Chronic Angle Closure Research Articles

Polypharmacy-associated potential contraindications of drug prescriptions in patients with primary angle closure disease in a real-world setting

BackgroundPrimary angle closure disease (PACD) is a type of glaucoma in which the intraocular pressure (IOP) is increased because of the blockage of the anterior chamber angle. Medications contraindicated for patients with PACD, such as anticholinergics, cause mydriasis, and can elevate IOP. However, anticholinergics are currently contraindicated only for primary angle closure glaucoma (PACG) in Japanese package inserts. In this study, we investigated the prescription status of medications contraindicated for PACD, such as anticholinergics, in patients with PACD scheduled for eye surgeries.MethodsForty-three Japanese patients diagnosed with PACD at Kobe City Eye Hospital, Japan, and scheduled hospitalization for eye surgeries between December 2017 and July 2018, were included. Data, including sex, age, diagnosis, IOP, anterior chamber depth, and patients’ regular medications prior to hospitalization, were collected for each patient from the electronic medical records.ResultsThe number of patients with chronic primary angle closure (CPAC) and acute primary angle closure (APAC) was 35 (81.4%) and 8 (18.6%), respectively. Among all the 43 patients with PACD, 8 (18.6%) received 15 medications that are potentially contraindicated for PACD by non-ophthalmologist. According to medication categories, benzodiazepine hypnotics were the most commonly prescribed. Among the 8 patients with APAC, 2 (25.0%) had routinely received medications contraindicated for PACD. The median number of all kinds of prescriptions on the day of hospitalization was significantly higher for patients who received medications contraindicated for PACD than for those who did not receive them (p = 0.010).ConclusionsAbout 20% of patients with PACD received medications potentially contraindicated for PACD, such as anticholinergics. Attention should be paid to patients prescribed multiple drugs for adverse events, such as increase in intraocular pressure.

Association Between Anterior Chamber Angle and Corneal Endothelial Cell Density in Chronic Angle Closure.

PurposeTo study the association between corneal endothelial cell density (ECD) and degree of anterior chamber angle (ACA) opening in eyes with chronic angle closure glaucoma.MethodsThe study was conducted at JEC Eye Hospitals in Indonesia. Treatment-naïve patients aged ≥40 years with IOP >21 mmHg and peripheral anterior chamber depth (ACD) grade 2 or less by Van Herick’s technique were recruited. Trabecular iris angle (TIA; degree) was measured using anterior segment optical coherence tomography (AS-OCT) and classified as: grade 1 ≤10°, grade 2 11–20°, and grade 3 >20°. Noncontact specular microscopy was performed, and the following corneal parameters were obtained:ECD (cells/mm2), coefficient of variation (CV; μm2/cell), percentage of hexagonal cells, and central corneal thickness (CCT; μm).ResultsA total of 52 eyes from 52 subjects were recruited (16 grade 1 TIA, 24 grade 2 TIA, and 12 grade 3 TIA). Presenting IOP was not significantly different between groups. The median central corneal ECD was 2684.5 (1433–2934), 2587.0 (1902–3103), and 2441.0 (1659–3005) cells/mm2 in grade 1, 2, and 3 TIA, respectively, with no significant differences across the groups (P = 0.67). The CV was lowest in grade 3 TIA (36.4 ± 7.2 μm2/cell), and highest in grade 1 TIA (38.3 ± 9.6 μm2/cell), but the differences were not significant (P = 0.74). Likewise, the percentage of hexagonality and CCT was not significantly different. TIA was not correlated with IOP but was modestly correlated with age.ConclusionThe corneal ECD and morphological characteristics such as CV and hexagonality were not significantly different across various TIA grading in chronic angle closure. This may reflect the lack of chronic and gradual IOP insult on corneal endothelial parameters as TIA did not show direct effect towards IOP.

Laser peripheral iridoplasty for chronic angle closure.

Laser peripheral iridoplasty for chronic angle closure.

