Acute primary angle closure during the Omicron outbreak

AIM:To investigate Omicron’s impact on clinical presentation of acute primary angle closure(APAC)in China.METHODS:A consecutive case series with historical controls was conducted at Shenzhen Eye Hospital,the largest specialized hospital in Shenzhen,China.Medical records from a two-month period during the Omicron pandemic(December 1,2022,to January 31,2023)were compared with records from two control groups(12/2018–1/2019 and 12/2021–1/2022)before pandemic.Patients with APAC were included,and the prevalence of APAC and demographic characteristics in Omicron-infected and noninfected patients were compared.RESULTS:Seventy-one(23.43%)out of 303 patients were diagnosed with APAC in the pandemic cohort,which was 2.98 and 2.61 times higher than that in control cohorts(7.87%in 2019,8.96%in 2022,P<0.001).The pandemic cohort has significantly higher Omicron-infected rate(78.87%vs 0 vs 0;P<0.001),lower proportion of glaucoma history(16.90%vs 42.86%vs 41.67%,P=0.005),higher surgical rate(95.77%vs 83.33%vs 78.57%,P=0.024),higher total medical costs and larger pupil diameter(5.63±0.15 vs 4.68±0.15 vs 4.69±0.22 mm,P<0.01).In 83%Omicron-infected patients,ocular symptoms appeared within 3d after systemic symptoms onset.In multivariate analysis,Omicron infection(P<0.001)was the only independent predictor of pupil diameter.CONCLUSION:In the Omicron epidemic in China,there is an increase of prevalence and severity of APAC,particularly focusing on the first 3d following infection.

A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.

A Meta-Analysis: Safety and Efficacy of Phacoemulsification with Goniosynechialysis versus Trabeculectomy for Acute Angle Closure Glaucoma in China

Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.

Anterior segment changes after pharmacologic mydriasis using Pentacam and optical coherence tomography in angle closure suspects

AIM: To compare the dynamic changes of anterior segment parameters especially iris morphology induced by pharmacologic mydriasis between angle closure suspects and normal controls. METHODS: The study group comprised 19 eyes of 19 angle closure suspects and 19 eyes of 19 age- and sexmatched normal open-angle eyes. Pentacam and optical coherence tomography measurements before and 30min after instillation of compound tropicamide eye drop were performed and compared. Biometric evaluations of iris tomography and anterior chamber angle were estimated by a customized image-processing software. RESULTS: Baseline axial length, iris cross sectional area and volume did not differ significantly between angle closure suspects and normal controls. Angle closure suspects had smaller pupil size, narrower anterior segment dimension and axial length, thinner iris with greater curve in comparison with normal controls. Pharmacologic mydriasis led to significant increments in iris thickness at 750 mu m, anterior chamber depth and volume, whereas significant decrements in iris curve, cross sectional area and volume in both groups. Angle opening distance at 500 mu M was increased significantly in normal controls (from 0.465 +/- 0.115 mm to 0.539 +/- 0.167 mm, P=0.009), but not in angle closure suspects (from 0.125 0.100 mm to 0.145 +/- 0.131 mm, P=0.326). Iris volume change per millimeter of pupil dilation (Delta IV/Delta PD) decreased significantly less in angle closure suspects than normal controls (-2.47 +/- 1.33 mm(2) vs -3.63 +/- 1.58 mm(2), P=0.019). Linear regression analysis showed that the change of angle opening distance at 500 mu M was associated most with the change of central anterior chamber depth (beta= 0.841, P=0.002) and Delta IV/Delta PD (beta=0.028, P=0.002), followed by gender (beta=0. 062, P=0.032). CONCLUSION: Smaller iris volume decrement per millimeter of pupil dilation is related significantly with the less anterior angle opening in angle closure suspects after pharmacologic mydriasis. Dynamic iris change may be as a prospective indicator of iris compressibility and angle closure glaucoma.

