New understandings of the pathogenesis of primary angle-closure glaucoma / 中华实验眼科杂志

Primary angle-closure glaucoma (PACG) is still one of the common blinding eye diseases in China.Because of the irreversibility of the vision loss it caused, the factors affecting the early development of glaucoma are of great concern.The understanding of static anatomic structure of high-risk anterior segment, such as shallow anterior chamber, short axial length, thick iris and large anterior lens cannot fully explain the transformation process of PACG, so the specific role of dynamic changes in the development of glaucoma should be further considered.This article expounded the differences in iris volume and dynamic process of elasticity between normal people and patients with PACG, the incoordination between lens and intraocular structure during eyeball development, the dynamic block and expansion of ciliary body, vitreous and choroid, and the latest research on the relationship between the abnormal ocular nerve and vascular system adjustment and change with the onset of PACG, in order to provide guidance for understanding the pathogenesis of PACG, accurate clinical diagnosis and formulation of treatment strategies.

Lowering of intraocular pressure after phacoemulsification in primary open-angle and angle-closure glaucoma: Correlation with lens thickness

Purpose: To assess anterior chamber configuration changes during phacoemulsification in primary angle?closure suspect (PACS/PAC) and primary open?angle glaucoma (POAG). Methods: Prospective observational comparative study of anterior segment optical coherence tomography (AS?OCT) findings before and after phacoemulsification on three groups of patients (PACS/PAC, POAG, and controls). Data were collected over a period of 9 months. Main outcome measures included mean change in anterior chamber depth (ACD), angle opening distance (AOD), and trabecular iris space area (TISA). Results: 153 patients (51 PACS/PAC, 51 POAG, and 51 controls) were included in the study. Change in all parameters (ACD, AOD at 500 um, and AOD at 750 um) between the groups demonstrated a greater change in PACS/PAC as compared to POAG and controls. AOD at 750 ?m in the temporal quadrant, which has been considered to be having the highest correlation or best representation of the angle, increased in all groups after phacoemulsification (463.59 ± 10.99 vs. 656.27 ± 9.73 mm in PACS; 521.29 ± 16.36 vs. 674.37 ± 8.72 mm in POAG; 549.27 ± 12.40 vs. 702.82 ± 13.04 mm in controls, (P < 0.001). After phacoemulsification, intraocular pressure (IOP) decreased by 2.75 ± 1.17 mm Hg in PACS/PAC (P < 0.001), 2.14 ± 1.33 mm Hg in POAG and 1.90 ± 1.25 mm Hg in controls and it was statistically significant in the PACS group compared to control (P < 0.001). Conclusion: Phacoemulsification with intraocular lens implantation is associated with increase in the ACD and angle parameters and a corresponding decrease in IOP. Findings were more pronounced in PACS/PAC suggesting early phacoemulsification may be a treatment option in this group

Efficacy of laser peripheral iridotomy for different type of primary angle closure suspect based on UBM / 局解手术学杂志

Objective This thesis is aimed to compare and analyze the effectiveness of laser peripheral iridotomy ( LPI) in treating pu-pillary block primary angle-closure suspect ( PACS) and multimechanism PACS in eyes .Methods A total of 85 eyes of 75 patients with PACS in ophthalmology department of Daping hospital affiliated to army medical university were divided by using ultrasound biomicroscopy (UBM) into two groups:pupillary block PACS group(36 eyes) and multimechanism PACS group(49 eyes).All patients received LPI treat-ment,and the images of anterior chamber angle were collected by anterior segment optical coherence tomography (AS-OCT) at the time of be-fore,1 week and 3 months after treatment.Then,the parameter values (AOD500,AOD750,TISA500,TISA750,ACV,ACD,ACW,CCT)of an-terior chamber in AS-OCT images were recorded .Results Comparing to the parameter values before treatment ,AOD500,AOD750,TISA500, TISA750,ACV and ACD significantly increased at the time of 1 week and 3 months after LPI in both groups(P<0.05),while ACW or CCT remain unchanged(P>0.05).Moreover,the increasement in AOD500,AOD750,TISA500 and TISA750 in pupillary block group was more significant than that in multimechanism group 1 week and 3 months after treatment(P<0.05).The differences of AOD500,AOD750,TI-SA500 and TISA750 between pre-operation and post-operation(1 week and 3 months after treatment) in pupillary block group were more sig-nificantly increased than those in multimechanism group (P<0.05).Conclusion LPI can significantly increase the angle width in PACS , which is more effective for pupillary block group than multimechanism group .

