Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1,...Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.展开更多
Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1,...Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.展开更多
Introduction Acute angle closure crisis (AACC) is a major ophthalmic emergency. It is a sight-threatening pathology that is very common in women but rarely described in melanodermas. The aim of this work is to investi...Introduction Acute angle closure crisis (AACC) is a major ophthalmic emergency. It is a sight-threatening pathology that is very common in women but rarely described in melanodermas. The aim of this work is to investigate the epidemiological and clinical aspects of acute angle closure crisis. Results We collected 24 patient records, totaling 25 eyes. The average age of our patients was 52.04 years, with a male-to-female ratio of 0.6. A family history of glaucoma occurred in 34% of patients. Patients consulted for a painful red eye associated or not with decreased visual acuity (DVA). The condition was bilateral in one patient. The average visual acuity wax 0.34/10<sup>e</sup>. The cornea was cloudy and the pupil in areflexic mydriasis in all sick eyes. Hypothalamia was present in 72% of eyes and cataracts in 54.16% of cases. The average intraocular press was 44.38 mmHg and the average cup/disc (C/D) was 0.46. Gonioscopy was performed in 7 patients. The fellow eye did not present any abnormalities in 92% of cases. Conclusion The acute angle closure crisis is a rare condition in melanodermas and common in woman. His diagnostic is essentially clinical and completed by gonioscopy which plays a fundamental role. .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
·AIM:To compare the ciliary body thickness between eyes with primary angle closure(PAC)and primary angle-closure glaucoma(PACG)with the normal eyes,and to investigate the association between ciliary body thicknes...·AIM:To compare the ciliary body thickness between eyes with primary angle closure(PAC)and primary angle-closure glaucoma(PACG)with the normal eyes,and to investigate the association between ciliary body thickness and ciliary processes situation.·METHODS:In this cross-sectional study,57 patients with PAC/PACG were matched to 57 normal subjects after propensity score matching(PSM)adjusting for age and gender.All subjects underwent conventional ocular examinations and ultrasound biomicroscopy(UBM)examination,among which the patients with PAC/PACG performed the examinations one month after laser peripheral iridotomy(LPI).Quantitative parameters were measured,which included ciliary body thickness at the position of 1 mm posterior to the scleral spur(CBT1),trabecular-ciliary process distance(TCPD)and trabecularciliary process angle(TCA).·RESULTS:Eyes with PAC/PACG presented significantly thinner CBT1,shorter TCPD and smaller TCA(P<0.001)than the normal eyes,both in comparison of the means of four quadrants and in comparisons of each quadrant.After removing images with peripheral anterior synechia(PAS),the same results were also found in comparisons between the two groups.Significant correlations were found between TCPD(R~2=0.537,P<0.001)and TCA(R~2=0.517,P<0.001)with CBT1.·CONCLUSION:Eyes with PAC/PACG have thinner ciliary body thickness and more anteriorly situated ciliary processes.Thinner ciliary body thickness is associated with anterior situation of the ciliary processes.展开更多
Dear Sir,We hereby report a case of bilateral acute angle closure glaucoma secondary to a systemic decongestant containing pseudoephedrine freely available over the counter.Acute angle closure glaucoma is an ocular em...Dear Sir,We hereby report a case of bilateral acute angle closure glaucoma secondary to a systemic decongestant containing pseudoephedrine freely available over the counter.Acute angle closure glaucoma is an ocular emergency.Delayed recognition and treatment inevitably leads to permanent visual impairment.Acute angle closure occurs as a result of obstruction to aqueous drainage by blockage of the trabecular meshwork by the iris.Typical presenting symptoms include acute onset of ocular pain,headache and blurred vision.On clinical examination,it is characterized by a markedly raised IOP of above 21 mm Hg together展开更多
Dear Sir,I am Dong Hyun Lee from the Department of Ophthalmology at the Pusan National University Yangsan Hospital,Yangsan,Korea.Herein,I present the development of a lens-induced angle closed glaucoma and iris neovas...Dear Sir,I am Dong Hyun Lee from the Department of Ophthalmology at the Pusan National University Yangsan Hospital,Yangsan,Korea.Herein,I present the development of a lens-induced angle closed glaucoma and iris neovascularization in the patient with Sturge Weber syndrome(SWS)with open angle glaucoma.Informed consent was obtained from a patient before each procedure The study was conducted in accordance with the tenets of the Declaration of Helsinki.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
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
