History Of Angle-closure Glaucoma Research Articles

Medications for attention deficit hyperactivity disorder associated with increased risk of developing glaucoma.

Attention deficit hyperactivity disorder (ADHD) therapies including atomoxetine, methylphenidate, and amphetamines are some of the most prescribed medications in North America. Due to their sympathomimetic action, these drugs are contraindicated in patients with a history of angle closure glaucoma (ACG). This study aims to determine the risk of ACG and open angle glaucoma (OAG) among users of these treatments. This is a retrospective cohort study with a case control analysis using the PharMetrics Plus Database (IQVIA, USA). We created a cohort of new users of atomoxetine, methylphenidate, and amphetamines and they were followed to the first diagnosis of (1) ACG or OAG; or (2) end of follow up. For each case, four age-matched controls were selected. A conditional logistic regression model was used to adjust for confounders and to calculate adjusted incidence-rate-ratios (aIRRs). A total of 240,257 new users of the ADHD medications were identified. The mean age was 45.0 ± 19.4 years and 55% of the cohort was female. Regular users of atomoxetine and amphetamines had a higher aIRR for developing ACG compared with non-users (aIRR = 2.55 95% CI [1.20-5.43] and 2.27 95% CI [1.42-3.63], respectively); while users of methylphenidate had a higher aIRR for developing OAG (aIRR = 1.23 95% CI [1.05-1.59]). Use of amphetamines and atomoxetine had a higher risk for ACG, while use of methylphenidate was associated with a higher risk for OAG. Given the prevalence of ADHD medication use (medically and recreationally), our current data on their associated risk of glaucoma have profound public health implications.

A case report on cataract surgery in eyes with bilateral inferior iridoschisis

PurposeThe purpose of the paper is to report a case of bilateral inferior iridoschisis who underwent cataract surgery with intraocular lens implantation successfully with the help of iris hooks or pupillary expanders.Design/methodology/approachA 71-year-old male presented with inferior iridoschisis in both eyes, history of angle closure glaucoma (ACG), cataract and shallow anterior chamber (AC) angles inferiorly. A localized area of iris stroma is cleaved in two with anterior atrophic portion disintegrating into fibrils from the posterior stroma, and muscle layer is termed as iridoschisis. Iridoschisis is a rare condition associated with fibrillary iris degeneration, narrow drainage angles and cataract.FindingsPreoperative and postoperative ocular examination, including visual acuity, intraocular pressure and degrees of iris damage, was evaluated. Cataract surgery was performed under topical anesthesia with flexible iris hooks. There were no intraoperative complications whereas marked corneal edema was shown at immediate postoperative period but subsided completely in two weeks’ time. Visual acuity improved from 20/60 to 20/25.Practical implicationsThis case report demonstrates that while iridoschisis care during cataract surgery has been reported to be difficult, cataract extraction was managed using iris hooks.Originality/valueThis paper reports the successful management of cataract in a patient with bilateral inferior iridoschisis.

Increased Iris Stiffness in Patients With a History of Angle-Closure Glaucoma: An Image-Based Inverse Modeling Analysis.

Previous studies have shown that iris mechanical properties may play a role in the pathophysiology of primary angle-closure glaucoma (PACG). Such studies, however, were not conducted in vivo and as such were limited in application and scope, especially for the development of diagnostic methods or new treatment options. The purpose of this study was to quantify in vivo iris mechanical properties both in patients with a history of angle-closure glaucoma and in healthy volunteers. We acquired optical coherence tomography scans of anterior segments under standard and dim light conditions. Using a combination of finite element simulation and an inverse fitting algorithm, we quantified the stiffness of the iris. The irides in the eyes of patients with a history of PACG were significantly stiffer when compared with healthy control irides, a result consistent with ex vivo studies. This result was independent of the compressibility assumption (incompressible: 0.97 ± 0.14 vs. 2.72 ± 0.71, P = 0.02; compressible: 0.89 ± 0.13 vs. 2.57 ± 0.69, P = 0.02) when comparing the normalized elastic modulus of the iris between patients with PACG and healthy controls. Our noninvasive, in vivo quantification is free of numerous ethical issues and potential limitations involved with ex vivo examinations. If further studies confirm that the iris stiffness is an omnipresent PACG risk factor and a mechanistic role between increased iris stiffness and angle-closure glaucoma does exist, treatment methods such as lowering the iris stiffness can be developed.

