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

OBJECTIVE: To investigate the pathogenesis and treatment of high myopia in patients with angle-closure glaucoma. METHODS: Clinic data of 692 patients with angle closure glaucoma were analyzed retrospectively. Eleven patients with high myopia and angle closure underwent surgery. RESULTS: Eleven patients with high myopia in the 692 angle-closure glaucoma were identified: 3 Weill-Marchesani syndrome, 1 plateau iris configuration and syndrome, 5 primary pupillary block, and 2 iris cyst. Intraocular pressure in 19 eyes of the 11 patients was successfully controlled after receiving phaco or filtering surgery. CONCLUSION Angle closure can occur in eyes with high myopia, and pupillary block may be the main cause of angle closure.
Adult ; Aged ; Female ; Glaucoma, Angle-Closure ; diagnosis ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Myopia ; complications ; diagnosis ; Retrospective Studies ; Young Adult

PURPOSE: To evaluate the influence of biometric variables on refractive outcomes after cataract surgery in angle-closure glaucoma (ACG) patients. METHODS: In this case-control study, 42 ACG patients, 40 open-angle glaucoma (OAG) patients, and 35 controls without glaucoma who had undergone conventional cataract surgery were enrolled consecutively. Electronic medical records, including preoperative biometric variables (keratometric diopter, axial length, anterior chamber depth, and lens thickness), the refractive change (RC), and the absolute value of refractive change (ARC) were reviewed. RESULTS: In the control and OAG patients, the anterior chamber depth was negatively correlated with the ARC (r = -0.344, p = 0.043 and r = -0.431, p = 0.006, respectively), whereas there was no correlation in the ACG patients. Lens thickness was positively correlated with the RC, but not with the ARC, in the control and OAG groups (r = 0.391, p = 0.020 and r = 0.501, p = 0.001, respectively). In contrast, lens thickness in the ACG group was not correlated with the RC but was positively correlated with the ARC (r = 0.331, p = 0.032). CONCLUSIONS: In contrast with the anterior chamber depth, preoperatively measured lens thickness may be a useful predictor of the direction of the RC after cataract surgery in control and OAG patients. However, in ACG patients, a thicker lens was correlated with a larger RC, regardless of the direction of the shift (hyperopic or myopic).
Aged ; Anterior Chamber/*diagnostic imaging ; Biometry/*methods ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/*complications/diagnosis/surgery ; Glaucoma, Open-Angle/*complications/diagnosis/surgery ; Humans ; *Intraocular Pressure ; Male ; Middle Aged ; *Phacoemulsification ; Refraction, Ocular/*physiology ; Retrospective Studies ; Tomography, Optical Coherence

OBJECTIVETo evaluate the efficacy and safety of phacoemulsification with foldable posterior chamber intraocular lens(PC-IOL) implantation in the management of acute or chronic primary angle-closure glaucoma(APACG or CPACG) with cataract.

METHODSTwenty-six cases(28 eyes) with simple cataract and 60 cases(70 eyes)of PACG with cataract, including 14 eyes of preclinical APACG, 29 eyes of paroxysmal APACG, 27 eyes of CPACG. Visual acuity distributed from hand movement to 0.8. Phacoemulsification and intraocular lens implantation were performed and patients were followed up for(8.5+/-4.5) months.

RESULTIn simple cataract group, postoperative IOP did not decrease(t=1.9201, P>0.05); in preclinical APACG group, postoperative IOP decreased (t=3.9910, P<0.01); in paroxysmal APACG group, postoperative IOP decreased (t=4.7441, P<0.01); in CPACG groups, postoperative IOP decreased (t=4.4976, P<0.01). In APACG and CPACG groups postoperative antiglaucoma medication reduced. In APACG and CPACG groups, angle of anterior chamber was widen. Preoperative central and peripheral ACD of APACG and CPACG were much less than those of postoperative. In 56 eyes of PACG, visual acuity was corrected in 48 eyes(85.7%) including 28 eyes(50%) with corrected visual acuity>0.5.

CONCLUSIONThe phacoemulsification with foldable posterior chamber intraocular lens implantation is beneficial for PACG with cataract, and the curative efficacy of APACG is better than that of CPACG.

