Swept-source optical coherence tomography detects anterior-chamber changes in patients with angle-closure after laser peripheral iridotomy / Tomografia de coerência óptica swept-source detecta alterações na câmara anterior em pacientes com fechamento angular após iridotomia

ABSTRACT Purpose: This study aimed to compare an teriorchamber parameters acquired by a swept-source anteriorsegment optical coherence tomography before and after laser peripheral iridotomy. Methods: This study prospectively evaluated 14 patients with primary-angle closure and six patients with primary-angle closure glaucoma. Gonioscopy and anterior-segment optical coherence tomography using the DRI OCT Triton® were performed before and after laser peripheral iridotomy. Anterior-segment optical coherence tomography parameters were studied using scleral spur as reference: angle opening distance at 250, 500, and 750 µm, trabecular-iris space at 500 µm, trabecular-iris angle, trabecular-iris contact length, and iris curvature. Results: Anterior-segment optical coherence tomography identified 61% of the patients with two or more quadrants closed. Gonioscopy identified more closed angles than anterior-segment optical coherence tomography before laser peripheral iridotomy. In angle parameters, only the angle opening distance of 250 µm at the nasal quadrant was not significantly increased after laser peripheral iridotomy. The iris curvature and trabecular-iris contact length showed a significant reduction induced by the laser procedure. Even in eyes in which gonioscopy did not identify angular widening after laser peripheral iridotomy (n=7), the angle opening distance of 750 µm increased (nasal, 0.15 ± 0.10 mm to 0.27 ± 0.16 mm, p=0.01; temporal, 0.14 ± 0.11 mm to 0.25 ± 0.12 mm, p=0.001) and the iris curvature decreased (nasal, 0.25 ± 0.04 mm vs. 0.11 ± 0.07 mm, p=0.02; temporal, 0.25 ± 0.07 mm vs. 0.14 ± 0.08 mm, p=0.007). Conclusions: Anterior-chamber changes induced by laser peripheral iridotomy could be quantitatively evaluated and documented by DRI OCT Triton®

RESUMO Objetivo: Comparar os parâmetros de câmara anterior obtidos através da tomografia de coerência óptica de segmento anterior antes e após a iridectomia periférica a laser. Métodos: Quatorze pacientes com fechamento angular primário e seis com glaucoma primário de ângulo fechado foram prospectivamente avaliados neste estudo. Gonioscopia e tomografia de coerência óptica de segmento anterior com DRI OCT Triton® foram realizadas antes e após a iridectomia periférica a laser. Os seguintes parâmetros de tomografia de coerência óptica de segmento anterior, baseados na localização do esporão escleral, foram avaliados: ângulo de abertura angular a 250 µm, 500 µm e 750 µm, área do espaço entre a íris e o trabeculado a 500 µm, ângulo entre a íris e o trabeculado, extensão do contato entre a íris e o trabeculado e curvatura da íris. Resultados: A tomografia de coerência óptica de segmento anterior identificou 61% dos indivíduos com dois ou mais quadrantes fechados. A gonioscopia identificou mais quadrantes com ângulo fechado do que tomografia de coerência óptica de segmento anterior antes da iridectomia periférica a laser. Quanto aos parâmetros angulares, apenas ângulo de abertura angular a 250 µm no quadrante nasal não aumentou significativamente após a iridectomia periférica a laser. A curvatura da íris e a extensão do contato entre a íris e o trabeculado apresentaram redução significativa induzida pelo procedimento a laser. Mesmo nos olhos em que a gonioscopia não identificou aumento da amplitude angular após iridectomia periférica a laser (n=7), ângulo de abertura angular a 750 µm aumentou (nasal: 0,15 ± 0,10 mm para 0,27 ± 0,16 mm, p=0,01; temporal: 0,14 ± 0,11 mm para 0,25 ± 0,12 mm, p=0,001), e ICURVE diminuiu (nasal: 0,25 ± 0,04 mm vs. 0,11 ± 0,07 mm, p=0,02; temporal: 0,25 ± 0,07 mm vs. 0,14 ± 0,08 mm, p=0,007). Conclusões: As alterações na câmara anterior induzidas pelo iridectomia periférica a laser puderam ser avaliadas quantitativamente e documentadas pelo DRI OCT Triton®.

