Case Of Acute Glaucoma Research Articles

Response to regarding the case image article entitled "A case of angle-closure glaucoma caused by spontaneous lens dislocation" by Kondo etal.

The occurrence of acute angle closure with posterior displacement of the lens is rare compared with that of anterior dislocation; however, several studies have reported its occurrence.

Regarding the case image article entitled "A case of angle-closure glaucoma caused by spontaneous lens dislocation" by Kondo etal.

Regarding the case image article entitled "A case of angle-closure glaucoma caused by spontaneous lens dislocation" by Kondo etal.

Comparison of Gonioscopy and Anterior Segment OCT for Detecting Angle Closure in Different Quadrants of Anterior Chamber Angle in Angle Closure Glaucoma

Purpose: To measure angle of anterior chamber with Gonioscopy and compare with anterior segment OCT. Study Design: Descriptive observational study. Place and Duration of Study: This study was conducted at the Department of Ophthalmology, Pakistan institute of Medical Sciences, Islamabad from 1st March 2021 to 31st August 2021. Methods: A total number of 102 patients participated in the study. Study included participants older than 30 years of age, of either gender, who were either diagnosed as a case of angle closure-Glaucoma or were angle closure-Glaucoma suspect. Sampling was done using convenient sampling technique. The selected patients underwent gonioscopy and the anterior segment OCT and the grades of the angle were determined. Grading was compared between the two techniques. The collected data was analyzed by using SPSS 23 version. Result: The mean age of patients was 59.16 ± 6.03 years. Out of 102 patients, 34 (33.3%) patients were male and 63 (66.7%) patients were female. The mean intraocular pressure was 17.80 ± 4.25 (mmHg). The accuracy of angle closure detection by Gonioscopy was 35.3% and by anterior segment, OCT was 60.8%. The p value was significant in both the groups. The Anterior segment OCT turned out to be better than Gonioscopy. Conclusion: Anterior segment OCT is more efficient in determination of angle of anterior chamber than gonioscopy. Using anterior segment OCT to examine anterior chamber angle and surrounding tissues helps in diagnosing early stages of disease and directing therapy.

Descemet’s Membrane Injury Post YAG Peripheral Iridotomy

Neodymium: Yittrium - Aluminium-Garnet (Nd YAG) laser iridotomy is one of the most common laser procedures performed in the Asian continent as the proportion of Angle closure glaucoma cases is significant. The Nd YAG iridotomy appears to be a simple outpatient procedure but can result in a number of complications including haemorrhage, cataract formation, dysphotopsia, intraocular pressure elevation and corneal endothelial damage resulting in corneal decompensation at a later date. A forty one year old female patient, a case of Primary Angle Closure Suspect (PACS), who had undergone a Nd YAG laser iridotomy of both the eyes elsewhere presented to us for a second opinion. The anterior segment examination was unremarkable except for the bilateral peripheral Iridotomies. The slit lamp examination revealed three small defects in the temporal cornea at the level of the Descemet’s membrane and posterior stroma overlying the iridotomy in the right eye. A specular microscopy did not reveal any endothelial damage or change in the cell morphology overlying the iridotomy or in other areas. Anterior segment Ocular Coherence Tomography (OCT) demonstrated the exact nature of the injury to the Decemets membrane. To the best of our knowledge, its the first case report in the literature of a Descmet’s membrane injury following a ND-YAG laser iridotomy. It emphasizes the importance of accurate focus on the iris and choosing a quadrant with adequate distance between the iris and the cornea to avoid injury to surrounding structures.

Plateau iris syndrome: A case report

Angle closure glaucoma is a major cause of glaucoma related visual disability worldwide. Plateau iris is one of the causes of angle closure which needs to be kept in mind while dealing with a case of angle closure glaucoma. Plateau iris configuration (PIC) refers to the anatomical configuration of the iris in which iris is inserted anteriorly on the ciliary body. This alters the position of the peripheral iris in relation to the trabecular meshwork, and thus results in narrowing of the angle of the anterior chamber. Plateau iris syndrome (PIS) is defined as persistently narrow angle capable of closure in spite of a patent iridotomy. Here we report a case of 48 years old female who presented with acute angle closure in the Department of Ophthalmology, Dr.RPGMC,Kangra. She was diagnosed as a case of plateau iris syndrome and was managed surgically. Early recognition and intervention are the key components to prevent vision loss in this patient population.