Postoperative complicated peripheral cortical cataract after ultrasound cycloplasty: a case report

BackgroundUltrasound cycloplasty (UCP) is a non-invasive procedure for glaucoma treatment. Using high-intensity focused ultrasound to work on the ciliary body, the generation of aqueous humor can be reduced and the drainage of aqueous humor through the uveoscleral pathway can be enhanced. Recently, this therapy is gradually gaining clinical recognition. We report a case of a patient with glaucoma who accepted UCP in another hospital, but because of a worsening of a preexistent cataract and an insufficient IOP lowering effect, finally underwent cataract surgery in both eyes in our hospital, during the surgery we observed the unusual opacities probably due to UCP mistreatment.Case presentationPatient was diagnosed as chronic angle closure glaucoma and catacract, accepted UCP on both eyes in another hospital 4 months ago. After the UCP therapy, the pupil was vertical ellipse, the UCP didn’t have a sufficient effect on IOP and forced us to do cataract surgery to lower IOP. During the cataract surgery, some unusual white opacities in the peripheral cortex with clear boundary were found. Inaccurate WtW measurement was the most likely cause of the injury, which resulted in the use of the small-size UCP probe and the downward movement of the UCP probe.ConclusionUCP should not be a first line treatment in a patient with cataract and angle closure glaucoma, cataract extraction is a better choice. The appropriate case selection needs to be more strict and the preoperative indexes measurements need to be more accurate.

Outcomes of combined gonioscopy-assisted transluminal trabeculotomy and goniosynechialysis in primary angle closure: a retrospective case series.

To evaluate the additional intraocular pressure (IOP) lowering effect of gonioscopy-assisted transluminal trabeculotomy (GATT) to contemporary goniosynechialysis (GSL) in endeavouring to abolish subsequent occlusion after chronic iridotrabecular contact in primary angle closure (PAC) patients. A retrospective case series of all PAC eyes underwent GATT + GSL with or without phacoemulsification and intraocular lens implantation (PEA + IOL) from December 2016 to May 2018 were recruited. IOP and the number of anti-glaucoma medications were compared pre- and post-operatively by Wilcoxon signed-rank test. Repeated measure ANOVA was used to evaluate the difference in IOP change after the operation between a subgroup of operations (GATT + GSL + PEA + IOL and GATT + GSL) and the arc of cutting of trabeculotomy. Thirty-nine eyes of 30 patients, 37 chronic angle closure glaucoma (CACG), 1 acute primary angle closure (APAC), and 1 plateau iris syndrome were recruited. Mean preoperative IOP was 21.8 ± 5.4mmHg. Mean post-operative IOP was lowered to 15.1 ± 3.8mmHg at 1month, 14.4 ± 1.2mmHg at 3months, 14.8 ± 2.1mmHg at 6months, 14.5 ± 0.8mmHg at 1year, and 15 at 2years (P < 0.001, P = 0.0012, P = 0.001, P = 0.028, and P = 0.317 (n = 1), consecutively). Mean of overall post-operative IOP at the last follow-up was 15.1 ± 4.4mmHg (P < 0.001). Mean preoperative number of anti-glaucoma medications was 3.5 ± 1.4. Mean post-operative number of anti-glaucoma medications was reduced to 1.5 ± 1.4 at 1month, 0.9 ± 0.9 at 3months, 1.4 ± 1.4 at 6months, 1.5 ± 0.5 at 1year, and 2 at 2years (P < 0.001, P = 0.01, P = 0.002, P = 0.028, and P = 0.317 (n = 1), respectively). Mean of overall post-operative number of anti-glaucoma medications was 1.1 ± 1.2 (P < 0.001). There was no significant difference found between the IOP lowering effect in subgroup analysis. GATT + GSL could significantly reduce IOP and number of anti-glaucoma medications from baseline compared to the last follow-up; however, there seemed not to be any superiority to the effects found in previous studies reported about GSL + PEA or PEA alone in PAC patients.

Nanophthalmos refractory to medical treatment: What to do?

Nanophthalmos, a congenital rare condition, is defined as a small eye characterized by hypermetropia, narrow anterior chamber, and thickened choroid and sclera. These features create an environment with high risk of developing angle-closure glaucoma (AGC) and higher risk of intraoperative and postoperative complications. This is a case of young female patient with nanophthalmos, chronic angle closure, elevated intraocular pressure (IOP) refractory to medical therapy, iridotomy, and iridoplasty, yet without glaucomatous changes. In a case of nanophthalmos refractive to medical treatment, it is challenging to decide whether lowering IOP and preventing ACG are worth the risk of vision reduction by intraocular lens miscalculation or surgical complications.

