Shallow Anterior Chamber Research Articles

The Efficacy of the Temporal View in Detection of Shallow Anterior Chamber

The Efficacy of the Temporal View in Detection of Shallow Anterior Chamber

Progression of corneal thinning and melting after collagen cross-linking for keratoconus.

To study the aetiology, diverse clinical manifestations, therapeutic interventions, and prognoses in patients with corneal thinning after collagen cross-linking (CXL) treatment. a retrospective observational study of all patients presenting with corneal thinning after collagen cross-linking, in a tertiary eye care hospital in south India from 2011 to 2017. Preoperative details were noted. Patients who presented with corneal thinning were subjected to investigative measures to assess thinning, received appropriate management, and underwent follow-up evaluations. Among the 12 patients, 8 were female and 4 were male, all of whom had undergone standard classical CXL. The duration between CXL and corneal melting/thinning onset varied from 5 to 12 years. Notably, among female patients, 2 were pregnant, 2 were lactating mothers, 1 was undergoing in vitro fertilization (IVF) treatment, and 1 had comorbid diabetes mellitus and hyperthyroidism. Clinical examination revealed corneal thinning accompanied by hypopyon in 1 patient, corneal perforation with shallow anterior chamber in 1 patient, and epithelial defect with crystalline deposit in another patient, the remaining patients exhibited corneal thinning. Corneal thinnest corneal thickness measurements ranged from 212 to 351 µm. Treatment approaches included penetrating keratoplasty (PKP) in 2 patients, deep anterior lamellar keratoplasty (DALK) in 1 patient, cyanoacrylate glue application in 1 patient, and awaiting DALK/PKP in three patients, 4 patients showing no signs of increased thinning. The incidence of corneal thinning after collagen cross-linking is less but fulminant, requiring timely and appropriate management to prevent visual complications.

Carotid–cavernous sinus fistula with functional filtering bleb: A case report

We describe a rare case of carotid-cavernous sinus fistula (CCF) in a 91-year-old woman's right eye with a functional filtering bleb. Upon examination, best-corrected visual acuity was light perception and intraocular pressure (IOP) was 14 mmHg, and a shallow anterior chamber, a swollen filtering bleb, dilated episcleral veins, choroidal detachment, and ocular manifestations accompanied with CCF were observed. During the healing process post transcatheter arterial embolization (TAE), significant hypotony and prolonged choroidal detachment were observed. Generally, IOP elevation is known to be a common ocular manifestation in CCF cases. When CCF develops in an eye with a functional filtering bleb post trabeculectomy, no IOP elevation is observed because the aqueous humor drains from the bleb. Dilated episcleral veins and a shallow anterior chamber may be observed, and although significant hypotony can occur soon after TAE, closure of the CCF results in recovery of vision without ophthalmic intervention.

Tackling the tubes of refractory Sturge–Weber syndrome with secondary glaucoma: A surgeon’s nightmare!

Hypotony with shallow anterior chamber (AC) post glaucoma surgery in Sturge–Weber syndrome (SWS) patients is commonly due to choroidal effusions. We report two cases of SWS patients having hypotony and shallow AC after Ahmed Glaucoma valve (AGV) implantation with no wound leak or choroidal effusion. Case 1 had persistent shallow AC, which was diagnosis of exclusion, as valve malfunction, a rare occurrence in AGV. Case 2 resolved after AC reformation with 1.8% sodium hyaluronate. Two cases describe the clinical approach and surgical management in patients of hypotony with shallow AC after AGV implantation in SWS patients.

