Primary Angle-closure Glaucoma Research Articles (Page 1)

Phacoemulsification combined with intraocular lens implantation and goniosynechialysis (PEI + GSL) represents a mainstream ​surgical technique​for the treatment of primary angle-closure glaucoma (PACG). As the disease progresses, when the extent of peripheral anterior synechiae (PAS) gradually expands to 360°, whether PEI + GSL remains effective remains uncertain. This study aimed to investigate the long-term clinical efficacy​of PEI + GSL in treating PACG patients with 360° PAS. A case‒control study was conducted on PACG patients with 360° PAS (360° PAS group) and those with PASs ranging from 90° to 180° (90°≤ PAS ≤ 180° group). Patients underwent PEI + GSL and were followed up for 1-3 years. The data collected included intraocular pressure (IOP), glaucoma medications, visual acuity, PAS extent, complications, and other relevant parameters. Kaplan‒Meier curves were used to analyse the cumulative surgical success rates in both groups. The 360° PAS group included 31 eyes (31 patients), and the 90°≤ PAS ≤ 180° group included 32 eyes (32 patients). At the final follow-up (36 months), the IOP was 14.8 ± 3.9 mmHg in the 360°PAS group and 15.5 ± 2.9 mmHg in the 90°≤ PAS ≤ 180° group (P = 0.507). The degree of IOP reduction was 47.9% in the 360°PAS group and 33.0% in the 90°≤ PAS ≤ 180° group (P = 0.272). The mean number of glaucoma medications decreased by 2.5 in the 360°PAS group and 1.1 in the 90°≤ PAS ≤ 180° group (P < 0.001). The complete plus qualified success rates at 3 years were 90.3% and 93.8%, respectively, with no significant difference (P = 0.970). PEI + GSL in PACG patients with 360° PAS resulted in a 47.9% reduction in IOP, a mean reduction of 2.5 glaucoma medications, and a high overall surgical success rate (90.3%), comparable to the 90°≤ PAS ≤ 180° group (93.8%). ChiCTR2400086966 The study protocol was approved in the Chinese Clinical Trial Registry at 2024-07-16.

Correlation between pupillary light reflex (PLR) amplitude and visual function in primary angle-closure glaucoma: a retrospective clinical study.

Does trabeculectomy work equally well in different types of glaucoma? A single-center, retrospective, comparative cohort study.

PurposeThis study evaluated the differences in anterior segment bioparameters between the primary angle closure glaucoma eye and the fellow eye in asymmetrical primary angle closure disease and identified the key factors linked to PACG.MethodWe retrospectively analyzed data from Hebei Eye Hospital from September 2023 to October 2024. Anterior segment optical coherence tomography (AS-OCT) was used to assess the bioparameters in a 360-degree swept-source model. Parameters included anterior chamber depth (ACD), anterior chamber width (ACW), anterior chamber volume (ACV), lens vault (LV), angle opening distance at 500 μm and 750 μm from the scleral spur (AOD500 and AOD750), trabecular iris angle at 500 μm and 750 μm (TIA500 and TIA750), trabecular iris space area at 500 μm and 750 μm (TISA500 and TISA750), and iris parameters (iris thickness at 750 μm from the scleral spur(IT750);iris volume(IV); iris curvature(IC); iridotrabecular contact(ITC). These parameters were compared between PACG and fellow eyes.ResultMultivariable logistic regression showed that higher lens vault (OR: 1.224 [1.040–1.407], p = 0.017), narrower TIA750 (odds ratio(OR): 1.130 [1.021–1.238], p = 0.019), smaller AOD750 (OR: 1.985 [1.253–2.716], p = 0.009), and smaller TISA750 (OR: 1.225 [1.041–1.409], p = 0.017) were significant predictors of PACG incidence. The area under the curve (AUC) for LV, AOD750, TIA750, and TISA750 ranged from 0.807 to 0.939, with satisfactory sensitivity and specificity.ConclusionIn general, the PACG eye of unilateral PACG patients exhibited a more crowded anterior segment, with AS-OCT features including higher LV, narrower TIA750, and smaller AOD750 and TISA750.

To evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) compared to compound trabeculectomy for treating primary angle-closure glaucoma (PACG). Retrospective comparative interventional study. We analyzed consecutive cases of uncontrolled PACG treated at Fuzhou Eye Hospital (December 2019-April 2021) with either modified SAPC (study group) or compound trabeculectomy (control group). Postoperative evaluations occurred at 1 week and 1, 3, 6, and 12 months. Outcome measures included mean diurnal intraocular pressure (mdIOP), anti-glaucoma medication burden, surgical success rate (complete: mdIOP ≤18 mmHg without medications; qualified: mdIOP ≤18 mmHg with medications), and complications. The final analysis included 19 eyes in the modified SAPC group and 17 eyes in the control group. At the 12-month follow-up, the SAPC group demonstrated a significant reduction in mdIOP from 20.17±6.00 mmHg to 12.38±2.60 mmHg (P<0.001), with medications reduced from 3.21±1.03 to 0.11±0.32 (P<0.001). Compared to the control group's mdIOP of 16.82±2.36 mmHg with 0.43±0.68 medications at 12 months, the modified SAPC group maintained significantly better pressure control (P<0.001). The complete success rate was substantially higher in the SAPC group (89.47% vs. 52.94%, P=0.038). Transient IOP elevation occurred in 5 eyes (26.3%) following SAPC, representing the most frequent postoperative complication. No significant vision loss or serious adverse events were observed. Modified SAPC provides effective and sustained IOP reduction with a favorable safety profile, outperforming compound trabeculectomy in PACG patients over 12 months. while minimizing medication dependence, demonstrating superior effectiveness to compound trabeculectomy with a favorable short-term safety profile. Why carry out this study? 1. This study aimed to evaluate the effectiveness and safety of a modified suture-assisted penetrating canaloplasty (SAPC) technique compared to compound trabeculectomy in treating primary angle-closure glaucoma (PACG). 2. This study addressed the limitations of high-cost microcatheters and bleb-related complications. What was learned from the study? 1. Modified SAPC demonstrated superior intraocular pressure (IOP) reduction (12.38±2.60 mmHg vs. 16.82±2.36 mmHg at 12 months) and higher complete success rates (89.47% vs. 52.94%) compared to compound trabeculectomy, with fewer complications and reduced dependence on postoperative medications. 2. The technique's cost-effective use of 5-0 polypropylene sutures and adjustable sutures simplified the procedure while maintaining high catheterization success (87.5%), offering a viable alternative for mild-to-moderate PACG. 3. Younger patients with short axial lengths showed an increased risk of malignant glaucoma post-SAPC, highlighting the need for refined surgical approaches in this subgroup.

IntroductionNeuroinflammation is a key pathological response involved in secondary optic nerve injury following retinal ischemia–reperfusion injury. The expression of activating transcription factor 3 (ATF3), a highly conserved protein, is rapidly induced post-injury and is crucial for regulating immunity and inflammation. The potential neuroprotective mechanisms, function, and therapeutic potential of ATF3 following retinal ischemia–reperfusion remain largely unexplored. In this study, we examined the expression and distribution of ATF3 and achieved the overexpression of ATF3 in mouse retina via injection of adeno-associated virus vectors.MethodsRetinal ganglion cell survival was assessed using immunofluorescence staining and terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. Activation status and polarization of microglia and microglia-associated neuroinflammation were also evaluated. In addition, peripheral venous blood samples and aqueous humor were collected from 20 individuals, 10 patients with primary angle-closure glaucoma and 10 controls, to detect changes in ATF3 expression.ResultsATF3 overexpression partially suppressed retinal ganglion cell apoptosis by activating the p-Akt pathway, inhibited microglial activation, reversed microglial M1/M2 polarization, and reduced the release of inflammatory factors by decreasing integrin CD11b expression. ATF3 overexpression improved retinal structure and function by regulating microglial behavior and decreased neuronal death post-retinal ischemia–reperfusion.DiscussionATF3 overexpression may be a potential therapeutic strategy for the management of retinal ischemia–reperfusion-associated neurodegenerative diseases.

