Pathogenetic Justification of a New View on the Treatment of Angle-Closure Glaucoma

Purpose. To study the effectiveness of vascular, anti-inflammatory and fibrinolytic therapy, to conduct a comparative assessment with treatment without vascular therapy in patients with angle-closure (ACG) and mixed glaucoma.Methods. A total of 55 patients with angle-closure and mixed glaucoma, mainly with hypermetropic refraction of varying degrees, were examined: 7 people with acute glaucoma attack, 6 people with subacute glaucoma attack (group 1, with anti-inflammatory treatment), 7 people with acute glaucoma attack and 6 people with subacute glaucoma attack (group 2, with vascular treatment), 14 people with chronic angle-closure glaucoma (group 3) and 15 people with mixed glaucoma (group 4). All patients underwent an ophthalmological examination, which included visometry, refractometry, tonometry, computer perimetry, OCT and OCT angiography, and an ELISA analysis to determine cytokines.Results. The administration of the drug Pentoxifylline as a cytokine blocker and antiplatelet agent in ACG contributed, in our opinion, to an improvement in visual acuity, perimetry (MD), an increase in the density of capillaries of the deep vascular plexus at the level of lamina cribrosa in the peripapillary zone (%), i.e. improved blood circulation in the vessels of the optic nerve disc and also contributed to the blockade of cytokines, mainly in the 2-nd group of patients. In our opinion, a personalized approach to the treatment of ACG is to maintain the improvement of blood circulation in the peripapillary zone by prescribing a course of treatment with Pentoxifylline for 6 months after surgery. After phacoemulsification, there was a significant increase in the density of capillaries of the deep peripapillary vascular plexus at the level of lamina cribrosa (p ≤ 0.05) (51.0 ± 3.5 %), and after further treatment with Pentoxifylline, the capillary density continued to increase in 2–4 groups in the next 6 months of follow-up. The thickness of RNFL (Retinal nerve fiber layer, structural parameter) decreased due to a decrease in edema in 1–2 groups, slightly increased in 3–4 groups, in our opinion, due to improved blood circulation. Increased reperfusion in the capillaries of the deep plexus during normalization of IOP in glaucoma patients and further treatment with pentoxifylline indicates the effectiveness of the proposed treatment in addition to surgical treatment. The results obtained emphasize the advantages of the proposed therapy for the treatment of patients with angle-closure and mixed glaucoma.Conclusion. To date, there are no clear recommendations of vascular therapy for the treatment of patients with ACG and mixed glaucoma, which creates the need for its addition to treatment regimens, taking into account the vascular component of ACG and mixed glaucoma.

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Vascular and vegetative factors of glaucoma attack

Russian Ophthalmological Journal ◽

10.21516/2072-0076-2021-14-4-22-30 ◽

2021 ◽

Vol 14 (4) ◽

pp. 22-30

Author(s):

N. A. Bakunina ◽

L. N. Kolesnikova ◽

G. V. Poryadin ◽

J. M. Salmasi ◽

L. M. Balashova

Keyword(s):