Assessment of clinical efficacy and safety of ICL implantation in patients with relatively shallow anterior chamber depth in early and midterm postoperative time

ObjectiveTo investigate the clinical effect and safety of ICL implantation in myopic patients with relatively shallow anterior chamber depth ( ACD ). MethodsRetrospective analysis,comparative, non-interventional case series. Patients with myopia who underwent ICL implantation were included in the study and were categorized into two groups: one with a relatively shallow ACD ( 2.60 mm ≤ ACD ＜ 2.80 mm ) and the other with a normal ACD ( ACD ≥ 2.80 mm ). Each group comprised 51 eyes and were reviewed for at least 6 months. To evaluate preoperative and postoperative visual acuity, intraocular pressure ( IOP ), central vault, ACD, endothelial cell density ( ECD ) and anterior chamber angle parameters( trabecular iris angle ( TIA ), angle opening distance at 500 μm and 750 μm ( AOD500, AOD750 ), trabecular iris space area at 500 μm and 750 μm ( TISA500, TISA750 ). Analyze the trend of postoperative data changes of 1 week, 1 month, 3 months, and at least 6 months. Patients in relatively shallow ACD with vault <100 μm or >1000 μm were performed detailed follow-up. ResultThe postoperative uncorrected distance visual acuity ( UDVA ) and best corrected visual acuity ( BCVA ) surpassed the preoperative BCVA in two groups. The group differences of effectiveness index ( EI ) was p=0.409 and of safety index ( SI ) was p=0.563. The EI were 1.07 and 1.09, SI were1.10 and 1.21. Postoperative vision and refractive error were effectively corrected. The preoperative and postoperative IOP and ECD values of the two groups were within the normal range, and the preoperative and postoperative differences and the group differences of IOP and ECD were p=0.649, p=0.501, p=0.222, p=0.276. The ACD in two groups were reduced by approximately 25% and 26%, the nasal and temporal TIA were reduced to 45% and 50% approximately. The nasal and temporal AOD500, AOD750, TISA500, and TISA750 in the relatively shallow ACD group were reduced 40% approximately and in the normal ACD group were reduced to 30% approximately. All the preoperative and postoperative differences and the group differences of anterior segment parameters were statistically significant ( all p<0.01 ), with more significant anterior segment changes in normal ACD group.The postoperative data in two groups showed that when the follow-up time was prolonged, the central vault was decreasing, and the postoperative ACD was increasing, the postoperative TIA increased slowly in relatively shallow ACD group and decreased slowly in normal ACD group, temporal TIA were greater than nasal TIA, with no significant variation. There were four eyes in the relatively shallow ACD group in the remarkable abnormal postoperative central vault. Three eyes had second operation: one eye had an ICL alignment, and two eyes had ICL replacement. ConclusionPatients with relatively shallow ACD who underwent ICL implantation had fine postoperative clinical efficacy and safety.

Clinical characteristics and diagnostic test for spherophakia: A retrospective analysis

BackgroundThis study aimed to analyze ocular characteristics in patients diagnosed with spherophakia, establish effective diagnostic criteria, and aid clinicians in prompt identification and management. MethodsA retrospective case series identified spherophakia cases through medical records and literature searches. The case group included spherophakia patients, and the control group comprised individuals with similar eye conditions. Intraocular lens calculations used the SRK-T formula, and statistical analyses were performed using SPSS. Diagnostic efficacy was assessed through receiver operating characteristic (ROC) curve analysis. ResultsThe study included 12 cases (23 eyes) from medical records and 86 patients (142 eyes) from literature sources. Characteristics of spherophakia included bilateral involvement, younger age, shallow anterior chamber depth, lens dislocation, and secondary glaucoma. A diagnostic criterion based on lens power demonstrated high sensitivity (94.3 %) and specificity (91.9 %). ROC analysis yielded area under the ROC curve (AUROC) values of 0.974 for lens power, outperforming refractive error (0.119), corneal curvature (0.465) and axial length (0.496). The lens power cutoff for diagnosing spherophakia was 31.25D. ConclusionThe study offers crucial insights into spherophakia's clinical characteristics and presents a practical diagnostic criterion using lens power, enhancing early detection and management. Further research is needed to validate and refine these findings, establishing standardized diagnostic criteria for spherophakia.

Preoperative Structural Risk Factors for Glaucoma After Penetrating Keratoplasty for Congenital Corneal Opacity: An Observational Study.

