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 ...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.展开更多
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 t...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.展开更多
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(PA...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.展开更多
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 (PA...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.展开更多
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)wit...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.展开更多
AIM:To examine the association between the single nucleotide polymorphisms (SNPs)of matrix metalloprotease-9 (MMP-9) gene and primary angleclosure glaucoma(PACG)in a Chinese Han population.METHODS:DNA samples were ext...AIM:To examine the association between the single nucleotide polymorphisms (SNPs)of matrix metalloprotease-9 (MMP-9) gene and primary angleclosure glaucoma(PACG)in a Chinese Han population.METHODS:DNA samples were extracted from peripheral-blood mononuclear cells of 214 PACG patients and 224 healthy controls.Genotyping of rs3918249,rs3918254,rs17577 and rs3787268 in MMP-9was performed using polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP)analysis and the direct sequencing technique.The association between these genetic polymorphisms and risk of PACG was estimated by χ2 test.RESULTS:The distributions of rs3918249,rs3918254,rs17577 and rs3787268 genotypes among cases and healthy controls were compatible with that from HardyWeinberg equilibrium(HWE,P】0.05).The increased frequency of CC and CT genotypes of rs3918254 were observed in PACG patients compared to healthy controls[P=0.006,P corrected(Pcorr)=0.048].The haplotype analysis showed that the CCGG haplotype was nominal associated with PACG(P=0.015),however,the significant was lost when the Bonferroni correction was used(Pcorr=0.105).CONCLUSION:Our results revealed that rs3918254 in MMP-9 may be a susceptible locus to PACG in China,people with the CC and CT genotypes of rs3918254 are more susceptible to PACG.The susceptibility to PACG inChinese Han patients may be not influenced by SNPs rs3918249,rs3787268 and rs17577 in MMP-9.展开更多
AIM: To compare the efficacy and safety of phacoemulsification(Phaco) against combined phacotrabeculectomy(Phacotrabe) in primary angle-closure glaucoma(PACG) with coexisting cataract.·METHODS: By searchi...AIM: To compare the efficacy and safety of phacoemulsification(Phaco) against combined phacotrabeculectomy(Phacotrabe) in primary angle-closure glaucoma(PACG) with coexisting cataract.·METHODS: By searching electronically the Pub Med,EMBASE, Scientific Citation Index and Cochrane Library published up from inception to January 2014, all randomized controlled trials that matched the predefined criteria were included. The quality of included trials was evaluated according to the guidelines developed by the cochrane collaboration. And the outcomes estimating efficacy and safety of two different surgical treatments were measured and synthesised by Rev Man 5.0.· RESULTS: Five randomized controlled trials were selected and included in Meta-analysis with a total of468 patients(468 eyes) with both PACG and cataract. We found that Phacotrabe had a greater intraocular pressure(IOP) lowing effect [preoperative IOP: weighted mean difference(WMD)=0.58, 95% confidence intervals(95% CI,-0.53 to 1.69), P =0.31; postoperative IOP: WMD =1.37,95% CI(0.45 to 2.28), P =0.003], a lower number of antiglaucoma medications [risk ratio(RR)=0.05, 95% CI(0.02 to 0.18), P 〈0.00001] needed postoperatively and less serious damage of optic nerve [RR =0.48, 95% CI(0.21 to 1.07), P =0.07], but a higher risk of complications[odds ratio(OR)=0.04, 95% CI(0.01 to 0.16), P 〈0.00001]compared with Phaco. The rest studies indicated that there had no significantly difference between the two surgical methods for postoperative best-corrected visual acuity(BCVA) [WMD =-0.05, 95% CI(-0.14 to 0.05), P =0.32] and loss of visual field [RR=1.06, 95% CI(0.61 to1.83), P =0.83].·CONCLUSION: Phaco alone compared with Phacotrabe had a better effect in IOP reduction, whereas the securitydecline. Considering the number of sample size, our results remains to be further studied.展开更多
