Chronic Primary Angle-closure Glaucoma Research Articles

A Rare Case of Chronic Primary Angle-Closure Glaucoma in a Young Woman with Coexisting Pathologic Myopia

Introduction: Primary Angle-Closure Glaucoma (PACG) is usually present in adults older than forty and is more common in hyperopic eyes. Angle-closure is usually related to structural or developmental ocular abnormalities in young individuals. Case presentation: We presented a rare case of PACG in a 32 years old woman with pathologic myopia of -23.0 RLE. The chief complaint was blurring of the right eye three months before the visit. Right eye Intraocular Pressure (IOP) was 30mmHg-38mmHg despite treatment with three intra-ocular pressure-lowering agents. Axial length was 32.36 mm and 31.19 mm RLE. Anterior chamber depth was 2.36 mm and 2.60 mm RLE. Lens thickness was 5.07 mm and 5.40 mm RLE. Signs of GON and pathologic myopia were found in both eyes. GON was present asymmetrically (0.9 and 0.6 RLE), with the myopic crescent as well as baring and peripapillary atrophy. The optic disc was slightly tilted with the myopic crescent. There was also a marked sign of retinal pigment epithelium thinning and attenuation along with myopic chorioretinal atrophy. Conclusions: PACG in a young myopic individual is challenging to diagnose because myopia and glaucoma share similar optic nerve head pathology. Comprehensive examinations including gonioscopy, biometry, and OCT may confirm the diagnosis. In the presented case, angle-closure was caused by thick lenses and a shallow anterior chamber, along with excessively long axial length. Primary angle-closure at a young individual with myopic eyes is highly uncommon. Nonetheless, clinicians should always consider glaucoma even in the presence of high axial length and myopic fundus.

Cyclophotocoagulation under Microscopy Combined with Phacoemulsification for Primary Angle-Closure Glaucoma.

The purpose of this study was to evaluate the safety and efficacy of cyclophotocoagulation under microscopy combined with phacoemulsification in patients with primary chronic angle-closure glaucoma. We retrospectively reviewed the results of cyclophotocoagulation under microscopic direct vision combined with phacoemulsification in 35 eyes (35 patients) with primary chronic angle-closure glaucoma and coexisting visually significant cataracts, treated between January 2017 and April 2020 at the glaucoma unit of the affiliated Changshu Hospital of Xuzhou Medical University. All patients were followed up for at least 12 months postoperatively. The preoperative to postoperative changes in best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications, and surgery-associated complications were recorded. The BCVA improved from 1.15 ± 0.91 logMAR preoperatively to 0.86 ± 0.82 logMAR at the final postoperative examination (Z = −3.62, P < 0.0001). The mean IOP was 36.63 ± 13.50 mmHg preoperatively and 15.14 ± 3.19 mmHg at the final examination (Z = −5.16, P < 0.0001). The number of antiglaucoma drugs was significantly reduced from 2.23 ± 0.55 preoperatively to 0.54 ± 0.86 at the final postoperative examination (Z = −5.26, P < 0.0001). The absolute value of the mean defect and retinal nerve fiber layer thickness at the last follow-up postoperatively were significantly reduced compared to preoperative values (Z = −3.35, P=0.001; Z = −4.56, P < 0.001, respectively). One patient experienced an explosive suprachoroidal hemorrhage during the operation. The sclera was incised at the corresponding site of the intraoperative hemorrhage. The operation was continued once there was no active bleeding, and the outcome was satisfactory. None of the patients required additional surgery to treat complications. Thus, cyclophotocoagulation under microscopic direct vision combined with phacoemulsification can be performed safely for the management of primary angle-closure glaucoma.

Clinical observation of macular choroidal thickness in primary chronic angle-closure glaucoma.

To comparatively analyze differences in macular choroidal thickness and volume in primary chronic angle-closure glaucoma (PACG) eyes. Thirty-one PACG patients were sequentially selected for this case-control study. Thirty-one eyes with PACG were included in group A, 31 fellow eyes were included in group B, and group C included 67 normal eyes. Enhanced-depth imaging optical coherence tomography (EDI-OCT) was used to measure choroidal thickness and volume. The choroidal thicknesses and volumes of the central subfield macula (CSM), nasal inner macula (NIM), temporal inner macula (TIM), inferior inner macula (IIM), temporal outer macula (TOM), inferior outer macula (IOM), and mean macula (MM) in group A were all higher than those in group C (P <0.05). The choroidal thicknesses and volumes of the NIM, superior inner macula (SIM), IIM, nasal outer macula (NOM), and MM in group B were all higher than those in group C (P <0.05). No statistically significant differences were found between groups A and B (P >0.05). The choroidal thicknesses of different macular regions in group A were not correlated with the mean defect (MD). Increased macular choroidal thickness may be a common anatomical characteristic of PACD eyes. Macular choroidal thickness is not a good marker for assessing PACG severity.

