Primary Angle-closure Glaucoma Eyes Research Articles

Is increased choroidal thickness a risk factor for primary angle-closure glaucoma

Primary angle-closure glaucoma (PACG) is the main form of glaucoma in China. The pathological mechanism of PACG is not yet well understood. Traditional anatomic disorders are characterized by biometric factors such as shallow anterior chamber depth, narrow anterior chamber angle, short axial length, and thick crystalline lens.Newly found potential risk factors include dynamic changes of iris and choroid.With the development of enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and swept source OCT (SS-OCT), it is possible to measure choroidal thickness accurately.Several studies have found the choroid of PACG eyes was thicker than that of primary open-angle glaucoma (POAG) and normal subject eyes, which suggests that increased choroidal thickness might be another risk factor for PACG.

Factors correlating with failure to control intraocular pressure in primary angle-closure glaucoma eyes with coexisting cataract treated by phacoemulsification or combined phacotrabeculectomy.

To identify clinical factors correlating with failure to control intraocular pressure (IOP) in primary angle-closure glaucoma (PACG) eyes with cataract after phacoemulsification or phacotrabeculectomy. Retrospective analysis of two prospective randomized controlled clinical trials. Primary angle-closure glaucoma eyes with cataract received phacoemulsification or phacotrabeculectomy. Failure was defined as having IOP of 21mm Hg or greater, or requiring glaucoma drugs to maintain an IOP of less than 21 mm Hg, or having had additional IOP-lowering surgery. Factors correlating with failure at 24 months after surgery were identified using logistic regression model. One hundred twenty-three PACG eyes with cataract and receiving phacoemulsification (n = 62) and phacotrabeculectomy (n = 61) were analyzed. With univariate analysis, factors associated with failure included a higher preoperative IOP, a higher preoperative requirement for glaucoma drugs, absence of plateau iris configuration, and phacoemulsification alone. With multivariate analysis, factors associated with failure included a higher preoperative IOP [odds ratio (OR), 1.732 per increase in IOP of 5 mm Hg], a higher preoperative requirement for glaucoma drugs (OR, 1.913), and performance of phacoemulsification alone (OR, 10.24). In PACG eyes with cataract, higher preoperative IOP and increased requirement for glaucoma drugs correlate with failure to control IOP after phacoemulsification or phacotrabeculectomy. Phacotrabeculectomy is more likely than phacoemulsification to achieve IOP control.

Intraocular Pressure Spikes After a Sequential Laser Peripheral Iridotomy for Angle Closure

To determine the incidence of intraocular pressure (IOP) spikes within the first 30 minutes after sequential argon-Nd:YAG laser peripheral iridotomy (LPI) in patients with angle closure and to explore risk factors for their occurrence. A total of 428 consecutive eyes of 298 patients who had undergone LPI at the Singapore National Eye Centre between June 2011 and August 2011 were reviewed retrospectively. There were 238 primary angle closure suspect eyes, 85 primary angle closure eyes, 92 primary angle closure glaucoma eyes, and 13 acute primary angle closure (APAC) eyes. The pre-LPI IOP and post-LPI IOP, gonioscopic findings, medications, laser parameters, and the need for acute IOP-lowering treatment were recorded. The proportion of patients with a post-LPI IOP elevation ≥8 mm Hg was 10.7% (n=46) and those with a significant IOP spike of ≥30 mm Hg was 31 (7.2%). There were no significant differences between those with or without a post-LPI IOP elevation ≥8 mm Hg and those with or without a post-LPI IOP of ≥30 mm Hg, in terms of age, gender, race, total laser energy used, and seniority of the physician performing the procedure. Patients who experienced IOP spike ≥8 mm Hg were on fewer pre-LPI medications (P=0.009). On logistic regression, patients with APAC had a significantly higher probability of an IOP spike (P=0.003). The incidence of postsequential LPI IOP elevation ≥8 mm Hg was 10.7%. The primary diagnosis of APAC was a risk factor, and using preprocedure ocular hypotensives can potentially reduce their occurrence.

Appositional angle closure in Chinese with primary angle closure and primary angle closure glaucoma after laser peripheral iridotomy.

