Diagnosis Of Primary Angle-closure Glaucoma Research Articles

Endocannabinoids and cortisol in plasma, aqueous and tear samples of primary angle closure glaucoma versus controls.

To compare the levels of endocannabinoids (EC) in plasma, aqueous humor and tears, cortisol in plasma and aqueous, in primary angle closure glaucoma (PACG) and controls, while comparing the quality of life in both groups. A total of 60 patients, ≥40years of age, with a diagnosis of PACG or cataract, 30 in each group were recruited. They were subjected to a detailed ophthalmic evaluation, a WHO Quality of Life Brief Version (WHOQOL-BREF) questionnaire answering and collection of tear, aqueous and blood samples. The levels of endocannabinoids-anandamide (AEA), 2-arachidonoylglycerol (2AG) in plasma, aqueous humor and tears; cortisol in plasma and aqueous humor; and WHO-QOL score in each group were noted. Plasma AEA (p = 0.01) and plasma 2-AG, (p = 0.002) levels were significantly higher in the control group as compared to the PACG group. WHO-QOL score was better in controls (p < 0.001). The EC were in undetectable levels in aqueous. Plasma and aqueous cortisol were significantly higher in PACG and both had the highest Area under the receiver operating characteristics (AUROC) curve value for differentiating PACG from controls. Tear 2AG and tear AEA had a moderately strong positive correlation with plasma 2-AG. Females had insignificantly higher levels of plasma and tear endocannabinoids. Tear endocannabinoids were determined for the first time in PACG and normal with no difference between the two groups. Plasma and aqueous cortisol levels are a differentiating factor between normal and glaucoma patients with plasma endocannabinoids being remarkably higher in normals. Quality of life in glaucoma patients with high cortisol levels is poorer.

GLAUCOMA SECONDARY TO NONSPECIFIC ORBITAL INFLAMMATION: A DIAGNOSIS NOT TO OVERLOOK

Introduction : Nonspecific Orbital Inflammation (NSOI) is an inflammatory condition of unknown etiology manifesting as pain, ocular motility disturbances, eyelid edema, chemosis, and increased intraocular pressure (IOP). We illustrate a case of glaucoma secondary to NSOI and the importance of understanding the cause-effect relationship between the two conditions.&#x0D; Case Illustration : An eighteen-year-old girl presented with severe pain, ptosis, chemosis, ophthalmoplegia, and increased IOP (38 mmHg) despite a leaking trabeculectomy bleb, on the left eye. She was referredwith the diagnosis of primary angle-closure glaucoma (PACG) and a history of twice trabeculectomy surgeries done elsewhere two months before she came to our hospital. She could not move her lefteye nasally five months before the first surgery and felt joint pains for a year. After thorough diagnostics, she was assessed with left eye NSOI and secondary glaucoma with spondyloarthropathy. Oral prednisone 30 mg/day was given to manage the inflammation and the resultant glaucoma. One week follow-up showed an improved condition with decreased IOP (16 mmHg) despite the same anti-glaucoma therapy regimen.&#x0D; Discussion : NSOI can mimic various diseases, making diagnosis challenging. The raised IOP in NSOI is often caused by extraocular muscles and orbital tissue swelling, which compresses the superior and inferior ophthalmic veins, resulting in choroidal circulation problems. The IOP was quickly reduced once the inflammation was managed. This is a case of secondary glaucoma caused by an overlooked NSOI, aggravated by the immunological process in the orbit after trabeculectomy surgeries.&#x0D; Conclusion : Secondary glaucoma should be considered as a differential diagnosis of PACG in patients with NSOI.