Heart Rate ◽

Degradation Products ◽

Lamina Cribrosa ◽

Acute Attack ◽

Ganglion Cell Complex ◽

Ophthalmological Examination ◽

Vascular Plexus ◽

Acute Glaucoma ◽

Sympathetic Regulation ◽

Treatment Plans

Purpose. To study the involvement of vascular and vegetative factors in the pathogenesis of glaucoma attack. Material and methods. 12 patients (24 eyes) aged 49 to 82 — 5 men and 7 women, including 3 patients with acute glaucoma and 9 patients with subacute glaucoma were subjected to an ophthalmological examination that included visometry, tonometry, automated static perimetry, OCT and OCT angiography. They were also tested for heart rate variability (HRV) using a Polar heart rate monitor, and for plasminogen content and products of fibrin/fibrinogen degradation in the tear. For comparison, the contralateral eyes of these patients were examined. Results. In the eyes with an acute glaucoma attack, the vascular network was noticeably weakened, especially in the area of the deep peripapillary vascular plexus at the lamina cribrosa level, and focal capillary loss was observed. The peripapillary density of the deep vascular plexus in the eyes with an acute attack was 33.0 ± 5.6 % (М ± m), which was significantly (p < 0.01) lower as compared to 50.0 ± 4.7 % in the unaffected eyes. This indicator correlated with the thickness of the ganglion cell complex (GCC) (p < 0.01). In unaffected eyes, no correlations were found between these glaucoma-related parameters. A significant amount of fibrin/fibrinogen degradation products was found in the tear of glaucoma patients, which may point to a violation of blood circulation in the optic nerve vessels. It has been established that glaucoma attack occurs with increased activity of sympathetic regulation of blood flow. Conclusion. When monitoring this contingent of patients, it is essential to determine the sympathetic-parasympathetic status of the patient. Taking into account the vascular component of the condition, it is expedient to introduce the necessary additions into its treatment plans

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

Ophthalmology in Russia ◽

10.18008/1816-5095-2021-1-123-128 ◽

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.

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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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Efficacy of prophylactic antiglaucoma and anti-inflammatory medications in canine primary angle-closure glaucoma: a multicenter retrospective study (2004-2012)

Veterinary Ophthalmology ◽

10.1111/vop.12069 ◽

2013 ◽

Vol 17 (3) ◽

pp. 195-200 ◽

Cited By ~ 14

Author(s):

D. Dustin Dees ◽

Kevin J. Fritz ◽

Nicole E. MacLaren ◽

Douglas W. Esson ◽

Annora M. Sheehan Gaerig ◽

...

Keyword(s):

Retrospective Study ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Anti Inflammatory

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Bilateral Acute Angle-Closure Glaucoma: A Case Report of an Unusual Cause of Acute Headache in a Child

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.7.52671 ◽

2021 ◽

Vol 5 (4) ◽

pp. 443-446

Author(s):

Breelan Kear ◽

Claudia Gold ◽

Rahul Bhola

Keyword(s):

Case Report ◽

Anterior Segment ◽

Acute Attack ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Ophthalmological Examination ◽

Eye Pain ◽

Acute Angle Closure ◽

Acute Angle Closure Glaucoma

Introduction: Acute angle-closure glaucoma (AACG) is typically considered a disease of adulthood. However, AACG may occasionally be seen in children. The clinical presentation is similar to adults, including headache, vomiting, and eye pain. However, the etiology of angle closure in children is different and most often associated with congenital anterior segment abnormalities. A precipitating factor of AACG in children with previous established, anterior segment abnormalities is eye dilation, which may occur during routine ophthalmological examination with topical mydriasis, or physiologic mydriasis upon entering a dark room. Case Report: We describe a 5-year-old child with a history of severe prematurity and retinopathy of prematurity (ROP) presenting with bilateral AACG following a routine outpatient, dilated ophthalmological examination. While angle-closure glaucoma has previously been reported in cases of ROP, a bilateral acute attack of AACG following pupil dilation in regressed ROP has hitherto been unreported. Conclusion: Given the association of ROP and AACG, it can be expected that as the survival rate of premature infants improves, the incidence of ROP and AACG may also increase. It is therefore prudent for the emergency physician to have AACG on the differential for pediatric patients with headache and eye pain.

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Frequency-specific oscillations synchronization in primary angle-closure glaucoma

Acta Radiologica ◽

10.1177/0284185119870975 ◽

2019 ◽

Vol 61 (4) ◽

pp. 537-548

Author(s):

Fei Jiang ◽

Yin-Quan Ye ◽

Jin-Min Zuo ◽

Xin Huang ◽

Chen Yu ◽

...

