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

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.

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

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.

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.

scholarly journals Glaucomatocyclitic Crises May Occur in Patients with Narrow or Closed Angles

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Pei-Kang Liu ◽  
Han-Yi Tseng ◽  
Min-Yu Huang ◽  
Kwou-Yeung Wu
Keyword(s):  
Anterior Chamber ◽  
Anterior Segment ◽  
Case Series ◽  
Field Tests ◽  
University Hospital ◽  
Angle Closure ◽  
Narrow Angle ◽  
Grade Ii ◽  
Medical University ◽  
Glaucomatocyclitic Crisis

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.

scholarly journals Changes in Intraocular Pressure and Anterior Chamber Depth after Phacoemulsification in Non-Glaucomatous Patients

2019 ◽  
pp. 1-7
Author(s):  
Mona Abdallah ◽  
Omar M. Ali ◽  
Abd El-Nasser A. Mohammad ◽  
Wael Soliman
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Open Angle Glaucoma ◽  
Anterior Chamber Depth ◽  
Cataract Extraction ◽  
University Hospital ◽  
Narrow Angle ◽  
Department Of Ophthalmology ◽  
Significant Difference ◽  
Applanation Tonometer

Aims: To evaluate changes in intraocular pressure (IOP) and anterior chamber depth (ACD) after uneventful phacoemulsification with intraocular lens (IOL) implantation. Study Design: Prospective interventional comparative study. Place and Duration of Study: Department of Ophthalmology, Assuit University Hospital, Assuit, Egypt between September 2016 and October 2017. Methodology: 100 Patients with visually significant cataract (39 males (39%) and 61 females (61%). All patients underwent uneventful phacoemulsification. Intraocular pressure and ACD were measured preoperatively by using Goldmann applanation tonometer and Ultrasonography  respectively, and at 1 week, 1 month, and 3 months postoperatively. Results: The postoperative ACD was higher than the preoperative value by 0.26± 0.06 mm at 1 week, 0.45±0.06 mm at 1 month, and 0.59±0.08 mm at 3 months postoperatively (P=.000). P < 0.05 was considered to indicate a statistically significant difference. The IOP at 1 week, 1 month, and 3 months postoperatively was lower than the preoperative value by 1.03±0.3 mmHg, 1.52±0.46 mmHg, and 2.14±0.62 mmHg, respectively (P=.001). Conclusion: This study revealed that there was a decrease in IOP and increase in ACD after cataract extraction by phacoemulsification. Patients with ocular hypertension, open-angle glaucoma, and narrow-angle glaucoma may benefit from cataract extraction.

scholarly journals Polypharmacy-associated potential contraindications of drug prescriptions in patients with primary angle closure disease in a real-world setting

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Fumiaki Tanaka ◽  
Naoki Shibatani ◽  
Kazumi Fujita ◽  
Hiroaki Ikesue ◽  
Satoru Yoshimizu ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Anterior Chamber Depth ◽  
Japanese Patients ◽  
Median Number ◽  
Angle Closure ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Number Of Patients ◽  
Multiple Drugs

Abstract Background Primary angle closure disease (PACD) is a type of glaucoma in which the intraocular pressure (IOP) is increased because of the blockage of the anterior chamber angle. Medications contraindicated for patients with PACD, such as anticholinergics, cause mydriasis, and can elevate IOP. However, anticholinergics are currently contraindicated only for primary angle closure glaucoma (PACG) in Japanese package inserts. In this study, we investigated the prescription status of medications contraindicated for PACD, such as anticholinergics, in patients with PACD scheduled for eye surgeries. Methods Forty-three Japanese patients diagnosed with PACD at Kobe City Eye Hospital, Japan, and scheduled hospitalization for eye surgeries between December 2017 and July 2018, were included. Data, including sex, age, diagnosis, IOP, anterior chamber depth, and patients’ regular medications prior to hospitalization, were collected for each patient from the electronic medical records. Results The number of patients with chronic primary angle closure (CPAC) and acute primary angle closure (APAC) was 35 (81.4%) and 8 (18.6%), respectively. Among all the 43 patients with PACD, 8 (18.6%) received 15 medications that are potentially contraindicated for PACD by non-ophthalmologist. According to medication categories, benzodiazepine hypnotics were the most commonly prescribed. Among the 8 patients with APAC, 2 (25.0%) had routinely received medications contraindicated for PACD. The median number of all kinds of prescriptions on the day of hospitalization was significantly higher for patients who received medications contraindicated for PACD than for those who did not receive them (p = 0.010). Conclusions About 20% of patients with PACD received medications potentially contraindicated for PACD, such as anticholinergics. Attention should be paid to patients prescribed multiple drugs for adverse events, such as increase in intraocular pressure.

