Evaluation of optic nerve in patients with acute primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the damage to optic nerve by detecting the morphological and functional changes of optic nerve in patients with acute primary angle-closure glaucoma.METHODS: The correlation among the positive rates of fundus photography, visual field examination, optical coherence tomography(OCT)scan of the optic nerve, and pattern visual evoked potentials(P-VEP)were analyzed in 28 patients with acute primary angle-closure glaucoma affecting.RESULTS: Among 28 eyes of 28 patients, optic nerve images were obtained in 25 eyes(89%), optic disc color in 25 eyes: there were 9 normal eyes and 16 eyes with congestion and edema, without pallor; C/D: < 0.6 in 5 eyes, > 0.6 in 1 eye, and indistinguishable in 19 eyes; disk edge: 6 eyes were normal, and 19 eyes could not be distinguished.Optic nerve images could not be obtained in 3 eyes(11%). Visual field examination: 9 eyes(32%)were normal, 2 eyes(7%)had visual field damage, 8 eyes(29%)had no reference value due to cataract visual field examination, 2 eyes(7%)had false positive rate ≥15%, and 7 eyes(25%)could not cooperate with the examination. The retinal nerve fiber layer thickness around optic disc was measured by OCT in 26 eyes(93%), of which the thickness of nerve fiber layer was normal in 24 eyes and local thinning in 2 eyes. Severe opacification of refractive stroma could not be measured in 2 eyes(7%). PVEP showed that the peak of P100 was normal in 18 eyes(64%)and prolonged in 10 eyes(36%). The amplitude of P100 wave was normal in 11 eyes(39%)and decreased in 17 eyes(61%).CONCLUSION: After a major acute attack of primary angle-closure glaucoma, the optic nerve does not exhibit typical glaucomatous damage but may present with optic disc congestion and edema. Therefore, a comprehensive evaluation combining subjective and objective examination methods is necessary for optic nerve assessment, and currently, no more precise assessment method is available.

Changes in peripapillary choroidal thickness within one year of the first episode of acute primary angle closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the changes in peripapillary choroidal thickness(pCT)within 1a of the first episode of acute primary angle closure glaucoma(APACG).METHODS: A prospective cohort study. A total of 31 patients with APACG who admitted to the ophthalmology department of Shijiazhuang People's Hospital from October 2015 to September 2019 were selected, with 31 eyes in attack group, 31 fellow eyes in preclinical group and 30 cases(30 eyes)in control group. pCT of the three groups was measured respectively at the attack period, 1wk, 1, 3, 6mo and 1a after surgery.RESULTS: The pCT of the attack group was thicker than that in the attack period when at 1wk after surgery, and continued to become thinner within the following 1a(P<0.05). The pCT of the attack group was thicker than that of the other two groups during the attack period and at 1wk after surgery, while it became thinner at 1a(P<0.05). In the attack group, the average pCT was positively correlated with the duration of intraocular hypertension and negatively correlated with the anterior chamber depth(P<0.05).CONCLUSION: For patients with first episode of APACG, pCT was diffusely thickened during attack and at 1wk after surgery. The pCT returned to normal at 1mo, while it became thinner at 1a. Furthermore, the average pCT was positively correlated with the duration of intraocular hypertension, and the choroidal thickness may play an important role in the attack of APACG.

Relationship between expression of chemokine receptor 2 and basic fibroblast growth factor in aqueous humor and prognosis of trabeculectomy in patients with acute primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the relationship between the levels of chemokine receptor 2(CXCR2)and basic fibroblast growth factor(bFGF)in aqueous humor and the prognosis of trabeculectomy in patients with acute primary angle-closure glaucoma(APACG).METHODS: A total of 80 cases(80 eyes)APACG patients who underwent trabeculectomy in our hospital from June 2020 to January 2022 were collected in the case group. According to the postoperative efficacy, they were grouped into a success group of 60 cases(60 eyes)and a failure group of 20 cases(20 eyes). Another 86 cataract patients(86 eyes)who underwent phacoemulsification with normal intraocular pressure in our hospital during the same period were included in the control group. Enzyme linked immunosorbent assay was applied to detect the levels of CXCR2 and bFGF in aqueous humor. ROC curve was applied to analyze the value of predicting trabeculectomy failure in APACG patients by the levels of CXCR2 and bFGF in aqueous humor. Furthermore, multivariate Logistic regression was applied to analyze the influencing factors of trabeculectomy failure in APACG patients.RESULTS: The levels of CXCR2 and bFGF in the aqueous humor of the case group were significantly higher than those of the control group(P<0.05). The levels of CXCR2 and bFGF in the aqueous humor of the failed group and the proportion of patients with postoperative shallow anterior chamber were significantly higher than those of the successful group(P<0.05). The AUC for predicting trabeculectomy failure in APACG patients using CXCR2 and bFGF levels alone and in combination was 0.885, 0.883 and 0.953, respectively. CXCR2 and bFGF were independent risk factors for trabeculectomy failure in APACG patients(P<0.05).CONCLUSION: The levels of CXCR2 and bFGF in the aqueous humor of APACG patients are obviously elevated, and both are risk factors for trabeculectomy failure.