Changes in Ocular Hypotensive Drug Usage for Glaucoma Treatment After Cataract Surgery: A Nationwide Population-based Study in Taiwan.

The aims of this study were to observe the changes in the demand for prescriptions of ocular hypertensive drug (OHD) after cataract surgery, to investigate patterns of change in the required OHD amount in open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) cases, and to determine the associated factors related to the change. This population-based cohort study using the Taiwan National Health Insurance Research Database enrolled patients with glaucoma who underwent bilateral cataract surgeries within 2 years between 2001 and 2012. The major dependent variables were the total amounts of OHDs prescribed within 1 year before the first cataract surgery and 1 year after the second cataract surgery. We compared the overall change in the required OHD amount before and after cataract surgery and further explored potential factors affecting the change. Among the 440 patients, there were more cases of ACG than OAG (68.6% vs. 31.4%). The total OHD amount prescribed reduced significantly after cataract surgery in patients with OAG (median, from 12 to 6 bottles before and after the surgery, P<0.0001) and ACG (median, from 10 to 3 bottles, P<0.0001), and the reduction was sustained for 5 years. The reduction was significantly larger in patients with ACG and higher demand for OHD (P=0.0157). Among the OAG cases, the reduction was significantly larger in patients who were female individuals (P=0.0138), treated in clinics (P=0.0305), and exhibited high demand for OHD (P=0.0282). The prescriptions of OHDs by glaucoma patients reduced considerably after cataract surgery. Although the reduction proportion of the demand for OHD after cataract surgery was significantly larger in patients with ACG than in those with OAG, the reduction was sustained for 5 years in both types of glaucoma.

The prevalence of blindness caused by primary angle closure glaucoma in middle-aged Chinese population: a systematic review and meta-analysis

Objective: To evaluate the rate of blindness caused by primary angle closure glaucoma (PACG) in Chinese population of more than 40 years old, and to explore the effectiveness of a prevention and treatment system on PACG. Methods: We searched the databases of Pubmed, ScienceDirect, Springer Link, CNKI and Wanfang Data and collected all the original studies of the prevalence and blindness of angle closure glaucoma in China. The population was limited to over 40 years old. The research site was limited to the community-based, while the published time was not limited. Two researchers completed the literature search, data extraction and methodological quality assessment independently, with same criteria. Meta analysis was performed using R software. Results: Five papers were included in this study finally. A total of 26 437 cases of natural population over the age of 40 were observed, and 306 cases of angle closure glaucoma were found, of which 113 cases had binocular or monocular blindness caused by PACG. The random effect model meta-analysis results showed that the overall blindness rate was 38.3% [95%CI (28.1%, 49.6%)]. In Beijing, where the prevention and treatment system was well established, the blindness rate was far lower than that in the areas where the system was poorly established. Compared with the past, the blindness rate caused by PACG in Beijing decreased sharply. Conclusions: The rate of blindness caused by PACG is still high in the mainland of China. The prevention and treatment system is effective and worth promoting. (Chin J Ophthalmol, 2017, 53: 373-377).

A comparison of amniotic membrane and Mitomycin C applied in glaucoma trabeculectomy

Objective To compare the anti-scarring effects of amniotic membrane and mitomycin C in glaucoma trabeculectomy. Methods Sixty-eight eyes of 38 cases of angle closure glaucoma were divided into mitomycin C (MMC) group and amniotic membrane group with 34 eyes in each group.In MMC group, the MMC with concentration of 0.3mg/ml was applied only once for 3 min. Patients in amniotic membrane group underwent trabeculectomy combined with amniotic membrane implantation under scleral flap. Patients were followed up for 10 months. Results The total success rate, including conditional success rate and cumulative complete success rate was 81.05% and the complete success rate was 62.03% in MMC group, and they were 94.02% and 82.09% in amniotic membrane group. The differences were statistically significant between two groups (χ2=2.403, P=0.238; χ2=2.101, P=0.210). Postoperative complications in amniotic membrane group included postoperative shallow anterior chamber in 6 eyes, cataract in 2 eyes, hyphema in 2 eyes and thin bleb in 2 eyes. Postoperative complications in MMC group were mainly shallow anterior chamber in 8 eyes, cataract in 7 eyes, hyphema in 9 eyes, thin-wall bleb in 9 eyes, leaking filtering blebs in 6 eyes, persistent hypotony in 9 eyes, and macular disease caused by low intraocular pressure in 6 eyes. Conclusion Amniotic membrane used in trabeculectomy can effectively prevent the scar formation of blebs in operation, and can effectively preserve the functional follicles for a long time with less complication than MMC. Key words: Glaucoma; Trabeculectomy; Mitomycin C; Amnion