To determine the prevalence of appositional angle closure (AAC) after laser peripheral iridotomy (LPI) in the eyes of Chinese patients with primary angle closure (PAC) and primary angle closure glaucoma (PACG) and to evaluate its pathogenesis by investigating anatomic characteristics. This was a cross-sectional observational study. PAC and PACG subjects were consecutively enrolled after LPI. Ultrasound biomicroscopy (UBM) images, obtained in darkness, of each quadrant without peripheral anterior synechia (PAS) under gonioscopy were qualitatively assessed. Darkroom provocative test (DRPT) was also performed. A total of 134 eyes of 134 patients were enrolled. AAC was observed in ≥ 1 quadrant of UBM image in 85 subjects (63.4%). There were 116 randomly selected quadrants without PAS for 134 patients (86.6%). AAC existed in 38 quadrants (32.8%). Among these, plateau iris accounted for 44.7%, anteriorly inserted iris for 13.2%, thick iris for 13.2%, and anteriorly inserted iris combined with thick iris for 18.4% of the total. One hundred fifteen patients underwent DRPT and its positive rate of eyes with AAC ≥ 2 quadrants (37.5% [12 of 32 patients]) was significantly higher than those ≤ 1 quadrant (16.9% [14 of 83 patients]; P = 0.018). However, no significant differences were found between eyes with nonsynechia plateau iris ≥ 2 quadrants (36.4% [4 of 11 patients]) and those ≤ 1 quadrant (21.2% [22 of 104 patients]; P = 0.266). Approximately two-thirds of PAC and PACG eyes of Chinese patients after LPI had AAC. Plateau iris accounted for less than 50% of AAC. Other factors such as a thick peripheral iris and an anteriorly inserted iris also contributed to AAC. DRPT results suggested AAC might have more functional meaning than plateau iris.

Matrix metalloproteinases and tissue inhibitors of metalloproteinases in the aqueous humour of patients with primary angle closure glaucoma - a quantitative study

BackgroundAltered levels of specific matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in the aqueous humour of primary open-angle glaucoma (POAG) eyes have been described. In this study, levels of specific MMPs and TIMPs in the aqueous humour of primary angle-closure glaucoma (PACG) eyes were measured and compared with those of POAG as well as non-glaucoma control eyes.MethodsAqueous humour from 16 PACG, 28 POAG and 27 control eyes were sampled during intraocular surgery. Levels of total protein, MMP-2, MMP-3, TIMP-1 and TIMP-2 were quantified by protein assay and enzyme immunoassay.ResultsTotal protein levels were significantly higher in PACG (0.426 ± 0.126 mg/ml, p = 0.043) and POAG (0.578 ± 0.360 mg/ml, p = 0.007) compared to controls (0.292 ± 0.192 mg/ml). The difference between PACG and POAG was not significant (p = 0.158). MMP-2 was significantly higher in PACG (p = 0.032) and POAG (p < 0.001) compared to controls. The difference between PACG and POAG was also not significant (p = 0.133). MMP-3 was significantly higher in POAG compared to controls (p = 0.002) and PACG (p = 0.029). The difference between PACG and controls was not significant (p = 0.962). TIMP-1 was significantly higher in PACG (p = 0.049) and POAG (p = 0.010) compared to controls. The difference between PACG and POAG was also not significant (p = 0.961). TIMP-2 was significantly higher in POAG (p = 0.004) compared to controls. The difference between PACG and either controls or POAG was not significant (p > 0.05). Although not statistically significant (p > 0.05), the MMP-2/TIMP-2 ratio was highest in PACG (2.83 ± 7.40), followed by POAG (1.38 ± 1.55) and controls (1.34 ± 3.05). Similarly, the MMP-2/TIMP-1 ratio was highest in PACG (1.50 ± 1.69), followed by POAG (1.40 ± 0.77) and controls (1.15 ± 0.92). The MMP-2 + MMP-3/TIMP-1 + TIMP-2 ratio was higher in PACG (0.83 ± 0.80) and POAG (0.82 ± 0.53) compared to controls (0.70 ± 0.63). In both POAG and PACG, there were no significant differences in the levels of total protein, MMP-2, MMP-3, TIMP-1 and TIMP-2 between patients on prostaglandin analogues and those not.ConclusionWe found altered levels of MMPs and TIMPs as well as imbalance of MMP:TIMP ratios in the aqueous humour of PACG eyes that were different from POAG and non-glaucoma control eyes.

Comparison of relation between visual function index and retinal nerve fiber layer structure by optical coherence tomography among primary open angle glaucoma and primary angle closure glaucoma eyes.