Comparison of uveal parameters between acute primary angle-closure eyes and fellow eyes in South Indian population

Purpose: To analyze the ocular biometric parameters of eyes with acute primary angle closure (APAC) as compared to fellow eyes. Methods: A cross?sectional study was conducted on 27 patients presenting with recent onset APAC to a tertiary eye institute in India. Anterior and posterior ocular biometric parameters were measured simultaneously by anterior segment optical coherence tomography (AS?OCT), A?scan, ultrasound biomicroscopy (UBM), and B?mode ultrasonogram (USG). The parameters measured were anterior chamber depth (ACD), anterior chamber angle (ACA), angle opening distance (AOD500, AOD750), lens vault (LV), axial length (AL), ciliary body thickness maximum (CBTmax) and at the point of scleral spur (CBT0), anterior placement of the ciliary body (APCB), and retinochoroidal thickness (RCS). Results: Mean age � SD of patients with APAC was 55.66 � 7.2 years with female preponderance (21:6 patients). Mean presenting IOP � SD of the affected eye and fellow eye were 54.74 � 11.67 mm Hg and 18.7 � 11.67 mm Hg, respectively. Eyes with APAC had statistically significant narrower anterior ocular biometric parameters, higher LV, decreased ciliary body thickness, more APCB, and longer AL than the fellow eyes. CBTmax is the only variable that had significance (? = ?0.421,95% CI: ?0.806 to ? 0.035, P = 0.034) in the univariate analysis with RCS thickness in APAC eyes. Further, there was a correlation between CBT0 and APCB with CBTmax both in univariate (? = 0.894, P < 0.0001 and ? = ?0.351, P = 0.039) and multivariable analysis (? = 0.911, P < 0.0001 and ? = ?0.416, P = 0.016). Conclusion: Compared to the fellow eyes, APAC eyes had different ocular biometric parameters. In addition to known biometric parameters associated with pupillary block (narrower anterior biometric parameters?ACA, ACD, and AOD), our study found multiple nonpupillary block factors such as higher lens vault and thinner and more anteriorly placed ciliary body to be associated with APAC.

Outcomes of trabeculectomy in eyes with refractory acute primary angleclosure in Indian eyes

Purpose: To report the outcomes of trabeculectomy in eyes with refractory acute primary angle?closure attack. Methods: Patients with acute primary angle?closure attack and who underwent trabeculectomy for medically uncontrolled intraocular pressure within 2 months of presentation were retrospectively analyzed. Primary outcome was intraocular pressure (IOP). Secondary outcome measures were visual acuity, number of antiglaucoma medication (AGM), complications, and risk factors for failure of trabeculectomy. Results: Thirty?five eyes of 31 patients with median (interquartile range) follow?up of 3 (0.5, 9) years were included in the study. Median age at presentation was 55 (47, 60) years. Median duration of symptoms at presentation was 10 (4, 16) days and median time from presentation to surgery was 13 (6, 25) days. Median IOP reduced from 42 (36, 46) to 13 (12, 16) mmHg (P < 0.001) and median number of AGM reduced from 3 (1, 3) to 0 (0, 0) after trabeculectomy at the end of 1 year. The probability of complete and qualified success was 88% (95% confidence interval [CI]: 72%–95%) and was 97% (95% CI: 81%–99%) at 1 year, respectively. Failure was noted in six eyes. Subsequent cataract surgery was needed in 13 eyes (37%) with a median duration from trabeculectomy being 6.75 (1, 11) years. None of the preoperative, intraoperative, or postoperative factors tested were associated with failure (P > 0.10 for all associations on Cox proportional hazard regression analysis). Conclusion: In medically unresponsive cases of acute primary angle?closure attack, primary trabeculectomy seems safe and effective in Indian eyes