Angle closure glaucoma(ACG)is one of the major causes of blindness.Angle closure occurs from the obstruction of the trabecular meshwork by the peripheral iris,which results in increased intraocular pressure(IOP)throug...Angle closure glaucoma(ACG)is one of the major causes of blindness.Angle closure occurs from the obstruction of the trabecular meshwork by the peripheral iris,which results in increased intraocular pressure(IOP)through impaired aqueous flow.Considering pupillary block by crystalline lens is the most frequent mechanism,lens extraction is regarded as an effective therapy.Recently,to validate the effect of lens extraction,the EAGLE study was reported.In this study,subjects were 50 years or older,did not have cataracts,and had newly diagnosed primary angle closure(PAC)with intraocular pressure 30 mmHg or greater or primary angle-closure glaucoma(PACG),and were divided into clear-lens extraction group and standard care group(laser peripheral iridotomy and topical glaucoma medication).This study suggested that clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy.Initial clear lens extraction showed better clinical course and patient-reported outcomes.This study provided evidence to support clear lens extraction as the first line treatment for PAC with high IOP or PACG patients.展开更多
Background:Trabecular microbypass stents have allowed improved multidirectional flow with good efficacy and safety profile in primary open-angle glaucoma(OAG).The efficacy of these devices in primary angle closure gla...Background:Trabecular microbypass stents have allowed improved multidirectional flow with good efficacy and safety profile in primary open-angle glaucoma(OAG).The efficacy of these devices in primary angle closure glaucoma has been understudied.We aimed to assess the one-year postoperative outcomes following implantation of trabecular micro-bypass stents with concomitant cataract surgery in angle-closure glaucoma patients.Methods:We evaluated the baseline clinical characteristics and the 12-month outcomes of patients with mild to severe primary angle-closure glaucoma who underwent cataract surgery with implantation of either a first generation trabecular microbypass stent(iStent group)or two second generation trabecular microbypass stents(iStent-inject group).The primary outcomes included intraocular pressure(IOP)and anti-glaucoma medication use.The secondary outcomes were success rate(defined by IOP between 5-18 mmHg with IOP reduction of at least 20%)and visual acuity.Results:A total of 83 eyes(58 from the iStent and 25 from the iStent-inject group)were included with an average age of 68.9±8.6 and 67.6±8.3 years,respectively.All eyes had mild to severe angle-closure glaucoma.At one-year follow-up,the IOP decreased by 21%(from 18.8±4.5 mmHg)and 25%(from 18.7±3.6 mmHg),in each group respectively(P<0.001).Additionally,the medication burden dropped by 52%and 50%at one-year follow-up(P<0.001).The 12-month success rate was 45%in the iStent group compared to 64%in the iStent-inject group(P=0.086)and visual acuity remained stable.Conclusions:The present study provides clinically relevant,real-world data on the utility of iStent and iStent inject with cataract surgery in angle-closure glaucoma-a population that has been understudied in the world of trabecular micro-bypass stents.Our data demonstrated efficacy of these stents in reducing intraocular pressure and medication burden among patients with primary angle closure glaucoma.展开更多
Objective To assess the agreement between gonioscopy and ultrasound biomicroscopy(UBM) in detecting angle closure in Chinese patients with shallow anterior chamber. Methods An observational comparative study of the tw...Objective To assess the agreement between gonioscopy and ultrasound biomicroscopy(UBM) in detecting angle closure in Chinese patients with shallow anterior chamber. Methods An observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded. Results 85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor(κ<0.4) with Kappa analysis in both dark and light conditions in each quadrant. The accordance of agreement between gonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber(P=0.005) or plateau iris configuration tended to produce different results(P=0.075) in the 2 methods. Conclusion Gonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.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
AIM:To observe the differences of damage patterns of retinal nerve fiber layer(RNFL)between acute and chronic intraocular pressure(IOP)elevation in primary angle closure glaucoma(PACG)using optical coherence tomograph...AIM:To observe the differences of damage patterns of retinal nerve fiber layer(RNFL)between acute and chronic intraocular pressure(IOP)elevation in primary angle closure glaucoma(PACG)using optical coherence tomography(OCT). METHODS:Twenty-four patients(48 eyes)with unilateral acute PACG(APACG)attack in the 6 months after admission and 36 patients(64 eyes)with chronic PACG(CPACG)were included in this prospective study.For all cases,IOP has been controlled under 21mmHg after treatment.Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days,2 weeks,1,3 and 6 months after IOP was controlled. Repeated measures ANOVA was used to examine the changes of RNFL thickness at different time after IOP being controlled in both acute attack eyes and unaffected fellow eyes of APACG and eyes with CPACG. RESULTS:The mean RNFL thickness for the APACG-attacked eyes increased significantly within 3 days(121.49±23.84)μm after acute onset and then became thinner along with time[(107.22±24.72)μm at 2 weeks,(93.58±18.37)μm at 1 month,(84.10±19.89)μm at 3 months and(78.98±19.17)μm at 6 months].In APACG-attacked eyes,there were significant differences of average RNFL thickness at 5 different times after IOP was controlled(P【0.001).In the APACG unaffected fellow eyes and CPACG eyes,there were no significant differences in mean RNFL thickness at 5 different times(F=0.450,P=0.104 in APACG unaffected fellow eyes and F=1.558,P=0.200 in CPACG eyes).There was significant difference for interaction between time periods and groups(F=1.912,P=0.003). CONCLUSION:RNFL damage patterns are different under different IOP elevated courses.In APACG,RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time,while RNFL was found to be diffused thinness in CPACG.展开更多
