Chronic Primary Angle Closure Research Articles

The Evolution of Chronic Primary Angle Closure Glaucoma in the Inuit and Oriental Eye

The Evolution of Chronic Primary Angle Closure Glaucoma in the Inuit and Oriental Eye

The Difference of Lens Thickness in Acute and Chronic Primary Angle Closure Glaucoma

Background: Lens thickness is one of the factors that influence the mechanism of acute primary angle closure glaucoma (PACG). The thicker lens usually results in a shallower anterior chamber angle (ACA), and the gradual and progressive increase in lens thickness with age results in exaggerated shallowing of the ACA. Because lens thickness has an important role in acute PACG mechanism, prophylactic treatment like lens extraction might prevent PACG in early stages. This study aimed to describe the difference in lens thickness in acute and chronic PACG.
 Methods: The research was a cross-sectional study with samples conducted in Dr. M. Djamil General Hospital from September-December 2019. The number of eyes that fulfilled the inclusion criteria were 50 eyes from 50 patients consisting of 25 eyes with acute PACG and 25 eyes with chronic PACG. Subjects were examined with ocular biometry using A-scan biometry to evaluate lens thickness. Data were processed and analyzed using a computer program with a chi-square test.
 Results: Mean of lens thickness in acute PACG is 5.02 ± 0.45, while in chronic PACG is 4.86 ± 0.40. The difference in lens thickness in acute and chronic PACG were statistically significant (p = 0,037).
 Conclusion: Lens thickness is thicker in acute PACG than in chronic PACG.

Age-Related Changes in Dynamic Iris Behavior Assessed Using a Programmable Closed-Loop Iris Control System.

The purpose of this study was to develop and test a programmable closed-loop system for tracking, modulating, and assessing dynamic iris behavior, including in the mid-dilated position. A programmable closed-loop iris control system was developed by customizing an ANTERION OCT device (Heidelberg Engineering, Heidelberg, Germany). Custom software was developed to store camera and optical coherence tomography (OCT) images, track pupillary diameter (PD), control a light-emitting diode (LED), and modulate ambient lighting to maintain the iris in a dilated, constricted, or mid-dilated position in real-time. Study participants underwent 3 consecutive 65-second scan sessions. Dynamic iris behavior in the form of peak constriction velocity (PCV) and mid-dilated iris activity (MDIA) were calculated and analyzed offline. Among 58 participants, 56 (96.6%) were eligible for analysis based on achieving and maintaining mean PD within ±10% of the calculated mid-dilated PD. Mean participant age was 49.8 ± 18.9 years. Mean PCV was 3.92 ± 0.83 mm/s, and mean MDIA was 0.37 ± 0.15 mm. The mean difference between the calculated and achieved mid-dilated PD was 0.166 ± 0.192 mm. There were significant negative correlations between PCV and age (slope = -0.022, P < 0.001) and MDIA and age (slope = -0.004, P < 0.001). Success rates were lower (69.0%) but relationships between dynamic iris behavior and age were similar based on achieving and maintaining mean PD within ±5% of the calculated mid-dilated PD. A programmable closed-loop iris control system can modulate dynamic iris behavior and maintain the iris in a mid-dilated position. Pupillary constriction velocity and iris activity in the mid-dilated position decrease with age. This system can be applied to study dynamic disease processes involving the iris and establish novel biometric measures that could serve as risk factors for acute and chronic primary angle closure glaucoma (PACG).

Study of power use and complication frequency of Nd:YAG laser iridotomy in the management of primary angle closure glaucoma

