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AIM: To investigate the clinical efficacy of femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the treatment of acute angle-closure glaucoma complicated with cataract.METHODS: A total of 53 patients(60 eyes)with primary acute angle closure glaucoma complicated with cataract admitted to our hospital from April 2020 to February 2021 were selected. They were divided into two groups according to the surgical method, with 28 cases(30 eyes)who were treated with femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in group A, and 25 cases(30 eyes)who were treated with traditional cataract phacoemulsification combined with goniosynechialysis in group B. The effective phacoemulsification time(EPT)and cumulative dissipated energy(CDE)during surgery in two groups were recorded. Patients were followed up to 3mo after surgery, and the intraocular pressure, anterior chamber depth(ACD), best corrected visual acuity, corneal endothelial cell loss rate(ECL)and surgical complications were observed in both groups.RESULTS: The postoperative intraocular pressure was significantly decreased and ACD was significantly increased(all P<0.05), and there was no difference between the two groups(all P>0.05). The postoperative best corrected visual acuity of the two groups was significantly better than that before surgery(P<0.05), and group A was significantly better than group B at 1d after surgery(P<0.05). The EPT, CDE, ECL and incidence of complications(7% vs. 27%)in group A were significantly lower than those in group B(all P<0.05).CONCLUSION: Femtosecond laser-assisted cataract phacoemulsification combined with goniosynechialysis in the treatment of primary acute angle-closure glaucoma combined with cataract has a significant therapeutic effect, which can effectively improve surgical safety, reduce the rate of corneal endothelial cell loss, and have fewer complications.
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@#AIM: To measure the levels of IL-8 and IL-12p70 in the aqueous humor of patients with primary acute angle-closure glaucoma(AACG)and age-related cataract(ARC), and to investigate the clinical significance.<p>METHODS:Totally 29 eyes of 29 AACG patients, and 17 eyes of 17 ARC patients were enrolled in the study from October 2019 to December 2020. The levels of IL-8 and IL-12p70 were measured in the aqueous humor using Cytometric Beads Array. The clinical information was recorded in the same time for the correlation.<p>RESULTS:The level of IL-8 in AACG group was statistically elevated compared with the control group(Z= -5.384, P<0.05). However the IL-12p70 level did not differ in AACG group compared with ARC group(Z= -1.587, P=0.112). The IL-8 level was positively correlated with the duration of acute attack(rs=0.387, P=0.038). The concentrations of IL-8 and IL-12p70 in the filtration surgery group were significantly increased than that of the non-filtration surgery group(P<0.05).<p>CONCLUSION: The level of the inflammatory factor IL-8 in the aqueous humor of patients with AACG was significantly elevated. With the progression of the disease, the concentration of the immune-related factor IL-12p70 increased differentially. Both inflammation and immunity may play an important role in the pathogenesis of AACG.
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@#AIM: To investigate the effect of combined application of fluorouracil and adjustable suture in trabeculectomy for acute attack of primary angle-closure glaucoma in middle-aged patients. <p>METHODS: This was a prospective study. 60 patients(60 eyes)with primary angle-closure glaucoma in middle-aged patients were selected in our hospital from October 2016 to March 2019. Patients were randomly divided into suture group, 5-FU group and combined group, with 20 cases(20 eyes)in each group. Followed up for 6mo postoperatively, the patient's vision, visual field, intraocular pressure, adjuvant therapy and quality of life were observed.<p>RESULTS:The best corrected visual acuity among the three groups in the first week after operation was higher than that before surgery(<i>P</i><0.05). The intraocular pressure of the three groups at one week, one month and six months after operation were lower than that before operation(all<i> P</i><0.05). The intraocular pressure in the combined group were significantly lower than that in the suture group and the 5-FU group at 1mo and 6mo after operation(all <i>P</i><0.05). The number of eyes with anti-glaucoma drugs(2 eyes)and the number of anti-glaucoma drugs(0.20±0.016)in the combined group after operation were significantly lower than those in the suture group(11 eyes, 0.90±0.068)and the 5-FU group(12 eyes, 0.95±0.045)(all <i>P</i><0.05). There was no significant differences in preoperative CLVQOL scores among the three groups(<i>P</i>>0.05). The CLVQOL scores of the combined group(110.60±2.44)was higher than that of the suture group(101.50±2.61)and the FU group(98.55±2.50)at 6mo after operation(<i>P</i><0.05). The increase of CLVQOL scores(34.50±4.36)in the combined group before and after operation was significantly higher than that in the suture group(25.80±3.59)and the FU group(23.05±5.44)(<i>P</i><0.05). <p>CONCLUSION: Combined use of 5-FU and adjustable suture in trabeculectomy for the treatment of acute attack of middle-aged primary acute angle-closure glaucoma patients is safe and effective, which can improve the quality of life.