Cataract or clear lens extraction has been suggested as a treatment option for different spectrums of primary angle closure diseases.It might reduce the risk of progression of angle closure and/or glaucoma by helping ...Cataract or clear lens extraction has been suggested as a treatment option for different spectrums of primary angle closure diseases.It might reduce the risk of progression of angle closure and/or glaucoma by helping to open the angle and control the intraocular pressure (IOP).Conventionally,medically uncontrolled primary angle closure glaucoma was treated with trabeculectomy or phacotrabeculectomy and acute primary angle closure was treated with laser peripheral iridotomy. However,recent randomized controlled trials have demonstrated greater promise of phacoemulsification cataract surgery alone for control of the IOP. In this report we review the current literature to evaluate the impact of cataract surgery upon preventing and controlling primary angle closure diseases.展开更多
AIM: To investigate the efficacy and safety of krypton laser peripheral iridoplasty(LPIP) for Chinese patients with primary angle closure(PAC) or primary angle-closure glaucoma(PACG) status post laser iridotomy in rev...AIM: To investigate the efficacy and safety of krypton laser peripheral iridoplasty(LPIP) for Chinese patients with primary angle closure(PAC) or primary angle-closure glaucoma(PACG) status post laser iridotomy in reversing the positive results of the dark room provocative test(DRPT).METHODS: This study was prospective, noncomparative,interventional case series. Thirty-three patients(thirty-eight eyes) with PAC or PACG status post patent laser iridotomy and maintained normal intraocular pressure(IOP) but with positive DRPT results were enrolled. All the subjects were treated with krypton LPIP. DRPT was repeated after krypton LPIP. Results of DRPT were recorded. The visual acuity, IOP and gonioscopy were analyzed before and after krypton LPIP. A minimum time limit for follow-up was 6mo.RESULTS: Thirty-three patients(thirty-eight eyes)were followed for 17.7 ±8.37mo(range 7-41mo) after LPIP. Positive results of DRPT decreased from 38 eyes to9 eyes(23.7%) after LPIP. Peripheral anterior synechiae of angle in 34 of 38 eyes(89.5%) remained unchanged at dynamic gonioscopy throughout the follow-up period after LPIP.CONCLUSION: LPIP decreased positive rates of the DRPT significantly. The mechanism may be that LPIP minimized contact between the peripheral iris and trabecular meshwork, which is a key factor for developing peripheral anterior synechiae.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(PACG)...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.All the related data that matched our standards were abstracted.The quality of included trials was evaluated according to the Dutch Cochrane Centre.RevMan 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 trab 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
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 o...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展开更多
Purpose:To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension.Methods:A total of 36 patients.(40 eyes).with primary acute angle ...Purpose:To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension.Methods:A total of 36 patients.(40 eyes).with primary acute angle closure glaucoma,who were treated with combined trabeculectomy in the Ophthalmology Unit of our hospital,were selected.Before the procedure,patients were assigned to ocular hypertension group(≥ 40 mm Hg) or control group(< 40 mm Hg) based on intraocular pressure.These two groups were followed up for one year,and compared for post-operative visual acuity,intraocular pressure,filtering bleb,anterior chamber depth,and the occurrence of complications.Results:At 1 week,6 months,and 12 months after the procedure,intraocular pressure was controlled in both the ocular hypertension group and the control group,without significant differences between the two groups(P>0.05).At 1 week,6 months,and 12 months after the procedure,all of the patients,in both groups,had improved in terms of visual acuity,with a significant difference before and after the procedure for the ocular hypertension group(P<0.05).After follow-up at 12 months,the two groups presented no statistically significant differences in anterior chamber depth,filtering bleb survival,or the incidence of post-operative complications(P>0.05 for all).Conclusion:It is feasible,safe,and effective to perform combined trabeculectomy on patients with primary acute angle closure glaucoma complicated by persistent ocular hypertension.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 compri...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 30 min 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 μm, anterior chamber depth and volume, whereas significant decrements in iris curve,cross sectional area and volume in both groups. Angle opening distance at 500 μm 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(△IV/△PD) decreased significantly less in angle closure suspects than normal controls(-2.47 ±1.33 mm2vs-3.63±1.58 mm2, P =0.019).Linear regression analysis showed that the change of angle opening distance at 500 μm was associated most with the change of central anterior chamber depth(β =0.841, P =0.002) and △IV/△PD(β =0.028, P =0.002),followed by gender(β =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
文摘Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.
