Primary acute angle-closure glaucoma complicating ciliochoroidal detachment: report of four cases and review of the literature.

PURPOSE: To describe the ultrasound biomicroscopy (UBM) and B-scan ultrasonography findings and therapeutic approach for ciliochoroidal detachment secondary to acute primary angle-closure glaucoma (APACG) in four patients. We also reviewed the literature. METHODS: Case report and systematic literature review. RESULTS: The four patients were referred to our department for further management of APACG. The UBM and B-scan ultrasonography examinations were conducted 2 days after the beginning of medical treatment and demonstrated ciliochoroidal detachment in four eyes of the four patients. The patients all received intravenous infusion of corticosteroid therapy (10 mg dexamethasone once daily for 5-7 days). We reviewed the UBM findings, which confirmed that the ciliochoroidal detachment disappeared. The patients then underwent trabeculectomy combined with peripheral iridotomy surgery. The patients all ultimately recovered very well. CONCLUSION: APACG with ciliochoroidal detachment is rare and has hidden clinical manifestations, and the pathophysiological mechanism is not yet fully understood. Anti-glaucoma surgery may increase the detachment. UBM and B-scan ultrasounds are useful tools for ciliochoroidal detachment diagnosis in APACG patients before operative treatment.

Influence of Lens Factor and Effect of Selected Cataract Extraction on Acute Angle-Closure Glaucoma

PURPOSE: To analyze the affecting factor of lens in pathogenesis of acute primary angle-closure glaucoma (APACG) and the effect of selected cataract extraction with intraocular lens (IOL) implantation. METHODS: A survey was conducted on 25 eyes of 21 patients with acute angle-closure glaucoma accompanied by senile cataract against 21 eyes of 16 age-matched normal persons. Biometric measurements were made in both groups in order to analyze an affecting factor of lens in APACG. Before and after selected cataract extraction, other clinical findings were also evaluated. RESULTS: Biometric measurements such as anterior chamber depth (ACD), lens thickness (LT), ACD/axial length (AXL), LT/AXL, and relative lens position (RLP) were significantly larger for the 25 eyes of the 21 patients with APACG than the 21 eyes of the 16 age-matched normal persons (P<0.05). After selecting cataract extraction with IOL implantation, improved biometric measurements and clinical findings revealed the effectiveness of that operation. CONCLUSIONS: Selected cataract extraction with IOL implantation could be successful as primary surgery in APACG accompanied by senile cataract over intraocular pressure control and visual acuity improvement for lens factor removal of APACG.