scholarly journals Clinical management of a rare Peters’ anomaly-induced secondary childhood glaucoma: A case report

Narra J ◽  
2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Eva Imelda ◽  
Fany Gunawan
Keyword(s):  
Anterior Chamber ◽  
Light Exposure ◽  
Anterior Segment ◽  
Corneal Edema ◽  
Timolol Maleate ◽  
Post Surgery ◽  
Peters Anomaly ◽  
Shallow Anterior Chamber ◽  
Nasal Region ◽  
The Right

Childhood glaucoma is a rare disorder that occurs from birth until teenage years caused by an abnormality of aqueous humor pathways. About 50–70% of Peters' anomaly is accompanied by secondary childhood glaucoma. The presence of glaucoma will affect the prognosis. We reported the evaluation and treatment of secondary childhood glaucoma due to Peters’ anomaly. A 5 months-old boy was presented with the complaint of a enlarged left eye since 3 months old. The complaint was accompanied by a watering eye and frequently closed upon light exposure. The left eye looked opaquer than contralateral. Examination under anesthesia showed that the intraocular pressure (IOP) was 35 mmHg in the left eye and the corneal diameter was 14 mm. Other findings were keratopathy, diffuse corneal edema, buphthalmos, shallow anterior chamber, anterior synechiae, and linear slit shaped pupils in the nasal region. Patient was treated with ophthalmic timolol maleate which was later followed by trabeculectomy. After 1 week post-surgery, IOP assessment by palpation suggested the right eye within normal range while the IOP of left eye was higger than normal. Blepharospasm, epiphora, photophobia, bleb on superior, subconjunctiva bleeding, buphthalmos, keratopathy, minimal corneal edema, anterior chamber with shallow image, and posterior synechia were found in left eye anterior segment. In conclusion, trabeculotomy and trabeculectomy are recommended if there is no reduction of IOP observed after receiving timolol maleate therapy. The choice of surgical management is dependent on the feasibility of the protocol.

Anterior Segment OCT in Primary Angle Closure Compared to Normal Subjects with Similar Shallow Anterior Chamber

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Qinghong Xie ◽  
Ping Ma ◽  
Jutima Patlidanon ◽  
Murtaza Saifee ◽  
Sean Yonamine ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Anterior Segment ◽  
Normal Subjects ◽  
Angle Closure ◽  
Anterior Segment Oct ◽  
Primary Angle Closure ◽  
Shallow Anterior Chamber

Bilateral Isolated Spherophakia with Lens Subluxation, High Myopia and Secondary Angle Closure: A Case Report

2018 ◽  
Author(s):  
Ye Zhang ◽  
Ravi Thomas ◽  
Cong Wang ◽  
Xiangyu Shi
Keyword(s):  
Anterior Chamber ◽  
High Myopia ◽  
Rare Condition ◽  
Spherical Shape ◽  
Angle Closure ◽  
Lens Subluxation ◽  
Pars Plana Lensectomy ◽  
Shallow Anterior Chamber ◽  
One Year ◽  
The Right

Abstract Background: Spherophakia is a rare condition and compared to its occurrence with familial and systemic disorders, isolated spherophakia is even more uncommon. This rare case of isolated spherophakia will raise the alertness of physicians when dealing with a high myopia patient with shallow anterior chamber and relatively normal fundus. Case presentation: We report a case of a 17-year-old male who experienced painless decrease of vision in both eyes (OU) for 11 years, with progression of visual impairment and occasional ocular pain for one year. Examination revealed high myopia, increased intraocular pressures (IOP, 28 mmHg in the right eye (OD) and 33 mmHg in the left (OS)), shallow central anterior chambers, lenses of a spherical shape with superior subluxation, occludable angles without peripheral anterior synechiae, and healthy optic discs OU. A diagnosis of bilateral isolated spherophakia, lens subluxation, high myopia and secondary angle closure (AC) was made. Pars plana lensectomy with anterior vitrectomy and scleral suturing of an intraocular lens was performed. On postoperative follow-up at 19 days OD and 63 days OS, the visual acuity was 6/6 and the IOP was normal without any medication OU. Conclusions: A presentation with high myopia, shallow anterior chamber with a normal retina should alert the clinician to the possibility of spherophakia, as compared to high myopia caused by elongated axial length. Surgery should be considered in cases of spherophakia with AC where the IOP cannot be controlled by noninvasive means.

scholarly journals Ultrasound Biomicroscopy Detects Peters’ Anomaly and Rieger’s Anomaly in Infants