Phacoemulsification combined with goniosynechialysis under the gonioscope in the treatment of acute angle-closure glaucoma with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the changes of visual acuity, intraocular pressure(IOP)and anterior chamber structure after phacoemulsification intraocular lens(IOL)implantation and goniosynechialysis in acute angle-closure glaucoma with cataract.<p>METHODS: A prospective study. Totally 80 eyes with acute primary angle-closure glaucoma(APACG)and cataract were selected in our hospital from August 2019 to February 2021. All study underwent phacoemulsification IOL implantation and goniosynechialysis. Visual acuity, IOP, anterior chamber distance(ACD), trabecular iris angle(TIA)and angle opening distance(AOD500)were measured before and 1wk, 1, 3 and 6mo after surgery. Four quadrant angle classifications of upper, lower, nasal and temporal were determined by Scheie classification method and the measured values were statistically analyzed.<p>RESULTS: The postoperative corrected visual acuity in 1wk, 1, 3 and 6mo were improved than preoperative, there were no statistically significant differences between each postoperative period(<i>P</i>>0.05). The IOP in postoperative 1wk, 1, 3 and 6mo were reduced than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The ACD in postoperative 1wk, 1, 3 and 6mo were deepen than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The TIA in postoperative 1wk, 1, 3 and 6mo were widened than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The AOD500 in postoperative 1wk, 1, 3 and 6mo were increased than preoperative, there were not significantly different between each postoperative period(<i>P</i>>0.05). The depth of anterior chamber angle in four quadrants were deepened combined with the depth in postoperative 1wk, 1, 3 and 6mo(<i>P</i><0.05).<p>CONCLUSION: Phacoemulsification IOL implantation and goniosynechialysis in the treatment of acute angle-closure glaucoma with cataract can significantly improve visual acuity, increase the depth of central anterior chamber, open angle, reduce IOP. It is an effective and stable surgical method.

Comparison of phacoemulsification combined with goniosynechialysis and trabeculectomy in the treatment of APACG / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate and compare the quality of life of patients submitted to phacoemulsification combined with goniosynechialysis(PPI+GSL)and trabeculectomy, and analyze the potentially involved variables.<p>METHODS: A perspective, randomized case-control study was conducted. Patients with acute primary angle-closure glaucoma(ACG)and early cataracts underwent PPI+GSL implantation(group A, <i>n</i>=29)and trabeculectomy(group B, <i>n</i>=30). The quality of life was assessed using the National Eye Institute 25-Item Visual Function Questionnaire(NEI-VFQ-25)before and 6mo after surgery. Intraocular pressure(IOP), best corrected visual acuity(BCVA), review frequency and the basic characteristics were recorded simultaneously.<p>RESULTS: Compared with preoperative status, the IOP in both groups was significantly decreased(all <i>P</i><005), and the BCVA was significantly increased in group A(<i>P</i><0.05), while did not differ significantly in group B(<i>P</i>>0.05). Besides, group B presented higher review frequency than group A(<i>P</i><0.05). Moreover, significant increases in postoperative scores were founded in the two groups respectively(all <i>P</i><0.05). Compared with group B, group A had better postoperative performance in items of general vision, ocular pain, long-distance activities, social functioning and role limitations(all <i>P</i><0.05). Besides, group A presented significantly higher net increases in postoperative total scores than group B(<i>P</i><0.05), which was positively associated with the degree of the BCVA recovery and negatively associated with review frequency(<i>R</i>²=0.48, <i>F</i>=5.00, <i>P</i><0.05).<p>CONCLUSION: APACG patients with early cataracts, PPI+GSL determines better improvement in quality of life compared to trabeculectomy.