文摘Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.
文摘Introduction Acute angle closure crisis (AACC) is a major ophthalmic emergency. It is a sight-threatening pathology that is very common in women but rarely described in melanodermas. The aim of this work is to investigate the epidemiological and clinical aspects of acute angle closure crisis. Results We collected 24 patient records, totaling 25 eyes. The average age of our patients was 52.04 years, with a male-to-female ratio of 0.6. A family history of glaucoma occurred in 34% of patients. Patients consulted for a painful red eye associated or not with decreased visual acuity (DVA). The condition was bilateral in one patient. The average visual acuity wax 0.34/10<sup>e</sup>. The cornea was cloudy and the pupil in areflexic mydriasis in all sick eyes. Hypothalamia was present in 72% of eyes and cataracts in 54.16% of cases. The average intraocular press was 44.38 mmHg and the average cup/disc (C/D) was 0.46. Gonioscopy was performed in 7 patients. The fellow eye did not present any abnormalities in 92% of cases. Conclusion The acute angle closure crisis is a rare condition in melanodermas and common in woman. His diagnostic is essentially clinical and completed by gonioscopy which plays a fundamental role. .
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·AIM:To compare the ciliary body thickness between eyes with primary angle closure(PAC)and primary angle-closure glaucoma(PACG)with the normal eyes,and to investigate the association between ciliary body thickness and ciliary processes situation.·METHODS:In this cross-sectional study,57 patients with PAC/PACG were matched to 57 normal subjects after propensity score matching(PSM)adjusting for age and gender.All subjects underwent conventional ocular examinations and ultrasound biomicroscopy(UBM)examination,among which the patients with PAC/PACG performed the examinations one month after laser peripheral iridotomy(LPI).Quantitative parameters were measured,which included ciliary body thickness at the position of 1 mm posterior to the scleral spur(CBT1),trabecular-ciliary process distance(TCPD)and trabecularciliary process angle(TCA).·RESULTS:Eyes with PAC/PACG presented significantly thinner CBT1,shorter TCPD and smaller TCA(P<0.001)than the normal eyes,both in comparison of the means of four quadrants and in comparisons of each quadrant.After removing images with peripheral anterior synechia(PAS),the same results were also found in comparisons between the two groups.Significant correlations were found between TCPD(R~2=0.537,P<0.001)and TCA(R~2=0.517,P<0.001)with CBT1.·CONCLUSION:Eyes with PAC/PACG have thinner ciliary body thickness and more anteriorly situated ciliary processes.Thinner ciliary body thickness is associated with anterior situation of the ciliary processes.
文摘Dear Sir,We hereby report a case of bilateral acute angle closure glaucoma secondary to a systemic decongestant containing pseudoephedrine freely available over the counter.Acute angle closure glaucoma is an ocular emergency.Delayed recognition and treatment inevitably leads to permanent visual impairment.Acute angle closure occurs as a result of obstruction to aqueous drainage by blockage of the trabecular meshwork by the iris.Typical presenting symptoms include acute onset of ocular pain,headache and blurred vision.On clinical examination,it is characterized by a markedly raised IOP of above 21 mm Hg together
基金supported by clinical research grant from Pusan National University Yangsan Hospital 2014
文摘Dear Sir,I am Dong Hyun Lee from the Department of Ophthalmology at the Pusan National University Yangsan Hospital,Yangsan,Korea.Herein,I present the development of a lens-induced angle closed glaucoma and iris neovascularization in the patient with Sturge Weber syndrome(SWS)with open angle glaucoma.Informed consent was obtained from a patient before each procedure The study was conducted in accordance with the tenets of the Declaration of Helsinki.