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@#AIM: To assess the clinical efficacy of phacoemulsification, intraocular lens implantation with goniosynechialysis(PEI+GSL)for acute angle closure glaucoma(AACG)and cataract with extensive angle closure synechiae.<p>METHODS: A retrospective study, we studied 35 eyes of 32 patients with AACG and cataract in our hospital. The extent of anterior chamber angle-closure synechiae was defined as an eye with >180°. All patients underwent PEI+GSL and completed an ophthalmologic examination including vision, intraocular pressure(IOP), anterior chamber depth(ACD), angle-opening distance(AOD500), trabecular-iris space area(TISA500)were observed at 1d, 1wk, 1mo and 3mo after cataract surgery. The angle closure range and retinal nerve fiber layer(RNFL)thickness changes at postoperative 1mo and 3mo were observed, and recorded complications.<p>RESULTS: Postoperative 3mo BCVA(0.334±0.154)and IOP(14.63±3.59mmHg)were improved compared with preoperative(0.914±0.290, 42.54±8.06mmHg)(<i>P</i><0.05). ACD(3.203±0.214mm), OCT angle parameters AOD500 and TISA500(0.308±0.014, 0.315±0.015mm, 0.134±0.013, 0.139±0.018mm2)were significantly increased compared with preoperation. The extent of angle closure with gonioscopy(72.32±28.33°)decreased compared preoperation(215.29°±30.66°), and RNFL thickness thinner than preoperation(<i>P</i><0.001). Changes in AOD500 and TISA500 for both nasal and temporal were negatively correlated with IOP, but not with changes in ACD, and no significant complications occurred in the 3mo after surgery.<p>CONCLUSION: The treatment of PEI+GSL can improve vision, deeper ACD and effectively open ACA in the early stage, thus controlling IOP.
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@#AIM: To investigate the influence of high perfusion irrigation during phacoemulsification on the postoperative visual function of patients with acute angle-closure glaucoma(AACG).<p>METHODS: Totally 35 patients(37 eyes)with AACG with cataract were included to do the surgery of phacoemulsification with goniosynechialysis. They have been followed up for 6mo. The preoperative and postoperative(3mo and 6mo)best corrected visual acuity(BCVA), intraocular pressure, mean sensitivity(MS), mean defect(MD), and square root loss variance(sLV)were measured and compared.<p>RESULTS: Compared with preoperative results, 3mo and 6mo BCVA were significantly improved and intraocular pressure was significantly reduced after operation, with statistically significant differences(<i>P</i><0.001). There was no statistically significant difference between groups after operation(<i>P</i>>0.05). After surgery, 3mo and 6mo MS increased significantly, MD and sLV decreased significantly, and the difference was statistically significant(<i>P</i><0.001). There was no statistically significant difference between the groups after surgery(<i>P</i>>0.05).<p>CONCLUSION: The high perfusion irrigation during phacoemulsification does not damage the visual function of patients with AACG.
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@#AIM: To observe the clinical effect of trabeculectomy combined with dexamethasone iontophoresis in the treatment of acute angle-closure glaucoma(PACG)with diabetes mellitus.<p>METHODS: Totally 42 eyes of 42 patients with acute PACG combined with diabetes in our hospital were selected and divided into trabeculectomy combined with iontophoresis group(group A)and trabeculectomy combined with peribulbar injection of methylprednisolone group(group B)according to different ways of controlling inflammation after surgery. Intraocular pressure, anterior chamber inflammation and complications before and after surgery were compared between the two groups.<p>RESULTS: The intraocular pressure of the two groups after surgery was significantly improved compared with that before surgery, and the difference was statistically significant(<i>P</i><0.05). Postoperative anterior chamber inflammation was well controlled in both groups without statistical significance(<i>P</i>>0.05). In terms of complications, group A was significantly superior to group B.<p>CONCLUSION: Trabeculectomy combined with dexamethasone iontophoresis or peribulbar injection of methylprednisolone can effectively control postoperative intraocular pressure and anterior chamber inflammation in patients with acute angle-closure glaucoma complicated with diabetes mellitus. Among them, the effect of combined dexamethasone iontophoresis in reducing complications is better and patients suffer less pain.