AIM:To evaluate changes of proinflammatory cytokines in aqueous humor of patients with acute primary angleclosure(APAC) and age-related cataracts. METHODS:Twenty eyes of 20 APAC patients and 15 eyes of 15 age-rela...AIM:To evaluate changes of proinflammatory cytokines in aqueous humor of patients with acute primary angleclosure(APAC) and age-related cataracts. METHODS:Twenty eyes of 20 APAC patients and 15 eyes of 15 age-related cataract patients were included in this cross-sectional study. Aqueous humor samples were collected prospectively. The levels of 20 proinflammatory cytokines were evaluated in the aqueous humor of the APAC and cataract patients using the multiplex bead immunoassay technique. Clinical data were collected for correlation analysis.RESULTS:Seven of the 20 proinflammatory cytokines included in the magnetic bead panel were detectable in both APAC eyes and cataract eyes:interleukin(IL)-10, IL-12, IL-15, IL-21, IL-6, chemokine(C-C motif) ligand 20, and tumor necrosis factor alpha(TNF-α). IL-27 was only detectable in APAC eyes. Compared with the cataract eyes, the APAC eyes had significantly elevated concentrations of IL-12(P=0.036), IL-15(P=0.001), IL-6(P=0.012), and IL-27(only detectable in APAC eyes). Age was positively correlated with IL-12(P=0.022) and IL-6(P=0.037), and time elapsed between APAC onset and aqueous humor samples collection was positively correlated with IL-15(P=0.037), IL-27(P=0.040), and TNF-α(P=0.042).CONCLUSION:Several proinflammatory cytokines including IL-12,IL-15, IL-6 and IL-27, were elevated in the APAC eyes and may be implicated in its pathologic mechanism.展开更多
Background: Primary chronic angle-closure glaucoma(PCACG) is one of the main types of glaucoma in China. Trabeculectomy is the most commonly used glaucoma filtration surgery for glaucoma in the world. Conventional tra...Background: Primary chronic angle-closure glaucoma(PCACG) is one of the main types of glaucoma in China. Trabeculectomy is the most commonly used glaucoma filtration surgery for glaucoma in the world. Conventional trabeculectomy is prone to anesthesia-related complications intraoperative and operationrelated complications postoperative in PCACG treatment. Modified minimally invasive trabeculectomy maybe can reduce the incidence of complications.Methods: We conducted a prospective case series study and performed modified fornix-based trabeculectomy in 27 patients(30 eyes) under topical anesthesia; we then observed intraoperative anesthesia and cooperation ef ect, intraoperative and postoperative complications, preoperative and postoperative visual acuity, intraocular pressure(IOP), visual field, and the use of ocular hypotensive drugs. The patients were followed up for at least 12 months.Results: All operations were completed successfully with no intraoperative complications. All 27 patients(30 eyes) were followed up for at least 12 months. No significant decrease in visual acuity was observed at days 1 or 7 and at months 1, 3, 6, and 12 after operation; however, a signii cant decrease in IOP was observed at days 1 and 7 and at months 1, 3, 6, and 12 after operation. Moreover, no significant progression in visual field mean defect was observed at month 12 after operation, and the number of ocular hypotensive drugs required was significantly reduced at months 6 and 12 after operation. By month 12 after operation, the overall success rate was 93.33%(28/30).Conclusions: Modii ed minimally invasive trabeculectomy is safe and ef ective for the treatment of PCACG.展开更多
AIM:To evaluate the morphological changes in anterior segment in Chinese patients with uveal effusion(UE)after the attack of acute primary angle-closure(APAC)using ultrasound biomicroscopy(UBM),and to assess th...AIM:To evaluate the morphological changes in anterior segment in Chinese patients with uveal effusion(UE)after the attack of acute primary angle-closure(APAC)using ultrasound biomicroscopy(UBM),and to assess the clinical course and prognosis of the disease.METHODS:In a retrospective case series,26 eyes in 26 consecutive patients diagnosed with UE after the treatment of intraocular pressure(IOP)-lowering medication for the attack of APAC were enrolled. The unaffected fellow eyes served as controls. The morphological changes were observed by ultrasonography,slit lamp microscopy and gonioscopy. UBM was used to assess the degree and extent of effusion based on the analysis of parameters associated with UE.RESULTS:The mean IOP was 9.2(SD 2.1)mm Hg at the diagnosis of UE after IOP-lowering medication,while 14.1(SD,2.6)mm Hg in the fellow eyes(P=0.000). The anterior chamber depth(ACD)(P=0.000),angle opening distance at 500 μm(AOD500)(P〈0.01)and anterior chamber angle(ACA)(P〈0.05)were decreased significantly,while ciliary body thickness(CBT)(P〈0.05)increased significantly in UE eyes. UE grade analysis showed 7 eyes in grade 1,9 eyes in grade 2,and 10 eyes in grade 3. Quadrant scores were performed of 4 eyes in 1 quadrant,3 eyes in 3 quadrants,and 19 eyes in 4 quadrants. There was the positive correlation between grade and quadrant score(R=0.644,P=0.000). The effusion on all eyes were recovered after medication,which mean IOP was 13.9(SD,2.8)mm Hg.CONCLUSION:UE is a frequent complication in Chinese patients after the attack of APAC,partially associated with hypotony. The severity of UE is correlation with height of effusion,extent of detachment,and shallower ACD.展开更多