Purpose:To compare the visual field index (VFI) in primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) eyes, and to study the correlation with disc variables on optical coherence tomography (OCT) in all stages of severity.Materials and Methods:Thirty POAG and PACG underwent Humphrey visual field 24-2 along with detailed examination. They also underwent stratus OCT imaging of the optic nerve and retinal nerve fiber layer (RNFL). The correlation of VFI with RNFL thickness was compared in POAG and PACG.Results:The VFI significantly differed between POAG and PACG, with POAG eyes apparently having a better VFI at all severities of glaucoma. There were statistically significant differences in the superior max (Smax) and inferior max (Imax) in early and moderate POAG and PACG eyes. In early and moderate glaucoma, multivariate regression showed that maximum correlation of the VFI was seen with the mean deviation (b = 1.7, P < 0.001), average and superior RNFL thickness (b = 2.1, P < 0.001 and b = 1.8, P = 0.03, respectively), and age (b = 0.7, P = 0.04); while no correlation was seen with intraocular pressure (IOP), axial length, sex, or other clinical variables. VFI did not correlate well with RNFL thickness or other disc variables on OCT in severe glaucoma.Conclusion:VFI may not serve as a useful indicator of visual function in severe glaucoma. More useful indicators are required to monitor glaucoma patients with severe damage.

Central corneal thickness in primary angle closure and open angle glaucoma.

Purpose:To quantitatively analyze central corneal thickness (CCT) in patients with primary angle closure glaucoma (PACG) and primary open-angle glaucoma (POAG), and to evaluate its correlation with severity of glaucoma.Methods:In this retrospective study, records of patients with previously diagnosed POAG or PACG at a tertiary glaucoma service were reviewed. CCT was measured by ultrasound pachymetry. Mean deviation (MD) on visual field (VF) testing was recorded for glaucoma severity determination. CCT and age- and sex-adjusted CCT were compared among the study groups using Student's t-test and analysis of covariance (ANCOVA), respectively. Univariate and multivariate regression models were used for correlation of age, MD and CCT.Results:A total of 115 patients with PACG, 215 with POAG, and 100 normal controls were included with mean age of 64.1 ± 10.4, 59.9 ± 10.5, and 62.04 ± 10.80 years, respectively. CCT was thicker in PACG eyes (545.5 ± 46.1 μm) as compared to POAG eyes (531.7 ± 37.3 μm) and controls (531.0 ± 38.3 μm) even after age and gender adjustment (ANCOVA, P = 0.05). CCT was found to decrease with increasing age only in the POAG group (β = -0.57, P = 0.01). Disease severity (MD of VF) was significantly and inversely correlated with CCT in both POAG and PACG eyes (β = 1.89, P = 0.02; and β = 1.38, P = 0.04, respectively) after age and sex correction.Conclusion:PACG eyes had thicker CCT as compared to POAG and normal healthy eyes in Iranian subjects. Severity of the disease was inversely correlated with CCT in eyes with both POAG and PACG.

The biometric study in different stages of primary angle-closure glaucoma

This study compared the general and ocular biometric characteristics of normal, primary angle closure (PAC), and primary angle-closure glaucoma (PACG) patients to better understand the possible relationship between differences in ocular parameters that might predict risk for PACG in PAC patients. One hundred normal, 90 PAC, and 90 PACG eyes were retrospectively reviewed. General characteristics such as age, gender, body height, body weight, blood pressure, pulse, systemic diseases, and education level were recorded. Ocular findings included visual acuity, intraocular pressure, refraction, cup to disc ratio, and ocular biometry. Ocular biometry was obtained by A-scan ultrasonography (Digital A/B scan 5500; Sonomed Inc., Lake Success, NY, USA). The parameters recorded were anterior chamber depth (ACD), lens thickness (LT), axial length (AXL), lens/axial length factor (LAF), and relative lens position (RLP). Although the controls, PAC group, and PACG group were found to be significantly different in age (62.7±9.8; 65.3±7.5; and 66.0±7.4, respectively), there were no gender differences. With regard to ocular parameters, the ACD tended to decrease and the LT and LAF tended to increase from normal to PAC to PACG. The eyes of the PACG group had significantly shallower ACD (P<0.001) and thicker lens (P<0.001) than those of the PAC group. While PAC had similar lens position to the control group, PACG had more anteriorly positioned lens than the PAC group (P<0.001). Logistic regression analysis found a significant association between a decrease in ACD and increased risk of PACG (odds ratio (OR)=3.59 for 0.2 mm decrease in ACD) as well as a significant association between an increase in LT and increased risk of PACG (OR=1.30). In addition to LT, a shallower ACD owing to a change in RLP may have a role in the progression from PAC to PACG. Owing to the differences of certain biometric characteristics between PAC and PACG, A-scan ultrasonography might potentially be used for the early detection of PACG in PAC eyes.