Prevalence and Risk Factors of Blindness Among Primary Angle Closure Glaucoma Patients in the United States: An IRIS Registry Analysis

PurposeTo assess the prevalence and risk factors of blindness among patients newly diagnosed with primary angle closure glaucoma (PACG) in the United States (US). DesignRetrospective cross-sectional study. MethodsEligible patients from the American Academy of Ophthalmology (AAO) IRIS® Registry (Intelligent Research in Sight) had newly diagnosed PACG, defined as: 1) observable during a 24-month lookback period from index date of PACG diagnosis; 2) no prior history of eye drops, laser, or cataract surgery unless preceded by a diagnosis of anatomical narrow angle (ANA); 3) no prior history of glaucoma surgery. Logistic regression models were developed to identify risk factors for any (one or both eyes) or bilateral (both eyes) blindness (visual acuity ≤ 20/200) at first diagnosis of PACG. ResultsAmong 43,901 eligible patients, overall prevalence of any and bilateral blindness were 11.5% and 1.8%, respectively. Black and Hispanic patients were at higher risk of any (OR=1.42 and 1.21, respectively; p<0.001) and bilateral (OR=2.04 and 1.53, respectively; p<0.001) blindness compared to non-Hispanic White patients adjusted for ocular comorbidities. Age <50 or >80 years, male sex, Medicaid or Medicare insurance product, and Southern or Western practice region also conferred higher risk of blindness (OR>1.28; p≤0.01). Conclusions and RelevanceBlindness affects 1 out of 9 patients with newly diagnosed PACG in the IRIS® Registry. Black and Hispanic patients and Medicaid and Medicare recipients are at significantly higher risk. These findings highlight the severe ocular morbidity among PACG patients and the need for improved disease awareness and detection methods.

Rates and Patterns of Diagnostic Conversion from Anatomical Narrow Angle to Primary Angle-Closure Glaucoma in the United States

To assess rates of diagnostic conversion from anatomical narrow angle (ANA) to primary angle-closure glaucoma (PACG) in the United States and identify factors associated with diagnostic conversion. Retrospective case-control study. Patients diagnosed with ANA between the years 2007 and 2019 were identified based on International Classification of Diseases (ICD) codes in the Optum Clinformatics Data Mart Database. Inclusion was limited to newly diagnosed ANA, defined as the following: (1) continuous enrollment during a 2-year look back period and 6-year study period from index (first) date of ANA diagnosis; (2) diagnosis by an ophthalmologist or optometrist and record of gonioscopy; and (3) no history of intraocular pressure (IOP)-lowering drops, laser peripheral iridotomy (LPI), or intraocular surgery. Cox proportional hazards models were developed to assess factors associated with diagnostic conversion, defined as a change in ICD code from ANA to PACG. New diagnosis of PACG within the 6-year study period recorded after an index diagnosis of ANA. Among 3985 patients meeting inclusion criteria, 459 (11.52%) had detected diagnostic conversion to PACG within the study period. The conversion rate was stable at 3.54% per year after the first 6 months of ANA diagnosis. In the Cox proportional hazards model, age > 70 years and early (within 6 months of ANA diagnosis) need for LPI or IOP-lowering drops were positively associated with diagnostic conversion (hazard ratio [HR] > 1.59; P < 0.02). Cataract surgery at any time and late (after 6 months of ANA diagnosis) need for IOP-lowering drops appeared protective against diagnostic conversion (HR < 0.46; P < 0.004). Annual risk of diagnostic conversion from ANA to PACG is relatively low overall; elderly patients are at higher risk whereas patients receiving cataract surgery are at lower risk. The utility of long-term monitoring seems low for most patients with ANA, highlighting the need for improved clinical methods to identify patients at higher risk for PACG. Proprietary or commercial disclosure may be found after the references.

The ocular biometry characteristics of young patients with primary angle-closure glaucoma