Changes of choroid thickness in primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the changes and related factors of choroidal thickness(CT)in acute primary angle-closure glaucoma(APACG), and chronic primary angle-closure glaucoma(CPACG).<p>METHODS: It was a retrospective study. A total of 35 patients(43 eyes)with APACG, 26 patients(46 eyes)with CPACG and 46 patients(81 eyes)with normal eye condition and used as the control group in the study. EDI-OCT was used to measure and compare the foveal, nasal, temporal, superior and inferior CT of APACG, CPACG and normal control groups. The CT were labeled as subfoveal choroidal thickness(SFCT), nasal 2mm(N 2mm), temporal 2mm(T 2mm), superior 2mm(S 2mm), inferior 2mm(I 2mm).Linear regression analysis was used to explore the related factors of CT. Logistic regression analysis was used to evaluate the association between CT and presence of APACG and CPACG.<p>RESULTS: There was no significant difference in CT of APACG, CPACG and normal control group(<i>P</i>>0.05). CT of all sites was negatively correlated with axial length(AL). N 2 mm and I 2 mm were also negatively correlated with age, anterior chamber depth(ACD), SFCT was negatively correlated with age and AL(<i>P</i><0.05). Multivariate Logistic analysis showed that there was an association between S 2mm and APACG(<i>P</i>=0.029), the odds ratio(<i>OR</i>)and 95% confidence interval(<i>CI</i>)was 0.975(0.953, 0.997). There was no association between CPACG and CT at all locations(<i>P</i>>0.05).<p>CONCLUSION: Age, AL and ACD are the factors that related to choroidal thickness. It is also confirm that there is an association between decreased S 2mm and APACG. However, there is no correlation between CPACG and CT at all locations.

Correlation between retinal vessel density and retinal nerve fiber layer in acute primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To observe circumpapillary and macular vessel density(cpVD/MVD), and to evaluate correlations of cpVD/MVD with retinal nerve fiber layer(RNFL)in patients with acute primary angle-closure glaucoma(APACG).<p>METHODS: Patients with monocular APACG(<i>n</i>=29)visited the Affiliated Hospital of Xuzhou Medical University from March 1, 2019 to December 31, 2019 were prospectively enrolled. Moreover, 29 eyes with APACG attack were included in the experimental group to be performed with combined trabeculectomy, and 29 contralateral eyes were served as the control group to receive preventive laser peripheral iridotomy. Changes in the MVD, the cpVD and the thickness of optic nerve fiber layer(RNFL)before operation and 1wk, 1mo, 3mo and 6mo after operation were observed by oraphyptical coherence tomography angiography(OCTA), respectively.<p>RESULTS: Before operation, the experimental group showed lower cpVD in the superotemporal(ST)quadrant and the temporosuperior(TS)quadrant compared with the control group(all <i>P</i><0.01). In addition, a brief rise was observed in each quadrant of the experimental group 1wk after operation, but with lower cpVD in the supero-nasal(SN)quadrant, the ST quadrant and the TS quadrant than the control group(all <i>P</i><0.05). Furthermore, 1mo, 3mo and 6mo after operation, there was a steady downward trend in the cpVD and the MVD in each quadrant of the experimental group over time, and the RNFL thickness was increased at first within 6mo after operation, and then gradually thinned, but the RNFL thickness of the experimental group were thinner than those of the control group 6mo after operation. Correlation analysis showed that there was a positive correlation between the cpVD and the RNFL thickness in the SN, ST, temporoinferior(TI), IT, IN and nasoinferior(NI)quadrants in the experimental group 6mo after operation(all<i> P</i><0.05). <p>CONCLUSION: The RNFL was thickened in the affected eyes in the early stage after acute attack of APACG, and gradually thinned 3-6mo after operation. However, the cpVD was decreased continuously, and there was a correlation between the RNFL thickness and the cpVD 6mo after operation.

Surgical treatment of primary acute angle-closure glaucoma during COVID-19 disease outbreak in Wuhan / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To summarize the characteristics and treatment of primary acute angle-closure glaucoma during the outbreak of corona virus disease 2019(COVID-19)in Wuhan.<p>METHODS: Five patients(9 eyes)with primary acute angle-closure glaucoma(APACG)of our hospital were enrolled. Eight eyes with sustained high intraocular pressure(IOP)were given phacoemulsification with goniosynechialysis and one eye in preclinical phase was given YAG laser iridectomy from March 3-20, 2020. The preoperative and postoperative IOP, visual acuity, hospitalization days and complications were reviewed and analyzed.<p>RESULTS: Three out of five APACG cases were binocular attack. The onset time was 12-40(25.2±11.82)d. The IOP(48.38±3.22mmHg)of eight eyes decreased significantly after surgeries(12.63±1.68mmHg), the difference was statistically significant(<i>t</i>=12.192, <i>P</i><0.01). The hospitalization time was 2-6(3.8±1.48)d. No COVID-19 infection or severe complications were observed. <p>CONCLUSION:During the epidemic of COVID-19, phacoemulsification with goniosynechialysis is able to reduce IOP of APACG patients who suffered from longer, heavier and binocular attack in the epidemic area effectively and safely. Strict prevention management can effectively ensure the safety of medical staff and patients, but also increase the difficulty of the surgeries meanwhile.