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.

Expert recommendations of surgical technique for peripheral iridectomy with goniosynechialysis and goniotomy / 中华实验眼科杂志

Minimally invasive glaucoma surgery (MIGS) has been successfully incorporated in clinical practice in recent years.Increasing evidence shows that MIGS also plays an increasingly important role in the treatment of primary angle-closure glaucoma (PACG). Surgical peripheral iridectomy (SPI) plus goniosynechialysis (GSL) and goniotomy (GT), as a new procedure, has been proven to be safe and effective in the treatment of PACG with no or mild cataracts.However, there is still a lack of uniform standards for indications, surgical procedures, and perioperative medication.Therefore, it is necessary to formulate a detailed and complete expert recommendations on surgical procedures to standardize the application of combined SPI+ GSL+ GT in the treatment.Some experts in glaucoma treatment and management in China have discussed the current problems and developing trend in MIGS for PACG and put forward the expert recommendations of standard process, including indications, anaesthetic methods, surgical site, operating procedure and rational administration of drugs in perioperation, in order to standardize the medical process of clinicians using combined SPI+ GSL+ GT in PACG treatment and lay a foundation for better evaluation of the efficacy of MIGS.

Clinical analysis of combined microsurgery for nanophthalmic patients with uncontrolled intraocular pressure after peripheral iridectomy / 中华显微外科杂志

Objective:To evaluate the efficacy and safety of limited pars plana vitrectomy(LPPV), pressure-controlled phacoemulsification(PCP), intraocular lens implantation(IOL), and posterior capsulotomy (PC) in treatment of nanophthalmic glaucoma eyes which intraocular pressure(IOP) were still out of control after peripheral iridectomy.Methods:All 24 patients(29 eyes) with nanophthalmic glaucoma whose IOP failed to be reduced after peripheral iridectomy and needed LPPV plus PCP plus IOL plus PC were recruited from July 2017 to April 2021. The age of these patients was(44.6±11.0) years old. Preoperative and postoperative IOP, best corrected visual acuity(BCVA), anterior chamber depth(ACD) and number of glaucoma medications were recorded by chart review and compared by using paired t-test or Wilcoxon signed rank-sum test. P<0.05 was considered as statistical significant. IOP could be controlled in normal range(≥5 mmHg and≤21 mmHg), without both of disease progression and serious complications were regarded as the success criteria of the operation. Surgical success rate was evaluated. Surgery-associated complications were recorded. Results:The average follow-up time was(11.52±12.44) months. After the microsurgery, IOP decreased from(33.12±9.25) mmHg to(14.23±3.44) mmHg( P<0.01); The ACD increased from(1.23±0.46) mm to(2.86±0.62) mm, and the median number of glaucoma medications dropped from 3(3,4) to 3(0,3) at final follow-up visit( P<0.05). There were no significant differences in BCVA( P=0.196) and the degrees of angle closure(AC) ( P=0.478) before and after operation. The total surgical success rate was 86.2%(25/29) at the final follow-up visit. Two eyes suffered from local choroidal detachment which recovered within 2 weeks with medical treatment. Conclusion:LPPV plus PCP plus IOL plus PC is a safe and effective novel surgical procedure in the treatment of nanophthalmic glaucoma patients with uncontrolled IOP after peripheral iridectomy. It could significantly decrease IOP, increase the depth of ACD, reduce the number of glaucoma medications and maintain BCVA. It can be considered as a first choice for the surgical management for patients with a such condition.

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)

Peripheral iridectomy for preventing iris-related complications in glued intraocular lens surgery in children

Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis. Methods: Nonrandomized interventional case series of 34 eyes of 17 children (<15 years of age) who underwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013–June 2015) were compared with those without surgical PI (July 2015–December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery was to account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation, or repeat surgery. The secondary outcomes were changes in the best-corrected visual acuity (BCVA). Results: The mean age at surgery was 8.8 years (range: 3.5–15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture –6; rise in IOP –4; IOL subluxation –4; repeat surgery –5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ? 20/200) and post BCVA was 0.40 (±0.50) (Snellen ? 20/50). The mean preoperative refraction was ? 9 D (±8D) (range: ?5 D to ?23D) and postoperative was ?1 (±1.15) D. The mean follow-up was 25.4 months. Conclusion: Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic-capture-related complications.