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 random...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...展开更多
AIM: To determine the levels of aquaporin-1(AQP-1) in the lens epithelial cells(LECs) of primary glaucoma and to clarify its correlation with lens thickness.METHODS: This study comprised 64 eyes of 64 patients w...AIM: To determine the levels of aquaporin-1(AQP-1) in the lens epithelial cells(LECs) of primary glaucoma and to clarify its correlation with lens thickness.METHODS: This study comprised 64 eyes of 64 patients with primary glaucoma, who were divided into 3 groups: 25 eyes of 25 patients with acute primary angle-closure glaucoma(APACG), 19 eyes of 19 patients with chronic primary angle-closure glaucoma(CPACG) and 20 eyes of 20 patients with primary open angle glaucoma(POAG). This study also included 12 eyes of 12 patients with senile cataract as controls. The levels of AQP-1 in LECs were examined by real-time quantitative polymerase chain reaction(RT-q PCR) and immunohistochemistry. The lens thickness was measured by A-scan ultrasonography. RESULTS: The AQP-1 m RNA levels of LECs were 0.84±0.27, 0.69±0.34, 0.44±0.19 and 0.51±0.21 in APACG, CPACG, POAG and senile cataract group, respectively. The levels of AQP-1m RNA were significantly higher in PACG groups compared with those in senile cataract and POAG group(all P〈0.05). The immunohistochemistry showed the AQP-1 expression were strong-positive in PACG groups, but weak-positive in senile cataract and POAG group. A positive correlation was found between AQP-1 m RNA levels and the lens thickness(r=0.645, P〈0.001). CONCLUSION: These findings show that the higher expression of AQP-1 in LECs may contribute to increased lens thickness, which might be associated with the occurrence and development of PACG.展开更多
AIM: To assess the refractive status, anterior chamber depth (ACD) and axial length (AL) of patients with primary angle-closure disease (PACD). METHODS: Retrospective cohort. Data was collected from charts of...AIM: To assess the refractive status, anterior chamber depth (ACD) and axial length (AL) of patients with primary angle-closure disease (PACD). METHODS: Retrospective cohort. Data was collected from charts of all PACD patients treated from April 2013 to December 2015. Analysis was done on 137 patient charts with complete biometric data. Patient demographics, PACD type, refractive status (spherical equivalent), ACD and AL were studied. RESULTS: The median age of 137 subjects [53 with primary angle-closure suspects (PACS), 27 with primary angle- closure (PAC) and 57 with primary angle-closure glaucoma (PACG)] was 68y (range 21-88y). The majority was Chinese (n=68; 49.6%) and most of them were women (n=75; 54.7%). The distribution of myopia (n=51; 37.2%) and hyperopia (n=49; 35.8%) was similar. The ACD was shallower in myopes compared to hyperopes (P=-0.02) and emmetropia (P=-0.049) but the AL was not significantly different between groups. There were no patients blind from PACG. CONCLUSION: Both myopia and hyperopia can occur in PACD. Despite a shallower ACD in angle closure myopes, the AL was not different between groups.展开更多
Objective :To investigate the role the lens dimensions played on the pathogenesis of primary angle-closure glaucoma. Methods:38 eyes of 20 patients with primary angle-closure glaucoma (PACG) and 35 eyes of 22 norm...Objective :To investigate the role the lens dimensions played on the pathogenesis of primary angle-closure glaucoma. Methods:38 eyes of 20 patients with primary angle-closure glaucoma (PACG) and 35 eyes of 22 normal individuals without ocular abnormalities were examined. The anatomical parameters of the lens and other structures of the anterior segment were calculated using B ultrasound, computer image processing and ultrasound biomicroscopy (UBM). The parameters were compared between the patients and normal subjects. Correlation analysis was used to determine the relationship between the radii of curvature of the anterior lens surface (RCALS) and the other parameters of the anterior segment. Results:Compared with the normal eyes, the eyes of PACG had thicker lens, steeper curvature of anterior lens surface, decreased depth of the anterior chamber, narrower chamber angle, and more anterior position of the ciliary bodies and lens. All these differences were significant(P 〈 0.05 or P 〈 0.01). In the PACG group, the RCALS had significantly negative correlation with the central and peripheral lens thickness (P 〈 0.01 and P 〈 0.05 respectively), and had positive correlation with relative lens position, anterior chamber depth(ACD), angle-open distance at 500 um(AOD500), trabecular iris angle (TIA) and trabecular ciliary processes distance(TCPD, P 〈 0.05 or P 〈 0.01 ). Conclusion:The occurrence of PACG is relevant to the abnormal anatomical structures of the anterior segment. Among all factors, the lens parameters play an important role in the pathogenesis. Increased lens thickness, relative more anterior position of lens, especially steepened curvature of anterior lens surface are predisposing factors of the pathologic phenomenon in PACG including pupillary blockage, shallow anterior chamber, secondary closure of chamber angle and elevation of intraocular pressure.展开更多