Post-keratoplasty glaucoma (PKG) is a major complication following penetrating keratoplasty (PKP) for congenital corneal opacity (CCO). This study aims to assess the preoperative structural risk factors for PKG following PKP for CCO using ultrasound biomicroscopy (UBM). Pediatric patients with CCO who underwent preoperative UBM and primary PKP were enrolled. Patients with anterior segment operation history or witha follow-up duration less than 12months were excluded. The structural features of the anterior segment including central corneal thickness, anterior chamber depth, angle closure range (ACR), anterior synechia range, maximum iridocorneal adhesion length, abnormal iridocorneal synechia, and lens anomalies were identified on UBM images. The medical histories were reviewed to identify clinical features. The incidence of PKG was assessed to determine significant structural and clinical risk factors. Fifty-one eyes of 51 pediatric patients with CCO were included. The median age at surgery was 8.0months, and the mean follow-up duration was 33 ± 9months. Eleven (21.6%) eyes developed PKG. The main structural risk factors were abnormal iridocorneal synechia (P = 0.015), lens anomaly (P = 0.001), and larger ACR (P = 0.045). However, a larger range of normal anterior synechia without involvement of the angle was not a significant risk factor. Preoperative glaucoma (P < 0.001) and higher intraocular pressure (P = 0.015) were clinical risk factors. A shallow anterior chamber was a unique risk factor for sclerocornea (P = 0.019). Detailed preoperative examination of iridocorneal synechia, lens, and angle closure using UBM is critical for PKG risk assessment, surgical prognosis evaluation, and postoperative management in patients with CCO.

Clinical effect of XEN gel stent implantation or combined with phacoemusification and intraocular lens implantation on glaucoma

Objective: To evaluate the efficacy and safety of internal XEN gel stent implantation or combined with phacoemusification and intraocular lens (IOL) implantation in the treatment of glaucoma. Methods: It was a retrospective case series study. Forty-five patients (28 males and 17 females; 52 eyes) who had different types of glaucoma treated at the Shenzhen Eye Hospital from December 2021 to June 2023 were included. XEN gel stent implantation (the XEN group) or XEN implantation combined with phacoemusification and IOL implantation (the combined group) were performed in these patients. The postoperative follow-up was 18 months. The observational indexes included the best corrected visual acuity (recorded as the logarithm of the minimum angle of resolution), intraocular pressure (IOP), XEN implantation quadrant, number of IOP-lowering medications, corneal endothelial cell count, operation success rate and surgical complications. The one-way repeated measures of variance, LSD-t test, and rank sum test were used for statistical analysis. Results: There were 28 patients (33 eyes) in the XEN group and 17 patients (19 eyes) in the combined group. The postoperative best corrected visual acuity had no significant change in the XEN group, but improved significantly (0.21±0.30 at 6 months; P<0.05) in the combined group, compared with the preoperative value. The IOP of the two groups at 18 months after surgery [(12.2±3.1) and (11.9±3.9) mmHg (1 mmHg=0.133 kPa)] was significantly lower than that before surgery [(22.1±8.5) and (19.4±10.2) mmHg; P<0.05]. The average number of IOP-lowering medications in all patients was 3 (2, 3) before surgery and 0 (0, 0) at 18 months after surgery. The difference was statistically significant (P<0.05). In the XEN group, the corneal endothelial cell count was (2 387.37±478.22) cells/mm² preoperatively and (2 193.89±311.96) cells/mm² at 12 months. The decrease showed no statistical significance. The XEN gel stent was implanted in the supranasal quadrant in 8 eyes (15.4%), in the inferonasal quadrant in 36 eyes (69.2%), and in the infratemporal quadrant in 8 eyes (15.4%). The operation success rate [complete success rate, 86.5% (45/52); conditional success rate, 9.6% (5/52)] was 96.2% (50/52). The filtering bleb scarring occurred in 9.6% (5/52) of eyes. A small amount of hyphema, postoperative shallow anterior chamber, transient hypertension, and intraoperative drain breakage were found in 7.7% (4/52) of eyes, respectively. A small amount of subconjunctival bleeding was observed in 5.8%(3/52) of eyes. Re-implantation of an XEN gel stent was performed in 5.8% (3/52) of eyes. The intraoperative conjunctival tissue rupture, hypotony macular edema, and drain exposure were observed in 1.9% (1/52) of eyes, respectively. Conclusion: The XEN gel stent implantation or combined with phacoemusification and IOL implantation was effective and safe in treating different types of glaucoma, but its long-term clinical efficacy needs further follow-up observations in multi-center, larger-scale research.

