Primary Angle Closure Suspects Research Articles

Cost-utility analysis of prophylactic laser peripheral iridotomy for primary angle closure suspects

PurposeTo assess the cost-utility of prophylactic laser peripheral iridotomy (LPI) for primary angle closure (PAC) suspects (PACS). DesignEconomic evaluation. MethodsOur Markov model randomized PACS eyes to LPI or observation for 40 one-year cycles (100,000 iterations per strategy). Each cycle, an eye remained in its current health state, advanced linearly through PAC, mild, moderate, severe, and end-stage PAC glaucoma (PACG), or died. Transition rates were derived from the literature including the Zhongshan Angle Closure Prevention (ZAP) trial and the Singapore Asymptomatic Narrow Angles Laser Iridotomy Study (ANA-LIS). Eyes with acute-angle closure advanced to either PAC or directly to various PACG severities. A tracker monitored accumulated perimetric decibel reduction to progress PACG through increasing severities, with an annual probability of either stable or severity-dependent perimetry loss. We set a willingness to pay of an incremental cost-effectiveness ratio (ICER) <$50,000/quality-adjusted life years. ResultsAt age 50, LPI was cost-saving using ZAP data and cost-effective using ANA-LIS data. The ZAP iterations became cost-effective from the societal perspective when the model started at age 55 and third-party perspective at age 70. LPI was no longer cost-effective from the societal perspective using ANA-LIS data at age 80 or from the societal perspective using ZAP data or third-party perspective with ANA-LIS data at age 85. Probabilistic sensitivity analyses favored LPI until starting age 85. ConclusionsProphylactic LPI for PACS is cost-effective across a spectrum of ages and should be considered from a public health perspective.

Characteristics of beta parapapillary atrophy in primary angle-closure suspect

ObjectiveTo investigate the characteristics of beta parapapillary atrophy (β-PPA) in patients with primary angle-closure suspect (PACS).Methods and analysisIn total, 215 and 259 eyes with PACS and non-PACS (NPACS), respectively, were...

Comparison of Nd: YAG Laser Iridotomy Alone Versus Sequential Argon-Nd: YAG Laser Iridotomy in Patients with Primary Angle Closure Spectrum

Purpose: To compare the mean Nd: YAG energy used and mean decrease in IOP 3-hours post-laser, in Nd: YAG Laser iridotomyalone versus sequential Argon-Nd:YAGiridotomy in patients with primary angle closure spectrum. Study Design: Quasi experimental Study. Place and Duration of Study: Department of Ophthalmology, Allied Hospital, Faisalabad from March 2022 to August 2022. Methods: After taking approval from Ethical review board, 70 patients with angle closure spectrumwere included in the study. Out of 70, 25 patients were primary angle closure suspect (PACS), 28 had primary angle closure (PAC) and 17 patients had primary angle closure glaucoma (PACG). We sorted patients into Group A (those who underwent sequential Argon-Nd: YAG Laser peripheral iridotomy) and Group B (those who underwent Nd: YAG laser alone). Mean Nd: YAG energy used was noted in each group and compared using SPSS version 25.0. Mean decrease in IOP 3-hours post-laser was also noted and compared. Results: Mean decrease in IOP 3 hours post-laser was 5.46 ± 3.70 mmHg for sequential Argon-Nd: YAG LPI versus 3.46 ± 2.38 mmHg for Nd: YAG LPI alone (p-value = 0.009). Mean Nd: YAG energy used in sequential Argon-Nd: YAG LPI group was significantly lesser when compared to Nd: YAG LPI alone group (32.70 ± 38.87 versus 139.37 ± 62.32 mJ) which was found to be statistically significant (p = 0.0001). Conclusion: Sequential Argon-Nd-YAG laser iridotomy uses significantly less Nd:YAG energy than conventional Nd:YAG only method with better IOP control.