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Wen-Si Chen ◽  
Dao-Man Xiang ◽  
Lan-Xiang Hu
Keyword(s):  
Anterior Chamber ◽  
Anterior Segment ◽  
Corneal Stroma ◽  
Ultrasound Biomicroscopy ◽  
Type I ◽  
Imaging Features ◽  
Type Iv ◽  
Peters Anomaly ◽  
Flat Anterior Chamber ◽  
Corneal Opacities

Aim. Congenital corneal opacities (CCOs) are the major causes of early visual deprivation in infants. Balloon ultrasound biomicroscopy (UBM) examination is an effective method to diagnose CCO. However, whether it is suitable for children examination is still unknown. Methods. 26 Peters’ anomaly (PA) or Rieger’s anomaly (RA) infants with congenital corneal opacities (CCO) (40 eyes) underwent UBM examinations to study their imaging features. Results. Based on the results, they were divided into UBM Dx-Type I: Descemet’s membrane (DM) and endothelium have heterogenous or discontinuous echo accompanied with corneal stroma echo-enhanced or shallow anterior chamber. Type II: Type I alteration plus abnormal strand of iris extended to the border of the posterior corneal defect or iridocorneal adhesion. Type III: Type I or II combined with the abnormal hyperechoic lens, lens luxation, or keratolenticular adhesion. Type IV: echoes of the DM and the endothelium are continuous, corneal stroma echo is enhanced, and an abnormal strand of peripheral iris extends to the prominent Schwalbe line, accompanied by iris stroma or pupil heteromorphism and a shallow or flat anterior chamber. Conclusion. UBM not only could accurately evaluate the anterior segment abnormalities in CCO infants but also would be a step forward for the management of PA- and RA-associated CCO.

scholarly journals Angle stability and outflow in excisional ab interno trabeculectomy with active versus passive chamber management

2017 ◽  
Author(s):  
Chao Wang ◽  
Yalong Dang ◽  
Susannah Waxman ◽  
Xiaobo Xia ◽  
Robert N Weinreb ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Glaucoma Surgery ◽  
Training Model ◽  
Training System ◽  
Angle Stability ◽  
Ab Interno Trabeculectomy ◽  
The Right ◽  
Ab Interno

Purpose: To compare the intraoperative angle stability and the postoperative outflow of two ab interno trabeculectomy devices that excise the trabecular meshwork. The newer device has an active aspiration and irrigation port while the older requires viscoelastic to maintain the anterior chamber. We hypothesized that anterior segment optical coherence tomography (ASOCT) allows quantifying the intraoperative behavior in a microincisional glaucoma surgery (MIGS) pig eye training model. Methods: Twelve freshly enucleated porcine eyes were measured with ASOCT at baseline, at the beginning of the procedure and at its conclusion to determine the anterior chamber depth (ACD) and the nasal angle in degrees. The right and left eye of pairs were randomly assigned 24 to an active dual blade goniectome (aDBG) and a passive dual blade goniectome (pDBG) group, 25 respectively. The aDBG had an irrigation and aspiration port while the pDBG required surgery 26 under viscoelastic. We performed the procedures using our MIGS training system with a 27 standard, motorized ophthalmic operating microscope. We estimated outflow by obtaining 28 canalograms with fluorescent spheres. Results: In aDBG, the nasal angle remained wide open during the procedure at above 90° and 30 did not change towards the end (100±10%, p=0.9). In contrast, in pDBG, ACD decreased by 31 51±19% to 21% below baseline (p<0.01) while the angle progressively narrowed by 40±12% 32 (p<0.001). Canalograms showed a similar extent of access to the outflow tract with the aDBG 33 and the pDBG (p=0.513). The average increase for the aDBG in the superonasal and inferonasal 34 quadrants was between 27 to 31% and for the pDBG between 15 to 18%. Conclusion: ASOCT demonstrated that active irrigation and aspiration improved anterior 36 chamber maintenance and ease of handling with the aDBG in this MIGS training model. The 37 immediate postoperative outflow was equally good with both devices.

scholarly journals Assessment of anterior chamber configuration changes after phacoemulsification with swept-source optical coherence tomography

2019 ◽  
Author(s):  
Man Hu ◽  
Qian Zheng ◽  
Zhangliang Li ◽  
Pingjun Chang ◽  
Yun-e Zhao
Keyword(s):  
Optical Coherence Tomography ◽  
Cataract Surgery ◽  
Anterior Chamber ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Optical Coherence ◽  
Swept Source ◽  
Narrow Angle ◽  
Age Related ◽  
Shallow Anterior Chamber