High-risk factors for zonular complications during cataract surgery in eyes with pseudoexfoliation syndrome

AimsTo predict high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence in eyes with pseudoexfoliation (PXF) syndrome.Methods315 eyes of 315 consecutive patients with PXF scheduled...

A modified trabeculectomy technique with direct filtration into the Tenon's capsule

ObjectiveTo report the surgical outcomes of a modified trabeculectomy technique involving implanting the Tenon's layer under the scleral flap. DesignProspective, interventional case series. Participants51 eyes with medically uncontrolled glaucoma were enrolled for this study. A new trabeculectomy technique, the Tenon's filtration technique for trabeculectomy (TFT-LEC) was used in 26 eyes, while a conventional procedure, normal trabeculectomy (N-LEC), was used for 25 eyes. MethodsIntraocular pressure (IOP) control, the number of glaucoma medications, the need for additional interventions, and postoperative complications were assessed. ResultsTwelve months postoperatively, the mean IOP was 13.5 ± 0.5 mmHg in the TFT-LEC group and 15.4 ± 0.5 mmHg in the N-LEC group (p = 0.13). The TFT-LEC group required an average of 1.3 ± 1.0 additional glaucoma medications (21 cases required only ripasudil) postoperatively, with no cases of bleb needling revision or reoperation. The N-LEC group required an average of 1.7 ± 1.5 glaucoma medications (p = 0.43) compared to TFT-LEC group, eight cases (32%) required bleb needling revision (p = 0.002), and one case (4%) of reoperation (p = 0.49). The complications in the TFT-LEC group included shallow anterior chamber in six (23 %) cases (p = 1.00) compared to N-LEC group, choroidal detachment in two (8%) cases (p = 0.42), and anterior chamber hemorrhage in seven (27%) cases (p = 0.29). None of these complications affected visual function. ConclusionsThis new technique involving implanting the Tenon's layer under the scleral flap may improve the postoperative outcomes of trabeculectomy.

Complications Following XEN45 Gel Stent and Glaucoma Drainage Device Implantation During Glaucoma Fellowship.

Purpose XEN45 Gel Stent and glaucoma drainage device (GDD) implantation is safe and effective for glaucoma treatment and should be taught during glaucoma fellowship training. However, complications may still occur, with potentially sight-threatening consequences. The purpose of this study is to describe the management of complications following a series of XEN45 Gel Stent and GDDsurgeries performed over the course of glaucoma fellowship training. Methods This is a retrospective case series of XEN45 Gel Stent surgeries performed on 16 eyes and GDD surgeries performed on seven eyes. Patient demographics, disease characteristics, and complications are reviewed. The intra- and postoperative course of five select cases with complications are described in detail. Results The most frequent complications following XEN45 implantation were transient hypotony (10 eyes, 63%), reduced visual acuity (VA) (five eyes, 31%), choroidal effusion (three eyes, 19%), hyphema (two eyes, 13%), and intraocular pressure (IOP) spike (two eyes, 13%). Thirteen eyes (81%) required bleb needling, and three eyes (19%) required XEN45 replacement. Complications following GDD implantation included hypotony (three eyes, 43%), reduced VA (two eyes, 29%), choroidal effusion (two eyes, 29%), IOP spike (two eyes, 29%), implant exposure (two eyes, 29%), and shallow anterior chamber (one eye, 14%). Three eyes (43%) required revision or explantation with a secondary glaucoma surgery. One choroidal effusion following XEN45 surgery and one following GDD surgery were hemorrhagic choroidal effusions requiring surgical drainage. Conclusion Significant and potentially sight-threatening complications may occur following XEN45 Gel Stent and GDD implantation performed over the course of fellowship training. Glaucoma fellows should be ably equipped to recognize, diagnose, and manage these complications both intra- and postoperatively.

