Angle-closure glaucoma associated with vitreous prolapse after neodymium-doped yttrium-aluminum-garnet laser posterior capsulotomy

ABSTRACT Capsulotomy with neodymium-doped yttrium--aluminum-garnet (Nd:YAG) laser is an effective treatment for posterior capsule opacification following cataract surgery. A wide opening of the posterior capsule associated with the ruptured anterior hyaloid can cause anterior chamber vitreous prolapse. Two patients who developed angle-closure glaucoma associated with vitreous prolapse following Nd:YAG laser posterior capsulotomy were successfully treated with antiglaucoma medication and peripheral iridotomies. Patient identification for potential risk factors and a careful postoperative follow-up are essential to avoid these serious complications.

Glaucoma suspects referred by general ophthalmologists to a tertiary center in Brazil: outcomes of the glaucoma specialist assessment / Suspeitos de glaucoma encaminhados do oftalmologista geral para um centro terciário no Brasil: resultados da avaliação do especialista em glaucoma

ABSTRACT Purpose: To characterize patients with suspected glaucoma who were referred to the clinic for suspected glaucoma in a tertiary public hospital in southern Brazil and to evaluate differences in functional and structural damages between patients diagnosed with different types of glaucoma, those with normal eye examination results, and those who remained as glaucoma suspects. Methods: This is a cohort study of patients referred by general ophthalmologists to the clinic for suspected glaucoma at Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, between March 2016 and December 2018. The patients were followed up until they had undergone reliable examinations (eye examination, visual field screening, and optic coherence tomography for classification as normal and having a suspected glaucoma, glaucoma with an elevated intraocular pressure, normotensive glaucoma, or ocular hypertension. Results: A total of 135 patients were included in this study. Of the patients, 117 subjects completed all examinations and met the inclusion criteria. Most patients were normal (36.8%), followed by those with suspected glaucoma (25.64%), normal tension glaucoma (18.8%), glaucoma with elevated intraocular pressure (12%), and ocular hypertensive (6%). The main reason for referral was increased optic nerve head cupping. The patients with normal tension glaucoma were older than the other subjects on average (p=0.03). In addition, the normal tension glaucoma group had a significantly worse baseline visual field index and mean deviation of the visual field than the normal, glaucoma suspect, and ocular hypertensive groups. The circumpapillary retinal nerve fiber layer on OCT was thinner on average in the normal tension glaucoma group than in the normal and glaucoma suspect groups (p<0.002) but did not significantly differ between the glaucoma group with elevated intraocular pressure and the other groups. Conclusions: Patients with normal tension glaucoma tend to be diagnosed later because of their normal intraocular pressures; thus, the optic nerve cupping must be greater to raise the suspicion of glaucoma. In this study, we found that the patients with normal tension glaucoma had worse disease at the time of diagnosis.

RESUMO Objetivo: Caracterizar a população com suspeita de glaucoma encaminhada a um centro público terciário no sul do Brasil e avaliar diferenças no dano dos parâmetros funcionais e estruturais entre os pacientes diagnosticados com diferentes tipos de glaucoma e aqueles classificados como normais e aqueles mantidos como suspeitos de glaucoma. Métodos: Esta é uma coorte dos pacientes encaminhados para o setor de glaucoma suspeito do Hospital Nossa Senhora da Conceição, Porto Alegre - BR, no período de março de 2016 a dezembro de 2018. Os pacientes foram acompanhados até obterem exames confiáveis (exame oftalmológico completo, campimetria visual, tomografia de coerência óptica) para serem classificados como: normal, glaucoma suspeito, glaucoma com pressão intraocular elevada, glaucoma de pressão normal ou hipertenso ocular. Resultados: Um total de 135 pacientes foram incluídos neste estudo, sendo que destes, 117 pacientes completaram todos os exames e foram incluídos neste estudo. A maioria dos pacientes foi considerada normal (36,8%), seguido por glaucoma suspeito (25,64%), glaucoma de pressão normal (18,8%), glaucoma com pressão intraocular elevada (12%) e hipertensão ocular (6%). A principal razão para encaminhamento foi escavação do nervo óptico aumentada. Pacientes com glaucoma de pressão normal eram em média mais velhos que os demais (p=0,03). Esses também apresentavam índice de campo visual e desvio médio da campimetria visual piores que sujeitos normal, com suspeita de glaucoma e hipertensos oculares, e tinham a camada de fibra nervosa medida pela tomografia de coerência óptica mais fina que normais e suspeitos de glaucoma (p<0,002). Os pacientes com glaucoma de pressão elevada não diferiram significativamente dos outros grupos. Conclusão: Pacientes com glaucoma de pressão normal tendem a ser diagnosticados mais tardiamente devido ao fato da pressão intraocular não estar elevada, logo a escavação do disco óptico deve ser maior para gerar a suspeita de glaucoma. Neste estudo, paciente com glaucoma de pressão normal apresentaram doença mais avançada no momento do diagnóstico em comparação com os outros grupos.