Goniosynechialysis for secondary angle closure glaucoma in a pseudophakic patient after vitrectomy and silicone oil injection

Dear Sir,Iam Jonghoon Shin,from the Department of Ophthalmology of Pusan National University Hospital,Busan,Korea.I write to present a patient with secondary angle closure glaucoma(SACG)after vitrectomy and silicone oil(SO)injection who was successfully treated by

Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure

·AIM: To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure(APAC) using ultrasound biomicroscopy(UBM).·METHODS: Patients(n =23, 31 eyes) were randomized to receive phacoemulsification or combined phacotrabeculectomy(n =24, 31 eyes). Best-corrected visual acuity(BCVA), intraocular pressure(IOP), the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively.· RESULTS: The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group(P 【0.05). IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up(P 【0.05),whereas there was no significant difference between the two groups at the latter follow-up(P 】0.05).Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery(P 【0.05), whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group.·CONCLUSION: Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However,phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery.

Mechanism and Etiology of Primary Chronic Angle Closure Glaucoma

The ocular anatomic features, pupil-blocking force, status of angle synechiae closure and positivity of provocative tests were compared between the primary chronic angle closure glaucoma (PCACG) and primary a-cute angle closure glaucoma (PAACG) by using ultrasonic biometry, computerized anterior ocular segment image processing technique, gonioscopy and provocative tests. The studies showed that the anterior chamber depth of PAACG was shallower than that of PCACG; the pupil-blocking force of PAACG was st...

Ultrasound biomicroscopic imaging demonstrate thinner ciliary body thickness in eyes with angle closure

·AIM:To compare the ciliary body thickness between eyes with primary angle closure(PAC)and primary angle-closure glaucoma(PACG)with the normal eyes,and to investigate the association between ciliary body thickness and ciliary processes situation.·METHODS:In this cross-sectional study,57 patients with PAC/PACG were matched to 57 normal subjects after propensity score matching(PSM)adjusting for age and gender.All subjects underwent conventional ocular examinations and ultrasound biomicroscopy(UBM)examination,among which the patients with PAC/PACG performed the examinations one month after laser peripheral iridotomy(LPI).Quantitative parameters were measured,which included ciliary body thickness at the position of 1 mm posterior to the scleral spur(CBT1),trabecular-ciliary process distance(TCPD)and trabecularciliary process angle(TCA).·RESULTS:Eyes with PAC/PACG presented significantly thinner CBT1,shorter TCPD and smaller TCA(P<0.001)than the normal eyes,both in comparison of the means of four quadrants and in comparisons of each quadrant.After removing images with peripheral anterior synechia(PAS),the same results were also found in comparisons between the two groups.Significant correlations were found between TCPD(R~2=0.537,P<0.001)and TCA(R~2=0.517,P<0.001)with CBT1.·CONCLUSION:Eyes with PAC/PACG have thinner ciliary body thickness and more anteriorly situated ciliary processes.Thinner ciliary body thickness is associated with anterior situation of the ciliary processes.

Bilateral acute angle closure glaucoma precipitated by over the counter oral decongestant

Dear Sir,We hereby report a case of bilateral acute angle closure glaucoma secondary to a systemic decongestant containing pseudoephedrine freely available over the counter.Acute angle closure glaucoma is an ocular emergency.Delayed recognition and treatment inevitably leads to permanent visual impairment.Acute angle closure occurs as a result of obstruction to aqueous drainage by blockage of the trabecular meshwork by the iris.Typical presenting symptoms include acute onset of ocular pain,headache and blurred vision.On clinical examination,it is characterized by a markedly raised IOP of above 21 mm Hg together with

Mobile lens- induced angle closure glaucoma and rubeosis iridis in Sturge Weber syndrome

Dear Sir,I am Dong Hyun Lee from the Department of Ophthalmology at the Pusan National University Yangsan Hospital,Yangsan,Korea.Herein,I present the development of a lens-induced angle closed glaucoma and iris neovascularization in the patient with Sturge Weber syndrome(SWS)with open angle glaucoma.Informed consent was obtained from a patient before each procedure The study was conducted in accordance with the tenets of the Declaration of Helsinki.