Clinical and genetic features in autosomal recessive bestrophinopathy in Chinese cohort

PurposeTo provide a genotype and phenotype characterization of the BEST1 mutation in Chinese patients with autosomal recessive bestrophinopathy (ARB) through multimodal imaging and next-generation sequencing (NGS).MethodsSeventeen patients from 17 unrelated families of Chinese origin with ARB were included in a retrospective cohort study. Phenotypic characteristics, including anterior segment features, were assessed by multimodal imaging. Multigene panel testing, involving 586 ophthalmic disease-associated genes, and Sanger sequencing were performed to identify disease-causing variants.ResultsAmong 17 ARB patients, the mean follow-up was 15.65 months and average onset age was 30.53 years (range: 9–68). Best corrected visual acuity ranged from light perception to 0.8. EOG recordings showed a typically decreased Arden ratio in 12 patients, and a normal or slightly decreased Arden ratio in two patients. Anterior features included shallow anterior chambers (16/17), ciliary pronation (16/17), iris bombe (13/17), iridoschisis (2/17), iris plateau (1/17), narrow angles (16/17) and reduced axial lengths (16/17). Sixteen patients had multiple bilateral small, round, yellow vitelliform deposits distributed throughout the posterior pole, surrounding the optic disc. Initial diagnoses included angle-closure glaucoma (four patients), Best disease (three patients), and central serous chorioretinopathy secondary to choroidal neovascularization (CNV) (one patient), with the remainder diagnosed with ARB. Fourteen patients underwent preventive laser peripheral iridotomy, four of whom also received combined trabeculectomy and iridotomy in both eyes for uncontrolled intraocular pressure. One patient received intravitreal conbercept for CNV. Overall, 15 distinct disease-causing variants of BEST1 were identified, with 14 (82.35%) patients having missense mutations. Common mutations included p. Arg255-256 and p. Ala195Val (both 23.68%), with the most frequent sites in exons 7 and 5.ConclusionsThis study provides a comprehensive characterization of anterior segment and genetic features in ARB, with a wide array of morphological abnormalities. Findings are relevant for refining clinical practices and genetic counseling and advancing pathogenesis research.

Malignant glaucoma treated by low-dose laser cycloplasty: a 1-year multicenter prospective non-comparative study.

To report a one-year clinical outcomes of low-dose laser cycloplasty (LCP) among malignant glaucoma patients. In this prospective, multicenter, non-comparative clinical study, participants with malignant glaucoma were recruited and underwent LCP at eight ophthalmic centers in China. Patients were followed up at 1wk, 1, 3, 6, and 12mo. Intraocular pressure (IOP), number of glaucoma medications, anterior chamber depth (ACD), and complications were recorded. Anatomical success was defined as the reformation of the anterior chamber based on slit-lamp biomicroscopy. Recurrence was defined by the presence of a shallow or flat anterior chamber after initial recovery from treatment. A total of 34 eyes received LCP. Mean IOP and medications decreased from 36.1±11.5 mm Hg with 3.3±1.5 glaucoma medications pre-treatment to 20.9±9.8 mm Hg (P<0.001) with 2.9±1.6 medications (P=0.046) at 1d, and 17.4±6.7 mm Hg (P<0.001) with 1.3±1.7 medications (P<0.001) at 12mo. The ACD increased from 1.1±0.8 mm at baseline to 1.7±1.0 mm and to 2.0±0.5 mm at 1d and 12mo, respectively. A total of 32 (94.1%) eyes achieved initial anatomical success. During follow-up, 2 (5.9%) eyes failed and 8 (23.5%) eyes relapsed, yielding a 12-month anatomical success rate of 64.3%. Complications including anterior synechia (8.82%), choroidal/ciliary detachment (5.88%) and hypopyon (2.94%) were observed within 1wk. LCP is simple, safe, and effective in reforming the anterior chamber in malignant glaucoma.

