in the lens-induced angle closure glaucoma than in acute angle closure glaucoma.

Anterior Chamber Angle Changes in Primary Angle-closure Glaucoma Following Phacoemulsification Versus Phacotrabeculectomy: A Prospective Randomized Clinical Trial.

We used anterior segment optical coherence tomography to investigate anterior chamber angle in primary angle-closure glaucoma (PACG) eyes following phacoemulsification and phacotrabeculectomy. Angle widening was significantly greater after phacoemulsification up to 6 months after the surgery. To compare anterior chamber angle following 2 common surgeries for PACG. One hundred ten glaucoma patients were evaluated in this single center, prospective, randomized clinical trial. Those with concomitant PACG and senile cataract and without a history of ocular surgery, trauma, or chronic miotic use were recruited. Monocular patients were also excluded. Finally, 52 eligible subjects were randomly assigned to phacoemulsification ("Phaco" group, 25 eyes) or phacotrabeculectomy ("Combined" group, 27 eyes) surgeries. A swept-source, anterior segment optical coherence tomography device (CASIA SS-1000 OCT) was used to image the anterior segment. Mask graders used the images to measure the following parameters before and 1 week, 1 month, and 6 months after surgery: angle opening distance at 500 µm, trabecular iris surface area at 500 µm, and trabecular iris angle at 500 µm. There was no significant difference between study groups regarding best-corrected visual acuity, intraocular pressure (IOP), and the number of glaucoma medications in preoperative or postoperative visits (P>0.076). Also, the measured angle parameters were not statistically significantly different between the 2 groups before surgery (P>0.123). After surgery, all measured parameters were significantly increased in both groups (P<0.0001). At the 6-month follow-up, nasal angle opening distance at 500 µm was 0.383±0.027 vs. 0.349±0.017, trabecular iris surface area at 500 µm was 0.141±0.007 vs. 0.125±0.005, and trabecular iris angle at 500 µm was 40.1±12.9 vs. 34.6±3.1 in Phaco and Combined groups, respectively (P<0.0001 for all). Anterior chamber angle widening by anterior segment optical coherence tomography was observed in PACG patients following surgery and was significantly greater after phacoemulsification compared with combined phacotrabeculectomy at all time points. Similar IOP and medication burden were noted for up to 6 months as secondary outcomes. The contribution of angle changes to the IOP-lowering effect of phacoemulsification in PACG eyes needs further study.

Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT.

To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.

Anterior Chamber Configuration Changes after Phacoemulsification and Intraocular Lens Implantation Measured by Anterior Segment Optical Coherence Tomography

Background: Phacoemulsification can cause changes in the measurements of the anterior segment. Anterior segment optical coherence tomography [AS-OCT] is a disconnected probe device that can detect variations in the anterior segment parameters. The aim of the work: The current study aimed to investigate changes in anterior chamber angle [ACA] morphology and intraocular pressure [IOP] after phacoemulsification of cataract and intraocular lens implantation by comparing two groups of patients using two brands of IOL [Sensar 1 hydrophobic one-piece IOL] and [Eyecryl hydrophilic one-piece IOL] in patients with senile cataract using [AS-OCT]. Patients and Methods: Our study was a prospective randomized study including 30 eyes with impaired vision due to cataract, as the only cause of visual regression selected from the patients who attended Al-Azhar University Hospital [Damietta branch] Ophthalmic outpatient Clinic and were randomized into two groups. Group A [15 eyes] was implanted with [Sensar 1 hydrophobic IOL] and Group B [15 eyes] was implanted with [Eyecryl hydrophilic IOL]. Results: the results revealed that there was a significant increase in the AC angle in both groups, except for the AC depth in group A, but the difference between groups was statistically non-significant. Conclusion: Phacoemulsification with IOL implantation led to an increase in the ACA, a marked increase in BCVA and a reduction in IOP, if using [Sensar 1 hydrophobic one-piece IOL] or [Eyecryl hydrophilic one-piece IOL]. However, we cannot generalize the results because of the small sample size.

Comparison of anterior chamber angle changes following phakic intraocular lens with and without a central hole implantation for moderate to high myopic eyes.

