OBJECTIVETo assess the agreement between gonioscopy and ultrasound biomicroscopy (UBM) in detecting angle closure in Chinese patients with shallow anterior chamber.

METHODSAn observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded.

RESULTS85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor (Κ<0.4) with Kappa analysis in both dark and light conditions in each quadrant. The accordance of agreement between gonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber (P=0.005) or plateau iris configuration tended to produce different results (P=0.075) in the 2 methods.

CONCLUSIONGonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.

PURPOSE: To evaluate the ability of qualitative signs for glaucoma diagnosis, both alone and in combination, to discriminate between eyes with and without glaucomatous visual field damage. Furthermore, we investigated whether the characteristic optic disc changes in primary angle-closure glaucoma (PACG) differ from those in primary open-angle glaucoma (POAG). METHODS: Using color polaroid optic disc photographs, we examined 10 qualitative signs in 177 patients with PACG, 184 patients with POAG, and 181 normal subjects. RESULTS: Rim notches and rim shape alteration were found more frequently in patients with POAG than in those with PACG (p<0.05). Disc hemorrhage was not found in any eye in the PACG group. In the early stage (mean deviation >-6 dB) of the PACG and POAG groups, the best qualitative sign was rim shape alteration, and area under the receiver operating characteristic (ROC) curve was 0.696 and 0.768, respectively. The area under the ROC curve for the combination of qualitative signs was 0.802 and 0.918, respectively. CONCLUSIONS: These results suggest that glaucomatous disc damage was less pronounced in the PACG eyes than in the POAG eyes with similar visual field damage. A combination of the qualitative signs of optic disc using multiple logistic regression modelling improved the diagnostic ability.
Diagnosis ; Glaucoma ; Glaucoma, Angle-Closure* ; Glaucoma, Open-Angle* ; Hemorrhage ; Humans ; Logistic Models ; ROC Curve ; Visual Fields

Measurement of the depth and angle of the anterior chamber can provide valuable information for the diagnosis, treatment and prognosis of angle closure glaucoma. We measured the depth and angle of the peripheral anterior chamber in the normal and the angle closure glaucoma eyes by utilizing ultrasonographic biomicroscopy. We also measured the 4 directions of the depth and angle of the peripheral anterior chamber and iris thickness before and after dilation in the normal eyes. The mean depth and angle of the peripheral anterior chamber were 421 +/- 73 micro meter, 30.46 +/- 6.49 degree in the normal eyes and 294 +/- 25 micro meter, 29.12 +/- 3.75 degree in the angle closure glaucoma eyes respectively. The differences of the depth and angle of the peripheral anterior chamber between the two groups were statistically significant(P<0.05, respectively). The depth and angle of the peripheral anterior chamber significantly increased after dilation in the normal eyes(P<0.05, respectively). The thickness of the iris was 421 +/- 54 micro meter at the iris root site, 509 +/- 57 micro meter in at the middle site and 582 +/- 74 micro meter at the pupillary margin site.
Anterior Chamber* ; Diagnosis ; Glaucoma, Angle-Closure ; Iris* ; Microscopy, Acoustic* ; Prognosis