PurposeGlaucoma is characterized by progressive retinal ganglion cell loss and irreversible sight damage and is reported to be interacting with immunological dysregulation. Primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) are two of the most frequent subtypes. This study aimed to explore the associations between the immune system and glaucoma by investigating the causal relationships between POAG or PACG and immunocyte phenotypes.MethodsA two-sample Mendelian randomization (MR) approach was carried out to comprehensively analyze the genetic variants associated 731 immunocyte phenotypes and their influence on glaucoma outcomes. Data were obtained from genome-wide association studies and the FinnGen consortium, with rigorous statistical methods applied to ensure the robustness of the study.ResultsSignificant associations were identified between immunocyte phenotypes and glaucoma. Specifically, causal effects of 22 immunocyte phenotypes on POAG were observed, with CD25hi CD45RA− CD4 not regulatory T cell activated cells showing a bidirectional interaction. Additionally, 30 immunocyte phenotypes were found to have causal effects on PACG. Bidirectional interactions were identified with BAFF-R on immunoglobulin (Ig)D+ CD38− naive cells, BAFF-R on IgD+ CD38− unswitched memory cells, and CD62L on CD62L+ myeloid dendritic cells.ConclusionsThe present results highlighted the essential role of immune regulation in the pathogenesis of glaucoma. These findings powerfully indicate the significance of exploring the therapeutic potentials of targeting different immune cells and immune responses to regulate both POAG and PACG.Translational RelevanceThe present study highlighted immune–glaucoma interactions mediated by T-cell and monocyte phenotypes in primary open-angle glaucoma and primary angle-closure glaucoma development.

Timely and accurate diagnosis of primary glaucoma, along with reliable subtype and severity stratification, remains a major clinical challenge. Here, we develop a serum-based metabolomic fingerprint strategy that leverages flower-like hierarchical metal oxide heterojunctions as the matrix for laser desorption/ionization mass spectrometry, combined with a neural network algorithm. A total of 591 serum samples from two independent hospital cohorts were analyzed. In the internal test set, the model achieved exceptionally high diagnostic performance, with accuracy, F1 score, precision, and recall all reaching 1.000. External validation further confirmed its robustness, with an area under the curve (AUC) value of 1.000 and classification accuracy, F1 score, and recall each at 0.990. Subtype classification for primary angle-closure glaucoma (PACG) achieved an accuracy of 97.6%. Severity assessment of severe glaucoma showed strong performance, with an AUC of 0.990 and accuracy of 0.831. These results support the applicability of the proposed approach for precise glaucoma diagnosis and longitudinal monitoring across multicenter clinical cohorts.