·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 biomicr...·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.展开更多
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 ang...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...展开更多
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 manife...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).展开更多
AIM: To investigate whether the gene variants in MYOC and ABCA1 are associated with primary angle-closure glaucoma(PACG) and anterior chamber depth(ACD) and axial length(AL) in samples from northern China. METHODS: Th...AIM: To investigate whether the gene variants in MYOC and ABCA1 are associated with primary angle-closure glaucoma(PACG) and anterior chamber depth(ACD) and axial length(AL) in samples from northern China. METHODS: The present case-control association study consisted of 500 PACG patients and 720 unrelated controls. Each participant was genotyped for eleven single nucleotide polymorphisms(SNPs) in MYOC and ABCA1 genes(rs12076134, rs183532, rs235875 and rs235913 in MYOC, rs2422493, rs2487042, rs2472496, rs2472493, rs2487032, rs2472459 and rs2472519 near ABCA1) using an improved multiplex ligation detection reaction(iMLDR) technique. The genetic association analyses were performed by PLINK using a logistic regression model. The association between genotypes and ocular biometric parameters was performed by SPSS using generalized estimation equation. Bonferroni corrections wereimplemented and the statistical power was calculated by the Power and Sample Size Calculation. RESULTS: Two SNPs rs183532 and rs235875 as well as a haplotype TTC in MYOC were nominally associated with PACG despite the significance was lost after Bonferroni correction. No association was observed between ABCA1 and PACG, neither did the association between these variants and ACD as well as AL. CONCLUSION: The present study suggests MYOC and ABCA1 do not play a part in the pathogenesis of PACG as well as the regulation of ocular biometric parameters in a northern Chinese population. Further investigations with large sample size are needed to verify this consequence.展开更多
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 1...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.展开更多
AIM: To investigate the relationship between choroidal thickness and anterior chamber segment in subjects with eyes with narrow or open-angle. METHODS: The subfoveal choroidal thickness was measured with enhanced dept...AIM: To investigate the relationship between choroidal thickness and anterior chamber segment in subjects with eyes with narrow or open-angle. METHODS: The subfoveal choroidal thickness was measured with enhanced depth -imaging optical coherence tomography and anterior chamber parameters were measured with ultrasound biomicroscopy in one eye of 23 subjects with open-angle eyes and 38 subjects with narrow-angle eyes. The mean age was 59.52 +/- 7.04y for narrow-angle subjects and 60.76 +/- 7.23y for open angle subjects (P=0.514). Multivariate linear regression analysis was performed to assess the association between choroidal thickness and narrow -angle parameters. RESULTS: There were no differences in subfoveal choroidal thickness between open - and narrow-angle subjects (P=0.231). Anterior chamber parameters, including central anterior chamber depth, trabecular iris angle, iris thickness 500 mu m from the scleral spur (IT500), and ciliary body thickness at 1 mm and 2 mm from the sclera! spur (CBT1, CBT2) showed significant differences between the two groups (P<0.05). Subfoveal choroidal thickness showed negative correlation (beta=-0.496, P=0.016) only with anterior chamber depth in the open angle group and with age (beta=-0.442, P=0.003) and 11500 (beta=-0.399, P=0.008) in the narrow-angle group. However, subfoveal choroidal thickness was not correlated with trabecular iris angle, anterior chamber depth, ciliary body thickness, or central corneal thickness in the narrow-angle group. CONCLUSION: Choroidal thickness does not differ in the two groups and has not correlated with anterior chamber parameters in narrow-angle subjects, suggesting a lack of relationship between choroidal thickness and primary angle-closure glaucoma.展开更多
基金Supported by the National Natural Science Foundation of China(No.82301223No.82271102)+2 种基金the Guangdong Basic and Applied Basic Research Foundation(No.2022A1515111155)the Shenzhen Science and Technology Program(No.KCXFZ20211020163813019)the Shenzhen Science and Technology Program(No.RCBS20210706092347043).