Direct observation and measurement of circumlental space and its relation to anterior chamber angle characteristics in iridotomized phakic eyes with primary angle closure disease

Primary angle closure disease (PACD) is a major cause of blindness worldwide. It has a high prevalence in East Asia, especially in China, which leads to a higher incidence of blindness than open-angle glaucoma. The aim of this study was to directly observe the circumlental space (CLS) in laser peripheral iridotomized eyes with PACD and to determine whether this structure plays a role in the pathogenesis of PACD. Fifty eyes of 50 patients with PACD, who had received laser peripheral iridotomy performed with neodymium:yttrium–aluminum-garnet were recruited from glaucoma clinics from March 2021 to May 2022, including 17 primary angle closure suspect (PACS), 16 primary angle closure (PAC) and 17 primary angle closure glaucoma (PACG). They were classified into two groups based on whether the ciliary process and the crystalline lens equator were in contact using slit-lamp photograph: the attached group and the unattached group. The demographic, clinical characteristics and anterior segment parameters measured from ultrasound biomicroscopy were compared between the attached group and the unattached group. Thirty-three eyes were assigned to the attached group and 17 eyes belonged to the unattached group. In the unattached group, the mean CLS was 0.10 ± 0.07 mm. No significant differences were identified between the different diagnosis groups in age, sex, best-corrected visual acuity, intraocular pressure, white-to-white, axial length, central corneal thickness, anterior chamber depth, flat keratometry, steep keratometry or iridotomy diameter (p > 0.05). The unattached group had shorter trabecular-ciliary process distance (p = 0.021) and larger ciliary process area (p = 0.001) compared with the attached group. Small CLS and its potential effect (partial ciliary block) might be considered as one of the mechanisms of PACD.

Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect

Identifying primary angle closure suspect (PACS) eyes at risk of angle closure is crucial for its management. However, the risk of progression and its prediction are still understudied in long-term longitudinal studies about PACS. To explore baseline predictors and develop prediction models for the 14-year risk of progression from PACS to primary angle closure (PAC). This cohort study involved participants from the Zhongshan Angle Closure Prevention trial who had untreated eyes with PACS. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under both light and dark conditions. Primary angle closure was defined as peripheral anterior synechiae in 1 or more clock hours, intraocular pressure (IOP) greater than 24 mm Hg, or acute angle closure. Based on baseline covariates, logistic regression models were built to predict the risk of progression from PACS to PAC during 14 years of follow-up. The analysis included 377 eyes from 377 patients (mean [SD] patient age at baseline, 58.28 [4.71] years; 317 females [84%]). By the 14-year follow-up visit, 93 eyes (25%) had progressed from PACS to PAC. In multivariable models, higher IOP (odds ratio [OR], 1.14 [95% CI, 1.04-1.25] per 1-mm Hg increase), shallower central anterior chamber depth (ACD; OR, 0.81 [95% CI, 0.67-0.97] per 0.1-mm increase), and shallower limbal ACD (OR, 0.96 [95% CI, 0.93-0.99] per 0.01 increase in peripheral corneal thickness) at baseline were associated with an increased 14-year risk of progression from PACS to PAC. As for AS-OCT measurements, smaller light-room trabecular-iris space area (TISA) at 500 μm from the scleral spur (OR, 0.86 [95% CI, 0.77-0.96] per 0.01-mm2 increase), smaller light-room angle recess area (ARA) at 750 μm from the scleral spur (OR, 0.93 [95% CI, 0.88-0.98] per 0.01-mm2 increase), and smaller dark-room TISA at 500 μm (OR, 0.89 [95% CI, 0.80-0.98] per 0.01-mm2 increase) at baseline were identified as predictors for the 14-year risk of progression. The prediction models based on IOP and central and limbal ACDs showed moderate performance (area under the receiver operating characteristic curve, 0.69; 95% CI, 0.63-0.75) in predicting progression from PACS to PAC, and inclusion of AS-OCT metrics did not improve the model's performance. This cohort study suggests that higher IOP, shallower central and limbal ACDs, and smaller TISA at 500 μm and light-room ARA at 750 μm may serve as baseline predictors for progression to PAC in PACS eyes. Evaluating these factors can aid in customizing PACS management.