Influence of automated visual field testing on intraocular pressure

BackgroundTo evaluate the influence of automated visual field (VF) testing on intraocular pressure (IOP) in patients with ocular hypertension (OHT) or glaucoma.MethodsWe conducted a prospective observational study in the glaucoma department at Quinze-Vingts National Ophthalmology Hospital in Paris. Ninety-five right eyes of 95 patients followed for glaucoma or OHT were included. IOP was measured three times using a Nidek NT-510 non-contact tonometer within a maximum of 5 min before and after VF testing. Sub analyses using logistic regression analysis were performed to evaluate the impact of gender, age, central corneal thickness (CCT), mean deviation (MD) of the VF, VF test duration and filtration surgery on IOP fluctuations.ResultsThere was no significant change in IOP after VF testing, with IOP’s 15.14 ± 4.00 mmHg before and 14.98 ± 3.33 mmHg after the VF (P = 0.4). The average change in IOP was 0.15 ± 1.82 mmHg. Using multivariate analysis, no effect of the VF test on IOP was found (global model fit R2 = 0.12), whether based on duration of the VF test (P = 0.18) or the MD (P = 0.7) after adjustment for age, gender, CCT and history of glaucoma surgery. Similarly, there was no significant difference within different types of glaucoma, including open-angle glaucoma (P = 0.36), chronic angle closure glaucoma (P = 0.85) and OHT (P = 0.42). The subgroup of patients with an IOP elevation ≥2 mmHg had a significantly higher VF test duration (P = 0.002).ConclusionVF testing does not influence IOP as measured with a non-contact tonometer.

Intraocular Pressure Changes after Cataract Surgery in Patients with and without Glaucoma: An Informatics-Based Approach

To evaluate changes in intraocular pressure (IOP) after cataract surgery among patients with or without glaucoma using automated extraction of data from electronic health records (EHRs). Retrospective cohort study. Adults who underwent standalone cataract surgery at a single academic center from 2009-2018. Patient information was identified from procedure and billing codes, demographic tables, medication orders, clinical notes, and eye examination fields in the EHR. A previously validated natural language processing pipeline was used to identify laterality of cataract surgery from operative notes and laterality of eye medications from medication orders. Cox proportional hazards modeling evaluated factors associated with the main outcome of sustained postoperative IOP reduction. Sustained post-cataract surgery IOP reduction, measured at 14 months or the last follow-up while using equal or fewer glaucoma medications compared with baseline and without additional glaucoma laser or surgery on the operative eye. The median follow-up for 7574 eyes of 4883 patients who underwent cataract surgery was 244 days. The mean preoperative IOP for all patients was 15.2 mmHg (standard deviation [SD], 3.4 mmHg), which decreased to 14.2 mmHg (SD, 3.0 mmHg) at 12 months after surgery. Patients with IOP of 21.0 mmHg or more showed mean postoperative IOP reduction ranging from -6.2 to -6.9 mmHg. Cataract surgery was more likely to yield sustained IOP reduction for patients with primary open-angle glaucoma (hazard ratio [HR], 1.19; 95% confidence interval, 1.05-1.36) or narrow angles or angle closure (HR, 1.21; 95% confidence interval, 1.08-1.34) compared with patients without glaucoma. Those with a higher baseline IOP were more likely to achieve postoperative IOP reduction (HR, 1.06 per 1-mmHg increase in baseline IOP; 95% confidence interval, 1.05-1.07). Our results suggest that patients with primary open-angle glaucoma or with narrow angles or chronic angle closure were more likely to achieve sustained IOP reduction after cataract surgery. Patients with higher baseline IOP had increasingly higher odds of achieving reduction in IOP. This evidence demonstrates the potential usefulness of a pipeline for automated extraction of ophthalmic surgical outcomes from EHR to answer key clinical questions on a large scale.

Comparison of perimetric Glaucoma Staging Systems in Asians with primary glaucoma.

To compare functional staging classifications in Vietnamese patients with primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (PACG). A retrospective cross-section study was conducted at a national setting. Two hundred seven eyes of 207 patients were recruited. Patients were tested with standard automated perimetry. Field loss was generally classified in four stages (normal, early, moderate, and severe), using four classification strategies: (1) Hodapp-Parrish-Anderson (HPA), (2) enhanced Glaucoma Staging System (eGSS), (3) modified Glaucoma Staging System (mGSS) and (4) the Advanced Glaucoma Intervention Study (AGIS). AGIS as a standard method was used to judge the staging performance of the other three classifications in terms of agreement (Cohen Kappa-K) and association (Chi-Square Test-Cramer's V). The agreement between AGIS and mGSS (K = 0.687; p < 0.001) and HPA (K = 0.686; p < 0.001) was substantial while that between AGIS and eGSS was slight (K = 0.103; p < 0.001). The association between AGIS and mGSS (V = 0.748; p < 0.001) and HPA (V = 0.748; p < 0.001) was greater than eGSS (V = 0.594; p < 0.001). MGSS and HPA showed stronger agreement and closer association with AGIS than eGSS. We recommend mGSS should be used in managing a glaucoma clinic because of its simplicity and convenience over HPA and AGIS.