Changes in location parameters of the ciliary body and its correlation with narrow angle in patients with acute primary angle closure glaucoma / 眼科新进展

Objective To observe the positional variation of the ciliary body in eyes with acute primary angle-closure glaucoma (APACG) by ultrasound biomicroscopy (UBM),and to analyze the association between anterior chamber angle width and location parameters of the ciliary body in patients with APACG.Methods The subjects were divided into APACG group and normal control group and examined by UBM,and the clearer images were collected for quantitative analysis,followed by measurement of parameters including angle open distance 500 (AOD500),trabecular meshwork-ciliary process distance (TCPD),iris-ciliary process distance (ICPD),sclera-ciliary process angle (SCPA) and ciliary body length 500 (CBL500).Results Totally 89 patients (89 eyes) were enrolled in this study,including 57 patients with APACG (APACG group)and 32 normal controls (normal control group).According to the age-sex paired t test,the average of 23 pairs of measured data showed that the AOD500,TCPD,ICPD,SCPA,and CBL500 were (0.050 4 ± 0.031 0) mm,(0.499 6 ± 0.192 4) mm,(0.112 6 ± 0.089 2)mm,(35.317 0 ±4.575 2)° and (1.060 4 ±0.290 2)mm in the APACG group,and (0.242 6 ±0.078 5)mm,(0.741 7 ±0.240 4) mm,(0.272 6 ±0.218 8) mm,(44.913 0 ±10.089 2) ° and (0.633 0 ± 0.405 4)mm in the normal control group,respectively;and APACG group presented smaller AOD500,TCPD,ICPD and SCPA but larger CBL500 than normal control group,with significant differences (all P ＜ 0.01).Correlation analysis showed that TCPD,ICPD,SCPA and CBL500 were significantly correlated with AOD500 in APACG group.Conclusion Ciliary bodies are more anteriorly rotated in eyes with APACG,and anterior chamber angle width is associated with location parameters of ciliary body.

Resultados de tres alternativas quirúrgicas para la remoción del cristalino en el cierre angular primario agudo / Results of three surgical alternatives for the crystalline lens extraction in the acute primary angle- closure

Objetivo: evaluar la efectividad de la remoción del cristalino en el tratamiento del cierre angular primario agudo. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo de serie de casos en 27 ojos de igual número de pacientes con cierre angular primario agudo, distribuidos en tres alternativas: facoemulsificación (faco n= 7), túnel esclerocorneal (túnel n= 12) y túnel postrabeculectomía (túnel pos-TBT n= 8).Se analizaron las variables presión intraocular y número de colirios hipotensores en preoperatorio y posoperatorio a la semana, al mes, a los tres y a los seis meses, al año y a los dos años, así como las variables esfera, cilindro y agudeza visual mejor corregida en preoperatorio y a los dos años posoperatorios. Resultados: la presión intraocular posoperatoria fue estable en el tiempo en los 3 grupos (12-14 mmHg). A los dos años hubo reducción significativa de presión intraocular media en grupo túnel (3,83 ± 5,27 mmHg; p= 0,032); del número de colirios hipotensores en grupo faco (1,29 a 0,14; p= 0,038) y del grupo túnel (1,33 a 0,25; p= 0,006). Se indujo miopía en grupo túnel pos-TBT (-1,16 ± 1,12 D; p= 0,028) y astigmatismo en grupo túnel (1,00 ± 1,05 D; p= 0,016). La agudeza visual mejor corregida promedio se incrementó en los tres grupos, con significación en los grupos túnel y túnel pos-TBT (p= 0,003 y p= 0,012 respectivamente). Conclusiones: en pacientes con cierre angular primario agudo, la facoemulsificación y el túnel esclerocorneal reducen la presión intraocular y el número de colirios hipotensores en el mediano plazo de dos años, a la vez que se mantiene el poder hipotensor de una filtrante previa. Las tres variantes recuperan de manera efectiva la agudeza visual, mientras se induce el error miópico de 1 dioptría en pacientes con trabeculectomía previa y astigmatismo de 1 dioptría mediante túnel esclerocorneal(AU)