BackgroundGlaucoma is the leading cause of irreversible blindness worldwide, with a significant disease burden in China. Accurate prevalence estimates are crucial for guiding public health strategies, but large-scale epidemiological investigations remain challenging due to the need for comprehensive ophthalmic assessments. Through a systematic review and modelling approach, we aimed to estimate the national, regional, and provincial prevalence of glaucoma in China in 2020.MethodsWe performed an updated systematic literature search of the China National Knowledge Infrastructure, Wanfang, the China Science and Technology Journal Database, PubMed, Embase, and MEDLINE for articles published from 19 August 2017 to 12 July 2024 that reported the prevalence of glaucoma in the general Chinese population. We also included articles from the 2017 China Glaucoma Study whose data collection period started in 2000 or later. We included articles that used optic disc examination and/or visual field assessment for diagnosis, and excluded those defining glaucoma solely by intraocular pressure measurement. We conducted age-sex splitting to enhance data availability for estimating the prevalence of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). We applied a multi-level mixed-effects meta-regression to estimate the prevalence of POAG and PACG at national and regional levels, adjusting for age, sex and study year, while we used an associated factor-based model to derive provincial prevalence estimates. We estimated the prevalence of secondary glaucoma and congenital glaucoma through random-effects meta-analyses.ResultsWe included 43 articles comprising 286 577 participants. We estimated that the national prevalence of POAG among those aged 20–99 years in 2020 was 0.73% (95% confidence interval (CI) = 0.51, 1.03), equivalent to 7.88 million (95% CI = 5.58, 11.13) affected individuals in the mainland of China. We estimated PACG to be 0.81% (95% CI = 0.60, 1.10), equivalent to 8.79 million (95% CI = 6.50, 11.88) affected population. The prevalence of POAG and PACG both increased with age. The POAG prevalence was higher in males than in females across 20–99 years, while the PACG prevalence was higher in females. The POAG and PACG prevalence varied by region and province; the former was the highest in northeast China (0.77%, 95% CI = 0.55, 1.09) and the lowest in west China (0.71%, 95% CI = 0.50, 1.00), whereas the latter was the highest in central China (0.87%, 95% CI = 0.64, 1.17) and the lowest in east China (0.76%, 95% CI = 0.56, 1.02). Among 31 provinces or municipalities, Shanghai had the highest POAG prevalence (0.80%, 95% CI = 0.56, 1.12) and Tibet showed the lowest (0.56%, 95% CI = 0.40, 0.80). Regarding PACG, Sichuan had the highest prevalence (0.92%, 95% CI = 0.68, 1.25), whereas Beijing exhibited the lowest (0.56%, 95% CI = 0.42, 0.76). The pooled prevalence of secondary glaucoma and congenital glaucoma was 0.22% (95% CI = 0.16, 0.29) and 0.03% (95% CI = 0.00, 0.10), respectively.ConclusionsThe prevalence of glaucoma in China varied significantly across regions and provinces in our study period, highlighting the need for targeted screening programmes, early detection, and resource allocation. The modelling approach used here provides a valuable framework for estimating glaucoma prevalence in settings with limited large-scale epidemiological data.RegistrationPROSPERO: CRD420251005269.

BackgroundThis study aimed to evaluate the incidence and risk factors for early transient intraocular pressure (IOP) elevation after penetrating canaloplasty (PCP) in patients with primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG) and secondary glaucoma (SG).MethodsThis retrospective study included 198 eyes of 198 patients with glaucoma. Participants were classified as normal IOP, early transient high IOP (E-HIOP [Tst]), early persistent IOP elevation, late transient high IOP, and late persistent IOP elevation, based on the period and persistence of postoperative IOP elevation.ResultsE-HIOP (Tst) developed in 34.8%, 33.3%, and 40.9% of eyes with POAG, PACG, and SG, respectively. In comparison with normal IOP group, we observed the following variations in E-HIOP (Tst) cohorts: 8 − 10 years younger in patients with POAG and PACG; higher prevalence of hyphema (45.5% vs. 20.5%) in POAG; higher baseline IOP in PACG and SG (7 − 8 mmHg); higher preoperative IOP maximum (IOPpre−max) in SG (all p < 0.05). Higher IOPpre−max was a risk factor for E-HIOP (Tst) in PACG and SG (p < 0.05).ConclusionsNearly 30 − 40% of eyes developed E-HIOP (Tst) after PCP. E-HIOP (Tst) tended to develop in younger participants and those with higher preoperative IOP. A higher IOPpre−max was a risk factor for E-HIOP (Tst) in PACG and SG.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12886-025-04399-9.