Aged ; Cataract ; complications ; Cataract Extraction ; Female ; Glaucoma, Angle-Closure ; complications ; surgery ; Humans ; Lens Implantation, Intraocular ; methods ; Male ; Middle Aged ; Phacoemulsification ; Treatment Outcome ; Visual Acuity

PURPOSE: To report a case of acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment. METHODS: An 81-year-old woman visited our emergency room for severe ocular pain and vision loss in her left eye. Her intraocular pressures (IOPs) were 14 mmHg in the right eye and 58 mmHg in the left eye. Her visual acuity was 0.4 in the right eye but she had no light perception in the left eye. The left anterior chamber depth was shallow and gonioscopy of the left eye showed a closed angle. In comparison, the right anterior chamber depth was normal and showed a wide, open angle. Computed tomography and ultrasonography demonstrated retinal detachment due to subretinal hemorrhage. After systemic and topical antiglaucoma medications failed to relieve her intractable severe ocular pain, she underwent enucleation. RESULTS: The ocular pathology specimen showed that a large subretinal hemorrhage caused retinal detachment and pushed displaced the lens-iris diaphragm, resulting in secondary angle-closure glaucoma. CONCLUSIONS: Prolonged anticoagulant therapy may cause hemorrhagic retinal detachment and secondary angle-closure glaucoma. If medical therapy fails to relieve pain or if there is suspicion of an intraocular tumor, enucleation should be considered as a therapeutic option.
Tomography, X-Ray Computed ; Retinal Hemorrhage/*complications/pathology/radiography ; Retinal Detachment/*etiology/pathology/radiography ; Humans ; Glaucoma, Angle-Closure/*etiology/surgery ; Female ; Eye Enucleation ; Aged, 80 and over ; Acute Disease

BACKGROUNDTrabeculectomy has become a mainstream treatment in intraocular pressure (IOP) reduction for primary angle-closure glaucoma (PACG); combined trabeculectomy and cataract surgery was reported to reduce IOP and simultaneously improve vision for patients with PACG and coexisting cataract. This study was specialized to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy only in the treatment of PACG with coexisting cataract.

METHODSThis is a comparative case series study. Thirty-one patients (31 eyes) with PACG and coexisting cataract were enrolled. Of these, 17 underwent phacotrabeculectomy and 14 underwent trabeculectomy alone. IOP, filtering blebs, and complications were compared at the final follow-up. Complete success was defined as a final IOP less than 21 mmHg without IOP-lowering medication.

RESULTSAfter 10 months of postoperative follow-up, the phacotrabeculectomy and trabeculectomy groups showed no significant differences regarding IOP reduction ((20.59 ± 7.94) vs. (24.85 ± 14.39) mmHg, P = 0.614), complete success rate (88% vs. 71%, P = 0.370), formation rate of functioning blebs (65% (11/17) vs. 93% (13/14), P = 0.094), and complications (41% (7/17) vs. 57% (8/14), P = 0.380). IOP-lowering medication was not required for most of the patients in both groups. Additional surgery interventions, including anterior chamber reformation and phacoemulsification, were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group.

CONCLUSIONPhacotrabeculectomy and trabeculectomy treatments exhibit similar IOP reduction, successful rates, and complications when it comes to treating PACG patients with coexisting cataract, although additional surgery intervention may be needed for a few cases with cataract and complications after trabeculectomy.

Aged ; Cataract Extraction ; Female ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Phacoemulsification ; adverse effects ; methods ; Postoperative Complications ; etiology ; Trabeculectomy ; adverse effects ; methods ; Visual Acuity

INTRODUCTIONPrimary angle-closure glaucoma (PACG) is a major cause of blindness among Asians. A better understanding of the disease will improve the treatment and outcome of this condition.

METHODSA literature review of all recent publications on PACG was carried out. Articles were retrieved using a key word search of MEDLINE, PubMed and Science Citation Index databases.

RESULTSFollowing laser peripheral iritodomy for acute angle-closure, Asians were found to have a higher tendency to develop a subsequent rise in intraocular pressure compared to Caucasians. Furthermore, the extent and severity of visual field damage was more severe in Asians than Caucasians, particularly in eyes that presented insidiously with chronic PACG. Prophylactic laser iridotomy in the contralateral eye was found to be highly effective in preventing acute angle-closure attacks.

CONCLUSIONPACG is more difficult to manage and is associated with more severe long-term visual morbidity in Asians than Caucasians. Regular follow-up of patients with PACG is important for the early detection of progression of the disease and visual field deterioration.

Asian Continental Ancestry Group ; European Continental Ancestry Group ; Glaucoma, Angle-Closure ; complications ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Iridectomy ; adverse effects ; Ocular Hypertension ; etiology ; Visual Fields

OBJECTIVETo evaluate the efficacy of "straight scleral tunnel incision" -trabeculectomy with a releasable suture supplemented with mitomycin C (MMC) on reducing intraocular pressure (IOP), complications, and corneal astigmatism in patients with primary angle-closure glaucoma (PACG).

