Intraocular pressure changes after phacoemulsification in pseudoexfoliation versus healthy eyes.

BACKGROUND: Pseudoexfoliation (PXF) syndrome is the most common cause of secondary glaucoma worldwide. This systemic disorder causes further damage to the optic nerve and ultimately increases the need for surgical interventions. Therefore, intraocular pressure (IOP) control is very important in these patients. The aim of this study was to compare IOP changes after phacoemulsification in subjects with PXF syndrome compared to those without this syndrome. METHODS: 61 patients were enrolled in this prospective clinical study. Subjects were assigned into two groups based on presence or absence of PXF syndrome. IOP and anterior chamber angle parameters including: angle opening distance (AOD) and trabecular-iris surface area (TISA) measured one day preoperatively and 3 months postoperatively. Intraoperative metrics factors including: infusion fluid usage (IFU), cumulative dissipated energy (CDE) and aspiration time (AT) were obtained from the phacoemulsification machine at the end of each surgery. IOP changes, anterior chamber angle parameters and intraoperative metrics factors were compared between groups. RESULTS: Mean IOP before surgery was significantly higher in the PXF group (14.70 mm Hg) compared to controls (12.87 mm Hg) (P-value < 0.01). Phacoemulsification decreased IOP in both, but to greater extent in the PXF group (p-value < 0.01). AOD and TISA also increased significantly following surgery in both groups. The results showed that postoperative IOP was negatively correlated with preoperative IOP in both groups (p-value < 0.01). Also, IOP after phacoemulsification was negatively correlated with IFU in the PXF group (p-value = 0.03). CONCLUSIONS: Patients with PXF syndrome exhibited a reduction in IOP and increase in anterior chamber angle parameters after phacoemulsification. We observed a greater IOP reduction in PXF subjects when it was compared to controls. Higher preoperative IOP and intraoperative IFU were associated with more IOP reduction in the PXF group.

Comparison of Anterior Segment-Optical Coherence Tomography Parameters in Phacomorphic Angle Closure and Acute Angle Closure Eyes.

PURPOSE: The purpose of this study is to compare anterior segment-optical coherence tomography (AS-OCT) parameters in phacomorphic angle closure and acute primary angle closure (APAC) eyes. METHODS: In this cross-sectional case series, a total of 134 patients with phacomorphic angle closure (28 eyes) or APAC (54 eyes), as well as normal control subjects (52 eyes), were enrolled. Patients underwent AS-OCT imaging and A-scan biometry of both eyes. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness (IT), iris curvature, lens vault (LV), anterior vault (AV), and angle parameters including angle opening distance (AOD 500 and AOD750) and trabecular iris space area (TISA500 and TISA750) were measured in qualified images using the Zhongshan Angle Assessment Program and compared among eyes with phacomorphic angle closure, APAC, and normal control subjects. RESULTS: Phacomorphic angle closure and APAC eyes had smaller AOD, ACD, ACA, ACW, AV, and posterior corneal arc length and greater LV than normal controls (P < 0.001 for all comparisons). After adjustment for age, sex, and pupil diameter, phacomorphic angle closure had greater AOD500 (P = 0.02), TISA500 (P = 0.003), TISA750 (P = 0.05), axial length (P = 0.03), and LV (P = 0.001) and less ACD (P = 0.001), ACA (P = 0.003), IT750 (P = 0.01), and IT2000 (P = 0.04) than APAC eyes: ACD < 1.59 mm (odds ratio [OR], 29.57; P < 0.01) and LV > 1042 µm (OR,12.12; P < 0.01) were the two biometric parameters that could highly discriminate phacomorphic angle closure from the APAC eyes. In multivariate analysis, ACD, LV, AOD500, and axial length could significantly distinguish the two entities. CONCLUSIONS: Ocular biometric parameters can differentiate phacomorphic angle closure from APAC eyes. Shallower ACD and greater LV, axial length, and ACA are the main parameters that distinguish phacomorphic angle closure from APAC.

Orbital metastatic osteosarcoma.

At an estimated incidence of 2 cases per million persons per year, osteosarcoma is the most common primary malignant bone tumor in children and adults, excluding hematopoietic intraosseous tumors. Orbital metastases of osteosarcoma are very rare. Only 5 cases of orbital metastasis of osteosarcoma previously reported in the literature. We report the case of a 19-year-old man with known history of osteosarcoma of right distal femur who presented with acute visual loss and progressive protrusion of his left eye. Orbital CT scan and MRI revealed orbital mass eroding orbital walls and intracranial invasion. He underwent superotemporal orbitotomy for debulking of orbital mass. Histopathological examination (HPE) of the specimen was reported as metastatic osteosarcoma with extensive tumor necrosis. Then he underwent adjuvant chemotherapy and palliative radiotherapy. Although orbital metastasis of osteosarcoma is a rare event, it seems it has had an increasing trend recently. so, making efforts to palliate the patient's symptoms by multidisciplinary teamwork and proper interaction among ophthalmologist, orthopedic surgeons and oncologists is necessary.

Anterior segment optical coherence tomography parameters in phacomorphic angle closure and mature cataracts.

PURPOSE: To describe anterior segment optical coherence tomography (AS-OCT) parameters in phacomorphic angle closure eyes, mature cataract eyes, and their fellow eyes, and identify those parameters that could be used to differentiate phacomorphic angle closure eyes from those with mature cataract and no phacomorphic angle closure. METHODS: In this cross-sectional study, a total of 33 phacomorphic angle closure subjects and 34 control patients with unilateral mature cataracts were enrolled. All patients underwent AS-OCT imaging and A-scan biometry of both eyes. Anterior chamber depth (ACD), anterior chamber area (ACA), iris thickness, iris curvature, lens vault (LV), and angle parameters, including angle opening distance (AOD750) and trabecular-iris space area (TISA750), were measured in qualified images using customized software and compared among eyes with phacomorphic angle closure, mature cataract eyes, and their fellow eyes. RESULTS: There was no significant difference in axial length among the four groups. Phacomorphic angle closure had the smallest angle (AOD750, TISA750) and anterior chamber parameters (ACD, ACA, anterior chamber width) and the greatest LV among the groups. This pattern was similar when comparing fellow eyes of mature cataract patients and fellow eyes of phacomorphic angle closure. Anterior chamber area less than 18.62 mm(2), ACD less than 2.60 mm, LV greater than 532.0 µm, and AOD750 less than 0.218 mm had the highest odds ratios (ORs) for distinguishing fellow eyes of phacomorphic angle closure versus fellow eyes of mature cataracts, with OR values of 9.90, 8.31, 7.91, and 7.91, respectively. Logistic regression showed that ACA less than 18.62 was the major parameter associated with fellow eyes of phacomorphic angle closure (OR = 10.96, P < 0.001). CONCLUSIONS: Anterior chamber depth, ACA, AOD750, and LV are powerful indicators in differentiating phacomorphic angle closure eyes from those with mature cataract and their fellow eyes.