BackgroundAlthough primary angle-closure glaucoma (PACG) mainly occurs in elderly people, diagnosis of PACG in young patients is not uncommon. So far, there is no article specialized on the ocular anatomical characteristics in these patients.In this study, ocular anatomical characteristics in young PACG patients are analyzed.MethodsIn this retrospective, comparative study, patients diagnosed with PACG and received ultrasound biomicroscopy (UBM) examination in our department were included. Patients were divided into two groups: a young group composed of patients ≤ 45 years and an old group composed of patients > 45 years. A-scan ultrasonography and ultrasound biomicroscopy (UBM) were used to measure ocular biometric parameters of patients in the two groups including axial length (AL), lens thickness (LT), central anterior chamber depth (ACD), anterior chamber width (ACW), angle opening distance 500 (AOD500), anterior chamber angle 500 (ACA500), iris thickness 1000 μm from the iris root (IT1000), iris thickness 500 μm from the iris root (IT500), trabecular-ciliary process angle (TCPA), trabecular-ciliary process distance (TCPD), scleral– ciliary process angle (SCPA), lens vault (LV), and pupil diameter (PD). Plateau iris (PI) and basal iris insertion were determined from UBM images, and the prevalence of PI and basal iris insertion were compared between the two groups. The incidence of postoperative malignant glaucoma (MG) was also determined in both groups and ocular anatomical predictors for the development of MG were evaluated in young PACG patients.ResultsOne hundred fifteen patients were included into young group and 480 patients were included into old group. The young group had shorter TCPD, shorter AL, narrower TCPA, narrower SCPA thinner Lens compared to the old group. There were no significant differences in ACD, AOD 500, ACA500, LV, IT500, IT1000, PD or ACW between the two groups. The prevalence of PI was 22.6% in old group and 66.1% in young group (P < 0.001). More young PACG patients displayed basal iris insertion compared to old PACG patients (P < 0.001). 87 patients in the young group and 201 patients in the old group underwent trabeculectomy in our study. Among these patients, 21 young patients and 11 old patients developed MG after trabeculectomy (P < 0.001).ConclusionsShorter AL, more anteriorly positioned ciliary body, higher prevalence of PI may be responsible for the etiology of young PACG patients. Our results suggest that shorter AL, shorter TCPD and narrower TCPA may be predictors for development of MG in young PACG patients after trabeculectomy.

Racial and Sociodemographic Disparities in the Detection of Narrow Angles before Detection of Primary Angle-Closure Glaucoma in the United States

To assess the proportion of newly diagnosed cases of primary angle-closure glaucoma (PACG) with and without prior diagnosis of anatomical narrow angle (ANA) and to identify sociodemographic risk factors for late detection (PACG without prior ANA diagnosis). Retrospective cohort study. One hundred two thousand six hundred seventeen patients with PACG were identified from the Optum Clinformatics Data Mart Database (2007-2019). Patients with newly diagnosed PACG met the following criteria: (1) diagnosis made by an ophthalmologist, (2) disease observable for at least 12 months before diagnosis, and (3) no history of treatment before diagnosis unless preceded by a diagnosis of ANA. Multivariate logistic regression modeling was performed to identify sociodemographic risk factors for late detection. Proportion of patients with newly diagnosed PACG without prior ANA diagnosis and sociodemographic factors associated with late detection. Thirty-one thousand forty-four patients were eligible. More than 70% of PACG cases were detected without prior ANA diagnosis, regardless of patient age, sex, or race. The odds of late detection were significantly higher (P < 0.001) among men (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.25-1.40), Black patients (OR, 1.25; 95% CI, 1.15-1.37), and patients 80 years of age or older (OR, 1.28; 95% CI, 1.11-1.47) or living in Southern (OR, 1.30; 95% CI, 1.22-1.40) or Pacific (OR, 1.27; 95% CI, 1.16-1.36) regions. Findings were similar for patients with PACG with a record of gonioscopy and treatment or with a 24-month lookback period. Most patients who receive a new diagnosis of PACG in the United States do not have a prior diagnosis of ANA. The elderly, men, and Black patients are at higher risk of late detection. A need exists for increased disease awareness among providers and more accessible tools to detect patients at risk of developing PACG.

