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.

Secondary in-the-bag intraocular lens implantation combined with 120-and 360-degree goniotomy in glaucoma following congenital cataract surgery:a case report

Dear Editor,Glaucoma following cataract surgery(GFCS)is one of the most sight-threatening postoperative complications of pediatric cataract surgery,and often becomes refractory to medical treatment[1].Goniotomy has been an increasingly popular procedure for primary open angle glaucoma and primary angle-closure glaucoma with 120-.

Comment on “Management strategies in malignant glaucoma secondary to antiglaucoma surgery”

Dear Editor,We read with great interest the article by Wu et al[1]which comprehensively assessed the outcomes of various interventions in 38 eyes of 35 patients with malignant glaucoma（MG）secondary to antiglaucoma surgery whowere followed up for an average of 27.1mo.

Multiple methods of surgical treatment combined with primary IOL implantation on traumatic lens subluxation/dislocation in patients with secondary glaucoma

AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma,and discuss the multiple treating methods of operation combined with primary intraocular lens(IOL)implantation.METHODS:Non-comparativeretrospectiveobservational case series.Participants:30 cases(30 eyes)of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi’an No.4Hospital from 2007 to 2011.According to the different situations of lens subluxation/dislocation,various surgical procedures were performed such as crystalline lens phacoemulsification,crystalline lens phacoemulsification combined anterior vitrectomy,intracapsular cataract extraction combined anterior vitrectomy,lensectomy combined anterior vitrectomy though peripheral transparent cornea incision,pars plana lensectomy combined pars plana vitrectomy,and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy.And whether to implement trabeculectomy depended on the different situations of secondary glaucoma.The posterior chamber intraocular lenses(PC-IOLs)were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present.Main outcome measures:visual acuity,intraocular pressure,the situation of intraocular lens and complications after the operations.RESULTS:The follow-up time was 11-36mo(21.4±7.13).Postoperative visual acuity of all eyes were improved;28 cases maintained IOP below 21 mm Hg;2cases had slightly IOL subluxation,4 cases had slightlytilted lens optical area;1 case had postoperative choroidal detachment;4 cases had postoperative corneal edema more than 1wk,but eventually recovered transparent;2 cases had mild postoperative vitreous hemorrhage,and absorbed 4wk later.There was no postoperative retinal detachment,IOL dislocation,and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective,which can effectively control the intraocular pressure and restore some vision.

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

Secondary glaucoma after pediatric cataract surgery

AIM: To determine the incidence and risk factors of secondary glaucoma after pediatric cataract surgery.METHODS: Two hundred and forty nine eyes of 148 patients underwent cataract surgery without intraocular lens (IOL) implantation (group 1), and 220 eyes of 129 patients underwent cataract surgery with IOL implantation (group 2) retrospectively, were evaluated between 2000 and 2011. The outcome measure was the presence or absence of post-cataract surgery glaucoma, defined as an intraocular pressure (IOP) ≥26mmHg, as measured on at least two occasions along with corneal or optic nerve changes.RESULTS: The mean follow-up periods of group 1 and 2 were (60.86 ±30.95) months (12-123 months) and (62.11±31.29) months (14-115 months) respectively. In group 1, 12 eyes of 8 patients (4.8% ) developed glaucoma. None of the patients developed glaucoma after surgery in group 2. The mean age of the patients at the cataract surgery was (2.58±0.90) months (1 month-4 months) and the average period for glaucoma development after surgery was (9.50 ±4.33) months (4-16 months) in group 1. Three of the 12 glaucomatous eyes were controlled with antiglaucomatous medication and 9 eyes underwent trabeculectomy+mitomycinC surgery.Onepatientunderwent a second trabeculectomy+mitomycin C operation for both of his eyes.CONCLUSION:The incidence of glaucoma after pediatric cataract surgery is very low in patients in whom IOL is implanted. The aphakic eyes after pediatric cataract surgery are at an increased risk for glaucoma development particularly if they underwent surgery before 4 months of age.