To investigate responses to surgical interventions in concentrations of transforming growth factor-β2 (TGF-β2) and total protein (TP) in the aqueous humor (AH) of primary angle-closure glaucoma (PACG) eyes, with and without Ahmed glaucoma valve surgery in dogs. Nineteen eyes diagnosed with PACG from client-owned dogs and nine non-glaucomatous eyes from both client-owned dogs and research Beagles. AH samples were collected and analyzed for TP and TGF-β2 via bicinchoninic acid assay and an enzyme-linked immunosorbent assay. The samples included AH from pre-surgical eyes that had aqueous paracentesis for intraocular pressure (IOP) management (pre-surgical group; n = 6) and from post-surgical eyes when tissue plasminogen activator was injected (post-surgery group; n = 7); fluid aspirated from blebs during surgical revision (bleb group; n = 6), and normal control AH samples from both client-owned dogs undergoing ocular surgery for non-glaucomatous conditions and research Beagles (control group; n = 9). TP and TGF-β2 concentrations were significantly higher in all PACG groups compared to normal AH (p < 0.01). Bleb fluid exhibited the highest TP and TGF-β2 concentrations among glaucomatous groups. Post-surgical AH had significantly lower TGF-β2 concentrations than both pre-surgical and bleb fluid (p = 0.0168, p = 0.0023, respectively). No significant correlation was found between IOP and either TP or TGF-β2 in any group (p > 0.05). Elevated TGF-β2 in PACG could contribute to disease progression and post-surgical fibrosis. These findings support future studies to examine the potential of TGF-β2 modulation as a therapeutic approach to improving long-term surgical outcomes following Ahmed glaucoma valve surgery in canine PACG.

PurposeTo explore the clinical efficacy of goniotomy assisted by the LAN microhook goniotomy knife (LAN microhook), combined with phacoemulsification, in managing mid-to-late-stage primary angle-closure glaucoma (PACG) with cataract in a prospective observational context.MethodsA total of 33 patients (53 eyes) diagnosed with mid-to-late-stage PACG and cataract were recruited between February 2024 and November 2024. Preoperative and six-month postoperative data were collected, including intraocular pressure (IOP), antiglaucoma medication use, anterior chamber depth (ACD), peripapillary retinal nerve fiber layer (RNFL) thickness, best-corrected visual acuity (BCVA, logMAR), and surgical complications.ResultsAt baseline, IOP was 18.26 ± 4.52 mmHg and declined to 14.11 ± 2.87 mmHg at Month 6. The mean number of antiglaucoma medications were 1.91 ± 0.81 preoperatively, and all patients discontinued medications by Month 6. ACD increased from 2.36 ± 0.39 mm preoperatively to 3.68 ± 0.75 mm at Month 6.ConclusionsGoniotomy using the LAN microhook combined with phacoemulsification appears to effectively deepen the anterior chamber, lower IOP, improve visual acuity, and eliminate the need for antiglaucoma medication in patients with mid-to-late-stage PACG and cataract.

Diagnostic accuracy of next generation sequencing--based genetic research for primary glaucoma: A systematic review and meta-analysis.

This study developed and validated a machine learning-based risk prediction model to estimate the likelihood of postoperative hyperopic shift in patients with primary angle-closure glaucoma after IOL implantation, which may help guide individualized surgical decision-making. This study aims to construct a predictive model for the risk of hyperopic shift (HS) after phacoemulsification combined with intraocular lens (PE+IOL) surgery in patients with primary angle-closure glaucoma (PACG), with the goal of providing scientific evidence for personalized treatment and early warning. This is a retrospective cohort study that included PACG patients who underwent PE+IOL surgery between June 2019 and June 2024, according to predefined inclusion and exclusion criteria. We collected patients' demographic information, preoperative ocular examination data, and refractive changes 3 to 6 months post-surgery. The Boruta algorithm was used for feature selection of all clinical variables, and various machine learning models, including logistic regression (LR), random forest, support vector machine (SVM), k-nearest neighbors (KNN), and XGBoost, were developed. Model performance was assessed using receiver operating characteristic (ROC) curves and the area under the curve (AUC). The best-performing model was selected for visualization and interpretability analysis. Data processing and analysis were performed using R version 4.2.3. All statistical tests were two-sided, with a P-value <0.05 considered statistically significant. A total of 423 eyes were included, with n=267 in the Non-HS group and n=156 in the HS group. Key predictive variables identified by the Boruta algorithm included target refraction, preoperative best-corrected visual acuity (BCVA), axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), white-to-white distance (W2W), and pupil diameter (P). Both the SVM and LR models exhibited the best predictive accuracy, with AUCs of 0.704 and 0.696, respectively, demonstrating moderate classification ability. This study successfully developed a risk prediction model for HS after PE+IOL surgery in PACG patients based on various clinical features. The SVM and LR models show promising clinical application in predicting HS risk and can provide personalized postoperative management strategies for glaucoma surgery patients.

