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

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...

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.

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.

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.

Damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma

AIMTo observe the differences of damage patterns of retinal nerve fiber layer (RNFL) between acute and chronic intraocular pressure (IOP) elevation in primary angle closure glaucoma (PACG) using optical coherence tomography (OCT).

Surgical treatment for primary angle closure-glaucoma: a Meta analysis

AIM To evaluate the efficacy and safety of trabeculectomy, phacotrabeculectomy plus intraocular lens implantation (phacotrab+IOL group) and phacoemulsification with IOL (phaco+IOL) in primary angle-closure glaucoma(PACG). METHODS: It was a systematic review and meta-analysis, randomized controlled trials(RCT) and clinical controlled trials (CCT) were collected through electronic searches of the Cochrane Library, PubMed, EMbase, Wanfang Database online, Chinese journal Full-text Database, Chinese Scientific Journals Full-text Database (from the date of building the database to October 2010) We also checked the bibliographies of retrieved articles. M the related data that matched our standards were abstracted. The quality of included trials was evaluated according to the Dutch Cochrane Centre. Rev Man 5.0 software was used for Meta-analysis. RESULTS: A total of 5 RCT and 11 CCT involving 1495 eyes were included. The results of meta-analysis showed that phacotrab+IOL group was superior than trabeculectomy(trab group) (MD -3.93,95% CI [-7.31, -0.54]) which was also superior than phaco+IOL group(MD 0.52,95%CI [0.10, 0.95]) in decreasing Intraocular Pressure(IOP). Phacotrab group(MD -1.45,95%CI [-1.68, -1.22])and phaco group (MD-1.12,95% CI [-1.87, -0.37])are both deeper than trab group in the anterior chamber depth. In increasing the coefficient of outflow facility of aqueous humor (C values) there was no statistical difference in the three groups. And there was no statistical difference between phacotrab groups and phaco groups in visual acuity but phacotrab group was superior than phaco group (MD 1.07, 95% CI [0.73, 1.40])in the use of IOP-lowering drugs. There was no statistical difference among three groups. CONCLUSION: Current evidence suggests that phacotrab+IOL group was superior than tab group which was also superior than phaco+IOL group in decreasing IOP. Phacotrab group and phaco group are both deeper than trab group in the anterior chamber depth. Phacotrab group was superior than phaco group in the use of IOP-lowering drugs.

Genome-wide association study in primary angle closure glaucoma

Before the Human Genome Project,family-based mapping,positional cloning and mutation screening of candidate genes were largely used to ascertain the etiology of a given genetic disease.While this method proved to be very effective for most Mendelian single-gene disorders,it was not efficient for multigenic disorders with unknown genetic etiology.Subsequent advancement in molecular genetics techniques provided an opportunity to screen millions of biological markers in thousands of patients in a relatively short period of time.One rapid technique that is already used in a large number of clinical disorders is genome-wide association study(GWAS).Other screening methods include next-generation exome sequencing,whole-genome sequencing and targeted regional sequencing.

Role of Phacoemulsification in Angle Closure Glaucoma

Cataract or clear lens extraction has been suggested as a treatment option for different spectrums of primary angle closure diseases.It might reduce the risk of progression of angle closure and/or glaucoma by helping to open the angle and control the intraocular pressure (IOP).Conventionally,medically uncontrolled primary angle closure glaucoma was treated with trabeculectomy or phacotrabeculectomy and acute primary angle closure was treated with laser peripheral iridotomy. However,recent randomized controlled trials have demonstrated greater promise of phacoemulsification cataract surgery alone for control of the IOP. In this report we review the current literature to evaluate the impact of cataract surgery upon preventing and controlling primary angle closure diseases.

Safety and Efficacy of Combined Trabeculectomy for Primary Angle Closure Glaucoma with Persistent Ocular Hypertension

Purpose:To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension.Methods:A total of 36 patients.(40 eyes).with primary acute angle closure glaucoma,who were treated with combined trabeculectomy in the Ophthalmology Unit of our hospital,were selected.Before the procedure,patients were assigned to ocular hypertension group(≥ 40 mm Hg) or control group(< 40 mm Hg) based on intraocular pressure.These two groups were followed up for one year,and compared for post-operative visual acuity,intraocular pressure,filtering bleb,anterior chamber depth,and the occurrence of complications.Results:At 1 week,6 months,and 12 months after the procedure,intraocular pressure was controlled in both the ocular hypertension group and the control group,without significant differences between the two groups(P>0.05).At 1 week,6 months,and 12 months after the procedure,all of the patients,in both groups,had improved in terms of visual acuity,with a significant difference before and after the procedure for the ocular hypertension group(P<0.05).After follow-up at 12 months,the two groups presented no statistically significant differences in anterior chamber depth,filtering bleb survival,or the incidence of post-operative complications(P>0.05 for all).Conclusion:It is feasible,safe,and effective to perform combined trabeculectomy on patients with primary acute angle closure glaucoma complicated by persistent ocular hypertension.