Efficacy of microcatheter-assisted trabeculotomy on secondary glaucoma after congenital cataract surgery

AIM: To evaluate efficacy of microcatheter-assisted trabeculotomy(MAT) in eyes with secondary glaucoma after congenital cataract surgery and explore its correlation with the different degree of trabeculotomy. METHODS: A retrospective analysis was conducted on patients who underwent the said procedure between September 2019 and September 2020. The patients were classified into two groups according to the degree of trabeculotomy(group 1: ≤240-degree;group 2: 240–360-degree). The intraocular pressure(IOP) and antiglaucoma drugs before and after operation was collected during the 12-month follow-up. RESULTS: Totally 27 eyes of 25 patients were included: 11(40.7%) eyes in group 1 and 16(59.3%) eyes in group 2. The mean IOP of all patients was 34.67±9.18 mm Hg preoperatively and 8.74±4.32, 9.95±5.65, 14.39±5.30, 16.02±4.37, 15.82±3.28, and 16.19±3.56 mm Hg 1 d, 1 wk, 1, 3, 6, and 12 mo after surgery, respectively. In all patients, there were significant differences in IOP at each time point(F=65.614, P<0.01). In each group, IOP after surgery was lower than that before surgery(all P<0.01), but there was no difference in the rate of IOP reduction between the two groups(P=0.246). Furthermore, the amount of anti-glaucoma medications reduced to 0.30±0.67(0–2) at 12 mo from 2.63±0.49(2–3) preoperatively(P<0.01), and there was no difference between the two groups(P>0.05). At the end of follow-up, the partial success rate was 81.8% in group 1 vs 93.75% in group 2(P=0.549). Various amount of intraoperative and postoperative hyphema occurred in all eyes, which spontaneously absorbed or cleaned through paracentesis and irrigation. No other serious complications was observed.CONCLUSION: MAT can effectively reduce IOP in patients with secondary glaucoma after congenital cataract surgery with a high success rate and safety. And it can be used as the first choice for the treatment of secondary glaucoma after surgery for congenital cataracts.

A Case of Refractory Childhood Glaucoma Secondary to Weill-Marchesani Syndrome:Management with Combined CO_(2) Laser-Assisted Sclerectomy Surgery and Trabeculectomy

A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature,short and stubby hands and feet,language disorders and mental retardation.He developed bilateral angle closure glaucoma,ectopia lentis and suffered visual loss from the ocular features of Weill-Marchesani syndrome.The child was successfully treated by combined CO_(2) laser-assisted sclerectomy surgery and trabeculectomy.

Retinoblastoma in an older child with secondary glaucoma as the first clinical presenting symptom: A case report

BACKGROUND Retinoblastoma(Rb)is primarily found in infants or young children.The most common primary presenting sign of Rb is leukocoria.Rb is very rare in children who are 10 years old or older.Timely and correct diagnosis as well as proper treatment are the key factors affecting the prognosis of Rb.CASE SUMMARY A 10-year-old girl with symptoms of vision loss,redness,swelling and pain in the right eye for 2 mo was admitted to our Department of Ophthalmology.The visual acuity of the right eye was graded as hand movement.The intraocular pressure of the eye was 46.9 mmHg.No substantial space-occupying lesion or characteristic calcified plaque was found in the eye.The patient underwent anterior chamber irrigation under general anesthesia on the same day of admission,and 2 mL of irrigation solution was saved for pathological examination.Histopathological examination of the anterior chamber fluid revealed cancer cells.A diagnosis of Rb with masquerade syndrome was made.The patient underwent enucleation followed by 6 rounds of systematic chemotherapy.A follow-up examination almost 9 years later found no relapse of Rb.CONCLUSION For older pediatric patients who have secondary glaucoma and uveitis symptoms without a clear cause of the disease and have no space-occupying lesion found by imaging examination,aqueous humor or vitreous humor examination is recommended for timely and correct diagnosis and appropriate treatment.