Abstract Background To assess the changes of anterior chamber angle in patients with shallow anterior chamber and normal anterior chamber after phacoemulsification and intraocular lens implantation (IOL) using anterior segment swept-source optical coherence tomography (AS-SS-OCT). Methods This was a prospective case control study; 60 eyes of 60 patients who underwent cataract surgery. Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were classified into two groups, shallow anterior chamber group (30 eyes) and normal anterior chamber group (30 eyes). AS-SS-OCT was used to measure ACD and angle parameters angle opening distance (AOD), angle recess area (ARA), trabecular iris space area(TISA), and trabecular iris angle (TIA). Serial changes in each group were measured before and 3 months after phacoemulsification and IOL, and the differences between the two groups were compared. Results All angle parameters including ACD, AOD, ARA, TISA, and TIA in both groups at 3 months after cataract surgery were significantly different from the preoperative values (p<0.01). In addition, we found significant differences of all angle parameters between groups of shallow anterior chamber (SAC) and normal anterior chamber (NAC) (All P< 0.05). Besides, the TISA750 in superior quadrant and anterior chamber volume (ACV) were significantly smaller in the group of SAC than those in the group of NAC (P = 0.041 and 0.002, respectively). Conclusions The parameters of anterior chamber increased significantly in both two groups but not increase to the same extent 3 months after phacoemulsification. Iris thickening may also be one of the narrow angle factors,not just age-related lens thickening.

scholarly journals Spontaneous Scleral Perforation of an Anterior Chamber Intraocular Lens

2016 ◽  
Vol 7 (1) ◽  
pp. 249-252
Author(s):  
Oriel Spierer ◽  
Terrence P. O’Brien
Keyword(s):  
Optical Coherence Tomography ◽  
Anterior Chamber ◽  
Intraocular Lens ◽  
Anterior Segment ◽  
Optical Coherence ◽  
Chamber Length ◽  
Good Visual Acuity ◽  
Vertically Aligned ◽  
Eye Examination ◽  
The Right

A routine eye examination of a 69-year-old man revealed a scleral perforation of one of the haptics of the anterior chamber intraocular lens (AC IOL) which had been implanted many years ago. The patient was asymptomatic with good visual acuity. His history was negative for any trauma, eye rubbing, topical corticosteroid use, or autoimmune disease. The horizontal and vertical white-to-white diameters of the cornea in the right eye were 11.5 and 10.5 mm, respectively. Anterior segment optical coherence tomography showed the anterior chamber length to be 12.28 mm horizontally and 10.63 mm vertically. The patient underwent an IOL exchange, and the length of the explanted AC IOL was measured to be 12 mm. We speculate that the AC IOL, which was vertically aligned, was oversized. This case demonstrates the need for proper sizing and positioning of an AC IOL. In complex cases where AC IOL may be used, measuring the horizontal and vertical lengths of the anterior chamber by anterior segment optical coherence tomography prior to surgery may be useful.

scholarly journals Secondary angle closure glaucoma due to posterior scleritis in a case of empty sella syndrome

2020 ◽  
Vol 12 (2) ◽  
pp. 308-312
Author(s):  
Tarannum Mansoori
Keyword(s):  
Anterior Segment ◽  
Sella Turcica ◽  
Empty Sella ◽  
Angle Closure Glaucoma ◽  
Angle Closure ◽  
Posterior Scleritis ◽  
Diagnostic Dilemma ◽  
Disc Edema ◽  
Shallow Anterior Chamber ◽  
The Right

Introduction: We frequently come upon cases of posterior scleritis with secondary angle closure glaucoma. However, it can pose a diagnostic dilemma in a patient with bilateral disc edema along with unilateral angle closure glaucoma due to posterior scleritis. Case: We report a case of a 25 - year old male, who presented with the complaints of pain, redness and blurring of vision in the left eye for the last 3 days. On ocular examination, unaided visual acuity of the right eye was 6/6 and the best corrected in the left eye was 6/9 with - 6.25 D sphere. Apart from conjunctival congestion and shallow anterior chamber in the left eye, rest of the anterior segment evaluation in both the eyes were normal. On fundus evaluation, there was presence of disc edema in both the eyes. Intraocular pressure was 20 and 32 mm of Hg in the right and left eye respectively. Gonioscopy revealed open angles in the right eye and no visible angle structures in the left eye. B-Scan of the left eye showed a typical “T” sign suggestive of posterior scleritis. MRI brain revealed empty sella turcica. Conclusion: Empty sella turcica has been reported to present with the bilateral disc edema which, when accompanied with other entities such as Posterior scleritis can be misleading and the diagnosis can pose to be a challenge.

