Clinical features and treatment of glaucoma secondary to familial exudative vitreoretinopathy / 中华眼底病杂志

Objective:To investigate the etiology, clinical features and treatment of familial exudative vitreoretinopathy (FEVR) secondary glaucoma.Methods:A retrospective clinical study. From January 1, 2016 to January 1, 2022, 15 patients (17 eyes) were diagnosed with FEVR secondary glaucoma in Beijing Tongren Hospital, Capital Medical University were included in the study. All patients underwent systematic ophthalmological evaluation. According to the patient's age, visual acuity, intraocular pressure, anterior segment, vitreous body and retina condition, the choice of translimbal lensectomy combined with vitrectomy, goniectomy, cyclophotocoagulation, intravitreal injection of anti-vascular endothelial growth factor (VEGF) treatment were chosen. The follow-up time was 3 to 37 months. The clinical characteristics of the affected eye, and the changes of intraocular pressure, anterior chamber depth and complications after surgery were observed.Results:Among the 15 patients, there were 11 males with 13 eyes, and 4 females with 4 eyes. Age was 6.14±7.37 years old. FEVR stages 2B, 3B, 4A, 4B, 5A, and 5B were 1, 1, 5, 6, 3, and 1 eye, respectively. The intraocular pressure of the affected eye was 42.74±9.06 mm Hg (1 mm Hg=0.133 kPa). All eyes had shallow anterior chamber and angle closure, anterior or posterior iris adhesions, lens opacity, retinal detachment, iris neovascularization in 4 eyes, and vitreous hemorrhage in 2 eyes. Sixteen eyes were treated with translimbal lensectomy combined with vitrectomy and goniotomy, of which 8 eyes were treated with anti-VEGF treatment; 1 eye was treated with cyclophotocoagulation combined with anti-VEGF treatment. After operation, the intraocular pressure of 16 eyes returned to normal range, and the depth of anterior chamber of 16 eyes returned to normal, and no obvious complications occurred.Conclusions:The main etiology of secondary glaucoma in FEVR is the structural and functional abnormalities of the anterior chamber and angle, which are found in the 2B and above stages of FEVR. The lensectomy and vitrectomy via limbal approach can effectively control the intraocular pressure and restore the anterior chamber, with no serious complications.

Research progress of Posner-Schlossman syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

Posner-Schlossman syndrome(PSS)is a sporadic and recurrent self-limiting anterior uveitis, and its pathogenesis remains unclear. It was considered to be a prostaglandin-mediated inflammatory response. In recent years, it has been found to be related to viral infection, immune genetics, vascular endothelial dysfunction, and other factors. Clinically, the disease is predominantly unilateral. The patients with PSS suffer from increased intraocular pressure, mild pain in the affected eye, as well as blurred vision, and irisopsia. Seldom damage to the optic nerve and visual field was reported. The commonly treatment of PSS is local medication, such as anti-inflammatory drugs and intraocular pressure lowering drugs; otherwise systemic medication can be employed in severe cases. Surgical treatment can be performed for PSS if uncontrolled intraocular pressure elevation, frequent attacks, and optic nerve damage and visual field defect due to prolonged disease course. Early diagnosis and treatment of PSS can effectively reduce glaucoma-related damages. This review discussed the research progress of PSS from various aspects, aiming to provide references for the etiology, pathogenesis, and clinical diagnosis and treatment of this disease.

Gonioscopy-assisted transluminal trabeculotomy for secondary high intraocular pressure after vitrectomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of gonioscopy-assisted transluminal trabeculotomy(GATT)for secondary high intraocular pressure after vitrectomy.METHODS: A retrospective study was conducted on 10 patients(15 eyes)with secondary high intraocular pressure(IOP)after vitrectomy treated with GATT in Department of Ophthalmology, Chengdu First People's Hospital from January 2019 to May 2022. The best-corrected visual acuity(BCVA), IOP, number of IOP-lowering drugs, and complications before operation and at 1d, 1wk, 1, 3 and 6mo after operation were recorded, and the surgical success rate was analyzed.RESULTS:There was no difference in BCVA before and 6mo after operation(Z=0, P=1). The mean IOP decreased from 28.33±9.48mmHg to 17.47±3.78(1d), 18.8±3.29(1wk), 19.13±3.62(1mo), 20.31±3.66(3mo)and 18.03±3.23mmHg(6mo; all P<0.05). The average medication used before surgery was 2(2, 4), and the average medication used 6mo after surgery was 1(0, 2), which was significantly decreased(P<0.001). The total success rate of surgery at 1d, 1wk, 1, 3 and 6mo after surgery was 87%(13 eyes), 93%(14 eyes), 87%(13 eyes), 73%(11 eyes)and 93%(14 eyes)respectively. The main postoperative complications were transient hyphema(10 eyes, 67%)and transient elevated IOP(5 eyes, 33%). No complications seriously affecting the vision occurred.CONCLUSION: GATT is safe and effective in the treatment of secondary high intraocular pressure after vitrectomy.