Comparison of Glaucoma Diagnoses Using Stratus and Cirrus Optical Coherence Tomography in Different Glaucoma Types in a Chinese Population

To compare the glaucoma diagnostic power of Stratus and Cirrus optical coherence tomographies (OCTs) in a Taiwan Chinese population with different glaucoma types. One eye each was chosen from 21 ocular hypertension (OH) patients, 27 glaucoma-suspect (GS) patients, 35 primary open-angle glaucoma (POAG) patients, 26 primary angle-closure glaucoma (PACG) patients, and 52 normal subjects. Early glaucoma (EG) was identified among glaucomatous eyes on the basis of the visual field severity (better than -9 dB). All participants were imaged using 2 OCT units at the same visit. The area under the receiver operator characteristic (AROC) curve was used to differentiate normal eyes from OH, GS, POAG, PACG, and EG eyes, and the sensitivity and specificity of each parameter from internal normative classifications were analyzed. For normal versus OH eyes, the best AROC value was the average thickness (Stratus, 0.693; Cirrus, 0.697). For normal versus GS eyes, the best AROC value was the average thickness (Stratus, 0.807; Cirrus, 0.776). For normal versus POAG eyes, the best AROC value was the average thickness (Stratus, 0.943; Cirrus, 0.930). For normal versus PACG eyes, the best AROC value was the 5-o'clock hour (Stratus, 0.830; Cirrus, 0.817). For normal versus EG eyes, the best AROC value was the average thickness with Stratus (0.868) and the 5-o'clock hour with Cirrus (0.876). All sensitivities in the 5 groups were fair on the basis of the internal normal classification database of both OCTs. Cirrus and Stratus OCTs showed equal diagnostic power in EG, OH, GS, POAG, and PACG eyes in a Taiwan Chinese population. The utility of the current internal databases of both OCT units for the Chinese population is an interesting issue that needs to be addressed in the future.

Outcomes of Laser Peripheral Iridotomy in Angle Closure Disease

Purpose: To evaluate the long-term outcomes of laser peripheral iridotomy (LPI) in primary angle closure disease.Methods: We retrospectively reviewed the medical records of all Indian subjects of primary angle closure (PAC) and primary angle closure glaucoma (PACG) who underwent LPI between 2003 and 2004. Subjects requiring additional treatment in the form of antiglaucoma medications or trabeculectomy during the follow-up were identified. Baseline factors predicting the need for additional treatment following LPI in primary angle closure disease (PAC+PACG) were analyzed.Results: 84 eyes (PAC:PACG = 16:68) of 47 subjects had undergone LPI during the study period. Over a mean follow-up of 50 ± 22.7 months, 68 eyes (PAC:PACG = 9:59) required additional treatment, of which 26 eyes (PAC:PACG=2:24) subsequently underwent trabeculectomy. Over the initial 20 months of follow-up after LPI, the cumulative probability of requiring no additional treatment was similar between PAC [63.6% (95% CI: 29.7–84.5)] and PACG eyes [64.0% (95% CI: 44.5–78.3)]. Subsequently, the cumulative probability of requiring no additional treatment in PACG eyes dropped to 24.8% (9.7–43.5) at 4 years and 9.9% (1.8–26.7) at 7 years. Presenting IOP (p = 0.01) and highest recorded IOP before LPI (p = 0.03) were the most significant predictors of the need for additional treatment after LPI. Extent of synechial angle closure (p = 0.04) and the cup to disc ratio (p = 0.05) significantly predicted the need for trabeculectomy subsequently in PACG eyes.Conclusions: The majority of angle closure eyes required additional treatment after LPI. Eyes with a higher presenting IOP were more likely to require additional treatment and those with a greater amount of synechial angle closure and larger cup disc ratio at presentation were more likely to require surgery over the follow-up.