MFRP variations cause nanophthalmos in five Chinese families with distinct phenotypic diversity.

Nanophthalmos is a congenital ocular structural anomaly that can cause significant visual loss in children. The early diagnosis and then taking appropriate clinical and surgical treatment remains a challenge for many ophthalmologists because of genetic and phenotypic heterogeneity. The objective of this study is to identify the genetic cause of nanophthalmos in the affected families and analyze the clinical phenotype of nanophthalmos with MFRP gene variation (Microphthalmia, isolated; OMIM#611040 and Nanophthalmos 2; OMIM#609549, respectively). Comprehensive ophthalmic examinations were performed on participants to confirm the phenotype. The genotype was identified using whole exome sequencing, and further verified the results among other family members by Sanger sequencing. The normal protein structure was constructed using Alphafold. Mutant proteins were visualized using pymol software. Pathogenicity of identified variant was determined by in silico analysis and the guidelines of American College of Medical Genetics and Genomics (ACMG). The relationship between genetic variants and clinical features was analyzed. Five nanophthalmos families were autosomal recessive, of which four families carried homozygous variants and one family had compound heterozygous variants in the MFRP gene. Both family one and family three carried the homozygous missense variant c.1486G>A (p.Glu496Lys) in the MFRP gene (Clinvar:SCV005060845), which is a novel variant and evaluated as likely pathogenic according to the ACMG guidelines and in silico analysis. The proband of family one presented papilloedema in both eyes, irregular borders, thickened retinas at the posterior pole, tortuous and dilated retinal vessels, and indistinguishable arteries and veins, while the proband of family three presented uveal effusion syndrome-like changes in the right eye. In families one and 3, despite carrying the same gene variant, the probands had completely different clinical phenotypes. The homozygous nonsense variant c.271C>T (p.Gln91Ter) (Clinvar:SCV005060846) of the MFRP gene was detected in family 2, presenting shallow anterior chamber in both eyes, pigmentation of peripheral retina 360° from the equator to the serrated rim showing a clear demarcation from the normal retina in the form of strips. Family four proband carried the homozygous missense variant c.1411G>A (p.Val471Met) in the MFRP gene (Clinvar:SCV005060847), family five proband carried compound heterozygous missense variants c.1486G>A (p.Glu496Lys) and c.602G>T (p.Arg201Leu) in the MFRP gene (Clinvar:SCV005060848), which is a novel variant and evaluated as likely pathogenic according to the ACMG guidelines and in silico analysis, and they all presented clinically with binocular angle-closure glaucoma, family four also had retinal vein occlusion in the right eye during the follow-up. In this study, pathogenic variants of the MFRP gene were detected in five nanophthalmos families, including two novel variants. It also revealed a distinct phenotypic diversity among five probands harboring variants in the MFRP gene. Our findings extend the phenotype associated with MFRP variants and is helpful for ophthalmologists in early diagnosis and making effective treatment and rehabilitation strategies.

“Bubble Behind Iris” Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes

Purpose: Performing Descemet membrane keratoplasty (DMEK) in vitrectomized eyes can be challenging, owing to the compromised stability of the iris–lens diaphragm. This study presents a “bubble behind iris” technique in DMEK to achieve a shallower anterior chamber in vitrectomized and pseudophakic eyes. Methods: The patients with vitrectomized eyes who underwent DMEK between October 2022 and March 2023 were enrolled in this study. Following the insertion of the donor tissue into the anterior chamber, a 30-gauge blunt cannula was used to introduce an air bubble posterior to the iris. The depth of the anterior chamber was confirmed before unfolding the graft. Subsequently, the air bubble was carefully replaced with balanced salt solution insertion using the blunt cannula, and the anterior chamber was filled with gas for graft attachment. Results: This study included 3 eyes of 3 patients (3 men; mean age 62.3 ± 8.5 years). The best spectacle corrected visual acuity and central corneal thickness improved in all eyes with no notable complications. Conclusions: The “bubble behind iris” technique is a straightforward and minimally invasive approach for maintaining an optimal anterior chamber depth during DMEK in vitrectomized and pseudophakic eyes.