The Use of Butyl Bromide Medication amid Colonoscopy

Objective: the hyoscine-n-butylbromide (Buscopan) is ought to be avoided during colonoscopy in patients with a history of angle-closure glaucoma. Angle-closure glaucoma, nonetheless, is not very common, is asymptomatic before onset and is treated definitively by a single laser treatment (if spotted early). Open-angle glaucoma is not affected by hyoscine. Purpose: the purpose of this study was to evaluate the use of hyoscine amid colonoscopists, with certain reference to glaucoma. Materials and Methods: a short questionnaire was electronically managed to members of the Saudi Society of Gastroenterology and the Association of Coloproctology of KSA. The use of Hyoscine among colonoscopists and the effect of glaucoma history upon the prescribing practice. Results: sixty-three colonoscopists responded to some or all of the questions. 41/61 (67.2%) of respondents claimed they were aware of the guidelines. 53/62 (85.5%) sometimes or always use hyoscine, while 9/62 (14.5%) never do. 45/59 (76.3%) always enquire about glaucoma history prior to administration, even though 48/58 (82.8%) make no differentiation between open-angle or angle-closure forms. 42/59 (71.2%) would (incorrectly) withhold hyoscine if the patient declares a history of any form of glaucoma. 46/59 (78.2%) do not substitute glucagon as an antispasmodic. 2/60 (3.3%) had encountered ophthalmic complications post-administration. Conclusions: current guidelines pertaining to hyoscine use and glaucoma are inappropriate. Patients undergoing colonoscopy who have received hyoscine should, instead, be advised to seek urgent medical advice if they develop ophthalmic symptoms.

Novel BEST1 Mutations and Special Clinical Features of Best Vitelliform Macular Dystrophy

Purpose: To describe the clinical features and to analyze BEST1 mutations in patients with Best vitelliform macular dystrophy (BVMD). Methods: Thirteen individuals affected by BVMD from 6 unrelated Chinese families were studied. Complete ophthalmological examinations were performed, and the BEST1 gene was screened in all participants and 100 controls. Follow-ups were arranged within 12 months. Results: All 6 probands showed typical fundus appearances of BVMD. One of the 6 had a history of angle closure glaucoma, and another showed a unilateral focal choroidal excavation on optical coherence tomography. One patient experienced progression of the macular lesion during the follow-up. The asymptomatic mutation carriers had normal fundus but abnormal Arden ratios on electro-oculograms. Besides 4 previously reported mutations (p.Ser16Phe, p.Ser144Asn, p.Glu292Lys, p.Glu300Lys), 2 novel disease-causing mutations (p.Thr307Asp, p.Arg47His) were identified, of which p.Arg47His has been reported in adult-onset vitelliform macular dystrophy. Conclusions: Our findings have expanded the mutational and clinical spectrum of BVMD in a Chinese population. Clinical presentations of angle closure glaucoma and/or focal choroidal excavation may be related to BVMD, underlining the necessity of multimodal studies and risk assessment of angle closure glaucoma in BEST1 mutation carriers. BVMD and adult-onset vitelliform macular dystrophy may share a common etiology in some cases.

Administration of hyoscine- n-butylbromide during colonoscopy: a survey of current UK practice

ObjectiveCurrent British Society of Gastroenterology (BSG) guidelines suggest that hyoscine-n-butylbromide (Buscopan) should be avoided during colonoscopy in patients with a history of angle-closure glaucoma. Angle-closure glaucoma, however, is not very...

Reformation of the Anterior Chamber Following Trabeculectomy

ABSTRACT Sixteen eyes requiring surgical reformation of the anterior chamber (AC) in our Unit from December 1987 to August 1991 were studied retrospectively to determine the incidence of the problem in our hospital and to evaluate the operative measures used to restore the AC. The mean preoperative AC depth of these 16 eyes was 1.92 mm (range, 1.50 to 2.50 mm). Nine had a history of angle-closure glaucoma. Poor surgical technique was a contributing factor in the development of a flat AC in 3. Of the remaining 13 eyes, 11 had a trabeculectomy with a fornix-based, and 2 with a limbus-based, conjunctival flap. Wound leaks occurred in 10 eyes with fornix-based flaps, but in none of the eyes with limbus-based flaps. Factors associated significantly with the development of flat AC following trabeculectomy were: a preoperative shallow AC, a history of angle-closure glaucoma, and the use of a fornix-based conjunctival flap. Avoiding wound leakage when performing trabeculectomy in eyes with a shallow AC or a history of angle-closure glaucoma by using a limbus-based flap may help prevent postoperative flat AC.

TO DILATE OR NOT TO DILATE

It is generally accepted that examination of the ocular fundus is an important part of a complete physical examination. An adequate examination through an undilated pupil is, however, difficult, and significant systemic and ocular disease often goes unrecognized. Most physicians, wary of precipitating acute glaucoma are, therefore, reluctant to dilate the pupil in order to facilitate ophthalmoscopy. This is the unfortunate result of a lack of understanding of the natural history of angle closure glaucoma and confusion as to the difference between open angle glaucoma and angle closure glaucoma. The more common of the two diseases, open angle glaucoma, is chronic, asymptomatic, and a major cause of blindness. It is not seriously affected by mydriatic drops instilled for a single examination. Angle closure glaucoma, a much less common disease, characterized by acute episodes of pain and blurred vision, can be precipitated by dilating the pupil. These attacks, whether spontaneous or