PURPOSE: To compare the clinical and anterior segment anatomical features in primary angle closure sub-groups based on configurations of iris root insertion. METHODS: Primary angle closure patients were imaged using anterior segment optical coherence tomography. Anterior chamber depth, iris curvature, iris thickness (IT) at the scleral spur and 500, 750, and 1,500 µm from the scleral spur (IT(0), IT(500), IT(750), and IT(1500)), lens vault, iris area, angle opening distance (AOD(500)), angle recess area (ARA(750)), and trabecular iris space area (TISA(750)) were measured. Iris root insertion was categorized into a non-basal insertion group (NBG) and basal insertion group (BG). RESULTS: In total, 43 eyes of 39 participants belonged to the NBG and 89 eyes of 53 participants to the BG. The mean age of participants was greater in the NBG than the BG (62.7 ± 5.7 vs. 59.8 ± 7.3 years, p = 0.043), and the baseline intraocular pressure was higher in the BG than the NBG (16.4 ± 4.4 vs. 14.9 ± 3.3 mmHg, p = 0.037). The BG showed a greater IT(0) (0.265 ± 0.04 vs. 0.214 ± 0.03 mm, p < 0.001) and iris area (1.59 ± 0.24 vs. 1.52 ± 0.27 mm2, p = 0.045), lower ARA(750) (0.112 ± 0.08 vs. 0.154 ± 0.08 mm2, p = 0.017) and AOD(500) (0.165 ± 0.07 vs. 0.202 ± 0.08 mm, p = 0.014) compared to the NBG. CONCLUSIONS: The BG had a narrower anterior chamber angle, thicker peripheral iris, and higher pretreatment intraocular pressure.
Anterior Eye Segment/*diagnostic imaging ; Female ; Glaucoma, Angle-Closure/diagnosis/physiopathology/*surgery ; Gonioscopy ; Humans ; *Intraocular Pressure ; Iridectomy/*methods ; Iris/diagnostic imaging/*surgery ; Lens, Crystalline/diagnostic imaging ; Male ; Middle Aged ; Prospective Studies ; Tomography, Optical Coherence/*methods

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

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 explore the risk factors, the ciliary body anatomy structures, the therapeutic methods and the prognosis for malignant glaucoma through retrospectively collecting the clinical data from primary angle-closure glaucoma (PACG) patients. METHODS: Clinical data in 1183 patients (1456 eyes) with PACG were collected between July, 2010 and May, 2014 from Xiangya Hospital, Central South University. Thirty patients (38 eyes) were diagnosed as malignant glaucoma. According to symptom, these patients were divided into a PACG group (1418 eyes) and a malignant glaucoma group (38 eyes); according to age, they were divided into a 3-40 years old group (171 eyes), a 41-70 years old group (1016 eyes) and a ≥71 years old group (269 eyes); according to therapeutic methods, they were divided into a drug therapy group (5 eyes), a lens extraction group (6 eyes) and a vitrectomy surgery group (27 eyes); according to the different method of surgery, they were divided into a vitrectomy group (27 eyes), a nonvitrectomy group (11 eyes). The age, sex, anterior chamber depth (ACD), axial length (AL), lens thickness (LT), visual acuity, intraocular pressure, therapeutic methods and surgery history were recorded. Meanwhile, the ciliary body thickness (CBT), trabecular ciliary process angle (TCA) and lens diameter were measured by ultrsound biomicroscopy (UBM). RESULTS: Male and female ratio was 1:2 in the malignant glaucoma group. The average age [(51.87±12.92) years] in the malignant glaucoma group was less than that in the PACG group [(57.87±8.78) years](P<0.05). Malignant glaucoma was more likely to occur in the first 3 months after PACG trabeculectomy with a rate of 85.7%. The LT [(4.33±0.67) mm], AL[(21.44±1.18) mm] and ACD [(2.12±0.41) mm] in the malignant glaucoma group were less than those in the PACG group [(4.81±0.50), (22.17±0.97) and (2.49±0.48) mm, respectively](all P<0.05). The CBT0, CBT1, CBTmax, TCA and lens diameter in the malignant glaucoma group were less than those in the PACG group (all P<0.05). CONCLUSION Female PACG patients, with short axial length, shallow anterior chamber, thin lens, thin ciliary body, small trabecular ciliary process angle and short lens diameter, are more likely to suffer from malignant glaucoma. Vitrectomy can significantly reduce intraocular pressure.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Ciliary Body ; anatomy & histology ; Female ; Glaucoma, Angle-Closure ; drug therapy ; surgery ; Humans ; Intraocular Pressure ; Lens, Crystalline ; anatomy & histology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Tonometry, Ocular ; Trabeculectomy ; Visual Acuity ; Vitrectomy ; Young Adult

No abstract available.
Adult ; Female ; Glaucoma, Angle-Closure/*surgery ; Humans ; Intraocular Pressure/physiology ; *Iridectomy ; Iris/*surgery ; Laser Therapy/*methods ; Lens, Crystalline/*physiology ; Middle Aged ; Suture Techniques ; Tonometry, Ocular ; Viscosupplements/administration & dosage

BACKGROUNDArgon laser peripheral iridoplasty (ALPI) is proved to be effective in lowering intraocular pressure (IOP) of patients with mild acute primary angle closure (APAC). It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC. This study aimed to evaluate the IOP-lowering efficacy of ALPI and laser peripheral iridotomy (LPI) on patients with refractory APAC, who have previously responded poorly to intensive medical therapy.