Objectively measuring anterior segment alterations in the eyes of mucopolysaccharidoses: Its utility in early diagnosis of glaucoma

Purpose: Our study aimed to evaluate the utility of the anterior segment morphometry for objectively assessing anterior segment architectural changes of corneal clouding in the mucopolysaccharidoses (MPS) cohort and to investigate whether these measurements correlate with the slit?lamp findings on the cornea and early diagnosis of glaucoma. Methods: This retrospective study involved 70 eyes of 35 children with cloudy cornea due to MPS variants. Anterior segment architectural alterations were measured using anterior segment imaging and biometry in MPS children and compared with controls. Results: Mean age of the cohort at the time of assessment was 7.9 ± 4.5 years. Males constituted two?thirds of the cohort. Variants of MPS with cloudy cornea were as follows: Type I (62%), Type IV (11%), and Type VI (22%). Morphometric measurements were available in 22 eyes of 11 MPS children and an age?matched healthy control group. There were significant differences between MPS cohort and controls in refraction in Diopters (5.03 ± 0.39 and 0.01 ± 0.04; P < 0.0001), axial length (AXL) in mm (21.39 ± 0.28 and 23.04 ± 0.28; P = 0.0002), average keratometry in Diopters (40.67 ± 0.44 and 42.83 ± 0.44; P < 0.0001), anterior chamber depth (ACD) in mm (2.92 ± 0.07 and 3.65 ± 0.07; P < 0.0001), and intraocular pressure (IOP) in mmHg (25.2 ± 2.0 and 14.1 ± 2.3; P = 0.0003). Secondary glaucoma was observed in 28% of the MPS cohort. Conclusion: The anterior segment morphometry in the cloudy cornea due to MPS provides an objective measurement of anterior segment architectural changes, thus diagnosing early?onset secondary glaucoma. These findings highlight that cloudy cornea due to MPS variants merits close monitoring throughout life

A comparative analysis of surgical outcome in uveitic and non-uveitic steroid–induced glaucoma in children

Purpose: To compare outcomes of surgical management of uveitic glaucoma (UG) and steroid?induced glaucoma (SIG) in children in terms of intraocular pressure (IOP) control, visual acuity, and associations for failure. Methods: This was a retrospective case–control study of consecutive UG (cases) and non?uveitic SIG (controls) in children <18 years of age who underwent surgery between January 2005 and December 2017. Results: Primary trabeculectomy with mitomycin C (MMC) was performed in 12 cases (mean age: 9.2 ± 4.3 years) and 40 controls (mean age: 10.4 ± 3.7 years) (P = 0.33). Primary phaco?trabeculectomy with MMC was performed in 11 cases (mean age: 11.4 ± 4.7 years) and 16 controls (mean age: 10.4 ± 3.4 years) (P = 0.57). IOP control (P = 0.26), visual acuity (P = 0.97), number of glaucoma medications (P = 0.06), and survival rates (49% cases vs. 68% controls at 5 years; P = 0.22) were similar between the two groups following trabeculectomy. Survival rates in the phaco?trabeculectomy group at 5 years were 68% cases vs. 69% controls (P = 0.71). IOP was higher (P = 0.008) and visual acuity was worse (P = 0.02) in cases at the last visit. Associations for failure (univariate analysis) were younger age (OR: 6.29, 95% CL: 1.43, 27.67; P = 0.03) and male gender (OR: 4.79, 95% CL: 1.09, 20.97; P = 0.04). On multivariate analysis, younger age (OR: 11.985, 95% CL: 1.071, 134.153; P = 0.04) remained significant. Preoperative number of uveitic attacks was protective on univariate (OR: 0.75, 95% CL: 0.48, 1.15; P = 0.1) and multivariate analyses (OR: 0.49, 95% CL: 0.24, 0.09; P = 0.04). Conclusion: Outcomes of trabeculectomy between cases and controls were similar in our series. However, phaco?trabeculectomy in pediatric uveitic eye group fared worse than eyes with SIG.