Early occurrence of primary angle-closure glaucoma in a patient with retinitis pigmentosa and CRB1 gene variations / Manifestação precoce de glaucoma de ângulo fechado em paciente com retinopatia por mutação no gene CRB1

ABSTRACT We describe the case of a 15-year-old girl with decreased visual acuity associated with elevated intraocular pressure in both eyes and angle closure on gonioscopy. She also presented attenuation of retinal vessels and optic disc pallor with large excavation in the left eye. Ultrasound biomicroscopy revealed an anteriorly positioned ciliary body and absence of ciliary sulcus, confirming the plateau iris configuration. Spectral-domain optical coherence tomography revealed a bilateral cystoid macular edema. Genetic screening revealed heterozygous variants of the Crumbs homolog 1 (CRB1) gene (c.2843G>A and c.2506C>A). The patient underwent trabeculectomy for intraocular pressure control and topical treatment for macular edema. This case highlights the importance of performing gonioscopy and evaluating intraocular pressure in patients with a shallow anterior chamber despite young age. In addition, it also shows the importance of genetic screening, when available, in elucidating the diagnosis and providing patients and their families' information on the patient's prognosis and possible therapeutic options.

RESUMO Nós descrevemos um caso de uma paciente de 15 anos com queda de acuidade visual e aumento da pressão intraocular em ambos os olhos, juntamente com fechamento angular no exame de gonioscopia. Na fundoscopia a paciente apresentava atenuação dos vasos retinianos, palidez de disco e aumento de escavação em olho esquerdo. Ao exame da biomicroscopia ultrassônica, foi evidenciado corpo ciliar anteriorizado e ausência de sulco ciliar em ambos os olhos, relevando presença de íris em plateau. Ao exame de tomografia de coerência óptica, visualizamos presença de edema macular cistoide bilateral. O screening genético revelou heterozigose no gene CRB1 (c.2843G>A and c.2506C>A), confirmando o diagnóstico de retinose pigmentar. Este caso reforça a importância do exame de gonioscopia e da avaliação da pressão intraocular em pacientes em câmara rasa, mesmo em pacientes jovens. Além disso, mostra a importância do screening genético como ferramenta útil para elucidação diagnóstica.

Surgical outcome and safety of peripheral iridectomy plus goniosynechialysis and goniotomy in the treatment of advanced primary angle-closure glaucoma / 中华实验眼科杂志

Objective:To evaluate the preliminary effectiveness and safety of surgical peripheral iridectomy (SPI) combined with goniosynechilysis (GSL) and goniotomy (GT) in the treatment of advanced primary angle-closure glaucoma (PACG).Methods:A multicenter observational case series study was performed.Thirty-five eyes of 27 patients with advanced PACG, who underwent SPI+ GSL+ GT with a follow-up of at least 6 months, were included from August 2021 to January 2022 at Zhongshan Ophthalmic Center, Handan City Eye Hospital, Shijiazhuang People's Hospital, West China Hospital of Sichuan University, and the Third Affiliated Hospital of Chongqing Medical University.The mean follow-up time was 9(7, 10) months.Pre- and post-operative best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured with an ETDRS chart and a Goldmann applanation tonometer, respectively.The number of anti-glaucoma medications applied before and after surgery was recorded, and the complications after surgery were analyzed.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg (1 mmHg=0.133 kPa) and 20% reduction from baseline without anti-glaucoma medication or reoperation.Qualified success was defined as achieving criterion of complete success under anti-glaucoma medications.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.2021KYPJ177). Written informed consent was obtained from each subject.Results:The mean preoperative IOP was (30.83±8.87)mmHg, which was significantly decreased to (15.69±3.70)mmHg at 6 months after the surgery ( t=8.588, P<0.001), with a 44.00% (34.78%, 60.00%) decline of 13.00(8.00, 21.00)mmHg.The median number of anti-glaucoma medications was significantly reduced from 2(0, 3) preoperatively to 0 (0, 1) postoperatively ( Z=-3.659, P<0.001). The mean preoperative and postoperative 6-month BCVA were 0.80(0.63, 1.00) and 0.80(0.60, 1.00), respectively, showing no significant difference ( Z=-0.283, P=0.777). Complete surgical success rate was 62.86%(22/35), and the qualified success rate was 91.43%(32/35). Surgical complications mainly included hyphema (6/35), IOP spike (3/35), and shallow anterior chamber (4/35). There was no vision-threatening complication. Conclusions:SPI+ GSL+ GT is preliminarily effective and safe in the treatment of advanced PACG, which provides a new option for PACG.