Longitudinal Management of Primary Angle Closure Suspect

Longitudinal Management of Primary Angle Closure Suspect

Cost-effectiveness analysis of prophylactic laser peripheral iridotomy for primary angle-closure suspect in Japan

Background/ObjectivesThis study aimed to compare the cost-effectiveness of prophylactic laser peripheral iridotomy (LPI) with that of observation for primary angle-closure suspect (PACS) in Japan.Subjects/MethodsA Markov model was developed to compare the costs and utilities of prophylactic LPI with those of observation of 40-year-old patients with PACS. In the model with a yearly cycle over a 20-year time horizon, the disease was postulated to irreversibly progress from PACS to primary angle closure, followed by primary angle-closure glaucoma, unilateral blindness, and bilateral blindness. The parameters were estimated mainly based on a recent randomised controlled trial and analyses of Japanese claims data. The incremental cost-effectiveness ratio was estimated from the healthcare payer’s perspective and evaluated at the willingness-to-pay 5 million Japanese Yen per quality-adjusted life-year. The observation period and the age at entry into the cohort was changed to account for a variety of clinical courses in sensitivity analyses. We conducted one-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte Carlo simulations with 10 000 iterations.ResultsThe incremental cost-effectiveness ratio of LPI was 2,287,662 Japanese Yen (14,298 pounds sterling) per quality-adjusted life-year, which was below the willingness-to-pay threshold. The ratios were approximately 4 and 8 million in the 15-year and 10-year time horizons, respectively. Increasing the age at entry had little influence on the incremental cost-effectiveness ratio. The deterministic and probabilistic sensitivity analyses indicated that the results were robust.ConclusionsOur results indicate that prophylactic LPI for middle-aged patients with PACS is cost-effective in Japan.

Treatment Preferences and Factors Influencing the Management of Primary Angle-Closure Suspect in China: A National Survey Study.

This study explored the current views of ophthalmologists in China on the preferred strategy and the primary influencing factors in managing primary angle-closure suspect (PACS). An online survey was distributed via WeChat to ophthalmologists working in hospitals at all levels throughout China to investigate the optimal management strategy and factors influencing the strategy for treating PACS from February to March 2023. Management strategies examined included regular observation (RO), laser peripheral iridectomy (LPI), and phacoemulsification with intraocular lens implantation (PEI). The study explored the factors that influenced clinical decision-making processes and collected demographic information from the respondents for analysis. A total of 1009 ophthalmologists responded; 442 responders considered RO as a reasonable option for patients with PACS, while the majority opted for more positive treatments, with 460 choosing LPI and 107 selecting PEI. Further grouping analysis revealed significant differences between tertiary and lower-level hospitals (P < 0.01) and between public and private hospitals (P < 0.05). Significant differences were found among resident, attending, and senior doctors and between northern and southern hospitals. The top three considerations for ophthalmologists who selected RO were ultrasound biomicroscopy (UBM) without pupillary block, absence of a family history of glaucoma, and good compliance with regular follow-up. For LPI, the factors were UBM indicating pupillary block, glaucoma symptoms, and poor compliance with regular follow-up. For PEI the factors were age, family history of glaucoma, and poor compliance with regular follow-up. The majority of ophthalmologists prefer aggressive treatments such as LPI or PEI over RO when dealing with patients with PACS. Disparity existed among ophthalmologists based on their level of experience, hospital ownership and level, and geographical location. The survey underscores the complexity and multifactorial nature of PACS management and highlights the need for further research and standardization of treatment protocols to ensure optimal patient outcomes.

Outcomes of newly referred patients with suspected angle closure: do we need to redefine the clinical pathways?

