Attack Of Glaucoma Research Articles

Bilateral glaucoma attack after flow-diverting stent placement in the left inner catorid artery in the projection of the aneurysm neck: a case report

Bilateral glaucoma attack after flow-diverting stent placement in the left inner catorid artery in the projection of the aneurysm neck: a case report

Nanophthalmos-Associated MYRF gene mutation facilitates intraocular inflammation in mice

PurposePatients with nanophthalmos might be prone to developing intraocular inflammation following an acute glaucoma attack. Here, we aimed to investigate the role of MYRF in intraocular inflammation by modeling the mutation in mice. MethodsNanophthalmos frameshift mutation of Myrf was introduced into the mouse genome with the CRISPR-Cas9 system. Signaling pathways in eye tissues were delineated using RNA sequencing and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Intraocular inflammation was induced by a lipopolysaccharide (LPS) intravitreal injection. Dexamethasone (DEX) was administered systemically and locally a week before the LPS injection. The anterior segment clinical scores of the mice were examined 24 h after the LPS injection. Infiltrating inflammatory cells were evaluated with histopathology and immunofluorescence. The mRNA levels of inflammatory cytokines were quantified with reverse transcription-quantitative PCR (RT-qPCR) and the corresponding protein concentrations using enzyme-linked immunosorbent assay (ELISA). ResultsMany inflammation-associated signaling pathways were enriched in Myrf mut/+ mice ocular tissues. Clinical scores of Myrf mut/+ mice were significantly higher than those of Myrf +/+ mice 24 h after LPS administration. Histological examination demonstrated high inflammatory cell infiltration in the anterior and vitreous chambers in Myrf mut/+ mice, with numerous CD45+ and CD11b+ inflammatory cells. Moreover, enhanced expression of inflammatory cytokines MCP-1, TGF-β, and IL-1β in eyes and aqueous humor of Myrf mut/+ mice was detected. Remarkably, pretreating Myrf mut/+ mice with DEX relieved the intraocular inflammation. ConclusionNanophthalmos-associated MYRF mutation renders mouse eyes more susceptible to inflammation. Dexamethasone treatment ameliorates the inflammatory response.

PUPIL CYCLE TIME AND PERIPAPILLARY PERFUSION IN ANGLE CLOSURE GLAUCOMA

Introduction and Objective: One of important roles in the pathogenesis of glaucoma is vascular condition. To enhance glaucoma management, the clinical assessment of ocular perfusion is required. The pupillary light reflex's afferent or efferent pathways may become impaired as a result of pupil cycle time (PCT) elongation. PCT is a simple objective method to measure the function of optic nerve, including glaucoma. The purpose of this study is to evaluate the connection between pupil PCT and peripapillary perfusion. Methods: A cross-sectional study from Kariadi Hospital included 26 eyes with angle closure glaucoma and 26 eyes of healthy patients. Complete ophthalmologic examinations, PCT measurements, and OCT peripapillary angiography were performed on each patient. Patients with history of drugs use that can affect pupillary reflexes such as barbiturates, methyldopa, anaesthetics, and antidepressant, and patients with history of glaucoma attack are excluded. The comparisons between the two groups were examined, with a p<0.05 indicating statistical significance. Results: The mean PCT of normal subjects was 943,4ms (882,4ms – 993,4ms) and angle closure glaucoma subject was 1789,5ms (1060ms – 4600ms). There were statistically significant difference of PCT value in angle closure glaucoma compared to normal subjects (P<0,05). Peripapillary flow index and peripapillary vessel density in closed angle glaucomatous eyes were lower than normal eyes (P<0.05). There is a significant relationship between PCT with peripapillary flow index and peripapillary vessel density. (P<0,05). Conclusion: In angle closure glaucoma, prolonged PCT associated with decreased peripapillary perfusion as shown by decreases in peripapillary flow index and peripapillary vascular density.

