Bilateral Acute Angle Closure Research Articles

Bilateral acute angle closure attack in Weill–Marchesani syndrome: A case report

Bilateral acute primary angle closure attack, though possible, is a rare condition. Secondary causes such as psychotropic drugs (topiramate), snake bite, and general anesthesia have been implicated in various case reports. We hereby describe a rare case of bilateral simultaneous acute angle closure attack secondary to microspherophakia and lens subluxation in a young lady with Weill–Marchesani syndrome, which was initially misdiagnosed as acute primary angle closure glaucoma. This case highlights the importance of eliciting proper history and paying attention to general examination findings to rule out secondary causes in a young patient with bilateral acute angle closure glaucoma.

Acetazolamide –friend to foe

Bilateral acute angle closure attacks are rare and usually secondary to drugs or concurrent microspherophakia. Acetazolamide, a sulphonamide medication used in controlling intraocular pressure, is known to cause uveal effusion precipitating secondary acute angle closure attack. Here we report a well-documented case of concurrent bilateral angle closure with shallowing of the anterior chamber, supra-ciliary effusion, and serous and hemorrhagic choroidal detachment after administration of oral acetazolamide that resolved on withdrawing the insulting agent.

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.

Bilateral acute angle closure attack precipitated with dengue fever

Dengue is known to cause varied ocular problems from mild-to-severe sight threatening. We present the case of a 63-year-old female patient with bilateral shallow anterior chamber and acute angle closure attack precipitated during the convalescent phase of dengue infection. She arrived at the emergency department at midnight with a history of vomiting, headache, weakness, and pain in the left eye (LE). Her diagnosis of dengue fever was supported by specific serological testing. On ocular examination, the anterior chamber of both eyes was noticeably shallow and her LE felt stony hard on digital palpation. Intravenous mannitol 300 mL over 45 min were given stat followed by topical medications. In the morning, intraocular pressure measured was 10 mmHg (right eye [RE]) and 26 mmHg (LE). After thorough examination, she was diagnosed with occludable angle in RE and angle closure in LE after gonioscopy. Neodymium-doped Yttrium Aluminum Garnet laser peripheral iridotomy was done in both eyes. She was relieved of symptoms. The varied spectrum of possible ocular symptoms should prompt the ophthalmologist to suspect the potential involvement of eye in dengue fever. Detailed history taking is of utmost importance in early diagnosis of some rare presentation of dengue-related ophthalmic involvement. Increased awareness of dengue-related ophthalmic complications among clinicians involved in the care of patients with dengue would facilitate prompt ophthalmologic assessment and emergency medical care.

Simultaneous bilateral acute angle closure glaucoma in a young middle-aged female with nanophthalmos: A rare case report

Simultaneous bilateral acute angle closure glaucoma in a young middle-aged female with nanophthalmos: A rare case report

Drug induced secondary angle closure glaucoma- A case series

: We report 3 cases with acute bilateral angle closure glaucoma following intake of oral chlorthalidone, mefenamic acid, topiramate. : Case series. : All patients developed bilateral acute onset painful defective vision with shallow anterior chamber, raised intraocular pressure. Gonioscopy revealed bilateral occludable angle and ultrasonogram B scan showed shallow choroidal detachment, suggestive of drug induced non pupillary block secondary angle closure glaucoma. All patients were managed by discontinuation of causative drug and started on topical antiglaucoma medication and cycloplegic drug. : we would like to bring this potentially sight threatening and reversible ophthalmic condition to general physician, which can be managed effectively by timely referral and intervention.

Bilateral acute angle closure due to choroidal effusion: a case report

In this case study, a bilateral acute angle closure due to choroidal effusion was the initial manifestation of a previously undiagnosed hantavirus infection (hemorrhagic fever with renal syndrome). The diagnostic and treatment algorithms are described. Advanced diagnostic technologies and a systematic approach to the analysis of atypical angle closure allowed not only to identify the cause of clinical presentations — choroidal effusion and anterior displacement of the lens–iris complex, but also to reveal the underlying systemic disease. The clinicians’ awareness of acute angle closure mechanisms is important in preserving the patient’s vision and timely diagnosing potentially life-threatening conditions.