Keyword(s):

Frontal Lobe ◽

Regional Homogeneity ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Frequency Bands ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Full Band ◽

The Right ◽

Glaucoma Group

Background Previous neuroimaging studies demonstrated that patients with primary angle-closure glaucoma were accompanied by abnormal neuronal activity. Purpose To investigate frequency-dependent local oscillations synchronization in primary angle-closure glaucoma using the regional homogeneity method. Material and Methods In total, 37 individuals with primary angle-closure glaucoma (20 men, 17 women) and 37 normal-sighted controls (20 men, 17 women) closely matched in age, sex, and education underwent resting-state MRI scans. We compared the different regional homogeneity values in full band (0.01–0.08 Hz) and two different frequency bands (slow-4: 0.027–0.073 Hz and slow-5: 0.010–0.027 Hz) between two groups. Results Compared to the normal-sighted group, the primary angle-closure glaucoma group showed decreased regional homogeneity values in the left calcarine and left postcentral in full band. The primary angle-closure glaucoma group showed increased regional homogeneity values in the bilateral superior medial frontal lobe in the slow-4 band. The primary angle-closure glaucoma group exhibited decreased regional homogeneity values in the right calcarine in the slow-5 band. Specifically, we found that the regional homogeneity values in the right superior frontal lobe were greater in the slow-4 than in the slow-5 band, whereas regional homogeneity in the left calcarine, right pallidum, left inferior occipital gyrus, left superior occipital gyrus, left postcentral/angular gyrus, left paracentral lobule, left superior parietal gyrus, and right precuneus gyrus were greater in the slow-5 than in the slow-4 band. Conclusion Primary angle-closure glaucoma groups showed abnormal regional homogeneity in visual network (calcarine) and default mode network (superior medial frontal lobe) at two frequency bands. Moreover, the regional homogeneity signals in slow-5 band showed closely related to the severity of individuals with primary angle-closure glaucoma.

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Viscoelastic properties of the iris in different types of glaucoma

Medical Council ◽

10.21518/2079-701x-2021-12-379-383 ◽

2021 ◽

pp. 379-383

Author(s):

G. V. Voronin ◽

A. E. Sangahawi ◽

V. D. Yartsev ◽

Z. V. Surnina ◽

M. N. Narbut

Keyword(s):

Anterior Chamber ◽

Viscoelastic Properties ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Anterior Chamber Angle ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Glaucoma Group

Introduction. The iris is involved in maintaining the ocular hydrodynamic homeostasis as one of the elements of the anterior chamber angle of the eye. From there, the iris is one of the parts of its drainage area. The anterior chamber angle’s structure can predispose to an increase in intraocular pressure and thereby provoke the development of primary angle-closure glaucoma, a disease accompanied by clogging of the drainage area of the eye and, accordingly, an increase in intraocular pressure.Objective. To analyse the viscoelastic properties of the iris in primary angle-closure glaucoma and primary open-angle glaucoma.Materials and methods. The study material was a fragment of the iris obtained through iridectomy in the course of sinus trabeculectomy, which is considered the treatment for glaucoma surgery. A total of 43 samples (43 patients) were obtained and analysed, with 20 samples obtained from patients with primary angle-closure glaucoma (group 1), and 23 samples from patients with primary open-angle glaucoma (group 2). A standard ophthalmological examination, which included visometry, autorefractometry, tonometry, biomicroscopy, and indirect ophthalmoscopy, was carried out. The special examination included static perimetry, gonioscopy, ultrasound biomicroscopy or optical coherence tomography of the anterior chamber angle, optical coherence tomography of the disk of optic nerve.Results and discussion. The avascular part of the stroma (designated by us as S) is the most rigid part of the iris, according to the study. It is characterized by the greatest efforts of the viscous dynamic resistance to the indenter (0.4–2.0 gf/мм2 × S), as well as the maximum integral tensile strength (up to 4.9 × 10-2 N). The inner (vascular) part of the stroma has the lowest dynamic viscosity, according to this study.Conclusion. The samples vary enormously both in the biomechanical characteristics and relative thickness of this layer. It was observed that this biomechanically incompetent structure completely collapses and ceases to exist in partial dehydration of the sample.