METHODSTotally 217 acute or chronic PACG patients with occludable angle above 180 degrees and IOP above 21 mm Hg were divided into 3 groups. Patients in group A (98 cases, 128 eyes), B (71 cases, 95 eyes), and C (48 cases, 60 eyes) were treated with "straight scleral tunnel incision"-trabeculectomy with a releasable suture supplemented with MMC, releasable suture trabeculectomy with MMC, and trabeculectomy with MMC, respectively. IOP, complications, and surgically induced astigmatism (SIA) were evaluated preoperatively and up to 12 months postoperatively.

RESULTSIOP of 2 weeks after treatment was significantly lower than preoperative IOP in all the 3 groups (all P <0. 001). Success rates (IOP < or = 20 mm Hg) in group A, B, and C were 87.91%, 89.23%, and 83.72% respectively at 12 months after treatment (P = 0.256). The incidence of shallow anterior chamber and hypotony had no significant difference between group A and B, but both of them were lower than that in group C (P < 0.05). There were no significant differences in preoperative corneal astigmatism among the 3 groups. The corneal astigmatism after 2 weeks in group A (1.71 +/- 1.47D) was higher than that before operation (1.28 +/- 1.05D, P = 0.126). With 12 months gone, the astigmatism almost returned to preoperative levels. The corneal astigmatisms after 2 weeks in group B and C (1.99 +/- 1.20D and 2. 22 +/- 1.39D) were significantly higher than those before operation (1.20 +/- 0.85D and 1.18 +/- 0.93D, P = 0.002, P = 0.001), respectively. With 12 months gone, the mean astigmatisms in group B and C (1.87 +/- 0.91D and 1.90 +/- 1.16D) were still significantly higher than those before operation (P = 0.001, P = 0.003). The highest astigmatic polar values in group A, B, and C (1.00D, 1. 89D, and 1. 77D) occurred after 2 weeks, 1 month, and 1 month postoperation, respectively, which were significantly higher than those before operation (0.19 +/- 1.32D, 0.12 +/- 1.22D, and 0.17 +/- 1.25D, P < 0.01), respectively. With 12 months gone, they were 0. 03D, -0. 18D, and -0. 13D higher than those before operation, respectively. The rates of function bleb and thin-wall bleb were 71.43% and 26.37% in group A, 75.38% and 29.23% in group B, 72.09% and 25.58% in group C, respectively at 12 months after treatment There were no significant differences among the 3 groups.

CONCLUSION"Straight scleral tunnel incision" -trabeculectomy with a releasable suture supplemented with MMC can reduce complications and get satisfactory results in reducing IOP and SIA.

Aged ; Astigmatism ; etiology ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Mitomycin ; administration & dosage ; Postoperative Complications ; Sclera ; surgery ; Surgical Flaps ; Suture Techniques ; Trabeculectomy ; adverse effects ; methods

To determine the effect of apraclonidine hydrochloride on the acute intraocular pressure (IOP) rise after argon laser iridotomy (ALI), a double-masked comparative study was carried out. Twenty-nine eyes (20 patients) with angle-closure glaucoma underwent ALI. Eighteen eyes were treated with apraclonidine, and the remainder received a placebo 1 hour before and immediately after ALI. The mean IOP increase in the apraclonidine group was lower than that in the placebo group at each postlaser interval (p < 0.01). Although the average value of the maximal increases of IOP after ALI in the apraclonidine group was 4 mmHg, that in the placebo group was 16 mmHg. In the placebo group, 27.3% (3 out of 11 eyes) experienced an IOP rise > or = 10 mmHg. However, that kind of IOP rise was not found in the apraclonidine group (0 out of 18 eyes) (p < 0.01). Ocular or systemic side effects were not found in a series of examinations in both groups. Therefore, apraclonidine proved to be effective in lowering the IOP rise after ALI.
Acute Disease ; Adrenergic alpha-Agonists/*pharmacology ; Adult ; Aged ; Clonidine/*analogs & derivatives/therapeutic use ; Double-Blind Method ; Female ; Glaucoma, Angle-Closure/drug therapy/*surgery ; Humans ; Intraocular Pressure/*drug effects ; Iris/drug effects/*surgery ; *Laser Therapy ; Male ; Middle Aged ; Postoperative Complications/prevention & control ; Prospective Studies