Фактор передбачення закриття кута передньої камери за даними ультразвукової біометрії

The aim. To develop a predictive factor (PF) of anterior chamber (AC) angle closure based on biometric data and to compare its values with the Lowe coefficient and lens thickness to axial length factor (LAF) in healthy patients of different age, cataract patients and patients with chronic and acute angle-closure glaucoma. Materials and methods. The study was performed in 180 variously-aged (20 to 60 years) patients with different types of refraction, and in 20 patients with acute AC angle closure, in 20 patients with primary chronic angle-closure glaucoma and in 20 patients with cataract. The AC depth, the lens thickness (LT) and the axial length (AL) were measured by A-scan ultrasound biomicroscopy. Results. Based on ultrasound biometrics, a PF of anterior angle closure has been developed: PF = AC / AL / LT x 100. There was significant age-related decrease in the PF coefficient in patients with all types of refraction (p&lt;0.001). In case of hypermetropia, PF was significantly less than in cases with myopia and emmetropia (p&lt;0.001). Compared to the Lowe coefficient, the PF coefficient more sensitively showed the trend towards the closure of the AC angle in the age-refraction context. The AC depth in case of an acute glaucoma (2.3 ± 0.16 mm) was significantly less than that in case of chronic angle-closure glaucoma (2.4±0.21 mm) and differed significantly from that in case of cataract (3.32±0.33 mm), in all groups p &lt; 0.001. At the same time, LT did not differ significantly in patients with acute glaucoma, chronic angle-closure glaucoma and cataracts (p&gt;0.05). There was significant difference in PF coefficient between the groups of patients with an acute angle-closure glaucoma and cataracts, as well as chronic angle-closure glaucoma and cataracts (p&lt;0.001). Its significance was higher than the significance of the Lowe coefficient between the respective groups. PF less than 2.5 was a significant risk factor for the closure of the AC angle.

CORRELATION BETWEEN LOCUS POLYMORPHISM OF COL11A1 GENE AND OCULAR BIOMETRY IN ACUTE AND CHRONIC PRIMARY ANGLE CLOSURE GLAUCOMA

Objective: The objective of this study is to analyze the correlation between locus polymorphisms of genetics variants of rs3753841 (COL11A1) and ocular biometry, including anterior chamber depth (ACD), axial length (AL), and lens thickness (LT) in acute and chronic primary angle-closure glaucoma (PACG) patients.&#x0D; Methods: A total of 50 patients consisting of 25 acute PACG and 25 chronic PACG patients were included in this study. Ocular biometric parameters including anterior ACD, AL, and LT measurement were performed in all subjects using A-scan biometry. DNA isolation from blood samples was performed using PCR sequencing for genotyping locus polymorphisms of rs3753841 (COL11A1).&#x0D; Results: Mean ACD was shallower (2.40±0.40 mm), mean AL was shorter (21.86±1.31 mm), and mean LT was thicker (5.01±0.49 mm) in acute PACG compared to chronic PACG group, yet with no significant difference (p&gt;0.05). We found a statistically significant difference of rs3753841 (COL11A1) polymorphism, with heterozygous mutant was mostly found in chronic PACG and homozygous mutant was mostly found in acute PACG patients (p&lt;0.05). Significant correlations were also found between the locus polymorphism and ocular biometry (ACD and AL) in chronic PACG (p&lt;0.05).&#x0D; Conclusion: We confirmed the polymorphisms of rs3753841 (COL11A1) in both groups and its significant correlation with ocular biometry (ACD and AL) in chronic PACG.

Lens extraction for chronic angle-closure glaucoma.

Lens extraction for chronic angle-closure glaucoma.

Laser peripheral iridoplasty for chronic angle closure.

Laser peripheral iridoplasty for chronic angle closure.

Impact of binocular integrated visual field defects on healthy related quality of life in glaucoma.

