Phacoemulsification vs phacotrabeculectomy in chronic angle-closure glaucoma with cataract: complications [corrected].

OBJECTIVE: To compare the complications of phacoemulsification alone vs combined phacotrabeculectomy in chronic angle-closure glaucoma (CACG) with coexisting cataract. METHODS: Patients with CACG with coexisting cataract recruited into 2 randomized controlled trials comparing phacoemulsification alone vs combined phacotrabeculectomy were pooled for analysis. The first trial recruited patients with medically controlled intraocular pressure, while the second trial recruited patients with medically uncontrolled intraocular pressure. The 2 trials had otherwise identical study designs. All patients were reviewed every 3 months for 2 years after surgery. The main outcome measure was the surgical complications of phacoemulsification alone vs combined phacotrabeculectomy in CACG eyes with cataract. RESULTS: One hundred twenty-three CACG eyes with cataract from 123 patients were included. Sixty-two CACG eyes were randomized to receive phacoemulsification alone, and 61 eyes had combined phacotrabeculectomy. In the phacoemulsification group, 5 of the 62 CACG eyes (8.1%) had a total of 5 surgical complications. In the combined phacotrabeculectomy group, 16 of the 61 CACG eyes (26.2%) had a total of 19 surgical complications. The difference in the proportion of eyes with 1 or more surgical complications between the 2 treatment groups was statistically significant (P = .007, Pearson chi(2) test). There was no statistically significant difference in final visual acuity or glaucomatous progression during the 24-month follow-up. CONCLUSIONS: Combined phacotrabeculectomy resulted in significantly more surgical complications than phacoemulsification alone in CACG eyes with coexisting cataract. There was no difference in visual acuity or disease progression between the 2 treatment groups.

Novel approach for anterior chamber angle analysis: anterior chamber angle detection with edge measurement and identification algorithm (ACADEMIA).

OBJECTIVE: To describe a novel approach to measuring anterior chamber angle dimensions and configurations. METHODS: Sixty-nine images were selected randomly from the ultrasound biomicroscopic image database to develop the algorithm. Thirty images were selected for further analyses. The value of each pixel of the 8-bit grayscale ultrasound biomicroscopic images was quantized into 0 (black) or 1 (white), and the edge points outlining the angle were detected and fitted with straight lines. The dimensions and profiles of anterior chamber angles were then measured. RESULTS: The algorithm failed to identify the edge points correctly in 8 (11.6%) of 69 images because of strong background noise. Three basic types of angle configuration were identified based on the derived angle profiles: constant, increasing, and decreasing, which corresponded to flat, bowed forward, and bowed backward iris contours, respectively. The angle measurements demonstrated high correlation with trabecular-iris angle and angle opening distance 500 (calculated as the distance from the corneal endothelium to the anterior iris surface perpendicular to a line drawn at 500 mum from the scleral spur). The strongest association was found between the averaged angle derived from the angle profile and the angle opening distance 500 (r = 0.91). CONCLUSION: The proposed algorithm has high correlations with angle opening distance and trabecular-iris angle with the added advantages of being fully automated, reproducible, and able to capture the characteristic angle configurations. However, good-quality ultrasound biomicroscopic images with high signal-to-noise ratio are required to identify the edge points correctly.

Hemorrhagic complication in an unsuspected macular choroidal melanoma.

PURPOSE: To report a rare presentation of a hemorrhagic complication in a patient with unsuspected macular choroidal melanoma. DESIGN: Interventional case report. METHODS: A 32-year-old Chinese woman presented with disturbance of her left central vision. A hemorrhagic mass at the macula was noticed that was evacuated by submacular surgery. RESULTS: The mass expanded rapidly into a mushroom configuration after surgery. Fine-needle aspiration confirmed the diagnosis of malignant choroidal melanoma, and enucleation followed. Histology demonstrated moderately large epithelioid tumor cells with prominent nucleoli. The sclera was intact, and the optic nerve was not involved. The patient has been followed for 5 years without signs of local recurrence or metastasis. CONCLUSION: We should be alert for atypical presentations of choroidal melanoma. Unnecessary or inadvertent surgical intervention may induce tumor growth and subsequent local spread or metastasis.