SD-OCT assessment and visual field changes 1 year or more after a single episode of unilateral acute primary angle closure / Avaliação do SD-OCT e mudanças do campo visual 1 ano ou mais após episódio único de fechamento angular primário agudo unilateral

ABSTRACT Objective: To evaluate structural and visual field (VF) changes after ≥1 year of a single acute primary angle closure (APAC) attack using spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP). Methods: Patients with a single unilateral APAC crisis at least 1 year ago were included consecutively from 2013 to 2016. Contralateral eye was used as control. All patients underwent ophthalmic examination, RNFL imaging by SD-OCT, and SAP using Octopus 1-2-3. Results: 54 eyes (27 patients) were enrolled. Male-to-female ratio was 1:2. Mean time for the SD-OCT and SAP assessment after the crisis was 5.0±5.1 (1.0-23.5) years, and IOP was 52.5±9.8 mmHg. In APAC eyes, the thicknesses of all quadrants of peripapillary RNFL (36.3%; P<0.001) and some macular sections (from 2.1% to 4.7%; P<0.01) were reduced compared to contralateral eyes. Additionally, in APAC eyes, the mean defect on VF was negatively and statistically correlated with the reduction of all quadrants of peripapillary RNFL thickness. Conclusion: A single episode of APAC was associated with peripapillary RNFL and macular thickness and with VF defects after ≥1 year of the crisis in the affected eye. Statistically meaningful correlations were found between structural and functional damage.

RESUMO Objetivo: Avaliar alterações estruturais e do campo visual 1 ano ou mais após uma crise única de fechamento angular primário agudo utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada. Métodos: Pacientes que apresentaram crise unilateral única de fechamento angular primário agudo há pelo menos 1 ano foram consecutivamente incluídos entre 2013 e 2016. Os olhos contralaterais foram utilizados como controles. Todos os pacientes foram submetidos a exame oftalmológico, avaliação das camadas de fibras nervosas da retina utilizando tomografia de coerência óptica de domínio espectral e perimetria automatizada padronizada com o Octopus 1-2-3. Resultados: Foram incluídos 54 olhos (27 pacientes) com razão homem:mulher de 1:2. O tempo médio após a crise foi de 5,0±5,1 anos (1,0 a 23,5) e a pressão intraocular na crise foi 52,5±9,8mmHg. Nos olhos com fechamento angular primário agudo, todas as espessuras das camadas de fibras nervosas da retina peripapilares (36,3%; p<0,001) e de algumas seções maculares (de 2,1 a 4,7%; p<0,01) estavam reduzidas em comparação aos olhos contralaterais. Além do mais, nos olhos submetidos a fechamento angular primário agudo, o mean defect do campo visual foi estatisticamente e negativamente correlacionado com a redução da espessura de todos os quadrantes peripapilares da camada de fibras nervosas da retina. Conclusão: Um único episódio de fechamento angular primário agudo foi associado com redução na espessura da camada de fibras nervosas da retina peripapilar e da espessura macular e com defeitos de campo visual 1 ano ou mais após a crise no olho afetado. Correlações estatisticamente significativas foram identificadas entre danos estruturais e funcionais.

Influence of Biometric Variables on Refractive Outcomes after Cataract Surgery in Angle-closure Glaucoma Patients

PURPOSE: To evaluate the influence of biometric variables on refractive outcomes after cataract surgery in angle-closure glaucoma (ACG) patients. METHODS: In this case-control study, 42 ACG patients, 40 open-angle glaucoma (OAG) patients, and 35 controls without glaucoma who had undergone conventional cataract surgery were enrolled consecutively. Electronic medical records, including preoperative biometric variables (keratometric diopter, axial length, anterior chamber depth, and lens thickness), the refractive change (RC), and the absolute value of refractive change (ARC) were reviewed. RESULTS: In the control and OAG patients, the anterior chamber depth was negatively correlated with the ARC (r = -0.344, p = 0.043 and r = -0.431, p = 0.006, respectively), whereas there was no correlation in the ACG patients. Lens thickness was positively correlated with the RC, but not with the ARC, in the control and OAG groups (r = 0.391, p = 0.020 and r = 0.501, p = 0.001, respectively). In contrast, lens thickness in the ACG group was not correlated with the RC but was positively correlated with the ARC (r = 0.331, p = 0.032). CONCLUSIONS: In contrast with the anterior chamber depth, preoperatively measured lens thickness may be a useful predictor of the direction of the RC after cataract surgery in control and OAG patients. However, in ACG patients, a thicker lens was correlated with a larger RC, regardless of the direction of the shift (hyperopic or myopic).