Bilateral posterior scleritis presenting as acute primary angle closure:A case report

BACKGROUND Scleritis is a rare disease and the incidence of bilateral posterior scleritis is even rarer.Unfortunately,misdiagnosis of the latter is common due to its insidious onset,atypical symptoms,and varied manifestations.We report here a case of bilateral posterior scleritis that presented with acute eye pain and intraocular hypertension,and was initially misdiagnosed as acute primary angle closure.Expanding the literature on such cases will not only increase physicians’awareness but also help to improve accurate diagnosis.CASE SUMMARY A 53-year-old man was referred to our hospital to address a 4-d history of bilateral acute eye pain,headache,and loss of vision,after initial presentation to a local hospital 3 d prior.Our initial examination revealed bilateral cornea edema accompanied by a shallow anterior chamber and visual acuity reduction,with left-eye amblyopia(>30 years).There was bilateral hypertension(by intraocular pressure:28 mmHg in right,34 mmHg in left)and normal fundi.Accordingly,acute primary angle closure was diagnosed.Miotics and ocular hypotensive drugs were prescribed,but the symptoms continued to worsen over the 3-d treatment course.Further imaging examinations(i.e.,anterior segment photography and ultrasonography)indicated a diagnosis of bilateral posterior scleritis.Methylprednisolone,topical atropine,and steroid eye drops were prescribed along with intraocular pressure-lowering agents.Subsequent optical coherence tomography(OCT)showed gradual improvements in subretinal fluid under the sensory retina,thickened sclera,and ciliary body detachment.CONCLUSION Bilateral posterior scleritis can lead to secondary acute angle closure.Diagnosis requires ophthalmic accessory examinations(i.e.,ultrasound biomicroscopy,Bscan,and OCT).

Phacoemulsification,Intraocular Lens Implantation,Goniosynechialysis,and Pseudo-Pupilloplasty for Refractory Acute Primary Angle Closure with Atonic Dilated Pupil

Objective To evaluate the efficacy and safety of prompt phacoemulsification,intraocular lens implantation,visco-goniosynechialysis,combined with pseudo-pupilloplasty for refractory acute primary angle closure(APAC)with atonic dilated pupil and to describe a feasible method of pupilloplasty.Methods A consecutive series of refractory APAC patients who had atonic dilated pupil and undergone prompt phacoemulsification combined with pseudo-pupilloplasty at our center were retrospectively analyzed.Pseudo-pupilloplasty referred to a method of pupilloplasty which included 4.5-mm capsulorhexis,postoperative opacification of anterior capsule residue,and ultimate pseudo-pupil formation.Preoperative and postoperative measurements included intraocular pressure(IOP),best corrected visual acuity(BCVA),and anterior chamber depth(ACD).Intraoperative and postoperative complications were documented.The process of pseudo-pupil formation was also observed.Results A total of 20 eyes of 19 APAC patients were followed up for 19.7±9.8 months.IOP was lowered from preoperative 44.0±9.8 mmHg to 15.5±2.6 mmHg at final visit(t=11.945,P<0.001).ACD was deepened from preoperative 1.77±0.21 mm to 3.40±0.20 mm at final visit(t=-27.711,P<0.001).Twelve of 20 eyes had residual angle synechiae,whereas only 3 eyes needed anti-glaucoma medications.No severe complication was observed.All eyes had pseudo-pupil gradually formed within 3 months,accompanied with the gradual improvement of BCVA from preoperative 1.18+0.55 to 0.58±0.22,0.26±0.09,0.11±0.09,and 0.11±.09 at postoperative day 1,month 1,month 3,and last visit.Conclusions Prompt phacoemulsification-goniosynechialysis is effective and safe for refractory APAC with atonic dilated pupil.Pseudo-pupilloplasty is a feasible procedure for pupil reconstruction.