Background: The aim of the study was to assess the power use and efficacy of Nd:YAG laser iridotomy in the management of primary angle closure (PAC). Material and methods: A prospective cross-sectional analysis was done in 146 eyes of 81 cases who underwent neodymium: yttrium-aluminum-garnet laser iridotomy. There were 42 patients with chronic primary angle closure glaucoma (PACG), 46 with acute and subacute PAC, and 11 with PACS (suspects). After initial intraocular pressure (IOP) controlling, all patients were treated with Nd:YAG laser iridotomy. Before and after the laser therapy, IOP, laser parameters, mean power use, and complications, if any, were noted. Results: The average total power used was 78.56 ± 8.1 mJ per eye. The anatomy of angle structures improved by one or two of Shaffer’s grades. Controlled IOP was noted in 71% (17) of patients with PACG (chronic) and 93% (43) of patients with PAC (acute and subacute). The average total power used was 78.568.1 mJ per eye. Junior residents used more power than senior residents (88.5 62.5 mJ vs. 63.55 ± 5.8 mJ, p = 0.011). Complications included elevated IOP in 38.27% (31/81), aqueous flare/debris in 34.56% (24/81), iris bleeding in 18.51% (15/81), corneal burns in 4.93% (4/81), and lens damage in 3.71% (3/81). Laser peripheral iridotomy (LPI) was repeated in 48.14% of cases (39/81), with junior residents having a higher rate of repeat LPI than senior residents (p = 0.02). Complication rates differed between residents who performed the procedure (p = 0.16). In PACS subjects, 63.6% had a history of repeated LPI, followed by 58.33% in PACG and 39.1% in PAC cases. At follow-up, 3% of PAC eyes had glaucomatous optic neuropathy. Conclusion: Laser iridotomy in managing early PACG reduces IOP and improves patient acuity. Nd:YAG laser iridotomy is effective in widening the drainage angle and lowering elevated IOP in patients with PAC.

Anterior Lens Curvature Matters in the Course of Primary Angle Closure: An Analysis Based on Ultrasound Biomicroscopic Imaging.

Purpose To evaluate the effect of anterior lens curvature in primary angle closure (PAC) and find additional anatomical features of crystalline lens that may predispose primary angle closure to the acute course. Methods 435 eyes (263 subjects) were enrolled in this study. Four groups of eyes were included based on angle configurations and clinical features: (i) acute primary angle closure (APAC, 140 eyes); (ii) chronic primary angle closure (CPAC, 116 eyes); (iii) primary angle closure suspect (PACS, 84 eyes); and (iv) normal controls (95 eyes). All patients underwent thorough ophthalmic exams including applanation tonometry, gonioscopy, low-coherence interferometry, and ultrasound biomicroscopic imaging. Based on the panoramic anterior segment images from ultrasound biomicroscopic imaging measurements, the radius of anterior lens curvature (ALR) was calculated using the least-squares curve fitting technique. ALR, in addition to axial length (AL), anterior chamber depth (ACD), and lens thickness (LT), was compared among different groups using univariate and multivariate analysis with mixed effects linear model. Results APAC, CPAC, and PACS groups all had steeper ALR, shorter AL, shallower ACD, and thicker LT than normal control group. ACD and LT further differ between APAC and CPAC or PACS eyes. Moreover, a steeper ALR was also found in the APAC group as compared to CPAC, PACS, and normal control groups. Conclusions A steeper ALR may predispose the acute attack of PAC. In addition to the relative lens position and size, lens curvature is another variable that contributes to the pathophysiological mechanisms of primary angle closure.

Vision “wipe-out” phenomena following a nonincisional laser procedure in the management of narrow-angle glaucoma

The “Wipe-out” or “Snuff-out” phenomenon refers to a permanent and severe loss of vision without an identifiable cause and is considered a rare but dreaded consequence of incisional ocular surgery. It is believed to occur in patients with advanced glaucoma who demonstrate a residual central island of vision. A 42-year-old female patient presented to the general ophthalmology clinic with complaints of painless blurring of vision of the left eye for 8 months. Best-corrected visual acuity (BCVA) was 20/30 and 20/40 and intraocular pressure (IOP) was 26 mmHg and 28 mmHg in the right and left eyes, respectively. Relative afferent pupillary defect was noted in the left eye. Anterior segment examination showed peripherally shallow anterior chamber and gonioscopy revealed appositionally closed angles (Shaffer-<20 Deg) in both eyes. Fundus examination showed advanced glaucomatous optic neuropathy of the left eye. Generalized depression in the right eye and inferior arcuate scotoma with a superior nasal step, and split fixation in the left eye was seen on Humphreys 30-2 visual fields. A diagnosis of chronic primary angle closure glaucoma was made and the patient was offered Nd: Yag Laser Peripheral Iridotomy (LPI). LPI was completed for the right eye and Argon Laser Iridoplasty was performed in the left eye as Iridotomy was not possible due to the proximity of the iris to the cornea as the pupil was mid-dilated. After the procedure, the patient was prescribed topical antiglaucoma medications with topical steroids at 1 week follow-up, the patient had BCVA of 20/30 in the right eye and hand motion in the left eye, IOPs were well controlled on topical anti-glaucoma medication. A thorough examination including a dilated fundus examination, B-Scan ultrasound, and fundus fluorescein angiography were unremarkable. Magnetic resonance imaging scan of the brain and orbits was normal. “Wipeout” phenomenon is a rare but notorious complication associated with incisional surgeries in patients with advanced glaucoma. It is also reported to occur following cataract and retinal incisional surgeries. There are no reports of a wipe-out after a commonly performed laser procedure.