Acute Angle-Closure Attacks Are Uncommon in Primary Angle-Closure Suspects after Pharmacologic Mydriasis: The Zhongshan Angle-Closure Prevention Trial

Angle-closure glaucoma is a major cause of blindness worldwide that carries an excessive risk of severe, bilateral visual impairment. A common concern among clinicians is the precipitation of acute angle-closure (AAC) attacks because of mydriasis. We evaluated the risk of AAC after pharmacologic dilation in Chinese individuals classified as having bilateral primary angle-closure suspects (PACSs). Randomized, interventional, controlled trial. A total of 889 patients with bilateral PACSs, aged between 50 and 70 years, were identified through community screening in Guangzhou, China, and enrolled in the study. In the Zhongshan Angle-Closure Prevention Trial, bilateral PACSs were treated with laser peripheral iridotomy (LPI) in 1 randomly selected eye, with the fellow eye serving as an untreated control. Over 72 months of follow-up, the participants had their pupils pharmacologically dilated 6 times with 5% phenylephrine and 0.5% tropicamide. Incidence and risk of post-mydriasis AAC in LPI-treated and untreated, control eyes classified as PACSs. One bilateral AAC attack occurred after mydriasis at the 2-week post-LPI visit. No other AAC events occurred in the LPI-treated eyes. In the untreated eyes, 4 additional attacks occurred: 2 occurred after dilation (1 at 54 months and 1 at 72 months of follow-up) and 2 occurred spontaneously. The risk of post-mydriasis AAC in the untreated eyes was 1 attack in 1587 dilations. The risk of spontaneous AAC in the untreated eyes was 0.44 per 1000 eye-years (95% confidence interval, 0.11-1.77 per 1000 eye-years). The risk of incident AAC attacks in PACSs was extremely low, even in a higher-risk group that underwent repeated pharmacologic pupillary dilation over 6 years of follow-up. Prophylactic LPI reduced this small but real risk. This trial was registered at ISRCTN.com as ISRCTN45213099.

Management of Bilateral Ectopia Lentis and Acute Angle Closure Glaucoma on a Background of Homocystinuria

Management of Bilateral Ectopia Lentis and Acute Angle Closure Glaucoma on a Background of Homocystinuria

Bilateral Acute Angle Closure Attack and Choroidal Detachment in Patient with Acquired Immune Deficiency Syndrome

Bilateral Acute Angle Closure Attack and Choroidal Detachment in Patient with Acquired Immune Deficiency Syndrome

A case of bilateral acute angle closure glaucoma secondary to systemic decongestants

AbstractPurposeTo report a case of bilateral acute angle closure attack secondary to an oral decongestant and antihistamine use.MethodsA case report.ResultsA 42‐year‐old Chinese lady with no past medical or ocular history presented to the Emergency Department with a 2‐day history of headache, vomiting and bilateral eye redness. She had taken pseudoephedrine and chlorpheniramine the previous 5 days for cold symptoms. Best‐corrected visual acuity (BCVA) was 6/24 bilaterally. Her intraocular pressure (IOP) was 37 (right) and 39 (left) mmHg. On slit lamp examination, the corneas were hazy and edematous with mid‐dilated pupils. Gonioscopy revealed closed angles bilaterally. Glaukomflecken was noted on both lenses. A diagnosis of bilateral acute angle closure attack was made. She was immediately given intravenous acetazolamide and topical hypotensive drops (timolol 0.5%, brimonidine 0.1%, prednisolone acetate 1% and pilocarpine 2%) followed by oral acetazolamide and continuation of all the topical drops. 9 hours later, the BCVA had improved to 6/15 (right) and 6/9.5 (left). Her left cornea was clearer but right was still hazy. IOP was 32 (right) and 14 (left) mmHg. B‐scan ultrasound showed no choroidal thickening. Subsequently, a bilateral laser iridoplasty was performed followed by laser iridotomy. Her IOP normalized after the procedures to 8 mmHg in both eyes.ConclusionsSeveral systemic medications are known to precipitate angle closure glaucoma. It is important to counsel patients on risks and symptoms before initiating these seemingly benign medications for a common cold.

A Case of Bilateral Acute Angle Closure Attack with Some Unusual Clinical Features

Bilateral acute angle closure attack is a rare ocular emergency. Early diagnosis and immediate intervention can have a profound effect on patient’s visual outcome and ocular morbidity. A 70 year old female presented with vomiting about 7 to 8 episodes along with sudden diminution of vision in both eyes for last 3 days. Initially she was examined by physician where all the routine blood tests and upper GI endoscopy was advised which failed to reveal the cause. She was then referred to our department for ophthalmic evaluation. On ocular examination she was diagnosed as a case of bilateral acute angle closure attack with some unusual clinical features. After treatment with hyperosmotic agent, anti glaucoma drugs and Nd: Yag peripheral laser iridotomy, intraocular pressure came down to normal limits and the patient regained good vision.

Acute narrow-angle glaucoma induced by topiramate with acute myopia and macular striae: A case report

We report the case of a 29-year-old epileptic woman who had been on treatment with topiramate 25mg/day for 9 days. She was referred to the Emergency Department due to reduction in far visual acuity (VA) after increasing the dose to 50mg/day two days before. The ocular examination showed bilateral acute angle closure glaucoma (AACG) and macular striae in both eyes (AO) observed by Retinography and Optical Coherence Tomography (OCT). The AACG is a well-known side effect of topiramate, but the macular striae rarely accompanies it. Although macular striae have been previously described in other cases, very few document those using retinography and OCT images. Therefore, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action, and treatment. Mismanagement can have potentially serious consequences.