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).
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.
文摘Angle closure glaucoma(ACG)is one of the major causes of blindness.Angle closure occurs from the obstruction of the trabecular meshwork by the peripheral iris,which results in increased intraocular pressure(IOP)through impaired aqueous flow.Considering pupillary block by crystalline lens is the most frequent mechanism,lens extraction is regarded as an effective therapy.Recently,to validate the effect of lens extraction,the EAGLE study was reported.In this study,subjects were 50 years or older,did not have cataracts,and had newly diagnosed primary angle closure(PAC)with intraocular pressure 30 mmHg or greater or primary angle-closure glaucoma(PACG),and were divided into clear-lens extraction group and standard care group(laser peripheral iridotomy and topical glaucoma medication).This study suggested that clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy.Initial clear lens extraction showed better clinical course and patient-reported outcomes.This study provided evidence to support clear lens extraction as the first line treatment for PAC with high IOP or PACG patients.
文摘Background:Trabecular microbypass stents have allowed improved multidirectional flow with good efficacy and safety profile in primary open-angle glaucoma(OAG).The efficacy of these devices in primary angle closure glaucoma has been understudied.We aimed to assess the one-year postoperative outcomes following implantation of trabecular micro-bypass stents with concomitant cataract surgery in angle-closure glaucoma patients.Methods:We evaluated the baseline clinical characteristics and the 12-month outcomes of patients with mild to severe primary angle-closure glaucoma who underwent cataract surgery with implantation of either a first generation trabecular microbypass stent(iStent group)or two second generation trabecular microbypass stents(iStent-inject group).The primary outcomes included intraocular pressure(IOP)and anti-glaucoma medication use.The secondary outcomes were success rate(defined by IOP between 5-18 mmHg with IOP reduction of at least 20%)and visual acuity.Results:A total of 83 eyes(58 from the iStent and 25 from the iStent-inject group)were included with an average age of 68.9±8.6 and 67.6±8.3 years,respectively.All eyes had mild to severe angle-closure glaucoma.At one-year follow-up,the IOP decreased by 21%(from 18.8±4.5 mmHg)and 25%(from 18.7±3.6 mmHg),in each group respectively(P<0.001).Additionally,the medication burden dropped by 52%and 50%at one-year follow-up(P<0.001).The 12-month success rate was 45%in the iStent group compared to 64%in the iStent-inject group(P=0.086)and visual acuity remained stable.Conclusions:The present study provides clinically relevant,real-world data on the utility of iStent and iStent inject with cataract surgery in angle-closure glaucoma-a population that has been understudied in the world of trabecular micro-bypass stents.Our data demonstrated efficacy of these stents in reducing intraocular pressure and medication burden among patients with primary angle closure glaucoma.
基金Supported by Capital Medical Development Sciences Fund(2009-2034)Tsinghua-Yue-Yuen Medical Sciences Fund(20240000564)
文摘Objective To assess the agreement between gonioscopy and ultrasound biomicroscopy(UBM) in detecting angle closure in Chinese patients with shallow anterior chamber. Methods An observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded. Results 85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor(κ<0.4) with Kappa analysis in both dark and light conditions in each quadrant. The accordance of agreement between gonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber(P=0.005) or plateau iris configuration tended to produce different results(P=0.075) in the 2 methods. Conclusion Gonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.
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AIM:To observe the differences of damage patterns of retinal nerve fiber layer(RNFL)between acute and chronic intraocular pressure(IOP)elevation in primary angle closure glaucoma(PACG)using optical coherence tomography(OCT). METHODS:Twenty-four patients(48 eyes)with unilateral acute PACG(APACG)attack in the 6 months after admission and 36 patients(64 eyes)with chronic PACG(CPACG)were included in this prospective study.For all cases,IOP has been controlled under 21mmHg after treatment.Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days,2 weeks,1,3 and 6 months after IOP was controlled. Repeated measures ANOVA was used to examine the changes of RNFL thickness at different time after IOP being controlled in both acute attack eyes and unaffected fellow eyes of APACG and eyes with CPACG. RESULTS:The mean RNFL thickness for the APACG-attacked eyes increased significantly within 3 days(121.49±23.84)μm after acute onset and then became thinner along with time[(107.22±24.72)μm at 2 weeks,(93.58±18.37)μm at 1 month,(84.10±19.89)μm at 3 months and(78.98±19.17)μm at 6 months].In APACG-attacked eyes,there were significant differences of average RNFL thickness at 5 different times after IOP was controlled(P【0.001).In the APACG unaffected fellow eyes and CPACG eyes,there were no significant differences in mean RNFL thickness at 5 different times(F=0.450,P=0.104 in APACG unaffected fellow eyes and F=1.558,P=0.200 in CPACG eyes).There was significant difference for interaction between time periods and groups(F=1.912,P=0.003). CONCLUSION:RNFL damage patterns are different under different IOP elevated courses.In APACG,RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time,while RNFL was found to be diffused thinness in CPACG.
