Clinical significance of reopening anterior chamber angle for severe acute angle -closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To explore whether the drainage angle could be reopened by surgery in patients with severe acute angle-closure glaucoma at " the greatest degree " of angle closure, and to study the treatment methods, such as double-paracentesis, phacoemulsification combined with goniosychialysis, and the effectiveness. ·METHODS: Retrospective observational case series. From November 2008, to November 2015, there were 33 patients with severe acute angle-closure glaucoma and 360° angle closure. Drug treatment showed no effect on them, so initial double-paracentesis ( anterior chamber paracentesis combined with vitreous paracentesis ) was applied. Then, either phacoemulsification combined with goniosychialysis or trabeculectomy surgery was performed after 7-14d, which was chosen based on the result of gonioscope during the surgery. The intraocular pressure, angle changes, and complications were observed. The follow-up period was 6mo to 3a. ·RESULTS: Of 33 participants enrolled, 32 had normal intraocular pressure after " double-paracentesis" ( 2 had normal intraocular pressure after laser peripheral iridotomy ). The mean intraocular pressure was significantly reduced from 53. 4 ± 10. 7mmHg to 16. 9 ± 13. 2mmHg ( t= 9. 21, P<0. 001 ) by applying " double-paracentesis", and 1 still had higher intraocular pressure. The mean intraocular pressure ( 16. 7 ± 4. 8mmHg ) was 0. 2mmHg lower after phacoemulsification than after" double- paracentesis " while there was no significant difference (t=0. 38,P>0. 05). One patient had abnormal intraocular pressure until 30d after phacoemulsification. Every participant had 360° angle closed before " double-paracentesis", 32 patients had opened angle ( mean 131. 8°± 111. 3°) after " double-paracentesis " and mean (228. 6°± 108. 3°) during phacoemulsification, and mean (234. 6°± 107. 2°) at 3mo after phacoemulsification. There was a significant difference between the post -paracentesis and intraoperative values ( t = 4. 52, P <0. 001 ). There was no difference between the intraoperative and postoperative values ( t = 0. 46, P>0. 05). No patients had serious adverse events. · CONCLUSION: For the " maximum degree " angle closure of severe acute angle-closure glaucoma, "double-paracentesis" combined with phacoemulsification can be chosen to open the angle gradually, and reduce intraocular pressure in vast majority of patients.

Influence of intraoperative anterior chamber paracentesis on early stage intraocular pressure change after intravitreal injection / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the efficacy of intraoperative anterior chamber paracentesis on early stage intraocular pressure change after intravitreal injection of Conbercept.<p>METHODS: A prospective,randomized-controlled clinical trial was conducted on 30 eyes of 30 patients underwent intravitreal injection of Conbercept. The patients were randomly divided into Group A(15 patients with 22 treatments)and Group B(15 patients with 23 treatments)according to whether to applying anterior chamber paracentesis. IOP was measured before injection and 2, 30, 60min, 1d and 1wk after the injection with AccuPen tonometer. <p>RESULTS: Compared with preoperative intraocular pressure, there was no significant change in IOP of Group A(applying anterior chamber paracentesis)at any time we observed(<i>P</i>>0.05); while the IOP of Group B significantly increased at 2min after injection(42.4±9.3mmHg)with significant difference compared to Group A(<i>P</i><0.05), and then the IOP dropped to normal(17.4±5.0mmHg)within 30min without significant difference compared to Group A(<i>P</i>>0.05). <p>CONCLUSION: Intraoperative anterior chamber paracentesis during intravitreal Conbercept can effectively control the early stage intraocular pressure raise after the injection.

A Case of Phacoanaphylactic Uveitis Presenting as Endophthalmitis

PURPOSE: To report a case of phacoanaphylactic uveitis presenting as endophthalmitis. CASE SUMMARY: A 77-year-old woman presented with sudden visual disturbance and painful red right eye. She did not have a history of trauma or surgery in her right eye. Her best corrected visual acuity was hand movement in the right eye and log MAR 0.22 in the left eye; intraocular pressure was 27 mm Hg in the right eye and 15 mm Hg in the left eye. Slit-lamp examination revealed corneal edema and prominent inflammation with hypopyon in the anterior chamber. B-scan showed vitreous opacity behind the lens. Based on the diagnosis of endophthalmitis, anterior chamber paracentesis and irrigation were performed. After irrigation, a hypermature cataract with intact anterior capsule was observed. Therefore, we performed extracapsular cataract extraction and intravitreal antibiotics injection. Gram staining of the aqueous humor revealed numerous macrophages filled with lens protein but no organisms. She was treated with hourly topical corticosteroid and an antibiotic agent. One month later, the anterior chamber is clear, and the cultures remained negative. CONCLUSIONS: We report a case of spontaneous phacoanaphylactic uveitis presenting as endophthalmitis in a patient with no history of eye trauma or surgery.

The Immediate Treatment of Acute Primary Angle Closure Glaucoma with High Blood Pressure / 医学研究杂志

Objective To investigate the effects on intraocular pressure and blood pressure following anterior chamber paracentesis in acute primary angle closure glaucoma with high blood pressure.Methods 64 eyes of 64 glaucoma patients with high blood pressure were received anterior chamber paracentesis.the intraocular pressure and blood pressure were measured before and after paracentesis.Results The mean systolic blood pressure(SBP) and diastolic blood pressure(DBP) before paracentesis of 64 glaucoma were 195.10?15.24mmHg and 117.1?11.76mmHg respectively,after administration of paracentesis,the SBP and DBP were 138.82?20.86mmHg and 93.19?12.07mmHg respectively,the intraocular pressure also significantly decreased from 68.64?10.05mmHg to 10.66?4.41mmHg.There was statistical difference in SBP,DBP and intraocular pressure before and after administration of paracentesis.Conclusions Administration of paracentesis in acute primary angle closure glaucoma with high blood pressure can significantly reduce intraocular pressure and blood pressure simultaneously.

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

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