Clinical case of successful treatment ocular hypertension caused by organic closure of anterior chamber angle after penetrating keratoplasty

Clinical case of successful treatment ocular hypertension caused by organic closure of anterior chamber angle after penetrating keratoplasty is presented. The patient underwent keratoplasty in the right eye and on the first day after the operation the clinic of acute glaucoma attack in the operated eye was revealed. In view lack of effect from medication and laser treatment carried out, the synechiae surgical removal was done. Carbachol Intraocular Solution (0.1 ml MIO-CHOL Sterile Solution, APPASAMY OCULAR DEVICES (P) LTD. (PHARMA DIVISION), India) was injected into anterior chamber to narrow the pupil. But its action turned out to be paradoxical – instead of constriction there was sharp pupil dilation. In addition to standard treatment, the patient received keratoprotection and reparative therapy. To restore neurotrophic processes in the iris, intravenous infusions of 1000 mg of gliatilin were first performed, followed by a switch to the tablet form of this drug. After 4 months, the patient experienced increase in uncorrected visual acuity to 0.1; best corrected visual acuity – up to 0.2 with diaphragm against the background of complete absence of signs of inflammation. The graft was completely transparent, the intraocular pressure – 19 mm Hg, mydriasis persisted 5–6 mm, the reaction of the pupil to light appeared, but was weakened. Key words: ocular hypertension after penetrating keratoplasty, acute glaucoma attack, synechiae surgical removal.

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INTRAVITREAL INTRODUCTION OF LUCENTIS AND TRANS-SCLERAL CYCLOPHOTOCOAGULATION IN THE TREATMENT OF NEOVASCULAR GLAUCOMA IN DIABETES MELLITUS

Бюллетень Восточно-Сибирского научного центра Сибирского отделения Российской академии медицинских наук ◽

10.12737/23792 ◽

2016 ◽

Vol 1 (6) ◽

pp. 122-124

Author(s):

Ефремова ◽

Tatyana Efremova ◽

Балалин ◽

Sergey Balalin ◽

Фокин ◽

...

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Laser Surgery ◽

Neovascular Glaucoma ◽

Mean Value ◽

Anterior Chamber Angle ◽

Second Stage ◽

Anti Vegf ◽

Chamber Angle

We analyzed the results of surgical treatment of 42patients (42eyes) with neovascular glaucoma on the background of proliferative diabetic retinopathy. Intravitreal injections of anti-VEGF-drugs allow to remove newly formed vessels in anterior chamber angle, to reduce intraocular pressure, to avoid complications in patients with neovascular glaucoma and the closed anterior chamber angle of the eye. The second stage of the treatment can be laser surgery. This approach helped to reduce intraocular pressure from 28.9±0.9 to 18.5±0.9mmHg on the background of medical treatment (t>2.0; p<0.05). Visual acuity increased from 0.23±0.07 to 0.44±0.08 (t>2.0; p<0.05).In patients with NVG and closed anterior chamber angle of the eye, having aching glaucoma the use of laser surgery as the first stage of treatment allows to reduce intraocular pressure and to eliminate pain, and to apply intravitreal anti-VEGF-therapy as the second stage. The mean value of IOP decreased from 30.9±1.2 to 20.1±1.1mmHg. During the year period, the second stage (intravitreal introduction of Lucentis) was performed in all patients. As a result, IOP was reduced to 17.5±0.09mmHg. Visual acuity increased from 0.18±0.1 to 0.25±0.07 (p>0.05).

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Membrane trophic effect of hyperglycemia on the anterior chamber angle tissues in ocular hypertension

Oftalmologicheskii Zhurnal ◽

10.31288/oftalmolzh201624143 ◽

2016 ◽

Vol 60 (2) ◽

pp. 41-43

Author(s):

V. Yurevich ◽

Keyword(s):

Anterior Chamber ◽

Ocular Hypertension ◽

Anterior Chamber Angle ◽

Trophic Effect ◽

Chamber Angle

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Quantitative Ultrastructural Study of the Anterior Chamber Angle of the Rabbit with Corticosteroid-induced Ocular Hypertension

Ophthalmic Research ◽

10.1159/000265172 ◽

1982 ◽

Vol 14 (1) ◽

pp. 40-45 ◽

Cited By ~ 2

Author(s):

M. Fossarello ◽

S. Carta ◽

Del Fiacco ◽

G. Diaz ◽

N. Orzalesi

Keyword(s):

