Changes of anterior chamber architecture induced by laser peripheral iridotomy in acute angle closure crisis

2014 ◽  
Vol 35 (4) ◽  
pp. 549-556 ◽  
Author(s):  
J. D. Unterlauft ◽  
Y. Yafai ◽  
P. Wiedemann
Keyword(s):  
Anterior Chamber ◽  
Acute Angle ◽  
Angle Closure ◽  
Laser Peripheral Iridotomy ◽  
Acute Angle Closure ◽  
Peripheral Iridotomy

scholarly journals Bilateral simultaneous acute angle closure in an adult Nepalese woman

2018 ◽  
Vol 16 (1) ◽  
pp. 51-54
Author(s):  
Sabin Sahu ◽  
Lila Raj Puri
Keyword(s):  
Intraocular Pressure ◽  
Corneal Edema ◽  
Acute Angle ◽  
Posterior Segment ◽  
Angle Closure ◽  
Laser Peripheral Iridotomy ◽  
Peripheral Iridectomy ◽  
Acute Angle Closure ◽  
The Right ◽  
Peripheral Iridotomy

Purpose: To report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. Methods: Observational case report. Results: A 50-year-old Nepalese woman presented with decreased vision, pain, redness, and watering in both eyes with associated coloured haloes, nausea, and vomiting for 10 days. At presentation, her visual acuity was 20/400 in the right eye and hand motions close to face with accurate projection of rays in the left eye. Intraocular pressure was 38 mmHg in the right eye and 48 mmHg in the left eye without any antiglaucoma medications. A slit-lamp examination revealed bilateral circum-corneal conjunctival congestion, corneal edema, and shallow anterior chambers. Both pupils were mid-dilated and non-reactive to light. Gonioscopy showed closed angles in all four quadrants bilaterally. Posterior segment examination revealed normal optic disc with cup-disc-ratio of 0.3 in the right eye, and blurring of disc margin with cup-disc-ratio of 0.3 in the left eye. The patient was started on systemic acetazolamide 250 mg 4 times a day, topical brimonidine 0.2% and timolol 0.5% 2 times a day, and topical dexamethasone 6 times a day in both eyes, following which IOP reduced to 11 and 12 mmHg, respectively, the corneal edema subsided, but the anterior chamber remained shallow. Laser peripheral iridotomy was performed in the right eye and surgical peripheral iridectomy was performed in the left eye. After two weeks, vision improved to 20/30 in both eyes with normal intraocular pressure off antiglaucoma medications. Anterior chambers deepened significantly with clear corneas bilaterally. Gonioscopy at this stage showed essentially open angles with appositional closure in superior and temporal quadrants in the right eye and open angles in all four quadrants in the left eye. Posterior segment evaluation revealed normal optic disc in both eyes. Conclusions: Bilateral simultaneous acute angle closure is a rare presentation with very few reported secondary causes. We report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. The case was successfully managed with laser peripheral iridotomy in the right eye and surgical peripheral iridectomy in the left eye.  

scholarly journals Aphakic Pupillary Block by an Intact Anterior Vitreous Membrane after Total Lens Extraction by Phacoemulsification

2021 ◽  
pp. 882-888
Author(s):  
Michihiro Kono ◽  
Akiko Ishida ◽  
Sho Ichioka ◽  
Masato Matsuo ◽  
Hiroshi Shimizu ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Cataract Extraction ◽  
Japanese Woman ◽  
Acute Angle ◽  
Angle Closure ◽  
Pupillary Block ◽  
Lens Extraction ◽  
Old Japanese ◽  
Acute Angle Closure ◽  
Vitreous Prolapse

An 85-year-old Japanese woman with acute primary angle closure in her right eye underwent cataract extraction. Because of the weakness of the Zinn’s zonules, all of the lens tissue including the lens capsule was removed by phacoemulsification. Because of the absence of vitreous prolapse into the anterior chamber, vitrectomy was not performed. Nine days postoperatively, acute angle closure due to pupillary block by an anterior vitreous membrane developed. To resolve the pupillary block, anterior vitrectomy was performed on the same day. Postoperatively, her symptoms resolved, the anterior chamber deepened, and the intraocular pressure normalized. Although rare, acute angle closure due to pupillary block by an anterior vitreous membrane can occur after total lens extraction with phacoemulsification. If no vitreous prolapse occurs with total lens extraction, an intentional hyaloidotomy using an anterior vitreous cutter or iridectomy should be considered to avoid secondary angle closure.

scholarly journals Combined Acute Haemolytic and Secondary Angle Closure Glaucoma following Spontaneous Intraocular Haemorrhages in a Patient on Warfarin

