scholarly journals Development of a new algorithm for treatment of primary angle closure glaucoma

2018 ◽  
Vol 9 (2) ◽  
pp. 20-29
Author(s):  
N. I. Kurysheva ◽  
V. N. Trubilin ◽  
S. G. Kapkova ◽  
L. V. Lepeshkina
Keyword(s):  
Diabetes Mellitus ◽  
Corneal Endothelium ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Control Group ◽  
Lens Thickness ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Pigment Deposition

Purpose – to develop a new algorithm for treatment of primary angle closure glaucoma (PACG) based on laser peripheral iridotomy (PI) and selective laser trabeculoplasty (SLT) and to determine its indications and contraindications. 68 eyes with PACG were observed for 6 years. These patients had undergone PI and then SLT. The control group included 74 POAG eyes of the same age and stage of glaucoma. The effectiveness of SLT was assessed using the Kaplan-Meier survival analysis. The risk factors for SLT failure in the long-term period were studied to determine the indications and contraindications for this treatment algorithm, and the condition of corneal endothelium in dynamics was investigated using confocal microscopy. The hypotensive effect of SLT in PACG was worse than in POAG: 90 and 93% respectively one year after SLT, and 16 and 21% six years after SLT (log rank test, p=0.195). The following factors of SLT failure were common for both forms of glaucoma: IOP >24 mm Hg, corneal thickness ≤540 µm, corneal hysteresis <7 mm Hg and age of patients >68 years. The extension of laser action <1800 and lens thickness >4.8 mm were additional predictors of SLT failure in PACG. In both forms of glaucoma, diabetes mellitus, age of patients and duration of the disease before SLT had a negative effect on the condition of corneal endothelium. The anterior-posterior axis and the presence of pigment deposition on the endothelium were significant in PACG. The proposed algorithm for PACG treatment, including the initial performance of PI and then SLT, is an effective method of treating this form of glaucoma, provided that the opening of the anterior chamber angle is sufficient (at least half) and the lens thickness is no more than 4.8 mm. The initially high IOP, the age of patients over 68 and a thin cornea (<540 μm) worsen the SLT prognosis. Moreover, diabetes mellitus and the presence of pigment deposition on the endothelium along with long-term glaucoma history increase the risk of corneal endothelium damage after SLT.

scholarly journals Long-Term Outcomes of Primary Trabeculectomy in Diabetic Patients without Retinopathy with Primary Angle-Closure Glaucoma

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Jian Liu ◽  
Miaomiao Zhang ◽  
Bin Li ◽  
Jianrong Wang
Keyword(s):  
Case Series ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Control Group ◽  
Diabetic Patients ◽  
Surgical Success ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma

Purpose. To evaluate primary trabeculectomy with adjunctive mitomycin-C (MMC) in diabetic patients without retinopathy with primary angle-closure glaucoma (PACG). Design. This is a retrospective case series comparison. Participants. This retrospective trial compared outcomes of 88 eyes that underwent trabeculectomy in patients with diabetes mellitus (DM) without retinopathy and in 97 patients without DM. Methods. In this study, the intraocular pressure (IOP), visual acuity, visual field, and postoperative complications were compared between the two groups. Qualified surgical success is defined as an IOP between 6 and 18 mmHg with or without topical antiglaucoma medication. Results. After a follow-up of 5 years, the IOP decreased from a mean basal IOP of 27.8±7.3 mmHg to 15.0±5.6 mmHg in the DM group and from 27.3±6.0 mmHg to 12.4±5.3 mmHg in the control group. The mean number of antiglaucoma medications was 3.4±1.3 and 3.3±1.2 preoperatively (P=0.587) whereas it was 1.7±1.5 and 1.1±1.4 at the 5-year follow-up (P=0.049). The 5-year qualified surgical success rates were 42.9% and 65.4% for both groups (P=0.046; log-rank test). Encysted blebs were seen in 21 (23.9%) patients in the DM group and in 12 (12.4%) patients in the control group (P=0.041). Conclusion. PACG patients with DM without retinopathy undergoing primary trabeculectomy with MMC may have a lower long-term surgical survival rate compared with patients without DM.

scholarly journals Efficacy and Safety of Combined Phacoemulsification, Intraocular Lens Implantation, Goniosynechialysis, and Trabectome in Patients With Primary Angle-Closure Glaucoma

2021 ◽  
Author(s):  
Yu Wang ◽  
Zhiqiao Liang ◽  
Yu Zhang ◽  
Hennein Lauren ◽  
Ying Han ◽  
...  
Keyword(s):  
Intraocular Lens ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Intraocular Lens Implantation ◽  
Efficacy And Safety ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Lens Implantation