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Primary Angle-Closure Glaucoma Due to Cyst of the Ciliary Body. Clinical Case

Ophthalmology in Russia ◽

10.18008/1816-5095-2020-3-508-512 ◽

2020 ◽

Vol 17 (3) ◽

pp. 508-512

Author(s):

D. V. Angelova ◽

E. E. Kazaryan ◽

N. Yu. Shkolyarenko

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Ciliary Body ◽

Clinical Case ◽

Anterior Segment ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Ophthalmological Examination ◽

Static Perimetry ◽

The Right

There is a clinical case of the occurrence of angle-closure glaucoma due to closure of the angle of front camera with the cyst of a ciliary body. Patient A., 42 years old, complained about a feeling of transient blurring of the right eye vision, visual impairment in the evening. At the initial ophthalmological examination, the maximum corrected visual acuity in both eyes was 1.0, intraocular pressure according to pneumotonometry: OD — 21 mm Hg, OS — 14.8 mm Hg. There were no changes in the anterior segment of the eyeball according to biomicroscopic data. Taking into account the asymmetry of IOP data, the patient underwent the following studies: static perimetry, optical coherence tomography (OCT), flowmetry with the calculation of tolerant intraocular pressure (TIOP). According to OCT and static perimetry, pathological deviations were not detected. When performing flowmetry on the left eye, the indicators were within normal values, however, a significant decrease in the volume of eye ocular blood flow and an increase in the IOP were determined in the right eye. In the left eye, the TIOP corresponded to the IOP, and in the right eye, the IOP indicators exceeded the TIOP value. The lack of correlation between morphofunctional indicators and flowmetry data, an unburdened hereditary history of glaucoma, and a discrepancy between flowmetry and age could indicate the development of the angle-closed glaucoma, so the patient was referred to ultrasound biomicroscopy. The echographic picture of the anterior part of the right eye was characterized by a decrease in the depth of the anterior chamber, a partial displacement of the peripheral part of the iris anteriorly, a slight narrowing of the angle of the anterior chamber, and an uneven posterior chamber. In the region of the process part of the ciliary body along the meridian of 3 hours, a thinwalled volumetric formation, anechogenic, with clear contours and dimensions was revealed: height 4.3 mm, length 4.8 mm. The root of the iris was determined by the average attachment to the ciliary body. In accordance with this, the diagnosis was made: OD — cyst of the ciliary body, the patient was referred for consultation about a possible laser surgical intervention.

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New capabilities of optical coherence tomography in the diagnostics of primary angle-closure glaucoma

National Journal glaucoma ◽

10.53432/2078-4104-2021-20-2-14-22 ◽

2021 ◽

Vol 20 (2) ◽

pp. 14-22

Author(s):

V. P. Erichev ◽

R. P. Poleva ◽

Kh. Hadiri

Keyword(s):

Optical Coherence Tomography ◽

Anterior Chamber ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Ophthalmological Examination ◽

Optical Coherence ◽

Anterior Chamber Angle ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Chamber Angle

INTRODUCTION. Recently, posterior vitreous detachment (PVD) was suggested as a fundamental pathologic process in primary angle-closure glaucoma (PACG) in morphologically predisposed patients with anatomically narrow anterior chamber angle.PURPOSE. To study the role of PVD in the development and clinical manifestation of PACG in anatomically predisposed eyes and to assess the capabilities of posterior segment optical coherence tomography (PS-OCT) in PACG diagnostics.MATERIALS AND METHODS. Thirty eyes with newly diagnosed stage I-II PACG and thirty eyes predisposed to PACG (with narrow anterior chamber angle without glaucoma signs) were enrolled in the study. All patients underwent ophthalmological examination, Hyams test, ocular ultrasound (OU) and PS-OCT.RESULTS. PVD with retrohyaloid space (RHS) formation was revealed in all PACG eyes. Positive Hyams test was in 86.67% eyes with PACG, and 13.33% were negative. All the eyes with PVD as a result of Hyams test experienced RHS enhancement correlating with IOP rise. Despite the negative results of Hyams test in some PACG eyes with PVD — glaucomatous optic neuropathy signs were present. Possible causes are discussed.PVD with RHS formation was revealed in 53.33% predisposed to PACG eyes — all with positive result of Hyams test. The other 46.67% eyes predisposed to PACG had negative Hyams test, no PVD and no RHS.CONCLUSION. Obtained results confirm a new theory of PACG etiopathogenesis suggesting PVD with PGS to be the essential mechanism of POAG development in morphologically predisposed eyes. PS-OCT appears to be crucial in PACG early diagnostics.

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