Glaucomatocyclitic Crises May Occur in Patients with Narrow or Closed Angles

Purpose. To report cases of glaucomatocyclitic crises and discuss the possibility of occurrence in patients with narrow or closed angles. Background. The prevalence of angle closure is much higher among Asians than among the Western population. Currently, there is no evidence for a direct relationship between the etiology and angle structure. Design. A retrospective and observational case series. Methods. We retrospectively collected data from nine adult patients (three males and six females) who were diagnosed with a glaucomatocyclitic crisis and a shallow anterior chamber over a 21-year period, from 1995 to 2016, at the Kaohsiung Medical University Hospital. A narrow angle was defined as a grade less than the Shaffer system grade II. Ophthalmic examinations, including anterior segment biomicroscopy, direct ophthalmoscopy, intraocular pressure measurements, anterior chamber reaction, visual field tests, and the grade of the anterior chamber angle according to the Shaffer system, were reviewed. Results. These patients experienced at least one typical unilateral ocular hypertensive episode that fulfilled the criteria of a glaucomatocyclitic crisis without the angle feature. All patients had gonioscopically narrow or closed angles with or without peripheral anterior synechiae. Conclusions. The coexistence of narrow or closed angles and a glaucomatocyclitic crisis is possible, especially in patients of Asian descent. In patients with shallow anterior chambers, a glaucomatocyclitic crisis may be a cause of acute glaucoma episodes.

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A Case of Repeating Transient Increase in Intraocular Pressure by Instability of an Intraocular Lens Implanted in the Capsular Bag

Case Reports in Ophthalmology ◽

10.1159/000505597 ◽

2020 ◽

Vol 11 (1) ◽

pp. 60-67

Author(s):

Yukihisa Takada ◽

Takayoshi Sumioka ◽

Nobuyuki Ishikawa ◽

Shingo Yasuda ◽

Ryoko Komori ◽

...

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Intraocular Lens ◽

Anterior Chamber Depth ◽

Acute Angle ◽

University Hospital ◽

Angle Closure ◽

Light Reaction ◽

Narrow Angle ◽

Medical University

We observed repeated episodes of rapid increases in intraocular pressure (IOP) considered to be caused by an in-the-bag intraocular lens (IOL) instability in a patient with an implanted IOL. As acute glaucoma attack-like increase in IOP was noted in the left eye on November 8, she was admitted to Wakayama Medical University Hospital. The findings at the first examination included an IOP of 62 mm Hg, instability of a PMMA one-piece IOL, shallow anterior chamber, narrow angle, moderate mydriasis, and loss of pupillary light reaction in the left avitreous eye. On November 15, a 6-mm Hg increase in IOP was observed during 60-min dark room prone provocative testing. After the first examination, the patient perceived pain and reduced visual acuity of the left eye and emergently consulted our hospital twice. Despite miosis, normalization of the anterior chamber depth and IOP with widening of the angle were achieved by resting in the supine position. These episodes were thought to be caused by instability and anterior shift of the IOL. On January 17, 2018, suture fixation of the in-the-bag IOL was performed. The IOL was fixed by transscleral suturing of the bilateral supporting parts to the sclera. Recurrence of sudden ophthalmalgia, instability of the in-the-bag IOL, and an increase in IOP have not been observed for 1 year after surgical treatment. Instability of an in-the-bag IOL caused repeated acute angle-closure glaucoma-like attacks. The situation was well treated by suturing and fixing the haptics of IOL to the sclera.

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Residual anterior chamber angle closure in narrow-angle eyes following laser peripheral iridotomy: anterior segment optical coherence tomography quantitative study

Japanese Journal of Ophthalmology ◽

10.1007/s10384-011-0009-3 ◽

2011 ◽

Vol 55 (3) ◽

pp. 213-219 ◽

Cited By ~ 30

Author(s):

Kyoung Sub Lee ◽

Kyung Rim Sung ◽

Sung Yong Kang ◽

Jung Woo Cho ◽

Dong Yoon Kim ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Anterior Chamber ◽

Quantitative Study ◽

Anterior Segment ◽

Angle Closure ◽

Anterior Chamber Angle ◽

Laser Peripheral Iridotomy ◽

Narrow Angle ◽

Peripheral Iridotomy ◽

Chamber Angle

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Role of Anterior Segment OCT in the Management of Primary Narrow Angle Disease

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v36i4.1039 ◽

2020 ◽

Vol 36 (4) ◽

Author(s):

Javeria Muid ◽

Sadia Farooq

Keyword(s):

