Medium-long-term efficacy of trabeculectomy in the treatment of pigmentary glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To observe the medium-long-term efficacy of trabeculectomy in the treatment of pigmentary glaucoma(PG).METHODS: The clinical data of 38 patients(51 eyes)who were diagnosed with PG and received trabeculectomy at the Affiliated Hospital of Yunnan University from January 2010 to September 2022 were retrospectively analyzed. The postoperative follow-up ranged from 3 to 144mo. The intraocular pressure(IOP), visual acuity and refractive status were analyzed, complications were recorded and surgical efficacy was evaluated.RESULTS: The average preoperative use of IOP lowering drugs was 2.90±0.12, with a mean IOP of 18.89±7.40mmHg. The IOP at 3d, 1, 3, 6mo, 1a after surgery and the last follow-up visit were 14.68±5.08, 13.99±2.95, 14.25±2.50, 14.36±2.83, 14.33±2.66, 14.94±1.95mmHg, respectively, and postoperative IOP was significantly lower at all time points than that before surgery(P<0.05), while there was no significant difference at all time points after surgery(P>0.05). During the follow-up period, the visual acuity of all patients was stable, and no endophthalmitis or malignant glaucoma occurred. At the last follow-up, the complete success rate was 90%, the qualified success was 8%, and the failure rate was 2%.CONCLUSION: Trabeculectomy is a safe and effective treatment method for PG, which can effectively control the IOP, and stabilize the visual acuity and relieve the reverse pupil block.

Comparison of anterior chamber angle parameters and iris structure of juvenile open-angle glaucoma and pigmentary glaucoma

Purpose: To compare the quantitative measurements of the anterior chamber angle (ACA) and iris parameters in patients with juvenile open?angle glaucoma (JOAG), pigmentary glaucoma (PG), and healthy controls using anterior segment optical coherence tomography (AS?OCT). Methods: This was a retrospective, cross?sectional study of 25 eyes with JOAG, 25 eyes with PG, and 25 control eyes. Anterior chamber depth, angle?opening distance 500 and 750, trabecular–iris space 500 and 750, scleral spur angle, iris thickness (IT, measured at the thickest part), and iris bowing were obtained using AS?OCT (Visante” OCT 3.0 Model 1000, Carl Zeiss Meditec, Inc). Results: The quantitative ACA parameters were found to be significantly higher in JOAG and PG patients compared to healthy controls (P < 0.001); there was no significant difference between the eyes with JOAG and PG (P > 0.05). In eyes with JOAG and PG, there was significantly backward bowing of the iris in temporal and nasal angles compared to control subjects (P < 0.001). Median iris bowing was not significantly different between the patients with JOAG and PG (P > 0.05). The temporal and nasal angle iris thickness were significantly thinner in eyes with JOAG than the eyes with PG (P < 0.001) and age?matched control subjects (P < 0.001). The median IT did not differ between the patients with PG and control subjects (P > 0.05). In patients with JOAG, the intraocular pressure (IOP) was inversely correlated with IT (r = ?0.43, P < 0.05). Conclusion: AS?OCT provided quantitative data on the ACA and iris parameters in JOAG and PG. The evaluation of the ACA and iris structures using AS?OCT revealed higher ACA measurements and posterior bowing of the iris in patients with JOAG and PG. Furthermore, the patients with JOAG were found to have thinner IT than the ones with PG and healthy controls

A Case of Pigmentary Glaucoma Due to Multidrug-Resistant Tuberculosis Treatment

PURPOSE: To report a case of secondary pigmentary glaucoma due to clofazimine treatment for extensive drug-resistant tuberculosis. CASE SUMMARY: A 23-year-old man presented with blurred vision in both eyes. The patient started to take clofazimine for extensive drug-resistant tuberculosis six months prior, after which his facial skin color changed to a dark-brown. Intraocular pressure (IOP) was 50 mm Hg in the right eye and 48 mm Hg in the left eye. Slit lamp examination revealed corneal edema, opacity, and flare in the anterior chamber in both eyes. A color vision test revealed a mild color defect in both eyes. Visual field (VF) test revealed superior temporal VF loss in the left eye. Gonioscopy revealed open angles with high pigmentation in the trabecular meshwork in both eyes. The patient was diagnosed with pigmentary glaucoma, and maximum tolerated medical therapy was performed. However, the IOP was uncontrolled. Trabeculectomy was performed in both eyes. Postoperative IOP was measured to be 12 mm Hg in both eyes without medication, and visual acuity measured 20/22 in the right eye and 20/17 in the left eye. CONCLUSIONS: To the best of our knowledge, this report is the first case of clofazimine being a possible cause of pigmentary glaucoma in a patient with extensive drug-resistant tuberculosis.