Objective: to evaluate the effectiveness of the crystalline lens extraction in the treatment of the acute primary angle-closure. Methods: prospective, longitudinal and descriptive study of a case series of 27 eyes from the same number of patients suffering acute primary angle-closure, distributed according to three alternatives: phacoemulsification (n=7, phaco), sclerocorneal tunnel (n=12, tunnel)and postrabeculectomy tunnel ( n=8, post-TBT tunnel). The variables intraocular pressure and number of hypotensive eyedrops used in the preoperative and postoperative period were analyzed a week, a month, three months, six months, one year and two years after the surgery as well as sphere, cylinder and best corrected visual acuity in the preoperative phase and two years after surgery. Results: postoperative intraocular pressure was steady in the course of time in the three groups (12-14 mmHg). Two years later, there had been a significant reduction of average intraocular pressure in the tunnel group (3.83 ± 5.27 mmHg; p= 0.032), of the number of hypotensive eyedrops used in the phaco group (1.29 to 0.14; p= 0.038) and the tunnel group (1.33 to 0.25; p= 0.006). Myopia in the post-TBT tunnel group(-1.16 ± 1.12 D; p= 0,028) and astigmatism in the tunnel group(1.00 ± 1.05 D; p= 0.016) were both induced. The best average corrected visual acuity increased in the three groups, being significant in the tunnel and the post-TBT tunnel groups (p= 0.003 and p= 0.012, respectively. Conclusions: in those patients with acute primary angle-closure, phacoemultification and sclerocorneal tunnel reduce the intraocular pressure and the number of hypotensive eyedrops to be used in 2 years-term and the hypotensive power of a previous filtering bleb. The three variants can effectively recover the visual acuity whereas the myopic error of one diopter is induced in patients with previous trabeculectomy and one diopter astigmatism through the sclerocorneal tunnel(AU)

Change in the mGC-IPL in Patients with a History of APAC According to SD-OCT

PURPOSE: This study was conducted to measure macular ganglion cell-inner plexiform layer (mGC-IPL) thickness in patients with a history of unilateral single attack of acute primary angle closure (APAC) and to compare it with that of unaffected fellow eyes 8 weeks after resolution using spectrum domain optical coherence tomography (SD-OCT). METHODS: Medical records of 24 patients with history of first episode of unilateral APAC were reviewed retrospectively. Eight weeks after APAC, mGC-IPL thickness and peripapillary retinal nerve fiber layer thickness were measured with SD-OCT and analyzed in eyes affected by APAC (group 1) and fellow eyes (group 2). RESULTS: There were no significant differences between the groups with regard to best corrected visual acuity, spherical equivalent, central corneal thickness, or axial length (p > 0.05). There were no significant differences in mGC-IPL thickness in the superotemporal, superior, or superonasal sectors (p > 0.05). However, average, inferonasal, inferior, and inferotemporal sectors of group 1 were significantly thinner than those of group 2 (p = 0.002, 0.002, 0.001, 0.001, respectively). In addition, average mGC-IPL difference between affected eyes and fellow eyes showed a statistically significant correlation with attack duration (correlation coefficient = 0.249, p = 0.019). CONCLUSIONS: Normalization of elevated intraocular pressure as soon as possible after APAC onset is recommended in order to reduce mGC-IPL loss, and measurements of mGC-IPL thickness can be helpful for follow-up of APAC patients.

Paracentesis as an initial intervention in Malay Indonesian eyes with acute primary angle closure.

Background: Acute primary angle closure (APAC) is one of the causes of blindness in Department of Ophthalmology Cipto Mangunkusumo General Hospital. Management of APAC is still controversial. Laser peripheral iridotomy is difficult to be done due to corneal edema as a result of persistent high intraocular pressure (IOP). It is believe that paracentesis will lower IOP immediately. The objective of the study was to assess outcome of paracentesis as the initial management in Malay Indonesian eyes with APAC. Methods: This intervention study was conducted at the Eye Clinic of Cipto Mangunkusumo Hospital and Jakarta Eye Center commencing in January 2005 until December 2007. Malay Indonesian eyes with APAC were included in this study in accordance with the new Asia Pacific consensus. All APAC eyes underwent paracentesis to lower IOP. The presenting and post-paracentesis IOP and peripheral anterior synechiae were noted. The outcome was termed as good when IOP was ≤ 21 mmHg and poor when IOP was > 21 mmHg. Results: A total of 45 APAC eyes were recruited. Thirty-eight of these belonged to women; mean age was 54.6 ± 1.56 years. Meanwhile, average duration of symptoms was 13.15 ± 7.4 days and mean of extent of peripheral anterior synechiae (PAS) was 7.7 ± 3.1 hours. There was a strong correlation regarding duration of symptoms to the formation of PAS (r = 0.672; p < 0.001). The mean presenting IOP was 55 ± 13.37 mmHg and mean post-paracentesis IOP was 27 ± 12.78 mmHg. A decrease of 49% in IOP ( p < 0.001) was observed after paracentesis with good outcome in 19 eyes and poor outcome in 26 eyes. Conclusion: Paracentesis as an initial intervention in APAC eyes reduces the IOP immediately, but only as a temporary response.

