Vitreous Decompression Combined with Phacoemulsification for Medically Unresponsive Acute Angle Closure

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.

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Surgical Outcomes of Vitreous Needle Aspiration Combined With Phacoemulsification for Acute Angle Closure With Continuous High Intraocular Pressure-A Retrospective Analysis

10.21203/rs.3.rs-133418/v1 ◽

2020 ◽

Author(s):

Xiaoli Xiang ◽

Yuan Chen ◽

Jinyu Wang ◽

Zheng Gu ◽

Zhengru Huang

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Anterior Chamber Depth ◽

Needle Aspiration ◽

Acute Angle ◽

Angle Closure ◽

Final Examination ◽

Aspiration Technique ◽

Acute Angle Closure ◽

Medical University

Abstract Background: The management of acute angle closure combined with an extremely shallow anterior chamber and cataracts 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).Methods: 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), number of anti-glaucoma medications, and surgery-associated complications.Results: 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 (range, 1.17-1.94 mm) preoperatively and 3.35±1.51 mm at the final examination (p<0.001).Conclusions: Our vitreous needle aspiration technique can be performed safely in phacoemulsification for the management of acute angle closure with continuous high IOP.

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25-Gauge anterior vitrectomy via the scleral flap in phacoemulsification combined with trabeculectomy for glaucoma and cataract with extremely shallow anterior chamber

10.21203/rs.3.rs-63004/v1 ◽

2020 ◽

Author(s):

Hui Shao ◽

Bole Wu ◽

Xinming Ye ◽

Yiyu Meng

Keyword(s):

Anterior Chamber ◽

Anterior Chamber Depth ◽

Acute Angle ◽

Angle Closure ◽

Scleral Flap ◽

Anterior Vitrectomy ◽

Suprachoroidal Hemorrhage ◽

Corneal Decompensation ◽

Acute Angle Closure ◽

Shallow Anterior Chamber

Abstract Objective: To observe the safety and efficacy of a surgical technique of 25-gauge anterior vitrectomy via scleral flap in phacoemulsification combined with trabeculectomy for glaucoma and cataract with extremely shallow anterior chamber.Methods: This was a retrospective study composed with 18 eyes of 18 patinets（8 males and 10 females）, including 11 eyes with acute angle closure glaucoma, 8 eyes with lens subluxation combined with glaucoma. All patients underwent phacoemulsification, intraocular lens (IOL) implantation, trabeculectomy, and anterior vitrectomy via the scleral flap in cases where conservative managements cannot control intraocular pressure (IOP). The main outcomes were best corrected visual acuity (BCVA), anterior chamber depth (ACD), IOP, slit lamp microscopic examinations, medications, fundus examinations and complications.Results: The average axial length (AL) was 21.5 ± 0.6 mm (range: 20.0 to 23.2 mm). Mean age was 62.3 ± 7.9 years old (range: 46 to 73 years). Mean ACD increased statistically significant from 0.78 ± 0.43 mm to 2.89 ± 0.41 mm 1 week after surgery (P<0.001). Mean IOP decreased significantly from 43.28 ± 9.38 mmHg to 16.72 ± 6.28 mmHg (P<0.001). There were no serious complications occurred, such as endophthalmitis, retinal detachment, suprachoroidal hemorrhage, corneal decompensation and malignant glaucoma.Conclusions: 25-Gauge anterior vitrectomy via the scleral flap was a safe and effective technology in glaucoma combined with cataract with extremely shallow anterior chamber.

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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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Acute angle closure glaucoma precipitated by intranasal application of cocaine

The Journal of Laryngology & Otology ◽

10.1017/s0022215100143695 ◽

1999 ◽

Vol 113 (3) ◽

pp. 250-251 ◽

Cited By ~ 13

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.

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Ocular Biometric Characteristics of Chinese with History of Acute Angle Closure

Journal of Ophthalmology ◽

10.1155/2018/5835791 ◽

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.

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Biometric indicators of Eyes with Occult Lens Subluxation inducing Secondary Acute Angle Closure

10.21203/rs.2.432/v4 ◽

2019 ◽

Author(s):

Xiaoli Xing ◽

Liangyu Huang ◽

Fang Tian ◽

Yan Zhang ◽

Yingjuan Lv ◽

...

Keyword(s):