PUPIL CYCLE TIME AND PERIPAPILLARY PERFUSION IN ANGLE CLOSURE GLAUCOMA

Introduction & ObjectivesOne of important roles in the pathogenesis of glaucoma is vascular condition. To enhance glaucomamanagement, the clinical assessment of ocular perfusion is required. The pupillary light reflex'safferent or efferent pathways may become impaired as a result of pupil cycle time (PCT) elongation.PCT is a simple objective method to measure the function of optic nerve, including glaucoma. Thepurpose of this study is to evaluate the connection between pupil PCT and peripapillary perfusion.
 MethodsA cross-sectional study from Kariadi Hospital included 26 eyes with angle closure glaucoma and 26eyes of healthy patients. Complete ophthalmologic examinations, PCT measurements, and OCTperipapillary angiography were performed on each patient. Patients with history of drugs use thatcan affect pupillary reflexes such as barbiturates, methyldopa, anaesthetics, and antidepressant, andpatients with history of glaucoma attack are excluded. The comparisons between the two groupswere examined, with a p<0.05 indicating statistical significance.
 ResultsThe mean PCT of normal subjects was 943,4ms (882,4ms – 993,4ms) and angle closure glaucomasubject was 1789,5ms (1060ms – 4600ms). There were statistically significant difference of PCTvalue in angle closure glaucoma compared to normal subjects (P<0,05). Peripapillary flow index andperipapillary vessel density in closed angle glaucomatous eyes were lower than normal eyes(P<0.05). There is a significant relationship between PCT with peripapillary flow index andperipapillary vessel density. (P<0,05).
 ConclusionIn angle closure glaucoma, prolonged PCT associated with decreased peripapillary perfusion asshown by decreases in peripapillary flow index and peripapillary vascular density.

Adult-onset neuronal intranuclear inclusion disease related retinal degeneration: a Chinese case series.

To evaluate adult-onset neuronal intranuclear inclusion disease (NIID)-related retinopathy with guanine-guanine-cytosine repeat expansions in NOTCH2NLC. Neuro-ophthalmic evaluations, including best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP), ultrasound biomicroscopy, pupillometry, fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), Humphrey visual field, full-field electroretinography (ERG), and multifocal ERG (mf-ERG) were performed in patients with gene-proven NIID. Nine patients (18 eyes) were evaluated, with a median age of 62 years (55-68) and only one man was included in our study. Six patients presented with decreased visual acuity or night blindness, whereas the other three were asymptomatic. The visual acuity was measured from 20/200 to 20/20. Miosis was present in eight patients, four of whom had ciliary process hypertrophy and pronation, and three of whom had shallow anterior chambers. Fundus photography, FAF, and OCT showed consistent structural abnormalities mainly started from peripapillary areas and localized in the outer layer of photoreceptors and inner ganglion cell layer. ERG and mf-ERG also revealed retinal dysfunction in the corresponding regions. Patients with NIID showed both structural and functional retinopathies which were unique and different from common cone-rod dystrophy or retinitis pigmentosa. Patients with miosis may have a potential risk of an angle-closure glaucoma attack. Neuro-ophthalmic evaluations is essential for evaluating patients with NIID, even without visual symptom.

Acute glaucoma attack in a patient recovered from coronavirus infection (case report)

The prevalence of ophthalmic manifestations in COVID-19 ranges from 2 to 32%. The most common ophthalmic disease associated with COVID-19 is viral conjunctivitis, but there are also reports of cases with episcleritis, uveitis, occlusions of the central retinal artery and vein, retinopathy, glaucoma, dry eye syndrome, as well as rare neuroophthalmological manifestations such as diplopia, ophthalmoplegia and nystagmus. This study reports a case of bilateral acute angle-closure glaucoma attack in a patient recovered from severe COVID-19 pneumonia.PURPOSE. To determine the causes of bilateral acute angle-closure glaucoma attack associated with COVID-19 pneumonia, and to evaluate the effectiveness of laser iridotomy and transciliary drainage of the posterior chamber of the eye.METHODS. Bilateral acute angle closure glaucoma attack was observed in a female patient recovered from COVID-19 pneumonia. Low hypermetropia and co-existing cataract were diagnosed in both eyes. In order to normalize the IOP and restore visual acuity, laser iridotomy was performed in both eyes, followed by surgical treatment of glaucoma with transciliary drainage of the posterior chamber in both eyes. After that the patient underwent phacoemulsification with implantation of intraocular lenses (IOL) in both eyes.RESULTS. Laser iridotomy and transciliary drainage of the posterior chamber was performed in both eyes. The target IOP without topical therapy and stabilization of glaucoma were achieved in both eyes. The second step was phacoemulsification with implantation of IOL, which significantly improved visual acuity of both eyes.CONCLUSION. COVID-19 can lead to vision loss and disability, therefore IOP should be monitored in patients that remain in prone position for ventilation for extended periods of time and receive systemic steroid medications. This is especially relevant for patients with a predisposition to glaucoma or with diagnosed glaucoma.