Delayed Non-arteritic Anterior Ischemic Optic Neuropathy Following Acute Primary Angle Closure

No abstract available.

Delayed Non-arteritic Anterior Ischemic Optic Neuropathy Following Acute Primary Angle Closure

No abstract available.

Cierre angular agudo bilateral inducido por benzodiazepinas / Bilateral acute angle closure induced by benzodiazepins

El cierre angular agudo o glaucoma agudo como es conocido mundialmente es un cuadro clínico característico producido por un cierre angular brusco, constituye una urgencia oftalmológica que pone en peligro la función visual si no es resuelto satisfactoriamente en las primeras horas de instaurado. El mecanismo fisiopatológico más frecuente es el bloqueo pupilar primario y el tratamiento de elección es la iridotomía láser periférica. Se debe realizar el diagnóstico diferencial con el bloqueo pupilar secundario y con otras causas sin bloqueo pupilar en las que la iridotomía no es suficiente. El cierre angular agudo es generalmente unilateral aunque se puede presentar de forma bilateral desencadenado por el empleo de drogas que producen dilatación pupilar como en el caso clínico que se describe a continuación

The acute angle closure or acute glaucoma as it is worldwide known is a characteristic clinical picture that is caused by sudden angle closure, It represents ophthalmological emergency that endangers the visual function if not satisfactorily solved in the first hours of occurrence. The most frequent physiopathological mechanism is primary pupil blocking and the treatment of choice is peripheral laser iridotomy. The differential diagnosis must be made with the secondary pupil blocking and with other causes without pupil blocking in which iridotomy is not enough. The acute angular closure is generally unilateral, although it may appear bilaterally and be caused by the use of drugs that give rise to pupil dilation like the clinical case which was described here

Síndrome endotelial iridocorneal: reporte de un caso / Iridocorneal endothelial syndrome: report of a case

Se presenta un caso clínico en el municipio Cristóbal Rojas, estado Miranda, República Bolivariana de Venezuela, con el diagnóstico de síndrome endotelial iridocorneal (atrofia esencial de iris) en un paciente del sexo masculino, con una buena evolución de su cuadro clínico, controlado solo con hipotensores oculares. Este síndrome se observa en el sexo femenino fundamentalmente, y es una entidad poco frecuente, no solo dentro de las enfermedades oftalmológicas sino también dentro del grupo de los glaucomas, y de muy mal pronóstico.

We present a clinical case from the municipality Cristobal Rojas, Miranda State, Bolivarian Republic of Venezuela, with the diagnostic of iridocorneal endothelial syndrome (the iris essential atrophy) in a male patient, with a good evolution, only controlled with ocular hypotensors. This syndrome is observed mainly in the female genre, and it is a little frequent entity, not only among the ophthalmologic diseases but also among the glaucoma group. It has a very bad prognosis.

Bilateral nonarteritic anterior ischemic neuropathy following acute angle-closure glaucoma in a patient with iridoschisis: case report / Neuropatia óptica isquêmica anterior não arterítica bilateral após crise de fechamento angular num paciente com iridosquise: relato de caso

A 55-year-old woman was referred to our clinic because of a one-week history of visual loss and raised intraocular pressure in the left eye followed 4 days later by visual loss in the right eye. Slit-lamp examination showed bilateral conjunctival hyperemia, slight diffuse corneal edema, shallow anterior chamber and fixed and dilated pupil in both eyes. Splitting of the anterior layers of the iris with fibrillar degeneration extending for approximately one quadrant inferiorly was presented in each eye. Fundus examination showed opitc disc edema with no vascular tortuosity and no cup in both eyes. The condition was treated as bilateral acute angle-closure glaucoma in a patient with irisdoschisis. After medical treatment and improvement of visual acuity, perimetry revealed a significant visual field defect especially in left eye; this case represents a rare concurrence of acute angle-closure glaucoma and bilateral nonarteritic ischemic optic neuropathy. Although most cases of elevated intraocular pressure, including acute angle-closure glaucoma, do not result in optic disc edema and irreversible vision loss, variations in the vascular supply of the nerve optic head along with others ocular systemic risk factors, may predispose certain individuals to nonarteritic ischemic optic neuropathy during periods of elevated intraocular pressure.

