Comparisons of clinical characteristics of lens-subluxated eye with or without acute angle closure: A retrospective study

Abstract BackgroundTo compare clinical characteristics of lens subluxation between eyes with or without acute angle closure (AAC).MethodsThis is a retrospective and case control study. Thirty-four cases with lens subluxation were recruited from 2015 to 2017. Patients with acute angle closure were assigned to the AAC group (n=17 eyes) and those without AAC were in the non-AAC group (n=17 eyes). Quantitative anterior segment was evaluated by ultrasound biomicroscopy (UBM). Axial length (AL) was measured with IOL master. All patients underwent lens extraction surgery and were followed up for 6 months. ResultsThe history of blunt trauma was accounted for 11 (64.7%) cases in the AAC group and 14 (82.3%) cases in the non-AAC group. Nine (52.9%) patients in the AAC group had LPI or SPI treatment history, and high intraocular pressure was recurred. The UBM analysis showed that the average central ACD of affected eyes in the AAC group was 1.75 mm, which was significantly shallower than the fellow eyes (2.39 mm, P < 0.05) or both eyes in the non-AAC group (affected eye 3.24mm vs fellow eye 3.81mm). Lens vault and AOD500 also showed a remarkable difference between affected eye than fellow eye (P < 0.001) in the AAC group. The both eyes in the AAC group presented a shorter AL and shallower anterior chamber, comparing with those in the non-AAC group. Besides, the affected eyes in the AAC group presented significantly higher LV. ConclusionsThe crowded anterior chamber structure and shorter AL might be an anatomic basis for the eye with lens subluxation induced AAC. Quantitative evaluation of these ocular structures to identify zonular compromise, increased LV and shorter AL are valuable for the diagnosis of lens subluxation induced AAC.

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Comparisons of Ocular Anatomic Differences of Lens-Subluxated Eye with or without Acute Angle Closure: A Retrospective Study

Journal of Ophthalmology ◽

10.1155/2020/6974202 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hong-Liang Lin ◽

Yong-Jie Qin ◽

Yu-Lin Zhang ◽

Yu-Qiao Zhang ◽

Yong-Yi Niu ◽

...

Keyword(s):

Anterior Chamber ◽

Anterior Segment ◽

Ultrasound Biomicroscopy ◽

Acute Angle ◽

Angle Closure ◽

Lens Extraction ◽

Lens Subluxation ◽

History Of ◽

Acute Angle Closure ◽

Anatomic Basis

Purpose. To compare ocular anatomy differences of lens subluxation between eyes with or without acute angle closure (AAC). Methods. This is a retrospective and case-control study. Sixty cases with mild lens subluxation were recruited. Among them, 30 eyes with acute angle closure were assigned to the AAC group and 30 eyes without AAC were assigned to the non-AAC group. The anterior segment was quantitatively evaluated by ultrasound biomicroscopy (UBM). The axial length (AL) was measured with IOL Master. All patients underwent lens extraction surgery and were followed up for six months. Results. The history of blunt trauma accounted for 22 (73.3%) cases in the AAC group and 21 (70%) cases in the non-AAC group. Fifteen (50%) patients in the AAC group had iridotomy history, and high intraocular pressure recurred. The UBM analysis showed that the average central chamber depth of the affected eyes in the AAC group was 1.82 mm, which was significantly shallower than that in the fellow eyes (2.58 mm, P<0.05) or both eyes in the non-AAC group.Both eyes in the AAC group presented a shorter AL and shallower anterior chamber than the eyes in the non-AAC group. Conclusions. An asymmetrical anterior chamber between bilateral eyes is an important feature in lens subluxation-induced AAC. The crowded anterior chamber and shorter AL might be the anatomic basis for the eye with lens subluxation-induced AAC.

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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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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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Acute angle-closure glaucoma with choroidal effusion revealing a hantavirus infection: Description of ultrasound biomicroscopy imagery and optical coherence tomography Visante

European Journal of Ophthalmology ◽

10.1177/1120672119858895 ◽

2019 ◽

pp. 112067211985889

Author(s):

Alexandre Baillieul ◽

Tich Ludovic Le ◽

Jean-François Rouland

Keyword(s):