Pseudophakic Pupillary Block after Toxic Anterior Segment Syndrome

PURPOSE: We report a case of pseudophakic pupillary block after toxic anterior segment syndrome (TASS). CASE SUMMARY: An 84-year-old woman underwent phacoemulsification and intraocular lens implantation in the posterior chamber. Six days after surgery, anterior chamber inflammation was seen. Twenty-five days after surgery, a sudden increase in intraocular pressure (IOP) associated with pupillary block was observed. Despite the use of IOP-lowering medication, the IOP was not controlled. Peripheral laser iridotomy failed. After surgical peripheral iridectomy, IOP decreased significantly and was controlled. CONCLUSIONS: Despite the rarity of TASS combined with pseudophakic pupillary block, clinicians must be aware of this condition in patients showing prolonged inflammatory state and IOP elevation after surgery.

Combined laser peripheral iridectomy for primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of combined laser peripheral iridectomy for primary angle-closure glaucoma.<p>METHODS: A total of 82 eyes were included in 82 patients with primary angle-closure glaucoma who visited our hospital from August 2015 to October 2017. They were randomly divided into two groups. Patients in the simple laser group were performed Nd:YAG laser only. In the combined laser group, 532 semiconductor laser combined with Nd: YAG laser were used for laser peripheral iridectomy. Intraocular pressure(IOP)was measured preoperative and postoperative. Laser energy was recorded. Iridemia were observed.<p>RESULTS: Postoperative IOP increased significantly in the simple laser group compared with the combined laser group, and the differences between the two groups 1h, 1d and 1wk after operation were statistical significances(<i>P</i><0.01). The IOP of the two groups was basically restored to the preoperative level at 1mo postoperatively. The success rate of single laser surgery was significantly lower than that of combined laser surgery(73% <i>vs </i>100%, <i>P</i><0.05). The total energy of Nd:YAG laser was significantly higher than that of the combined laser group(40.16±13.43mJ <i>vs</i> 23.23±6.70mJ, <i>P</i><0.05). There was no significant difference in intraoperative iris bleeding rate between the two groups(33% <i>vs</i> 26%, <i>P</i>>0.05).<p>CONCLUSION: Totally 532 semiconductor laser combined with Nd: YAG laser for peripheral iridectomy has a high rate of penetration, especially for patients without iris recess. It can significantly decreases laser energy, reduces the difficulty of laser operation and relieves intraocular inflammation.

Effect of long-term low-dose aspirin on hyphema during and after laser iridectomy / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To evaluate the effects of long-term low-dose aspirin on intraoperative and preoperative hyphema of laser peripheral iridectomy(LPI). ·METHODS: The included 63 cases (63 eyes) with primary angle closure glaucoma went to our hospital from January 2014 to June 2017 were divided into two groups:Group A was control group and Group B was study group,according to whether taken aspirin. The hyphema was compared between the two groups. ·RESULTS: There was no significant difference between the two groups in intraoperative and postoperative hyphema (P>0.05). No serious hyphema occurred. ·CONCLUSION: LPI can be performed safely without stopping aspirin.