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@#AIM: To study and analyze the clinical effect of phacoemulsification and intraocular lens(IOL)implantation combined with goniosychialysis in treatment of acute angle-closure glaucoma with cataract. <p>METHODS: From June 2010 to October 2018, 40 patients(40 eyes)with acute angle-closure glaucoma and cataract which anterior chamber angle adhesion is less than 180°admitted to our hospital were enrolled in this study. They were divided into observation group and control group according to different surgical methods. The patients in the control group were treated by phacoemulsification and IOL implantation. The observation group was treated with phacoemulsification and IOL implantation combined with goniosychialysis. The difference between the two groups was compared. <p>RESULTS: At 3mo, 6mo after operation, the visual acuity, intraocular pressure, anterior chamber depth, anterior chamber angle grading of the observation group were better than those of the control group(<i>P</i><0.05). <p>CONCLUSION: Regarding the treatment of acute angle closure glaucoma, who has cataract and less than 180° peripheral anterior synechia, phacoemulsification and IOL implantation combined with goniosychialysis showed significant clinical effect.
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@#AIM: To compare the clinical efficacy of phacoemulsification combined with angle separation with trabeculectomy in the treatment of acute angle-closure glaucoma complicated with cataract.<p>METHODS: A total of 46 patients(60 eyes)diagnosed as acute angle-closure glaucoma complicated with cataract in our hospital from January 2016 to December 2017 were enrolled in this study. Thirty eyes were treated with phacoemulsification combined with chamber angle separation(group A). Thirty eyes were treated with trabeculectomy(group B). The visual acuity, intraocular pressure(IOP)and central anterior chamber depth were observed at preoperative and 4d, 7d, 1mo, 3mo postoperative.<p>RESULTS: The LogMAR visual acuity of group A(0.20±0.18)was significantly higher than that of group B(0.39±0.09)at 3mo postoperatively(<i>P</i><0.05). Before operation, IOP in group A(18.3±5.0mmHg)was no difference to IOP(17.2±1.9mmHg)postoperatively(<i>P</i>>0.05). Before operation, IOP in group B(18.2±5.0mmHg)was significantly difference to IOP(12.4±2.1mmHg)postoperatively(<i>P</i><0.05). There was a statistically significant difference in IOP between groups in 3mo after surgery(<i>P</i><0.05). In group A, the preoperative anterior chamber depth(ACD)was 2.23±0.21mm. The ACD was 3.46±0.1mm at 3mo postoperatively. In group B, the preoperative ACD was 2.21±0.12mm. The ACD was 3.36±0.09mm at 3mo postoperatively. In group A, there was no significant difference between the preoperative visual field loss(6.32±1.57db)and the 3mo postoperatively(6.54±1.42db)(<i>P</i>>0.05). In group B, there was no significant difference between the preoperative visual field loss(6.31±1.46db)and the 3mo postoperatively(6.57±1.52db)(<i>P</i>>0.05).<p>CONCLUSION: In this study, phacoemulsification combined with angle separation and trabeculectomy are both effectively in controlling IOP of acute angle-closure glaucoma.
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Feminino , Humanos , Masculino , Catarata , Diagnóstico , Glaucoma de Ângulo Fechado , Incidência , Coreia (Geográfico) , Programas Nacionais de Saúde , Estudos RetrospectivosRESUMO
Objective To measure the levels of monocyte chemoattractant protein-1 (MCP-1) in the aqueous humor of patients with acute primary angle-closure glaucoma (APACG),and its correlation with the patients' prognosis after trabeculectomy.Methods This retrospective case-control study included 19 patients with APACG who experienced a failed trabeculectomy (case group) and 57 age-and sex-matched patients with APAGG who underwent successful trabeculectomy (control group).Aqueous humor was collected before trabeculectomy for the detection of MCP-1 levels in the both groups by enzyme-linked immunosorbent assay.And finally,logistic regression analysis was applied to assess the risk factors for failed trabeculectomy.Results The MCP-1 concentration in aqueous humor was (5688.04 ± 2099.99)ng · L-1 in the case group and (2077.57 ± 568.44)ng · L-1 in the control group,and the difference between both groups were significant (P ＜ 0.001).Logistic regression analysis revealed MCP-1 level (OR =1.005;95％ CI =1.001-1.008) and a shallow anterior chamber after surgery (OR =31.430;95％ CI =1.577-57.350) were the independent risk factors for failed trabeculectomy procedures.Conclusion MCP-1 levels in aqueous humor are higher in APACG eyes with failed trabeculectomy than those with successful one during 1-year follow-up,so MCP-1 level is considered as an independent risk factor for failed trabeculectomy.