To investigate outcomes of referrals for suspected angle closure and explore whether anterior segment optical coherence tomography (AS-OCT) can be used to tighten triaging criteria in a glaucoma virtual clinic. Retrospectively collected data. The first audit (04/2018-03/2019) identified referrals for suspected angle closure without other glaucoma-related findings (primary angle closure suspect (PACS) referrals). All patients underwent gonioscopy. The second audit (04-08/2019) identified patients with suspected angle closure in a virtual clinic. Management outcomes were assessed, using gonioscopy as reference standard. The outcomes of the second audit were re-audited after changing the triaging criterion from angle width <10° to iridotrabecular contact (ITC) in ≥1 quadrants on AS-OCT. Out of 1754 glaucoma referrals (first audit), 24.6% (431/1754) were PACS referrals. Of these, only 10.7% (42/393) had an occludable angle on gonioscopy, with 97.6% (41/42) being PACS. Of these, 78% (32/41) underwent laser peripheral iridotomy. Out of 137 referrals in the virtual clinic (second audit), 66.4% (91/137) were triaged to the face-to-face clinic. Of these, 31.9% (29/91) were discharged. AS-OCT had positive and negative predictive value of 74.3% (95% confidence intervals (CI) 57.8-86.0) and 82.1% (95% CI 70.0-90.2%), respectively, in detecting ITC in ≥1 quadrants. In the re-audit 45.9% (45/98) of those with suspected angle closure were triaged for gonioscopy, with 24.4% (11/45) of them being discharged. PACS referrals represent a substantial burden to hospital-based services and their accuracy is low. ITC in ≥1 quadrants on AS-OCT can be useful in triaging those who need further evaluation with gonioscopy.

Classification of Angle Closure Severity by Hierarchical Cluster Analysis of Ocular Biometrics in the Dark and Light.

The purpose of this study was to investigate the classification of angle closure eyes based on hierarchical cluster analysis of ocular biometrics measured in the dark and light using anterior segment optical coherence tomography (AS-OCT). Participants of the Chinese American Eye Study received complete eye examinations to identify primary angle closure suspects (PACS) and primary angle closure without/with glaucoma (PAC/G). AS-OCT was performed in the dark and light. Biometric parameters describing the angle, iris, lens, and anterior chamber were analyzed. Hierarchical clustering was performed using Ward's method. Post hoc logistic regression models were developed to identify biometric predictors of angle closure staging. Analysis of 159 eyes with PACS (N = 120) or PAC/G (N = 39) produced 2 clusters in the dark and light. In both analyses, cluster 1 (N = 132 in the dark and N = 126 in the light) was characterized by smaller angle opening distance (AOD)750 and trabecular iris space area (TISA)750, greater iris curvature (IC), and greater lens vault (LV; P < 0.001) than cluster 2. The proportion of PAC/PACG to PACS eyes was significantly higher in cluster 1 than 2 in the light (36:90 and 3:30, respectively; P = 0.02), but not the dark (36:96 and 3:24, respectively; P = 0.08). On multivariable regression analyses, smaller TISA750 (odds ratio [OR] = 0.84 per 0.01mm2) and AOD750 (OR = 0.93 per 0.01mm) in the light and smaller TISA750 (OR = 0.86 per 0.01mm2) in the dark conferred higher risk of PAC/G (P ≤ 0.02). Unsupervised cluster analysis of ocular biometrics can classify angle closure eyes by severity. Static biometrics measured in the light and dark are both predictive of PAC/G. Clustering of biometrics measured in the light could provide an alternative source of information to risk-stratify angle closure eyes for more severe disease.

Role of Static and Dynamic Ocular Biometrics Measured in the Dark and Light as Risk Factors for Angle Closure Progression

To assess the role of static and dynamic ocular biometric parameters measured in the dark and light for predicting progression of primary angle closure suspect (PACS) to primary angle closure (PAC). Retrospective cohort study using prospective randomized controlled trial data from untreated, control eyes. Zhongshan Angle Closure Prevention Trial subjects underwent anterior segment optical coherence tomography (AS-OCT) imaging in the dark and light. Static biometric parameters were measured, consisting of angle, iris, lens, and anterior chamber parameters. Dynamic change parameters were calculated by subtracting light measurements from dark measurements. Cox proportional hazards regression models were developed to assess risk factors for PACD progression. A total of 861 eyes of 861 participants were analyzed (36 progressors). On univariable analysis, TISA500 measurements in the light and dark were associated with progression (P < .001), whereas dynamic change parameters were not (P ≥ .08). In the primary multivariable model, older age (hazard ratio [HR]=1.09 per year), higher intraocular pressure (IOP) (HR=1.13 per mm Hg), and smaller TISA500 in the light (HR=1.28 per 0.01 mm2) were significantly associated with greater risk of progression (P ≤ .04). Dark TISA500 had similar significance (HR=1.28, P=.002) when replacing light TISA500. Risk of progression was more predictive among eyes in the lowest quartile of light TISA500 measurements (HR=4.56, P < .001) compared to dark measurements (HR=2.89, P=.003). Static parameters measured in the light are as predictive, and possibly more so, of angle closure progression as those measured in the dark. Ocular biometrics measured under light and dark conditions may provide additional information for risk-stratifying patients for angle closure progression.