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 Diode laser transscleral cyclophotocoagulation causes intraocular collamer lens displacement in pseudophakic eye: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wei Wei ◽  
Xueqing Yu ◽  
Lu Yang ◽  
Chan Xiong ◽  
Xu Zhang
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Anterior Chamber ◽  
Intraocular Lens ◽  
Angle Closure ◽  
Pigment Dispersion ◽  
Intraocular Lens Implantation ◽  
Lens Implantation ◽  
Elevated Intraocular Pressure ◽  
Transscleral Cyclophotocoagulation

Abstract Background With the rapid development of intraocular collamer lens (ICL) operation, it is foreseeable that we will encounter a large number of glaucoma patients with ICL implantation history. However, our current understanding of the treatment of glaucoma patients with ICL is limited. Hence we report a rare case of refractory glaucoma after intraocular collamer lens and intraocular lens implantation in a patient who underwent unsuccessful transscleral cyclophotocoagulation, which led to intraocular collamer lens displacement, angle closure and uncontrolled intraocular pressure. Case presentation A 39-year-old woman presented with intractably elevated intraocular pressure in the right eye. Since her intraocular collamer lens implantation surgery in 2017, her intraocular pressure had remained over 40 mmHg while using 3 types of anti-glaucoma medications. The patient had a history of phacoemulsification and posterior chamber phakic intraocular lens implantation for complicated cataracts secondary to uveitis in 2006. On gonioscope examination, there were signs of pigment dispersion, and the anterior chamber angle was open. Ultrasound biomicroscopy examination showed contact and rubbing between the intraocular collamer lens and posterior surface of the iris. And typical advanced glaucomatous optic neuropathy and visual field defects were observed. Transscleral cyclophotocoagulation was performed to control the intraocular pressure and prevent further visual field loss. However, the intraocular collamer lens was displaced after transscleral cyclophotocoagulation, which resulted in formation of a shallow anterior chamber 1 week later, angle closure and loss of intraocular pressure control 1 month later, even though the maximum dose of anti-glaucoma medication was used. Finally, an Ahmed glaucoma valve was successfully implanted in her anterior chamber, and the glaucoma was controlled, as observed at the 10-month follow-up. Conclusions Pigment dispersion is a common phenomenon after intraocular collamer lens implantation and may accelerate the progression of glaucoma. Transscleral cyclophotocoagulation should be carefully considered in glaucoma patients with elevated intraocular pressure after intraocular collamer lens implantation, given that transscleral cyclophotocoagulation may cause intraocular collamer lens displacement.

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 Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT

2021 ◽  
Vol 14 (10) ◽  
pp. 1527-1532
Author(s):  
Qian Zheng ◽  
◽  
Zhang-Liang Li ◽  
Ping-Jun Chang ◽  
Yun-E Zhao ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Anterior Chamber ◽  
Anterior Chamber Depth ◽  
Anterior Chamber Angle ◽  
Swept Source ◽  
Narrow Angle ◽  
Significant Difference ◽  
Shallow Anterior Chamber ◽  
Chamber Angle

AIM: To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS: This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS: There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). CONCLUSION: Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.

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

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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