2016 ◽  
Vol 7 (3) ◽  
pp. 511-516 ◽  
Author(s):  
Walter Andreatta ◽  
Stavroula Boukouvala ◽  
Atul Bansal
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Acute Angle ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
First Case ◽  
Oral Warfarin ◽  
Acute Angle Closure ◽  
Excessive Anticoagulation ◽  
Acute Angle Closure Glaucoma

Background: To report the first described case of combined haemolytic and acute angle closure glaucoma secondary to spontaneous intraocular haemorrhages in a patient on excessive anticoagulation. To the best of our knowledge, this is the first case reported in the literature presenting with raised intraocular pressure due to both mechanisms. Case Description: A 90-year-old woman presented with acute pain and reduction in vision in the left eye. Her intraocular pressure (IOP) was 55 mm Hg. There were red tinted blood cells in the anterior chamber giving it a reddish hue. The patient was known to have advanced wet macular degeneration. She was taking oral warfarin for atrial fibrillation. Her international normalised ratio (INR) was 7.7. B-scan ultrasound of posterior segment showed vitreous and suprachoroidal haemorrhages. An ultrabiomicroscopic examination confirmed open angles. A diagnosis of haemolytic glaucoma secondary to intraocular haemorrhages was made. The IOP was controlled medically. Warfarin was withdrawn and oral vitamin K therapy was initiated leading to a rapid INR reduction. Three days later, her anterior chamber became progressively shallower causing a secondary acute angle closure which was managed medically. After 2 months, the left IOP was well-controlled without any medications and the eye was not inflamed. Her vision in that eye remained perception of light. Conclusion: Patients with suprachoroidal haemorrhages should be closely monitored as they might subsequently develop acute angle closure despite an initially open angle and well-controlled INR and IOP. Excessive anticoagulation needs to be prevented to minimise the risk of sight-threatening complications.

scholarly journals Vitreous Decompression Combined with Phacoemulsification for Medically Unresponsive Acute Angle Closure

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Xiaoli Xiang ◽  
Yuan Chen ◽  
Jinyu Wang ◽  
Zhengru Huang ◽  
Zheng Gu
Keyword(s):  
Anterior Chamber ◽  
Anterior Chamber Depth ◽  
Needle Aspiration ◽  
Acute Angle ◽  
Angle Closure ◽  
Final Examination ◽  
Aspiration Technique ◽  
Acute Angle Closure ◽  
Shallow Anterior Chamber ◽  
Medical University

The management of acute angle closure combined with an extremely shallow anterior chamber and cataract remains complex. This study evaluated a technique of vitreous needle aspiration combined with phacoemulsification for the treatment of acute angle closure with continuous high intraocular pressure (IOP). We retrospectively reviewed the results of vitreous needle aspiration combined with phacoemulsification in 17 eyes (17 patients) with acute angle closure with continuous high IOP and coexisting visually significant cataracts between September 2018 and April 2020 at the glaucoma unit of the affiliated Changshu Hospital of Xuzhou Medical University. The main outcomes were the best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), angle open distance 500 (AOD500), number of antiglaucoma medications, and surgery-associated complications. There were no complications during phacoemulsification and a foldable acrylic intraocular lens was implanted in the capsular bag in all 17 patients. For all patients, vitreous needle aspiration was successful at the first attempt. The BCVA improved from 2.02 ± 0.54 logMAR preoperatively to 0.73 ± 0.57 logMAR postoperatively at the final examination ( p < 0.001 ). The mean IOP was 54.47 ± 5.33 mmHg preoperatively and 15.59 ± 2.35 mmHg at the final examination ( p < 0.001 ) without any medication. The ACD was 1.70 ± 0.16 mm preoperatively and 3.35 ± 1.51 mm at the final examination ( p < 0.001 ). The AOD500 was 0.07 ± 0.02 mm preoperatively and 0.51 ± 0.04 mm at the final examination ( p < 0.001 ). Our vitreous needle aspiration technique can be performed safely in phacoemulsification for the management of acute angle closure with continuous high IOP.