Features Local Interlacing Status of Elderly Patients with Primary Angle-Closure Glaucoma

An increased share of the elderly in the structure of modern society, along with other causes and risk factors, is accompanied by the growing the incidence of glaucoma. According to international research in the world by 2020 it is predicted that glaucoma patients will increase to 80 million. Among the elderly, glaucoma is a common pathology, the development of which is associated with local disorders of the interleukin profile. However, the features of the latter in patients with primary closed-angle glaucoma in the elderly have not been studied. The purpose of this work is to identify the features and informativeness of local interleukin profile indicators in elderly patients with primary angle — closure glaucoma. The study included 58 patients with primary angle-closure glaucoma of stage II, who made up the main group, aged 60–74 years with a median of 70.1 ± 2.5 years. All patients underwent a comprehensive ophthalmological examination. The diagnosis of primary angle-closure glaucoma was established in accordance with the requirements of the National glaucoma guidelines. The control group consisted of 27 elderly people aged 60 to 74 years with a median of 68.7 ± 2.1 years without signs and manifestations of primary angle-closure glaucoma, who also underwent a comprehensive ophthalmological examination. Changes in proinflammatory interleukins at the local level in the development of primary angle-closure glaucoma are accompanied by a significant increase in their content in all cases. On the contrary, changes in anti-inflammatory interleukins in the lacrimal fluid in patients with the considered ophthalmological pathology are characterized by a significant inhibition of their production. IL-10 are characterized by the most significant decrease at the local level and it is less related to IL-4. Local interlacing profile of patients with primary angle-closure glaucoma elderly are characterized by increased level in the tear fluid of anti-inflammatory IL-2, IL-17, IL-8 and lower production of anti-inflammatory IL-10. These local interleukins have the greatest informative value, which is of scientific and practical significance for identifying new mechanisms of development, diagnostics and justification of selective immunotropic therapy of the pathology in question.

Genetic/Epigenetic Modulation, Ocular Diseases, and Therapeutic Prospective

Complex eye diseases often have significant genetic components. Previous work exploring the genetic contributions of ocular diseases has implicated numerous genomic regions and a variety of candidate genes as modulators of the disease susceptibility, including cataract, age-related macular degeneration (AMD), diabetic retinopathy (DR), glaucoma, high myopia, and others. With the advance of techniques both on genotyping and phenotyping, additional genes with a role in complex eye disease are waiting to be discovered. In contrast, it is apparent that a significant portion of the heritability of ocular disease cannot be explained through the alteration of DNA sequences. The field of epigenetics pursues the changes in gene expression or cellular phenotypes caused by mechanisms other than changes in the underlying DNA sequence. In general, epigenetic changes pertain to DNA methylation and histone modification. Aberrant epigenetic changes are associated with genomic instability and have been implicated in various human diseases. Recent advances in high-throughput platforms can generate voluminous data, which requires desperately the tools of system biology to effectively elucidate the true pictures underlying them. Knowledge and understanding of these genetic components and pathways have led to the development of promising therapies including small inference RNA (siRNA). This special issue contains 5 articles, the contents of which are summarized as follows. In the original paper “An extensive replication study on three new susceptibility loci of primary angle closure glaucoma in Han Chinese: Jiangsu Eye Study” by A. Shi et al., the authors tried to replicate recent findings of three new susceptibility loci for primary angle closure glaucoma (PACG) reported by a genome-wide association study. For a long time, the genetic study on glaucoma has been focused on primary angle open glaucoma. Instead of using clinical diagnosis of PACG as the phenotype to study, the authors chose a preclinical condition, primary angle closure (PAC), and same anatomical features of eyes to investigate. This community-based study did not find any significant association between the defined phenotypes and the single nucleotide polymorphisms in PLEKHA7, COL11A1, and PCMTD1-ST18. In the review paper “Vascular adhesion protein 1 in the eye” by W. Luo et al., the authors gave an overview on the new research progresses of VAP-1 in the ocular diseases including uveitis, AMD, DR, and ocular tumor. Based on the properties and results obtained so far from preclinical and clinical studies VAP-1 may provide a novel research direction or a potent therapeutic strategy for ophthalmological diseases. In the original paper “RNA interference targeting connective tissue growth factor inhibits the transforming growth factor-β2 induced proliferation in human Tenon capsule fibroblasts” by J. Jing et al., the authors showed that siRNA could efficiently prevent TGF-β2 induced proliferation of human Tenon capsule fibroblast, through targeting CTGF gene expression. Therefore, a siRNA based therapeutic approach was proposed for eliminating filtration bleb scarring after glaucoma filtration surgery. In the original paper “RNA interference targeting snail inhibits the transforming growth factor β2-induced epithelial-mesenchymal transition in human lens epithelial cells” by P. Li et al., the authors tested the concept to use Snail targeting siRNA to block TGF β2-induced proliferation in human lens epithelial cells. The results show that epithelial-mesenchymal transition was inhibited by Snail targeting siRNA in the model system that the article described, accompanied by the suppression on snail expression. The finding is informative for the design of the preventive strategy on posterior capsule opacification after cataract surgery. In the original paper “Systems biology profiling of AMD on the basis of gene expression” by M. S. Abu-Asab et al., a systems biology analytical paradigm called parsimony phylogenetics was used to reveal the various transcriptomic profiles of AMD's subtypes. Genetic pathways underlying the initiation and progression of AMD and the correlations of AMD's genotypes, phenotypes, and disease spectrum were investigated. On the whole, the papers contained in this special issue covered the most active fields of genetic studies on complex eye diseases. Jingsheng  Tuo Lai  Wei Nan  Hu