Comparative study of the effects of laser peripheral iridotomy and cataract surgery on anterior chamber angle parameters in primary angle closure suspect patients

IntroductionProphylactic laser peripheral iridotomy (LPI) and cataract surgery are considered the primary treatments for primary angle closure suspect (PACS) as they have proven effectiveness in widening the iridocorneal angle and...

Changes in Anterior Segment Parameters After Laser Peripheral Iridotomy in Caucasian Eyes With Different Primary Angle Closure Mechanisms.

Subgrouping of angle closure mechanisms based on the swept-source optical coherence tomography images may help to identify the predominant underlying anatomic mechanism, evaluate personal treatment, and improve the better outcomes. The purpose of this study was to evaluate changes in anterior segment parameters in Caucasian eyes with different angle closure mechanisms before and after laser peripheral iridotomy (LPI). Sixty-six subjects underwent swept-source optical coherence tomography (CASIA, Tomey Corporation) angle imaging in the dark before and 7 days after LPI. On the basis of the baseline swept-source optical coherence tomography images, the eyes were categorized into 4 angle closure mechanisms, namely pupillary block (PB), plateau iris configuration (PIC), thick peripheral iris (TPI), and large lens vault (LLV). Sixteen out of 128 cross-sectional images (11.25 degrees apart) per volume scan were selected for analysis. We used a generalized estimating equation to compare quantitative parameters among angle closure mechanisms and between before and after LPI after adjusting the intereye correlation. The mean age of subjects was 67.7±9.2 years, with the majority being female (82.2%). One hundred twenty-nine eyes (67 primary angle closure suspects, 34 primary angle closure, and 28 primary angle closure glaucoma) were categorized into PB (n=71, 55%), PIC (n=40, 31%), TPI (n=14, 10.9%), and LLV (n=4, 3.1%). Anterior chamber depth was the shallowest in the LLV, followed by TPI, PB, and PIC group at baseline. Widening of the angle and reduction of the iris curvature (IC) due to LPI were observed in all groups (all P <0.01). When compared to the PB group, the LPI-induced angle widening in the TPI group was significantly less even though the iris curvature reduction in the TPI group was greater (all P <0.05). In patients with angle closure, anterior segment morphology and LPI-induced angle widening were different among the various angle closure mechanisms.

Deep Learning Classification of Angle Closure based on Anterior Segment OCT

To assess the performance and generalizability of a convolutional neural network (CNN) model for objective and high-throughput identification of primary angle-closure disease (PACD) as well as PACD stage differentiation on anterior segment swept-source OCT (AS-OCT). Cross-sectional. Patients from 3 different eye centers across China and Singapore were recruited for this study. Eight hundred forty-one eyes from the 2 Chinese centers were divided into 170 control eyes, 488 PACS, and 183 PAC+ PACG eyes. An additional 300 eyes were recruited from Singapore National Eye Center as a testing data set, divided into 100 control eyes, 100 PACS, and 100 PAC+ PACG eyes. Each participant underwent standardized ophthalmic examination and was classified by the presiding physician as either control, primary angle-closure suspect (PACS), primary angle closure (PAC), or primary angle-closure glaucoma (PACG). Deep Learning model was used to train 3 different CNN classifiers: classifier 1 aimed to separate control versus PACS versus PAC+ PACG; classifier 2 aimed to separate control versus PACD; and classifier 3 aimed to separate PACS versus PAC+ PACG. All classifiers were evaluated on independent validation sets from the same region, China and further tested using data from a different country, Singapore. Area under receiver operator characteristic curve (AUC), precision, and recall. Classifier 1 achieved an AUC of 0.96 on validation set from the same region, but dropped to an AUC of 0.84 on test set from a different country. Classifier 2 achieved the most generalizable performance with an AUCof 0.96 on validation set and AUC of 0.95 on test set. Classifier 3 showed the poorest performance, with an AUC of 0.83 and 0.64 on test and validation data sets, respectively. Convolutional neural network classifiers can effectively distinguish PACD from controls on AS-OCT with good generalizability across different patient cohorts. However, their performance is moderate when trying to distinguish PACS versus PAC+ PACG. The authors have no proprietary or commercial interest in any materials discussed in this article.