Objective: In previous decades, glaucoma has been primarily attributed to elevated intraocular pressure (IOP), but this has gradually been replaced by the development of optic neuropathy as the central concept of glaucoma in developed countries. However, there still remain strong controversies in the definition of glaucoma in China. In this current review, we are going to discuss these controversies and elaborate on the historical transitions of the definition of glaucoma both in China and developed countries. Furthermore, we will briefly describe the "ocular-cranial pressure gradient" theory and discuss the relationship between glaucoma and degenerative diseases of the central nervous system (CNS) in order to show the complex pathogenesis of glaucoma and the importance for the modification to the definition of glaucoma. Data Sources: We performed a comprehensive search in both PubMed and SinoMed using the following keywords: (a) "primary glaucoma" and "guideline," (b) "ocular-cranial pressure gradient," and (c) "glaucoma," "Alzheimer's disease," and "Parkinson's disease." The literature search included the related articles with no restrictions on publication date. Study Selection: The primary references were Chinese and English articles including (a) original guidelines and expert consensuses of primary glaucoma, (b) reviews focusing on the differences between various versions of these guidelines and consensuses, and (c) papers about ocular-cranial pressure gradient theory and the relationship between glaucoma and CNS degenerative diseases. Results: The definitions and classifications of both primary open-angle glaucoma and primary angle-closure glaucoma differ between Chinese glaucoma consensuses and international primary glaucoma guidelines. Chinese definitions and classifications put more emphasis on the IOP, while international guidelines put more emphasis on the presence of optic neuropathy. The ocular-cranial pressure gradient theory and the research on the relationship between glaucoma and CNS degenerative diseases have provided new directions for exploring the pathogenesis of glaucoma. Conclusions As regards the definition and classification of primary glaucoma, we find that there are still some discrepancies between Chinese expert consensuses and international guidelines. Glaucoma is a disease with complex etiologies, while its common characteristic is a specific optic neuropathy. The current definition and understanding of glaucoma is an ongoing and evolving process, reflecting our latest available evidence on its pathogenesis. Chinese ophthalmology community may need to update our guidelines, accommodating these latest developments.
China ; Glaucoma ; diagnosis ; physiopathology ; Glaucoma, Angle-Closure ; diagnosis ; physiopathology ; Glaucoma, Open-Angle ; diagnosis ; physiopathology ; Humans ; Intraocular Pressure ; physiology ; Ophthalmology ; methods

No abstract available.
Female ; Glaucoma, Angle-Closure/complications/surgery ; Humans ; Middle Aged ; Optic Neuropathy, Ischemic/complications/*diagnosis

No abstract available.
Female ; Glaucoma, Angle-Closure/complications/surgery ; Humans ; Middle Aged ; Optic Neuropathy, Ischemic/complications/*diagnosis

OBJECTIVETo review the major progress in primary angle closure glaucoma (PACG).

METHODSContents of this article were selected from the original papers or reviews related to primary angle closure glaucoma published in Chinese and foreign journals. A total of 76 articles were selected from several hundred original articles or reviews. The content of selected articles is in accordance with our purpose and the authors are authorized scientists in the study of glaucoma.

RESULTSPrimary angle closure glaucoma is the most common type of glaucoma in the Sino-Mongoloid population. PACG in Chinese can be classified into three types depending on the mechanism of angle closure: 1. Multimechanism: 54.8% of Chinese PACG is caused by co-existing factors. The pattern of angle closure appears to mainly be creeping closure. After iridectomy, almost 40% of the cases still manifest a positive response to the darkroom provocative test and progressive synechial closure or recurrent angle closure may occur. Several mechanisms are involved in this form of PACG such as pupillary blocking component, iris crowding component and anterior positioned ciliary body. These factors can coexist in the follow patterns: pupillary blocking and iris crowding coexist; pupillary blocking and anterior positioned ciliary body coexist or three of them co-exist. 2. Pupillary block: (38.1% of Chinese PACG) is caused by iris bombe due to pupillary block with acute or subacute attack. It responds well to iridectomy or laser iridotomy. 3. Non-pupillary blocking: (7.8% of Chinese PACG). They usually have a deeper anterior chamber, and tend to be younger (below 40 years of age). Angle closure in this form of PACG is caused by: iris crowding mechanism or/and anteriorly positioned ciliary body against iris root to angle. It is critical to distinguish multi-mechanism PACG from other types. The initial treatment for this type of PACG is also iridectomy, but after the pupillary block component is eliminated by iridectomy, the residual non-pupillary blocking components should be highlighted by a diagnostic treatment procedure or by a ultrasound biomicroscopy (UBM) provocative test. Finally, the role of UBM in the observation and evaluation of the mechanism of angle closure is discussed and future research directions on PACG in Asians are proposed.