Objectives: Acute angle-closure glaucoma (AACG), a subset of primary angle-closure glaucoma (PACG), is marked by a sudden increase in intraocular pressure (IOP). AACG is considered an ocular emergency due to its rapid onset and distinct anatomical pathology, requiring immediate treatment. Timely diagnosis, prompt intervention, and appropriate referral are crucial for improving patient outcomes and reducing morbidity. Following AACG attacks, a reduction in corneal endothelial cell density has been documented, as elevated IOP can damage the corneal endothelium like mechanical trauma. Corneal endothelium undergoes morphological alteration following an episode of AACG. The study aims to evaluate corneal endothelial cell density using specular microscopy in patients reporting with AACG. Material and Methods: A prospective consecutive observational study was conducted on 16 eyes of patients with PACG that had experienced a symptomatic acute attack in one eye, and compared with their fellow eyes, which were diagnosed as primary angle-closure suspects. Subjects having other intraocular pathology, corneal disease, contact lens user, history of ocular surgery or trauma, or those having congenital abnormalities were excluded. The Goldmann Applanation tonometer was used to measure IOP. Endothelial images were obtained by indirect specular microscopy (TOPCON -3000P) and were then analyzed. Results: The average increase in IOP in eyes experiencing an acute attack of PACG (cases) was 49.69 mmHg, whereas the fellow eyes without a history of such attacks (control) had an average increase in IOP of 16.13 mmHg. The mean endothelial cell count in cases was 1964 cells/mm2, while in the control group it was 2359 cells/mm2. This represented a 17% depletion in mean endothelial cell density compared to the fellow eye. No significant correlation was observed between the duration of the attack and the decrease in corneal endothelial cell density. Conclusion: A significant reduction in corneal endothelial cell density was observed in eyes following an acute attack of PACG.

To explore the treatment outcomes and related differences among different types of glaucoma. The research selected 45 primary open-angle glaucoma patients (Group A), 45 primary angle-closure glaucoma patients (Group B), and 46 secondary glaucoma patients (Group C) as subjects, and all these patients underwent trabeculectomy. Treatment effectiveness was evaluated based on five aspects: the degree of intraocular pressure (IOP) reduction, the rate of visual field loss progression, changes in optic nerve fiber layer thickness, the incidence of postoperative complications, and patient quality of life scores. Data were processed using statistical methods such as one-way ANOVA. Overall comparisons of IOP reduction, visual field loss progression rate, optic nerve fiber layer thickness changes, and postoperative complication incidence among the three groups showed P values all less than 0.001, which indicates significant statistical differences. Two-tailed comparisons within the groups revealed that Group B had a significantly higher degree of IOP reduction than Groups A and C, while Group C had a higher degree than Group A. Additionally, Group B showed a significantly faster rate of visual field loss progression and thinner optic nerve fiber layers compared to Groups A and C, with Group C having a faster progression rate than Group A. Group B also had a significantly higher incidence of postoperative complications than Groups A and C. Group C had a higher incidence than Group A. In terms of quality of life scores, comparisons of total NEI-VFQ scores, as well as scores in the visual function, psychological state, and social activity participation dimensions, among the three groups showed P values all less than 0.001; Group B had the lowest scores, and Group A had the highest. There are significant differences in treatment outcomes and quality of life among different types of glaucoma, with primary angle-closure glaucoma being more severe and having a poorer prognosis. Clinically, personalized treatment plans should be developed based on the characteristics of different types of glaucoma.