Intracameral vent and flush technique for silicone oil blockade in Ahmed glaucoma valve

The presence of emulsified silicone oil in the eye can lead to many complications, glaucoma being one of the most common. Adequate IOP control is difficult to achieve with medical management alone; surgical intervention is often required. Glaucoma drainage device implantation is often the preferred line of surgical intervention in such cases due to trabeculectomy failure from emulsified silicone oil droplets and associated conjunctival scarring. However, the silicone tube of Ahmed glaucoma valve (AGV) may attract the silicone oil droplets, causing blockade of the tube with persistent raised IOP postoperatively. We report one such case where post?AGV silicone oil tube occlusion was treated with semi?conservative surgical management instead of revising the entire surgery or implantation of another drainage device. Our surgical technique of intracameral “vent and flush” offers rapid and effective IOP control in such cases. Postoperatively, normal IOP was achieved. Patency of tube continued to be maintained along with normalization of IOP on subsequent follow?ups.

Axenfeld-Rieger Syndrome: Case Report

Aims:To describe a Axenfeld-Rieger Syndrome.Presentation of Case: MCL, 7 years old, female, brown, was taken to the ophthalmology outpatient clinic of the Hospital Universit醨io Ant鬾io Pedro, Brazil by her parents, complaining of low visual acuity and malformation of the pupil perceived since birth.Discussion: Axenfeld-Rieger Syndrome is a rare and hereditary disease. Clinically, Axenfeld's anomaly is characterized by the presence of posterior embryotoxon, and there may be adherence of iridian tissue in its periphery. In addition to Rieger's anomaly, posterior embryotoxon is added to iris hypoplasia and iris thickness defects, uveal ectropion and pupillary alterations, such as corectopia. Rieger's syndrome is associated with extraocular changes, of which hypodontia, myicrodontia, maxillary hypoplasia, telecanthus, hypertelorism and hypospadias stand out.Conclusions: Therefore, the importance of early diagnosis, follow-up and adequate treatment becomes evident in order to preserve the visual function of patients and thus avoid an unfavorable evolution.

Bilateral Iridocorneal Endothelial Syndrome

Objectives@#We presented a case of bilateral iridocorneal endothelial (ICE) syndrome with secondary glaucoma and discussed its clinical presentation and management.@*Study design@#This is a case report.@*Results@#A 12-year old female consulted for a one-year history of progressive blurring of vision in both eyes associated with abnormal pupils and occasional eye pain. Polycoria, shallow anterior chambers, increased intraocular pressures (IOP), areas of closed angles on gonioscopy, and increased cup-to-disc ratio in both eyes indicative of ICE syndrome were present. Management included anti-glaucoma medications and implantation of glaucoma drainage devices (GDD).@*Conclusion@#Early detection with regular follow-ups leading to prompt management of the ICE syndrome are necessary. IOP control may be challenging due to the nature of the disease and may require multiple surgeries including GDD implantation to achieve successful outcomes. Early use of GDD may be beneficial for pediatric patients with ICE and glaucoma, and may require additional surgeries to adequately manage the IOP.

Increased intraocular pressure in patients with Carotid-Cavernous Fistula seen at a Tertiary Eye Care Center

Objectives@#We described the demographic and clinical profiles of patients with carotid-cavernous fistula (CCF), determined the prevalence of increased intraocular pressure (IOP), and described the IOP outcomes after endovascular treatment.@*Methods@#This was a single-center, retrospective review of records of patients with clinical signs and radiologic evidence of CCF from January 2012 to December 2017. Outcome measures included the prevalence of increased IOP in those with CCF, mean and range of IOPs, average number of IOP-lowering medications needed, and percentage of eyes with normal, controlled, and uncontrolled IOP before and after endovascular intervention. @*Results@#Ninety-six (96) eyes of 92 patients with radiologic evidence of CCF on 4-vessel cerebral angiography were included. Fifty-nine (59) percent were between the ages of 20 to 39 years. Majority (65%) were males. Direct CCFs accounted for 70% of cases. Increased IOP was the third most common ocular sign with a prevalence of 78%, ranging from 10 to 56 mmHg (mean 20.3 ± 8.0). The average number of antiglaucoma medications for IOP control was 2. Eleven (11) underwent definitive management for CCF. Post-treatment, 33% of 13 eyes had normal, 27% controlled, and 40% uncontrolled IOPs.@*Conclusion@#There was a high prevalence of increased IOP in patients with CCF. Those who did not achieve IOP control should be referred for endovascular intervention to prevent serious complications, including secondary glaucoma.