A Case of Pigmentary Glaucoma after Posterior Chamber Phakic Intraocular Lens Implantation

PURPOSE: To report a case of secondary pigmentary glaucoma after implantable contact lens (ICL) implantation successfully treated with trabeculectomy without ICL removal. CASE SUMMARY: A 29-year-old woman presented with refractory intraocular pressure (IOP) increase in both eyes. IOP was 22 mm Hg in the right eye and 39 mm Hg in the left eye. The patient received posterior chamber phakic intraocular lens implantation in both eyes 22 months prior. Slit lamp examination revealed patent iridotomy sites in both eyes. Gonioscopy revealed open angles with 4-degree pigment deposits on the trabecular meshwork in both eyes. Ultrasound biomicroscopy examination confirmed contact between ICL and the posterior surface of the iris. In spite of well tolerated medical therapy and selective laser trabeculoplasty, IOP was 46 mm Hg in her left eye. Trabeculectomy was performed in her left eye without ICL removal. At 6 months postoperative, IOP measured 6 mm Hg without any anti-glaucoma medication and bleb was maintained in good condition in the left eye. CONCLUSIONS: The results from this case study indicate that ICL implantation can lead to secondary pigmentary glaucoma and trabeculectomy without ICL removal may help to decrease the IOP.

Síndrome de dispersión pigmentaria versus glaucoma pigmentario: [revisión] / Pigmentary dispersion syndrome and pigmentary glaucoma: [review]

El glaucoma pigmentario es el más frecuente de los glaucomas secundarios. Se presenta en pacientes jóvenes durante la tercera o cuarta década de la vida y el diagnóstico se realiza en una etapa de daño glaucomatoso avanzado con graves secuelas visuales, por lo que genera un gran impacto social. El propósito de este trabajo es realizar una actualización del tema a fin de perfeccionar el manejo y el tratamiento del síndrome de dispersión pigmentaria/glaucoma pigmentario, e incidir satisfactoriamente en la evolución de los pacientes.

Pigmentary glaucoma is the most frequent of secondary glaucoma. It occurs in young patients in the third or fourth decade of life and the diagnosis is made in an advanced stage of glaucomatous damage with serious visual sequelae and a great social impact. The purpose of this paper was to update this topic in order to improve the management and treatment of pigmentary dispersion syndrome and pigmentary glaucoma, and to have a positive effect on the recovery of these patients.

A Case of Iridocorneal Endothelial Syndrome with Pigmentary Glaucoma

PURPOSE: To report a case of iridocorneal endothelial syndrome with pigmentary glaucoma. METHODS: We encountered a 44-year-old unilateral glaucoma patient who complained of intermittently decreased visual acuity in the right eye. For differential diagnosis, we carried out ophthalmic and systemic examination. RESULTS: Binocular corrected visual acuity was 1.0. His intraocular pressure, measured using a Goldmann applanation tonometer, was 50 mm Hg in the right eye and 18mm Hg in the left. Upon examination of the right eye, we found pigments with a Krukenberg's spindle appearance on the corneal endothelium, peripheral anterior synechia extending beyond Schwalbe's line, trabecular hyperpigmentation, endothelial pleomorphism, polymegathism, cell loss, dark area within the cells, a light central spot and light peripheral zone, retinal nerve fiber layer defects, and visual field defects, which together led to the diagnosis of iridocorneal endothelial syndrome with pigmentary glaucoma. We observed progressed glaucomatous injury upon examination of the disc stereo photograph, retinal nerve fiber layer photograph, and visual field test, even though we used topical IOP reducers. Eventually, we performed a trabeculectomy in the right eye. CONCLUSIONS: We experienced a case of iridocorneal endothelial syndrome with unilateral pigmentary glaucoma. The glaucoma was not well-controlled with topical IOP reducers. The glaucoma was then treated by a trabeculectomy. We report this case with a review of the literature.

IOP and Gonioscopic Changes after Implantable Contact Lens Implantation in Myopic Eyes

PURPOSE: To evaluate the effects of ICL implantation on angle structures, intraocular pressure (IOP) and pupil diameter. METHODS: A Staar implantable contact lens (ICL) was implanted in 81 eyes of 43 patients with spherical equivalent over -6D. Gonioscopy was done 1 day after laser iridotomy and 6 months after ICL implantation and postoperative changes in gonioscopic findings were evaluated. Also IOP and pupil diameter were examined. RESULTS: There were occlusion or narrowing of the LI opening site in 10 eyes (12.3%). Width of angle was wide over 30 degrees in all cases but that was narrowed under 20 degrees in 16 eyes (19.8%) at postoperative 6 months. The mean pigmentation was 2.11 in inferior, 0.47 in nasal, 0.22 in temporal and 0.18 in superior angle at 6 months postoperatively by semiquantitative method (Grade 0~4). There was decrease of pigmentation in nasal and temporal angle but no change in inferior and superior angle after ICL implantation. There was temporary increase of IOP at 1 week and 1 month postoperatively due to steroid eye drops but returned to preoperative level and maintained until the 6 months postoperatively. There was significant decrease of pupil diameter at postoperative 1 and 3 months but returned to the preoperative level at postoperative 6 months. There was no evidence of pigment dispersion syndrome and pigmentary glaucoma. CONCLUSIONS: ICL implantation caused the narrowing of width of angle but did not increase trabecular pigmentation. We expect that ICL implantation is safe about pigment dispersion syndrome and pigmentary glaucoma.