Differentiating primary open-angle, exfoliative, and primary angle-closure glaucoma in moderate-stage cases using blood-based inflammatory indices and structural metrics.

ABSTRACTA shallow anterior chamber (AC) after glaucoma filtration surgery is a common early postoperative complication that can be vision‐threatening. So, early recognition of the causative factors and prompt management are necessary to avoid such devastating complications after surgery. This case report presents a 33‐year‐old patient with primary angle closure glaucoma who initially presented with an acute angle closure crisis in both eyes. Despite having maximum tolerated anti‐glaucoma medications, his target IOP was not achieved, and he later underwent augmented trabeculectomy with mitomycin C in his right eye. However, frequent swallowing of the AC was noticed in the early postoperative days. Revision surgeries with AC reformation were done after initially dealing with the unrecognized patient factor and maintaining good vision with well‐controlled intraocular pressure and a well‐formed AC. After incisional glaucoma surgeries, it is essential to warn patients about external factors contributing to postoperative complications, like shallow AC.

This study aimed to evaluate the characteristics of laser peripheral iridotomy (LPI), including area size, location, and distance from the pupil center, using ImageJ software, and to explore their correlation with changes in anterior segment parameters observed through Pentacam imaging. This retrospective study analyzed 29 eyes of 29 patients with angle-closure who underwent LPI between April 2023 and December 2024. Patients diagnosed with primary angle-closure glaucoma, primary angle closure, and high-risk primary angle-closure suspects were included. Anterior segment parameters were assessed pre- and post-LPI using Pentacam imaging. ImageJ software was used to analyze anterior segment photographs to assess LPI characteristics, including the area size, location, and distance from the center of the pupil. Following LPI, significant increases were observed in superior (0.93 to 1.00mm), inferior (1.12 ± 0.20 to 1.26 ± 0.19mm), temporal (1.23 ± 0.20 to 1.36 ± 0.17mm), and nasal (1.0 to 1.06mm) peripheral anterior chamber depths (ACD), anterior chamber volume (ACV) (74.1 ± 13.5 to 84.6 ± 10.8 mm3), and anterior chamber angle (20.4 ± 4.1º to 23.4 ± 4.4º) (p < 0.05, for all), while central ACD (1.92 ± 0.21 to 1.91 ± 0.20mm) remained unchanged (p = 0.432). The mean intraocular pressure decreased significantly from 18.6 ± 4.2 mmHg to 16.6 ± 3.3 mmHg (p < 0.001). Negative correlations were found between increases in superior and temporal peripheral ACDs and the pupil-to-LPI area ratio (p < 0.05 for all). Additionally, ACV improvement was negatively correlated with the LPI distance (β=-0.531, p = 0.013). The characteristics of the LPI, specifically the pupil-to-LPI area ratio and the LPI distance from the pupil, may significantly influence changes in anterior segment parameters. A small LPI area relative to the pupil area and excessively peripheral LPI locations may be associated with reduced treatment efficacy. These findings may highlight the importance of considering both pupil size and the precise positioning of the LPI to optimize therapeutic outcomes.

Minimally invasive glaucoma surgeries (MIGS) targeting the trabecular meshwork are emerging as a new modality in the management of primary angle closure glaucoma (PACG). Aqueous angiography (AA) allows in vivo, real-time assessment of conventional aqueous humor outflow (AHO) using tracer dyes. Herein, we discuss a novel case of AA demonstrating changes seen in AHO post-trabecular MIGS in a PACG patient. This case provides evidence that supports the hypothesis of using trabecular MIGS in treating PACG patients and encourages further research to innovate and study the efficacy of trabecular MIGS in the management of primary angle closure disease.