Relationship between appositional angle closure and darkroom provocative test in fellow eyes of acute primary angle closure after laser peripheral iridotomy / 中华实验眼科杂志

BackgroundLaser peripheral iridotomy(LPI) can break the pupillary block,and is an effective method of treating acute primary angle closure (APAC).However,a part of APAC eyes may gradually develop a formation and extension of peripheral anterior synechia(PAS) and increased intraocular pressure(IOP) after LPI.ObjectiveTo investigate the relationship between appositional angle closure and darkroom provocative test(DRPT) in the fellow eyes with APAC after LPI.Methods Fellow eyes of APAC without PAS after LPI were studied.Ultrasounic biomicroscopy(UBM) were performed in darkness to observe whether appositional angle closure occurred and compare the relationship between the quadrants with appositional angle closure and the results of DRPT.Results Fifty-four patients were included in the study.Appositional angle closure was observed in at least one quadrant in 20(37.0％ ) of the 54 fellow eyes with APAC after LPI.Fifty-one patients were given DRPT and positive result in 9 patients( 17.6％ ).According to the quadrants with appositional angle closure,there were 5 patients with DRPT positive results in 46 patients with appositional angle closure 0 to 2 quadrants,and 4 patients with DRPT positive results in 5 patients with appositional angle closure 3 to 4 quadrants ( P =0.003 ).Bivariate correlation analysis indicated a positive correlation between the value of the increased IOP in DRPT and the number of quadrants with appositional angle closure in darkness( r =0.397,P =0.004).ConclusionsA certain proportional fellow eyes of APAC appeared appositional angle closure in darkness and DRPT positive result after LPI.The more the quadrants of appositional angle closure after LPI,the greater the likelihood of a positive DRPT.It suggests that the APAC fellow eyes and attack eyes with the same anatomical configuration still have the possibility of angle closure after LPI,and need follow-up and treatment for a long time.

The Refractive Change After Cataract Surgery in Patients With Acute Primary Angle Closure

PURPOSE: To evaluate the change of postoperative refraction after cataract surgery in patients with a history of acute primary angle closure. METHODS: A survey was conducted on 40 eyes of 40 patients who underwent cataract surgery with a history of acute primary angle closure, and 40 eyes of 40 patients who underwent cataract surgery only during the follow-up period of six months. We reviewed changes in the postoperative refraction and compared the difference between the postoperative spherical equivalent and target refraction in both groups. RESULTS: In the group with a history of acute primary angle closure, target refraction was -0.20+/-0.27D and the six months postoperative spherical equivalent was -0.76+/-1.12D. In the group with cataract only, target refraction was -0.30+/-0.20D and the six months postoperative spherical equivalent was -0.22+/-0.57D. In the group with the history of acute primary angle closure, the postoperative refraction shifted to myopic refractive power significantly. CONCLUSIONS: In cataract patients with a history of acute primary angle closure, there was a myopic shift in postoperative refraction after cataract surgery. Therefore, this finding should be considered during cataract surgery.

A Case of Decompression Retinopathy After Resolution of Acute Primary Angle-Closure Glaucoma

PURPOSE:To report a case of ocular decompression retinopathy after resolution of acute primary angle closure (APAC) subsequent to medical treatment and laser peripheral iridotomy (LPI). CASE SUMMARY: A patient presented with APAC of the right eye with markedly elevated intraocular pressure (IOP) and a LPI was done after lowering the IOP with medical treatment. On presentation, visual acuity was 0.3 in the right eye (OD) and IOP was 74 mmHg OD. Two hours after medical treatment IOP was found to be 16 mmHg OD. Ten hours after resolution of the acute attack, the patient's visual acuity was 0.2 OD and IOP was 11 mmHg OD. LPI was subsequently performed in the right eye. The post-LPI IOP was 10 mmHg and the patient complained of visual disturbance and floaters OD. Three days after LPI the IOP was normal but her visual acuity had decreased to counting fingers OD. In addition, scattered retinal hemorrhages including alarge pre-retinal hemorrhage on the macula were found upon dilated funduscopic examination. After three months the retinal hemorrhage had been absorbed and her visual acuity was 0.7 OD. CONCLUSIONS: Decompression retinopathy can develop in the posterior pole of the retina in patients with APAC after medical treatment and LPI.