CONCLUSIONChinese eyes have been recognized to be prone to the development of creeping angle closure. There is some direct evidence that creeping angle closure is caused by multiple mechanisms. Further study on this topic is needed.

angle closure glaucoma (AACG). Therefore, we estimated the nationwide, population-based standardized incidence rate of AACG in Korea.METHODS: We conducted a nationwide, population-based, retrospective study using the database of National Health Insurance (NHI) system, which includes the entire Korean population (approximately 50 million people) from 2009 to 2015. We identified patients with incident AACG during the 5-year study period from 2011 to 2015 based on their diagnosis and AACG-related treatments (laser iridotomy and cataract surgery), and estimated age- and gender-standardized incidence rate of AACG during the study period.RESULTS: We identified 11,049 patients (8,022 women, 72.6%) with incident AACG during the 5-year study period. Of these, after excluding 6 patients under 20 years old, 11,043 patients (8,020 women, 72.6%) aged ≥ 20 years were included in the analysis. The average standardized incidence rate during the 5-year study period was 59.95 (95% confidence interval [CI], 58.87–61.03) per 1,000,000 person-years. The incidence rates increased sharply with age and peaked at individuals aged 75–79 years; in men, those peaked at the same age group, however, in women, those peaked at individuals aged 70–74 years. Women has a 2.56 folds higher incidence rate (85.84 [95% CI, 84.03–87.66] per 1,000,000 person-years) than men (33.48 [95% CI, 32.33–34.62] per 1,000,000 person-years).CONCLUSION: The present study provides detailed estimates for AACG incidence according to all age groups and gender through the 5-year study period.]]>
Cataract ; Diagnosis ; Female ; Glaucoma, Angle-Closure ; Humans ; Incidence ; Korea ; Male ; National Health Programs ; Retrospective Studies

PURPOSE: To compare the clinical characteristics of primary open-angle glaucoma (HTG), normal-tension glaucoma (NTG) and primary angle-closure glaucoma (ACG) patients. METHODS: We investigated the clinical characteristics of HTG (n=75), NTG (n=58), and ACG (n=150) patients from March 2000 to November 2002. We compared the age at initial glaucoma diagnosis, sex, family history, systemic diseases, refractive errors, and corneal curvature among the three groups. RESULTS: HTG was younger than the others at initial glaucoma diagnosis. In ACG, the incidence rate was higher in women, but it was in HTG, higher in men. Family history of glaucoma was significantly more prevalent in HTG than in the others. NTG showed higher prevalence of cardiovascular disease and hypotension than the others. In refractive errors, there was statistically significant difference among the three groups and HTG had more severe myopia than the others. ACG had the steepest cornea curvature. CONCLUSIONS: Three types of primary glaucoma (HTG, NTG and ACG) differed somewhat in clinical feature. This finding will be helpful in the early diagnosis and treatment of glaucoma.
Cardiovascular Diseases ; Cornea ; Diagnosis ; Early Diagnosis ; Female ; Glaucoma* ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Humans ; Hypotension ; Incidence ; Male ; Myopia ; Prevalence ; Refractive Errors

The anterior chamber depth is important in diagnosis and treatment of glaucoma, thus the research of the anterior chamber depth would help the understanding of angle closure glaucoma. Then the estimation of anterior chamber depth might help the diagnosis of certain cases of glaucoma. It has been reported by other authors in Korea, but there were not enough subjects to see the correlation between age and the anterior chamber depth. The purpose of this study was to measure the variation of the anterior chamber depth in relation to the normal aging process. The anterior chamber depth was measured in 2,524 eyes of normal subjects aged 20 years or older who visited our hospital to receive a health examination. Measurements of the anterior chamber depth were carried out conviniently with the Haag-Streit pachometer. Intraocular pressures were measured with the Pulsair non-contact tonometer, and the refractive errors of each subject were divided into hyperopia, emmetropia, and myopia. These data were analyzed statistically by Student's t-test. Female subjects had a smaller measurement for anterior chamber depth than male. The average anterior chamber depth of the emmetropes was smaller than that of the my opes and larger than that of the hyperopes. It was found that the anterior chamber depth decreased with age(0.015mm/year). The anterior chamber depth seemed not to be correlated with the intraocular pressure.
Adult* ; Aging ; Anterior Chamber* ; Diagnosis ; Emmetropia ; Female ; Glaucoma ; Glaucoma, Angle-Closure ; Humans ; Hyperopia ; Intraocular Pressure ; Korea ; Male ; Myopia ; Refractive Errors