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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.
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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&#x003C;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&#x003C;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&#x003C;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.
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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.
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@#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.
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@#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><sup>2</sup>=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.
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@#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.
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@#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.
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@#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.
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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.
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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.
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Humans , Decompression , Eye , Fingers , Glaucoma, Angle-Closure , Hemorrhage , Intraocular Pressure , Retina , Retinal Hemorrhage , Visual AcuityABSTRACT
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.
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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.
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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.