To investigate the impact of different types of binocular integrated visual field defects on the quality of life in glaucoma.Ninety-six patients with primary glaucoma were divided into 5 groups with 25, 24, 11, 15, and 21 patients according to types of the binocular integrated visual field (BVF) defects. The criteria for BVF grouping included mild visual field defect in binocular eyes, mild visual field defect in 1 eye and moderate or advanced defect in the other, moderate and non-overlapping visual field defect in both eyes, overlapping and moderate visual field defect in binocular eyes, and severe defect in both eyes, respectively. The visual field (VF) evaluation was based on H-P-A visual field grading system. Visual acuity, visual field tests and Glaucoma Quality of Life-15 Questionnaire (GQL-15) were performed for enrolled patients, and binocular visual field results were integrated. The changes and correlations of the Visual field index values and quality of life scores were compared among the 5 groups. The main factors affecting the quality of life in glaucoma were analyzed by multiple regression analysis.The best binocular integrated visual field index (BVFI) and optimal quality of life were observed in group A. The BVFI of group B was better than that of group C or group D, but the peripheral vision glare and dark adaptation were worse. No significant difference was noted between group C and group D in terms of BVFI. However, the glare and dark adaptation in group C were better than that in group D. The BVFI was the lowest and the quality of life was the worst in group E. In all, BVFI and decibels (dB) values were negatively correlated with GQL-15 scores and positively correlated with patients’ quality of life.Binocular integrated visual field accurately reflects the visual function in glaucoma. Higher binocular integrated visual field indices represent a better quality of life for patients with glaucoma. Mild to moderate synchronous or complementary binocular VF defects had a slight effect on the quality of life, while severe and non-compensated VF loss significantly impacts on quality of life in glaucoma patients.

Proteome Characterization of Glaucoma Aqueous Humor

Glaucoma is the leading cause of irreversible blindness worldwide. The proteome characterization of glaucoma is not clearly understood. A total of 175 subjects, including 57 primary acute angle-closure glaucoma (PAACG), 50 primary chronic angle-closure glaucoma (PCACG), 35 neovascular glaucoma (NVG), and 33 cataract patients, were enrolled and comparison proteomic analysis was provided. The samples were randomly divided into discovery group or validation group, whose aqueous humor proteome was analyzed by data-independent acquisition or by parallel reaction monitoring. The common proteome features of three types of glaucoma were immune response, lipid metabolism, and cell death. Three proteins, VTN, SERPIND1, and CD14, showed significant upregulation in glaucoma and could discriminate glaucoma from cataract. Mutual differential proteomic analysis of PAACG, PCACG, and NVG showed different proteome characterization of the three types of glaucoma. NVG was characterized with activated angiogenesis. PAACG was characterized with activation of inflammation response. SERPIND1 was discovered to play vital role in glaucoma occurrences, which is associated with eye transparency decrease and glucose metabolism. This study would provide insights in understanding proteome characterization of glaucoma and benefit the clinical application of AH proteome.

Effect of intraoperative application of viscoelastic on corneal endothelium during trabeculectomy with mitomycin C surgery in primary angle-closure glaucoma patients