scholarly journals Ex-PRESS shunt implantation for intractable glaucoma with posterior chamber phakic intraocular lens: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rongrong Hu ◽  
Wei Xu ◽  
Baishuang Huang ◽  
Xiaoyu Wang
Keyword(s):  
Anterior Chamber ◽  
Intraocular Lens ◽  
High Myopia ◽  
Posterior Chamber ◽  
Filtration Surgery ◽  
Phakic Intraocular Lens ◽  
Glaucoma Filtration Surgery ◽  
Shallow Anterior Chamber ◽  
The Right ◽  
Intractable Glaucoma

Abstract Background Implantation of the posterior chamber phakic intraocular lens has been widely performed to correct high and extreme myopia. Chronic intraocular pressure (IOP) elevation may occur in its late postoperative period. For medically uncontrolled cases, surgical treatment is necessary, and benefits should be weighed against risks when determining whether to remove the lens. Case presentation A 32-year-old man with extremely high myopia presented with progressive blurred vision and medically uncontrolled IOP in the right eye. His past ocular history was significant for bilateral implantable collamer lens (ICL) implantation ten years ago. On ophthalmic examination, the ICL was well placed with a vault height of 456 µm in the right eye. The anterior chamber angles were open but narrow, and mild to moderate trabecular pigmentation was noted. Ex-PRESS glaucoma filtration surgery without ICL removal was performed to control IOP. During surgery, an Ex-PRESS P50 shunt was inserted into the anterior chamber via the front edge of the blue-grey transition zone between the sclera and cornea. Transient hypotony and shallow anterior chamber occurred in the first week after surgery, along with an ICL tilt towards the cornea with reduced vault height. No other complications related to either the ICL or the Ex-PRESS shunt were noted. IOP remained stable at 12 ~ 14 mmHg at the first 3-month follow-up. Conclusions Ex-PRESS glaucoma filtration surgery might be a safe and effective alternative treatment for intractable glaucoma with high myopia and ICL implantation. Careful assessment of the ICL position and anterior chamber angle is necessary to plan the appropriate surgical procedure. A postoperative shallow anterior chamber may result in ICL dislocation.

Tube Shunt Related Complications of the Anterior Chamber

2013 ◽  
Author(s):  
Parag A. Gokhale
Keyword(s):  
Anterior Chamber ◽  
Ciliary Body ◽  
Corneal Edema ◽  
Tube Plate ◽  
Scleral Tunnel ◽  
Flat Anterior Chamber ◽  
Bleb Formation ◽  
Shallow Anterior Chamber ◽  
Incomplete Occlusion ◽  
Tube Shunt

Postoperative complications in the anterior chamber can affect both glaucoma progression and vision. Preoperative considerations and surgical technique are important to reduce and prevent these complications. A flat anterior chamber is one of the most common complications following tube shunt surgery, occurring at a rate of 3.5%– 27%. Although often associated with hypotony and choroidal effusions and usually due to increased outflow after surgery, it may also be related to decreased aqueous production, especially in eyes with previous ciliary body ablation. Increased outflow could result from leakage around the tube or overfiltration either before fibrous capsule formation over the plate or through tube fenestrations. Diagnosis of the cause of hypotony can be made with a careful slit-lamp examination. Leakage around the tube can be viewed internally by gonioscopy, though a flat or shallow anterior chamber can make seeing potential leakage difficult. The location of overfiltration can be determined by looking at areas of conjunctival elevation. Conjunctival bleb formation at the limbus could help identify leakage around the tube at its scleral tunnel insertion. Early elevation of a bleb over the reservoir of a tube shunt is also seen with incomplete occlusion in the nonvalved (or sometimes valved) tube. Elevation near the tube-plate junction could also indicate overflow at a fenestration but is unusual. Intracameral irrigation of fluorescein can help identify the source of leakage. A flat anterior chamber associated with hypotony can have serious sequelae, including corneal edema, cataract, and failure of the procedure. Medical treatment to deepen the anterior chamber with cycloplegics and reduction of wound healing inhibitors should be tried first but is often insufficient, as this treatment will not quickly eliminate the source of leakage. More aggressive intervention will be needed if there is central flattening (Grade 2 or 3 flat chamber). Identifying the source of leakage is important in determining management. If there is leakage at the site of the tube’s entry into the sclera, viscoelastic may be needed to fill the anterior chamber. Air injection is an alternative that allows for continued visualization of the leak if desired.

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