Effect of Phacoemulsification on Drainage Angle Status in Angle Closure Eyes with or without Extensive Peripheral Anterior Synechiae

Purpose. To evaluate the anatomic effects of phacoemulsification on drainage angle status in primary angle closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). Methods. A total of 62 eyes of 58 patients underwent cataract surgery in Farabi Rye Hospital, Tehran, Iran. Patients were examined postoperatively on day 1, week 1, and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery. Main outcome measures were angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy. Thirty-five eyes had PAS =180 degrees (group 1) and 27 eyes had >180-degree synechial closure (group 2). Results. Mean age of the patients was 64.3±9.0 years. The mean extent of PAS was significantly reduced from 45.9 to 32.2 degrees (p<0.03) in group 1, and from 277.4 to 159.0 degrees (p<0.001) in group 2. Group 2 showed significantly greater reduction in PAS extent (p<0.001). Angle opening distance and trabecular-iris space area at 500 µm from the scleral spur measured by AS-OCT increased significantly in both groups (p<0.001 for both). Anterior chamber depth (ACD) increased and lens vault (LV) decreased after both procedures. However, the amount of change in ACD and LV and angle parameters were not significant between the 2 groups. Conclusions. Phacoemulsification resulted in opening of the drainage angle, deepening of the anterior chamber, and reduction of PAS extent in PACG eyes with or without extensive PAS. Greater reduction of PAS could be considered in eyes with PAS >180 degrees.

Effect of adjunctive viscogonioplasty on drainage angle status in cataract surgery: a randomized clinical trial

To compare the anatomic effects of phacoemulsification (Phaco) versus combined phacoemulsification and viscogonioplasty (Phaco-VGP) on drainage angle status in primary angle-closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). Prospective, randomized clinical trial. Sixty-seven eyes of 57 patients with the diagnosis of PACG. Patients were randomized to undergo Phaco alone (33 eyes) or Phaco-VGP (34 eyes). Patients were examined postoperatively on day 1, week 1 and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery. Angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy. Sixty-five eyes of 55 patients completed the trial. The mean extent of PAS was significantly reduced from 127.7 to 95.0 degrees (P < 0.001) by Phaco alone, and from 174.0 to 77.3 degrees (P < 0.001) by Phaco-VGP. Phaco-VGP resulted in significantly greater reduction in PAS extent (P = 0.002). Angle-opening distance and trabecular-iris space-area measured by AS-OCT increased significantly after Phaco alone and Phaco-VGP (P < 0.001 for both). Although the change was higher in the Phaco-VGP group, this did not reach statistical significance. Anterior chamber depth (ACD) increased, and lens vault (LV) decreased after both procedures. The amount of change in ACD and LV was not significant between the two groups. Both Phaco alone and Phaco-VGP resulted in widening of the drainage angle, deepening of the anterior chamber and reduction of intraocular pressure (IOP) and PAS extent in PACG eyes. Phaco-VGP resulted in significantly more reduction of PAS. However, it seems that additional VGP has no significant effect on short-term IOP.

Dynamic Changes in Anterior Segment (AS) Parameters in Eyes with Primary Angle Closure (PAC) and PAC Glaucoma and Open-Angle Eyes Assessed Using AS Optical Coherence Tomography

To evaluate serial changes in anterior segment (AS) parameters in terms of variation in pupil diameter (PD) using AS optical coherence tomography (OCT) in eyes with primary angle closure or primary angle closure glaucoma (PCG), age-matched open-angle (AO) eyes, and young open-angle (YO) eyes. Forty-four PCG (mean ± SD; 62.2 ± 7.5 years), 36 AO (62.0 ± 12.3 years), and 58 YO eyes (29.1 ± 7.0 years) were imaged under four standardized lighting conditions (3.25, 100.8, 426, and 1420 cd/m(2)). PD, anterior chamber depth (ACD), iris cross-sectional area (IA), iris thicknesses at 750 and 1500 μm from the scleral spur (IT750, IT1500), iris curvature (IC), lens vault (LV), and anterior chamber area (ACA), were calculated. The slope of the change in each AS parameter in terms of variation in PD was determined by a linear mixed-effect model. The mean ACD was significantly shallower (P < 0.001), the IC higher (P < 0.001), the IT750 greater (P = 0.026), the ACA smaller (P < 0.001), the LV greater (P < 0.001), and the IA wider (P = 0.019) in PCG eyes compared with AO eyes. However, the mean slope of no parameter differed significantly between PCG and AO eyes. The mean slopes of IC, IT1500, and IA differed between AO and YO eyes. Older eyes showed significantly different dynamic AS parameter responses in terms of change in PD compared with younger eyes. Thus, the authors suggest that changes in the dynamic features of AS parameters with age may contribute to angle closure development, in addition to any predisposing anatomic condition.