Capsular tension ring and iris hooks for secondary glaucoma associated with lens subluxation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the application effect of iris hooks combined with suture fixation of capsular tension ring(CTR)in the treatment of phacoemulsification with secondary glaucoma associated with lens subluxation.METHODS: Retrospective case series. A total of 18 eyes of patients with serious secondary glaucoma associated with lens subluxation were enrolled in Aier Eye Hospital(Changchun)from October 2017 to May 2020 as the observation group. All the patients had iris hooks inserted to support the capsule during the phacoemulsification combined with intraocular lens(IOL)implantation. Iris hooks were inserted through the incisions and placed in the capsulorhexis to support the capsule, then CTR was implanted and sutured onto the sclera of the dislocation side. A total of 11 eyes of patients had intracapsular cataract extraction combined with IOL suspension were enrolled in Aier Eye Hospital(Changchun)from October 2015 to October 2017 as the control group. The postoperative complications were recorded. The postoperative examinations included visual acuity, intraocular pressure(IOP)and positions of the capsule and IOL.RESULTS: The postoperative follow-up at least 12(12-40)mo, both the IOP of observation group and control group returned to normal, with statistically significant difference compared with pre-operation(t=9.994, 8.790, all P&#x003C;0.001). At 12mo after operation, the best corrected visual acuity of the two groups were significantly improved compared with surgery before(Z=-3.900, P&#x003C;0.001; Z=-3.002, P=0.003). The IOL in the observation group of the 18 eyes were in the expected position without complications such as an obvious tilt or displacement. In the control group with 11 eyes, the position of IOL in 8 eyes were centered, 3 eyes were slightly biased, and 2 eyes with cystoids macular edema.CONCLUSION: The application of suture fixation capsular tension ring and iris hooks for secondary glaucoma associated with lens subluxation in patients can be used as an effective auxiliary method, it could effectively control the IOP and maintain long-term stability of the capsule.

Clinical characteristics and genetic mutation analysis in a family with familial vitreous amyloidosis / 中华实验眼科杂志

Objective:To analyze the clinical characteristics and transthyretin ( TTR) gene mutation of a family with familial vitreous amyloidosis (FVA). Methods:A pedigree investigation was performed.The clinical data of 20 family members of a Han family with FVA treated in the Affiliated Hospital of Guizhou Medical University from May 2005 to March 2019 were collected, including demographic data and ophthalmic examination results.Nine eyes of five patients underwent vitrectomy successively, and vitreous samples collected during operation were sent for pathological examination by Congo red staining.The best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and the anterior segment as well as fundus was observed under the slit lamp microscope at 1 week and 6 months after surgery.Peripheral venous blood (4 ml) was collected from 20 members in this family and DNA was extracted.The next-generation sequencing technology was used for gene detection of proband, and Sanger sequencing was performed in 20 family members including the proband.The pathogenicity of the mutation sites was analyzed according to ACMG guidelines.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Affiliated Hospital of Guizhou Medical University (No.2019-296). Written informed consent was obtained from each subject.Results:The preoperative BCVA of the nine eyes (5 patients) remained 0.1 to 0.2 in 6 eyes, and counting fingers to 50 cm in 3 eyes, and the mean value of preoperative IOP was (15.18±1.32) mmHg (1 mmHg=0.133 kPa). Cotton-wool like opacity in the vitreous and white pedal disc punctate granule on the posterior lens capsule were seen in the 9 eyes under the slit lamp microscope.Vitreous specimens of patients were Congo red stain positive.The BCVA remained 0.8 in 8 eyes and 0.6 in 1 eye at 1 week after vitrectomy, and remained 0.8 in 6 eyes, 0.6 in 2 eyes and light perception in 1 eye at 6 months after surgery.Mean values of postoperative IOP were (15.32±2.11) mmHg and (16.13±1.25) mmHg at 1 week and 6 months after surgery, respectively.Secondary glaucoma occurred in 8 eyes at 3 to 14 years postoperatively.Mean BCVA of the 13 phenotypic normal family members (26 eyes) remained 0.8 to 1.0, and the mean value of IOP was (15.52±1.15) mmHg, and abnormalities were not found in anterior segment or fundus.Additionally, two members (4 eyes) failed to take examinations.Genetic testing revealed heterozygous mutation in p. Gly103Arg of TTR gene in 15 family members.According to ACMG guidelines, the variation score was PS1+ PM2+ PP3, and it was likely pathogenic. Conclusions:The secondary glaucoma is of relatively high incidence in patients with FVA after vitrectomy.The heterozygous mutation of TTR gene (p.Gly103Arg) might be the variation site of the family with vitreous amyloidosis.