New understandings of the pathogenesis of primary angle-closure glaucoma / 中华实验眼科杂志

Primary angle-closure glaucoma (PACG) is still one of the common blinding eye diseases in China.Because of the irreversibility of the vision loss it caused, the factors affecting the early development of glaucoma are of great concern.The understanding of static anatomic structure of high-risk anterior segment, such as shallow anterior chamber, short axial length, thick iris and large anterior lens cannot fully explain the transformation process of PACG, so the specific role of dynamic changes in the development of glaucoma should be further considered.This article expounded the differences in iris volume and dynamic process of elasticity between normal people and patients with PACG, the incoordination between lens and intraocular structure during eyeball development, the dynamic block and expansion of ciliary body, vitreous and choroid, and the latest research on the relationship between the abnormal ocular nerve and vascular system adjustment and change with the onset of PACG, in order to provide guidance for understanding the pathogenesis of PACG, accurate clinical diagnosis and formulation of treatment strategies.

Outcomes and safety of phacoemulsification combined with intraocular lens implantation plus goniosynechialysis and goniotomy for advanced primary angle-closure glaucoma / 中华实验眼科杂志

Objective:To evaluate the effectiveness and safety of phacoemulsification cataract extraction combined with intraocular lens implantation (PEI) plus goniosynechilysis (GSL) and goniotomy (GT) for advanced primary angle-closure glaucoma (PACG).Methods:An observational case series study was performed.Fifty eyes of 50 patients with advanced PACG were enrolled in Zhongshan Ophthalmic Center from August 2020 to June 2021.All the patients received PEI+ GSL+ GT and were followed up for over 6 months, with a mean follow-up of 7.5 (6, 10) months.Intraocular pressure (IOP) was measured with a Goldmann applanation tonometer.Best corrected visual acuity (BCVA) was examined with an ETDRS chart and converted to logarithm of the minimum angle of resolution (LogMAR) units for analysis.Types and number of anti-glaucoma medications applied before and after surgery, and the surgical complications were collected.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg (1 mmHg=0.133 kPa) with a reduction of 20% from baseline without anti-glaucoma medication, no vision-threatening complications, no loss of light perception, and no reoperation.Qualified success was defined as an IOP of 5-18 mmHg with a reduction of 20% from baseline with or without anti-glaucoma medication, no vision-threatening complications, no loss of light perception, and no reoperation.This study adhered to the Declaration of Helsinki.This research protocol was approved by an Ethics Committee of Zhongshan Ophthalmic Center (No.2021KYPJ177). Written informed consent was obtained from each subject before entering the cohort.Results:The mean preoperative IOP was (28.81±7.81)mmHg, and the IOP at the end of follow-up was (13.41±4.10)mmHg, showing a statistically significant decrease ( t=12.260, P<0.001). The postoperative IOP was decreased by 13.80 (9.10, 19.40)mmHg, with a percentage decrease of 51.1% (38.6%, 67.1%). The mean preoperative and postoperative BCVA was (0.92±0.11) LogMAR and (0.88±0.10) LogMAR, respectively, and no significant difference was found ( t=-0.560, P=0.580). The number of anti-glaucoma medications was reduced from 2 (1, 3) before operation to 0 (0, 0) after operation.The complete success rate of surgery was 80% (40/50), and the qualified success rate was 94% (47/50). Surgical complications mainly included hyphema in 7 eyes, IOP spike in 7 eyes, and corneal edema in 3 eyes.No vision-threatening complication occurred. Conclusions:PEI+ GSL+ GT is preliminarily effective and safe for advanced PACG by reducing IOP and application of anti-glaucoma medications with few complications.

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.

Acute angle closure triggered by oral benzodiazepines / Fechamento angular agudo desencadeado por uso oral de benzodiazepínicos

ABSTRACT Benzodiazepines are psychoactive drugs that are prescribed worldwide with limited information on their ocular side effects. Acute angle closure glaucoma is an adverse event with a high risk of blinding, especially in the elderly. We report two patients under 45 years old who presented with bilateral acute angle closure secondary to use of two long half-life benzodiazepines (clonazepam and alprazolam). In addition to suspending the use of these medications and administering ocular hypotensive drugs, both patients were successfully treated with bilateral peripheral laser iridotomy. To the best of our knowledge, this is the first report of bilateral acute angle closure secondary to the use of clonazepam and alprazolam.(AU)

RESUMO Os benzodiazepínicos são medicamentos psicoativos prescritos em todo o mundo, mas com poucas informações sobre seus efeitos colaterais oculares. O glaucoma por fechamento agudo do ângulo iridocorneano é um dos eventos adversos com maior risco de cegueira, sendo descrito particularmente em idosos. Relatamos aqui dois pacientes com menos de 45 anos de idade, com fechamento agudo do ângulo bilateral secundário ao uso de dois diferentes benzodiazepínicos de meia-vida longa (clonazepam e alprazolam). Além da suspensão dessas medicações e do tratamento clínico com drogas hipotensoras oculares, ambos os casos alcançaram sucesso com iridotomias periféricas bilaterais à laser. Considerando o conhecimento atual, estes são os primeiros relatos de fechamento agudo do ângulo bilateral secundária ao uso de clonazepam e alprazolam.(AU)

