A prospective study of blotchy pigments distribution in anterior chamber among angle closure glaucoma patients

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 Warfarin was withdrawn and oral vitamin K therapy was initiated leading to a rapid INR reduction.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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Anatomical effects of clear lens extraction by phacoemulsification versus trabeculectomy on anterior chamber drainage angle in primary angle-closure glaucoma (PACG) patients

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-015-2936-z ◽

2015 ◽

Vol 253 (5) ◽

pp. 773-778 ◽

Cited By ~ 20

Author(s):

Xiaofei Man ◽

Noel C. Y. Chan ◽

Nafees Baig ◽

Yolanda Y. Y. Kwong ◽

Dexter Y. L. Leung ◽

...

Keyword(s):

Anterior Chamber ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Lens Extraction ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma

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Single-pass four-throw pupilloplasty for secondary angle-closure glaucoma associated with silicon oil tamponade

European Journal of Ophthalmology ◽

10.1177/1120672118780809 ◽

2018 ◽

Vol 29 (5) ◽

pp. 561-565 ◽

Cited By ~ 1

Author(s):

Priya Narang ◽

Ashar Agarwal ◽

Amar Agarwal

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Intraocular Pressure ◽

Anterior Chamber ◽

Anterior Segment ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Single Pass ◽

Silicon Oil ◽

The Mean

Purpose: To describe the feasibility and efficacy of performing single-pass four-throw pupilloplasty for secondary angle-closure glaucoma post silicon oil tamponade. Methods: The procedure was performed in five eyes of five patients. All the cases underwent silicon oil removal with single-pass four-throw pupilloplasty. Single-pass four-throw procedure involves a single pass of needle through the iris tissue that is to be apposed followed by taking four throws by passing the suture end through the loop that is withdrawn from the anterior chamber as in a modified Siepser’s slip-knot technique. Both the suture ends are pulled and this leads to sliding of the loop into the anterior chamber. Surgical pupilloplasty stretches the peripheral iris tissue and helps in breaking the peripheral anterior synechia. Intraoperative gonioscopy and anterior segment optical coherence tomography were performed in all the cases. Results: Intraoperative gonioscopy and anterior segment optical coherence tomography demonstrated opening of the anterior chamber angles with breakage of peripheral anterior synechia. The mean preoperative and postoperative best-corrected visual acuity in logarithm of minimum angle of resolution was 1.24 ± 0.23 and 0.56 ± 0.18, respectively (p < 0.001). The mean preoperative and postoperative intraocular pressure was 38.2 ± 4.97 and 13.0 ± 2.35 mm Hg, respectively. There was a significant decrease in intraocular pressure and marked improvement in visual acuity in all the cases. Conclusion: Surgical pupilloplasty helps to relieve the post-silicon oil-induced secondary angle-closure glaucoma by breaking peripheral anterior synechia and significantly opening the anterior chamber angles.

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Effect of Phacoemulsification on Anterior Chamber Angle in Eyes with Medically Uncontrolled Filtered Primary Angle-Closure Glaucoma

Journal of Ophthalmology ◽

10.1155/2020/8720450 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Chengguo Zuo ◽

Bing Long ◽

Xinxing Guo ◽

Liming Chen ◽

Xing Liu

Keyword(s):

Anterior Chamber ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Anterior Chamber Angle ◽

Iol Implantation ◽

Anatomical Changes ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

The Mean ◽

Chamber Angle

Purpose. To evaluate the effect of phacoemulsification and intraocular lens (IOLs) implantation in eyes with medically uncontrolled primary angle-closure glaucoma (PACG) previously treated with trabeculectomy and to quantify the anatomical changes in the anterior chamber angle by ultrasound biomicroscopy (UBM). Methods. Forty-four eyes of 37 consecutive patients with medically uncontrolled PACG coexisting cataracts with a surgical history of trabeculectomy were included in this study. Each patient underwent phacoemulsification and IOL implantation. Indentation gonioscopy and UBM were performed preoperatively and then again 3 months after surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications and anatomical changes in the anterior chamber angle. Results. The mean logarithm of the minimum angle of resolution BCVA significantly improved from 0.52 ± 0.30 preoperatively to 0.26 ± 0.23 postoperatively (p<0.001). The mean IOP significantly decreased from 24.33 ± 9.65 mmHg preoperatively to 18.04 ± 7.86 mmHg postoperatively (p<0.05). 001). The median number of antiglaucoma medications decreased from 2 preoperatively to 1 postoperatively (p<0.001). There was no significant difference in the extent of peripheral anterior synechia after the surgery (p>0.05). Some parameters, including anterior central chamber depth, angle opening distance at 500 μm, trabecular-iris angle, and scleral ciliary process angle, were significantly higher after than before surgery (p<0.001). However, the crystalline lens rise was significantly smaller following the surgery (p<0.001). Conclusions. Phacoemulsification and IOL implantation reduced the IOP and improved vision in eyes with medically uncontrolled filtered PACG. The mechanism underlying the outcomes observed following surgery might be related to the anterior chamber deepening, widened drainage angle, and improved aqueous fluid flow to the trabecular meshwork.

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