Phacotrabeculectomy Without Mitomycin C in Primary Angle-closure and Open-angle Glaucoma

To compare the surgical outcomes of single site phacotrabeculectomy without mitomycin C (MMC) in primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG). We retrospectively reviewed the records of all patients with a diagnosis of PACG and POAG, who underwent single site phacotrabeculectomy without MMC between January 2001 and December 2005 and had a minimum follow-up of 12 months. The primary outcome measure was cumulative success probability, defined as complete [intraocular pressure (IOP) ≤21 mm Hg without antiglaucoma medications or additional surgery] and qualified (IOP <21 mm Hg with medications). Secondary outcome measures were reduction of IOP, the number of antiglaucoma medications at last follow-up, and complication rates. Seventy-one eyes of 63 PACG patients (mean age 61.2 y) and 72 eyes of 57 POAG patients (mean age 64.0 y) were analyzed. Mean duration of follow-up was 38.7 and 41.7 months in the PACG and POAG groups, respectively. Complete success in PACG (72.1%) was more than the POAG group (56.1%), but the difference was not statistically significant (P=0.06). Qualified success in the PACG and POAG group was 87.4% and 92.8%, respectively (P=0.43). IOP reduction was greater (P=0.03) in the PACG group and PACG group required fewer antiglaucoma medications postoperatively (P=0.03) for IOP control. Survival probability of single site phacotrabeculectomy without MMC was not significantly different between the PACG and POAG groups. IOP reduction was greater and the need for antiglaucoma medications after surgery was lesser in the PACG group.

Incidência de glaucoma agudo primário no Serviço de Glaucoma do Hospital São Geraldo

To determine the incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital, to establish the profile of these patients and to identify the possible risk factors. Transversal study. Period of assessment: from September/2005 to August/2006. diagnosis of primary angle-closure glaucoma. presence of cataracts that cause low visual acuity or index-myopia, secondary glaucoma, plateau iris. Number of visits, incidence of primary angle-closure glaucoma, age, gender, race, family history of glaucoma, keratometric, and biometric data were assessed. Of 879 attended patients, 20 (2.3%) had the diagnosis of primary angle-closure glaucoma, therefore, the incidence of the primary angle-closure glaucoma was 22.7 cases per 1000 attended. Of those patients with primary angle-closure glaucoma: 6 (30.0%) were men and 14 (70.0%) women; the age varied from 40 to 73 years (average: 60.4 +/- 8.1 years); 12 (60.0%) were leukodermics and 8 (40.0%) pheodermics; 5 (25.0%) with positive familiar history of glaucoma. The relative risk for women was 1.44 (95% IC). Eleven (55.0%) patients had primary angle-closure glaucoma of the right eye and 9 (45.0%) of the left. When biometric data and keratometry were compared between the affected and contralateral eye, no statistical significant difference was observed. The incidence of the primary angle-closure glaucoma at the Glaucoma Service of São Geraldo Hospital was 22.7 cases per 1000 attended. It was more frequent in leukodermic women, without family history of glaucoma and with an average age of 60.4 years. The affected and contralateral eyes were biometrically similar.