Optical Coherence Tomography ◽

Anterior Chamber ◽

Anterior Segment ◽

Ultrasound Biomicroscopy ◽

Acute Angle ◽

Angle Closure ◽

Hantavirus Infection ◽

Optical Coherence ◽

Blurred Vision ◽

Ciliochoroidal Effusion

Purpose: To report a case of bilateral angle-closure associated with systemic hantavirus infection. Materials and methods: A 32-year-old Caucasian man was referred with blurred vision, fever, cough, dyspnea and thrombocytopenia. Ophthalmologic examination revealed myopic shift, elevated intraocular pressure (30 mmHg right eye and 24 mmHg left eye), corneal edema, iridocorneal angle closure and shallow anterior chamber. Ciliochoroidal effusion was detected on anterior segment optical coherence tomography and ultrasound biomicroscopy. Serologic test and polymerase chain reaction confirmed the diagnosis of hantavirus infection and the serotype Puumala. On the sixth day after he started topical anti-glaucoma and cycloplegic medications, the anterior chamber and iridocorneal angles were normalized with disappearance of ciliochoroidal effusion. Conclusion: Puumala hantavirus infection is an exceptional cause of acute bilateral angle-closure combined with ciliochoroidal effusion.

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Characteristic Manifestations regarding Ultrasound Biomicroscopy Morphological Data in the Diagnosis of Acute Angle Closure Secondary to Lens Subluxation

BioMed Research International ◽

10.1155/2019/7472195 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Fenglei Wang ◽

Dabo Wang ◽

Ling Wang

Keyword(s):

Clinical Diagnosis ◽

Risk Ratio ◽

Ultrasound Biomicroscopy ◽

Acute Angle ◽

Morphological Data ◽

Angle Closure ◽

Control Group ◽

Imaging Features ◽

Lens Subluxation ◽

Acute Angle Closure

Purpose. To investigate the mechanisms underlying the occurrence of acute angle closure (AAC) and to further explore the sensitive indicators for clinical diagnosis of acute angle closure secondary to lens subluxation (AACSLS) through qualitative and quantitative analysis of ultrasound biomicroscopy (UBM) imaging features of eyes with AAC to provide a theoretical basis for the selection of treatment schemes.Methods. A retrospective analysis was conducted from 2013 to 2018 on 160 eyes (160 patients) with uniocular acute angle closure crisis (AACC) complicated by cataract. The case group consisted of 29 eyes (29 patients) with lens subluxation and the control group consisted of 131 eyes (131 patients) without lens subluxation. Before the operation, computer optometry, best corrected visual acuity, intraocular pressure, slit lamp, gonioscopy, preset lens, A-mode ultrasonography, and UBM were performed. All the enrolled subjects underwent cataract surgery with or without other operations. The pupil was fully dilated, and the position of the lens was recorded before the operation. The zonular rupture and lens subluxation were further confirmed during operation. SPSS version 20.0 was used to analyze UBM imaging data from the lens subluxation group and non-lens subluxation group.Results. The iris span (IS) value in the whole quadrant of the lens subluxation group was significantly higher than that of the non-lens subluxation group (P=0.033, 95%CI 0.01 to 0.31). The iris lens angle (ILA) in the lens subluxation group was significantly lower than that in the non-lens subluxation group in the upper, lower, nasal, temporal, and whole quadrants (P<0.001, 95%CI -8.79 to -2.78; P=0.001, 95%CI -8.36 to -2.27; P<0.001, 95%CI -9.85 to -4.98; P=0.015, 95%CI -6.67 to -0.72; P<0.001, 95%CI -8.74 to -5.83, respectively). However, the ILA of the maximum difference among the four quadrants in the lens subluxation group was significantly higher than that in the non-lens subluxation group (P<0.001, 95%CI 4.74 to 9.86). The ILA and iris lens contact distance (ILCD) showed significant negative correlations in both the lens subluxation group and non-lens subluxation group (Y=20.984-7.251X, R=0.520, and P<0.001; Y=19.923-3.491X, R=0.256, and P<0.001, respectively). The risk ratio of lens subluxation in exposed eyes with ILA=0 in one quadrant at least was significantly higher than that in nonexposed eyes without ILA=0 in all quadrants (X2=87.859, P<0.001, and odds ratio (OR)=79.200, 95% CI 23.063 to 271.983). The risk ratio of zonular rupture in exposed quadrants with ILA=0 was significantly lower than that in nonexposed eyes without ILA=0 (X2=33.884, P<0.001, OR=0.122, and 95% CI 0.053 to 0.278). The risk ratio of zonular rupture in exposed quadrants with nonforward convexity of iris was significantly lower than that in nonexposed quadrants with forward convexity of iris (X2=6.413, P=0.011, and OR=0.381; 95% CI 0.176 to 0.825).Conclusions. ILA=0 and nonforward convexity of iris as UBM sensitive and characteristic indicators for screening lens subluxation and zonular rupture can provide new ideas and hints for clinical diagnosis of acute angle closure secondary to lens subluxation.

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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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