Клинический случай сочетания острого приступа закрытоугольной глаукомы с острым увеитом: конкуренция или синергизм

An atypical clinical case of a combination of an acute attack of angle-closure glaucoma with acute anterior uveitis with the simultaneous development of both diseases is represented. Keywords: acute attack of angle-closure glaucoma, acute anterior uveitis, differential diagnosis, therapy

Оценка коэффициента LAF в качестве критерия риска острого приступа закрытоугольной глаукомы

Purpose. To study the possibility of using the LAF coefficient in predicting an acute attack of angle-closure glaucoma (AACG) in anatomically short eyes of Europoids. Material and methods. In total, 4 groups of patients were formed: healthy individuals with hyperopia, patients with primary angle closure (PCA) of the anterior chamber, patients with primary angle-closure glaucoma (PACG), and patients with an acute attack of angle-closure glaucoma. The anteroposterior axis of the eye (APA), lens thickness (LT) were studied, and the LAF coefficient was calculated based on the results of these studies. Results. For each of the three factors studied (LT, APA, and LAF), an ROC analysis was performed to identify the cut-off points that best separate the hyperopic and acute attack groups. Cut-off points, sensitivity, specificity, areas under the ROC-curves (AUC) were found. Conclusion. Comparative analysis of LT and LAF parameters in the groups of hypermetropes, patients with PCA and with the initial stage of PACG did not reveal significant differences. In the acute attack group, LT and LAF were statistically significantly higher than the other groups. It was revealed that the LAF coefficient provides a better separation of the group of hypermetropes and the group of acute attack of the primary angle-closure, in comparison with the indicators of LT and especially the APA of the eyes. Our data showed that a high risk of an acute attack of glaucoma in eyes with a short APA occurs at LAF values greater than 2.332. This is confirmed by the high sensitivity, specificity and AUC of this indicator. Keywords: LAF coefficient, acute attack of angle-closure glaucoma, hypermetropia, primary closure of the anterior chamber angle

Difficulties of Cataract Surgery in Lens-Induced Glaucoma Due to Subluxated Cataract

Introduction: Cataract is a disease of the eye in which the normal clear lens has opacified and obscured the passage of light. A mature cataract occurs when the lens is opacified. Lens subluxation is a condition when the crystalline lens is not in its anatomical position that can result in decreased anterior chamber depth. It is a potentially high risk of developing pupillary block, leading to lens-induced glaucoma (secondary angle closure glaucoma). In this case, the definitive therapy is lens extraction, which is challenging for cataract surgeons. This case report aims to expose the difficulties of cataract surgery in lens-induced glaucoma due to subluxated cataract. Case Presentation: A 56-year-old male presented with unable to see in his right eye, followed by foggy vision, glare when seeing the light, and a history of an acute glaucoma attack. His right best corrected visual acuity (BCVA) was 1/300, and the intraocular pressure (IOP) was 5 mmHg on therapy with glaucoma medications. Slit lamp examination of the right eye showed a shallow anterior chamber, irradiated iris, mid-dilated pupil, completely cloudy lens, and a capsular instability around 12 to 6 clock hours (180°/2 quadrant). This patient was diagnosed with mature cataract and lens-induced glaucoma due to subluxated mature cataract and was given glaucoma medications also underwent phacoemulsification (PE) along with Intraocular lens (IOL) and capsular tension ring implantation due to the lens instability and excessive lens movement. Conclusions: Cataract surgery for subluxated mature cataract and lens-induced glaucoma is challenging because of the shallow anterior chamber, capsular instability, and excessive lens movement. A thorough diagnosis, preoperative evaluation, postoperative monitoring, and evaluation are essential for safe cataract surgery, reducing the risk of complications and achieving a good result.