Influence of Lens Factor and Effect of Selected Cataract Extraction on Acute Angle-Closure Glaucoma

PURPOSE: To analyze the affecting factor of lens in pathogenesis of acute primary angle-closure glaucoma (APACG) and the effect of selected cataract extraction with intraocular lens (IOL) implantation. METHODS: A survey was conducted on 25 eyes of 21 patients with acute angle-closure glaucoma accompanied by senile cataract against 21 eyes of 16 age-matched normal persons. Biometric measurements were made in both groups in order to analyze an affecting factor of lens in APACG. Before and after selected cataract extraction, other clinical findings were also evaluated. RESULTS: Biometric measurements such as anterior chamber depth (ACD), lens thickness (LT), ACD/axial length (AXL), LT/AXL, and relative lens position (RLP) were significantly larger for the 25 eyes of the 21 patients with APACG than the 21 eyes of the 16 age-matched normal persons (P<0.05). After selecting cataract extraction with IOL implantation, improved biometric measurements and clinical findings revealed the effectiveness of that operation. CONCLUSIONS: Selected cataract extraction with IOL implantation could be successful as primary surgery in APACG accompanied by senile cataract over intraocular pressure control and visual acuity improvement for lens factor removal of APACG.

Efficacy and safety of anterior chamber paracentesis in treatment of acute primary angle-closure glaucoma:report of 327 cases / 第三军医大学学报

Objective To study the safety and effectiveness of anterior chamber paracentesis,combined with antiglaucomatous medications,in the intraocular pressure control and relief of symptoms of acute primary angle-closure glaucoma(PACG).Methods Totally 327 patients with first attack of acute PACG who were admitted in our hospital during July 2000 and October 2006 were collected in this study,and were divided into 2 groups according to whether receiving anterior chamber paracentesis or not(paracentesis group and control).Their clinical data such as sex,age,intraocular pressure(IOP) and visual acuity before hospitalization,types and times of administration of IOP drugs before and after operation,preparative time for operation and postoperative complications were retrospectively analyzed.Results There were 94 out of 327 patients receiving anterior chamber paracentesis,who had faster intraocular pressure control(2.37?1.63 d vs 2.75?2.01 d),and lesser types and dosages and shorter times of IOP drugs,shorter therapeutic time after paracentesis,shorter time to prepare operation,lesser postoperative complications [shallow anterior chamber,12 cases(12.77%) vs 57 cases(24.46%)] and better visual acuity than control.Anterior chamber paracentesis more than one time didn't increase the risk of complications.Conclusion Anterior chamber paracentesis is safe and effective in controlling the intraocular pressure and eliminating symptoms in acute PACG.

Long-term Intraocular Pressure Outcome after Successful Laser Iridotomy for the Acute Primary Angle-closure Glaucoma

PURPOSE: To evaluate the long-term outcome of intraocular pressure (IOP) after successful laser peripheral iridotomy in the eyes with acute primary angle-closure glaucoma. METHODS: Retrospective study of 45 eyes of 40 consecutive patients with acute primary angle-closure glaucoma was performed. After successful laser peripheral iridotomy, the subsequent long-term (at least 6 months) IOP outcome was analyzed. Re-elevation of IOP on follow-up was defined as IOP greater than 21 mmHg requiring medications or surgery. RESULTS: Thirty-two eyes (71.1%) of 45 eyes were successfully treated without additional treatment in the long-term follow-up. However, re-elevation of IOP developed in 13 eyes (28.9%) on follow-up, of which 5 eyes (11.1%) eventually underwent trabeculectomy. Sex and age of the patient, duration of acute symptoms and level of IOP were not the risk factors. CONCLUSIONS: Although the laser peripheral iridotomy has been known to be effective in initial treatment of acute primary angle-closure glaucoma, close monitoring of IOP is recommended in the long-term follow-up.