Three-dimensional choroidal vascularity index and choroidal thickness in fellow eyes of acute and chronic primary angle-closure using swept-source optical coherence tomography

AIM:To compare the three-dimensional choroidal vascularity index(CVI)and choroidal thickness between fellow eyes of acute primary angle-closure(F-APAC)and chronic primary angle-closure glaucoma(F-CPACG)and the eyes of normal controls.METHODS:This study included 37 patients with unilateral APAC,37 with asymmetric CPACG without prior treatment,and 36 healthy participants.Using swept-source optical coherence tomography(SS-OCT),the macular and peripapillary choroidal thickness and three-dimensional CVI were measured and compared globally and sectorally.Pearson’s correlation analysis and multivariate regression models were used to evaluate choroidal thickness or CVI with related factors.RESULTS:The mean subfoveal CVIs were 0.35±0.10,0.33±0.09,and 0.29±0.04,and the mean subfoveal choroidal thickness were 315.62±52.92,306.22±59.29,and 262.69±45.55μm in the F-APAC,F-CPACG,and normal groups,respectively.All macular sectors showed significantly higher CVIs and choroidal thickness in the F-APAC and F-CPACG eyes than in the normal eyes(P<0.05),while there were no significant differences between the F-APAC and F-CPACG eyes.In the peripapillary region,the mean overall CVIs were 0.21±0.08,0.20±0.08,and 0.19±0.05,and the mean overall choroidal thickness were 180.45±54.18,174.82±50.67,and 176.18±37.94μm in the F-APAC,F-CPACG,and normal groups,respectively.There were no significant differences between any of the two groups in all peripapillary sectors.Younger age,shorter axial length,and the F-APAC or F-CPACG diagnosis were significantly associated with higher subfoveal CVI and thicker subfoveal choroidal thickness(P<0.05).CONCLUSION:The fellow eyes of unilateral APAC or asymmetric CPACG have higher macular CVI and choroidal thickness than those of the normal controls.Neither CVI nor choroidal thickness can distinguish between eyes predisposed to APAC or CPACG.A thicker choroid with a higher vascular volume may play a role in the pathogenesis of primary angle-closure glaucoma.

Diffusion tensor imaging of optic nerve and optic radiation in primary chronic angle-closure glaucoma using 3T magnetic resonance imaging

AIM: To evaluate the value of quantitative diffusion tensor imaging (DTI) in assessing the axonal and myelin damage of the optic nerves and optic radiations in patients with chronic primary angle -closure glaucoma (PACG) by using high -field magnetic resonance (MR) imaging (3T). METHODS: Twenty patients with bilateral chronic PACG and twenty age - and sex matched disease -free control subjects were enrolled. Conventional MRI and DTI were performed on all subjects using 3T MR scanner. Mean diffusivity (MD), fractional anisotropy (FA), axial diffusivities (AD) and radial diffusivities (RD) of each optic nerve and each optic radiation were measured by using post -processing software of DTI studio 2.3, and then compared between left eyes and right eyes and between patients group and control group. The pairedsample t- test were used. RESULTS: There was no abnormality in the shape and signal intensity of the optic nerves and optic radiations in patients group and control group on the conventional MRI. No significant differences were observed in the FA, MD, AD and RD between the right and left optic nerves and optic radiations within patients group and control group (P>0.05). The optic nerves and optic radiations of patients with chronic PACG, as compared with control subjects, had significantly higher MD, AD, RD and significantly lower FA (P<0.05). CONCLUSION: The diffusivity of optic nerves and optic radiations in chronic PACG group showed abnormal and diffusivity parameters could be used markers of axonal and myelin injury in glaucoma.