Short-term changes detected by corneal topography and optical coherence tomography after prophylactic laser iridotomy in primary angle closure suspect.

To evaluate early changes in anterior segment parameters by Scheimpflug-Placido disc topography system and changes in retinal layers by optical coherence tomography in primary angle-closure suspects after laser peripheral iridotomy. One eye of 26 patients with primary angle closure suspect and of 20 healthy subjects were included in this retrospective cross-sectional study. Anterior chamber depth/volume, iridocorneal angle and central corneal thickness were obtained by Scheimpflug-Placido disc topography system. Retinal thickness, retinal nerve fiber layer thickness and ganglion cell-inner plexiform layer thickness were acquired by optical coherence tomography. All the tests were repeated 1week and 1month after laser peripheral iridotomy. The mean ages of the patients and healthy controls were 64.8 ± 10.7years and 64.5 ± 3.9years, respectively (p = 0.990). Anterior chamber depth/volume and iridocorneal angle value were lower in the PACS group (p < 0.001, for all). Anterior chamber volume and iridocorneal angle increased significantly after laser peripheral iridotomy (p = 0.004, for both). While foveal thickness decreased significantly after laser peripheral iridotomy (p = 0.027), retinal nerve fiber layer thickness increased in superior and temporal quadrants (p = 0.038 and p = 0.016, respectively). Our results suggest that LPI in patients with PACS provides improved retinal thickness and RNFL thickness, as well as anterior chamber parameters.

PACS plus criteria: a retrospective cohort review of 612 consecutive patients treated with bilateral YAG peripheral iridotomies

IntroductionWith an ageing population and better life expectancy, the prevalence of angle closure disease is expected to increase by 20% per decade. In 2022, the Royal College of Ophthalmologists (RCOphth) issued a guideline on managing angle closure disease. Hospital eye service (HES) referral and prophylactic treatment are recommended only for primary angle closure suspect (PACS) with “Plus” features only. We aimed to examine patients previously treated with YAG peripheral iridotomies (YAG PI) for the presence of “PACS Plus” features.MethodsA retrospective cohort study of consecutive patients treated with YAG PI between 2015 and 2019 at a tertiary referral NHS eye centre was reviewed. Cases were examined to identify and classify patients into Primary Angle Closure (PAC), PACS, and Primary Angle Closure Glaucoma (PACG). Patients with PACS were studied for “Plus” features.ResultsSix hundred twelve patients with gonioscopy-confirmed angle closure (defined as a minimum 180 degrees iridotrabecular contact) treated with YAG PI from years 2015 to 2019 were included in the analysis. The mean age of patients presenting with angle closure disease was 68.5 years (SD 11.3). There were 390 (63.7%) patients with PACS, 102 (16.6%) with PAC and 120 (19.7%) with PACG. Of the PACS patients, 159(40.8%) patients had no “Plus” features. 181 (40.2%) patients had 1 “Plus” feature, 37 (9.5%) had 2 “Plus” features and 13 (3.3%) patients had 3 “Plus” features.ConclusionIn our cohort, a considerable proportion (40.8%) of PACS patients treated with YAG PI did not have Plus features and therefore that would not meet the proposed criteria for HES referral and YAG PI. With the proposed guidance, we expect a considerable reduction in HES referrals. Nonetheless, community optometry services should be supported and trained to provide monitoring for patients with PACS not referred to the HES.