Comparison and significance of scleral cribriform curvature in different types of glaucoma / 中华眼底病杂志

Objective:To observe the differences in scleral lamina curvature (SLC) of patients with pseudoexfoliation glaucoma (PXG), primary open-angle glaucoma (POAG), and primary chronic angle-closure glaucoma (CPACG) were compared and analyzed and their significance was analyzed.Methods:A retrospective clinical study. From June 2017 to December 2020, 30 PXG (PXG group), POAG (POAG group) and CPACG patients (CPACG group) diagnosed at Eye Center of Cangnan County people's Hospital of Zhejiang Province (Cangnan Hospital Affiliated to Wenzhou Medical University) were included in the study. The age difference between the three groups of patients was statistically significant ( t=17.925, P=0.001); gender composition ratio ( χ2=2.158, P=0.276), intraocular pressure ( t=4.993, P=0.078), and axial length ( t=1.956, P=0.532), central corneal thickness ( t=1.407, P=0.724), average visual field defect ( t=2.725, P=0.496), optic disc retinal nerve fiber layer thickness ( t=2.185, P=0.492) in comparison, the differences were not statistically significant ( P>0.05). The frequency-domain optical coherence tomography deep-enhanced imaging (OCT EDI) technology was used to measure the average and 0°, 30°, 60°, 90°, 120°, 150° SLC of the affected eyes, and calculate the SLC index (SLCI) and SL curve depth (SLCD). Quantitative data comparison between groups used independent sample t test. Count data comparison used χ2 test. Univariate and multivariate logistic regression analysis were used for correlation analysis. Results:The results of OCT EDI examination showed that the SLC of eyes with PXG and CPACG was significantly steep, while the SLC of eyes with POAG was relatively flat. Except for the angle of 150°, the other 6 angles of SLCI and SLCD in the PXG group and CPACG group were higher than those in the POAG group, and the differences were statistically significant ( P<0.05). However, there was no statistically significant difference between PXG group and CPACG group for 7 angles of SLCI and SLCD ( P>0.05). Logistic regression analysis showed that the average SLCI [odds ratio (OR)=1.498, 95% confidence interval ( CI) 1.137-2.018, P=0.001], age ( OR=1.074, 95% CI 1.019-1.143, P=0.016) was significantly correlated with PXG; mean SLCI ( OR=1.625, 95% CI 1.192-1.997, P=0.001), intraocular pressure ( OR=1.383, 95% CI 1.106-1.993, P=0.012) was significantly correlated with CPACG. POAG group ( β=0.143, 95% CI 0.032- 0.208, P=0.016), CPACG group ( β=0.132, 95% CI 0.079-0.315, P=0.043) intraocular pressure was correlated with mean SLCI; all factors of PXG group were correlated with SLCI without correlation ( P>0.05). Conclusion:Compared with POAG, the SLC of eyes with PXG and CPACG is steeper and related to disease occurrence.

Factores que influyen en la progresión del cierre angular primario posterior a iridotomía periférica láser / Factors influencing the progression of primary angular closure following Laser peripheral iridotomy

RESUMEN Introducción: los efectos de la iridotomía periférica láser están demostrados, sin embargo, no siempre logra controlar la presión intraocular ni la progresión de la enfermedad por cierre angular primario. Objetivo: analizar los factores que influyen en la progresión de la enfermedad por cierre angular primario de pacientes pinareños tratados con iridotomía periférica láser. Método: se realizó un estudio analítico de cohorte retrospectivo en el servicio de Oftalmología del Hospital General Docente Abel Santamaría, de Pinar del Río, durante el año 2019. El universo estuvo constituido por pacientes con diagnóstico de enfermedad por cierre angular primario tratados con iridotomía periférica láser. La muestra final quedó integrada por 223 ojos de 123 pacientes. El análisis estadístico se realizó con el programa SPSS. Resultados: el 20,6 % de la muestra experimentó progresión de la enfermedad, lo que se relacionó de forma significativa con la forma clínica (p<0,001), la edad (p=0,012), la amplitud de la cámara anterior (p<0,001), el cierre angular residual (p<0,001), la presión intraocular (p<0,001) y la medicación hipotensora (p<0,001). No arrojó diferencias significativas el sexo (p=0,427), el color de la piel (p=0,741) y la longitud axial (p=0,549). Conclusión: los factores que influyen en la progresión de la enfermedad por cierre angular primario de los pacientes pinareños tratados con iridotomía periférica láser estudiados fueron la forma clínica, menor amplitud de la cámara anterior, presencia de cierre angular residual y presión intraocular superior a 18 mmHg con uso de mayor número de colirios hipotensores oculares.