Eye Emergency: A Case Report On Acute Primary Angle Closure

Acute Primary Angle Closure (APAC) or Acute Glaucoma is a condition where intraocular pressure rapidly increases due to the occlusion of the trabecular meshwork by the iris. This case report aims to present the clinical manifestations of APAC and evaluate the initial treatment strategies to immediately reduce intraocular pressure (IOP) and prevent visual loss. A 63-year-old woman presented with a sudden onset of pain in her left eye, accompanied by redness, headache, blurred vision, and nausea. Her visual acuity in the left eye was 1/300, with an IOP of 69.3 mmHg. Slit-lamp examination revealed hyperemic conjunctiva, mixed conjunctival and pericorneal injection, corneal edema, a shallow anterior chamber with Van Herrick grade I, radially dilated iris, a mid-dilated pupil (4 mm in diameter), and a cloudy lens. Gonioscopy confirmed a closed angle and peripheral anterior synechiae (PAS). The right eye had a shallow anterior chamber with normal IOP. Initial treatment included oral glycerin, intravenous analgesic, oral acetazolamide 250 mg, potassium chloride 600 mg, and topical beta-blocker 0.5%, but showed no improvement. Subsequently, a trabeculectomy was performed. The patient also underwent Laser Peripheral Iridotomy (LPI) on the right eye. This case underscores that acute primary angle closure is an ophthalmic emergency, and timely management is crucial to prevent further complications and visual loss. Postoperative follow-up indicated a significant reduction in IOP and stabilization of visual acuity, highlighting the importance of rapid intervention in APAC cases.

Intraocular Pressure Changes after Phacoemulsification with Posterior Vitreous Tap in Cataractous Eyes with Shallow Anterior Chamber

Intraocular Pressure Changes after Phacoemulsification with Posterior Vitreous Tap in Cataractous Eyes with Shallow Anterior Chamber

Efficacy and Safety of Surgical Peripheral Iridectomy, Goniosynechialysis, and Goniotomy for Advanced Primary Angle Closure Glaucoma Without Cataract: 1-Year Results of a Multicenter Study.

The combination of surgical peripheral iridectomy, goniosynechialysis, and goniotomy is a safe and effective surgical approach for advanced primary angle closure glaucoma without cataract. To evaluate the efficacy and safety of surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) in advanced primary angle closure glaucoma (PACG) eyes without cataract. A prospective multicenter observational study was performed for patients who underwent combined SPI, GSL, and GT for advanced PACG without cataract. Patients were assessed before and after the operation. Complete success was defined as achieving intraocular pressure (IOP) between 6 and 18mmHg with at least a 20% reduction compared with baseline, without the use of ocular hypotensive medications or reoperation. Qualified success adopted the same criteria but allowed medication use. Factors associated with surgical success were analyzed using logistic regression. A total of 61 eyes of 50 advanced PACGs were included. All participants completed 12 months of follow-up. Thirty-six eyes (59.0%) achieved complete success, and 56 eyes (91.8%) achieved qualified success. Preoperative and postsurgical at 12 months mean IOPs were 29.7±7.7 and 16.1±4.8mmHg, respectively. The average number of ocular hypotensive medications decreased from 1.9 to 0.9 over 12 months. The primary complications included IOP spike (n=9), hyphema (n=7), and shallow anterior chamber (n=3). Regression analysis indicated that older age (odds ratio [OR]=1.09; P =0.043) was positively associated with complete success, while a mixed angle closure mechanism (OR=0.17; P =0.036) reduced success rate. The combination of SPI, GSL, and GT is a safe and effective surgical approach for advanced PACG without cataract. It has great potential as a first-line treatment option for these patients.