Bilateral laser peripheral iridotomy in a co-occurrence of unilateral iridocorneal endothelial syndrome and chronic angle closure glaucoma.

To report a case of unilateral Iridocorneal endothelial (ICE) syndrome- Progressive iris atrophy (PIA) with an overlapping chronic angle closure glaucoma (CACG) and to highlight the effect of bilateral Laser peripheral iridotomy (LPI) in such a co-occurrence. A patient presented to us with bilateral gradual painless progressive diminution of vision. Both eyes (BE) had a clear cornea, shallow peripheral anterior chamber depth, grade 2 nuclear sclerosis, raised intraocular pressure and glaucomatous optic neuropathy. In addition, the Left eye (LE) had an irregular anterior chamber, peripheral anterior synechiae (PAS) extending to cornea, patchy iris atrophy, subtle corectopia and a low endothelial cell count on specular microscopy. Indentation gonioscopy led to the diagnoses of CACG BE with ICE syndrome- PIA LE. LPI was performed bilaterally. On Anterior Segment Optical Coherence Tomography (ASOCT), there was evident widening of the angle away from PAS in the Right eye as well as in the LE with PIA post LPI. This is a unique case of unilateral PIA with an associated CACG in BE. It is the first case demonstrating the effect of bilateral LPI in such a case scenario. Though not indicated in ICE syndrome, LPI did show short term evidence of significant widening of the angle away from areas of PAS even in the eye with PIA having a limited high PAS and a concurrent primary (chronic) angle closure disease.

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.

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.

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.

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.

Longitudinal Change in Peripheral Anterior Chamber Depth of Eyes with Angle Closure after Laser Iridotomy.

Purpose To investigate longitudinal changes in peripheral anterior chamber depth (pACD) of eyes with angle closure after laser iridotomy (LI) and factors related to prognosis. Design Retrospective cohort study. Methods Eyes with primary angle closure (PAC), acute PAC, or chronic angle closure glaucoma (CACG) that underwent LI (LI group) and eyes that underwent phacoemulsification and intraocular lens insertion (PEA + IOL group) were employed. Longitudinal changes in pACD were evaluated with a scanning peripheral anterior chamber depth analyzer (SPAC) in addition to routine ophthalmic examination. Results Forty-eight eyes of LI groups (69.8 ± 8.5 years) and 21 eyes of PEA + IOL group (65.6 ± 12.7 years) were enrolled. Mean follow-up times of LI group and PEA + IOL group were 43.4 ± 12.7 months and 36.5 ± 2.5 months, respectively. LI significantly increased pACD as indicated by the SPAC grade change from 3.8 ± 1.1 to 4.6 ± 1.2 (p < 0.001). However, SPAC grade was gradually reduced and reached the pre-LI level by the third year of follow up. PEA + IOL also significantly increased SPAC grade from 6.7 ± 1.6 to 8.7 ± 2.0 (p < 0.001), but no time-related change was observed. Twenty-three cases of LI group presented with deterioration of glaucoma control. The type of angle closure, plateau iris configuration, peripheral anterior synechia, and glaucomatous visual field defects were significantly associated with prognosis of glaucoma after LI. Conclusions Peripheral ACD is temporarily deepened by LI, but returns to the pre-LI level in approximately three years. The type of angle closure and some factors may be related to glaucoma prognosis after LI.

Comparative Clinical Study of Medically Controlled Nonsevere Chronic Primary Angle-closure Glaucoma with Coexisting Cataract Surgically Managed by Phacoemulsification as against Combined Phacotrabeculectomy.