The Clinical Analysis of Secondary Glaucoma Following Posterior Chamber Intraocular Lens Implantation

We present 14 patients with secondary gluacoma following the implantation of a posterior chamber intraocular lens (lOLs). All patients were u-nilateral gluacoma , which developed within 1 month following the IOL implantation in 10 cases, and from 1 to 3 years in 4 cases. The angle of anterior chamber was open in 8 patients, and close in 6 ones. Seven patients required treatment of antiglaucomatous medicine; 4 patients underwent laser indecto-my and 3 patients required antiglaucoma surgery. The results s...

Management strategies in malignant glaucoma secondary to antiglaucoma surgery

AIM：To assess the outcomes of various interventions for malignant glaucoma（MG）.·M ETHODS：A retrospective,comparative analysis of case series were performed on 38 eyes of 35 MG patients treated in Aier Eye Hospital of Wuhan between Jan.2009and Dec.2012.Numerous treatments were administered including medical therapy,neodymium：yttriumaluminium-garnet（Nd：YAG）laser posterior capsulotomy and hyaloidotomy as well as 3 surgical options.The characteristic,treatment option and outcome of MG in every individual patient were reviewed and analyzed among all patients who were followed up for an average of 27.1±9.1mo.·RESULTS：Four eyes of 3 patients achieved complete resolution with medical therapy.Nd：YAG laser posterior capsulotomy and hyaloidotomy were performed on 2 eyes,both of which achieved resolution after initial intervention.Thirty-two eyes were given surgical treatments with anterior vitrectomy-reformation of anterior chamber in13 eyes,phacoemulsification-intraocular lens implantation in 10 eyes and phacoemulsification-intraocular lens implantation-anterior vitrectomy in 9 eyes.Resolution of MG was seen in almost all patients.The mean intraocular pressure decreased from 41.87±9.44 mm Hg at presentation to 15.84±3.73 mm Hg at the last visit.The mean anterior chamber depth improved from 0.28±0.27 mm to 2.28±0.19 mm.Twenty eyes with preoperative visual acuity better than counting figure/50 cm had various visual improvements.Complications occurred in 3 eyes of 3 patients including bleeding at the entry site of vitrectomy into vitreous cavity,corneal endothelial decompensation and allergic to atropine respectively.·CONCLUSION：MG occurs as a result of multiple mechanisms involved simultaneously or sequentially.Medical therapy is advocated as the initial treatment,laser therapy is beneficial in pseudophakic eyes,and different surgical regimen is recommended based on different pathogenesis of MG when non-response occurs to nonsurgical management.MG can be managed successfully by appropriate and timely interventions with good visual outcome.

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.

Trabeculectomy with Ologen implant versus mitomycin C in congenital glaucoma secondary to Sturge Weber Syndrome

AIM： To compare the efficacy and safety of collagen matrix implant [Ologen（OLO） implant] versus mitomycin C（MMC） with subscleral trabeculectomy（SST） for the surgical treatment of congenital glaucoma（CG） in SturgeWeber Syndrome（SWS）.METHODS： A prospective comparative randomized study of 20 eyes of 16 patients with CG associated with SWS was divided into two groups. The first group（MMC Group） included 10 eyes that were subjected to SST with MMC. The second group（OLO Group） included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant（OLO implant）. Postoperative evaluation included intraocular pressure（IOP） level, bleb evaluation, complications, and the need for further medication or surgical intervention. RESULTS： The mean preoperative IOP was 29±3.16 mm Hg in MMC and 29.8±3.08 mm Hg in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups（57.9% and 56.3%）. At the end of the 12 postoperative follow-up month, in the MMC Group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to OLO Group which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC Group had a higher rate of complications than the OLO Group in the form of thin polycystic bleb in 6 eyes（60%）, blebitis in only one eye（10%） treated with topical antibiotics, shallow anterior chamber in two eyes（20%）.CONCLUSION： This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of CG in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.