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@#AIM: To investigate the clinical efficacy and safety of EX-PRESS glaucoma drainage combined with phacoemulsification in the treatment of patients with acute angle-closure glaucoma and ocular hypertension with cataract. <p>METHODS: Patients with acute angle-closure glaucoma and cataract sustained high intraocular pressure who were admitted to our hospital from January 2016 to January 2017 were enrolled in this study. All patients were treated with EX-PRESS glaucoma drainage device combined with phacoemulsification. The anterior chamber depth before and after operation, intraocular pressure, corrected visual acuity at 1, 4, 8, 12, 24, and 48wk after surgery were performed. The success rate of surgery and intraoperative and postoperative complications were recorded. <p>RESULTS: The anterior chamber depth of the preoperative patients was 1.974±0.182mm, and that after operation was 2.961±0.175mm. The difference was statistically significant(<i>P</i><0.01). At 1, 4, 8, 12, 24, and 48wk, the intraocular pressure was significantly lower than that before surgery(<i>P</i><0.05). The proportion of successful patients at 12, 24, and 48wk after surgery gradually decreased, but the total success rate was 100%. The corrected visual acuity of the patients was significantly improved compared with the preoperative 48wk after operation, and the difference was statistically significant(<i>P</i><0.05). There were no serious intraoperative and postoperative complications in this group of patients. <p>CONCLUSION: EX-PRESS glaucoma drainage combined with phacoemulsification is safe and effective in cataract patients with acute angle-closure glaucoma with high intraocular pressure.
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@#AIM: To study and analyze the clinical effect of phacoemulsification with intraocular lens(IOL)implantation in patients with acute angle-closure glaucoma complicated with cataract. <p>METHODS: From June 2016 to January 2018, 80 patients with acute angle-closure glaucoma and cataract admitted to our hospital were enrolled in this study. They were divided into two groups according to random number table. They were divided into observation group and control group, respectively. The patients in the control group were treated by phacoemulsification and IOL implantation. The observation group were treated with combined surgery for glaucoma and cataract. The difference between the two groups was compared. <p>RESULTS: After operation, the visual acuity, intraocular pressure and complications of the observation group were better than those of the control group(<i>P</i><0.05). <p>CONCLUSION: The clinical effect of phacoemulsification with IOL implantation in the treatment of acute angle-closure glaucoma with cataract is of great clinical value.
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@#AIM: To study the effect of two kinds of phacoemulsification combined with goniosynechialysis for primary angle-closure glaucoma with cataract. <p>METHODS: Phacoemulsification combined with goniosynechialysis was performed in 60 patients 62 eyes for primary angle-closure glaucoma with cataract. They were randomly divided into two groups, 31 eyes underwent phacoemulsification with goniosynechialysis combined with I/A catheterization were performed in Group A; in Group B, 31 eyes were performed phacoemulsification with goniosynechialysis combined with viscoelastics. Best corrected visual acuity, the intraocular pressure, anterior chamber depth, anterior chamber angle width and pupil size were measured before the operation, and 3mo after the operation.<p>RESULTS: Intraocular pressure of all cases were reduced obviously after the operation(<i>P</i><0.05). Visual acuity of the 62 eyes were improved in different extent; the anterior chamber depth and anterior chamber angle width after 3mo of the operation were deeper and wider than those before the operation(<i>P</i><0.05). There were no different in the intraocular pressure, best corrected visual acuity and anterior chamber depth between the two groups(<i>P</i>>0.05), but, Group A was superior to Group B in anterior chamber angle width(<i>P</i><0.05). At 3mo after operation, there were 8 eyes in Group A with more than 1mm lessen pupil size, two eyes in Group B had the same. <p>CONCLUSION: Two kinds of goniosynechialysis combined with phacoemulsification in the treatment of primary acute angle-closure glaucoma with cataract are effective. Among them, the goniosynechialysis with I/A was more effective to increase the anterior chamber angle width.