Central Corneal Thickness in Chinese Subjects With Primary Angle Closure Glaucoma

To characterize central corneal thickness (CCT) in Chinese eyes with primary angle closure glaucoma (PACG). CCT was measured by ultrasound pachymetry in PACG eyes and compared with primary open-angle glaucoma (POAG) eyes. POAG eyes were further subdivided into high-tension glaucoma (HTG) and normal-tension glaucoma (NTG) for analysis. PACG eyes had glaucomatous optic neuropathy and visual field loss, an angle in which at least 180 degrees of angle in which the posterior trabecular meshwork was not visible, and raised intraocular pressure (IOP) and/or peripheral anterior synechiae. Both HTG (IOP >21 mm Hg) and NTG (IOP consistently <21 mm Hg) eyes had glaucomatous optic neuropathy with compatible visual field defects and open angles. Further comparison was made with CCT data of 1067 normal subjects previously enrolled in a population-based study. We enrolled 154 patients with PACG and 300 with POAG. Mean age of PACG patients was 68.1±8.3 years compared with 71.1±12.4 years in POAG patients (P=0.002). There was no difference in mean CCT of PACG eyes (541.28±33.95 μm) and POAG eyes (539.28±34.84 μm, P=0.56) or normal eyes of control subjects (536.74±31.08 μm) (P=0.07). However, mean CCT of NTG eyes (535.23±36.10 μm) was significantly lower than that of HTG eyes (543.44±33.10 μm, P=0.04), and HTG eyes had thicker CCT than normal eyes (P=0.01). PACG eyes had similar CCT as those with POAG or normal eyes in Chinese subjects.

Comparison of Ocular Response Analyzer Parameters in Chinese Subjects With Primary Angle-Closure and Primary Open-Angle Glaucoma

To evaluate corneal hysteresis (CH) and intraocular pressure (IOP) measured by the Ocular Response Analyzer in Chinese subjects with primary angle-closure glaucoma (PACG), assess their relationship with Goldmann applanation tonometry (GAT) measurements, and compare this with subjects with primary open-angle glaucoma (POAG) and normal controls. In this prospective observational study, consecutive subjects with PACG and POAG without prior intraocular surgery were enrolled from glaucoma clinics. Normal subjects were recruited from an ongoing population-based study. One eye of each subject underwent standardized ocular examination and IOP measurement by GAT and the Ocular Response Analyzer. Corneal hysteresis and corneal-compensated IOP were compared between groups. Of the 443 subjects recruited, 131 had PACG, 162 had POAG, and 150 were normal. Corneal hysteresis was lower in PACG (9.1 mm Hg; 95% confidence interval [CI], 8.7 to 9.4 mm Hg) and POAG (9.5 mm Hg; 95% CI, 9.2 to 9.5 mm Hg) eyes compared with control eyes (10.4 mm Hg; 95% CI, 10.1 to 10.6 mm Hg; P<.001 for both), with no difference (P=.16) in CH found between PACG and POAG eyes. After adjusting for age, sex, and IOP measurement by GAT, CH persisted to be lower only in eyes with PACG in comparison with control eyes (9.4 vs 10.1 mm Hg; P=.006). Eyes with POAG had lower CH than control eyes but the difference was not statistically significant (9.6 vs 10.1 mm Hg; P=.06). Corneal hysteresis was lower in eyes with glaucoma. After adjusting for age, sex, and IOP measurement by GAT, a persistently lower hysteresis was noted in eyes with PACG compared with other groups.