PURPOSE:Comparative clinical study of medically controlled non-severe chronic Primary Angle Closure Glaucoma (PACG) with co-existing cataract surgically managed by phacoemulsification as against combined phacotrabeculectomy.METHODS:This randomized clinical trial was conducted between December 2011 and December 2013. Patients were randomly assigned to Phacoemulsification (PE) and Phacotrabeculectomy (PT) groups for surgery. Intraocular pressure, anti-glaucoma medications, Best Corrected Visual Acuity, anterior chamber angle widening and post-operative complications in both groups were compared after 12 months.RESULTS:There were 46 eyes with PACG in PE group and 45 in PT group. The IOP at 12 months in PE group was 11.5±1.3mmHg and 11.8±1.2mmHg in PT gr. (p = 0.28). The eyes requiring single anti-glaucoma medications at 12months in PE group was 0, PT group was 1 (p = 0. 495). The post op BCVA at 12months in PE group 0.3+-0.12 and 0.33±0.15 in PT group (p = 0.22). 3 cases in PT group required additional intervention whereas no additional intervention was required in PE group and this difference was statistically significant (p = 0.116).CONCLUSION:Phacoemulsification is equally effective in terms of intraocular pressure control and visual outcome as phacotrabeculectomy with better safety and less post-operative complication.

Correlation of visual field with corneal changes in angle closure glaucoma

Forty four patients(84 eyes)with primary chronic angle closure glaucoma, including 14 cases(26 eyes)with mild visual field defect, 22 cases(42 eyes)with moderate defect and 8 cases(16 eyes)with severe defect, treated in our hospital from January 2014 to January 2016 were enrolled in the study. The visual field defect (MD), corneal endothelial cell density (ECD) and central corneal thickness (CCT) were measured. The average CCT in mild, moderate and severe visual field defect groups was (531.4±27.1) μm, (521.2±31.4)μm and(513.3±28.2)μm, respectively (F=-3.24, P=0.04). The mean endothelial cell density in three groups was (2 635.0±320.3) cells/mm2, (2 619.2±161.4) cells/mm2 and(2 589.7±290.4)cells/mm2, respectively (F=0.22, P=0.80). The results indicate that with the aggravation of visual field defect in patients with chronic angle closure glaucoma, the central corneal thickness is significantly thinner, and the mean density of central corneal endothelial cells shows a downward trend. Close observation and active intervention are needed for chronic angle closure glaucoma with thin central corneal thickness. Key words: Visual fields defect; Corneal endouthelial cell loss

Clinical study of phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of primary chronic angle closure glaucoma

Clinical study of phacoemulsification and intraocular lens implantation combined with goniosynechialysis in the treatment of primary chronic angle closure glaucoma

Biometric Differences between Unilateral Chronic Primary Angle Closure Glaucoma and Fellow Non-Glaucomatous Eyes

ABSTRACTPurpose: To compare biometric differences between eyes with unilateral chronic primary angle-closure glaucoma (PACG) and fellow non-glaucomatous eyes in the same patient. Methods: Clinical data and imaging records of 17 patients with unilateral PACG were retrospectively reviewed. The fellow eyes with primary angle-closure (PAC) or primary angle-closure suspected (PACS) were grouped in Group 1. The PACG eyes were set as Group 2. The biometric parameters of both eyes were measured by IOL-Master, anterior segment optical coherence tomography (AS-OCT), and swept source OCT. Results: The iris area in Group 1 was significantly thicker than that in Group 2 (1.590 ± 0.267 versus 1.365 ± 0.352, P = 0.016). Choroidal thickness in the macular region was thicker in Group 1 than in Group 2, with statistical significance at inner temporal grid (282.7 ± 121.1 versus 191.6 ± 90.3, P = 0.036), central field (297.4 ± 130.6 versus 200.1 ± 96.3, P = 0.029), inner nasal grid (283.1 ± 128.3 versus 194.8 ± 91.8, P = 0.040), and average value (265.3 ± 105.6 versus 191.1 ± 87.0, P = 0.049). Group 1 also had thicker peripapillary choroidal thickness at 1 o’clock (141.4 ± 68.4 versus 101.8 ± 39.0, P = 0.025) and 12 o’clock (141.5 ± 82.3 versus 104.5 ± 44.6, P = 0.037) compared to Group 2. The multivariate logistic regression analyses showed that only intraocular pressure was independently associated with PACG and explained 58.3% variance of PACG. Conclusions: In unilateral PACG, there was significant inter-eye difference in anterior and posterior segment parameters. Longitudinal comparisons are required to further understand the differences in pathology of angle closures.