Paciente de 55 anos, sexo feminino, encaminhada para nosso serviço com história de perda de visão e aumento da pressão intraocular no olho esquerdo há uma semana seguida quatro dias após de perda visual no olho direito. À biomicroscopia hiperemia conjuntival bilateral, edema difuso da córnea, câmara anterior rasa e pupilas fixas e dilatadas em ambos os olhos. Separação do folheto anterior da íris no quadrante inferior estava presente em ambos os olhos. O exame do fundo do olho mostrava edema de disco sem tortuosidade vascular e sem escavação em ambos os olhos. O quadro clínico foi tratado como crise de fechamento angular bilateral num paciente com iridosquise. Após tratamento clínico e iridotomia bilateral com melhora da acuidade visual, a perimetria computadorizada revelou grave perda de campo visual, especialmente no olho esquerdo; este caso representa a rara ocorrência simultânea de crise de fechamento angular e neuropatia óptica isquêmica anterior não-arterítica bilateral. Embora a maioria dos casos com pressão intraocular elevada, incluindo crise de fechamento angular, não resulta em edema de disco e perda visual irreverssível, variações no suprimento vascular da cabeça do nervo óptico associados com outros fatores de risco sistêmicos, podem predispor certos indivíduos à neuropatia óptica isquêmica anterior durante períodos de elevação da pressão intraocular.

Accuracy of Intraocular Lens Power Calculation Formulas in Primary Angle Closure Glaucoma

PURPOSE: To compare the accuracy of intraocular lens (IOL) power calculation formulas in eyes with primary angle closure glaucoma (ACG). METHODS: This retrospective study compared the refractive outcomes of 63 eyes with primary ACG with the results of 93 eyes with normal open angles undergoing uneventful cataract surgery. Anterior segment biometry including anterior chamber depth, axial length, and anterior chamber depth to axial length ratio were compared by the IOL Master. Third generation formulas (Hoffer Q and SRK/T) and a fourth generation formula (Haigis) were used to predict IOL powers in both groups. The predictive accuracy of the formulas was analyzed by comparison of the mean error and the mean absolute error (MAE). RESULTS: In ACG patients, anterior chamber depth and the anterior chamber depth to axial length ratio were smaller than normal controls (all p < 0.05). The MAEs from the ACG group were larger than that from the control group in the Haigis formula. The mean absolute error from the Haigis formula was the largest and the mean absolute error from the Hoffer Q formula was the smallest. CONCLUSIONS: IOL power prediction may be inaccurate in ACG patients. The Haigis formula produced more inaccurate results in ACG patients, and it is more appropriate to use the Hoffer Q formula to predict IOL powers in eyes with primary ACG.

Anterior ischemic optic neuropathy precipitated by acute primary angle closure.

A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION) apparently precipitated by bilateral sequential acute primary angle closure. NAION is very rarely reported in association with raised intraocular pressure. In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding. Possible reasoning for these observations is discussed.

Plateau iris configuration in eyes with narrow-angle: an ultrasound biomicroscopic study / Configuração da íris em platô em olhos com seio camerular estreito: um estudo ultrabiomicroscópico

PURPOSE: To investigate, through ultrasound biomicroscopy images, the presence of plateau iris configuration in eyes with narrow-angle from patients with open-angle glaucoma and in eyes with previous acute primary angle-closure and compare the biometric features of eyes with plateau iris configuration with those of normal eyes. METHODS: Ultrasound biomicroscopic images from 196 patients with open-angle glaucoma and narrow-angle and 32 patients with acute primary angle-closure were retrospectively analyzed. The inclusion and specific criteria for the diagnosis of plateau iris configuration was the presence of an anterior positioning of the ciliary processes, supporting the peripheral iris so that it was parallel to the trabecular meshwork; the iris root had a steep rise from its insertion point, followed by a downward angulation from the corneoscleral wall; presence of a central flat iris plane; an absent (complete plateau iris configuration) or partially absent (incomplete plateau iris configuration) ciliary sulcus. The ultrasound biomicroscopic parameters were compared between complete and incomplete plateau iris configuration. The same parameters of both groups were compared with those of normal eyes. The following measurements were performed: anterior chamber depth; angle opening distance at 500 µm from the scleral spur; peripheral iris thickness at 500 µm from the scleral spur; iris-ciliary process distance; trabecular-ciliary process distance and angle recess area. RESULTS: Plateau iris configuration was found in 33 eyes of 20 (10.2 percent) out of 196 patients with open-angle glaucoma and narrow-angle and in 4 eyes of 2 (6.3 percent) out of 32 patients with acute primary angleclosure. Seventeen (77.3 percent) patients with plateau iris configuration were female and 5 (22.7 percent) male. Twenty-three (62.2 percent) out of 37 eyes had complete plateau iris configuration, and 14 (37.8 percent) had incomplete plateau iris configuration. ...