Study on the pathogenesis of transient intraocular pressure after laser iridectomy with Krypton laser combined with Q -switched Nd:YAG laser / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To study the pathogenesis of transient intraocular pressure ( IOP ) after laser iridectomy with Krypton laser combined with Q-switched Nd:YAG laser.· METHODS: Totally 42 healthy rabbits ( 84 eyes ) provided by the Animal Experimental Center of our hospital were selected, including 18 female rabbits, 24 male rabbits, average weight 2. 24±0. 31kg, and they were randomly divided into 6 groups, 7 rats in each group (14 eyes) . We observed the change of intraocular pressure after laser iridectomy surgery at 20min, 2, 6, 18, 24h and the nitric oxide ( NO ) , malondialdehyde ( MDA ) , superoxide dismutase ( SOD) , 6-keto-prostaglandin ( 6-keto-PGF1α) and nitric oxide synthase ( NOS) content in aqueous.· RESULTS: There was no significant difference in intraocular pressure, NO, NOS, SOD, MAD and 6-keto-PGF1α before operation ( P > 0. 05 ). The intraocular pressure increased after operation, and the difference was statistically significant (P<0. 05) at 20min, 2 and 6h after operation, and decreased at 18h after operation, 24h after operation (P>0. 05). The levels of NO, NOS and SOD in the aqueous humor of the two groups decreased 20min, 2 and 6h after the operation (P<0. 05), while increased after 6h, increased more at 18 and 24h. The difference with control group was no more significant (P>0. 05). The levels of MDA and 6-keto-prostaglandin in the aqueous humor increased after the operation, and the difference was statistically significant at 20min, 2 and 6h after operation (P<0. 05), while decreased at 18 and 24h and the difference with control group was not significant ( P>0. 05).· CONCLUSION: The increase of transient intraocular pressure after laser iridectomy may relate to the increase of malondialdehyde, 6-keto-prostaglandin content and the decrease of superoxide dismutase and nitric oxide in the aqueous humor after operation.

Clinical observation of 3 minutes dark-room provocative test in patients with laser peripheral iridectomy in the fellow eyes of acute angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe related biological parameters of 3 minutes dark-room provocative test in patients with laser peripheral iridectomy(LPI) in the fellow eyes of acute primary angle-closure (APAC) by ultrasound biomicroscopy (UBM).To explore the risk factors in primary angle closure suspect(PACS) patients with progressive angle closure after LPI.METHODS: Seventy-eight eyes of APAC patients without peripheral anterior synechia were selected.Each eye underwent 3 minutes dark-room provocative test after LPI.Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber angle open distance500 (AOD500), peripheral iris thickness (PIT), iris convex (IC), the position of iris insertion and trabecular-ciliary process distance (TCPD), and the number of positional angle closure(NPAC) were observed and analyzed by statistic methods.RESULTS:Patients with APAC were examined by UBM after LPI and 26 eyes(33%) occurs at least one positional angle closure,19 eyes(24%)were positive in 3 minutes dark-room provocative test among them.It occurs a positive relationship between the elevation intraocular pressure and the number of positional angle closure in dark-room provocative test(r=0.84, P<0.01).AOD500, IT and IC were significantly changed from normal light to darkroom between positional angle closure positive group and positional angle closure negative group(all P<0.01).In single factor analysis, AOD500(P=0.003), IT(P=0.012), IC(P=0.043), TPCD(P=0.015), the position of iris insertion(P=0.024) were correlative factors of positive results.In multiple-factor analysis, only IT(P=0.011), TPCD(P=0.009), iris root attachment points(P=0.02) were independent risk factors of positive results.CONCLUSION:A certain proportion of patients with PACS after LPI appeared positional angle closure in a dark room.Peripheral iris hypertrophy, anterior displacement of the ciliary body and iris root attachment points are vital risk factors.Long-term follow-up study and intervention treatment are required in these patients after LPI.

The morphologic and quantitative evaluation of ocular anterior chamber parameters after laser peripheral iridotomy in primary angle-closure glaucoma eyes / 中华实验眼科杂志