Abstract We evaluated the efficacy and safety of combined phacoemulsification, intraocular lens implantation, goniosynechialysis (GSL), and trabectome in patients with primary angle-closure glaucoma (PACG). In this prospective interventional study, twenty patients (22 eyes) of PACG treated with combined phacoemulsification, intraocular lens implantation, GSL, and trabectome between September 2017 to September 2020 were recruited. The intraocular pressure (IOP), the number of glaucoma medications, and best-corrected visual acuity (BCVA) were recorded at baseline, 1, 3, 6, 12, and 24 months after operation. IOP was decreased significantly from 20.69±6.90 mmHg at baseline to 15.83±2.79mmHg at 24 months’ follow-up (P=0.043). The number of glaucoma medications reduced from 2.76±1.14 preoperatively to 0.73±0.77 at 24 months’ follow-up (P=0.026). The qualified success rate was 86.8% at 2 years. The reduction of IOP showed a positive correlation with baseline IOP (p<0.001) and the reduction of the number of glaucoma medications was positively correlated with baseline number of glaucoma medications (p<0.001). There was no vision-threatening complication during and after operation. The combined procedure of phacoemulsification, IOL implantation, GSL, and trabectome was effective and safe for PACG patients. It may provide a new method for PACG patients especially those with long term and extensive goniosynechia.

Determinants of Long-term Intraocular Pressure After Phacoemulsification in Primary Angle-closure Glaucoma

2011 ◽  
Vol 20 (9) ◽  
pp. 566-570 ◽  
Author(s):  
Catherine Jui-ling Liu ◽  
Ching-Yu Cheng ◽  
Yu-Chieh Ko ◽  
Ling-Ing Lau
Keyword(s):  
Intraocular Pressure ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma

scholarly journals Features Local Interlacing Status of Elderly Patients with Primary Angle-Closure Glaucoma

2021 ◽  
Vol 18 (1) ◽  
pp. 123-128
Author(s):  
A. M. Chukhraev ◽  
N. M. Agarkov ◽  
K. I. Proschayev ◽  
A. N. Ilnitskiy ◽  
A. S. Kulabukhov ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Local Level ◽  
The Elderly ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Control Group ◽  
Ophthalmological Examination ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma ◽  
Anti Inflammatory

An increased share of the elderly in the structure of modern society, along with other causes and risk factors, is accompanied by the growing the incidence of glaucoma. According to international research in the world by 2020 it is predicted that glaucoma patients will increase to 80 million. Among the elderly, glaucoma is a common pathology, the development of which is associated with local disorders of the interleukin profile. However, the features of the latter in patients with primary closed-angle glaucoma in the elderly have not been studied. The purpose of this work is to identify the features and informativeness of local interleukin profile indicators in elderly patients with primary angle — closure glaucoma. The study included 58 patients with primary angle-closure glaucoma of stage II, who made up the main group, aged 60–74 years with a median of 70.1 ± 2.5 years. All patients underwent a comprehensive ophthalmological examination. The diagnosis of primary angle-closure glaucoma was established in accordance with the requirements of the National glaucoma guidelines. The control group consisted of 27 elderly people aged 60 to 74 years with a median of 68.7 ± 2.1 years without signs and manifestations of primary angle-closure glaucoma, who also underwent a comprehensive ophthalmological examination. Changes in proinflammatory interleukins at the local level in the development of primary angle-closure glaucoma are accompanied by a significant increase in their content in all cases. On the contrary, changes in anti-inflammatory interleukins in the lacrimal fluid in patients with the considered ophthalmological pathology are characterized by a significant inhibition of their production. IL-10 are characterized by the most significant decrease at the local level and it is less related to IL-4. Local interlacing profile of patients with primary angle-closure glaucoma elderly are characterized by increased level in the tear fluid of anti-inflammatory IL-2, IL-17, IL-8 and lower production of anti-inflammatory IL-10. These local interleukins have the greatest informative value, which is of scientific and practical significance for identifying new mechanisms of development, diagnostics and justification of selective immunotropic therapy of the pathology in question.

Long-term clinical course of primary angle-closure glaucoma in an Asian population

Ophthalmology ◽  
2000 ◽  
Vol 107 (12) ◽  
pp. 2300-2304 ◽  
Author(s):  
Zainah Alsagoff ◽  
Tin Aung ◽  
Leonard P.K Ang ◽  
Paul T.K Chew
Keyword(s):  
Clinical Course ◽  
Asian Population ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Primary Angle Closure ◽  
Primary Angle Closure Glaucoma
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