Clinical efficacy of lens trabeculectomy combined with phacoemulsification in the treatment of angle-closure glaucoma with cataract

Objective To explore the clinical efficacy of trabeculectomy combined with phacoemulsification in the treatment of angle-closure glaucoma with cataract.Methods 56 cases of angle-closure glaucoma with cataract were selected in department of ophthalmology and were received trabeculectomy combined with phacoemulsification.Preoperative and postoperative visual acuity,intraocular pressure,anterior chamber angle,anterior chamber depth,filtering bleb and complications were observed.Results Six months after operation,53 (94.64％) were improved in visual acuity.There was significant difference between preoperative and postoperative visual acuity( Z =-5.074,P ＜0.05).IOP was( 15.26 ± 3.37 )mm Hg 6 months after operation,which was significant lower than(34.60 ± 3.85 ) mm Hg before operation( t =28.29,P ＜0.05 ).The anterior chamber depth was( 3.27 ± 0.64 ) mm 6 months after operation,which was significant larger than( 1.58 ± 0.39 )mm before operation (t =16.90,P ＜ 0.05 ).All patients had bleb formation with no serious complications.Conclusion Trabeculectomy combined with phacoemulsification was effective in treating angle-closure glaucoma and cataract. Key words: Glaucoma, angle-closure; Cataract; Trabeculectomy; Phacoemulsification

Topiramate and the vision: a systematic review.

Background and purposeTopiramate (TPM) is a sulfa-derivative monosaccharide that is used mainly for treating epilepsy and preventing migraine. Within the gamut of side effects attributable to this drug, ophthalmologic manifestations are of crucial importance. In this study, for the first time, the aim was to provide a systematic literature review regarding this issue.MethodsFor the time period 1996–2011, a PubMed search was made for the studies concerning the adverse/beneficial effects of TPM on vision. Overall, 404 citations out of a total of 2756 TPM-related studies were examined for relevance.ResultsA total of 74 relevant studies were reviewed, 65 of which comprise small observational studies describing the ophthalmic side effects of TPM in 84 patients. Of these patients, 66 were affected by ciliochoroidal effusion syndrome as the cardinal ocular side effect of TPM (17 cases of myopic shift and 49 cases of angle closure glaucoma). A comprehensive statistical analysis is provided on these 66 subjects. Other rare side effects of TPM on the vision were also reviewed, including massive choroidal effusion, ocular inflammatory reactions, visual field defects, probable effects on retina, cornea, and sclera, and neuroophthalmologic complications. In addition, a framework is provided to classify these results.DiscussionDue to the expanding spectrum of indications for the administration of TPM, neurologists and psychiatrists should be aware of its diverse ocular side effects. In conclusion, ocular complications following this drug should be taken seriously and be subjected to ophthalmic counseling.

Clinical observation on phacoemulsification combined with goniosynechiolysis in 86 patients with angle-clo-sure glaucoma

To investigate the clinical effect of phacoemulsification combined with goniosynechiol- ysis in treatment of angle-closure glaucoma. Methods 163 cases of angle-closure glaucoma with cataract were divid- ed into observed group（ 86 cases） and control group（ 87 cases）. The observed group was treated with phacoemulsification cataract extraction, artificial crystalline implantation and goniosynechiolysis, while the control group was treated with compound trabeculectomy. The vision,intraocular pressure and chamber depth after surgeries in the two groups were compared. Results The vision in observed group was enhanced distinctly after surgery,which was significantly better than the control group（ P 〈 O. 05 ）. The intraocular pressure in 2 weeks of observed group after surgery was significantly better than the conrol group（ P 〈 0.01 ）. Moreover the anterior chamber depth and chamber angle of observed group was better than the control group after operation（P 〈 0.05）. Conclusion The treatment of phacoemulsification combined with guniosynechiolysis for angle-closure glaucoma had good clinical effect. Key words: Angle-closure glaucoma; Phacoemulsification; Goniosynechiolysis

Dorzolamide as an Effective Topical Therapy for Glaucoma in a Case of Nanophthalmos.