Long-term efficacy of phacoemulsification for primary closure angle glaucoma following filtering surgery

目的 评价超声乳化术对小梁切除术后闭角型青光眼患者眼压的长期影响.方法 研究为系列病例观察性研究.选取已接受小梁切除术具有功能性滤过泡的原发性闭角型青光眼和年龄相关性白内障需行超声乳化术的患者19例,每例随机选择1眼进入研究.记录患者超声乳化术前,术后1、3、6个月,1年、2年的眼压和抗青光眼药物治疗情况.用Kaplan-Meier法计算生存率;比较术前、术后1个月、术后2年超声生物显微镜(UBM)对滤过泡和前房的生物测量值.结果 共15例患者完成2年的随访,纳入的患者中2例因死亡、另2例因依从性差而失访.超声乳化术前及术后各随访时间点的眼压为(13.5±2.9)、(12.8±2.9)、(12.9±2.7)、(13.0±3.5)、(13.4±3.6)、(12.7±2.9)mmHg,差异无统计学意义(F=0.443,P=0.817).超声乳化术后2年滤过泡的累积成功率为100%,绝对成功率为87%.UBM测量结果显示,术后前房深度加深,房角进一步开放的象限数量增加,滤过泡的高度下降,三者与术前比较差异均有统计学意义(Z=-3.411,P=0.001;χ2=8.775,P=0.006;Z=-2.927,P=0.003),但滤过泡的反射率及滤过道差异无统计学意义,术后1个月和术后2年的形态学变化差异无统计学意义.结论 长期随访显示,小梁切除术后的原发性闭角型青光眼患者进行超声乳化术眼压控制良好。

Structure–Function Correlations Using Scanning Laser Polarimetry in Primary Angle-Closure Glaucoma and Primary Open-Angle Glaucoma

To assess the correlations between retinal nerve fiber layer (RNFL) thickness measured with scanning laser polarimetry and visual field (VF) sensitivity in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Prospective, comparative, observational cases series. Fifty patients with POAG and 56 patients with PACG were examined using scanning laser polarimetry with variable corneal compensation (GDx VCC; Laser Diagnostic Technologies, Inc.) and Humphrey VF analyzer (Carl Zeiss Meditec, Inc.) between August 2005 and July 2006 at Taipei Veterans General Hospital. Correlations between RNFL thickness and VF sensitivity, expressed as mean sensitivity in both decibel and 1/Lambert scales, were estimated by the Spearman rank correlation coefficient (r(s)) and multivariate median regression models (pseudo R(2)). The correlations were determined globally and for 6 RNFL sectors and their corresponding VF regions. The correlation between RNFL thickness and mean sensitivity (in decibels) was weaker in the PACG group (r(s) = 0.38; P = .004; pseudo R(2) = 0.17) than in the POAG group (r(s) = 0.51; P < .001; pseudo R(2) = .31), but the difference in the magnitude of correlation was not significant (P = .42). With Bonferroni correction, the structure-function correlation was significant in the superotemporal (r(s) = 0.62), superonasal (r(s) = 0.56), inferonasal (r(s) = 0.53), and inferotemporal (r(s) = 0.50) sectors in the POAG group (all P < .001), whereas it was significant only in the superotemporal (r(s) = 0.53) and inferotemporal (r(s) = 0.48) sectors in the PACG group (both P < .001). The results were similar when mean sensitivity was expressed as 1/Lambert scale. Both POAG and PACG eyes had moderate structure-function correlations using scanning laser polarimetry. Compared with eyes with POAG, fewer RNFL sectors have significant structure-function correlations in eyes with PACG.

Effects of Phacoemulsification Versus Combined Phaco-trabeculectomy on Drainage Angle Status in Primary Angle Closure Glaucoma (PACG)

To document anatomic effects of phacoemulsification versus combined phaco-trabeculectomy on drainage angle in primary angle closure glaucoma (PACG). Indentation gonioscopy and ultrasound biomicroscopy were performed preoperatively, and then at 1 year after phacoemulsification alone or combined phaco-trabeculectomy in PACG patients. Seventy-two PACG eyes of 72 patients were included in this study. Thirty-eight eyes were randomized into receiving phacoemulsification alone, whereas 34 eyes had combined phaco-trabeculectomy. The mean extent of synechial angle closure was significantly reduced from 266.4 degrees to 198.9 degrees (P<0.001) by phacoemulsification alone, and from 266.0 degrees to 227.2 degrees (P=0.03) by combined surgery. The mean angle opening distance (AOD 500) measured by ultrasound biomicroscopy was significantly increased from 208.0 to 468.0 microm (P<0.001) by phacoemulsification, and from 214.6 to 344.4 microm (P<0.001) by combined surgery. The mean trabecular-ciliary process distance was significantly increased from 824.6 to 1043.6 microm (P<0.001) by phacoemulsification, and from 800.9 to 951.5 microm (P=0.01) by combined surgery. The mean anterior chamber depth was significantly increased from 1798.6 to 3528.4 microm (P<0.001) by phacoemulsification alone, and from 1781.6 to 3297.8 microm (P<0.001) by combined surgery. Phacoemulsification alone resulted in significantly greater postoperative angle opening distance 500 (P<0.001) and anterior chamber depth (P<0.001) than phaco-trabeculectomy. Phacoemulsification alone resulted in greater opening of drainage angle and greater deepening of anterior chamber than combined phaco-trabeculectomy in PACG eyes. Phacoemulsification alone resulted in greater opening of drainage angle and greater deepening of anterior chamber than combined phaco-trabeculectomy in PACG eyes.