Retrospective Analysis of Negative Dysphotopsia After Cataract Surgery

&amp;lt;i&amp;gt;Purpose&amp;lt;/i&amp;gt;: To describe the incidence and characteristics of negative dysphotopsia (ND) as well as the risk factors contributing to it. &amp;lt;i&amp;gt;Methods&amp;lt;/i&amp;gt;: For this retrospective study, data from patients who underwent cataract surgery between January 2018 and December 2019 at our department (Department of Ophthalmology, Hietzing Hospital, Vienna, Austria) was analyzed. A total of 8122 eyes had cataract surgery performed. Three different intraocular lenses (IOLs) have been used (EyeCee® One by Bausch + Lomb, TECNIS® by Johnson &amp; Johnson, HOYA Vivienx ™ by HOYA). Data from patients who postoperatively complained about ND as well as data from a gender and age-matched control group (34 eyes in each) was further analyzed: pupil size, axial length, anterior chamber depth, angle kappa, IOL power and other biometrical factors. The scotomas were depicted on a Harms tangent screen. &amp;lt;i&amp;gt;Results&amp;lt;/i&amp;gt;: An incidence of 1.99% of ND was found, of which 1.58% was transient and 0.42% persistent. The average duration of the symptoms was 5.40 (±6.15) weeks in the transient ND group. In the total cohort of 8122 eyes, there was no difference in the distribution of implanted IOL types or IOL power; neither played the surgeon a significant role in the development of ND. There was no significant difference between ND and control eyes regarding pupil size, axial length, and angle kappa. The anterior chamber was significantly shallower in the ND group: 5.1±0.58mm vs. 5.41±0.61mm (p=0.03). &amp;lt;i&amp;gt;Conclusion&amp;lt;/i&amp;gt;: According to our findings, a shallower anterior chamber poses a risk to the development of ND.

Clinical Observation of Posterior-Chamber Phakic Implantable Collamer Lens V4c Implantation in Myopic Patients with Shallow Anterior Chamber Depth: A Retrospective, Consecutive Observational Study.

The reference range for the preoperative anterior chamber angle width for ICL surgery is unclear. Our objective was to assess the clinical effect and the range of anterior chamber angle width of posterior-chamber implantable collamer lens V4c (ICL V4c) implantation in patients with anterior chamber depth (ACD) < 2.8 mm. Patients who underwent ICL V4c implantation with shallow ACD were included in this retrospective study. The patients' uncorrected and corrected distance visual acuity, angle of trabecular-iris (TIA), angle-opening distance (AOD500), trabecular-iris space area (TISA500), corneal endothelial cell density, vault, retinal nerve fiber layer thickness, intraocular pressure, visual field, and complications were analyzed. Forty-one patients (68 eyes) completed at least 12 months of follow-up (median follow-up, 30 months). The effectiveness and safety indices were 1.09 ± 0.13 and 1.04 ± 0.21, respectively. The preoperative TIA values on the nasal and temporal sides were 39.78 ± 7.68 degree (range, 25.8-65.1 degree) and 41.54 ± 8.03 degree (range, 28.5-63.00 degree). Forty-seven eyes had uncorrected distance visual acuity ≥1.0, and 55 had corrected distance visual acuity ≥1.0 at the last follow-up visit. The TIA, AOD500, and TISA500 on the nasal and temporal sides were significantly reduced compared to those before surgery (all P < 0.01); no eye had an angle closure or elevated intraocular pressure. The ICL V4c vault was 290.88 ± 153.36 μm (range, 60.0-880.0 μm). No severe complications occurred in any patient. In patients with myopia with shallow ACD (2.55-2.79 mm), a preoperative TIA >25.8° is safe and effective for a relatively long time after surgery; however, an extended long-term close follow-up is needed.