scholarly journals Morphological justifi cation of the pathogenesis of angleclosure glaucoma

2021 ◽  
Vol 99 (3) ◽  
pp. 198-202
Author(s):  
N. A. Bakunina ◽  
A A Fedorov ◽  
L. M. Balashova ◽  
Zh. M. Salmasi

Objective. To prove the role of interrelated autoimmune, hemostatic and infl ammatory mechanisms in the pathogenesis of angleclosure glaucoma on the basis of experimental morphological research. Material and methods. The work was performed on 3 denucleated eyes of patients with terminal “creeping” angle-closure glaucoma (ACG) and 2 eyes with terminal ACG during an intractable acute exacerbation. Sagittal sections through the area of Schlemm’s canal, as well as serial cross sections, were examined by the method of paraffi n sections stained with hematoxylin-eosin (HE). To assess the degree of the infl ammatory response in the eye tissues, the density of infl ammatory cells was calculated within the standard eyepiece micrometer grid at a magnifi cation of × 20.Results. The formation of peripheral anterior synechiae between the periphery of the iris and the trabecular meshwork in the iridocorneal angle is the main etiological factor in chronic angle closure. Several mechanisms contribute to the formation of anterior synechiae. First of all, in our opinion, it is autoimmune infl ammation. Edema and hyperemia of the ciliary processes pushes the iris anteriad, collagen fi bers of the trabecular meshwork are damaged; delayed endothelialization of the trabecular plate occurs, and the angle of the anterior chamber narrows and closes as a result. The resistance to the outfl ow of intraocular fl uid increases. Ischemia, due to increased intraocular pressure (IOP), causes the formation of new vessels in the iris, where aggregates of blood cells are observed. The walls of the newly formed vessels are defective, which contributes to hemorrhages. Thus, in addition to autoimmune infl ammation, we observe signs of endothelial dysfunction syndrome associated with infl ammatory processes with ACG.Conclusions. 1. The pathogenesis of chronic angleclosure glaucoma is based on autoimmune processes, as proved by lymphocytoplasmocytic infl ammatory infi ltration with an addition of pigment-containing macrophages and fi broblasts at the junction of the iris with the cornea. 2. The detection of intravascular aggregates is a proof of impaired hemostasis in angle-closure glaucoma. 3. Parietal thrombus formation in the newly formed vessels of the iris, fi brin in the tissues are evidence of chronic endothelial dysfunction in ACG. 4. The capillaries of the ciliary processes surrounded by a fi brin ring indicate an acute vasomotor disorder and the release of plasma containing fi brinogen into the surrounding tissue. This is indirect evidence of emotional and vasomotor instability in patients with this form of glaucoma. 5. Disturbances in the systems of immunity and hemostasis are interrelated processes. 6. Increased iris stiff ness is ACG biomarker and may serve as a further target for therapeutic intervention.

2019 ◽  
Vol 1 (2) ◽  
pp. 25-28
Author(s):  
Vallinayagam Muthukrishnan ◽  
Stephanie Sebastian ◽  
Sajeeth Kurinjhi ◽  
Senthil Prasad

2020 ◽  
Vol 3 ◽  
pp. 2
Author(s):  
Sanjay Mishra ◽  
Ashok Kumar

Objective: The objective of the study was to compare the posture-induced intraocular pressure (IOP) changes in primary angle-closure glaucoma (PACG) with or without glaucoma medications, and healthy control eyes with normal IOPs in Indian subjects. Materials and Methods: The IOP was measured in the sitting position and the supine position after 10, 20, and 30 min with a rebound tonometer. Results: Twenty-five patients with PACG and 30 controls with normal IOPs were studied. The IOP in the sitting position measured with the rebound tonometer was 13.8 + 3.2 mm Hg in eyes with PAC, and 12.9 + 2.9 mm Hg in eyes with normal IOPs. The IOP increased to 14.4 mm Hg, 16.8 mm Hg, and 18.9 mm Hg at 10 min, 20 min, and 30 min in PACG subjects. In normal age-matched controls, the IOP increased to 13.4 mm Hg, 14.9 mm Hg, and 17.8 mm Hg at 10 min, 20 min, and 30 min, respectively, but none of these differences were significant (P = 0.09; P = 0.08, P = 0.08). The mean postural IOP change from baseline was also not significant between the two groups. Only three patients were on single antiglaucoma medication with well-controlled IOP in the PACG group. Conclusions: Postural IOP changes are comparable among eyes with PACG with and without glaucoma medications, and control eyes.


1970 ◽  
Vol 3 (2) ◽  
pp. 123-127
Author(s):  
I Paudyal ◽  
SS Thapa ◽  
G Paudyal ◽  
R Gurung ◽  
S Ruit

Background: Glaucoma is an important cause of blindness. Objective: To report the distribution of various types of glaucoma among patients presenting to a tertiary eye hospital in Nepal. Materials and methods: All new patients visiting the hospital between March 2007 and February 2008 underwent a comprehensive eye examination. Whenever glaucoma was suspected, patients were referred to fellowship-trained glaucoma specialists. Patients received a comprehensive glaucoma workup including applanation tonometry, stereoscopic examination of the optic nerve head performed by the glaucoma specialists, and a Humphrey visual field analysis (SITA 24 - 2). Results: 447 patients were newly diagnosed with glaucoma. 171 (38.2 %) patients had primary open-angle glaucoma (POAG), while 143 (32 %) had primary angle-closure glaucoma (PACG). The average age of presentation of patients with POAG was 65.78 ± 9.1 years, while the average age for PACG patients was 54.6 ±12.8 years. 30 (21 %) patients with PACG had acute angle-closure on presentation, while 113 (79 %) had chronic angle closure glaucoma. 107 (75 %) of these patients with PACG had visual acuity of less than 3/60 (20/ 400) in the worse eye at presentation. The most common form of secondary glaucoma was lens-induced (5.3 %), followed by neovascular (3.2 %) and uveitic glaucoma (3.2 %). Conclusion: The most common glaucoma seen in a tertiary referral eye hospital of Nepal is primary open-angle glaucoma. Among the angle-closure glaucoma, chronic angle-closure is the most common. Lens-induced glaucoma is still the commonest cause of secondary glaucoma. Keywords: glaucoma, open-angle, angle-closure, lens-induced DOI: http://dx.doi.org/10.3126/nepjoph.v3i2.5263 Nepal J Ophthalmol 2011; 3(2): 123-127


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