Анатомо-морфометрические факторы риска первичной закрытоугольной глаукомы в глазах с короткой ПЗО

Purpose. To study the features of t anatomical and morphometric parameters of structures of the anterior segment of the eyes in young patients with moderate and high hyperopia to identify signs of an increased risk of developing primary angle-closure glaucoma (PACG) and its acute attack. Material and methods. Clinical material is presented by 58 patients (116 eyes) with the anteroposterior axis of the eyes less than 23 mm. The main group consisted of 33 patients (66 eyes) with moderate and high hyperopia. The comparison group included 25 patients (50 eyes) with PACG. Results. The study made it possible to identify a group with an increased risk of developing PACG from a selected total population of young patients with moderate and high degrees of hypermetropia, which included 19 people (58 %). Conclusion. Comparative analysis of the morphometric parameters of the structures of the anterior segment of anatomically «short» eyes in young patients with moderate and high hypermetropic refraction, on the one hand, and in patients with PACG, on the other, revealed statistically significant differences between them in the depth of the anterior chamber in the central zone, thickness of the lens, the volume of the anterior chamber, the depth of the anterior chamber at the periphery, the angle of the anterior chamber. But, given the 1.5-fold statistically significant difference in age between the groups, it can be assumed that in some young hypermetropes, due to the continuous increase in the volume of the lens, when they reach the appropriate age, a number of indicators can become comparable to the PACG group. Keywords: hyperopia, refractive surgery, primary angle-closure glaucoma, acute attack of angle-closure glaucoma

Поиски возможностей объективного критерия риска развития острого приступа глаукомы в анатомически коротких глазах

Purpose. To assess the prognostic significance of the LAF coefficient (Lens thickness/ Axial length Factor) as risk factor for acute attack of glaucoma in anatomically short eyes of Europeans. Material and methods. 1st group consisted of 24 patients (48 eyes) with axial hyperopia. 2nd group included 24 patients (48 eyes) with primary closure of the anterior chamber angle. The 3rd group was formed by 17 patients (34 eyes) with initial stage of primary angle-closure glaucoma. The 4th group included 35 patients (35 eyes) with an acute attack of glaucoma. The studied groups did not differ in age (p = 0.97) and gender (p = 0.28). Lens thickness and axial length (AL) were measured using A-scan on biometer IOLMaster 700 (Carl Zeiss®, Germany) with calculation of LAF coefficient. Results. The LAF coefficient in the 4th (acute attack) group was statistically significantly higher than in the first 3 groups. The best separation of the 1st and 4th groups is provided by LAF coefficient compared to lens thickness and AL indexes with sensitivity, specificity and the Area Under the Curve (AUC) of 89 %, 83 % and 0.9, respectively. LAF coefficient values greater than 2.332 in patients with short AL are objectively associated with high risk of acute attack of glaucoma. The average value of the LAF coefficient (2.528) obtained by us in the 4th (acute attack of glaucoma) group significantly exceeds these indexes in works of other authors, which may be due to morphometric features of structure of eyes of Europeans compared to eyes of Asians. Conclusion. The LAF coefficient provides better separation of the 1st and 4th groups, in comparison with the lens thickness indexes, and especially the AL. LAF coefficient values greater than 2.332 in eyes with short AL objectively indicate high risk of acute attack of glaucoma, as evidenced by high sensitivity, specificity, and AUC. Keywords: acute attack of glaucoma, LAF, lens thickness, short axial length, risk factor

Commentary: The impact of yoga practice on glaucoma.