ABSTRACT Introduction: the effects of Laser peripheral iridotomy have been demonstrated; however it does not always manage to control intraocular pressure or the progression of the disease by primary angular closure. Objective: to analyze the factors influencing the disease progression by primary angular closure in Pinar del Rio patients treated with Laser peripheral iridotomy. Methods: a retrospective analytical cohort study was carried out in the Ophthalmology Service at Abel Santamaria Cuadrado General Teaching Hospital in Pinar del Río, during 2019. The target group comprised the patients diagnosed with primary angular closure disease treated with Laser peripheral iridotomy and the final sample consisted of 223 eyes from 123 patients. The statistical analysis was performed with the SPSS program. Results: of the sample (20,6 %) experienced disease progression, which was significantly related to the clinical form (p<0,001), age (p=0,012), anterior chamber amplitude (p<0,001), residual angular closure (p<0,001), intraocular pressure (p<0,001) and hypotensive medication (p<0,001). Sex (p=0,427), skin color (p=0,741) and axial length (p=0,549) did not show significant differences. Conclusions: factors influencing on the progression of the disease by primary angular closure in Pinar del Rio patients who were treated with Laser peripheral iridotomy were: the clinical form, lower anterior chamber amplitude, presence of residual angular closure and intraocular pressure higher than 18 mmHg with the use of more ocular hypotensive eye drops.

Consideraciones quirúrgicas de la facoemulsificación del cristalino en pacientes con cierre angular primario / Surgical considerations of phacoemulsification of the lens in patients with primary angular closure

RESUMEN Introducción: la cirugía del cristalino se considera uno de los métodos quirúrgicos más seguros a nivel mundial. Objetivo: describir las consideraciones quirúrgicas a tener en cuenta para lograr el éxito de la facoemulsificación del cristalino en pacientes con cierre angular primario en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Río. Métodos: se realizó una búsqueda de los principales artículos científicos de los últimos años, así como de la literatura impresa que incluye el tema, siendo seleccionados los contenidos más relevantes para la confección del informe final. Desarrollo: la extracción del cristalino constituye un reto quirúrgico en pacientes con cierre angular primario por las peculiaridades anatómicas, variaciones de la presión intraocular y alteraciones del segmento anterior asociadas. Conclusiones: un detallado examen preoperatorio, una adecuada técnica quirúrgica realizada por un cirujano hábil puede reducir el índice de complicaciones y lograr total éxito.

ABSTRACT Introduction: crystalline lens surgery is considered one of the safest surgical methods in the world. Objective: to describe the surgical considerations to be taken into account to achieve the success of phacoemulsification of the crystalline lens in patients with primary angular closure at Abel Santamaría Cuadrado General Teaching Hospital in Pinar del Río. Methods: literature searching was conducted concerning the main scientific articles of the last years, as well as the printed literature that includes the topic, choosing the most relevant contents for the writing of the final report. Development: the removal of the crystalline constitutes a surgical challenge in patients with primary angular closure due to anatomical peculiarities, intraocular pressure variations and associated alterations of the anterior segment. Conclusions: a detailed preoperative examination, and the adequate surgical technique performed by a skilled surgeon can reduce the rate of complications and achieve total success.

Epidemiología del cierre angular primario en Pinar del Río / Epidemiology of primary angular closure in Pinar del Río

RESUMEN Introducción: la clínica del cierre angular primario puede variar desde una sospecha de la enfermedad hasta estadios avanzados del daño glaucomatoso, lo que puede provocar ceguera. Objetivo: describir la epidemiología del cierre angular primario en pacientes pinareños, una vez identificadas las variables sociodemográficas y oculares que determinan su forma clínica. Métodos: se realizó un estudio descriptivo transversal en Pinar del Río, en los años 2013 y 2017, el universo estuvo constituidos por 293 casos nuevos con diagnóstico de cierre angular primario en cualquiera de sus formas clínicas. El análisis estadístico se realizó con el programa SPSS. Resultados: la edad media fue 57,69 ± 7,35 años; predominaron las mujeres (89,5 %) y el 77,2 % evidenció una situación de estrés. Los valores promedio de longitud axial y amplitud de cámara anterior fueron 21,89 ± 0,49 mm y 2,65 ± 0,27 mm. El 87,03 % de los ojos mostró ángulo estrecho. La media de la presión intraocular basal fue de 23,86 ± 5,81. Al analizar las variables sociodemográficas y oculares en relación a la forma clínica, se encontró que los factores que la determinan fueron: edad (p<0,001), amplitud angular (p<0,001), sinequias anteriores periféricas (p<0,001) y presión intraocular (p<0,001). El análisis de regresión lineal confirmó estos resultados. Conclusión: el cierre angular primario es frecuente en mujeres de mediana edad sometidas a estrés; con ojos pequeños, ángulo camerular y cámara anterior estrecha. La edad, amplitud angular, sinequias anteriores periféricas y presión intraocular basal, determinan la forma clínica de la enfermedad.

