ABSTRACT
Acute angle closure glaucoma (AACG) is a rare complication of carotid-cavernous fistula (CCF). However, rarer is iatrogenic AACG subsequent to CCF's standard treatment, endovascular embolization. To our knowledge, this is the first case in which AACG after angiography (a failed attempt at embolization) is treated primarily with embolization, and the first case of AACG and CCF that has yielded such a successful visual recovery.
Subject(s)
Carotid-Cavernous Sinus Fistula/diagnostic imaging , Cerebral Angiography/adverse effects , Glaucoma, Angle-Closure/etiology , Acute Disease , Aged , Antihypertensive Agents/therapeutic use , Carotid-Cavernous Sinus Fistula/therapy , Drug Therapy, Combination , Embolization, Therapeutic , Female , Glaucoma, Angle-Closure/drug therapy , Glaucoma, Angle-Closure/physiopathology , Gonioscopy , Humans , Iatrogenic Disease , Intraocular Pressure/physiology , Tomography, X-Ray Computed , Visual Acuity/physiologyABSTRACT
PURPOSE: To evaluate the effectiveness of phacoemulsification and goniosynechialysis (PEGS) in managing acute and subacute primary angle closure unresponsive to conventional therapy. MATERIALS AND METHODS: Retrospective series of patients of six glaucoma-trained surgeons with primary angle closure that did not respond to medical management, Nd:YAG laser peripheral iridotomy, or argon laser peripheral iridoplasty. RESULTS: A total of twenty-one patients with an average age of 65.6 years were included. Underlying mechanism of angle closure included pupillary block (n = 18) and plateau iris (n = 3). Average intraocular pressure (IOP) immediately prior to PEGS was 40.7 mm Hg, and mean follow-up time after PEGS was 11.7 months. PEGS decreased mean IOP by 25 mm Hg (62%), and mean number of medications from 3.8 pre-surgery to 1.7 post-surgery (55%). Mean LogMar visual acuity improved after PEGS, from 0.64 to 0.44 (Paired t test t = 4.120 P = 0.001). Subsequent trabeculectomy was necessary in one case (5%). CONCLUSIONS: Phacoemulsification with goniosynechialysis may be an effective treatment option for primary angle closure unresponsive to conventional therapy.
Subject(s)
Glaucoma, Angle-Closure/surgery , Phacoemulsification/methods , Trabecular Meshwork/surgery , Aged , Aged, 80 and over , Female , Humans , Intraocular Pressure , Lens Implantation, Intraocular/methods , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Visual AcuityABSTRACT
BACKGROUND: In Canada, public drug plans may restrict the use of newer topical antiglaucoma agents. The goals of this retrospective study were to estimate the proportion of patients who, at the initiation of topical glaucoma therapy, had contraindications to the use of topical beta-blockers and to identify whether changes in formulary listing status (from restricted-drug list to generally available drug list) influenced the use of topical glaucoma agents in patients with contraindications to beta-blockers. METHODS: Claims databases administered by the Régie de l'assurance maladie du Quebec were used to identify incident users of beta-blockers (betaxolol and timolol) and newer antiglaucoma agents (brimonidine, dorzolamide and latanoprost) among patients aged 35 years or older. Drug claims and physician diagnoses were used to determine the prevalence of the following contraindications to the use of beta-blockers (including warnings and precautions): asthma or chronic bronchitis, diabetes, dysrhythmia and heart failure, all in the year preceding the initiation of therapy; or use of systemic beta-blockers at the time glaucoma therapy was started. The observation period was divided into 2 phases: the time during which newer agents were on the restricted-drug list (first-line use being limited to patients with contraindications to the use of beta-blockers; January 1997 to March 1999) and the time during which these agents were on the generally available drug list (that is, after reimbursement restrictions were relaxed; April 1999 to June 2000). RESULTS: Of the 20 309 eligible patients, 59.8% were female, and the mean age was 72 years. Contraindications to topical beta-blocker therapy were significantly more frequent among the patients using newer antiglaucoma agents than among those using beta-blockers (71.5% vs. 55.5%, p < 0.0001). Asthma and chronic bronchitis were also more frequent among the patients using the newer agents than among those using beta-blockers (43.1% vs. 22.5%, p < 0.0001). Among the patients without contraindications to topical beta-blocker therapy, the overall proportions started on therapy with a newer agent were 22.7% when there were reimbursement restrictions and 30.0% when the restrictions were relaxed (p < 0.0001). CONCLUSIONS: Among patients with contraindications to the use of beta-blockers, newer topical antiglaucoma agents were used more often than beta-blockers. Among patients without such contraindications, the use of the newer agents increased modestly when reimbursement restrictions were relaxed.