OBJETIVO: Investigar, através de imagens de biomicroscopia ultrassônica, a presença de configuração da íris em platô em olhos com seio camerular estreito em portadores de glaucoma primário de ângulo aberto e em olhos com fechamento angular primário agudo. Avaliar as características biométricas nestes olhos, comparando-os a olhos normais. MÉTODOS: As imagens de biomicroscopia ultrassônica foram analisadas retrospectivamente, sendo que 196 pacientes eram portadores de glaucoma primário de ângulo aberto e 32 pacientes eram portadores de fechamento angular primário agudo. O critério de inclusão para configuração da íris em platô baseado em imagens de biomicroscopia ultrassônica foi definido pela presença de corpo ciliar posicionado anteriormente, íris acentuadamente angulada em seu ponto de inserção seguida de uma angulação descendente a partir da parede corneoescleral, íris central plana e sulco ciliar ausente (configuração da íris em platô completa) ou parcialmente ausente (configuração da íris em platô incompleta). Os parâmetros biométricos medidos pela biomicroscopia ultrassônica foram comparados entre os olhos com configuração da íris em platô completa e incompleta. Os mesmos parâmetros de ambos os grupos foram comparados com os de olhos normais. Foram medidos: profundidade central da câmara anterior; a distância da abertura do ângulo a 500 µm do esporão escleral; a espessura da íris a 500 µm do esporão escleral; a distância íris-processo ciliar, a distância faixa trabecular-processo ciliar e a área de recesso angular. RESULTADOS: A configuração da íris em platô foi encontrada em 33 olhos de 20 pacientes portadores de glaucoma primário de ângulo aberto (10,2 por cento de um total de 196) e 4 olhos de 2 pacientes portadores de fechamento angular primário agudo (6,3 por cento de um total de 32). Dezessete (77,3 por cento) eram do sexo feminino e 5 (22,7 por cento) do sexo masculino. Dos 37 olhos, 23 (62,2 por cento) apresentaram configuração ...

Association of primary glaucomas with retinal vein occlusion.

AIMS AND OBJECTIVES: To determine the association of Primary glaucoma with retinal vein occlusion. METHODOLOGY: A prospective cross-sectional study was carried out in B.P. Koirala Lions Centre for Ophthalmic Studies from April 2002-July 2003. All diagnosed cases of retinal vein occlusion were evaluated in detail for the presence of primary glaucoma. Detailed history was taken. Best corrected visual acuity was recorded, slit-lamp evaluation of anterior segment was performed, intraocular pressure was assessed with the help of applanation tonometer, gonioscopy was done and fundus evaluation was done under full mydriasis. RESULTS: Out of 50 patients, 19 (38%) were central retinal vein occlusion and 31(62%) were branch retinal vein occlusion. Majority of the retinal vein occlusion patients were in the age group of (61-70 years) 12 out of 50 patients (24%). There were 12 patients of primary glaucoma in 50 patients of retinal vein occlusion. Out of which 11 patients had primary open angle glaucoma and 1 patient had primary angle closure glaucoma. CONCLUSION: This study shows association of primary glaucoma as a risk factor of retinal vein occlusion. Evaluation of retinal vein occlusion patients for primary glaucoma would be worthwhile for early detection and prevention of blindness.

Angle closure glaucoma: a cause for bilateral visual threat.

Glaucoma is one of the leading causes of blindness worldwide. Primary angle closure glaucoma (PACG) is a leading cause ofblindness in East Asian people and known to cause bilateral blindness more frequently than other glaucoma. A retrospective study was thus undertaken to see the visual profile among these cases attending glaucoma unit. Total of 387 cases of angle closure glaucoma were seen in 3 years period. Out of these, 278 (71.8%) were females and 109 were males (28.2%). Among total cases, 61.5% had chronic angle closure glaucoma (CACG) and 38.5% had acute angle closure glaucoma (AACG) in one or both eyes. Bilateral angle closure attack was encountered simultaneously in 16 of the total acute angle closure cases accounting for 10.7%. Vision evaluation at the time of diagnosis among chronic angle closure glaucoma revealed blindness in 97 patients accounting for 20.4%. In acute glaucoma cases, after breaking the acute attack, the prevalence of blindness was found to be 8.9% out of total cases. Bilateral blindness was seen in 17.6% of total cases presented with either acute attack or chronic glaucoma. Mean intraocular pressure (IOP) was 32 mmHg (SD = 9.456) and 44 mmHg (8.67) in CACG and AACG respectively. Cataract was associated in 15.1% of CACG and 12.8% of AACG. Cataract related blindness was presumed to be present in only 4.1% cases of CACG and 14.3% of AACG cases who were blind. (p = < 0.001) Angle closure glaucoma is the frequent cause of bilateral blindness.