Comparison of phacotrabeculectomy and sequential surgery in the treatment of chronic angle-closure glaucoma coexisted with cataract

AIM： To compare the safety and effectiveness of phacotrabeculectomy versus sequential surgery in chronic angle-closure glaucoma（CACG） with coexisting cataract.·METHODS： One hundred and sixty-two CACG patients（162 eyes） were retrospectively analyzed. Of them, 87patients（87 eyes） in group A had underwent phacotrabeculectomy with intraocular lens（IOL）implantation, and 75 patients（75 eyes） in group B had underwent sequential surgery with IOL implanted. Best-corrected visual acuity（BCVA）, intraocular pressure（IOP）, complications and anterior chamber angle（ACA）were measured.· RESULTS： Demographic characteristics of the two groups were similar. A mean follow-up period was 15±6mo（range 13 to 24mo）, a mean IOP of 12.14 ±5.32 mm Hg in group A and 11.38 ±4.06 mm Hg in group B（P =0.84） at the last follow up. The Kaplan-Meier analysis revealed that the cumulative probability of success in both groups was similar（P =0.61）. Anterior uveitis and hypotony were the most common complications in group A, whereas group B experienced shallow anterior chamber with trabeculectomy. With the exception of anterior uveitis, no complications occurred to 11 trabeculectomized eyes. All postoperative measurements of anterior chamber showed statistically significant differences in each group according to the preoperative data（P〈 0.05）. However,fewer changes occurred in group B than in group A.· CONCLUSION： Phacotrabeculectomy and sequential surgery exhibit similar IOP reduction, visual recovery,and complications when treating CACG patients with cataract. However, for a wider ACA, phacotrabeculectomy has demonstrated higher effectiveness than sequential surgery.

Post-miosis changes in the anterior chamber structures in primary and lens-induced secondary chronic angle-closure glaucoma

To evaluate post-miosis changes in the anterior chamber structures in various angle-closure glaucomas(ACG). Totally 14 eyes of primary chronic angle-closure glaucoma(PCACG), 12 eyes of lens-induced secondary chronic angleclosure glaucoma(LSACG) and 14 healthy eyes were recruited. After miosis, for PCACG group, intraocular pressure(IOP) and anterior chamber depth(ACD) changed not significantly, while anterior chamber angle widened significantly. LSACG group showed a significant increase in IOP, decrease in ACD, and narrowing in anterior chamber angle. Healthy eyes showed significant decreases in IOP and anterior chamber parameters. Thus, miosis could widen the anterior chamber angle of patients with PCACG, while increase the narrowing of anterior chamber angle and IOP of patients with LSACG. We should pay attention to the distinction between PCACG and LSACG patients and the proper administration of pilocarpine in the treatment of patients with chronic ACG.

Effect of low dose laser cycloplasty on deepening anterior chamber in chronic angle-closure glaucoma

AIM:To describe the outcome of using low-dose laser cycloplasty(LCP)in chronic angle-closure glaucoma(CACG).METHODS:A retrospective case series.Medical charts of CACG patients who underwent LCP in the Eye Hospital of Wenzhou Medical University were reviewed.The main outcomes included intraocular pressure(IOP),the number of glaucoma medication,anterior segment parameters and surgery-related complications.RESULTS:A total of 7 eyes of 7 CACG patients(age 38.9±11.0y)underwent LCP with a mean follow-up of 27.1±13.7mo(range 16-48mo).Following LCP,mean IOP and glaucoma medications decreased from 26.1±6.1 mm Hg with 3.1±1.1 glaucoma medications pre-treatment to 14.9±3.1 mm Hg(P=0.027)with 0.4±1.1 glaucoma medications(P=0.001)at final follow-up.The anterior chamber depth(ACD),angle opening distance500 and trabecular-iris angle increased from 1.65±0.33 mm,0.05 mm(range 0-0.30 mm)and 5.1°(range,0-31.97°)at baseline to 1.98±0.43 mm(P=0.073),0.53 mm(range 0.42-0.91 mm,P=0.015),45.9°(range,40.2°-59.4°),(P=0.015)in the long-term follow-up,respectively.The deepening of ACD and reopening of anterior chamber angle(ACA)was observed in 6 eyes(85.7%).CONCLUSION:LCP is a promising treatment option for patients with CACG via reducing IOP and glaucoma medication without serious complications.In addition,LCP can bring a significant deepening in ACD and reopening of ACA.