Agreement of angle closure assessments between gonioscopy, anterior segment optical coherence tomography and spectral domain optical coherence tomography

AIM: To determine angle closure agreements between gonioscopy and anterior segment optical coherence tomography(AS-OCT), as well as gonioscopy and spectral domain OCT(SD-OCT). A secondary objective was to quantify inter-observer agreements of AS-OCT and SD-OCT assessments.METHODS: Seventeen consecutive subjects(33 eyes)were recruited from the study hospital’s Glaucoma clinic.Gonioscopy was performed by a glaucomatologist masked to OCT results. OCT images were read independently by 2 other glaucomatologists masked to gonioscopy findings as well as each other’s analyses of OCT images.RESULTS: Totally 84.8% and 45.5% of scleral spurs were visualized in AS-OCT and SD-OCT images respectively(P 【0.01). The agreement for angle closure between AS-OCT and gonioscopy was fair at k =0.31(95% confidence interval, CI: 0.03-0.59) and k =0.35(95%CI: 0.07-0.63) for reader 1 and 2 respectively. The agreement for angle closure between SD-OCT and gonioscopy was fair at k =0.21(95% CI: 0.07-0.49) and slight at k =0.17(95% CI: 0.08-0.42) for reader 1 and 2 respectively. The inter-reader agreement for angle closure in AS-OCT images was moderate at 0.51(95% CI: 0.13-0.88). The inter-reader agreement for angle closure in SD-OCT images was slight at 0.18(95% CI: 0.08-0.45).CONCLUSION: Significant proportion of scleral spurs were not visualised with SD-OCT imaging resulting in weaker inter-reader agreements. Identifying other angle landmarks in SD-OCT images will allow more consistent angle closure assessments. Gonioscopy and OCT imaging do not always agree in angle closure assessments but have their own advantages, and should be used together and not exclusively.

Clear lens extraction as the first line treatment of primary angle closure/primary angle closure glaucoma

Angle closure glaucoma(ACG)is one of the major causes of blindness.Angle closure occurs from the obstruction of the trabecular meshwork by the peripheral iris,which results in increased intraocular pressure(IOP)through impaired aqueous flow.Considering pupillary block by crystalline lens is the most frequent mechanism,lens extraction is regarded as an effective therapy.Recently,to validate the effect of lens extraction,the EAGLE study was reported.In this study,subjects were 50 years or older,did not have cataracts,and had newly diagnosed primary angle closure(PAC)with intraocular pressure 30 mmHg or greater or primary angle-closure glaucoma(PACG),and were divided into clear-lens extraction group and standard care group(laser peripheral iridotomy and topical glaucoma medication).This study suggested that clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy.Initial clear lens extraction showed better clinical course and patient-reported outcomes.This study provided evidence to support clear lens extraction as the first line treatment for PAC with high IOP or PACG patients.

AB025.One-year outcomes of trabecular micro-bypass stents with concomitant cataract surgery in primary angle closure glaucoma

Background:Trabecular microbypass stents have allowed improved multidirectional flow with good efficacy and safety profile in primary open-angle glaucoma(OAG).The efficacy of these devices in primary angle closure glaucoma has been understudied.We aimed to assess the one-year postoperative outcomes following implantation of trabecular micro-bypass stents with concomitant cataract surgery in angle-closure glaucoma patients.Methods:We evaluated the baseline clinical characteristics and the 12-month outcomes of patients with mild to severe primary angle-closure glaucoma who underwent cataract surgery with implantation of either a first generation trabecular microbypass stent(iStent group)or two second generation trabecular microbypass stents(iStent-inject group).The primary outcomes included intraocular pressure(IOP)and anti-glaucoma medication use.The secondary outcomes were success rate(defined by IOP between 5-18 mmHg with IOP reduction of at least 20%)and visual acuity.Results:A total of 83 eyes(58 from the iStent and 25 from the iStent-inject group)were included with an average age of 68.9±8.6 and 67.6±8.3 years,respectively.All eyes had mild to severe angle-closure glaucoma.At one-year follow-up,the IOP decreased by 21%(from 18.8±4.5 mmHg)and 25%(from 18.7±3.6 mmHg),in each group respectively(P<0.001).Additionally,the medication burden dropped by 52%and 50%at one-year follow-up(P<0.001).The 12-month success rate was 45%in the iStent group compared to 64%in the iStent-inject group(P=0.086)and visual acuity remained stable.Conclusions:The present study provides clinically relevant,real-world data on the utility of iStent and iStent inject with cataract surgery in angle-closure glaucoma-a population that has been understudied in the world of trabecular micro-bypass stents.Our data demonstrated efficacy of these stents in reducing intraocular pressure and medication burden among patients with primary angle closure glaucoma.