Anterior Chamber ◽

Axial Length ◽

Anterior Chamber Depth ◽

Acute Angle ◽

Angle Closure ◽

Lens Subluxation ◽

Lens Thickness ◽

Primary Angle Closure ◽

Lens Position ◽

Acute Angle Closure

Abstract Background : To compare the anterior biometricsof eyes with secondary acute angle closure induced by occult lens subluxation (ASAC-LS), which were misdiagnosed at the first visit withacute primary angle closure (APAC), chronic primary angle closure glaucoma (CPACG), or cataracts. Methods: This retrospective case series ncluded 17 eyes with angle closure due to occult LS which were misdiagnosed with APAC at the first visit, 56 APACeyes, 54 CPACGeyes, and 56 cataracteyes. The axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AD), and lens thickness (LT) were recorded. The lens position (LP), relative lens position (RLP), and corrected lens position (CLP) were calculated. Quantitative data were subject to a one-way analysis of variance and correlation analysis. Categorical data were analysed using the chi-squared test. Receiver operating characteristic (ROC) curves were plotted to obtain a suitable cut-off value for ocular biometrics. Results: The ASAC-LSpatients had a longer ocular AL than the APACand CPACGpatients. The CCTinthe ASAC-LS patientsdid not significantly differ from that in the APAC patientsbut did significantly differ from that of the CPACG and cataract patients.The APAC patientshad the smallest ACD, while the ASAC-LS patientshad the smallest AD. The ASAC-LS patientshad the thickest lenses. According to the ROC curve analysis, the RLP, ACD, AD, CLP, and LP hada high power of discrimination. Conclusions: This study revealed that ASAC-LS patients had a shallower AD and thicker CCT compared to APAC, CPACG, and cataract patients. Biometric parameters ACD, ADwere characteristic of lens subluxation according to our data. The calculated parameters RLP,CLP, LP can be helpful in the differential diagnosis between ASAC-LSand APAC, CPACG, Cataract. Trial registration: NCT03752710, retrospectively registered. Keywords:Lens subluxation; Acute angle-closure; Biometry; Anterior chamber depth; Lens thickness; Axial length

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Retrospective Study of Vitreous Tap Technique Using Needle Aspiration for Management of Shallow Anterior Chamber during Phacoemulsification

Journal of Ophthalmology ◽

10.1155/2017/2801025 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Ashraf Ahmed Nossair ◽

Wael Ahmed Ewais ◽

Lamia Samy Ali

Keyword(s):

Retrospective Study ◽

Anterior Chamber ◽

Axial Length ◽

Anterior Chamber Depth ◽

Cost Effective ◽

Needle Aspiration ◽

Angle Closure ◽

Safe Technique ◽

Shallow Anterior Chamber

Purpose.To evaluate the technique of vitreous tap using needle aspiration for management of anterior chamber shallowness during phacoemulsification.Methods.A retrospective study included 26 eyes of 17 patients who underwent phacoemulsification in which vitreous tap was performed using a 27-gauge needle attached to a 5 ml syringe, inserted 3.5 mm from the limbus to aspirate 0.2 ml of liquefied vitreous if a cohesive (OVD) failed to sufficiently deepen the anterior chamber.Results.Preoperative anterior chamber depth was 2.31 ± 0.26 mm, axial length was 21.7 ± 0.67 mm, lens thickness was 4.5 ± .19 mm, and cataract grade was 3.77 ± 1.4. Preoperative CDVA in LogMAR units was 0.98 ± 0.75. Coexisting angle closure glaucoma was present in 7 patients (26.92%) preoperatively. Vitreous needle tap was successful in vitreous removal on the first attempt in 26 eyes (100%). Postoperative follow-up period was 22.88 ± 10.24 (4–39) months. The final postoperative CDVA in LogMAR units was 0.07 ± 0.1, while the final postoperative IOP was 16.54 ± 1.45 mmHg. No complications related to vitreous tap were noted.Conclusion.Vitreous needle tap is a simple, cost-effective, and safe technique for management of shallow anterior chamber in phacoemulsification.

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

Case Reports in Ophthalmology ◽

10.1159/000520176 ◽

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.

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

Case Reports in Ophthalmology ◽

10.1159/000452440 ◽

2016 ◽

Vol 7 (3) ◽

pp. 511-516 ◽

Cited By ~ 2

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.

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Biometric indicators of Eyes with Occult Lens Subluxation inducing Secondary Acute Angle Closure

10.21203/rs.2.432/v2 ◽

2019 ◽

Author(s):

Xiaoli Xing ◽

Liangyu Huang ◽

Fang Tian ◽

Yan Zhang ◽

Yingjuan Lv ◽

...

Keyword(s):

Axial Length ◽

Corneal Thickness ◽

Anterior Chamber Depth ◽

Acute Angle ◽

Angle Closure ◽

Lens Subluxation ◽

Lens Thickness ◽

Primary Angle Closure ◽

Lens Position ◽

Acute Angle Closure

Abstract Background: To compare the anterior biometry of eyes with secondary acute angle closure induced by occult lens subluxation (LS), misdiagnosed as acute primary angle closure (APAC) at the first visit, APAC, chronic primary angle closure glaucoma (CPACG), cataract. Methods: This retrospective case study included 17 eyes with PAC due to occult LS, who were misdiagnosed as APAC on their first visit, 56 eyes diagnosed as APAC, 54 eyes diagnosed as CPACG, and 56 eyes diagnosed as cataract. Axial length (AL), Central corneal thickness (CCT), anterior chamber depth (ACD) and lens thickness (LT) were recorded. Lens position (LP), relative lens position (RLP), corrected lens position (CLP) were calculated. Quantitative data were subject to one-way analysis of variance and correlation analysis. Categorical data were analyzed using the chi-squared test. Results: The patients in the LS group had a longer ocular axial length than those with acute angle closure and CPACG. Corneal thickness in the LS group was not significantly different from that in the APAC group, but was significantly different from those of the CPACG and cataract group. The APAC group had the smallest ACD, while the LS group had the smallest AD. The LS group exhibited significantly shallower ACD (P<0.01). The LS group had the largest lens thickness. Conclusions: This study revealed that LS secondary PAC patients had a shallower ACD, thicker CCT and lens thickness comparing to those of APAC, CPACG and cataract patients. A short depth (< 1.25 mm) and a thick lens thickness (> 5.13 mm) are crisis of lens subluxation in our data. LP and CLP can be helpful for differential diagnosis. Trial registration: NCT03752710, retrospectively registered.

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