Traumatic optic neuropathy secondary to acupuncture treatment for glaucoma: A case report

Internal organ injuries have been recognized as a major complication of acupuncture. Reported ocular adverse events include traumatic cataract, oculomotor nerve injury, endophthalmitis and retinal puncture. We report a case of traumatic optic neuropathy and self-sealed globe perforation following acupuncture. A Chinese gentleman with primary open angle glaucoma presented with sudden loss of vision in the right eye after acupuncture therapy. The vision dropped to 2/60 from 6/6 premorbid. Relative afferent pupillary defect was present. Fundus examination showed hemorrhage from the optic disc into the vitreous. It is likely that the optic nerve injury occurred when the acupuncture needle was advanced deep into locations near the optic nerve. Main acupoints used in acupuncture treatment of glaucoma include Tongziliao GB-1, Jingming BL-1 and Chengqi ST-1. It is crucial to have a good understanding of ocular anatomy to avoid potentially blinding complications.

Effective treatment for secondary angle-closure glaucoma caused by traumatic lens subluxation:phacoemulsification with capsular-tension-ring implantation combined with ophthalmic endoscope-controlled goniosynechialysis

AIM:To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechialysis(Phaco-CTR-IOL-OE-GSL)for treating secondary angle-closure glaucoma induced by traumatic lens subluxation.METHODS:A retrospective and descriptive study was performed on patients with lens subluxation,angle closure,goniosynechia,and evaluated intraocular pressure(IOP)that cannot be controlled with medication,who underwent Phaco-CTR-IOL-OE-GSL.The postoperative best-corrected visual acuity(BCVA),IOP,range of goniosynechia and complications were retrospectively observed.RESULTS:Nine patients with secondary angle-closure glaucoma induced by traumatic lens subluxation were included.The follow-up period was 51.1±8.6 mo.The preoperative range of zonule rupture was 158.2°±33.0°,and the range of goniosynechia was 220.0°±92.5°.The baseline BCVA was 0.9±1.0 logMAR,IOP was 30.7±17.3 mm Hg and number of anti-glaucoma medication was 3.2±1.1.Mild intraoperative hyphaemia with 8 eyes(88.8%)in the anterior chamber,and was absorbed two days postoperatively.One eye(11.1%)had postoperative ciliary body detachment and was recovered after five days of topical drug treatment.BCVA was 0.2±0.2 logMAR at 3 mo postoperatively.The average IOP at the last follow-up was 16.7±2.0 mm Hg,and no anti-glaucoma medications were used.The average range of recurrent goniosynechia was 54.9°±33°at the final postoperative gonioscopic examination.CONCLUSION:Phaco-CTR-IOL-OE-GSL is safe and effective in the treatment of secondary angle-closure glaucoma induced by traumatic lens subluxation.The use of an endoscope provides a more direct and clear examination for GSL,and 360°dissection is easily achieved.

Glaucomatous Damage Secondary to Long Term Topical Corticosteroid Use in a 7-Year-Old Female

Introduction: Topical corticosteroids are commonly prescribed for children with atopic dermatitis. Although generally well tolerated, long term unsupervised use can lead to ocular damage, including glaucoma. Much of the current literature focuses on the periorbital use in older patients. We present a case of an adolescent who suffered glaucomatous damage secondary to long term topical steroid use on her extremities. Methods: This is a case report of a child with extensive work-up for glaucoma suspect. Results: A 7-year-old African American female was found to have glaucomatous damage after using 2.5% hydrocortisone cream on her arms, legs, and back of neck twice daily continuously for 2 years. There were no other mechanisms that could have produced a secondary glaucoma. Congenital anomalous disk is a remote possibility. Discussion: Steroid cream use for atopic dermatitis is relatively common. The side effect profile of topical corticosteroids has been well documented and includes glaucoma. These patients may not have any visual symptoms, and can present at an advanced stage, with irreversible vision loss. Children with atopic dermatitis are especially susceptible to the systemic effects of steroids because of the damaged epithelial layer and also the body surface area to volume, both of which increase the bioavailability of the medication. Conclusion: Because topical steroids are commonly used, especially in children, patients need to be aware of the potentially dangerous side effects, including vision loss from glaucoma.