OCULAR BIOMETRY IN ANGLE CLOSURE GLAUCOMA AND SENILE CATARACT

senile population Objective To compare ocular biometric values in angle closure glaucoma and cataract in Methods Ocular biometry was performed in eyes classified to have angle closure glaucoma （29 eyes） and senile cataract （31 eyes）. Ocular biometry readings between two groups were compared and analyzed statistically, lntraocular pressure was also recorded before and after lens extraction. Results Anterior chamber depth was shallower in patients with angle closure glaucoma group [ （ 1, 79 ± 0. 56 ） mm ] compared with senile cataract group [ （2.69 ±0. 40） mm ] （ P 〈 0.01 ）. Lens thickness was greater in angle closure glaucoma group [ （5.30 ±0. 61） mm ] than that in senile cataract group [ （3.84 ＋-0. 61） mm ] （ P 〈0. 01）. Phacoemusification was performed in 5 patients with persistent acute attack of angle closure glaucoma, lOPs were controlled in all five cases after lens extraction. Conclusion Eyes with angle closure glaucoma seems to have significantly shallow anterior chamber and greater lens thickness compared to senile cataract eyes in the same age. Lens extraction might be effective in those cases with such anatomy features.

Intraocular pressure and gonioscopic findings in primary angle-closure disease in India—a big data study

AIM:To describe the gonioscopic profile and intraocular pressure(IOP)in primary angle-closure(PAC)disease in patients presenting to a tertiary eye care network in India.METHODS:A cross-sectional hospital-based study that included 31484 new patients presenting between 2011 and 2021.Patients with a clinical diagnosis of PAC/suspect/glaucoma were included.The data was collected from an electronic medical record system.RESULTS:PAC glaucoma(PACG)(47.55%)was the most common diagnosis followed by PAC(39.49%)and PAC suspect(PACS;12.96%).Female preponderance(54.6%)was noted with higher mean age at presentation among males(P<0.0001).PACS and PAC showed the highest prevalence in 6th decade but PACG was higher at 7th decade.The probability of angle opening was 95.93%,90.32%and 63.36%in PACS,PAC and PACG eyes respectively post peripheral iridotomy(PI).Plateau iris syndrome(PIS)was noted in 252 eyes and all showed post dilated rise of IOP.A post dilated IOP rise was also noted with 8.86%,33.95%and 57.19%eyes with PACS,PAC and PACG respectively with IOP rise between 6-8 mm Hg across the disease spectrum.CONCLUSION:The superior quadrant is the narrowest angle and difficult to open with indentation and post PI.The probability of angle opening is less in PIS especially the complete variety along with post dilated IOP rise.The post dilated IOP rise in angle closure eyes warrants a careful dilatation,especially with PIS.

Endoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation to manage primary angle-closure glaucoma