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@#AIM: To analyze the clinical effect and security of phacoemulsification combining goniosynechialysis to treat cataract accompanied with acute angle-closure glaucoma. <p>METHODS: The clinical data of totally 45 patients(48 eyes)with cataract and acute angle-closure glaucoma was retrospectively analyzed, including 28 patients(30 eyes)treated with phacoemulsification with goniosynechialysis(the study group)and 17 patients(18 eyes)treated with phacoemulsification with trabeculectomy(the control group). The visual acuity, intraocular pressure, iridocornealis, central anterior chamber depth and complications were compared between groups. <p>RESULTS: Before surgery, there was no significant difference in best corrected visual acuity and iridocornealis angle between groups(<i>P</i>>0.05). At 7d, 1mo, 3mo, 6mo and 1a after surgery, the best corrected visual acuity of both groups increased, and the study group was higher than the control group; the iridocornealis angle close degree of both groups decreased, and the study group was lower than the control group(<i>P</i><0.05). Both groups and time had an effect on intraocular pressure and chamber depth of patients(<i>P</i><0.05), and there was no reciprocal action between the two factors(<i>P</i>>0.05). Compare in groups: 7d, 1mo, 3mo, 6mo and 1a after surgery, the intraocular pressure of both groups decreased, and at 3mo, 6mo and 1a after surgery, the study group was lower than that at 7d after surgery(<i>P</i><0.05), the control group was similar to that at 7d after surgery(<i>P></i>0.05). At 7d, 1, 3, 6mo and 1a after surgery, the chamber depth of both groups were higher than 1d before surgery, 3, 6mo and 1a after surgery, the study group was similar to that at 7d after surgery(<i>P></i>0.05), the control group after 12mo was lower than that at 7d after surgery(<i>P<</i>0.05). Compare between groups: Before treatment, 7d, 1, 3 and 6mo after treatment, there was no significant difference between groups in intraocular pressure(<i>P</i>>0.05); at 1a after surgery, IOP of the study group was lower than the control(<i>P</i><0.05). Before treatment, there was no significant difference between groups in anterior chamber depth(<i>P></i>0.05); at 3, 6mo and 1a after surgery, the study group was higher than the control group(<i>P</i><0.05). <p>CONCLUSION: Phacoemulsification combined with goniosynechialysis is effective to treat acute angle-closure glaucoma, with prominent long-term efficacy and the risk is not increased.
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·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.
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Objective To evaluate the outcome of 23G minimally vitrectomy trocar on eyes with acute angle closure glaucoma.Methods A retrospective review was performed of patients with acute angle closure glaucoma who underwent combined compound trabeculectomy from September,2014 to June,2015 in Beijing MEM care system.Intraoperative 23G minimally vitrectomy trocar was used in all of the patients.30 eyes of 30 patients were enrolled in the study.All patients were followed up for 12 months.Visual acuity,intraocular pressure and complications were observed.Results No serious complications such as explosive choroid hemorrhage and retinal hemorrhage occurred during operation.All of 30 eyes maintained adequate pressure control.The average postoperative IOP was (15.93 ± 1.35) mmHg (1 kPa =7.5 mmHg),was less than the preoperative (56.34 ± 6.96) mmHg (P =0.00).And the visual acuity in 23 eyes were improved.Conclusion Combined trabeculectomy with 23G minimally vitrectomy trocar in acute angle closure glaucoma patients is a kind of safe and effective operation method,can obviously reduce the intraoperative explosive choroid hemorrhage.
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AIM: To discuss the details about the phacoemulsification and intraocular lens implantation combined with goniosynechialysis for the treatment of primary acute angle-closure glaucoma (PAACG).METHODS: Totally 21 patients (21 eyes) with PAACG from February 2013 to October 2015 were performed phacoemulsification and intraocular lens implantation combined with goniosynechialysis.The details such as incision, circular capsulorhexis, water separation, intraocular lens selection, goniosynechialysis were discussed.The vision, intraocular pressure, complications were observed.RESULTS: Postoperative intraocular pressure of all patients with were controlled under 21mmHg followed up for 1mo.Visual acuity was improved to some extent.The patients were observed with rapid recovery and fewer complications.There was 1 eye with posterior capsule rupture intraoperatively and 1 eye with decompensated corneal edema postoperatively.CONCLUSION: It makes this surgery more safe and perfect by disposing the details during operation.
