Increases in rates of both laser peripheral iridotomy and phacoemulsification have accompanied a fall in acute angle closure rates in the UK

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.

Download Full-text

Progression rate to primary angle closure following laser peripheral iridotomy in primary angle-closure suspects: a randomised study

International Journal of Ophthalmology ◽

10.18240/ijo.2021.08.07 ◽

2021 ◽

Vol 14 (8) ◽

pp. 1179-1184

Author(s):

Da-Peng Mou ◽

◽

Su-Jie Fan ◽

Yi Peng ◽

Ning-Li Wang ◽

...

Keyword(s):

Trabecular Meshwork ◽

Applanation Tonometry ◽

Acute Angle ◽

Angle Closure ◽

Progression Rate ◽

Laser Peripheral Iridotomy ◽

Randomised Study ◽

Primary Angle Closure ◽

One Year ◽

Peripheral Iridotomy

AIM: To report the progression rate (PR) to primary angle closure (PAC) following laser peripheral iridotomy (LPI) in PAC suspects (PACS). METHODS: Prospective, randomized controlled interventional clinical trial conducted at the Handan Eye Hospital, China. Totally 134 bilateral PACS, defined as non-visibility of the posterior trabecular meshwork for ≥180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye. Gonioscopy and Goldmann applanation tonometry were performed prior to, on day 7 and 12mo post LPI. RESULTS: Eighty of 134 patients (59.7%) could be followed up at one year. The mean intraocular pressure (IOP) in treated eyes was 15.9±2.6 mm Hg at baseline, 15.4±3.0 mm Hg on day 7; 16.5±2.9 mm Hg at one month, and 15.5±2.9 mm Hg at 12mo; the IOP in untreated eyes was similar (P=0.834). One or more quadrants of the angle opened in 93.7% of the LPI treated eyes, but 67.0% (53/79) remained closed in two or more quadrants. The PR to PAC in untreated eyes was 3.75% and one developed acute angle-closure glaucoma (AACG); the PR to PAC in treated eyes was 2.5% and none had developed peripheral anterior synechia (PAS) or AACG. CONCLUSION: LPI can open some of the occludable angle in the majority of eyes with PACS, but 67% continue to have non-visibility of the trabecular meshwork for over 180 degrees.

Download Full-text

The outcome of transscleral cyclophotocoagulation for the management of acute angle closure

European Journal of Ophthalmology ◽

10.5301/ejo.5001026 ◽

2017 ◽

Vol 28 (2) ◽

pp. 188-192 ◽

Cited By ~ 3

Author(s):

Patrick J. Chiam ◽

Velota C.T. Sung

Keyword(s):

Medical Treatment ◽

Case Series ◽

Acute Angle ◽

Angle Closure ◽

Inclusion Criteria ◽

Laser Peripheral Iridotomy ◽

Lens Extraction ◽

Acute Angle Closure ◽

Transscleral Cyclophotocoagulation ◽

The Mean

Purpose: To investigate the outcome of transscleral cyclophotocoagulation (TCP) in the treatment of acute angle closure (AAC) refractory to medical treatment. Methods: This is a retrospective interventional case series. The inclusion criteria include patients diagnosed with AAC who had TCP. Pre-TCP and post-TCP intraocular pressure (IOP), visual acuity, and AAC treatment were analyzed. The complications and the results of subsequent treatments including lens extraction if performed were also assessed. Results: Thirteen eyes (13 patients) met the study criteria. The median time to TCP from presentation was 5 days (range 3-30 days). The mean presenting IOP was 56 ± 6 mm Hg (range 48-70 mm Hg) and the medically treated mean IOP before TCP was 40 ± 5 mm Hg (range 34-52 mm Hg). All patients (100%) responded to TCP. The mean post-TCP IOP at day 1 and months 1, 3, 6, 12, and 24 were 19, 23, 19, 19, 18, and 17 mm Hg. There was 1 case of hyphema post-TCP. Lens extraction ± goniosynechialysis was performed in 10 patients (77%) from 1 month post-TCP onwards. The mean IOP prior to lens extraction was 26 mm Hg (range 19-32 mm Hg). The mean IOP 3 months after lens extraction was 15 mm Hg (range 8-19 mm Hg). The mean number of topical IOP-lowering medications 12 months post-TCP was 1.1. Conclusions: Transscleral cyclophotocoagulation is effective and safe in reducing IOP in patients with AAC refractory to medical and laser peripheral iridotomy treatments. We advocate that TCP should be considered early in the management of AAC refractory to medical treatment to avoid irreversible optic neuropathy.

Download Full-text

Complete Anterior Capsule Phimosis following Cataract Surgery in a Patient with a History of Retinopathy of Prematurity, Nystagmus, and a Narrow Angle

Case Reports in Ophthalmology ◽

10.1159/000502282 ◽

2019 ◽

Vol 10 (2) ◽

pp. 274-280 ◽

Cited By ~ 1

Author(s):

William K. Wong Jr. ◽

Malcolm R. Ing ◽

Carlthan J.M. Ling

Keyword(s):

Cataract Surgery ◽

Retinopathy Of Prematurity ◽

Acute Angle ◽

Angle Closure ◽

Laser Peripheral Iridotomy ◽

Anterior Capsule ◽

Narrow Angle ◽

History Of ◽

Acute Angle Closure ◽

The Right

The authors present a case of complete anterior capsule phimosis and vision decline which developed 4 weeks postoperatively in the right eye after uncomplicated cataract surgery. Prior ocular history included retinopathy of prematurity in both eyes, acute angle closure glaucoma in the left eye, prophylactic laser peripheral iridotomy for a narrow angle in the right eye, and nystagmus in both eyes. This condition was addressed by surgically releasing the anterior capsule with microscissors to open the pupillary space which had been completely obscured by the anterior capsule, also causing the haptics of the 1-piece intraocular lens to deform. When cataract surgery was performed on his left eye, the surgeon performed prophylactic relaxing incisions at 4 points on the capsular opening. It is notable that his left eye did not develop anterior capsule phimosis postoperatively.

Download Full-text