The Tajimi Study Report 2: Prevalence of Primary Angle Closure and Secondary Glaucoma in a Japanese Population

To determine the prevalence of primary angle-closure glaucoma (PACG), secondary glaucoma (SG), and all glaucoma in a Japanese population as a part of the Tajimi Study. Population-based epidemiological survey. A random sample of residents 40 years or older from Tajimi, Japan. Each subject underwent a screening program comprising an interview and an ophthalmic examination, including Goldmann applanation tonometry, slit-lamp examination, a van Herick test, fundus photography, and a screening visual field (VF) test using frequency-doubling technology. If glaucoma was suspected, the subject was referred for a definitive examination that included slit-lamp examination, gonioscopy, intraocular pressure measurement, a VF test, and optic disc and fundus examination. A diagnosis of PACG or SG was made based on slit-lamp examination, gonioscopy, optic disc appearance, and perimetric results. Prevalences of PACG, SG, and all cases of glaucoma. Of 3870 eligible people, 3021 (78.1%) participated in the study. Estimated prevalences of PACG and SG in those over 40 years were 0.6% (95% confidence interval [CI], 0.4%-0.9%) and 0.5% (95% CI, 0.2%-0.7%), respectively. Prevalences of all glaucoma and glaucoma/suspected glaucoma were estimated to be 5.0% (95% CI, 4.2%-5.8%) and 7.5% (95% CI, 6.5%-8.4%), respectively. Prevalences were 0.6%, 0.5%, and 5.0%, respectively, for PACG, SG, and all glaucoma in subjects over 40 years from Tajimi, Japan.

Epidemiology of angle-closure glaucoma: Prevalence, clinical types, and association with peripheral anterior chamber depth in the Egna-Neumarkt glaucoma study

Objective To assess the prevalence of primary angle-closure glaucoma (PACG), the frequency of its different clinical presentations, and its association with peripheral anterior chamber depth in a defined population in Northern Italy. Design Cross-sectional epidemiologic study in a defined population. Participants All subjects resident in the Egna-Neumarkt area of the South Tyrol Region (Northern Italy) and more than 40 years of age were invited to undergo an ophthalmologic examination. Intervention After the screening examination, subjects with suspected glaucoma were re-examined at the screening center to confirm the diagnosis. All cases that still proved suspect after the second examination underwent a third phase of investigations and were classified as healthy or as definitely glaucomatous. Each subject was examined according to a standard protocol, including medical history interview, refraction and visual acuity determination, ocular biomicroscopy, evaluation of peripheral anterior chamber depth by means of the Van Herick method, applanation tonometry, optic disc evaluation, and computerized perimetry. Gonioscopy was not performed during initial screening but only in all selected patients in the second and third phases of investigations. The diagnosis of PACG was made on the basis of the concomitant presence of at least two of the following criteria: intraocular pressure ≥ 22 mmHg, glaucomatous optic disc abnormalities, glaucomatous visual field defects. In addition, biomicroscopic or gonioscopic evidence of angle closure was also necessary. Main outcome measures Percentage distribution of peripheral anterior chamber depths, prevalence of angle-closure glaucoma, and frequency of the different PACG clinical presentations. Results Four thousand two hundred ninety-seven subjects were examined (73.9% overall participation rate). The peripheral depth of the anterior chamber according to the Van Herick method was grade 2 in 14.7%, grade 1 in 2.5%, and grade 0 in 0.3% of the population. The overall prevalence of angle-closure glaucoma was 0.6% (26 cases). Five of these were cases of previous acute attacks resolved by therapy, three were cases of chronic angle-closure after acute attacks, three were intermittent angle-closure glaucomas, and 15 were chronic angle-closure cases. Conclusions Occludable angles were more frequent than in other white populations previously studied. The prevalence of PACG is not as low as is usually believed; this type of glaucoma accounts for more than a quarter of all glaucomas found in the Egna-Neumarkt population. The most frequent clinical presentation is chronic angle-closure glaucoma.