Background Pentacam anterior segment analysis system (Pentacam) is more accurate in the quantitative evaluation of ocular anterior segment in primary angle-closure glaucoma (PACG) eyes than slit lamp microscope and ultrasound biomicroscope (UBM).However,its accuracy in the earlier stage of PACG before and after YAG laser peripheral iridotomy (LPI) is not fully elucidated.Objective This study was to assess the effect of YAG LPI in PACG patients with Pentacam.Methods A prospective self-controlled study was performed.Thirtyfive fellow eyes (pre-clinical stage of PACG) of acute PACG and 35 fellow eyes of chronic PACG were included in the Second Hospital of Hebei Medical University from July,2012 to December,2013.YAG LPI was performed on the eyes,and the parameters of ocular anterior segment including central anterior chamber depth (ACD),anterior chamber volume (ACV) and peripheral anterior chamber angle (ACA) were measured and compared by Pentacam before and 1 day,7 days,28 days after operation.This study was approved by the Ethic Committee of the Second Hospital of Hebei Medical University and informed consent was obtained from all subjects.Results In pre-clinical stage of PACG eyes,the postoperative ACD and ACV values were increased in comparison with preoperation,showing significant differences among various time points (ACD:F =6.783,P =0.004;ACV:F =19.090,P =0.000),and no significant difference was found in ACA among different time points (F =0.153,P =0.928).In the fellow eyes of chronic PACG,the postoperative ACD and ACV values were larger than those of preoperation,with significant differences among various time points (ACD:F =21.576,P =0.000;ACV:F =47.506,P =0.000),and no significant difference was found in ACA among different time points (F=0.581,P=0.629).The change values of ACD and ACV were (0.064±0.022) mm and (27.840±4.963) mm3 in the eyes of pre-clinical stage of PACG,and those in the fellow eyes of chronic PACG were (0.047-± 0.020) mm and (21.000 ± 3.278) mm3,showing significant differences between the two groups (ACD:t=2.783,P=0.008;ACV:t=5.749,P=0.000).Conclusions Pentacam allows easy,fast,automatic and non-contact quantification and three-dimension image of the anterior chamber parameters before and after YAG LPI in pre-clinical stage of PACG eyes and fellow eyes of chronic PACG.The ACD deepens and ACV increases after LPI in glaucomous eyes,especially in the pre-clinical stage of PACG eyes.

Efectividad de la iridotomía Nd: YAG láser en el glaucoma por cierre angular primario / Effectiveness of the Nd: YAG laser iridectomy in glaucoma caused by primary angle closing

Introducción: el manejo del glaucoma incluye la decisión quirúrgica oportuna. La iridotomía láser puede ser una solución quirúrgica, o utilizarse como profilaxis de un evento agudo que puede llevar a la ceguera. Objetivo: describir la efectividad de la iridotomía Nd: Yag láser en pacientes con glaucoma por cierre angular primario. Materiales y métodos: se realizó un estudio longitudinal, prospectivo, descriptivo. El universo lo conformaron 36 ojos sometidos a iridotomía periférica con Nd: Yag láser, en el Hospital Universitario Clínico Quirúrgico “Comandante Faustino Pérez Hernández”, de enero 2014 a enero 2015. Resultados: todos los ojos mostraron profundidad de la cámara anterior central menor de 2,5 mm. En el posoperatorio el 58,3 % de los casos mejoraron la profundidad. La gonioscopía preoperatoria mostró hasta el trabéculo anterior en un 66,7 % de los casos y 6 ojos (16,7 %) presentaron ángulos totalmente cerrados. En el posoperatorio, el 66,7 % de los ojos mostraron hasta espolón escleral o banda. Respondieron al proceder 14 ojos (38,9 %), sin necesidad de otro tratamiento, todos ellos con diagnóstico de acuerdo al procedimiento de asignación de causalidad; el resto necesitó alguna terapia extra. Conclusiones: se demostró que la iridotomía es un proceder de elección en casos de glaucoma por cierre angular primario, pero su efectividad es limitada.

Background: glaucoma management includes the opportune surgical decision. Laser iridectomy could be a surgical solution, or may be used as prophylaxis of an acute event that could lead to blindness. Aim: describing the Nd:YAG laser iridectomy effectiveness in patients with glaucoma caused by primary angular closing. Materials and methods: we carried out a longitudinal, prospective, descriptive study. The universe was formed by 36 eyes subjected to peripheral iridectomy with Nd:Yag laser, in the Teaching Clinic Surgical Hospital “Comandante Faustino Pérez Hernández”, from January 2014 until January 2015. Outcomes: all the eyes showed central anterior camera depths less than 2.5 mm. In the post-surgery period, depth improved in 58.3 % of the cases. Pre-surgery goniometry showed up to the anterior trabecula in 66.7 % of the cases, and 6 eyes (16.7 %) presented totally closed angles. In the post-surgery period, 66.7 % of the eyes showed up to sclerar spur or band. 14 eyes (38.9 %) answered to the procedure without any other treatment, all of them with diagnosis according to the procedure of chance assignation; the rest needed any other extra therapy. Conclusions: it was showed that iridectomy is a choice procedure in cases of glaucoma caused by primary angular closure, but its effectiveness is limited.