Rethinking Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects: A Review

To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of primary angle-closure suspects (PACSs) that emerged as a result of recent randomized clinical trials challenging the widely accepted clinical practice of offering laser peripheral iridotomy (LPI) to PACS patients. To synthetize findings from these and other studies. Narrative review. Patients classified as PACS. The Zhongshan Angle-Closure Prevention (ZAP)-Trial and the Singapore Asymptomatic Narrow Angle Laser Iridotomy Study (ANA-LIS) along with accompanying publications were reviewed. Epidemiologic studies reporting on the prevalence of primary angle-closure glaucoma and other precursor forms of the disease were also analyzed along with publications reporting on the natural course of the disease or studies reporting on outcomes after prophylactic LPI. Incidence of progression to more severe forms of angle closure. Patients recruited in recent randomized clinical trials are asymptomatic, do not have cataracts, may be younger, and have, on average, deeper anterior chambers depth compared with patients treated with LPI in clinics. The ZAP-Trial and ANA-LIS clearly represent the best available data on PACS management, additional parameters however may need to be considered when physicians face patients in clinic. PACS patients encountered at tertiary referral centers may represent more advanced cases with respect to ocular biometric parameters and may be at higher risk for disease progression compared with those recruited through population-based screening. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Zonulopathy Identified During Cataract Extraction in Patients With Primary Angle Closure Disease.

The proportion, clinical characteristics, and risk factors of zonulopathy in Primary Angle Closure Disease (PACD) were analyzed. Zonulopathy is an under-recognized common finding in PACD, especially in acute angle closure patients. To examine the proportion and risk factors associated with intraoperative zonulopathy in primary angle closure disease (PACD). This is a retrospective analysis of 88 consecutive PACD patients who underwent bilateral cataract extraction at Beijing Tongren Hospital from August 1, 2020 to August 1, 2022. Zonulopathy was diagnosed based on intraoperative findings including the presence of lens equator, radial folds of the anterior capsule while making capsulorhexis, and other signs of unstable capsular bag. The subjects were grouped based on their PACD subtype diagnoses: acute angle closure (AAC), primary angle closure glaucoma (PACG), primary angle closure (PAC), or primary angle closure suspect (PACS). Multivariate logistic regression was performed to identify risk factors associated with zonulopathy. The proportion and the risk factors of zonulopathy were estimated in PACD patients and in PACD subtypes. Of 88 PACD patients (67.3±6.9y old, 19 male, 69 female), the overall proportion of zonulopathy was 45.5% of patients (40/88) and 30.1% of eyes (53/176). Among the PACD subtypes, the proportion of zonulopathy was highest (69.0%) in AAC, followed by 39.1% in PACG, and 15.3% in PAC and PACS combined. AAC was an independent risk factor associated with zonulopathy (P= 0.015, AAC vs PACG, PAC and PACS combined, OR 0.340, CI 0.142-0.814). Shallower anterior chamber depth (P=0.031) and greater lens thickness (P= 0.036), but not laser iridotomy, were associated with increased proportion of zonulopathy. Zonulopathy is common in PACD, especially in AAC patients. Shallow ACD and thick LT were associated with increased proportion of zonulopathy.

Retinal vein occlusion in patients with primary angle closure: a prospective case–control study