Yoga is the most popular form of complementary therapy being practiced to maintain one’s physical and mental wellbeing. While yoga traditionally comprises advice for ethical lifestyle and spiritual practice, it is most often associated with physical postures (asanas), breathing techniques (pranayama), and meditation (dhyana). While these exercises are routinely safe, there are risks involved for certain patients including those suffering from or at risk of glaucoma. The effects of yoga on intraocular pressure (IOP) have been found to be bidirectional, and the exact mechanisms are not yet fully understood. The authors have reviewed literature to study the effect of yoga on IOP and glaucoma. They have observed a reduction of IOP in patients of glaucoma through Jyoti tratak (candle meditation) and slow yoga breathing exercises and a rapid increase in IOP immediately after head-down posture yoga.[1] Tratak kriya is said to lead to contraction and relaxation of ciliary muscles, which may possibly increase the aqueous humor outflow and subsequently decrease the IOP.[2] Dada et al.[3] have evaluated the effect of yoga and meditation on IOP, quality of life, stress markers, neurotrophins, and gene expression in patients with primary open-angle glaucoma and found an improvement in all parameters. On the other hand, progressive glaucomatous optic neuropathy and field loss in patients who regularly practiced Sirsasana (Headstand) has also been identified.[1,4,5] Four yogasanas [Adho Mukha Savasana (downward-facing dog), Uttanasana (standing forward bend), Halasana (plough pose), and Viparita Karani (legs-up-the-wall)] showed a 20–73.7% increase in IOP in all study subjects.[1] Yoga with head-down positions was associated with a rapid rise in IOP in glaucoma and healthy eyes and with the body vertical, with a doubling of the IOP, remaining elevated as long as the position was maintained.[1] Mani Baskaran et al.[6] observed a twofold increase in IOP during Sirsasana, which was maintained during the posture in all age groups irrespective of their ocular characteristics. Valsalva maneuver is known to affect IOP; so it is expected that breath-holding yogic exercises are likely to cause IOP elevation. Forced unilateral nostril breathing has also been observed to affect IOP significantly.[7] Rakstyte et al.[8] studied an impact on IOP before, during, and after Matsyasana (fish yoga pose) and found an increased IOP in head- down position which returns to the initial value shortly after. A case series by Mehrdad Malihi et al.[9] to study the effect of different body and head positions on IOP shows a lower measurement while sitting with a neutral neck position and a rise in IOP in all other positions. Acute angle-closure glaucoma attacks often precipitated by prone-position yoga exercises suggest that this position probably increases pupillary block in “at risk” eyes by causing the lens to fall onto the iris, which has been the principle of the prone provocative test for decades. Certain questions, however, remain unanswered. It is unclear whether yoga has any sustained effects on the IOP and optic nerve. Further research is needed to fully comprehend the mechanisms by which yoga exerts its effects and determine the types, optimal duration, and frequency of yoga practice for glaucoma patients. Future studies are also warranted to ascertain whether yoga-associated IOP changes are associated with parallel changes in perimetry and nerve fiber thickness and changes in cerebrospinal fluid pressure, blood pressure in lamina cribrosa capillaries, and the ocular blood flow. It is difficult to establish direct causality between different yogic postures and glaucomatous progression, but in patients with pre-existing glaucomatous optic neuropathy, dramatic changes in IOP can definitely be harmful. Inquiring about the practice of yoga in cases of unexplained progression despite an apparently well-controlled IOP can, therefore, be an important consideration. Relaxation and meditative aspects of yoga may help to reduce stress and improve the overall well-being of an individual which can be indirectly beneficial. The key is to “keep the head above the heart at all times.” It is also important to note that yoga should not replace traditional glaucoma treatment but rather be practiced/advised as a complementary therapy and glaucoma patients should consult their healthcare provider before beginning any new exercise or relaxation program, including yoga.

PHACOEMULSIFICATION OF IRIS AS A TREATMENT FOR PATIENTS WITH CLOSED-ANGLE GLAUCOMA

We examined 55 patients (62 eyes) with primary closed-angle glaucoma. All of them were operated by ultrasonic phacoemulsification with IOL implantation. The patients' age ranged from 55 to 75 years (mean age 65 years). There were 42 (78.7%) women and 13 (21.3%) men. The initial stage of glaucoma was detected in 29 eyes, advanced glaucoma in 47 eyes, and advanced glaucoma in 45 eyes. The operation was performed in 42 patients against the background of acute and subacute glaucoma attack. Intraocular pressure level was decreased in 51 eyes (36.4 %) before the planned operation. In the remaining patients the level remained elevated and high. Refraction in patients was mostly hyperopic. Complicated cataract of various degrees was detected in 127 (77,9%) eyes, preoperative visual acuity was 0,01 to 0,8, which averaged 0,31 to 0,09.