文摘Cataract or clear lens extraction has been suggested as a treatment option for different spectrums of primary angle closure diseases.It might reduce the risk of progression of angle closure and/or glaucoma by helping to open the angle and control the intraocular pressure (IOP).Conventionally,medically uncontrolled primary angle closure glaucoma was treated with trabeculectomy or phacotrabeculectomy and acute primary angle closure was treated with laser peripheral iridotomy. However,recent randomized controlled trials have demonstrated greater promise of phacoemulsification cataract surgery alone for control of the IOP. In this report we review the current literature to evaluate the impact of cataract surgery upon preventing and controlling primary angle closure diseases.
文摘AIM: To investigate the efficacy and safety of krypton laser peripheral iridoplasty(LPIP) for Chinese patients with primary angle closure(PAC) or primary angle-closure glaucoma(PACG) status post laser iridotomy in reversing the positive results of the dark room provocative test(DRPT).METHODS: This study was prospective, noncomparative,interventional case series. Thirty-three patients(thirty-eight eyes) with PAC or PACG status post patent laser iridotomy and maintained normal intraocular pressure(IOP) but with positive DRPT results were enrolled. All the subjects were treated with krypton LPIP. DRPT was repeated after krypton LPIP. Results of DRPT were recorded. The visual acuity, IOP and gonioscopy were analyzed before and after krypton LPIP. A minimum time limit for follow-up was 6mo.RESULTS: Thirty-three patients(thirty-eight eyes)were followed for 17.7 ±8.37mo(range 7-41mo) after LPIP. Positive results of DRPT decreased from 38 eyes to9 eyes(23.7%) after LPIP. Peripheral anterior synechiae of angle in 34 of 38 eyes(89.5%) remained unchanged at dynamic gonioscopy throughout the follow-up period after LPIP.CONCLUSION: LPIP decreased positive rates of the DRPT significantly. The mechanism may be that LPIP minimized contact between the peripheral iris and trabecular meshwork, which is a key factor for developing peripheral anterior synechiae.
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.All the related data that matched our standards were abstracted.The quality of included trials was evaluated according to the Dutch Cochrane Centre.RevMan 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 trab 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
文摘Purpose:To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension.Methods:A total of 36 patients.(40 eyes).with primary acute angle closure glaucoma,who were treated with combined trabeculectomy in the Ophthalmology Unit of our hospital,were selected.Before the procedure,patients were assigned to ocular hypertension group(≥ 40 mm Hg) or control group(< 40 mm Hg) based on intraocular pressure.These two groups were followed up for one year,and compared for post-operative visual acuity,intraocular pressure,filtering bleb,anterior chamber depth,and the occurrence of complications.Results:At 1 week,6 months,and 12 months after the procedure,intraocular pressure was controlled in both the ocular hypertension group and the control group,without significant differences between the two groups(P>0.05).At 1 week,6 months,and 12 months after the procedure,all of the patients,in both groups,had improved in terms of visual acuity,with a significant difference before and after the procedure for the ocular hypertension group(P<0.05).After follow-up at 12 months,the two groups presented no statistically significant differences in anterior chamber depth,filtering bleb survival,or the incidence of post-operative complications(P>0.05 for all).Conclusion:It is feasible,safe,and effective to perform combined trabeculectomy on patients with primary acute angle closure glaucoma complicated by persistent ocular hypertension.
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 30 min 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 μm, anterior chamber depth and volume, whereas significant decrements in iris curve,cross sectional area and volume in both groups. Angle opening distance at 500 μm 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(△IV/△PD) decreased significantly less in angle closure suspects than normal controls(-2.47 ±1.33 mm2vs-3.63±1.58 mm2, P =0.019).Linear regression analysis showed that the change of angle opening distance at 500 μm was associated most with the change of central anterior chamber depth(β =0.841, P =0.002) and △IV/△PD(β =0.028, P =0.002),followed by gender(β =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.