Clinical analysis of the secondary glaucoma and postoperative visual acuity after infantile congenital cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze correlation of secondary glaucoma and postoperative visual acuity after infantile congenital cataract surgery. <p>METHODS: Retrospective case series. Totally 48 cases(86 eyes)were observed in our hospital from May 2006 to January 2018. All patients received intraocular lens(IOL)implantation with posterior continuous curvilinear capsulorhexies and anterior vitrectomy after cataract extraction. The best corrected visual acuity(BCVA)was determined, secondary glaucoma was evaluated during the 13a follow-up period. The independent samples <i>t</i>-test, Fisher exact test and multivariate Logistic regression were used to analyze the data.<p>RESULTS: Thirteen eyes(15%)with secondary glaucoma postoperative BCVA(LogMAR)were 0.63±0.20. And 73 eyes(85%)without secondary glaucoma postoperative BCVA were 0.44±0.27, there was statistically significant difference in BCVA between the two groups(<i>t</i>=2.417, <i>P</i><0.05). Glaucoma occurred in 29%, 18% and 3% of patients with cataract extraction ≤3mo, 3-12mo and >12mo, respectively. Fisher analysis there was statistically significant difference between operation age ≤3mo and >12mo(<i>P</i><0.05). The difference of axial length(AL)and refraction diopter between with and without secondary glaucoma were statistically significant(<i>t</i>=-2.92, <i>P</i>=0.004). Multivariate Logistic regression analysis showed surgery age ≤12mo was the risk factor(<i>OR</i>=8.372, 95%<i>CI</i>: 1.033-67.864, <i>P</i>=0.047). Cataract surgery age below 12mo is 8.372 times the probability of secondary glaucoma than surgery age above 12mo.<p>CONCLUSION: Most children can achieve good postoperative visual acuity and the secondary glaucoma occurred after surgery. The age of cataract surgery more than 12mo is a risk factor for postoperative secondary glaucoma, especially cataract surgery age below 3mo is much higher the probability of secondary glaucoma than above 12mo. Patients with secondary glaucoma have longer AL, smaller refraction diopter and more pronounced myopia drift than patients without secondary glaucoma.

Pseudoexfoliación ocular: un signo de alerta temprana de enfermedades sistémicas / Ocular pseudoexfoliation: an early warning signal in systemic diseases

El síndrome pseudoexfoliativo es una enfermedad relacionada con la edad, que afecta a la población mayor de 60 años y tiene una distribución mundial. Se caracteriza por la producción y la acumulación progresiva de un material fibrilar extracelular a nivel de las distintas estructuras del ojo, con repercusiones significativas sobre la salud ocular de los pacientes y, además, conduce a complicaciones quirúrgicas. El material pseudoexfoliativo no solo se encuentra en el globo ocular, sino en distintas partes del organismo, como el corazón, los pulmones, el cerebro y los vasos sanguíneos, por lo que algunos estudios sugieren la relación de este síndrome con ciertas afecciones cardíacas. Se presenta un paciente de 74 años de edad, negro, con antecedentes de hipertensión arterial, que se ingresa por pérdida brusca de la visión de ambos ojos, acompañado de dolor. Al examen oftalmológico, después del tratamiento hipotensor, se constató material pseudoexfolitivo y cristalino subluxado a cámara vítrea. Se diagnosticó glaucoma pseudoexfoliativo, disfunción asintomática del miocardio, hiperlipidemia, ateroma en la aorta abdominal e hipoacusia neurosensorial severa. Existen estudios que sugieren relación del síndrome pseudoexfoliativo con ciertas enfermedades y factores de riegos vasculares con alto impacto en la morbimortalidad a nivel mundial(AU)