Ocular biometric characteristics of chronic angle closure glaucoma in a South Indian population: A comparative study with normal subjects

To compare ocular biometric features of chronic angle closure glaucoma patients with normal subjects. 35 chronic angle closure glaucoma patients (group A) were compared with 35 normal subjects (group B). Chronic angle closure glaucoma was diagnosed in eyes with peripheral anterior synechiae [PAS] of &amp;#62; 270 degrees with a chronically elevated IOP with disc and field changes. Patients with history of intraocular surgeries or trauma, secondary angle closure, active keratitis or corneal opacities, previous history of Nd Yag laser peripheral iridotomy and those on miotic drops were excluded. Contact ultrasonic biometry was used for measuring ocular biometric parameters like axial length, AC depth, and lens thickness. LAF and RLP were calculated. Statistical analysis: Chi-square test and Independent sample t-test as applicable. Mean age, gender distribution and axial length measurements in both the groups were comparable. Lens thickness and LAF were significantly higher in Group A (p &amp;#60;0.001) whereas AC depth, keratometry and RLP were significantly lower in group A. Pachymetry, best corrected visual acuity and spherical equivalents were comparable in both groups. It is concluded that the mechanism of chronic angle closure glaucoma can be explained by the ocular biometric parameters with possibility of some additional factors like variations in the iris thickness/ insertion.

Biometric indicators of eyes with occult lens subluxation inducing secondary acute angle closure

BackgroundTo compare the anterior biometrics in eyes with secondary acute angle closure induced by occult lens subluxation (ASAC-LS), misdiagnosed as acute primary angle closure (APAC) at the first visit with APAC, chronic primary angle closure glaucoma (CPACG), and cataract.MethodsThis retrospective case study included 17 eyes with angel closure due to occult LS, who were misdiagnosed as APAC on their first visit, 56 APAC eyes, 54 CPACG eyes, and 56 cataract eyes. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AD) and lens thickness (LT) were recorded. Lens position (LP), relative lens position (RLP), corrected lens position (CLP) were calculated. Quantitative data were subject to one-way analysis of variance and correlation analysis. Categorical data were analyzed using the chi-squared test. Receiver operating characteristic (ROC) curves were plotted to obtain a suitable cutoff value of ocular biometrics.ResultsThe ASAC-LS patients had a longer ocular axial length than APAC and CPACG patients. Central corneal thickness of the ASAC-LS patients was not significantly different from APAC patients, but was significantly different from CPACG and cataract patients. The APAC patients had the smallest ACD, while the ASAC-LS patients had the smallest AD. The ASAC-LS patients had the largest lens thickness. According to ROC curve analysis, RLP, ACD, AD, CLP, LP had high power of discrimination.ConclusionsThis study revealed that LS secondary PAC patients had a shallower AD, thicker CCT comparing to those of APAC, CPACG and cataract patients. For patients with acute angle-closure glaucoma, it is necessary to exclude lens zonula relaxation.Trial registrationNCT03752710, retrospectively registered.

The correlation between frequency doubling technology matrix mean deviation and peripapillary retinal nerve fiber thickness of newly diagnosed glaucoma patients