The aim of this study was to compare the anterior chamber angle changes after implantation of phakic intraocular lens with and without a central hole for moderate to high myopic eyes in Chinese people.This study enrolled 106 eyes of 54 people with intraocular lens V4 implantation and 105 eyes of 53 people with intraocular lens V4c implantation. Postoperative vault, intraocular pressure, and anterior chamber angle changes were assessed using noncontract tonometer and ultrasound biomicroscope, respectively, at 1, 3, 6, and 12months after the surgery.There were no significant differences (all P > .05) between the 2 groups in the depth of the central vault, intraocular pressure, or the width of anterior chamber angle at any time point post-surgery. The anterior chamber angle width in degree had a baseline of 54.40 ± 10.51 in V4c group, and decreased to 27.80 ± 5.62, 26.95 ± 5.56, 27.32 ± 5.66, 27.04 ± 5.47 at 1, 3, 6, and 12 months post-surgery, respectively. Mean preoperative value of 50.62 ± 11.77 decreased to 27.28 ± 6.53, 26.82 ± 6.03, 26.61 ± 5.80, 26.83 ± 5.76 at 1, 3, 6, 12 months, respectively, in V4 group. It had sufficient evidence (P < .001) that anterior chamber angle will narrow done after surgery, but there were no statistically significant differences within groups at any time point after surgery.The anterior chamber angle changes of the V4c group was essentially equivalent to that of conventional V4 group, although implantation of both models will lead to the decrease in anterior chamber angle width.

Comparative Study of the Effects of 1% Atropine on the Anterior Segment.

Purpose To investigate the influences of atropine on changes in anterior segment geometry, as measured by ultrasound biomicroscopy in children. Methods A prospective observational study was performed. Anterior segment parameters were obtained by UBM before and after the instillation of 1% atropine. Univariate linear regression was performed to identify the variables contributing to the changes in the trabecular meshwork-iris angle (TIA). Results The study included 21 boys and 37 girls with a mean age of 10.79 ± 2.53 years. Anterior chamber parameters including the central anterior chamber depth, TIA, angle opening distance at 500 μm from the scleral spur, iris thickness 750 μm and 1500 μm from the scleral spur, trabecular-ciliary angle (TCA), trabecular-ciliary process distance, sclera-iris angle (SIA), and sclera-ciliary process angle significantly increased after cycloplegia (P < 0.05). In contrast, the lens vault, iris cross-sectional area, and maximum ciliary muscle thickness significantly decreased after cycloplegia. Univariate analysis identified the change in TCA and the change in SIA and the TIA before mydriasis as determinants of the change in TIA. Conclusions Atropine causes statistically significant changes in various anterior segment parameters in children. The change in anterior chamber angle is associated with the change in TCA and the change in SIA and the TIA before mydriasis.

Changes in Intraocular Pressure and Anterior Chamber Angle After Congenital Cataract Extraction.

Anterior chamber angle (ACA) narrowing continues to occur for at least 2 years after congenital cataract surgery. Risk factors for intraocular pressure (IOP) elevation after congenital cataract surgery were higher central corneal thickness (CCT) and surgery at <2 months. The purpose of this study was to study the changes in IOP and in the ACA during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes. A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, CCT pupil diameter, IOP, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary intraocular lens implantation, and perioperative subconjunctival steroid injection. Changes in IOP and in the ACA were recorded, and the risk factors for such changes were analyzed. Postoperative IOP elevation >18 mm Hg occurred in 23 eyes of 206 eyes (11%), who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Years 1 and 2, respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42, respectively). Higher preoperative CCT was a risk factor for early-onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late-onset IOP elevation.

Evaluation of pupil responses and anterior chamber parameters in overactive bladder syndrome before and after antimuscarinic treatment