Uveitis glaucoma hyphema syndrome as a result of glaucoma implant: A case report

BACKGROUND Glaucoma is caused by increased intraocular pressure(IOP)that damages the optic nerve,leading to blindness.The Ahmed glaucoma valve(AGV)is a glau-coma drainage implant device that is used in glaucoma patients with uncontrolled IOP.A possible complication after any ocular surgery however is hyphema,which can itself progress to uveitis glaucoma hyphema(UGH)syndrome on rare occasions.UGH syndrome has not yet been reported as a complication of AGV implantation.CASE SUMMARY Here,we have reported a case of a 55-year-old female who developed both hyphema and pigmentation as a result of AGV implantation.We confirmed UGH syndrome secondary to AGV implantation after the patient underwent another surgery to shorten and reposition the AGV tube.After the second surgery,the patient’s IOP was reduced,and she had a clear cornea and no signs of hyphema.CONCLUSION This first report of UGH syndrome as a complication of AGV implantation reminds clinicians that frequent follow-up is paramount.

Ultrasound cyclo plasty for the management of glaucoma secondary to ocular irradiation for choroidal melanoma

Dear Editor,In the past, enucleation has been considered the only available option and the standard of care for the management of malignant intraocular tumors. Thanks to the advances in the field of radiotherapy, new therapeutic approaches have been developed in the last decades, such as plaque brachytherapy and proton beam therapy(PBT)^([1]).

Secondary positioning of rotationally asymmetric refractive multifocal intraocular lens in a patient with glaucoma:A case report

BACKGROUND Asymmetric multifocal intraocular lenses(IOLs)are now widely used in the modern cataract surgery,providing a good level of visual performance over a range of distances and high postoperative patient satisfaction.We report a case of improved visual quality after shifting the near segment of an asymmetrical multifocal IOL to the superotemporal placement in the dominant eye of a glaucoma patient.CASE SUMMARY A 72-year-old woman with bilateral glaucoma underwent phacoemulsification in the dominant eye(left eye)with implantation of an asymmetrical multifocal IOL.Postoperative uncorrected distance visual acuity(UDVA)was 0.0 logMAR(20/20 Snellen)and uncorrected near visual acuity(UNVA)was 0.1 logMAR(20/25 Snellen).Two weeks later,the patient presented to our clinic with decreased vision due to migration of lens epithelial cells to IOL anterior surface and edema of corneal endothelial cells.Anterior capsule polishing and superotemporal placement of near segment[+3.00 diopter(D)addition(add)]of IOL were performed.As a result,UDVA at the first week and first year after reposition was 0.0 logMAR(20/20 Snellen),and compared with 0.3 logMAR(20/40 Snellen)in the first week,the UNVA was improved to 0.0 logMAR(20/20 Snellen)one year after surgery.CONCLUSION The postoperative inflammatory reaction and lens epithelial cells proliferation were obvious in this glaucoma patient.Capsule polishing and rotation of the lens were beneficial to the patient,which not only enhanced the patient's vision,but also improved the patient's satisfaction.Therefore,glaucoma patients need to be cautious of implanting multifocal IOLs.Placement of a near segment of an asymmetrical multifocal IOL in the dominant eye should be performed on an individual basis.

Phacoemulsification in Patients with Secondary Glaucoma Caused by Uveitis

Purposes: To evaluate the effect of phacoemulsification in the patients with uveitis,secondary glaucoma and complicated cataract. Methods: Phacoemulsification and implantation of a foldable intraocular len was performed in 12 patients(13 eyes) with uveitis, secondary glaucoma and complicated cataract. The complications, intraocular pressures (IOP), and visual acuity were observed postoperatively. Results: No severe complication was found in the patients postoperatively or within the operation procedure. The visual acuity was improved after the operation ( P ＜ 0.05) .The intraocular pressures and/or the number of antiglaucoma medications reduced in 3months of the follow-up time. Conclusion: phacoemulsification is the best way to treat the patients with secondary glaucoma and complicated cataract caused by uveitis. Eye Science 2001; 17: 8 ～ 10.