Objective: To evaluate the relationship between glaucomatous structural damage assessed by RTVue SD-OCT and functional loss as measured by Frequency Doubling Technology (FDT) perimetry. Materials and methods: One hundred and forty eyes of 70 newly diagnosed glaucomatous patients irrespective of intraocular pressure level were recruited from a private Tertiary Eye hospital in Lagos Nigeria. All the eyes underwent testing with Avanti RTVue XR SD-OCT (Optovue Inc., Fremont CA USA) and Frequency Doubling Technology (FDT) 24-2 threshold (Humphrey Matrix 800, 2011 Carl Zeiss Meditec, Dublin, CA). The relationship between average peripapillary retinal nerve fiber layer (pRNFL) and mean deviation on the FDT Matrix perimetry was evaluated using Pearson’s correlation coefficient regression analysis. Results: A total of 30 males (42.86%) and 40 (57.14%) females with mean age of 56±14 years with a range of 33-77 years. There were 46 (65.71%) patients with Primary Open-Angle Glaucoma (POAG) and 24 (34.29%) with chronic Primary Angle Closure Glaucoma (PACG). The FDT mean deviation was -14.68±10.59 dB and -10.88 ±8.34 dB for the Right eye (RE) and Left eye (LE) respectively. The mean average pRNFL thickness was 82.26±18.56 and 91.37±15.32 for RE and LE respectively. The Mean deviation significantly correlated with the average peripapillary RNFL thickness (Pearson correlation coefficient, r= 0.88, r2 = 0.77, p-value 0.001 for RE and r= 0.851, r2= 0.72, p-value 0.001 for LE). Conclusion: In this cohort of glaucoma patients, at least 70% of average peripapillary retinal nerve layer thinning measured with RTVue SD-OCT was associated with correspondent visual field loss in glaucoma.

Effect of Angle Narrowing on Sectoral Variation of Anterior Chamber Angle Width: The Chinese American Eye Study

To characterize the relationship between mean and sectoral variation of anterior chamber angle (ACA) width using anterior segment optical coherence tomography (AS-OCT). Subjects aged 50 years or older were identified from the Chinese American Eye Study (CHES), a population-based epidemiological study in Los Angeles, CA. Each subject underwent a complete ocular examination including gonioscopy and AS-OCT imaging. Primary angle closure disease (PACD) was defined as inability to visualize pigmented trabecular meshwork in 3 or more quadrants. Four AS-OCT images from one eye per subject were analyzed and parameters describing ACA width were measured at 500 and 750 μm from the scleral spur: angle opening distance (AOD), trabecular iris space area (TISA), and scleral spur angle (SSA). The relationship between mean and sectoral variation of ACA width was assessed using locally-weighted scatterplot smoothing (LOWESS) regression and change-point analyses and Spearman correlation coefficients. 674 eyes (337 with PACD, 337 without PACD) from 674 subjects were analyzed. Overall, sectoral variation of ACA width decreased as mean ACA width decreased. This relationship was divided into two phases based on the change-point analysis. Sectoral variation of ACA width was strongly and significantly correlated (P < 0.001) with mean ACA width with below parameter-specific change points for most parameters: AOD500 (r = 0.599), AOD750 (r = 0.246), TISA500 (r = 0.734), TISA750 (r = 0.664), SSA500 (r = 0.661), SSA750 (r = 0.394). Correlations were weaker but still significant (P < 0.004) above these change points for most parameters: AOD500 (r = 0.321), AOD750 (r = 0.550), TISA500 (r = 0.122), TISA750 (r = 0.275), SSA500 (r = -0.036), SSA750 (r = 0.313). Correlations to the left and right of the change points strengthened when sectoral variation of ACA width was adjusted for mean ACA width. Correlations between mean and sectoral variation of ACA width strengthen as the severity of angle narrowing worsens. This relationship likely reflects anatomical changes related to chronic angle closure and may be relevant for refining current definitions and management of PACD.

Clinical analysis of modified glaucoma combined with cataract surgery in the treatment of chronic angle closure glaucoma with cataract

Objective To investigate the clinical value of modified glaucoma combined with cataract surgery in the treatment of chronic angle closure glaucoma with cataract. Methods From May 2012 to August 2017, 350 patients with chronic angle closure glaucoma complicated with cataract in the Second Hospital of Shaoxing were studied.According to the difference of treatment methods, they were divided into two groups, with 175 cases in each group.The control group was treated with trabeculectomy, the observation group was treated with modified glaucoma combined with cataract surgery.The intraocular pressure (IOP), visual acuity were observed. Results The IOP values of the observation group were (22.50±1.48)mmHg, (18.77±2.38)mmHg, (14.21±0.93)mmHg at 3 d, one month and three months after operation, which were significantly lower than those of the control group [(28.91±2.05)mmHg, (23.28±2.49)mmHg, (17.75±1.16)mmHg], the differences were statistically significant(t=33.54, 17.32, 31.50, all P 0.05). Conclusion The modified glaucoma combined with cataract surgery is effective in the treatment of chronic angle closure glaucoma with cataract, and can significantly improve the IOP and visual acuity.And the safety is high. Key words: Cataract; Glaucoma, angle-closure; Cataract extraction; Modified combined operation; Intraocular pressure

