Bilateral simultaneous acute angle closure in an adult Nepalese woman

Purpose: To report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. Methods: Observational case report. Results: A 50-year-old Nepalese woman presented with decreased vision, pain, redness, and watering in both eyes with associated coloured haloes, nausea, and vomiting for 10 days. At presentation, her visual acuity was 20/400 in the right eye and hand motions close to face with accurate projection of rays in the left eye. Intraocular pressure was 38 mmHg in the right eye and 48 mmHg in the left eye without any antiglaucoma medications. A slit-lamp examination revealed bilateral circum-corneal conjunctival congestion, corneal edema, and shallow anterior chambers. Both pupils were mid-dilated and non-reactive to light. Gonioscopy showed closed angles in all four quadrants bilaterally. Posterior segment examination revealed normal optic disc with cup-disc-ratio of 0.3 in the right eye, and blurring of disc margin with cup-disc-ratio of 0.3 in the left eye. The patient was started on systemic acetazolamide 250 mg 4 times a day, topical brimonidine 0.2% and timolol 0.5% 2 times a day, and topical dexamethasone 6 times a day in both eyes, following which IOP reduced to 11 and 12 mmHg, respectively, the corneal edema subsided, but the anterior chamber remained shallow. Laser peripheral iridotomy was performed in the right eye and surgical peripheral iridectomy was performed in the left eye. After two weeks, vision improved to 20/30 in both eyes with normal intraocular pressure off antiglaucoma medications. Anterior chambers deepened significantly with clear corneas bilaterally. Gonioscopy at this stage showed essentially open angles with appositional closure in superior and temporal quadrants in the right eye and open angles in all four quadrants in the left eye. Posterior segment evaluation revealed normal optic disc in both eyes. Conclusions: Bilateral simultaneous acute angle closure is a rare presentation with very few reported secondary causes. We report a case of bilateral simultaneous angle closure in an adult Nepalese woman without any known secondary cause. The case was successfully managed with laser peripheral iridotomy in the right eye and surgical peripheral iridectomy in the left eye.

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Atypical Presentation of Acute Angle-Closure Glaucoma in Maroteaux-Lamy Mucopolysaccharidosis with Patent Prophylactic Laser Peripheral Iridotomy: A Case Report

The Permanente Journal ◽

10.7812/tpp/17-012 ◽

2017 ◽

Author(s):

Malini Veerappan

Keyword(s):

Case Report ◽

Acute Angle ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Atypical Presentation ◽

Laser Peripheral Iridotomy ◽

Acute Angle Closure ◽

Peripheral Iridotomy ◽

Acute Angle Closure Glaucoma

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Increases in rates of both laser peripheral iridotomy and phacoemulsification have accompanied a fall in acute angle closure rates in the UK

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2011-300255 ◽

2011 ◽

Vol 95 (9) ◽

pp. 1339-1340 ◽

Cited By ~ 7

Author(s):

A. C. Day ◽

P. J. Foster

Keyword(s):

Acute Angle ◽

Angle Closure ◽

Laser Peripheral Iridotomy ◽

Acute Angle Closure ◽

The Uk ◽

Peripheral Iridotomy

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Changes of anterior chamber architecture induced by laser peripheral iridotomy in acute angle closure crisis

International Ophthalmology ◽

10.1007/s10792-014-9982-0 ◽

2014 ◽

Vol 35 (4) ◽

pp. 549-556 ◽

Cited By ~ 7

Author(s):

J. D. Unterlauft ◽

Y. Yafai ◽

P. Wiedemann

Keyword(s):

Anterior Chamber ◽

Acute Angle ◽

Angle Closure ◽

Laser Peripheral Iridotomy ◽

Acute Angle Closure ◽

Peripheral Iridotomy

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A randomised prospective comparison of operative peripheral iridectomy and Nd:YAG laser iridotomy treatment of acute angle closure glaucoma: 3 year visual acuity and intraocular pressure control outcome

British Journal of Ophthalmology ◽

10.1136/bjo.81.10.884 ◽

1997 ◽

Vol 81 (10) ◽

pp. 884-888 ◽

Cited By ~ 51

Author(s):

B W Fleck ◽

E Wright ◽

E A Fairley

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Pressure Control ◽

Acute Angle ◽

Angle Closure ◽

Laser Iridotomy ◽

Prospective Comparison ◽

Peripheral Iridectomy ◽

Acute Angle Closure ◽

Acute Angle Closure Glaucoma

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Complete Anterior Capsule Phimosis following Cataract Surgery in a Patient with a History of Retinopathy of Prematurity, Nystagmus, and a Narrow Angle

Case Reports in Ophthalmology ◽

10.1159/000502282 ◽

2019 ◽

Vol 10 (2) ◽

pp. 274-280 ◽

Cited By ~ 1

Author(s):

William K. Wong Jr. ◽

Malcolm R. Ing ◽

Carlthan J.M. Ling

Keyword(s):

Cataract Surgery ◽

Retinopathy Of Prematurity ◽

Acute Angle ◽

Angle Closure ◽

Laser Peripheral Iridotomy ◽

Anterior Capsule ◽

Narrow Angle ◽

History Of ◽

Acute Angle Closure ◽

The Right

The authors present a case of complete anterior capsule phimosis and vision decline which developed 4 weeks postoperatively in the right eye after uncomplicated cataract surgery. Prior ocular history included retinopathy of prematurity in both eyes, acute angle closure glaucoma in the left eye, prophylactic laser peripheral iridotomy for a narrow angle in the right eye, and nystagmus in both eyes. This condition was addressed by surgically releasing the anterior capsule with microscissors to open the pupillary space which had been completely obscured by the anterior capsule, also causing the haptics of the 1-piece intraocular lens to deform. When cataract surgery was performed on his left eye, the surgeon performed prophylactic relaxing incisions at 4 points on the capsular opening. It is notable that his left eye did not develop anterior capsule phimosis postoperatively.

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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.

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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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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.

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