Choroidal effusion following laser peripheral iridotomy for the treatment of angle closure glaucoma in a patient with nanophthalmos.

We report a case of Nanophthalmos with choroidal effusion and retinal detachment following a peripheral laser iridotomy for the treatment of angle closure glaucoma. Angle closure glaucoma was diagnosed in the right eye of the patient after finding an elevated intraocular pressure and narrow angles on gonioscopy. The glaucoma was treated by lowering the intraocular pressure medically followed by laser peripheral iridotomy. The first day after a laser peripheral iridotomy, choroidal effusion was noticed that was followed by an exudative retinal detachment within a week. The medical and laser therapies for the lowering of intraocular pressure for the treatment of angle closure glaucoma in patients with nanophthalmos can be associated with choroidal effusion, retinal detachment and loss of vision.

Crisis de glaucoma agudo durante una laparotomía con el uso de anestesia general / Crisis of acute glaucoma during a laparotomy with general anesthesia

Se reporta el caso de una paciente del sexo femenino de 56 años de edad a la que se le realizó laparotomía con anestesia general orotraqueal con tiopental, succinilcolina, halotane, óxido nitroso y oxígeno sin que se observaran complicaciones inmediatas. A las 48 horas presentó el cuadro clínico correspondiente a un glaucoma agudo y, que por no ceder al tratamiento medicamentoso, se le realizó iridectomía periférica con anestesia local. En el análisis de los antecedentes patológicos familiares relacionados con la intervención quirúrgica para apendicectomía y de los medicamentos utilizados, se llegó a la conclusión de que la existencia de historia familiar de glaucoma en esta paciente, unida a la maniobra de laringoscopia, al uso de succinilcolina y la atropina fueron factores que de forma individual o asociados contribuyeron al ataque de glaucoma agudo

Angle closure glaucoma in nanophthalmos and pigmentary retinal dystrophy: a rare syndrome.

The simultaneous occurrence of nanophthalmos, angle closure glaucoma and pigmentary retinal dystrophy documented in the present case represents a rare syndrome.

Glaucoma primário de ângulo fechado em olho com miopia patológica (myopia vera) / Primary angle-closure glaucoma in a patient with pathologic myopia (myopia vera)

Os autores relatam o caso de uma paciente de 55 anos, que sofreu uma crise aguda de glaucoma primário no OD, apesar de apresentar miopia patológica comprovada pela ecobiometria e pelos achados ecográficos e fundoscópicos. Discutem os mecanismos etiopatogênicos da crise aguda de glaucoma na alta miopia e sugerem tratar-se de uma síndrome de iserçäo anômala anterior do cristalino, tendo em vista a ausência de alteraçöes facomórficas e facotópicas. Enfatizam ser este, ao que parece, o primeiro relato da literatura de miopia patológica (myopia vera) com fechamento primário do seio camerular

Síndrome de íris de platô / Plateau iris syndrome

Sindrome de íris em platô é uma forma de glaucoma primário de ângulo fechado, devido a uma conformaçäo anatômica do ângulo da câmara anterior que se apresenta estreito, suscetível ao fechamento angular sem bloqueio pupilar. O diagnóstico sindrômico só é comprovado na ocorrência de fechamento angular em midríase, mesmo após realizaçäo de iridectomia. O tratamento indicado é pilocarpina, ou iridoplastia periférica (gonioplastia) com laser de argônio

Pseudoexfoliation syndrome: case report and review of clinical features

Pseudoexfoliation syndrome is characterized by the presence of gray-white flakes on the pupillary borders and anterior lens capsule, increased trabecular meshwork pigmentation, and association with glaucoma. We describe 3 patients with this syndrome seen at Asan Meidcal Center Department of Ophthalmology in 1989, and we focus on their clinical features and management. We believe that patients with this syndrome are not as rare in Korea as has been thought, judging by scant report of cases in the past.

Recent views and techniques for surgery of late cases of acute congestive closed angle glaucoma [with extensive peripheral anterior synechiae] whether primary or due to intumescent senile cataract

If compression gonioscopy shows presence of extensive peripheral anterior synechiae, the treatment of late cases of acute closed angle glaucoma whether primary or due to intumescent cataract must be changed to the recent views. Ten cases of each group of late acute closed angle glaucoma: 1. of primary type 2. due to intumescent cataract, were operated upon by described technique and followed for five years showed one hundred per cent success as regards normalization of ocular tension and improved visual acuity