Evaluation of the change of anterior chamber parameters before and after laser peripheral iridectomy in primary angle -closure suspetive with Pentacam anterior segment analysis system / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM:To investigate the sensitive parameters of the anterior chamber changes with Pentacam anterior segment analysis system before and after laser peripheral iridectomy (LPl) in primary angle-closure suspetive (PACS). ? METHODS: Sixty eyes of 33 PACS patients were enrolled in this study. Pentacam examination was performed before and 1d after LPl to measure the central anterior chamber depth ( CACD ) , the peripheral anterior chamber depth ( PACD ) , the anterior chamber volume ( ACV) and the peripheral anterior chamber angle ( ACA) . Statistical analysis used paired t test. ?RESULTS: There was no statistical significance on the changes of ACD. PACD and ACV increased significantly between before and 1d after LPl. ACA was widened from (22. 26o±5. 18o) to (26. 42o±5. 20o), which were increased significantly between before and 1d after LPl. ?CONCLUSlON: LPl can deepen the PACD and increase the ACV in PACS. PACD and ACV are the sensitive parameters of the anterior chamber changes with Pentacam anterior segment analysis system.

Non-pupillary block angle-closure mechanisms: a comprehensive analysis of their prevalence and treatment outcomes / Mecanismos de fechamento angular sem bloqueio pupilar: análise de prevalência e resultados terapêuticos

Purpose: To assess the prevalence and treatment outcomes of angle-closure mechanisms other than pupillary block in a population of Brazilian patients. Methods: A retrospective chart review was conducted to evaluate patients who had undergone laser peripheral iridotomy (LPI) due to occludable angles at a single institution between July 2009 and April 2012. An occludable angle was defined as an eye in which the posterior trabecular meshwork was not visible for ≥180° on dark-room gonioscopy. Key exclusion criteria were any form of secondary glaucoma and the presence of >90° of peripheral anterior synechiae. Collected data were age, race, gender, angle-closure mechanism (based on indentation goniocopy and ultrasound biomicroscopy), intraocular pressure (IOP), number of antiglaucoma medications and subsequent management during follow-up. If both eyes were eligible, the right eye was arbitrarily selected for analysis. Results: A total of 196 eyes of 196 consecutive patients (mean age 58.3 ± 11.6 years) who underwent LPI were included. In most of the patients [86% (169 patients; 133 women and 36 men]), LPI sucessfully opened the angle. Mean IOP was reduced from 18.3 ± 6.4 mmHg to 15.4 ± 4.5 mmHg after LPI (p<0.01). Among the 27 patients with persistent occludable angles, the most common underlying mechanisms were plateau iris (56%) and lens-induced component (34%). Most of these patients (85%) were treated with argon laser peripheral iridoplasty (ALPI); approximately 90% showed non-occludable angles following the laser procedure (mean IOP reduction of 18.9%), with no significant differences between patients with plateau iris and lens-induced components (p=0.34; mean follow-up of 11.4 ± 3.6 months). Conclusion: Our findings suggest that, in this population of Brazilian patients, several eyes with angle closure were not completely treated with LPI. In the present large case series involving middle-age patients, plateau iris was the ...

Objetivo: Reportar a prevalência e os resultados terapêuticos em casos de fechamento angular por outros mecanismos além de bloqueio pupilar em uma população de pacientes brasileiros. Métodos: Realizou-se um estudo retrospectivo para avaliar pacientes apresentando ângulo oclusível submetidos à iridotomia periférica a laser (LPI), em uma única instituição, entre julho/2009 e abril/2012. Ângulo oclusível foi definido pela não observação do trabeculado posterior em mais de 180° à gonioscopia sem identação. Olhos com glaucomas secundários ou >90º de sinéquia anterior periférica foram excluídos. Foram coletados os seguintes dados: idade, raça, sexo, mecanismo de fechamento angular (com base na gonioscopia e biomicroscopia ultrassônica), pressão intraocular (PIO), número de medicações antiglaucomatosas e manejo subsequente durante o seguimento. Sempre que ambos os olhos eram elegíveis, o olho direito foi escolhido arbitrariamente para análise. Resultados: Foram incluídos 196 olhos de 196 pacientes (58,3 ± 11,6 anos) que foram submetidos à LPI. Na maioria dos casos [86% (169 pacientes; 133 mulheres e 36 homens), a LPI foi capaz de abrir o ângulo. A PIO média foi reduzida de 18,3 ± 6,4 para 15,4 ± 4,5 mmHg após a LPI (p<0,01). Entre os 27 casos que persistiram com ângulo oclusível, os mecanismos mais comuns envolvidos foram íris em platô (56%) e induzido por componente cristaliniano (34%). A maioria desses casos (85%) foram tratados com iridoplastia periférica a laser (ALPI). Aproximadamente 90% tornaram-se não oclusíveis após a ALPI (redução média da PIO de 18,9%), não havendo diferença significativa entre os pacientes com componentes de íris em platô ou cristaliniano (p=0,34; seguimento médio de 11,4 ± 3,6 meses). Conclusões: Nossos resultados sugerem que, nessa população de pacientes brasileiros, parte dos olhos com fechamento angular não foi completamente tratada com LPI. Nesta série de pacientes de meia-idade, a presença de íris em ...