Evaluation of influence of non-office hours diurnal variation of intraocular pressure in management of glaucoma

Aim and Objectives: This article attempts to elucidate the role of round the clock IOP control and its relevance to current glaucoma practice. Materials and Methods: A prospective observational study was carried out on 50 patients of POAG or CACG on medical management whose intraocular pressures were found to be controlled by daytime office hours IOP estimation. The diurnal IOP readings obtained with Clarkes Hand held Perkins applanation tonometer and Reicherts Tonopen at 7am, 10am, 1pm, 4pm, 7pm, 10pm, 1am and 4am. Comparison of office hours IOP, extended office hours DVT and 24 hours IOP was done. Results: Fifty patients were enrolled (mean age: 53.88 ± 8.42 years) in the study. The mean office hours IOP for both eyes was significantly less (16.31±2.46) than extended office hours (17.18±2.50) and 24 hours DVT (17.49 ±2.45). There was significant difference in IOP fluctuation in office (3.72±2.14) versus extended office hours (9.26±3.11) and 24 hours DVT (10.28±2.76). The mean office hours peak IOP was significantly lower than that of extended office hours and 24 hours DVT. Conclusion: 24-hour IOP monitoring can reveal higher peaks and wider fluctuation of IOP than those found during typical office hours, it suggests a greater role for IOP-related risk for glaucoma progression. Thus may justify a more aggressive IOP-lowering treatment strategy. Keywords: Chronic angle closure glaucoma (CACG), Clarkes hand held perkins applanation tonometer, Intraocular pressure (IOP), glaucoma, Primary open angle glaucoma (POAG), Reicherts tonopen.

Anterior Segment Features in Nanophthalmos With Secondary Chronic Angle Closure Glaucoma: An Ultrasound Biomicroscopy Study.

We compare anterior segment parameters and the risk of malignant glaucoma between nanophthalmos with secondary chronic angle closure glaucoma (NSCACG) and chronic primary angle-closure glaucoma (CPACG). This retrospective case-control study included 32 NSCACG (32 eyes) and 36 CPACG (36 eyes) patients. Anterior segment parameters, including anterior chamber depth (ACD) and width (ACW), pupil diameter (PD), lens vault (LV), ciliary process-ciliary process distance (CCD), angle opening distance500 (AOD500), trabecular-iris angle (TIA), trabecular-ciliary processes distance (TCPD), ciliary body max thickness (CBMT), iris convexity (IC), peripheral iris thickness (PIT), iris-zonule distance (IZD), trabecular ciliary process angle (TCPA), and anterior vault (AV), were measured by ultrasound biomicroscopy. A-scan ultrasonography measurements, including lens thickness (LT) and axial length (AL), also were reviewed. ACD, ACW, CCD, TCPD, and AL were smaller, whereas the LV, LT/AL, LV/LT, LV/ACD, LT/ACD, LV/AV, and AV/AL were larger in NSCACG compared to CPACG eyes (all Bonferroni-corrected P < 0.05). Eyes with NSCACG had a higher risk of malignant glaucoma postoperatively than eyes with CPACG (P = 0.018). Characterized by narrower anterior segment, forward movement of larger lens, more anteriorly rotated ciliary bodies, and smaller CCD, NSCACG eyes have a higher risk of malignant glaucoma than CPACG eyes.

Novel inflammatory cytokines (IL-36, 37, 38) in the aqueous humor from patients with chronic primary angle closure glaucoma

Glaucoma eventually leads to optic nerve damage and vision loss without medical intervention. More than 50% of glaucoma caused blindness are attributed to primary angle closure glaucoma, particularly in Asians. It is reported that immune inflammation is involved in the progress of glaucoma.Increased inflammation cytokines are detected in the aqueous humor of chronic primary angle closure glaucoma (CPACG). IL-36, IL-37 and IL-38, are novel cytokines and are involved in many inflammatory diseases, including inflammatory bowel diseases and acute anterior uveitis, but the possible contributing role in the pathogenesis of CPACG is unclear. In our current study, increased IL-36, IL-37 and IL-38 were detected in the aqueous humor of CPACG compared with age-related cataract (ARC). Furthermore, a significant correlation was detected between mean deviation of visual field (MDVF) of CPACG and IL-36, IL-37 or IL-38, respectively. Our data suggest IL-36, IL-37 and IL-38 might contribute to the immunological mediated pathogenesis of CPACG, despite the eye being an immune-privileged organ under normal conditions. The precise underlying mechanism of these cytokines during the development of CPACG remains to be explored. Our findings may be useful in therapeutic targeting of specific pathology.