AIM: To describe and evaluate a new ophthalmic endoscope surgical technique combined with phacoe-mulsification and intraocular lens (IOL) implantation to treat goniosynechialysis and manage primary angle-closure glaucoma (PACG). ·METHODS: Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation was performed in 32 eyes of 29 patients with PACG. Regular follow-up was performed 1 week and 1 month, 3, and 6 months after surgery to assess complications, intraocular pressure (IOP), anterior chamber depth, visual acuity, and anterior chamber angle. ·RESULTS: Preoperative mean IOP was 24.88±7.22mmHg with pharmacological treatment, and was 13.70 ±4.02, 13.06 ±3.74, 14.29 ±4.70, and 14.33 ±5.01mmHg 1 week, 1 month, 3 months, and 6 months after surgery, respectively. The postoperative decrease in IOP was significant (P 【 0.05). The rate for all eyes with IOP of 21mmHg or less was 93.8% (30 eyes) at the final visit without ocular hypotensive agents. The average preoperative anterior chamber depth was 1.60 ±0.64mm, and this value significantly increased to 2.72±0.62, 2.76±0.70, 2.73±0.68, and 2.74 ±0.71mm at 1 week, 1 month, 3 months, and 6 months, respectively. Visual acuity was improved in 28 eyes (87.5% ) at 6 months postoperatively. The anterior chamber angle had increased in 25 eyes (78.1% ) at the final visit; it was adhesive 90°-180° in 6 eyes, 180°-270° in only 1 eye. Two eyes exhibited minimal hyphema in the early postoperative period, but it could gradually be absorbed. Fibrinous reaction was observed in five eyes and spontaneously disappeared within 7 days. No shallow anterior chamber, iridodialysis, choroidal deta-chment, or malignant glaucoma was found in any eyes.CONCLUSION:Endoscope-assisted goniosynechialysis combined with phacoemulsification and IOL implantation to manage PACG has several advantages, including optimized visualization, greater accuracy, and improved safety. Our results suggest that it has certain curative effects and clinical application value.

Efficacy of laser peripheral iridoplasty and iridotomy on medically refractory patients with acute primary angle closure： a three year outcome

Background Argon laser peripheral iridoplasty （ALPI） is proved to be effective in lowering intraocular pressure （lOP） of patients with mild acute primary angle closure （APAC）. It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC. This study aimed peripheral iridotomy （LPI） on patients with refractory APAC, therapy. to evaluate the IOP-lowering efficacy of ALPI and laser who have previously responded poorly to intensive medical Methods Thirty-six patients （8 men and 28 women） were identified as medically refractory APAC, who still had ocular pain, red eye, hazy cornea, closed anterior chamber （AC） angle, and lOP of not less than 21 mmHg after two days or more of anti-glaucoma medication. All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity （VA）, best corrected VA （BCVA）, lOP, biomicroscopy, and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes. Results All patients were affected unilaterally, with average age of （54.6±11.7） （range, 37.0-75.0） years old. The mean lOP value of the affected eyes dropped from （31.6±7.7） （range, 21.0-39.0） mmHg at enrollment to （18.4±8.7） （range, 10.0-27.0） mmHg 2 hours after ALPI. At follow-up day 7, the mean lOP value maintained at （14.8±4.2） （range, 9.0-21.0） mmHg, which was significantly different （P=0.000） compared with baseline. The average decrease of lOP in the APAC eyes was （16.8±7.4） （range, 12.0-21.0） mmHg. At follow-up three years later, the mean lOP of the APAC eyes stabilized at （16.3±3.2） （range, 9.0-20.0） mmHg with at least 180° of AC angle opened. Conclusion ALPI and LPI lower the lOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.

Clear lens extraction in angle-closure glaucoma patients

AIM: To describe the results of 5 consecutive cases of clear lens extraction in angle closure patients for the treatment of elevated intraocular pressure (IOP). ·METHODS: Retrospective observational case series. All angle closure patients were on two or more topical glaucoma medications and had prior laser iridotomy. Eyes underwent clear lens extraction by phacoemu - lsification with intraocular lens implantation. ·RESULTS: All five patients in this case series carried the diagnosis of angle -closure glaucoma and had uncontrolled IOP prior to surgery despite topical medications. After clear lens extraction three of the cases had good IOP control (IOP 【22mmHg) without the need for topical medications. In one case the IOP was better controlled after surgery, however, topical medications were required. The desired IOP was not met in one case despite restarting maximum topical therapy. ·CONCLUSION: This case series suggests that there may be a role for therapeutic clear lens extraction in select cases of angle-closure glaucoma.