Outcomes of chronic angle-closure glaucoma treated by phacoemulsification and endocyclophotocoagulation with or without endoscopically goniosynechialysis

AIM:To investigate the surgical outcomes of patients with chronic angle-closure glaucoma(CACG)treated with phacoemulsification(phaco)/endocyclophotocoagulation(ECP)with and without endoscopic goniosynechialysis(E-GSL).METHODS:A retrospective,nonrandomized,comparative case series was conducted.Patients with CACG who underwent phaco in combination with either ECP alone(ECP group)or GSL with ECP(E-GSL group)from 2018 to 2019 were followed for 12mo and reviewed.Clinical features and outcomes were identified and analyzed.The ECP and E-GSL groups were matched in age and baseline intraocular pressure(IOP).Changes in IOP,mean of visual acuity(VA),peripheral anterior synechiae(PAS)formation,and the number of glaucoma medications was examined.RESULTS:The ECP group included 32 eyes of 27 patients,and the E-GSL group included 32 eyes of 26 patients.The preoperative baseline IOP was 22.18±6.48 mm Hg in the ECP group and 22.95±6.71 mm Hg in the E-GSL group(P=0.644).The mean IOP reduction was 26.2%in the ECP group and 41.6%in the E-GSL group at 12mo.The mean postoperative VA(log MAR units)at 12mo was 0.47 in the ECP group and 0.36 in the E-GSL group.The reduction in PAS formation and the number of glaucoma medications was also higher in the ECP group than E-GSL group at 12mo.CONCLUSION:The phaco/ECP and phaco/E-GSL groups both achieve a significant reduction in IOP without complications associated with traditional glaucoma filtration surgeries.

Primary Chronic Angle-closure Glaucoma in Chinese——A Clinical Exploration of Its Pathogenesis And Natural Course

Fourty-three cases (86 eyes) of primary chronic angle-closure glaucoma were randomly selected. An additional 44 cases (77 eyes) of primary acute angle-closure glaucoma and 30 normal subjects (34 eyes) were also randomly enrolled as control groups for comparison in the clinical study. Ultrasonic biometric measurements of the anterior chamber depth, lens thickness and axial length of the eyeball were performed. Using an potic microgauge attached to the slit-lamp, the entrance of anterior chamber angle was...

Indicating and predicting role of the horizontal C/D ratio in preclinical diabetic retinopathy associated with chronic angle-closure glaucoma

AIM: To observe morphological optic disc characteristics in patients with preclinical diabetic retinopathy(DR) associated with chronic angle-closure glaucoma(CACG). METHODS: Twenty-two cases(43 eyes) of preclinical DR associated with CACG were enrolled in group A; 24 preclinical DR cases(46 eyes) were enrolled in group B; 26 CACG cases(51 eyes) were enrolled in group C; and 49 normal controls(49 eyes) were enrolled in group D. All underwent optical coherence tomography to measure the horizontal C/D ratio(HCDR), C/D area ratio(CDaR), vertical C/D ratio(VCDR), rim area(RA), cup volume(CV), disc area(DA) and average retinal nerve fiber layer(RNFL) thickness. RESULTS: The ages of groups A, B, C, and D were 67.60±3.36, 66.78±3.33, 65.98±3.83, and 67.54±3.17 y, respectively. The HCDR values in groups A, B, and C were distinct relative to those in group D(P<0.0001, P<0.01, and P<0.05, respectively). The HCDR values in group A were higher compared with those in groups B(P<0.0001) and D(P<0.0001); while these values were virtually identical statistically between groups A and C(P>0.05). The CDaR values in group A were higher in comparison to those in groups B and D(P<0.0001 in both groups); while these values were virtually identical statistically between groups A and C(P>0.05). The RA values in group A were smaller relative to those in groups B and D(P<0.0001 in both groups); while groups A and C were not distinct statistically(P>0.05). The CV values in group A were greater in comparison to those in groups B and D(P<0.0001 in both groups); while groups A and C were not distinct statistically(P>0.05). DA was not distinct for comparisons of two groups among the four groups(P>0.05). HCDR value correlated with mean nasal RNFL thickness(r=-0.909,P<0.0001), mean superior RNFL thickness(r=-0.866, P<0.0001), mean inferior RNFL thickness(r=-0.650, P<0.001) and mean temporal RNFL thickness(r=-0.562, P<0.01) in group A. CONCLUSION: The HCDR was a sensitive morphological parameter in detecting structural visual disc changes in preclinical DR associated with CACG, which can reflect optic nerve damage caused jointly by CACG and diabetes. A higher HCDR may predict optic nerve atrophy.