Background Mitomycin C (MMC), as a wound-healing modulatory factor, can be applied during trabeculectomy to increase its success rate. This may affect the morphology and function of corneal endothelium as well as its central cell count.Aim The aim of this study was to investigate the effect of intracameral injection of viscoelastic combined with subconjunctival application of viscoelastic in trabeculectomy with MMC performed for uncontrolled chronic primary angle-closure glaucoma (PACG) in order to decrease the MMC side effects on the corneal endothelial cells.Patients and methods This is a prospective randomized comparative case-series study that included 70 eyes of 70 patients with uncontrolled chronic PACG. The patients were referred for glaucoma surgery in a tertiary hospital. They were randomized into two groups with 35 eyes in each group: group 1 included 35 eyes that underwent subscleral trabeculectomy with MMC with intracameral injection of dispersive viscoelastic and subconjunctival application of cohesive viscoelastic, while group 2 included 35 eyes that underwent subscleral trabeculectomy with MMC application only. In both groups, endothelial cells were assessed by specular microscopy preoperatively and postoperatively. The outcome measures included the corneal endothelial cell density, hexagonality (HEX), coefficient of variation of cell size, central corneal thickness, as well as intraocular pressure (IOP).Results The mean age of the patients was 53.43±5.14 years in group 1 and 52.54±4.2 years in group 2. The IOP decreased from 31.09±3.17 mmHg preoperatively to 11.2±0.8, 11.8±0.9, 11.9±0.9, and 11.9±0.9 mmHg at 1, 3, 6, and 12 months postoperatively, respectively, in group 1, while it decreased from 30.5±3.7 mmHg preoperatively to 13.7±1.1, 14.4±0.9, 14.6±0.8, and 14.7±0.7 mmHg at 1, 3, 6, and 12 months postoperatively, respectively, in group 2. The corneal endothelial cell density significantly decreased from 2482±179 cells/mm2 preoperatively to 2350±62 cells/mm2 at 12 months postoperatively (P<0.001) in group 1, while it significantly decreased from 2461.17±41.58 cells/mm2 preoperatively to 2273±37.5 cells/mm2 at 12 months postoperatively (P<0.001) in group 2, with a significant difference between the two groups (P<0.001). The coefficient of variation as a measurement of polymegathism was significantly increased from 27.21±0.41 preoperatively to 27.73±0.478 postoperatively in group 1 (P<0.001), while it significantly increased from 27.18±0.40 preoperatively to 27.72±0.4 postoperatively in group 2 (P<0.001). HEX, which is an indication of variability in HEX shape, was significantly decreased from 71.5±0.4% preoperatively to 62.0±1.8% at 1 month and then significantly increased to 68.2±1.8% at 12 months postoperatively in group 1 (P<0.001). On the other hand, it decreased from 71.55±0.40% preoperatively to 62.0±1.75% at 1 month and then significantly increased to 68.17±1.77% at 12 months postoperatively in group 2 (P<0.001). Intracameral combined with subconjunctival application of viscoelastic significantly reduced the IOP in group 1 to 11.94±0.91 mmHg more than in group 2 (14.69±0.76 mm Hg) at the end of the follow-up period (P<0.001).Conclusion Intracameral injection of dispersive viscoelastic, in addition to subconjunctival injection of cohesive viscoelastic, may be a good method to preserve the corneal endothelium in PACG cases, for which trabeculectomy with MMC application was performed. Moreover, this extrastep may increase the trabeculectomy success rate and reduce its complications.

Safety and efficacy of incisional goniotomy as an adjunct with phacoemulsification in primary angle-closure glaucoma.

To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of incisional goniotomy as an adjunct to phacoemulsification in primary angle-closure glaucoma (PACG) patients. Consecutive patients with PACG (high or borderline IOP) deemed fit for phacoemulsification were enrolled. After phacoemulsification, incisional goniotomy was performed with or without goniosynechialysis. Patient demographic profile, clinical data, and adverse events, if any, were analyzed during at least a 6-month follow-up period. Success was defined as IOP of 18 mm Hg or lesser with or without medications. Tertiary care Ophthalmic hospital. Prospective interventional case series. Of 46 eyes (38 patients) included, 69.6% eyes were classified as having advanced glaucoma. The mean treated IOP decreased by 7.3 ± 1.0 (SE) mm Hg (95% CI, 5.2-9.3) from 21.4 ± 6.6 to 14.2 ± 3.7 mm Hg at a mean duration of 11.7 ± 5.5 months (6-22 months) postoperatively (P < .001, paired t test). There was 66.6% reduction in median number of hypotensive medications (P < .001, Wilcoxon signed-rank test). Observed complications included hyphema (13 eyes [28%]), IOP spike (3 eyes [6.5%]), and cyclodialysis (1 eye [2.17%]). High treated IOP and number of medications were significantly associated with failure in univariate analysis (P < .05, Fisher exact test). The cumulative survival probability for qualified success at 22 months was 87.8% ± 0.07 (95% CI, 0.65-0.96). Incisional goniotomy as an adjunct with phacoemulsification resulted in a significant and sustained reduction in IOP along with decrease in number of glaucoma medications in chronic PACG eyes, irrespective of the disease stage.

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.

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.

Morphological features of parapapillary beta zone and gamma zone in chronic primary angle-closure glaucoma.