Laser peripheral iridoplasty combined with iridectomy for the unmanageable acute angle-closure glaucoma by medication / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the effect and safety of laser peripheral iridoplasty combined with iridectomy in the unmanageable acute angle - closure glaucoma by medication. METHODS:Totally 19 cases (21 eyes) with acute angle-closure glaucoma, including 15 cases ( 17 eyes ) with primary glaucoma and 4 cases (4 eyes) with intumescent cataract - induced glaucoma, were recruited into the study. The intraocular pressure ( IOP ) of all cases were still >21mmHg after 24h drug treatment, and then were treated by laser peripheral iridoplasty combined with iridectomy. The visual accurity, IOP, cornea, peripheral anterior chamber depth, anterior chamber angle and complications were observed at 24h after the surgery. RESULTS:The mean IOP of all cases was reduced from 53. 09±11. 01mmHg before the surgery to 14. 98±4. 21mmHg at 24h after the treatment, with significant statistical difference ( P CONCLUSION: Laser peripheral iridoplasty combined with iridectomy is an effective and safe method for the treatment of the unmanageable acute angle - closure glaucoma by medication.

Complications and treatment in early time of posterior chamber phakic intraocular contact lens implantation / 局解手术学杂志

Objective To investigate the complications and outcomes of the treatments in the early time of posterior chamber phakic in-traocular contact lens ( ICL) implantation for the treatment of high myopia, and to analyze the causes. Methods Forty-six patients ( 92 eyes) who underwent ICL/TICL implantations were enrolled in this study. The intraoperative and the postoperative complications in 6 months were observed,at the same time also the treatments and the outcomes were observed. Results None of the patients had a pupillary block. Only 8 eyes in all the patients had an elevated IOP after peripheral iridectomy ( PI) ,and 7 eyes after the ICL implantation,the highest IOP in which was 28 mmHg. No medication was given for treatment. In the YAG PI group,the incidence rate of iris bleeding and pigment dispersion were all higher than that in the YAG PI group (P<0. 05);2 crystalline lens of different patient were damaged intraoperation. Rotation of TICL was observed in 2 eyes. Only 2 individuals of all the patients in this study had complained visual disturbances,which was shadows and glare. Visual psychological change occurred in 1 patient. Conclusion The complications in the early time after ICL implantation for treat-ment of high myopia can prevent and control,the satisfaction of the patients is high.

Study on blood-ocular barrier between the anterior and posterior chamber after peripheral iridectomy by contrast-enhanced magnetic resonance in rabbit / 中华实验眼科杂志