Efficacy of Combined Phacoemulsification and Goniosynechialysis in the Treatment of Patients with Primary Angle Closure Disease and Concomitant Cataract at Preah Ang Duong Hospital in Cambodia

Background: Goniosynechialysis is a surgical procedure that has been shown to slow the progression of glaucoma in oriental eyes with chronic angle closure glaucoma. This procedure was successful in 80% of cases, and the peripheral anterior syenchiae did not exist until one year later. Nonetheless, there is little evidence of its efficacy in our context. Our study aims to investigate the efficacy of goniosynechialysis during phacoemulsification in patients with primary angle closure disease and concomitant cataract. Methods: This was an observational, prospective study. The intra-ocular pressure, need for anti-glaucoma drugs, visual acuity, the extent of synechiae, anterior chamber depth, surgical success rate, and other indicators were monitored for at least three months following surgery. Results: This study included 114 patients (118 eyes), 61 with chronic angle closure glaucoma (51.69%), 33 with primary angle closure (27.97%), and 24 with acute attack angle closure (20.34%), who were surgically treated with phacoemulsification and goniosynechialysis (Phaco-GSL). The mean intra-ocular pressure had significantly decreased three months after surgery (pre- vs post-op: 22.04 ± 10.86 vs 15.41 ± 6.06 mmHg, p-value p-value p-value p-value p-value Conclusion: Regardless of the type of glaucoma, combined phacoemulsification-goniosynechialysis is effective in lowering pressure, restoring vision, reducing the need for anti-glaucoma drugs, and preventing the synechial recurrence. Success was higher in eyes with less extensive synechiae. Phaco-GSL is safe and effective in the treatment of primary angle closure diseases with co-existing cataract.

矿泉浴治疗慢性单纯性青光眼研究

目的 了解矿泉浴对慢性单纯性青光眼的治疗作用。方法 采用兴城矿泉水对１７ 例３１ 眼慢性单纯性青光眼患者进行全身浸浴，水温３９ ～４０ ℃，每次３０ 分钟，２０天１ 个疗程，用Ｓｃｈｉｏｘｚ 眼压计于浴前、浴后测量２４ 小时眼压曲线。结果 浴前所有患眼２４ 小时眼压差值均大于１－０６ｋＰａ，平均１－２１ ±０－６１ｋＰａ ；浴后所有患眼２４ 小时眼压曲线差值均较浴前降低，平均０－９２ ±０－５８ｋＰａ，与浴前比较ｔ＝ ３ ．２２２ ， Ｐ ＜ ０ ．０１ 。结论 兴城矿泉浴能降低慢性单纯性青光眼的眼压。

晶状体超声乳化术对慢性闭角型青光眼的疗效评价

目的评价单纯晶状体超声乳化人工晶状体植入术或再联合小梁切除术治疗伴有白内障的原发慢性闭角型青光眼的疗效。方法30例(44眼)慢性闭角型青光眼,按房角粘连关闭范围分组,分别行单纯超声乳化人工晶状体植入术或超声乳化人工晶状体植入联合小梁切除术。比较两组术后眼压、视力、前房深度以及前房角的变化。结果前房角粘连关闭范围小于180°的,单纯超声乳化人工晶状体植入术,术后眼压94.11%稳定在正常范围;而对前房角粘连关闭范围大于180°者,其中11眼行单纯超声乳化人工晶状体植入术,术后63.64%眼压稳定在正常范围;另16眼行超声乳化人工晶状体植入联合小梁切除术,术后眼压93.75%稳定在正常范围。所有病例,手术后的视力大多有提高,前房深度增加,均未见前房角关闭或粘连范围扩大。结论超声乳化对治疗前房角粘连关闭范围<180°者具有显著效果,而对于前房角粘连关闭范围>180°者联合小梁切除术的疗效高于单纯超声乳化术。