To report a case of nanophthalmos in which the intraocular pressure (IOP) off medication was 45 mm Hg and on dorzolamide hydrochloride once daily was 15 mm Hg for many years. No other medication affected the IOP. A chart review of a patient with nanophthalmos and glaucoma. A case of angle closure glaucoma in a nanophthalmic eye which had an unusually great and prolonged reduction of IOP secondary to the use of dorzolamide once daily, was reported.

Angle-Closure Glaucoma after Piggyback Intraocular Lens Implantation

To report a case of angle closure glaucoma after piggyback intraocular lens implantation and its treatment. The authors present the case of a 75-year-old woman who was seen in the emergency department with angle closure glaucoma. Two years before she had undergone piggyback intraocular lens (IOL) implantation in order to correct a refractive error after cataract surgery. Ultrasound biomicroscopy revealed a closed angle with synechiae in 360 degrees as well as the presence of two IOLs: one in the capsular bag and the other in the ciliary sulcus. Extraction of the anterior IOL was precluded due to the poor endothelial count. Peripheral iridotomy and trabeculectomy were ineffective to lower the intraocular pressure (IOP); the authors decided to implant with an Ahmed valve and to place the valve's tube between the two IOLs to protect the endothelium. After Ahmed valve implantation, IOP maintains stable around 10-12 mmHg without medical treatment. Ahmed valve implantation is a good option in angle closure glaucoma due to piggyback. The placement of the valve's tube between the two IOLs is a good option to protect corneal endothelium.

Common causes of red eye presenting at an ophthalmic clinic

Redness of the eye is a common ophthalmic symptom. The problem causing redness could arise from within or outside the globe. These range from cases of simple inflammation following itching and minor trauma for example, to severe cases like orbital cellulitis and tumours. Patients may not even be aware of the redness. The aim of this study is to highlight the common causes of red eye as seen in an outpatient department in an ophthalmic set up. This should be of immense help to the general medical practitioners to whom the patients often first present. All patients presenting for the first time to Ladoke Akintola University of Technology Teaching Hospital over a four month period were screened. 117 had red eyes and were recruited. 125 eyes were found to be red. The characteristics of the redness were then studied to determine the cause. There was a male preponderance, M : F of 2:1. Persons 45 years and below, were most commonly involved 88 (66.67%). The most frequent cause of red eye was trauma, in 48 (41.03%) patients, followed by allergic conjunctivitis in 29 (24.77%). The main causes of redness differed in different age groups and occupation. There was no case of angle closure glaucoma seen as a cause of redness. There are diverse causes of redness of the eye. Persons who are not eye specialists to whom patients with red eyes present first should be conversant with the causes, to know what action to take, especially when to refer to the eye specialist.

Phacoemulsification using iris-hooks for capsular support in high myopic patient with subluxated lens and secondary angle closure glaucoma

We report an unusual case of angle closure glaucoma in a 78-year-old highly myopic female patient. The patient did not show any preoperative signs of subluxation of lens. However, the capsular bag was noted to be unstable during surgery. The patient was managed with phacoemulsification of lens using a novel method of iris hooks for stabilization of capsular bag during surgery.

A case of angle closure glaucoma caused by plateau iris and adie’s pupil

PurposeTo describe a case of plateau iris associated with bilateral Adie’s pupil. DesignInterventional case report. MethodsA 54-year-old woman presented with pain in her right eye and headache. Intraocular pressure was 34 mm Hg in the right eye. Light reflex was defective bilaterally. ResultsUltrasound biomicroscopic imaging revealed normal anterior chamber depth and narrow angle. The ciliary processes were situated anteriorly. The eyes showed supersensitivity to 0.125% pilocarpine. The patient was diagnosed as having bilateral angle-closure glaucoma induced by Adie’s pupil and plateau iris. ConclusionMild pupillary dilation caused by Adie’s pupil may have played a role in the development of angle closure in the plateau iris configuration of our patient.