Anterior Chamber ◽

Ocular Hypertension ◽

Ultrastructural Study ◽

Anterior Chamber Angle ◽

Chamber Angle

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Individualized transscleral cyclophotocoagulation as the initial surgical intervention for medically uncontrolled glaucoma after blunt trauma

European Journal of Ophthalmology ◽

10.1177/1120672120965512 ◽

2020 ◽

pp. 112067212096551

Author(s):

Xu Hou ◽

Jing Wu ◽

Jian Zhou ◽

Yu-Sheng Wang ◽

Dan Hu

Keyword(s):

Visual Acuity ◽

Anterior Chamber ◽

Success Rate ◽

Blunt Trauma ◽

Surgical Intervention ◽

Ultrasound Biomicroscopy ◽

Anterior Chamber Angle ◽

Significant Difference ◽

Transscleral Cyclophotocoagulation ◽

Chamber Angle

Aim: To investigate the safety and feasibility of individualized transscleral cyclophotocoagulation (TSCPC) as the initial non-incisional surgical intervention for medically uncontrolled glaucoma after blunt trauma. Methods: The therapy records were reviewed of medically uncontrolled traumatic glaucoma after blunt trauma treated with TSCPC in a single hospital between January 2014 and December 2018. Thirty-one patients (31 eyes) received individualized TSCPC after ultrasound biomicroscopy and gonioscopy examination to localize and quantify the injured quadrants of the anterior chamber angle. In addition to the number of IOP lowing drugs, visual acuity (VA), IOP, inflammation and hemorrhage in the anterior chamber were analyzed at 1 day, 3 weeks and 3 months after operation, respectively. Success was defined as the IOP was not more than 21 mmHg. Results: Compared with the data of pre-operation, constituent ratio of VA had no significant difference at 3 weeks (χ2 = 0.56, p > 0.75). At 3 months the average IOP was 22.2 ± 6.8 mmHg, which was significantly lower than that of pre-operation (46.6 ± 5.6 mmHg) ( t = 19.818, p < 0.001). No IOP lowing drug was needed in 12 eyes, and more than three kinds of drugs were still needed in five eyes. The average number of medications decreased to 1.2 ± 1.2 (χ2 = 93.496, p < 0.001). The complete success rate was 38.7% and the relative success rate (combined with no more than two kinds of drugs) was 83.9% at 3 months. Conclusions: Individualized TSCPC could be applied as an initial non-incisional surgical intervention to treat traumatic glaucoma refractory to the medicine therapy.

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Pupil cerclage technique for treatment of traumatic mydriasis

European Journal of Ophthalmology ◽

10.1177/1120672119839304 ◽

2019 ◽

Vol 30 (3) ◽

pp. 480-486

Author(s):

Rino Frisina ◽

Raffaele Parrozzani ◽

Luigi Tozzi ◽

Elisabetta Pilotto ◽

Edoardo Midena

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Pupil Size ◽

Anterior Chamber Angle ◽

Corrected Visual Acuity ◽

Round Shape ◽

New Variant ◽

Chamber Angle ◽

Best Corrected Visual Acuity

Aim: The aim of this study is to evaluate the efficacy of pupil cerclage and a new variant of sliding knot technique for repairing traumatic mydriasis. Design: This is a observational case series study. Setting/methods: A series of consecutive patients affected by traumatic permanent mydriasis who underwent pupil cerclage were recruited at the Department of Ophthalmology of the University of Padova, Italy. Best-corrected visual acuity, measured in logarithm of minimum angle of resolution (logMAR), and intraocular pressure at 1, 3, 6, and 12 months were monitored. Postoperative pupil size and anterior chamber angle were measured. Postoperative cystoid macular edema (CME) and glaucoma were evaluated. Results: Twelve patients were recruited. Phakic patients (7) underwent cataract surgery combined with pupil cerclage. Vitrectomy was performed in nine patients. Best-corrected visual acuity improved from 2.9 ± 1.1 logMAR at baseline to 0.3 ± 0.8 logMAR at 12th month. No significant difference between the preoperative and postoperative intraocular pressure was demonstrated. Mean pupil size at 12th month was 2.82 ± 0.5 mm with round shape. Anterior chamber angle mean was 47° ± 4.5°. Six patients developed a CME, and two patients a glaucoma. Conclusion: Pupil cerclage technique reestablishes the pupil with a precise regulation of the pupil size without distortion of its natural round shape. New sliding knot allows surgeon to reduce the risk of iatrogenic iris damage and to make a security permanent knot.

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