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

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.

Download Full-text

Vitreous Decompression Combined with Phacoemulsification for Medically Unresponsive Acute Angle Closure

Journal of Ophthalmology ◽

10.1155/2021/5528281 ◽

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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.

Download Full-text

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

Download Full-text

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.

Download Full-text

First experience using micropulse cyclophotocoagulation in complex treatment acute angle closure glaucoma

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-1-71-74 ◽

2021 ◽

pp. 71-74

Author(s):

V.V. Egorov ◽

◽

A.V. Postupaev ◽

N.V. Postupaeva ◽

A.N. Marchenko ◽

...

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Laser System ◽

Corneal Edema ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Complex Treatment ◽

Acute Angle Closure ◽

Acute Angle Closure Glaucoma

Purpose. To study effectiveness of micropulse cyclophotocoagulation (MP-CPC) in complex treatment acute angle closure glaucoma (ACG). Material and methods. Dynamic observation of 4 patients with acute ACG was carried out. There was stagnant injection of the conjunctiva, corneal edema, shallow anterior chamber, iris bombe, mydriasis up to 4–6 mm, closed anterior chamber angle in all quadrants. In three cases, the initial lens opacities were determined, in one eye the lens was transparent. Against the background of drug therapy and laser iridectomy, the intraocular pressure (IOP) level reached values from 26 to 33 mm Hg. On days 2–3 after admission to the hospital, all patients underwent MP-CPC using the Cyclo G6 Glaucoma Laser System the MicroPulse P3 glaucoma device (Iridex, USA). Results. The operation and postoperative period were uneventful. All patients had pain relief, inflammatory response was absent. Corneal edema was stopped 1–2 days after surgery. In all eyes, on the first day after the operation, there was significant decrease in IOP level to 14–23 mm Hg. One month after the complex treatment, the IOP level remained stably normal and ranged from 16 to 21 mm Hg in all patients. Increase in visual acuity was noted in all cases. Conclusion. MP-CPC is effective, safe and low-traumatic operation and can be used in complex treatment of patients with an acute ACG. Key words: micropulse cyclophotocoagulation, acute angle closure glaucoma, intraocular pressure.

Download Full-text

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

Journal of Pharmaceutical Health Care and Sciences ◽

10.1186/s40780-021-00196-w ◽

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.

Download Full-text

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.

Download Full-text

Unilateral Optic Neuropathy and Acute Angle-Closure Glaucoma following Snake Envenomation

Case Reports in Ophthalmological Medicine ◽

10.1155/2015/687829 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Osman Okan Olcaysu ◽

Kenan Cadirci ◽

Ahmet Altun ◽

Afak Durur Karakaya ◽

Huseyin Bayramlar

Keyword(s):

Intraocular Pressure ◽

Optic Nerve ◽

Optic Neuropathy ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Hand Motion ◽

Snake Envenomation ◽

Acute Angle Closure ◽

Acute Angle Closure Glaucoma

Purpose. We aimed to describe a unique case in which a patient developed unilateral optic neuritis and angle-closure glaucoma as a result of snake envenomation.Case Report. Approximately 18 hours after envenomation, a 67-year-old female patient described visual impairment and severe pain in her left eye (LE). The patient’s best corrected visual acuity was 10/10 in the RE and hand motion in the LE. Cranial magnetic resonance imaging showed signs of neuropathy in the left optic nerve. In the LE, corneal haziness, closure of the iridocorneal angle, and mild mydriasis were observed and pupillary light reflex was absent. Intraocular pressure was 25 mmHg and 57 mmHg in the RE and LE, respectively. The patient was diagnosed with acute angle-closure glaucoma in the LE. Optic neuropathy was treated with intravenous pulse methylprednisolone. Left intraocular pressure was within normal range starting on the fourth day. One month after the incident, there was no sign of optic neuropathy; relative afferent pupillary defect and optic nerve swelling disappeared.Conclusions. Patients with severe headache and visual loss after snake envenomation must be carefully examined for possible optic neuropathy and angle-closure glaucoma. Early diagnosis and treatment of these cases are necessary to prevent permanent damage to optic nerves.

Download Full-text