Evaluation of the change of anterior chamber parameters before and after laser peripheral iridectomy in primary angle -closure suspetive with Pentacam anterior segment analysis system / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM:To investigate the sensitive parameters of the anterior chamber changes with Pentacam anterior segment analysis system before and after laser peripheral iridectomy (LPl) in primary angle-closure suspetive (PACS). ? METHODS: Sixty eyes of 33 PACS patients were enrolled in this study. Pentacam examination was performed before and 1d after LPl to measure the central anterior chamber depth ( CACD ) , the peripheral anterior chamber depth ( PACD ) , the anterior chamber volume ( ACV) and the peripheral anterior chamber angle ( ACA) . Statistical analysis used paired t test. ?RESULTS: There was no statistical significance on the changes of ACD. PACD and ACV increased significantly between before and 1d after LPl. ACA was widened from (22. 26o±5. 18o) to (26. 42o±5. 20o), which were increased significantly between before and 1d after LPl. ?CONCLUSlON: LPl can deepen the PACD and increase the ACV in PACS. PACD and ACV are the sensitive parameters of the anterior chamber changes with Pentacam anterior segment analysis system.

Management of angle closure glaucoma.

Primary angle closure glaucoma (PACG) is equally prevalent in Indian in Asian population as the primary open angle glaucoma. Eighty-six percent of people with PACG are in Asia, with approximately 48.0% in China, 23.9% in India and 14.1% in southeast Asia. To understand PACG, it is mandatory to understand its classification and type of presentation with the underlying pathophysiology. The treatment options are medical, laser and/or surgical. The present article provides an overview of PACG.

Laser Peripheral Iridotomy with Iridoplasty in Primary Angle Closure Suspect: Anterior Chamber Analysis by Pentacam

PURPOSE: To compare conventional laser peripheral iridotomy (LPI) and LPI combined with laser peripheral iridoplasty in eyes with primary angle closure suspect (PACS) by assessment of anterior chamber dimensional changes using a Pentacam. METHODS: Forty-eight eyes of 24 subjects with bilateral PACS were recruited consecutively. Each eye was randomly allocated to treatment with conventional LPI, argon LPI only, or LPI plus iridoplasty, which consisted of simultaneous argon LPI and peripheral iridoplasty. Anterior chamber measurements were performed on each eye using a Pentacam, both before and after treatment. Mean anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle were measured, and topographic ACD analysis was performed. Results were compared between the two treatment groups. RESULTS: After treatment with either conventional LPI or LPI plus iridoplasty, the mean ACD and ACV increased significantly. Topographic ACD analysis revealed that the mid-to-peripheral ACD increase was significantly greater in the LPI plus iridoplasty group than in eyes treated with conventional LPI. Intraocular pressure changes and post-LPI complications did not differ between the groups. CONCLUSIONS: Compared with conventional LPI, our study showed that LPI plus iridoplasty improved the mid-to-peripheral ACD increase. This procedure may have a role as an adjunct for reducing angle closure by simultaneously eliminating pupillary and non-pupillary block components.

Profile of angle closure in a tertiary care center in north India.

Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC) were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434) were diagnosed to have various subtypes of angle closure. Mean (±SD) age at presentation was significantly higher for males (57.57 ± 11.62 years) as compared to females (53.64 ± 10.67 years) (P < 0001). Primary angle closure glaucoma (PACG) was most frequently diagnosed subtype (49.38%) followed by Primary angle closure (PAC) (39.68%) and Primary angle closure suspect (PACS) (10.93%) respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < 0001 using Greenhouse-Geisser correction). Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical) done.