文摘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.
文摘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.
基金Supported by the "Evidence-Based Medicine Innovation Project" of Evidence-Based Medicine Center of Lanzhou University, China (No.2010LDEBM-A)
文摘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.
文摘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.
文摘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.
基金Supported by National Natural Science Foundation of China(No.81270990No.81070723)
文摘AIM:To examine the association between the single nucleotide polymorphisms (SNPs)of matrix metalloprotease-9 (MMP-9) gene and primary angleclosure glaucoma(PACG)in a Chinese Han population.METHODS:DNA samples were extracted from peripheral-blood mononuclear cells of 214 PACG patients and 224 healthy controls.Genotyping of rs3918249,rs3918254,rs17577 and rs3787268 in MMP-9was performed using polymerase chain reaction restriction fragment length polymorphism(PCR-RFLP)analysis and the direct sequencing technique.The association between these genetic polymorphisms and risk of PACG was estimated by χ2 test.RESULTS:The distributions of rs3918249,rs3918254,rs17577 and rs3787268 genotypes among cases and healthy controls were compatible with that from HardyWeinberg equilibrium(HWE,P】0.05).The increased frequency of CC and CT genotypes of rs3918254 were observed in PACG patients compared to healthy controls[P=0.006,P corrected(Pcorr)=0.048].The haplotype analysis showed that the CCGG haplotype was nominal associated with PACG(P=0.015),however,the significant was lost when the Bonferroni correction was used(Pcorr=0.105).CONCLUSION:Our results revealed that rs3918254 in MMP-9 may be a susceptible locus to PACG in China,people with the CC and CT genotypes of rs3918254 are more susceptible to PACG.The susceptibility to PACG inChinese Han patients may be not influenced by SNPs rs3918249,rs3787268 and rs17577 in MMP-9.
文摘AIM: To compare the efficacy and safety of phacoemulsification(Phaco) against combined phacotrabeculectomy(Phacotrabe) in primary angle-closure glaucoma(PACG) with coexisting cataract.·METHODS: By searching electronically the Pub Med,EMBASE, Scientific Citation Index and Cochrane Library published up from inception to January 2014, all randomized controlled trials that matched the predefined criteria were included. The quality of included trials was evaluated according to the guidelines developed by the cochrane collaboration. And the outcomes estimating efficacy and safety of two different surgical treatments were measured and synthesised by Rev Man 5.0.· RESULTS: Five randomized controlled trials were selected and included in Meta-analysis with a total of468 patients(468 eyes) with both PACG and cataract. We found that Phacotrabe had a greater intraocular pressure(IOP) lowing effect [preoperative IOP: weighted mean difference(WMD)=0.58, 95% confidence intervals(95% CI,-0.53 to 1.69), P =0.31; postoperative IOP: WMD =1.37,95% CI(0.45 to 2.28), P =0.003], a lower number of antiglaucoma medications [risk ratio(RR)=0.05, 95% CI(0.02 to 0.18), P 〈0.00001] needed postoperatively and less serious damage of optic nerve [RR =0.48, 95% CI(0.21 to 1.07), P =0.07], but a higher risk of complications[odds ratio(OR)=0.04, 95% CI(0.01 to 0.16), P 〈0.00001]compared with Phaco. The rest studies indicated that there had no significantly difference between the two surgical methods for postoperative best-corrected visual acuity(BCVA) [WMD =-0.05, 95% CI(-0.14 to 0.05), P =0.32] and loss of visual field [RR=1.06, 95% CI(0.61 to1.83), P =0.83].·CONCLUSION: Phaco alone compared with Phacotrabe had a better effect in IOP reduction, whereas the securitydecline. Considering the number of sample size, our results remains to be further studied.