Anterior Segment ◽

Case Series ◽

Sampling Technique ◽

Angle Closure ◽

Definitive Treatment ◽

Disease Treatment ◽

Anterior Segment Oct ◽

Lens Extraction ◽

Narrow Angle

Purpose: To highlight the role of anterior segment OCT, in complementing gonioscopic findings in the management of angle closure glaucoma. Study Design: Descriptive observational case series. Study Place and Duration: Study was conducted at Eye department of Shifa International Hospital, from January 2019 to March 2019. Methods: After taking informed consent from the patients, the study was conducted at Shifa International Hospital Islamabad. Patients were selected by convenient sampling technique. Patients were diagnosed on the basis of history and clinical examination. Patients with angle closure on Gonioscopy were included in this series. Detailed ocular examination including visual acuity for distance and near, tonometry, Gonioscopy and anterior segment OCT were performed. Data was collected and presented as case series. Results: The median age 57 years with 50% more than 60 years and 50% less than 60 years of age. Presenting IOP was less than 21 mmHg in 50% and higher in remaining 50%. On examination 37.5% were categorized as PACS, 12.5% having PAC and 50% as PACG. After definitive treatment 12.5% still needed medical treatment to prevent progression in PACG and none in PACS and PAC. Conclusion: In narrow angle disease, treatment is designed not only to control intraocular pressure (IOP) but also to keep angle open as much as possible. Appositional closure or peripheral anterior synechiae (PAS) can damage the trabecluar meshwork. Iridoplasty, peripheral Iridotomy (PI) and early lens extraction can defer the need for filtration procedure if done well in time. Key Words: OCT anterior segment, Narrow angle, Optic nerve head.

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Application of Anterior Segment Optical Coherence Tomography in Pediatric Ophthalmology

Journal of Ophthalmology ◽

10.1155/2012/313120 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Ricardo Salles Cauduro ◽

Caroline do Amaral Ferraz ◽

Maira Saad Ávila Morales ◽

Patricia Novita Garcia ◽

Yara Cristina Lopes ◽

...

Keyword(s):

Anterior Chamber ◽

Pediatric Population ◽

Anterior Segment ◽

Anterior Chamber Depth ◽

Case Series ◽

Angle Closure ◽

Optical Coherence ◽

Pediatric Ophthalmology ◽

Retrospective Clinical Study ◽

Shallow Anterior Chamber

Purpose.Application of anterior segment optical coherence (AS-OCT) in pediatric ophthalmology.Methods.Retrospective clinical study case series of 26 eyes of 19 pediatric patients throughout a 21-month period, presenting anterior segment pathologies, were submitted to AS-OCT examination (OCT Visante, 1310 nm, Zeiss), noncontact technique, no sedation requirement.Results.AS-OCT images were obtained from 19 patients (range: 2 months to 12 years). Clinical diagnosis of anterior segment abnormalities included cornea disease (n=7), congenital anterior segment conditions (n=10), ocular trauma (n=1), anterior segment surgeries (n=2), iridocorneal angle abnormalities (n=4), intermediate uveitis (n=2). The most common OCT findings were corneal hyperreflectivity and thickening (n=15), shallow anterior chamber with iris-lens diaphragm anterior displacement (n=4), atypical corneal curvature (n=4), corneal thinning (n=4), peripheral synechiae with angle closure (n=3), increased anterior chamber depth (n=2), and proximal portion of glaucoma drainage tube (n=2).Conclusion.In the present study, noncontact AS-OCT demonstrated to be a feasible technique to evaluate the anterior segment providing anatomic details and useful to clarify diagnosis in the pediatric population.

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Etiologies and clinical characteristics of young patients with angle-closure glaucoma: a 15-year single-center retrospective study

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05172-6 ◽

2021 ◽

Author(s):

Feng Gao ◽

Jiajian Wang ◽

Junyi Chen ◽

Xiaolei Wang ◽

Yuhong Chen ◽

...

Keyword(s):

Clinical Characteristics ◽

Anterior Segment ◽

Young Patients ◽

Case Series ◽

Neovascular Glaucoma ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Uncommon Presentation ◽

Underlying Causes

Abstract Purpose To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese. Methods Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts. Results A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan’s syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat’s disease, and neurofibromatosis. Conclusions We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.