FIRST POSNER SCHLOSSMAN SYNDROME POST COVID-19 INFECTION

Introduction: We reported a unique case report of Posner Schlossman Syndrome (PSS) after Covid-19 infection. Case Illustration: Female 54 y.o. came in our hospital with chief complaint of painless blurred vision, red eye, and very high pressure on right eye (RE). She had the same complaint 1½ months before and diagnosed as acute primary angle closure glaucoma (PACG), treated successfully with good outcome. She also had history of covid-19 infection 1 month before the first attack. Initial visual acuity (VA) of RE is 20/70. Anterior segment showed mild inflammation with flare and cell but no KP, while posterior segment cannot be assessed. IOP was 57.0 mmHg. After 1 month of medication (patient rejected to go inward), the patient finally agreed to the trabeculectomy because VA decreased to 20/200. Perimetry and OCT has been done before the operation, showed decreased parameter. One day, 7-days, and 28-days post operated VA were 3/60, 20/50, and 20/40 respectively, while IOP were 9.0 mmHg, 6.7 mmHg, and 15.0 mmHg respectively. Discussion: PSS can be very similar to acute PACG, though with careful history taking and examination we can distinct the disease. History taking for recurrent attack and unilateral is very important. Examination that showed acute open angle marked IOP with sign of uveitis should lead to PSS. Conclusion: In every attack of glaucoma, PSS has resemblance with acute PACG. The foresight of an ophthalmologist in determining the diagnosis is indeed very important.

Парацентез передней камеры глаза при глаукоме как метод экстренного снижения внутриглазного давления у собак и кошек

The article presents the technique of paracentesis of the anterior chamber of the eye with simultaneous intra-chamber administration of 0,5% pilocarpine solution, to identify the dynamics of intraocular pressure reduction, as well as to determine the effectiveness of this procedure both immediately after its execution and in the long term; based on the analysis of the data obtained, to determine complications. The study included 37 animals (39 eyes): 24 dogs and 13 cats with glaucoma, which, according to the anamnesis, developed no more than 10 days. without any prior hypotensive treatment. All animals underwent paracentesis without the use of general anesthesia or sedation. The procedure was performed under 6x magnification using frontal illumination, with a 27G needle for 9 hours for the right eye and for 3 hours for the left eye. The puncture was carried out on the periphery of the cornea at a distance of 1 mm from the limb. The volume of aspirated intraocular fluid was no more than 2 drops. Then a 0,5 % solution of pilocarpine was injected into the anterior chamber through the opening of the paracentesis. The volume of the injected solution did not exceed 0,3 ml. After paracentesis and pilocarpine administration, dexamethasone solution was subconjunctively instilled in combination with gentamicin and novocaine. Then hypotensive therapy was prescribed from a combination of eye drops. The study shows that the method with simultaneous intra-chamber injection of 0,5 % pilocarpine solution is effective in dogs and cats without any pronounced side effects. These results allow us to suggest anterior chamber paracentesis as a procedure for emergency reduction of intraocular pressure, especially in acute attacks of glaucoma in dogs and cats.

Features of cataract surgery and the postoperative period in patients with glaucoma (part 2)

According to the results of various studies, in up to 50% cases after cataract phacoemulsification patients with glaucoma experience ophthalmic hypertension on the first day. This occurs due to the mechanical retention of aqueous humor in the anterior chamber. Temporary decrease in the function of the eye drainage system is explained by pigment particles, viscoelastic, erythrocytes, protein cells, product of postoperative inflammation and lens particles obstructing the trabecula. In the long-term period after phacoemulsification in glaucoma patients there is a decrease in the intraocular pressure in up to 74% of cases.A decrease in the density of endothelial cells in these patients occurs as a result of fluctuation of intraocular pressure, prolonged application of hypotensive drops, surgical intervention and presence of drainage devices after antiglaucoma surgery. This leads to the increase of inflammatory reaction of the cornea in the form of edema of up to 16.9% after cataract phacoemulsification.Phacoemulsification also provides a significant hypotensive effect (up to 34%) and is a preventive measure for an acute attack in patients with angle-closure glaucoma. However, the state of acute glaucoma attack leads to difficulties in phacoemulsification in the form of high intraocular pressure, corneal edema and small chamber. Cataract extraction under such circumstances causes an increase in postoperative corneal edema and eye inflammation of up to 22.85%.