ABSTRACT Introduction: the clinic behavior of primary angular closure can range from suspected disease to advanced stages of glaucomatous damage, which can lead to blindness. Objective: to describe the epidemiology of primary angular closure in Pinar del Río patients by identifying the socio-demographic and ocular variables that determine its clinical type. Methods: a cross-sectional descriptive study was performed in Pinar del Río from 2013 to 2017. The target group consisted of 293 new cases with a diagnosis of primary angular closure in any of its clinical types. The statistical analysis was performed with the SPSS program. Results: mean age was 57.69 ± 7.35 years; women predominated (89.5 %) and 77.2 % evidenced a stressful situation. The average values of axial length and anterior chamber width were 21.89 ± 0.49 mm and 2.65 ± 0.27 mm. 87.03 % of the eyes showed a narrow angle. The mean basal intraocular pressure was 23.86 ± 5.81. When analyzing the socio-demographic and ocular variables in relation to the clinical type, it was found that the factors that determine its onset were: age (p<0.001), angular amplitude (p<0.001), peripheral anterior synechia (p<0.001) and intraocular pressure (p<0.001). Linear regression analysis confirmed these results. Conclusion: primary angular closure is common in middle-aged women under stress; with small eyes, camerular angle and narrow anterior chamber. Age, angular amplitude, peripheral anterior synechiae, and basal intraocular pressure determine the clinical type of the disease.

Clinical analysis of modified glaucoma combined with cataract surgery in the treatment of chronic angle closure glaucoma with cataract / 中国基层医药

Objective@#To investigate the clinical value of modified glaucoma combined with cataract surgery in the treatment of chronic angle closure glaucoma with cataract.@*Methods@#From May 2012 to August 2017, 350 patients with chronic angle closure glaucoma complicated with cataract in the Second Hospital of Shaoxing were studied.According to the difference of treatment methods, they were divided into two groups, with 175 cases in each group.The control group was treated with trabeculectomy, the observation group was treated with modified glaucoma combined with cataract surgery.The intraocular pressure (IOP), visual acuity were observed.@*Results@#The IOP values of the observation group were (22.50±1.48)mmHg, (18.77±2.38)mmHg, (14.21±0.93)mmHg at 3 d, one month and three months after operation, which were significantly lower than those of the control group [(28.91±2.05)mmHg, (23.28±2.49)mmHg, (17.75±1.16)mmHg], the differences were statistically significant(t=33.54, 17.32, 31.50, all P<0.05). Three months after operation, the depth of central anterior chamber in the observation group was (3.21±0.51)mm, which was obviously higher than that in the control group [(2.90±0.77)mm], the difference was statistically significant (t=4.44, P<0.05). The visual acuity index of the observation group was better than that of the control group (P<0.05). There was no statistically significant difference in the incidence of adverse events between the two groups (1.14% vs.4.00%, χ2=2.85, P>0.05).@*Conclusion@#The modified glaucoma combined with cataract surgery is effective in the treatment of chronic angle closure glaucoma with cataract, and can significantly improve the IOP and visual acuity.And the safety is high.

The topological properties of brain structural network based on diffusion tensor imaging in primary angle-closure glaucoma patients:a graph theoretical analysis / 中华放射学杂志

Objective To analyze the topological characteristics of the brain structural network in primary angle-closure glaucoma (PACG) patients by applying graph theoretical approaches.Methods From October 2015 to April 2017, nineteen PACG patients and nineteen gender-and age-matched healthy controls (HCs) were enrolled to undergo MRI scan. The whole brain was parceled into 90 regions by automated anatomical labeling template, and the brain structural network was constructed by the fiber distribution of continuous tracking method.Both the weighted and unweighted network analyses were performed.The global and regional properties were computed by graph theoretical analysis.To compare the brain network regional properties between two groups, two-sample t-test was utilized.The correlations between the brain structural network properties and clinical parameters were further analysed. Results Both two groups were found to follow the efficient small-world characteristics. Compared to HCs, the brain structural network in PACG patients showed no statistical significance in the small-worldness, average shortest path, clustering coefficient, global efficiency and local efficiency(P＞0.05). Compared to the HCs, the PACG patients showed decreased nodal efficiency in the right superior frontal gyrus, right inferior frontal gyrus, left median cingulate and paracingulate gyri, left amygdala and left cuneus(P＜0.05). Compared to HCs, the PACG patients showed decreased node degree in left superior frontal gyrus, medial orbital, right inferior frontal gyrus, left amygdala, left cuneus and left lingual gyrus(P＜0.05). Compared with the hub regions in healthy controls'network, we found that two hub regions disappeared.Those hubs were right inferior parietal lobule and left middle temporal gyrus. Node degree in left amygdala showed negatively correlated with visual ability (r=-0.679, P=0.001). Node degree in left lingual gyrus showed negatively correlated with vertical CDR(r=-0.791, P=0.001),which showed positively correlated with visual acuity(r=0.538, P=0.018).Conclusions The brain structural network in PACG patients showed small-worldness properties as HCs group. The alterations of local properties in visual, emotion-cognition brain regions were observed, manifesting that PACG can affect the topology properties of the structural brain network.