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Anatomical and Visual Effects of Implantable Phakic Contact Lens on Correction of Myopia

10.21203/rs.3.rs-1245764/v1 ◽

2022 ◽

Author(s):

Mahmoud Ekram ◽

Ahmed Mohamed Kamal Elshafei ◽

Asmaa Anwar Mohamed ◽

Mohamed Farouk Sayed Othman Abdelkader

Keyword(s):

Visual Acuity ◽

Anterior Chamber ◽

Contact Lens ◽

Anterior Segment ◽

Anterior Chamber Depth ◽

Case Series ◽

Care Group ◽

Case Series Study ◽

Significant Difference ◽

The Mean

Abstract Purpose: To evaluate the anatomical effects of implantable phakic contact lens (IPCL) (Care Group, India) on anterior segment and its visual outcomes .Patients and methods: In a prospective interventional case series study, 60 highly myopic eyes of 32 patients were subjected to IPCL implantation in the Ophthalmology Department of Minia University Hospital, Egypt from January 2019 to June 2021. All patients had complete ophthalmic examination and were followed up for 1 year. Pentacam was used for preoperative and postoperative estimation of anterior chamber depth (ACD), anterior chamber angle (ACA), anterior chamber volume (ACV) and IPCL vault in the 1st, 3rd, and 12th months. Assessment of corneal endothelium was done using specular microscope preoperatively and after 12 months. Preoperative and postoperative refraction and visual acuity were measured. Results: There was a statistically significant decrease in ACD, ACA, and ACV. There was no significant difference between preoperative and postoperative mean intraocular pressure (IOP) by the 12th month (P=0.163). The mean preoperative endothelial cell count (ECD) was significantly reduced from 2929.3±248 cells/mm2 to 2737.9±303 cells/mm2 at the 12th month (P<0.001). with a statistically highly significant improvement of mean Log Mar uncorrected visual acuity (UCVA) from 1.48±0.19 preoperatively to 0.46±0.11 by the end of follow up (P<0.001) with insignificant difference between preoperative best corrected visual acuity (BCVA) and postoperative UCVA (P=0.209). In the 12th month, the mean vault was 240±540 μm. No sight threatening complications occurred.Conclusion: Although IPCL induced anatomical changes, it was safe and effective for correction of high myopia.

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Anterior Segment OCT in Primary Angle Closure Compared to Normal Subjects with Similar Shallow Anterior Chamber

Journal of Glaucoma ◽

10.1097/ijg.0000000000001915 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Qinghong Xie ◽

Ping Ma ◽

Jutima Patlidanon ◽

Murtaza Saifee ◽

Sean Yonamine ◽

...

Keyword(s):

Anterior Chamber ◽

Anterior Segment ◽

Normal Subjects ◽

Angle Closure ◽

Anterior Segment Oct ◽

Primary Angle Closure ◽

Shallow Anterior Chamber

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Single-pass four-throw pupilloplasty for secondary angle-closure glaucoma associated with silicon oil tamponade

European Journal of Ophthalmology ◽

10.1177/1120672118780809 ◽

2018 ◽

Vol 29 (5) ◽

pp. 561-565 ◽

Cited By ~ 1

Author(s):

Priya Narang ◽

Ashar Agarwal ◽

Amar Agarwal

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Anterior Segment ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Single Pass ◽

Silicon Oil ◽

The Mean

Purpose: To describe the feasibility and efficacy of performing single-pass four-throw pupilloplasty for secondary angle-closure glaucoma post silicon oil tamponade. Methods: The procedure was performed in five eyes of five patients. All the cases underwent silicon oil removal with single-pass four-throw pupilloplasty. Single-pass four-throw procedure involves a single pass of needle through the iris tissue that is to be apposed followed by taking four throws by passing the suture end through the loop that is withdrawn from the anterior chamber as in a modified Siepser’s slip-knot technique. Both the suture ends are pulled and this leads to sliding of the loop into the anterior chamber. Surgical pupilloplasty stretches the peripheral iris tissue and helps in breaking the peripheral anterior synechia. Intraoperative gonioscopy and anterior segment optical coherence tomography were performed in all the cases. Results: Intraoperative gonioscopy and anterior segment optical coherence tomography demonstrated opening of the anterior chamber angles with breakage of peripheral anterior synechia. The mean preoperative and postoperative best-corrected visual acuity in logarithm of minimum angle of resolution was 1.24 ± 0.23 and 0.56 ± 0.18, respectively (p < 0.001). The mean preoperative and postoperative intraocular pressure was 38.2 ± 4.97 and 13.0 ± 2.35 mm Hg, respectively. There was a significant decrease in intraocular pressure and marked improvement in visual acuity in all the cases. Conclusion: Surgical pupilloplasty helps to relieve the post-silicon oil-induced secondary angle-closure glaucoma by breaking peripheral anterior synechia and significantly opening the anterior chamber angles.

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