Pseudoexfoliation syndrome is an aging-related disease of worldwide distribution affecting people aged over 60 years. It is characterized by progressive production and accumulation of extracellular fibrillar material in the different structures of the eye, with significant impacts on the patients' ocular health. It may also lead to surgical complications. Pseudoexfoliative material is not only found in the eyeball, but also in various parts of the body, such as the heart, the lungs, the brain and blood vessels, this being the reason why some studies suggest a relationship to certain heart conditions. A case is presented of a male black 74-year-old patient with a history of arterial hypertension, admitted due to sudden vision loss in both eyes, accompanied by pain. The ophthalmological examination performed after hypotensive treatment confirmed the presence of pseudoexfoliative material and crystalline subluxated to the vitreous chamber. The diagnosis was pseudoexfoliation glaucoma, asymptomatic myocardial dysfunction, hyperlipidemia, abdominal aorta atheroma and severe neurosensory hypoacusis. Some studies suggest a relationship between pseudoexfoliation syndrome and certain vascular diseases and risk factors with a high impact on worldwide morbidity and mortality(AU)

Clinical research status of iridocorneal endothelial syndrome / 国际眼科杂志(Guoji Yanke Zazhi)

@#Iridocorneal endothelial(ICE)syndrome presents a group of ocular pathologies mostly characterized by corneal endothelial abnormalities and iris atrophy. Iridocorneal endothelial syndrome is typically a unilateral and generally not involving genetic condition, frequently affecting women in early to middle adulthood. There is no treatment for absence of symptoms in early stages. When complicated with corneal edema and secondary glaucoma, treatment is mainly symptomatic. In this group of diseases, there are many similarities and some differences in their pathogenesis, clinical manifestations and treatment. So far no universal information on these features has been published. Recent clinical studies on iridocorneal endothelial syndrome are reviewed in this paper.

Etiology and treatment of secondary glaucoma after vitreoretinal surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#Surgical treatment of vitreoretinal diseases, including scleral buckling, vitrectomy, and vitreous cavity gas injection or oil injection,may lead to increased intraocular pressure after surgery. If not treated promptly, it may develop into secondary glaucoma and lead to permanent vision loss. The causes of secondary glaucoma after vitreoretinal surgery are complex and varied. Different treatment methods can be used according to the different causes of the patients. Early glaucoma is mainly treated with drugs or lasers, while patients with advanced glaucoma are treated with multiple surgeries. However, the failure rate of traditional trabeculectomy is high, and glaucoma drainage valve implantation can effectively reduce intraocular pressure. This article reviews the pathogenesis of high intraocular pressure after routine vitreoretinal surgery and the current research progress in treatment at home and abroad.

A clinical analysis on 15 cases of Axenfeld-Rieger syndrome associated with secondary glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical features of Axenfeld-Rieger syndrome associated with secondary glaucoma and its surgical treatment. <p>METHODS: It was a retrospective case series study. The general clinical data and related ocular manifestations in 15 patients(26 eyes)with Axenfeld-Rieger syndrome associated with secondary glaucoma in our hospital from January 2003 to January 2016 were collected and analyzed retrospectively. <p>RESULTS: Age of the patients ranged from 3-month to 43 years old, and the median age was 11 years old. There were of all 11 patients(73%)had bilateral glaucoma and 4(27%)had unilateral glaucoma. In the aspect of clinical features, hypoplasia or deficiency of the iris was found in 20 eyes(77%), peripheral iridocorneal adhesions was found in 17 eyes(65%)in various extent, and pupil distortion or multiple-pupil was found in 14 eyes(54%); Also posterior embryotoxon was found in 14 eyes(54%)as well; And 11 eyes(42%)had anomalies in corneal size. That root of iris is located at a more anterior position than that of a normal eye was found in all affected eyes by gonioscopy, coupled with different extent of angle synechiae-closure. According to the data, in 15 patients only two had a family history of ARS, while 5 had systematic abnormalities, eyes excepted, in dental, maxillary, cardiovascular, <i>et al</i>. Anti-glaucoma surgeries including trabeculotomy, trabeculectomy, glaucoma valve implantation were performed in 20 eyes. Nine patients(11 eyes)were followed up for 59mo on average. Intraocular pressure was significantly lower than pre-operation(<i>t</i>=2.4185, <i>P</i>=0.0362), and intraocular pressure in 7 followed-up eyes was controlled ≤21mmHg. The long-term success rate of surgery was 64%. <p>CONCLUSION: The clinical features of Axenfeld-Rieger syndrome associated with secondary glaucoma were diverse. The patients might concomitant with other systematic dysplasia. Although it was tough to treat, surgery for glaucoma could reduce the intraocular pressure effectively.