Vogt-Koyanagi-Harada syndrome presenting as bilateral simultaneous acute angle closure

Vogt-Koyanagi-Harada syndrome presenting as bilateral simultaneous acute angle closure

Glaucoma agudo de ángulo cerrado inducido por topiramato con miopización aguda y estrías maculares: a propósito de un caso

We report the case of a 29-year-old epileptic woman who had been on treatment with topiramate 25mg/day for 9 days. She was referred to the Emergency Department due to reduction in far visual acuity (VA) after increasing the dose to 50mg/day two days before. The ocular examination showed bilateral acute angle closure glaucoma (AACG) and macular striae in both eyes (AO) observed by Retinography and Optical Coherence Tomography (OCT). The AACG is a well-known side effect of topiramate, but the macular striae rarely accompanies it. Although macular striae have been previously described in other cases, very few document those using retinography and OCT images. Therefore, it is important to differentiate a case of AACG induced by topiramate from a case of primary AACG, since they differ in their clinical presentation, mechanism of action, and treatment. Mismanagement can have potentially serious consequences.

Bilateral simultaneous acute angle closure in an adult Nepalese woman

Purpose: To report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause.
 Methods: Observational case report.
 Results: A 50-year-old Nepalese woman presented with decreased vision, pain, redness, and watering in both eyes with associated coloured haloes, nausea, and vomiting for 10 days. At presentation, her visual acuity was 20/400 in the right eye and hand motions close to face with accurate projection of rays in the left eye. Intraocular pressure was 38 mmHg in the right eye and 48 mmHg in the left eye without any antiglaucoma medications. A slit-lamp examination revealed bilateral circum-corneal conjunctival congestion, corneal edema, and shallow anterior chambers. Both pupils were mid-dilated and non-reactive to light. Gonioscopy showed closed angles in all four quadrants bilaterally. Posterior segment examination revealed normal optic disc with cup-disc-ratio of 0.3 in the right eye, and blurring of disc margin with cup-disc-ratio of 0.3 in the left eye. The patient was started on systemic acetazolamide 250 mg 4 times a day, topical brimonidine 0.2% and timolol 0.5% 2 times a day, and topical dexamethasone 6 times a day in both eyes, following which IOP reduced to 11 and 12 mmHg, respectively, the corneal edema subsided, but the anterior chamber remained shallow. Laser peripheral iridotomy was performed in the right eye and surgical peripheral iridectomy was performed in the left eye. After two weeks, vision improved to 20/30 in both eyes with normal intraocular pressure off antiglaucoma medications. Anterior chambers deepened significantly with clear corneas bilaterally. Gonioscopy at this stage showed essentially open angles with appositional closure in superior and temporal quadrants in the right eye and open angles in all four quadrants in the left eye. Posterior segment evaluation revealed normal optic disc in both eyes.
 Conclusions: Bilateral simultaneous acute angle closure is a rare presentation with very few reported secondary causes. We report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. The case was successfully managed with laser peripheral iridotomy in the right eye and surgical peripheral iridectomy in the left eye.

Bilateral acute angle closure in a patient with dengue

Bilateral acute angle closure in a patient with dengue

A Rare Serious Ocular Side Effect of Topiramate: Bilateral Acute Angle Closure Glaucoma

A Rare Serious Ocular Side Effect of Topiramate: Bilateral Acute Angle Closure Glaucoma

Topiramate-induced hypertensive uveitis and evolving Fuchs′ uveitis: A case report

We intend to report an interesting case of topiramate-induced bilateral uveitis (TIU) and angle closure glaucoma that gradually developed signs of Fuchs' uveitis (FU) in right eye after resolution of the attack. A 41-year-old female was started on oral topiramate for migraine following which she developed bilateral acute angle closure glaucoma and uveitis. She improved with topical and systemic steroids. As the attack resolved, her right eye started developing classical features of FU which were initially confused with viral uveitis. Patient was followed-up without steroids for 2 years. She remained asymptomatic in right eye and healthy systemically proving diagnosis of FU. We recommend high index of suspicion for FU in an asymptomatic low-grade uveitis even though typical features of FU are absent initially. Few weeks of observation may allow FU to manifest on its own, which will prevent unnecessary investigations and treatment.

Retraction: Bilateral acute angle closure glaucoma following a snake bite: Are we missing it?

[This retracts the article on p. 40 in vol. 20, PMID: 26955216.].