To evaluate the static and dynamic pupillometric responses and anterior chamber parameters in overactive bladder (OAB) patients before and after solifenacin succinate treatment and to compare these results with those of healthy control subjects. Forty OAB patients who were planned to be treated with solifenacin succinate and 40 control subjects without any systemic or ocular diseases were included in the study. Following detailed ophthalmological examination, Pentacam imaging in order to detect anterior chamber angle, depth and volume; and static and dynamic pupillometry measurement in order to detect high-photopic (100 cd/m2), low-photopic (10 cd/m2), mesopic (1 cd/m2) and scotopic (0.1 cd/m2) pupil diameters, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation and velocity of pupil dilation were performed at baseline and at the first month of treatment. Data from the right eyes of the participants were used for statistical analysis. Baseline low- and high-photopic pupil diameters, duration of pupil contraction, latency of pupil dilatation and velocity of pupil dilatation values were significantly higher; and velocity of pupil contraction and duration of pupil dilation values were lower in the OAB group compared to the control group (P < 0.05 for all). One-month treatment with oral solifenacin succinate revealed higher scotopic and mesopic pupil diameters (P = 0.042, P = 0.031, respectively). Also, latency of pupil contraction was found to be increased and velocity of pupil dilatation was found to be decreased compared to pretreatment (P = 0.003, P < 0.001, respectively). We did not find any significant change in anterior chamber angle, depth and volume measured with Pentacam HR compared to pretreatment. Patients with OAB also have pupil abnormalities which probably reflect an underlying autonomic disorder that affects the bladder and pupils. One-month treatment of solifenacin succinate may lead to enlargement of pupil diameters under low illumination conditions and may lead to changes in dynamic pupillometric responses compatible with antimuscarinic treatment. Systemic antimuscarinic therapy has no effect on anterior chamber depth and intraocular pressure.

Anterior chamber angle and intraocular pressure changes after eventless phacoemulsification surgery in non-glaucomatous Egyptian patients.

The purpose was to evaluate the angle of the anterior chamber (ACA) and intraocular pressure (IOP) changes following eventless phacoemulsification surgery done for non-glaucomatous Egyptian patients. A prospective, interventional study involved 126 cataractous patients undergoing phacoemulsification with intraocular lens implantation. Patients were investigated for ACA and IOP preoperatively and postoperatively at 1month and 6months. Anterior chamber angles were evaluated by Scheimpflug camera, and IOP was measured by Goldmann applanation tonometer. A total of 144 eyes from 126 patients were enrolled: 65 males and 79 females; mean age was 59.72years. At 6months after phacoemulsification, there was highly significant decrease in IOP (P = 0) and anterior chamber angle (P = 0). The change in IOP did not correlate statistically with patient age, preoperative IOP, preoperative ACA or ACA widening. Phacoemulsification reduced significantly IOP which was maintained for 6months and widened significantly the anterior chamber angle. None of the studied parameters in our study has proved to be a reliable predictive factor to the amount of IOP drop after phacoemulsification.

Changes in intraocular pressure and anterior chamber angle after congenital cataract extraction

The Abouelreesh Pediatric Cataract Database (APCD) is an electronic database started on January 2016 to record data of pediatric cataract cases performed in Cairo University Children's Hospital with minimal data loss.

Changes in Anterior Chamber Depth and Angle Before and After Phacoemulsification of Intumescent Cataract

Changes in Anterior Chamber Depth and Angle Before and After Phacoemulsification of Intumescent Cataract

Comparison of Intraocular Pressure and Anterior Chamber Angle Changes between Pilocarpine and Laser Peripheral Iridotomy.

ABSTRACTAimTo compare intraocular pressure and anterior chamber angle changes between pilocarpine and laser peripheral iridotomy in primary angle closure.Materials and methodsIn this clinical trial study, 34 eyes of 29 patients with primary angle-closure were prospectively enrolled between November 2015 and February 2016. Intraocular pressure and anterior segment optical coherence tomography were performed at three separate times: on the initial conditions, 3–5 days of administration of topical pilocarpine 2%, and 1 week after laser iridotomy. Anterior chamber angle parameters were the angle opening distance (AOD) and trabecular–iris space area (TISA).ResultsThe intraocular pressure reduction following pilocarpine administration was significant compared to laser iridotomy: 3.9 mm Hg (−32.5 to 0.20) vs 1.8 mm Hg (−33.5 to 2.30) (p = 0.002). Meanwhile, the increment of angle parameters following laser iridotomy was significant compared to pilocarpine. The AOD750 increment of both nasal and temporal quadrant following laser iridotomy was significant compared to pilocarpine: 0.13 mm (−0.27 to 0.28) vs 0.05 mm (−0.35 to 0.29) (p = 0.003) and 0.12 mm (−0.10 to 0.34) vs 0.04 mm (−0.27 to 0.19) (p = 0.002), respectively. The TISA750 increment of both nasal and temporal quadrant following laser iridotomy was also significant compared to pilocarpine: 0.05 mm2 (−0.06 to 0.20) vs 0.02 mm2 (−0.12 to 0.13) (p = 0.023) and 0.04 mm2 (−0.04 to 0.17) vs 0.01 mm2 (−0.14 to 0.18) (p = 0.012), respectively.ConclusionLaser peripheral iridotomy widens the angle greater than topical pilocarpine, but topical pilocarpine lowers the intraocular pressure greater than laser iridotomy. These data suggest that pilocarpine has another mechanism to decrease the intraocular pressure in primary angle-closure, besides widening the angle.How to cite this articleYunard A, Oktariana VD, et al. Comparison of Intraocular Pressure and Anterior Chamber Angle Changes between Pilocarpine and Laser Peripheral Iridotomy. J Curr Glaucoma Pract 2019;13(1):32–36.