Background Whether ocular anterior and posterior chamber exist a blood-aqueous barrier is in controversy.Conventional method can not offer a good evidence because it is unable to detect the aqueous component in the posterior chamber.Objective This study was to investigate the distribution of Gadolinium-diethylene triamine pentaacetic acids(Gd-DTPA)after peripheral iridectomy with magnetic resonance imaging(MRI)in rabbit.Methods Monocular peripheral iridectomy was performed on the right eyes in 8 clean New Zealand white rabbits and the fellow eyes were as controls.0.2 ml/kg(0.5 mol/L)Gd-DTPA,a tracer of MRI,was injected into ear vein in vivo to scan the eyes with MRI for the observation of the permeability and distribution.The signal enhanced ratio of interest region associated with time were analyzed.Results The signal in ciliary body of both eyes showed an immediately sharp enhancement within 10 minutes following the injection of Gd-DTPA with a peak intensity at 30-40 minutes,and then the intensity was gradually weaken over time.The signal was stronger in the operative eyes than that in the fellow eyes.The signal in the posterior chamber was gradually increased after operation,however,that in posterior chamber of the control eyes was lower.The interest regions of Gd-DTPA were ciliary,anterior chamber and posterior chamber,and the enhanced signal intensities were consisted in the posterior chamber after operation.However,the increase of the signal was not seen in the posterior chamber in the control eyes.Conclusions The pathway of plasma protein entering into the anterior chamber is very different from that of aqueous secretion.There exists a barrier between the anterior and posterior chamber which might be an integral part of the blood-ocular barrier.

Study on the correlation between short,long term efficacy with cut width in primary angle closure glaucoma iris weeks after cutting holes / 中国基层医药

Objective To investigate the primary angle-closure glaucoma iris weeks after cutting holes cut the width of the near future, long-term effect relationship, selected after close to long-term efficacy of the forecasting methods to improve iridectomy success rate. Methods 90 cases (116 eyes) with primary angle-closure glaucoma were randomly divided into three groups:A group(the width of the iris-week cut-hole cut 1.5mm) ,30 cases 42 eyes;B group(removal of the width of the iris weeks Ceccon 2 mm) ,30 cases 40 eyes;C group(the width of the iris-week cut-lole cut 3 mm) ,30 cases 34 eyes,after over 1 month,they were followed up to observe the intraocular pressure,anterior chamber angle width of the depth, depending on the features, the iris in recent weeks, as well as cutting holes,long-term concurrency disease. Results A:recent surgery success rate of 85.79% ,long-term surgical success rate of 76. 19% ;B group of recent surgery success rate of 87.5% ,long-term surgical success rate of 82.5% ;C group of recent surgery success rate of94.11% ,long-term surgical the success rate of 88.23%, X2 test the difference was significant(P＜ 0. 05) ;3 postoperative IOP decreased in varying degrees compared with the preoperative differences were significant(P＜0.01) ;peripheral angle after deep Random mean :A group of ≥ 1/3CT,compared the difference between before and after surgery were significantly( P ＜ 0.01 ) ;B group and C group ＞ 1/2CT,2 groups were compared before and after surgery the difference was highly significant( P ＜ 0.05 ). Conclusion Iridectomy was the treatment of primary angle-closure glaucoma safe and effective method of cutting holes. The width of the iris weeks to 2～3 mmwas appropriate, beneficial to control the iris weeks before the adhesion and angle-cut hole shallow narrowing.

Evidências obtidas de um caso de melanoma de íris recidivado / Evidences from a case of recurrent iris melanoma

O artigo apresenta uma análise histológica de um caso de melanoma recidivado de íris após sete meses da iridociclectomia, em uma paciente de 45 anos. Após enucleação, o exame histopatológico do globo ocular demonstrou a persistência de um pequeno fragmento do tumor no coto da íris remanescente, evoluindo para recorrência da neoplasia. O caso traz dados para uma discussão sobre a cirurgia conservadora de melanomas oculares, visando uma postura analítica dentro do espírito da Medicina Baseada em Evidência. Um caso raro, com documentação apenas do ponto de vista histopatológico, que motiva a utilização destes achados na discussão do assunto. A não contiguidade do que restou do tumor com as tumorações da recidiva fala em favor da disseminação e proliferação de células neoplásicas nas cirurgias conservadoras.

The article presents a histologic study of a rare recurrent iris melanoma seven months after iridocyclectomy, in a 45-year-old female patient. After enucleation, the histopathological examination of the ocular globe demonstrated the persistence of a small tumor fragment in iridectomy stump, developing the neoplasia recurrence. The case brings data for a discussion about the conservative surgery of ocular melanomas and an analytical position of Evidence Based Medicine. A rare case, with documentation only histopathologic, motivates the use of this finding into the subject matter. The distance of what remained from the tumor with the recurrent tumors reinforces the dissemination and proliferation of neoplastic cells in the conservative surgeries.