Bilateral acute angle closure in a patient with dengue fever: a case report / Fechamento de ângulo agudo bilateral em paciente com dengue: relato de um caso

ABSTRACT We report the case of a 46-year-old female patient who presented with bilateral acute angle closure during the course of dengue infection. Dengue diagnosis was confirmed by serological tests. The patient had plateau iris configuration identified by ultrasound biomicroscopy. This is the second reported case with this condition during dengue fever and the first to describe the characteristics of the angle.

RESUMO Os autores relatam o caso de uma mulher de 46 anos que teve fechamento agudo de ângulo bilateral durante a infecção por dengue. O diagnóstico de dengue foi confirmado por testes sorológicos. A paciente teve configuração de íris em platô confirmada pela biomicroscopia ultrassônica. Esse é o segundo caso descrevendo essa condição durante um episódio de dengue e o primeiro a descrever as características do ângulo.

Aqueous misdirection syndrome in persistent fetal vasculature (PFV) / Síndrome de mau direcionamento do humor aquoso em persistência da vasculatura fetal (PVF)

ABSTRACT We report a case of a 5-year-old girl with persistent fetal vasculature who presented with unilateral acute angle closure caused by aqueous misdirection syndrome that was apparently associated with regression of cycloplegia. Initial treatment with topical steroids, anti-glaucomatous drops, and atropine showed insufficient control of the intraocular pressure (IOP). Surgical treatment with lensectomy and vitrectomy resulted in satisfactory IOP control and no complications at the 6-month follow-up.

RESUMO Relatamos o caso de uma criança de 5 anos, sexo feminino com persistência do vítreo primário que apresentou crise de fechamento angular por síndrome do mau direcionamento do humor aquoso, aparentemente associado a regressão da cicloplegia. Tratamento inicial com corticoide tópico, colírios antiglaucomatosos e atropina mostraram controle insuficiente da pressão intraocular (PIO). Tratamento cirúrgico com lensectomia e vitrectomia anterior permitiu o controle satisfatório da PIO, sem intercorrências no seguimento de 6 meses.

The auxiliary effect of suramin application in acute angle closure glaucoma surgery patients / 中国医师杂志

Objective To investigate the effects of suramin application in acute angle closure glaucoma surgery patients.Methods A prospective study method was used.From February 2012 to January 2016,178 acute angle closure glaucoma surgeries in our hospital for treatment were selected,and were equally divided into observation and control groups (89 cases in each group) according to the order of admission,and two groups were given filtration surgery.The observation group was treated with suramin adjuvant therapy after surgery.The duration were 1 ～ 14 d after operation.The prognosis of two groups was observed.Results All patients were successfully completed surgery.The intraoperative and postoperative complications were no seriously occurred;the postoperative intraocular pressure in the observation group and the control group were (11.52 ± 3.24) mmHg and (16.98 ± 5.33) mmHg that compared preoperative [(31.98 ± 5.22) mmHg,(31.87 ± 5.11) mmHg] with significantly different (P ＜ 0.05),while the observation group was significantly lower than that of the control group (P ＜ 0.05).The postoperative peak systolic velocity (PSV) and end diastolic velocity (EDV) values of the central retinal artery of the observation group and the control group were significantly higher than that of preoperation (P ＜ 0.05),and the postoperative PSV and EDV values of the central retinal artery of the observation group were significantly higher than that in the control group (P ＜ 0.05).The postoperative ratios of functional filtering bleb in the observation group and control group were 80.9％ and 60.7％,respectively.The observation group was significantly higher than that of the control group (P ＜ 0.05).Conclusions The application of suramin in acute close angle glaucoma filtration surgery can promote the function of filtering bleb and intraocular pressure reduction,and improve the ocular blood flow speed that has good application effects.

Clinical study of small incision cataract extraction in the treatment of acute angle-closure glaucoma complicated with cataract / 中国基层医药

Objective To study the clinical effect of small incision cataract extraction in the treatment of acute angle-closure glaucoma with cataract.Methods Fifty-eight patients with acute angle-closure glaucoma combined with cataract were selected,and according to the digital table they were randomly divided into two groups:control group and observation group.The patients in the control group were treated by conventional method.The patients in the observation group were treated with small incision cataract.The changes of intraocular pressure,anterior chamber depth and visual acuity before and after treatment were observed.The incidence of complications and the satisfaction of treatment were compared between the two groups.Results There were no significant differences in IOP,visual acuity and anterior chamber depth between the two groups before treatment(all P>0.05).After treatment,the intraocular pressure,anterior chamber depth and visual acuity of the observation group were (10.2±4.0)mmHg,(3.3±0.5)mm,(0.85±0.08),respectively,which of the control group were (17.5±5.0)mmHg,(3.2±0.5)mm and (0.50±0.06),respectively.The improvement of intraocular pressure and anterior chamber depth of the observation group was more significant than the control group(t=0.120,0.520,1.012,all P0.05).Conclusion Small incision cataract extraction is an effective treatment for acute angle-closure glaucoma complicated with cataract,and the postoperative complications are less.The patients are satisfied with the treatment and deserve to be popularized.