基金Supported by the National Natural Science Foundation of China(No.81670847No.81600728)
文摘AIM:To evaluate changes of proinflammatory cytokines in aqueous humor of patients with acute primary angleclosure(APAC) and age-related cataracts. METHODS:Twenty eyes of 20 APAC patients and 15 eyes of 15 age-related cataract patients were included in this cross-sectional study. Aqueous humor samples were collected prospectively. The levels of 20 proinflammatory cytokines were evaluated in the aqueous humor of the APAC and cataract patients using the multiplex bead immunoassay technique. Clinical data were collected for correlation analysis.RESULTS:Seven of the 20 proinflammatory cytokines included in the magnetic bead panel were detectable in both APAC eyes and cataract eyes:interleukin(IL)-10, IL-12, IL-15, IL-21, IL-6, chemokine(C-C motif) ligand 20, and tumor necrosis factor alpha(TNF-α). IL-27 was only detectable in APAC eyes. Compared with the cataract eyes, the APAC eyes had significantly elevated concentrations of IL-12(P=0.036), IL-15(P=0.001), IL-6(P=0.012), and IL-27(only detectable in APAC eyes). Age was positively correlated with IL-12(P=0.022) and IL-6(P=0.037), and time elapsed between APAC onset and aqueous humor samples collection was positively correlated with IL-15(P=0.037), IL-27(P=0.040), and TNF-α(P=0.042).CONCLUSION:Several proinflammatory cytokines including IL-12,IL-15, IL-6 and IL-27, were elevated in the APAC eyes and may be implicated in its pathologic mechanism.
基金supported by Medical Scientific Research Foundation of Guangdong Province,China (B2012264)
文摘Background: Primary chronic angle-closure glaucoma(PCACG) is one of the main types of glaucoma in China. Trabeculectomy is the most commonly used glaucoma filtration surgery for glaucoma in the world. Conventional trabeculectomy is prone to anesthesia-related complications intraoperative and operationrelated complications postoperative in PCACG treatment. Modified minimally invasive trabeculectomy maybe can reduce the incidence of complications.Methods: We conducted a prospective case series study and performed modified fornix-based trabeculectomy in 27 patients(30 eyes) under topical anesthesia; we then observed intraoperative anesthesia and cooperation ef ect, intraoperative and postoperative complications, preoperative and postoperative visual acuity, intraocular pressure(IOP), visual field, and the use of ocular hypotensive drugs. The patients were followed up for at least 12 months.Results: All operations were completed successfully with no intraoperative complications. All 27 patients(30 eyes) were followed up for at least 12 months. No significant decrease in visual acuity was observed at days 1 or 7 and at months 1, 3, 6, and 12 after operation; however, a signii cant decrease in IOP was observed at days 1 and 7 and at months 1, 3, 6, and 12 after operation. Moreover, no significant progression in visual field mean defect was observed at month 12 after operation, and the number of ocular hypotensive drugs required was significantly reduced at months 6 and 12 after operation. By month 12 after operation, the overall success rate was 93.33%(28/30).Conclusions: Modii ed minimally invasive trabeculectomy is safe and ef ective for the treatment of PCACG.
基金Supported by the Key Science and Technology Program of Shaanxi Province,China(No.2015SF146)
文摘AIM:To evaluate the morphological changes in anterior segment in Chinese patients with uveal effusion(UE)after the attack of acute primary angle-closure(APAC)using ultrasound biomicroscopy(UBM),and to assess the clinical course and prognosis of the disease.METHODS:In a retrospective case series,26 eyes in 26 consecutive patients diagnosed with UE after the treatment of intraocular pressure(IOP)-lowering medication for the attack of APAC were enrolled. The unaffected fellow eyes served as controls. The morphological changes were observed by ultrasonography,slit lamp microscopy and gonioscopy. UBM was used to assess the degree and extent of effusion based on the analysis of parameters associated with UE.RESULTS:The mean IOP was 9.2(SD 2.1)mm Hg at the diagnosis of UE after IOP-lowering medication,while 14.1(SD,2.6)mm Hg in the fellow eyes(P=0.000). The anterior chamber depth(ACD)(P=0.000),angle opening distance at 500 μm(AOD500)(P〈0.01)and anterior chamber angle(ACA)(P〈0.05)were decreased significantly,while ciliary body thickness(CBT)(P〈0.05)increased significantly in UE eyes. UE grade analysis showed 7 eyes in grade 1,9 eyes in grade 2,and 10 eyes in grade 3. Quadrant scores were performed of 4 eyes in 1 quadrant,3 eyes in 3 quadrants,and 19 eyes in 4 quadrants. There was the positive correlation between grade and quadrant score(R=0.644,P=0.000). The effusion on all eyes were recovered after medication,which mean IOP was 13.9(SD,2.8)mm Hg.CONCLUSION:UE is a frequent complication in Chinese patients after the attack of APAC,partially associated with hypotony. The severity of UE is correlation with height of effusion,extent of detachment,and shallower ACD.