Anterior segment dysgenesis and secondary glaucoma in Goldenhar syndrome

A 3-year-old girl presented with a history of watering, haze and increase in the size of the right eye for two months. The child had bilateral preauricular skin tags, limbal dermoid and dermolipoma, consistant with the diagnosis of Goldenhad syndrome. In addition, her right eye manifested enlarged cornea, flat anterior chamber, atrophic iris and elevated intraocular pressure. This case report highlights a possible association of anterior segment dysgenesis and glaucoma with Goldenhar syndrome.

Current surgical management approaches for uveitic glaucoma / 中华实验眼科杂志

Glaucoma is a potentially blinding complication of uveitis.Management of uveitic glaucoma remains challenging.Vision can be partly recovered if correct diagnosis and timely treatment are given.The mechanisms of intraocular pressure (IOP) elevation include peripheral anterior synechia, pupillary block, trabecular meshwork inflammation, cyclitis and prolonged corticosteroid use.Treatment is targeted at identifying the cause of raised IOP first, followed by etiological treatment and IOP lowering medications.The indications for surgery include uncontrolled IOP despite maximum-tolerated medical management or definite optic nerve damage.Recently, selective laser trabeculopasty for steroid-induced intraocular hypertension/open angle glaucoma, CO2 laser-assisted sclerectomy surgery or micro-invasive glaucoma surgery for uveitic glaucoma have been gradually applied in clinical practice.

Current surgical management approaches for uveitic glaucoma / 中华实验眼科杂志

Glaucoma is a potentially blinding complication of uveitis. Management of uveitic glaucoma remains challenging. Vision can be partly recovered if correct diagnosis and timely treatment are given. The mechanisms of intraocular pressure ( IOP) elevation include peripheral anterior synechia,pupillary block,trabecular meshwork inflammation, cyclitis and prolonged corticosteroid use. Treatment is targeted at identifying the cause of raised IOP first,followed by etiological treatment and IOP lowering medications. The indications for surgery include uncontrolled IOP despite maximum-tolerated medical management or definite optic nerve damage. Recently,selective laser trabeculopasty for steroid-induced intraocular hypertension/open angle glaucoma,CO2 laser-assisted sclerectomy surgery or micro-invasive glaucoma surgery for uveitic glaucoma have been gradually applied in clinical practice.

Risk Factors of Secondary Glaucoma after Congenital Cataract Surgery in Korean Patients

PURPOSE: To assess the risk of development of secondary glaucoma after congenital cataract surgery using a long-term follow-up study. METHODS: In total, 148 eyes of 91 patients who underwent congenital cataract surgery at our hospital or other hospitals were included in a retrospective chart review. A diagnosis of secondary glaucoma was made if the intraocular pressure (IOP) exceeded 21 mmHg and the corneal diameter, axial length, or the cup-to-disc ratio increased, or surgery was performed to control the IOP. To analyze the clinical features and risk factors of secondary glaucoma, we evaluated the mean age at cataract surgery, binocularity, presence of a nuclear cataract, methods of cataract surgery, presence of an intraocular lens (IOL), duration of diagnosis of secondary glaucoma after cataract surgery, duration of follow-up, recent best-corrected visual acuity, and refractive errors. RESULTS: Thirty-five eyes (23.6%) were diagnosed with secondary glaucoma as a complication of congenital cataract surgery. Of these, 11 eyes (31.4%) were treated with glaucoma surgery a mean of 3.4 times. The mean duration from congenital cataract surgery to diagnosis of glaucoma was 112.2 ± 113.1 months. Patients with aphakia had a higher risk of developing secondary glaucoma compared with patients undergoing primary IOL implantation (p = 0.001). Younger age (<3 months at surgery), a nuclear cataract, and aphakia were risk factors for the development of secondary glaucoma (p = 0.03, p = 0.006, and p < 0.001, respectively), and the risk of developing secondary glaucoma increased with secondary IOL implantation (p = 0.052). CONCLUSIONS: Secondary glaucoma after congenital cataract surgery was more common in patients with secondary IOL implantation, aphakia, a younger age (<3 months), and a nuclear cataract. Patients who underwent congenital cataract surgery had an increased risk for developing secondary glaucoma. Long-term monitoring of the IOP and optic nerve is therefore required for these patients.