Multiplex Cytokine Analysis of Aqueous Humor from the Patients with Chronic Primary Angle Closure Glaucoma

ABSTRACTPurpose: To compare the levels of cytokines and growth factor in aqueous humor of the patients with chronic primary angle closure glaucoma (PACG) and cataract.Methods: Aqueous humor samples were collected from 19 chronic PACG patients and compared with 14 nonglaucomatous controls presenting for cataract surgery. The levels of 27 cytokines and growth factors were measured in the aqueous samples using multiplex bead immunoassay and compared across groups.Results: Significantly higher levels of interleukin (IL)-8 (p < 0.001), eotaxin (p < 0.001), interferon gamma-induced protein (IP)-10 (p < 0.001) and macrophage inflammatory protein-1-beta (MIP-1β; p < 0.001) were observed in aqueous of chronic PACG patients compared to controls. In comparison to controls, significantly lower levels of IL-9 (p = 0.001), IL-17 (p < 0.001), tumor necrosis factor-alpha (TNF-α; p < 0.001), granulocyte–macrophage colony-stimulating factor (GM-CSF; p < 0.001), and IL-5 (p = 0.001) were observed in chronic PACG eyes. All other assayed cytokines—IL-1β, interleukin-1 receptor antagonist (IL-1rα), IL-6, IL-7, IL-10, IL-12, IL-13, IL-15, fibroblast growth factor-basic (FGF-basic), granulocyte colony-stimulating factor (G-CSF), monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1-alpha (MIP-1α), and vascular endothelial growth factor (VEGF) —showed no significant difference between the groups.Conclusions: These results suggest that the aqueous cytokine levels of chronic PACG eyes differ significantly from nonglaucomatous eyes. This is the first study reporting significantly increased levels of eotaxin, MIP-1β, and IP-10 and lower levels of TNF-α, IL-5, IL-9, IL-17, and GM-CSF in chronic PACG patients, suggesting a plausible role of these inflammatory cytokines in its pathogenesis.

Comparing the lamina cribrosa in eyes with primary open angle glaucoma and chronic primary angle closure glaucoma

Objective To compare the lamina cribrosa parameters between primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) eyes. Methods A total of 73 POAG eyes (73 subjects), 64 CPACG eyes (64 subjects), and 40 normal control eyes (40 subjects) with matched ages were included in this cross-sectional observational study. No significant difference was found in sex (χ2=2.07) and age (F=0.38) among three groups (P>0.05). The intraocular pressure, average retinal nerve fiber layer (RNFL) thickness and average visual field defect were not significantly different between POAG and CPACG patients (F=15.67, 21.15, 44.40, 27.99; P<0.05). All subjects underwent spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI). The optic nerve head was scanned radially at the angle of 20; six high resolution B-scan images were obtained from each eye. The center and para-center lamina cribrosa thickness (LCT) and anterior lamina cribrosa surface depth (ALCSD) were measured in each image. The mean LCT and ALCSD were recorded as the average of the LCT and ALCSD of the 6 images and compared among POAG, CPACG and normal control eyes. Results The average LCT of normal control eyes were (211.48±12.07) μm, while those of the POAG eyes were (145.43±34.33) μm, CPACG eyes were (156.79±33.66) μm. The mean LCT of the POAG and CPACG eyes were thinner than those of the control eyes (t=-11.76, -9.88; P<0.01). All LCT of the POAG eyes were significantly thinner than those of the CPACG eyes (t=-1.96, P=0.03). The average ALCSD of normal control eyes were (390.73±84.40) μm, while those of the POAG eyes were (558.51±176.66) μm, CPACG eyes were (539.39±177.30) μm, respectively. The average ALCSD of the POAG and CPACG eyes were deeper than those of the control eyes (t=5.65, 4.96; P<0.01). But no significantly different ALCSD was shown between POAG and CPACG eyes (t=0.63, P=0.49). Conclusions POAG and CPACG eyes have thinner LCT and deeper ALCSD than normal eyes. POAG eyes have thinner LCT than CPACG eyes when their visual field defect and damage of RNFL were in the same degree. Key words: Glaucoma, open-angle/diagnosis; Glaucoma, angle-closure/diagnosis; Tomography, optical coherence