METHODSThirty-six patients (8 men and 28 women) were identified as medically refractory APAC, who still had ocular pain, red eye, hazy cornea, closed anterior chamber (AC) angle, and IOP of not less than 21 mmHg after two days or more of anti-glaucoma medication. All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity (VA), best corrected VA (BCVA), IOP, biomicroscopy, and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes.

RESULTSAll patients were affected unilaterally, with average age of (54.6 ± 11.7) (range, 37.0 - 75.0) years old. The mean IOP value of the affected eyes dropped from (31.6 ± 7.7) (range, 21.0 - 39.0) mmHg at enrollment to (18.4 ± 8.7) (range, 10.0 - 27.0) mmHg 2 hours after ALPI. At follow-up day 7, the mean IOP value maintained at (14.8 ± 4.2) (range, 9.0 - 21.0) mmHg, which was significantly different (P = 0.000) compared with baseline. The average decrease of IOP in the APAC eyes was (16.8 ± 7.4) (range, 12.0 - 21.0) mmHg. At follow-up three years later, the mean IOP of the APAC eyes stabilized at (16.3 ± 3.2) (range, 9.0 - 20.0) mmHg with at least 180° of AC angle opened.

CONCLUSIONALPI and LPI lower the IOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.

Adult ; Aged ; Female ; Glaucoma, Angle-Closure ; physiopathology ; surgery ; Humans ; Intraocular Pressure ; Iridectomy ; methods ; Iris ; surgery ; Laser Therapy ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo evaluate the early therapeutic effect of endoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation for management of primary angle-closure glaucoma.

METHODSEndoscope-assisted goniosynechialysis combined with phacoemulsification and intraocular lens implantation was performed in 31 patients (31 eyes) with primary angle-closure glaucoma, including 17 eyes with acute angle closure glaucoma and 14 eyes with chronic angle closure glaucoma. The patients were regularly followed up to observe the postoperative complications and changes in the intraocular pressure, visual acuity, anterior chamber depth and anterior chamber angle.

RESULTSHyphema occurred in 3 eyes after the operation and was absorbed gradually. The intraocular pressure decreased significantly in all the patients after the operation (P<0.05) but showed no significant differences between the acute and chronic cases (P>0.05). The intraocular pressure was over 21 mmHg in only one eye in the chronic group, and could be controlled by ocular hypotensive agents. Visual acuity improved and the anterior chamber depth increased in all the patients, showing no significant differences between the two groups (P>0.05). The anterior chamber angle all opened after the operation in 16 eyes (94.1%) in acute group, a rate significantly higher than that in the chronic group (9 eyes, 64.3%) (P<0.05). Anterior chamber angle was adhesive in 1 eye in the acute group and in 5 eyes in the chronic group. No further extension of goniosynechiae was found in these cases during the follow-up period.

CONCLUSIONSEndoscope-assisted goniosynechialysis has such advantages as optimized visualization, accuracy and safety in the management of primary angle-closure glaucoma.

Aged ; Endoscopy ; Female ; Glaucoma, Angle-Closure ; surgery ; Humans ; Lens Implantation, Intraocular ; Male ; Middle Aged ; Phacoemulsification ; Treatment Outcome

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

PURPOSE: To evaluate changes in anterior chamber depth (ACD) and angle width induced by phacoemulsification and intraocular lens (IOL) implantation in eyes with glaucoma, using anterior segment optical coherence tomography (AS-OCT). METHODS: Eleven eyes of 11 patients with angle-closure glaucoma (ACG) and 12 eyes of 12 patients with open-angle glaucoma (OAG) underwent phacoemulsification and IOL implantation. Using AS-OCT, ACD and angle parameters were measured before and 2 days after surgery. Change in intraocular pressure (IOP) and number of ocular hypotensive drugs were evaluated. RESULTS: After surgery, central ACD and angle parameters increased significantly in eyes with glaucoma (p < 0.05). Prior to surgery, mean central ACD in the ACG group was approximately 1.0 mm smaller than that in the OAG group (p < 0.001). Post surgery, mean ACD of the ACG group was still significantly smaller than that of the OAG group. No significant differences were found in angle parameters between the ACG and OAG groups. In the ACG group, postoperative IOP at the final visit was significantly lower than preoperative IOP (p = 0.018) and there was no significant change in the number of ocular hypotensive medications used, although clinically, patients required fewer medications. In the OAG group, the IOP and number of ocular hypotensive drugs were almost unchanged after surgery. CONCLUSIONS: The ACD and angle width in eyes with glaucoma increased significantly after phacoemulsification and IOL implantation. Postoperative ACD significantly differed between the ACG and OAG groups, whereas angle parameters did not differ.
Aged ; Aged, 80 and over ; Anterior Chamber/anatomy & histology/*surgery ; Female ; Glaucoma, Angle-Closure/drug therapy/pathology/*surgery ; Glaucoma, Open-Angle/drug therapy/pathology/*surgery ; Humans ; Intraocular Pressure ; Lens Implantation, Intraocular/*adverse effects ; Male ; Middle Aged ; Phacoemulsification/*adverse effects ; Postoperative Period ; Preoperative Period ; Tomography, Optical Coherence