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@#AIM: To investigate the effect of compound trabeculectomy in patients with primary acute angle closure glaucoma under persistent high intraocular pressure. <p>METHODS: From February 2015 to February 2016, we selected 62 cases(62 eyes)of primary acute angle closure glaucoma in our hospital, the control group 34 patients 34 eyes(preoperative intraocular pressure control in the normal range, intraocular pressure ≤ 21mmHg), the observation group 28 patients 28 eyes(preoperative intraocular pressure not in the normal range, the intraocular pressure 28-50mmHg and lasted for more than 3d). The two groups were treated with compound trabeculectomy and observed for visual acuity, intraocular pressure and so on. <p>RESULTS: Compared with preoperative, at 3mo postoperatively visual acuity improved, unchanged and decreased rate in observation group were 68%, 21% and 11%, the difference were not statistically significant compared with the control group(<i>P</i>>0.05). The postoperative intraocular pressure of the two groups compared with preoperative significantly decreased(<i>P</i><0.05). The postoperative intraocular pressure of observation group and control group were 11.10±2.20mmHg and 11.73±2.71mmHg, the difference was not statistically significant(<i>P</i>>0.05). The preoperative and postoperative anterior chamber depth of observation group was lower than that in the control group(<i>P</i><0.05). The postoperative anterior chamber depth of the two groups compared with preoperative increased(<i>P</i><0.05). The postoperative axial length of the two groups compared with preoperative decreased(<i>P</i><0.05). The postoperative complication rate of observation group was 14%, and the control group was 18%, the difference was not statistically significant(<i>P</i>>0.05). <p>CONCLUSION: Compound trabeculectomy in patients with primary acute angle closure glaucoma under high intraocular pressure is effective, but there still needs further study.
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PURPOSE: To report a case of acute angle-closure glaucoma secondary to spontaneous suprachoroidal hemorrhage in a hemodialysis patient. CASE SUMMARY: A 71-year-old man visited our clinic after 3 days of vision loss and ocular pain in the right eye. He had been treated with hemodialysis using heparin due to diabetic nephropathy. Visual acuity (VA) was hand motion in the right eye and 0.2 in the left eye. The intraocular pressure (IOP) was 58 mmHg in the right eye and 15 mmHg in the left eye. Gonioscopic examination revealed a closed angle in the right eye. Fundus examination of the right eye showed a massive hemorrhagic retinal detachment and ultrasound sonography revealed a dome-shaped retinal detachment with suprachoroidal hemorrhage in the right eye. The patient was treated with topical aqueous suppressants and cycloplegics. After two weeks of medical treatment, VA in the right eye was still hand motion and IOP was 8 mmHg. Gonioscopic examination showed a wide-open angle in the right eye. During the two-month observation period, VA in the right eye did not recover, however there was no sign of IOP elevation or symptoms of ocular pain. CONCLUSIONS: Spontaneous suprachoroidal hemorrhage can occur in patients who receive hemodialysis with heparin. This spontaneous suprachoroidal hemorrhage can be subsequently accompanied by acute angle-closure glaucoma. Spontaneous decrease of suprachoroidal hemorrhage, loss of angle-closure, and decline of IOP can be expected by treating with topical aqueous suppressants and cycloplegics.
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Idoso , Humanos , Nefropatias Diabéticas , Glaucoma de Ângulo Fechado , Mãos , Hemorragia , Heparina , Pressão Intraocular , Midriáticos , Diálise Renal , Descolamento Retiniano , Ultrassonografia , Acuidade VisualRESUMO
PURPOSE: To evaluate long-term change in intraocular pressure (IOP) in eyes undergoing laser iridotomy (LI) and early phacoemulsification after LI in patients with acute angle-closure glaucoma (AACG). METHODS: The retrospective, comparative chart review included patients with AACG, Group A who underwent only LI and Group B who underwent early phacoemulsification within 1 month after LI. Patients were followed up on day 1; week 1; and months 1, 3, 6, and 12 after LI. IOP changes were studied. RESULTS: This study included a total 99 eyes from 99 patients, 37 in group A and 62 in group B. The mean IOP were not significantly different between the two groups at the initial visit or 1 month later. However, group B showed a consistently lower mean IOP that that of group A at 3, 6, and 12 months (p= 0.003, <0.001, <0.001, respectively). The prevalence of IOP increase to greater than 21 mmHg was 3 (8.11%), 5 (13.51%), and 5 patients (13.51%) in group A and 0, 2 (5.41%), and 1 patients (1.61%) in group B at 3, 6, and 12 months, respectively. Group B showed a significantly lower prevalence of IOP increase (p = 0.050, 0.038, 0.026). CONCLUSIONS: We found that patients treated with early phacoemulsification after LI had better outcomes of well-maintained IOP compared to those undergoing LI alone. For AACG patients with coexisting cataract, early phacoemulsification after LI can be considered as a reasonable treatment to maintain IOP.