Diagnosis and treatment of angle-closure glaucoma

Glaucoma is a polyetiological disease, which is based on increased intraocular pressure, leading to impaired visual fields and pathology of the optic nerve. As a result of increased pressure, there is an increase in the hydrodynamic load on the optic disc, gradually leading to its atrophy. Progressive narrowing of visual fields is another classic sign of glaucoma. This disease is one of the main causes of vision loss and related disability of the population. There are three main forms of glaucoma: primary open-angle, primary closed-angle, and secondary glaucoma, which develops against the background of the existing pathology of the organs of vision (diabetic retinopathy, acute iridocyclitis, post-thrombotic oculopathy). Primary open-angle glaucoma is the most common form of the disease, usually affecting the elderly. Angle-closure glaucoma is less common, but it is more dangerous. This form of the disease is often observed against the background of existing hypermetropia. This type of primary glaucoma develops as a result of a violation of the outflow in the drainage system of the eye due to the occlusion of the internal scleral sinus. In this case, the anterior chamber is significantly reduced in size or even disappears, and the lens is close to the cornea. Angle-closure glaucoma is characterized by a paroxysmal course, rapid progression, and a less favorable prognosis. In some cases, an acute attack of angle-closure glaucoma requires immediate hospitalization with subsequent surgical intervention.

State of the art in acute glaucoma attack predisposition issue

Angle-closure glaucoma diagnosis verification is based on biometric indicators and computer tomography data of the anterior segment of the eye. However, not every patient with a narrow angle and a shellow anterior chamber develops an acute attack. The review summarizes the literature data on risk factors for an acute glaucoma attack and lists additional parameters to be considered when examining patients with angle-closure glaucoma to identify a predisposition to an acute glaucoma attack.

Metastatic tumor of the ciliary body manifesting as phacomorphic glaucoma: A clinical case

Introduction: Metastatic ciliary body tumor is a relatively rare tumor with a poor prognosis. Ciliary body tumors manifest as closed angle glaucoma, secondary glaucoma (phacomorphic glaucoma (PG), neovascular glaucoma), chronic uveitis, and cataract. The diverse manifestation of symptoms leads to diagnostic errors. Case presentation: This article presents a clinical case of a man aged 59 years with PG of the left eye. Ultrasound biomicroscopy revealed: a mushroom-shaped mass on the ciliary body penetrating toward the posterior chamber, with indistinct boundaries. Metastatic tumor of ciliary body had clinical manifestation as PG in this patient. Conclusion: All types of secondary glaucoma and acute attack of primary closed angle glaucoma should be carefully examined for intraocular tumor. Incorrect choice of treatment tactics for such patients can lead to common complications such as metastasis.

Выявление случаев повышенного риска первичной закрытоугольной глаукомы у молодых пациентов с высокой степенью гиперметропии

Purpose. Evaluation of the incidence of risk of primary angle-closure glaucoma (PACG) in young patients with a high hyperopia. Material and methods. The main group consisted of 58 healthy patients (116 eyes) with high hyperopia. Their age ranged from 32 to 40 years. Selection criteria: the anteroposterior axis (APA) of the eye is less than 22 mm, the absence of ophthalmic and systemic somatic pathology. The comparison group was formed by 52 patients (104 eyes) with high hyperopia (APA less than 22 mm) and the initial stage of PACG, as well as the presence of a functional block of the front camera angle. Their age ranged from 45 to 50 years with a median of 47 years. The morphometric parameters of the anterior segment of the eyes were evaluated in groups. Results. We determined statistically significant differences in all studied parameters of the compared groups: the depth of the anterior chamber in the central zone, the thickness of the lens, the volume of the anterior chamber. However, when comparing these indicators with the comparison group, it was found that in 15 patients in the main group, most of them were comparable. Conclusion. Comparative analysis of the topographic and anatomical parameters of the anterior segment of the eyes of young healthy hypermetropes made it possible to identify 15 people. (26 %) with an increased risk of developing PACG and an acute attack. Keywords: acute attack of angle-closure glaucoma, hyperopic refraction, anteroposterior axis of the eye, lens thickness, anterior chamber depth, anterior chamber volume.