The effect of phacoemulsification plus goniosynechialysis in acute and chronic angle closure patients with extensive goniosynechiae

BackgroundPatients with primary angle closure/glaucoma (PAC/PACG) with extensive peripheral anterior synechiae (PAS), and coexisting cataract, increasingly have been treated with phacoemulsification combined with goniosynechialysis (Phaco-GSL). Since the mechanisms of acute and chronic PAC/PACG may differ, the treatment effect of this procedure also may differ. The purpose of this study was to establish whether there was a difference in the therapeutic effect of Phaco-GSL on these two groups of patients, the results of which could provide clinical evidence for improvement in treatment protocols for patients with PAC/PACG and extensive PAS.MethodsThis study was a retrospective cohort study. Twenty-seven patients, 13 with acute PAC/PACG and 14 with chronic PAC/PACG, were treated surgically by Phaco-GSL. The intraocular pressure (IOP), surgical success rate, the need of medication, the extent of PAS, the time and the rate of recurrence of PAS (re-PAS) and other indicators were observed post-operatively for at least 3 months.ResultsAfter surgery, IOP decreased (preoperative vs postoperative: 29.77 ± 11.55 mmHg vs 14.92 ± 1.66 mmHg in the acute group and 26.00 ± 11.2 mmHg vs 14.93 ± 2.7 mmHg in the chronic group), the extent of PAS reduced (preoperative vs. postoperative: 314.23 ± 49.07° vs 116.54 ± 73.78° in the acute group and 285.00 ± 53.28° vs 156.43 ± 56.35° in the chronic group), the topical and systemic anti-glaucoma drug requirements decreased, in both groups and in the acute group, respectively. Compared with the acute group, the success rate (acute vs chronic: 100% vs 64.3%) was lower in the chronic group, while the incidence of re-PAS (acute vs chronic: 30% vs 83.3%) were higher in the chronic group. All differences mentioned above were statistically significant (p < 0.05). In addition, there were five patients in total who showed re-PAS of more than 90° (4 in chronic group and 1 in acute group) and all these re-PASs formed within 1 week postoperatively.ConclusionAlthough Phaco-GSL is effective in both groups, there may be differences in the effect between the two groups. Chronic patients are more susceptible to re-PAS. Thus, these patients should be observed closely and treated appropriately in the early post-surgical time period.

Darkroom prone provocative testing in primary angle closure suspects and those with open angles

PurposeTo describe the results of darkroom prone provocative testing (DRPPT) in primary angle closure suspects (PACS) and to compare the findings to controls with open angles.Methods889 subjects with PACS in...

Comparison of pretreatment measurements of anterior segment parameters in eyes with acute and chronic primary angle closure

To compare pretreatment anterior segment parameters between eyes with acute primary angle closure (APAC) and chronic primary angle closure (CPAC), and to identify the characteristics of eyes with APAC. Retrospective. We measured pretreatment anterior chamber depth (ACD), iris convexity (IC), and pupil diameter in eyes with APAC and CPAC using anterior segment optical coherence tomography. The risk of APAC associated with anterior segment parameters was investigated using multiple logistic regression. Eyes with APAC were discriminated from eyes with CPAC using the receiver-operating characteristic (ROC) curve and area under the curve (AUC). The best cutoff for these variables was determined. Thirty-four eyes with APAC and 60 eyes with CPAC were included. The mean intraocular pressure was 52.3 ± 12.6mmHg in APAC and 15.5 ± 3.5mmHg in CPAC (P < .001). Eyes with APAC had a shallower ACD (1.407 ± 0.301mm vs. 1.960 ± 0.205mm, P < .001) and less IC (0.233 ± 0.087mm vs. 0.294 ± 0.068mm, P < .001) than eyes with CPAC. In multivariate analysis, significant variables associated with APAC were ACD (P < .001) and IC (P = .001). The AUC for ACD was 0.931 and for IC, 0.742. The best cutoff for ACD was 1.699mm (sensitivity 0.824, specificity 0.917) and for IC, 0.282mm (sensitivity 0.853, specificity 0.533). Eyes with APAC had a shallower ACD and less IC. Eyes with an ACD < 1.7mm may be at risk for APAC.