The Damage Patterns of Retinal Nerve Fiber Layer in Acute and Chronic Intraocular Pressure Elevation in Primary Angle Closure Glaucoma

Purpose:To observe the differences of damage patterns of retinal nerve fiber layer(RNFL) between acute and chronic intraocular pressure(IOP) elevation in primary angle closure glaucoma.(PACG).using optical coherence tomography(OCT).Methods:Twenty four patients(48 eyes) with unilateral acute PACG(APACG) attack in the 6 months after remission and 36 patients(64 eyes) with chronic PACG(CPACG) were included in this prospective study.For all cases,IOP has been controlled less than 21 mmHg after treatment.Using stratus OCT,the RNFL thickness was assessed in eyes with PACG within 3 days,2 weeks,1,3 and 6 months after IOP controlled.Repeated measures ANOVA was used to examine the time course of changes after IOP controlled in RNFL thickness in both acute attack and unaffected fellow eyes of APACG and eyes with CPACG.Results:The mean RNFL thickness(μm) for the APACG-attacked eyes increased significantly within 3 days.(121.49±23.84).after acute strike and then became thinner along with time.(107.22±24.72 at 2 week,93.58±18.37 at 1 month,84.10±19.89 at 3 months and 78.98±19.17 at 6 months).In APACG-attacked eyes,there were significant differences of average RNFL thickness among 5 different times after IOP was controlled(P<0.001).In the APACG unaffected fellow eyes and CPACG eyes,there were no significant differences in mean RNFL thickness among 5 different times(F=0.450,P=0.104 in APACG unaffected fellow eyes and F=1.558,P=0.200 in CPACG eyes).There was significant difference for interaction between time periods and groups(F=1.912,P= 0.003).Conclusion:RNFL damage patterns are different under different IOP elevated courses.In APACG,RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time,while RNFL was found to be diffused thinness in CPACG.

Iridoschisis misdiagnosed as acute angle-closure glaucoma:a case report and literature review

We present the case of a patient with iridoschisis complicated with cataract,peripheral anterior synechiae(PAS),secondary glaucoma,and corneal endothelial damage.The patient was initially misdiagnosed with acute angle-closure glaucoma.Iridoschisis is a rare condition characterized by the splitting of the iris into two layers:the anterior layer breaks down into fibers,floating freely in the anterior chamber with a“shredded wheat”appearance.

Micropulse transscleral laser therapy for secondary angle-closure glaucoma in nanophthalmos: a case report

Dear Editor,The choice of surgical intervention for nanophthalmos patients with secondary angle-closure glaucoma poses a challenging decision for ophthalmologists.Because nanophthalmos patients who have undergone filtration surgery or other intraocular procedures are more susceptible to severe complications,including choroidal effusion,malignant glaucoma,and explosive choroidal hemorrhage,all of which can lead to vision loss[1].This dilemma is particularly pronounced in patients with shorter axial lengths.Micropulse transscleral laser therapy(M-TLT),also known as micropulse transscleral cyclophotocoagulation(MP-TSCPC),is a nonincisional laser therapy surgery for glaucoma[2].In 2015,Golan and Kurtz[3]were the first to report four patients with secondary angle-closure glaucoma in nanophthalmos with axial lengths ranging between 17 and 19 mm(mean 18 mm)who were successfully treated with M-TLT,and choroidal detachment was observed in all patients(recovery spontaneously in two patients and recovery after systemic steroid treatment in the other two),of which two had a slight decrease in visual acuity.

Clinical Application of Cataract Ultrasonic Emulsification Combined with Atrial Angle Segmentation in the Treatment of Primary Angle-Closure Glaucoma

Objective:To evaluate the therapeutic effect of cataract ultrasonic emulsification(PE)combined with atrial angle separation(CSS)for primary angle-closure glaucoma(PACG).Methods:78 patients with PACG admitted to the hospital between October 2021 and October 2023 were selected and grouped by randomized numerical table;39 cases were counted in the observation group and selected PE combined with CSS surgery;39 cases were counted in the reference group and selected PE combined with trabeculectomy and the total effective rate,the state of the atrial angle,the clinical indexes,the degree of ocular symptoms,and the complication rate were compared.Results:The total effective rate of the observation group was higher than that of the reference group,and the percentage of the wide atrial angle of the atrial angle status was higher than that of the reference group;3 months after the operation,the logarithm of the minimum angle of resolution(Log MAR)and intraocular pressure of the observation group was lower than that of the reference group,and the central anterior chamber depth(ACD)was greater than that of the reference group;the scores of the degree of ocular symptoms of the observation group were lower than that of the reference group,and the rate of complication was lower than that of the reference group(P<0.05).Conclusion:PE combined with CSS surgical treatment for PACG patients can improve the efficacy of treatment,improve the state of the patients’atrial angles,and restore the ocular function indexes.It can alleviate the ocular symptoms as soon as possible and has a high surgical safety.

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.

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.