To investigate the morphological features of parapapillary beta zone and gamma zone and their associated factors in eyes with chronic primary angle-closure glaucoma (CACG). The observational cross-sectional study included 65 CACG eyes and 65 non-myopic control eyes. On enhanced depth imaging of optical coherent tomography images, the area of parapapillary beta zone and gamma zone, and the peripapillary choroidal thickness at 6 sectors were measured. The optic disc ovality index and Bruch's membrane opening (BMO) shape were further calculated. Beta zone was present in 103 (79.2%) eyes and gamma zone in 29 (22.3%) eyes. Compared to control eyes, CACG was associated with larger parapapillary beta zone, female gender, and older age (P < 0.01). No significant difference was observed in axial length and peripapillary choroidal thickness between both groups (P > 0.05). In multivariate analysis, beta zone area was positively associated with older age and higher prevalence of CACG (P < 0.01), while a larger gamma zone area was associated with a smaller disc ovality index and a higher BMO ovality ratio (P < 0.01). The peripapillary choroidal thickness at six sectors was decreased with older age (P < 0.01). In mainly non-myopic subjects with or without CACG, larger parapapillary beta zone was correlated with older age and presence of glaucoma, while a larger parapapillary gamma zone was correlated with disc ovality but not with glaucoma. Parapapillary beta zone and gamma zone may play different roles in physiological and glaucomatous changes around optic nerve head.

Automated Iris Segmentation from Anterior Segment OCT Images with Occludable Angles via Local Phase Tensor.

Morphological changes in the iris are one of the major causes of angle-closure glaucoma, and an anteriorly-bowed iris may be further associated with greater risk of disease progression from primary angle-closure suspect (PACS) to chronic primary angle-closure glaucoma (CPCAG). In consequence, the automated detection of abnormalities in the iris region is of great importance in the management of glaucoma. In this paper, we present a new method for the extraction of the iris region by using a local phase tensor-based curvilinear structure enhancement method, and apply it to anterior segment optical coherence tomography (AS-OCT) imagery in the presence of occludable iridocorneal angle. The proposed method is evaluated across a dataset of 200 anterior chamber angle (ACA) images, and the experimental results show that the proposed method outperforms existing state-of-the-art method in applicability, effectiveness, and accuracy.

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.

Changes in corneal biomechanical properties before and after operation in different types of glaucoma

Objective To compare the differences of corneal biomechanics in different types of glaucoma and its related influence factors, and to investigate the change trends of cornea biomechanics after the operations. Methods In a prospective comparative case series, 61 eyes of 61 acute primary angle-closure glaucoma (APACG) (remission or chronic phase)patients, 94 eyes of 94 chronic primary angle-closure glaucoma (CPACG) patients, 70 eyes of 70 primary open angle glaucoma (POAG) patients and 64 eyes of 64 age-related cataract (ARC) patients were recruited in Tianjin Eye Hospital from January to July, 2017.Corneal biomechanical properties were measured by using Corvis ST.The differences of corneal biomechanics in different types of glaucoma and the change trends after surgeries were assessed; the association between parameters and the age, intraocular pressure after correction (IOPcc), central cornea thickness (CCT), axial length (AL), average corneal diopter (K) were assessed by multiple linear regression analysis.This study followed the Declaration of Helsinki.This study protocol was approved by Ethic Committee of Tianjin Eye Hospital (TJYYLL-2016-17). Written informed consent was obtained from each subject prior to any medical examination. Results Compared with the ARC group, the first applanation velocity (A1V) and second applanation time (A2T) were both smaller in preoperative CPACG, POAG groups (all at P 0.05). Conclusions CPACG and POAG have poorer ability of corneal deformation, which gradually returns to normal after surgery; because the intraocular pressure of APACG (remission or chronic stage) return to normal after transient elevated stage, the corneal biomechanics is basically similar to ARC, which has no difference between pre-and post-operation.The parameters of corneal biomechanics are affected by IOPcc and K. Key words: Glaucoma; Cornea biomechanical properties; Glaucoma surgery; Cornea refractive power

Post-miosis changes in the anterior chamber structures in primary and lens-induced secondary chronic angle-closure glaucoma.

To evaluate post-miosis changes in the anterior chamber structures in various angle-closure glaucomas (ACG). Totally 14 eyes of primary chronic angle-closure glaucoma (PCACG), 12 eyes of lens-induced secondary chronic angle-closure glaucoma (LSACG) and 14 healthy eyes were recruited. After miosis, for PCACG group, intraocular pressure (IOP) and anterior chamber depth (ACD) changed not significantly, while anterior chamber angle widened significantly. LSACG group showed a significant increase in IOP, decrease in ACD, and narrowing in anterior chamber angle. Healthy eyes showed significant decreases in IOP and anterior chamber parameters. Thus, miosis could widen the anterior chamber angle of patients with PCACG, while increase the narrowing of anterior chamber angle and IOP of patients with LSACG. We should pay attention to the distinction between PCACG and LSACG patients and the proper administration of pilocarpine in the treatment of patients with chronic ACG.

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.