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.

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.

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.

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...

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

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.

Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

AIM：To compare the effect of phacoemulsification on intraocular pressure（IOP）in patients with primary open angle glaucoma（POAG）and pseudoexfoliation glaucoma（PXG）.METHODS：A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico.The study enrolled consecutive patients having phacoemulsification with intraocular lens（IOL）implantation and a diagnosis of POAG or PXG.Data about IOP values and number of glaucoma medications used was collected at baseline,1,3,6 and12mo postoperatively.RESULTS：The study enrolled 88 patients（88 eyes）.After phacoemulsification,there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients（P〈0.001）.In the POAG group,a 20%decrease in IOP values was evidenced,and a 56.5%reduction in the number of medications used at the one-year follow-up.The PXG group showed a 20.39%,and a 34.46%decrease in IOP and number of medications used,respectively.A significant difference in the meanΔIOP（postoperative changes in IOP）was evidenced between groups（P=0.005）.The reduction of the postsurgical IOP mean values in both groups,the POAG group showed a greater reduction in IOP values compared to the PXG group.CONCLUSION：In both types of glaucoma,phacoemulsification cataract surgery can result in a significant IOP reduction（20%）over a 12mo follow-up period.The number of medications used is also significantly reduced up to 12mo after surgery,especially in the PXG group.

Surgical management of uveitis-glaucoma-hyphema syndrome

AIM:To report outcomes of patients after intraocular lens(IOL)repositioning or exchange for the version of the uveitisglaucoma-hyphema(UGH)syndrome that does not include closed loop anterior chamber IOL(nUGH).METHODS:Chart review of patients with nUGH who underwent IOL repositioning or exchange by one surgeon were reviewed.The main outcome measures were best corrected visual acuity(BCVA)as a decimal fraction preoperatively and postoperatively after IOL repositioning or exchange.Clinical findings evaluated included the presence of uveitis,hyphema,elevated intraocular pressure(IOP),and other complications such as pigment dispersion or vitreous hemorrhage.The number of anti-inflammatory and glaucoma medications were assessed before and after IOL repositioning or exchange.RESULTS:The study included 14 pseudophakic eyes.The median time at the onset of contemporary UGH after cataract extraction and IOL implantation(CE/IOL)was7.5 y.IOL repositioning or exchange was performed at a mean duration of 8.1±4.7 mo(median:4 mo)after onset of UGH.The mean BCVA was improved from 0.45±0.26 preoperatively after onset of UGH syndrome to 0.76±0.22(P=0.016)after IOL repositioning or exchange.Among the14 eyes,uveitis,elevated IOP,and hyphema were present preoperatively in 13,13,and 6 eyes,respectively.Uveitis and hyphema resolved in all cases after IOL surgery.The mean IOP was reduced from 26.4±4.5 mm Hg preoperatively to 14.7±4.9 postoperatively(P=0.01).The mean number of glaucoma medications used was reduced from 1.7±1.1 medications preoperatively to 0.8±1.08(P=0.04)postoperatively.CONCLUSION:IOL repositioning or exchange is an effective treatment in many cases for medically resistant contemporary UGH syndrome.

Referral patterns of children with glaucoma and their caretakers in Northern Tanzania

AIM:To describe the referral patterns of children with primary childhood glaucoma(PCG)or secondary childhood glaucoma(SCG)and their presenting symptoms in Northern Tanzania.METHODS:A retrospective observational study of children<17 y with PCG or SCG who were referred to Kilimanjaro Christian Medical Centre(KCMC)Eye Department between 2000 and 2013 was conducted.Presenting symptoms,age at presentation,place of origin,distance to hospital,type of glaucoma,visual acuity,optic disc appearance(vertical cupto-disc ratio)and type of referral were described.RESULTS:Seventy patients with PCG and 27 patients with SCG were included in the study.Median age at first presentation was 1 y in the PCG group(range 0-16 y)and 9 y in the SCG group(range 1-15 y).In both groups around 87%of the children presented already with low vision(logM AR>0.48,better eye).Most of the children(60%)and their caretakers presented on their own initiative,while 24%were sent by different general health cadres and 16%by eye care professionals.Buphthalmos was the main symptom mentioned as a trigger for presentation.CONCLUSION:The study shows that most of the children presented late resulting in advanced stages of glaucoma at the time of initiation of treatment.The majority attended the referral eye department on their own initiative with buphthalmos being the most commonly 452described symptom.Awareness creation among caretakers of children,general health and eye care providers,ideally embedded in general child health promotion activities,is needed to increase and accelerate referrals.

Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

Intraocular pressure(IOP)modifications in patients with acute central/hemicentral retinal vein occlusions(RVOs)consist in IOP reductions and increases.The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor,that increases gradually until 3 mo after the venous occlusion onset,and then finally disappears after month 4 th.The IOP increases lead to the ocular hypertension and glaucoma.The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups:1)the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis;2)the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance(ocular hypertension,primary angle-closure,primary angle-closure glaucoma,and open angle glaucomas);and 3)the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations,lacking a causal connection between the 2 conditions.

Eye Tumors Misdiagnosed as Glaucoma

INTRODUCTION Eye tumors can show diverse clinical signs.They can be misdiagnosed as glaucoma because of red eye,pain,severe headache,elevated intraocular pressure （IOP）,even adhesion of the angle of the anterior chamber.In a study by Shields et al.,[1] 58 in 144 （40%） of patients with iris melanoma were diagnosed as glaucoma on their initial visit.However,special clinical characteristics,ophthalmic examination,and imaging technology can assist in making the right diagnosis.Ultrasound examinations,high-resolution ultrasound biomicroscopy （UBM）,fluorescein angiography,optical coherence tomography,computerized tomography （CT）,magnetic resonance imaging （MRI）,and fine-needle aspiration biopsy are technologies that may help with early tumor detection.In this study,we highlighted the importance of correctly diagnosing tumor-related glaucoma through the review of nine cases that were initially misdiagnosed as glaucoma.