文摘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...
基金Supported by the Science and Technology Planning Project of Guangdong Province(No.2012B050600032)the Science and Technology Planning Project of Guangzhou(No.1515000176)
文摘AIM: To determine the levels of aquaporin-1(AQP-1) in the lens epithelial cells(LECs) of primary glaucoma and to clarify its correlation with lens thickness.METHODS: This study comprised 64 eyes of 64 patients with primary glaucoma, who were divided into 3 groups: 25 eyes of 25 patients with acute primary angle-closure glaucoma(APACG), 19 eyes of 19 patients with chronic primary angle-closure glaucoma(CPACG) and 20 eyes of 20 patients with primary open angle glaucoma(POAG). This study also included 12 eyes of 12 patients with senile cataract as controls. The levels of AQP-1 in LECs were examined by real-time quantitative polymerase chain reaction(RT-q PCR) and immunohistochemistry. The lens thickness was measured by A-scan ultrasonography. RESULTS: The AQP-1 m RNA levels of LECs were 0.84±0.27, 0.69±0.34, 0.44±0.19 and 0.51±0.21 in APACG, CPACG, POAG and senile cataract group, respectively. The levels of AQP-1m RNA were significantly higher in PACG groups compared with those in senile cataract and POAG group(all P〈0.05). The immunohistochemistry showed the AQP-1 expression were strong-positive in PACG groups, but weak-positive in senile cataract and POAG group. A positive correlation was found between AQP-1 m RNA levels and the lens thickness(r=0.645, P〈0.001). CONCLUSION: These findings show that the higher expression of AQP-1 in LECs may contribute to increased lens thickness, which might be associated with the occurrence and development of PACG.
文摘AIM: To assess the refractive status, anterior chamber depth (ACD) and axial length (AL) of patients with primary angle-closure disease (PACD). METHODS: Retrospective cohort. Data was collected from charts of all PACD patients treated from April 2013 to December 2015. Analysis was done on 137 patient charts with complete biometric data. Patient demographics, PACD type, refractive status (spherical equivalent), ACD and AL were studied. RESULTS: The median age of 137 subjects [53 with primary angle-closure suspects (PACS), 27 with primary angle- closure (PAC) and 57 with primary angle-closure glaucoma (PACG)] was 68y (range 21-88y). The majority was Chinese (n=68; 49.6%) and most of them were women (n=75; 54.7%). The distribution of myopia (n=51; 37.2%) and hyperopia (n=49; 35.8%) was similar. The ACD was shallower in myopes compared to hyperopes (P=-0.02) and emmetropia (P=-0.049) but the AL was not significantly different between groups. There were no patients blind from PACG. CONCLUSION: Both myopia and hyperopia can occur in PACD. Despite a shallower ACD in angle closure myopes, the AL was not different between groups.