Acute angle closure glaucoma precipitated by intranasal application of cocaine

1999 ◽  
Vol 113 (3) ◽  
pp. 250-251 ◽  
Author(s):  
C. K. Hari ◽  
D. G. Roblin ◽  
M. I. Clayton ◽  
R. G. Nair
Keyword(s):  
Anterior Chamber ◽  
Acute Angle ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Potential Complication ◽  
Intranasal Cocaine ◽  
Acute Glaucoma ◽  
Acute Angle Closure ◽  
Shallow Anterior Chamber ◽  
Acute Angle Closure Glaucoma

AbstractWe describe a patient who developed acute angle-closure glaucoma following the application of topical intranasal cocaine. A 46-year-old woman underwent an elective antral washout under general anaesthesia and with local application of 25 per cent cocaine paste to the nasal mucosa. Twenty-four hours post-operatively the patient developed sudden painful blindness which was found to be due to acute glaucoma. Cocaine with its indirect sympathomimetic activity causes mydriasis, that can precipitate acute angle-closure glaucoma in predisposed individuals with a shallow anterior chamber. Although the incidence is rare, otolaryngologists need to be aware of this potential complication.

scholarly journals Ocular Biometric Characteristics of Chinese with History of Acute Angle Closure

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Wei-ran Niu ◽  
Chun-qiong Dong ◽  
Xi Zhang ◽  
Yi-fan Feng ◽  
Fei Yuan
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Anterior Chamber ◽  
Axial Length ◽  
Anterior Chamber Depth ◽  
Acute Angle ◽  
Angle Closure ◽  
Biometric Parameters ◽  
History Of ◽  
Acute Angle Closure

Purpose. To investigate the biometric characteristics of Chinese patients with a history of acute angle closure (AAC). Methods. In this clinic-based, retrospective, observational, cross-sectional study, biometric parameters of eyes were acquired from a general population of Chinese adults. The crowding value (defined as lens thickness (LT); central corneal thickness (CCT); anterior chamber depth (ACD)/axial length (AL)) was calculated for each patient. Logistic regression analysis was performed to identify risk factors for AAC. Receiver operating characteristic (ROC) curves were plotted, and biometric variables were compared to compile a risk assessment for AAC. Result. This study included 1500 healthy subjects (2624 eyes, mean age of 66.54 ± 15.82 years) and 107 subjects with AAC (202 eyes, mean age of 70.01 ± 11.05 years). Eyes with AAC had thicker lens (P≤0.001), shallower anterior chamber depth (P≤0.001), and shorter axial length (P≤0.001) than healthy eyes. Logistic regression analysis and ROC curve analysis indicated that a crowding value above 0.13 was a significant (P<0.05) risk factor for the development of AAC. Conclusions. Biometric parameters were significantly different between the eyes from the AAC group to the normal group. Ocular crowding value might be a new noncontact screening method to assess the risk of AAC in adults.

scholarly journals Comparisons of clinical characteristics of lens-subluxated eye with or without acute angle closure: A retrospective study

2019 ◽  
Author(s):  
Hong-Yang Zhang ◽  
Hong-Liang Lin ◽  
Yong-Jie Qin ◽  
Yu-Lin Zhang ◽  
Yu-Qiao Zhang ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Clinical Characteristics ◽  
Anterior Segment ◽  
Ultrasound Biomicroscopy ◽  
Acute Angle ◽  
Angle Closure ◽  
Fellow Eye ◽  
Lens Extraction ◽  
Lens Subluxation ◽  
Acute Angle Closure

Abstract BackgroundTo compare clinical characteristics of lens subluxation between eyes with or without acute angle closure (AAC).MethodsThis is a retrospective and case control study. Thirty-four cases with lens subluxation were recruited from 2015 to 2017. Patients with acute angle closure were assigned to the AAC group (n=17 eyes) and those without AAC were in the non-AAC group (n=17 eyes). Quantitative anterior segment was evaluated by ultrasound biomicroscopy (UBM). Axial length (AL) was measured with IOL master. All patients underwent lens extraction surgery and were followed up for 6 months. ResultsThe history of blunt trauma was accounted for 11 (64.7%) cases in the AAC group and 14 (82.3%) cases in the non-AAC group. Nine (52.9%) patients in the AAC group had LPI or SPI treatment history, and high intraocular pressure was recurred. The UBM analysis showed that the average central ACD of affected eyes in the AAC group was 1.75 mm, which was significantly shallower than the fellow eyes (2.39 mm, P < 0.05) or both eyes in the non-AAC group (affected eye 3.24mm vs fellow eye 3.81mm). Lens vault and AOD500 also showed a remarkable difference between affected eye than fellow eye (P < 0.001) in the AAC group. The both eyes in the AAC group presented a shorter AL and shallower anterior chamber, comparing with those in the non-AAC group. Besides, the affected eyes in the AAC group presented significantly higher LV. ConclusionsThe crowded anterior chamber structure and shorter AL might be an anatomic basis for the eye with lens subluxation induced AAC. Quantitative evaluation of these ocular structures to identify zonular compromise, increased LV and shorter AL are valuable for the diagnosis of lens subluxation induced AAC.

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