Long-term outcomes of laser peripheral iridectomy for primary angle closure glaucoma

To explore the long-term efficacy and safety of laser peripheral iridectomy for primary angle closure glaucoma (PACG). It was a retrospective case series study. Data were collected from those patients who received laser peripheral iridectomy (LPI) for acute or chronic PACG from April 1992 through October 2002 at the Peking Union Medical College Hospital. Only patients who were followed for at least 5 years were included in this study. The control of intraocular pressure (IOP), visual acuity and managements after LPI were analyzed. All of the studied eyes were re-classified into three categories according to the status of anterior chamber angle, optic nerve head and visual field before LPI: primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG). Satisfactory control of IOP was defined as the IOP was less than 21 mm Hg (1 mm Hg = 0.133 kPa) without any medications after LPI. No satisfactory control of IOP was defined as the IOP was greater than 21 mm Hg after LPI, yet could be controlled below 21 mm Hg by anti-glaucoma medications. A failure in IOP control was defined as an acute attack of angle closure developed or filtering surgery was required to control IOP after LPI. Chi-square analysis was used for comparison of IOP control in different groups. One hundred and thirty one patients (251 eyes) with PACG were eligible for this study. The mean follow-up period was (9.2 +/- 3.7) years. Of the 251 eyes, 18 eyes (7.2%) were identified as PACS, 98 eyes (39.0%) PAC, 129 eyes (51.4%) PACG, and 6 eyes (2.4%) could not be classified owing to the lack of the information on the optic nerve head and visual field before LPI. The rates of satisfactory control of IOP were 27.1% in all eyes, and 88.9% (16/18), 38.8% (38/98) and 10.9% (14/129) in PACS, PAC and PACG eyes respectively. The rates of no satisfactory control of IOP were 59.8% in all eyes, and 5.6% (1/18), 48.0% (47/98) and 75.2% (97/129) in PACS, PAC and PACG eyes respectively. The rates of failure in IOP control were 13.1% in all eyes, and 5.6% (1/18), 13.3% (13/98) and 14.0% (18/129) in PACS, PAC, PACG eyes respectively. The difference in IOP control between PACS, PAC and PACG eyes was statistically significant (chi(2) = 59.08, P = 0.000). Only 8 eyes had an acute attack of angle closure after LPI. No long-term complications after LPI were observed in all eyes. The IOP control after LPI in PACG eyes is not so good as expected. However, most of PACG eyes after LPI are free of acute attack of angle closure. PACG eyes should be given close and regular follow-up in a long-term to monitor the IOP control and the progression of PACG after LPI.

Plateau Iris in Asian Subjects With Primary Angle Closure Glaucoma

To determine the prevalence of plateau iris in Asian eyes with primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). In this cross-sectional observational study, subjects older than 40 years with PACG who had a patent laser peripheral iridotomy underwent UBM in 1 eye. Ultrasound biomicroscopy images were qualitatively analyzed using standardized criteria. Plateau iris in a quadrant was defined by anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact. At least 2 quadrants had to fulfill these UBM criteria for an eye to be classified as having plateau iris. One hundred eleven subjects (70 from Singapore, 41 from Thailand) with PACG were recruited. The mean (SD) age was 65.6 (8.1) years, and 63.9% were female. Based on standardized UBM criteria, plateau iris was found in 36 of 111 eyes (32.4%; 95% confidence interval, 24.4%-41.6%). In these 36 eyes, quadrant-wise analysis showed 66.7% had plateau iris in 2 quadrants; 22.2%, in 3 quadrants; and 11.1%, in all quadrants. About 30% of PACG eyes with a patent laser peripheral iridotomy were found to have plateau iris on UBM, highlighting the importance of non-pupil block mechanisms in Asian individuals.