Bilateral acute angle-closure glaucoma as a first presentation of granulomatosis with polyangiitis (Wegener's) / Glaucoma de ângulo fechado bilateral agudo como uma primeira apresentação da granulomatose com poliangeíte (de Wegener)

ABSTRACT We report a case of bilateral acute angle-closure glaucoma in a patient with undiagnosed granulomatosis with polyangiitis (Wegener's). A 59-year-old man presented with a severe headache, ocular pain, blurred vision, shortness of breath, and mild fever. Clinical examination revealed conjunctival chemosis, corneal edema, and shallow anterior chambers. Closed angles were observed bilaterally on gonioscopy. The patient was treated with intravenous mannitol, oral acetazolamide, and anti-glaucomatous eye drops. Over the following two days, his vision improved and intraocular pressures decreased. Subsequently, laser iridotomies were performed bilaterally and the patient attended consultations with our departments of respiratory medicine, nephrology, and rheumatology and was subsequently diagnosed with granulomatosis with polyangiitis. Bilateral acute angle-closure glaucoma is a very rare ocular manifestation of granulomatosis with polyangiitis. The association of this clinical entity with Wegener's granulomatosis remains unknown.

RESUMO Relatamos um caso glaucoma bilateral agudo de ângulo fechado em um paciente sem diagnóstico prévio de granulomatose com poliangeíte (Wegener). Um homem de 59 anos apresentou-se com uma forte dor de cabeça, dor nos olhos, visão turva, dificuldade em respirar e febre baixa. Observamos quemose conjuntival, edema da córnea e câmara anterior rasa. A gonioscopia demonstrou ângulos fechados bilateralmente. Ele foi tratado com manitol intravenoso, acetazolamida oral, olho e colírios antiglaucomatosos. Durante os dois dias seguintes a sua visão melhorou e as pressões intra-oculares diminuíram. A seguir, foram realizadas iridotomias a laser bilateralmente e ele foi referido para os departamentos de doenças pulmonares, nefrologia e reumatologia. Ele foi diagnosticado com poliangeíte granulomatosa. Glaucoma bilateral agudo de ângulo fechado é uma entidade clínica muito rara e sua associação com a granulomatose de Wegener é desconhecida e deve acrescentar-se à lista de manifestações oculares de granulomatose com poliangeíte.

Opciones quirúrgicas en el cierre angular primario por iris en meseta / Surgical options for the primary angle closure in a plateau iris case

Se describen dos casos clínicos (hermanos), con el objetivo de mostrar diferentes opciones terapéuticas en el glaucoma por cierre angular primario por iris en meseta. El primer caso representa una paciente femenina con antecedentes de iris en meseta e iridectomía periférica quirúrgica, quien presentaba cifras de tensión intraocular elevadas y progresión del daño glaucomatoso, por lo que se decidió realizar trabeculectomía en ambos ojos, con evolución satisfactoria. El segundo caso se trata de un paciente masculino, con antecedentes de salud, quien acudió por molestias oculares. Tras examen físico oftalmológico se constató glaucoma por cierre angular por iris en meseta, con presión intraocular elevada y opacidad del cristalino asociada, por lo que se realizó trabeculectomía en ojo derecho más extracción del cristalino en ambos ojos. Como complicaciones posoperatorias presentó desprendimiento coroideo y edema macular, resueltos con tratamiento médico. La trabeculectomía luego de la extracción del cristalino en ojo derecho falló, por lo que actualmente se encuentra compensado con tratamiento médico. La elección de la terapéutica adecuada debe tener en cuenta los factores fisiopatológicos involucrados y la forma de presentación(AU)

Different therapeutic options for the primary angle closure glaucoma by plateau iris were described in two clinical cases. The first one was a female patient with a a history of plateau iris and peripheral iridectomy. Elevation of intraocular pressure and progression to glaucoma was confirmed, so it was decided to perform trabeculectomy in both eyes and the result was satisfactory. The second case was a male patient with history of health problems, who suffered with eye disturbances. After ophthalmological exam, a primary angle closure glaucoma caused by plateau iris was confirmed with marked eye hypertension and associated crystalline lens opacity. Trabeculectomy of right eye and lens extraction in both eyes was applied. Choroidal detachment and macular edema were the postoperative complications, but the medical treatment managed to solve this situation. After the lens extraction, trabeculectomy in the right eye failed and today it is compensated with medical treatment. The right therapeutic choice should take into consideration the physiopathologic factors and the form of presentation(AU)