Design of low cost glaucoma screening.

In 1991 the Netherlands Glaucoma Patient Association organized a glaucoma screening survey. This survey was designed to evaluate the effectiveness of a low cost screening setting. During a screening period of 8 days, 1259 subjects over the age of 49 years were examined by a team of non-ophthalmologically trained students. The following screening methods were used: visual field analysis (Henson CFS3000 perimeter), retinal nerve fiber layer photography (Canon non-mydriatic camera), intraocular pressure measurement (Pulsair non-contact tonometer) and determination of the peripheral anterior chamber depth (slitlamp biomicroscope, the van Herick method). In a later stage, subjects with glaucomatous abnormalities in the visual field and/or the photograph were re-examined by a glaucoma specialist using applanation tonometry, gonioscopy, ophthalmoscopy and Humphrey 30-2 visual field analysis. The time taken to conduct the individual screening tests in a subject varied from 1 to 5 min: perimetry took 5 min, photography 2 min, tonometry 3 min and angle-width determination 1 min. Fifty-six (4.4%) subjects showed glaucomatous defects in perimetry and/or photography. Thirty-seven could be re-examined and glaucoma was diagnosed in 16 subjects. Visual field defects and glaucomatous abnormalities in the photograph were confirmed by Humphrey perimetry in 72.7% and 35.7% respectively. Sixty-seven (5.3%) subjects had an intraocular pressure above 21 mm Hg, while no cases of angle closure glaucoma were found in this population. The costs of this screening setting were estimated at F1. 48,60 per screen. A future low cost screening survey might be limited to non-contact tonometry and visual field analysis with the Henson CFS3000 perimeter or a similar device, using suprathreshold testing with a limited number of points. Screening might be performed by non-medically trained employees. The costs of such a screening program may be estimated at F1. 16,- per screen and F1. 1.989,- per glaucoma case using a mobile screening unit (addendum).

Familial Exudative Vitreoretinopathy Associated With Nonneovascular Chronic Angle-Closure Glaucoma

Cases of angle-closure glaucoma in patients with familial exudative vitreoretinopathy have been reported secondary to neovascularization of the anterior segment. Cases secondary to nonneovascular mechanisms have not been previously reported. Two cases are presented of angle-closure glaucoma as a result of a nonneovascular mechanism. Neovascularization was found to be a very unlikely explanation for the angle closure in these two cases. There may be an association between familial exudative vitreoretinopathy and angle-closure glaucoma as a direct result of a retrolental process or more likely a relative lens-iris pupillary block with a large lens.

Aetiology of severe visual impairment and blindness in microphthalmos.

Microphthalmos occupies a spectrum from a normal, but small globe, to a globe with multiple anterior and posterior segment abnormalities. This study examines 54 eyes of 27 patients who had bilateral microphthalmos and severe visual impairment or blindness. Congenital cataract was the commonest cause of severe visual impairment (44%), followed by presumed retinal or optic nerve dysplasia (30%) and chorioretinal coloboma (22%). Lensectomy was followed by phthisis bulbi in 3/23 cases and retinal detachment in 2/23 cases. There were no cases of angle closure glaucoma. The three clinical conditions associated with a poor prognosis were cataract, chorioretinal coloboma, and a markedly reduced corneal diameter. A corneal diameter of 6 mm or less was associated with a visual acuity of no perception of light in 81% (21/26) compared with 4% (1/28) of those with larger corneas.

Acute Angle-Closure Glaucoma in a Patient With Acquired Immunodeficiency Syndrome Successfully Treated With Argon Laser Peripheral Iridoplasty

Laser iridectomy relieves pupillary block and is the procedure of choice for angle-closure glaucoma. Since not all cases of angle closure glaucoma are due to this mechanism, iridectomy is not always curative. Argon laser peripheral iridoplasty causes a contraction of peripheral iris away from the trabecular meshwork, and is useful in these circumstances. We successfully treated bilateral acute angle-closure glaucoma in a patient with acquired immunodeficiency syndrome with this procedure.