Observation on the effect of corneal suture depth for wound healing of corneal perforating injury

Objective To observe the effect of corneal suture depth on wound healing after corneal perforating suture surgery. Methods The data of 55 eyes of 55 consecutive cases with corneal perforating injury from Jan.2015 to Jan.2016 were collected. All cases received corneal perforating suture surgery. They were examined with anterior segment panoramic optical coherence tomography (AS-OCT) under panoramic mode. The corneal suture depth, structural changes of cornea and anterior chamber angle were observed and analyzed after surgery. Results All cases were divided into 5 groups according to depths of corneal suture. The depths compared with cornea thickness (CT) were 3/4 CT in 22 cases; 2/3 CT in 25 cases; 1/2 CT in 5 cases; 1/3 CT in 2 cases and 1/4 CT in 1 case. No wound healed or iris prolapse happened in patients with depth≥2/3CT. Corneal wound dislocation, dehiscence and iris attachment occurred in cases with depth ≤1/2CT. Conclusion The corneal suture depth ≥2/3CT for wound healing of patients with corneal perforating injury is effective.Anterior segment panoramic OCT is of value for evaluating outcomes after corneal penetrating suture, determining prognosis, guiding management decisions and surgical planning. Key words: Wound healing; Suture, corneal; Injury, penetrating, corneal

Temporal ocular coherence tomography-measured changes in anterior chamber angle and diurnal intraocular pressure after laser iridoplasty: IMPACT study

AimsTo evaluate temporal change in anterior chamber angle anatomy following argon laser peripheral iridoplasty (ALPI) in eyes with occludable angles postlaser peripheral iridotomy (LPI) compared with control eyes. Additionally, the...

Phacoemulsification combined with goniosynechialysis in the treatment of cataract with acute angle-closure glaucoma

Objective To observe the clinical efficacy of phacoemulsification combined with goniosynechialysis for cataract patients with acute primary angle-closure glaucoma. Methods From February 2010 to January 2014, 54 eyes of 54 cases with cataract and acute primary angle-closure glaucoma admitted to our department were selected in this study. All patients received phacoemulsification combined with goniosynechialysis. The visual acuity, intraocular pressure, anterior chamber depth and angle changes before and after the treatment were compared. The clinical effects of this surgical approach were analyzed. Results The visual acuities 6 months after the surgery were significantly better than those before the surgery(P<0.05), and only two eyes with age-related macular diseases had poor visual acuities less than 0.1. One day after the surgery, the intraocular pressure was (13.22±3.44) mmHg (1 mmHg=0.133 kPa). One month after the surgery, the intraocular pressure was (13.87±1.11) mmHg.The intraocular pressure of three and six months after surgery were (13.81±0.97)mmHg and(13.07±1.05)mmHg respectively. Six months after the surgery, the central and peripheral anterior chamber depth were (3.53±0.32)mm and (3.91±0.14)mm respectively, both were evidently higher than those before the surgery (P<0.05). The angle grading after the surgery were improved remarkably compared with the preoperative one(P<0.05). Corneal edemas occured in six eyes, and anterior chamber inflammation and iris fibrinoid exudations occured in four eyes. The anterior chamber of two eyes were shallow. The intraocular lens were adhered to pupil in three eyes. Conclusion Phacoemulsification combined with goniosynechialysis is safe and effective for angle-closure glaucoma. This kind of combined surgery can obviously increase the depth of the anterior chamber, improve the openness of angle, improve the vision and reduce the intraocular pressure. Key words: Glaucoma, angle-closure; Phacoemulsification; Cataract; Goniosynechialysis