ObjectifComparer la prévalence de la fermeture de l'angle dans des yeux présentant une occlusion veineuse rétinienne (OVR) et dans des yeux témoins, d'une part, et vérifier s'il existe une association entre la fermeture de l'angle et l'OVR, d'autre part. Patients et méthodesCette étude cas-témoins prospective qui a été réalisée à l'insu regroupait des patients ayant des antécédents d'OVR (cas cliniques) et des sujets témoins appariés pour l’âge et l'erreur de réfraction. Ont été analysées les caractéristiques cliniques des patients et les images des structures de l'angle obtenues par tomographie par cohérence optique (OCT) du segment antérieur. RésultatsAinsi, 88 patients (44 par groupe) ont été inclus dans notre étude. L’âge moyen des sujets dans les groupe OVR et témoin était de 59,8 ± 11,6 ans et de 60,8 ± 9,0 ans, respectivement (p = 0,667). Il n'y avait pas de différence statistiquement significative entre les 2 groupes quant aux caractéristiques cliniques, notamment la pression intraoculaire (p = 0,837) et la classification de Shaffer (p = 0,620). Aucune des caractéristiques des structures de l'angle visibles dans les images de l'OCT du segment antérieur ne différait significativement d'un groupe à l'autre. Le nombre de diagnostics de fermeture de l'angle relevés dans le groupe OVR (1 cas de fermeture primaire de l'angle et 7 suspicions de fermeture primaire de l'angle) et dans le groupe témoin (6 suspicions de fermeture primaire de l'angle) ne différait pas de manière significative (p = 0,560). La profondeur de la chambre antérieure (PCA) était moins prononcée dans les yeux atteints d'OVR (2,72 ± 0,31 mm) que dans les yeux controlatéraux exempts d'OVR (2,76 ± 0,31 mm; p = 0,014). ConclusionsCette étude prospective à l'insu comprenant des cas-témoins appariés n'a pas mis au jour de différence significative quant aux mesures cliniques ni aux images des structures de l'angle obtenues à l'OCT du segment antérieur dans des yeux présentant une OVR, comparativement à des yeux témoins. Cela dit, la PCA était légèrement moins prononcée dans les yeux atteints d'OVR que dans les yeux controlatéraux exempts d'OVR. D'après l'ensemble des résultats obtenus, il est peu probable qu'il existe une association entre les mécanismes à l'origine de la fermeture primaire de l'angle et l'OVR. Cependant, la PCA moins prononcée observée en présence d'OVR pourrait accroître le risque de blocage pupillaire intermittent ou permanent.

Comparative study of the efficacy of lens extraction and laser peripheral iridotomy in primary anterior chamber angle closure

PURPOSE. To compare the anatomical and functional effectiveness of lensectomy (LE) and laser peripheral iridotomy (LPI) in patients with primary anterior chamber angle closure.METHODS. This prospective study included 120 patients aged 41 to 80 years (60 eyes — primary angle closure (PAC), 30 — primary angle closure suspects (PACs), 30 eyes — without ophthalmic pathology). 30 PAC eyes were treated using LE with intraocular lens implantation, and 30 eyes with LPI. All subjects underwent swept source optical coherence tomography (SS-OCT). The following parameters were analyzed: spherical equivalent (SE), uncorrected and corrected distance visual acuity, intraocular pressure (IOP), Shaffer grade of angle opening, lens opacity, goniosyne chiae, choroidal thickness in the macular region, axial length (AL) of the eye, anterior chamber depth (ACD), lens vault (LV), iris curvature (ICurv), iris thickness at 750 µm from scleral spur (IT750), angle opening distance (AOD500, AOD750), iridotrabecular space area (TISA500, TISA750). Along with standard descriptive statistics methods, machine learning methods were used, including Data Driven Soft Independent Modelling of Class Analogies (DD-SIMCA).RESULTS. Every third eye with PAC had reached control group values after LE (DD-SIMCA specificity 0.67), which was not the case after LPI (DD-SIMCA specificity 1.0) with the probability of getting into the control group estimated as 0.01. After LE, all parameters of the anterior chamber angle did not significantly differ from the norm (p&gt;0.05 for all), while ACD, ICurv even exceeded the norm (p=0.000). After LPI, there was a deepening of the ACD (from 2.34±0.28 mm to 2.36±0.280 mm, p=0.000) and a decrease in LV (from 0.864±0.120 µm to 0.843±0.110 µm, p=0.000), however, the result comparable to control was achieved only in ICurv (p=1.000). After LE in PAC, all parameters, including uncorrected visual acuity, SE, ACD, LV, iris profile, Shaffer grade of angle opening, and AOD500, AOD750, TISA500, TISA750 parameters in the superior and inferior sectors had advantages over those in PACs without treatment (p&lt;0.05). After LPI, an improvement in a number of pa rameters was also achieved compared to LPI: ICurv, Shaffer grade of angle opening, AOD500, AOD750, TISA500, TISA750 in the superior sectors and AOD500 in the inferior sector (p&gt;&lt;0.05).CONCLUSION. The effectiveness of LE in PAC is higher than LPI due to the better postoperative anterior chamber topography and lower IOP. Both treatments, especially LE, improve these parameters compared to PACs. Lens extraction is the treatment of choice at the early stages of primary angle closure.