基金This work was supported by Science and Technology Foundation ofShanxi Province [No: 2005K12- G(3)]
文摘Objective :To investigate the role the lens dimensions played on the pathogenesis of primary angle-closure glaucoma. Methods:38 eyes of 20 patients with primary angle-closure glaucoma (PACG) and 35 eyes of 22 normal individuals without ocular abnormalities were examined. The anatomical parameters of the lens and other structures of the anterior segment were calculated using B ultrasound, computer image processing and ultrasound biomicroscopy (UBM). The parameters were compared between the patients and normal subjects. Correlation analysis was used to determine the relationship between the radii of curvature of the anterior lens surface (RCALS) and the other parameters of the anterior segment. Results:Compared with the normal eyes, the eyes of PACG had thicker lens, steeper curvature of anterior lens surface, decreased depth of the anterior chamber, narrower chamber angle, and more anterior position of the ciliary bodies and lens. All these differences were significant(P 〈 0.05 or P 〈 0.01). In the PACG group, the RCALS had significantly negative correlation with the central and peripheral lens thickness (P 〈 0.01 and P 〈 0.05 respectively), and had positive correlation with relative lens position, anterior chamber depth(ACD), angle-open distance at 500 um(AOD500), trabecular iris angle (TIA) and trabecular ciliary processes distance(TCPD, P 〈 0.05 or P 〈 0.01 ). Conclusion:The occurrence of PACG is relevant to the abnormal anatomical structures of the anterior segment. Among all factors, the lens parameters play an important role in the pathogenesis. Increased lens thickness, relative more anterior position of lens, especially steepened curvature of anterior lens surface are predisposing factors of the pathologic phenomenon in PACG including pupillary blockage, shallow anterior chamber, secondary closure of chamber angle and elevation of intraocular pressure.
文摘·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.
文摘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...
文摘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).
基金Supported by the National Natural Science Foundation of China(No.81460093)the Ningxia Nature Science Funding from the Department of Science and Technology of Ningxia Hui Autonomous Region(No.NZ16194)
文摘AIM: To investigate whether the gene variants in MYOC and ABCA1 are associated with primary angle-closure glaucoma(PACG) and anterior chamber depth(ACD) and axial length(AL) in samples from northern China. METHODS: The present case-control association study consisted of 500 PACG patients and 720 unrelated controls. Each participant was genotyped for eleven single nucleotide polymorphisms(SNPs) in MYOC and ABCA1 genes(rs12076134, rs183532, rs235875 and rs235913 in MYOC, rs2422493, rs2487042, rs2472496, rs2472493, rs2487032, rs2472459 and rs2472519 near ABCA1) using an improved multiplex ligation detection reaction(iMLDR) technique. The genetic association analyses were performed by PLINK using a logistic regression model. The association between genotypes and ocular biometric parameters was performed by SPSS using generalized estimation equation. Bonferroni corrections wereimplemented and the statistical power was calculated by the Power and Sample Size Calculation. RESULTS: Two SNPs rs183532 and rs235875 as well as a haplotype TTC in MYOC were nominally associated with PACG despite the significance was lost after Bonferroni correction. No association was observed between ABCA1 and PACG, neither did the association between these variants and ACD as well as AL. CONCLUSION: The present study suggests MYOC and ABCA1 do not play a part in the pathogenesis of PACG as well as the regulation of ocular biometric parameters in a northern Chinese population. Further investigations with large sample size are needed to verify this consequence.
文摘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.
文摘AIM: To investigate the relationship between choroidal thickness and anterior chamber segment in subjects with eyes with narrow or open-angle. METHODS: The subfoveal choroidal thickness was measured with enhanced depth -imaging optical coherence tomography and anterior chamber parameters were measured with ultrasound biomicroscopy in one eye of 23 subjects with open-angle eyes and 38 subjects with narrow-angle eyes. The mean age was 59.52 +/- 7.04y for narrow-angle subjects and 60.76 +/- 7.23y for open angle subjects (P=0.514). Multivariate linear regression analysis was performed to assess the association between choroidal thickness and narrow -angle parameters. RESULTS: There were no differences in subfoveal choroidal thickness between open - and narrow-angle subjects (P=0.231). Anterior chamber parameters, including central anterior chamber depth, trabecular iris angle, iris thickness 500 mu m from the scleral spur (IT500), and ciliary body thickness at 1 mm and 2 mm from the sclera! spur (CBT1, CBT2) showed significant differences between the two groups (P<0.05). Subfoveal choroidal thickness showed negative correlation (beta=-0.496, P=0.016) only with anterior chamber depth in the open angle group and with age (beta=-0.442, P=0.003) and 11500 (beta=-0.399, P=0.008) in the narrow-angle group. However, subfoveal choroidal thickness was not correlated with trabecular iris angle, anterior chamber depth, ciliary body thickness, or central corneal thickness in the narrow-angle group. CONCLUSION: Choroidal thickness does not differ in the two groups and has not correlated with anterior chamber parameters in narrow-angle subjects, suggesting a lack of relationship between choroidal thickness and primary angle-closure glaucoma.