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Elhusseiny AM, Hassan AK, Elsaman AS, Azhari JO, VanderVeen DK, Abdelnaem S, Pakravan M, Chang TC, Khodeiry MM, Khouri AS, Sayed MS, Lee RK, Sallam AB. Continuous Wave Transscleral Cyclophotocoagulation and Endoscopic Cyclophotocoagulation in Childhood Glaucoma: A Meta-Analysis. J Glaucoma 2024; 33:456-463. [PMID: 38506746 PMCID: PMC11142875 DOI: 10.1097/ijg.0000000000002365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/27/2023] [Indexed: 03/21/2024]
Abstract
PRCIS Transscleral cyclophotocoagulation (TS-CPC) and endoscopic cyclophotocoagulation (ECP) were effective in reducing intraocular pressure (IOP) and glaucoma medications in childhood glaucoma. OBJECTIVE To report the outcomes of continuous wave TS-CPC and ECP in childhood glaucoma. MATERIALS AND METHODS We performed a systematic search of relevant databases. We collected data on age, follow-up duration, type of glaucoma, previous surgical interventions, preoperative and postoperative IOP, preoperative and postoperative number of glaucoma medications, adverse events, number of sessions, and success rates at different time points. The main outcome measures are the amount of IOP and glaucoma medication reduction. RESULTS We included 17 studies studying 526 patients (658 eyes); 11 evaluated the effectiveness of TS-CPC (268 patients, 337 eyes), 5 evaluated ECP (159 patients, 197 eyes), and one study compared both techniques (56 patients, 72 eyes for TS-CPC vs 43 patients, 52 eyes for ECP). The median duration of follow-up was 28 months in the TS-CPC group and 34.4 months in the ECP group. The mean number of treatment sessions was 1.7 in the TS-CPC and 1.3 in the ECP. In the TS-CPC group, the mean IOP was significantly reduced from 31.2 ± 8 to 20.8 ± 8 mm Hg at the last follow-up ( P < 0.001). The mean number of glaucoma medications was reduced from 2.3 ± 1.3 to 2.2 ± 1.3 ( P = 0.37). In the ECP group, there was also a significant reduction in the mean IOP from 32.9 ± 8 mm Hg with a mean of 1.7 ± 0.7 glaucoma medications to 22.6 ± 9.8 mm Hg ( P < 0.0001) on 1.2 ± 1.1 medications ( P = 0.009) at the last follow-up. CONCLUSION Both TS-CPC and ECP were effective in reducing the IOP and glaucoma medications in childhood glaucoma. Multiple treatment sessions were required.
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Affiliation(s)
- Abdelrahman M. Elhusseiny
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amr K. Hassan
- Department of Ophthalmology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed S. Elsaman
- Department of Ophthalmology, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Jamal O. Azhari
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Deborah K. VanderVeen
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Salah Abdelnaem
- Department of Immunology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mohammad Pakravan
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ta C. Chang
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, USA
| | | | - Albert S. Khouri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ
| | - Mohamed S. Sayed
- Moorfields Eye Hospital Dubai, Dubai Healthcare City, Dubai, UAE
| | - Richard K. Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL, USA
| | - Ahmed B. Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Fries FN, Náray A, Munteanu C, Stachon T, Lagali N, Seitz B, Käsmann-Kellner B, Szentmáry N. The Effect of Glaucoma Treatment on Aniridia-Associated Keratopathy (AAK) - A Report from the Homburg Register for Congenital Aniridia. Klin Monbl Augenheilkd 2023. [PMID: 37852284 DOI: 10.1055/a-2194-1580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND Congenital aniridia is a severe malformation of almost all eye segments. Aniridia-associated keratopathy (AAK) and secondary glaucoma, which occur in more than 50% of affected individuals, are typically progressive and pose a high risk of blindness for patients with congenital aniridia. Our aim was to investigate the effect of glaucoma treatment on AAK in patients of the Homburg Aniridia Center. METHODS Our retrospective monocentric study included patients who underwent a comprehensive ophthalmological examination at the Homburg Aniridia Center between June 2003 and January 2022. RESULTS There were 556 eyes of 286 subjects (20.1 ± 20.1 years; 45.5% males) included. In 307 (55.2%) eyes of 163 subjects (27.5 ± 16.3 years; 43.1% males), glaucoma was present at the time of examination. The mean intraocular pressure in the glaucoma group was 19.0 mmHg (± 8.0), while in the non-glaucoma group, it was 14.1 mmHg (± 3.6) (p < 0.001). In the glaucoma group, 68 patients used antiglaucomatous topical monotherapy, 51 patients used 2 agents, 41 patients used 3 agents, 7 patients used quadruple therapy, and 140 did not use topical therapy (e.g., after pressure-lowering surgery, pain-free end-stage glaucoma, or incompliance). Patients were classified according to the following stages of AAK: Stage 0 (96 eyes [17.2%], no keratopathy), Stage 1 (178 eyes [32.0%]), Stage 2 (107 eyes [19.2%]), Stage 3 (67 eyes [12.0%]), Stage 4 (62 eyes [11.1%]), Stage 5 (45 eyes [8.0%]). The mean stage of AAK was 1.4 (1.2 - 1.5) in the group without eye drops, 1.9 (1.5 - 2.2) in the group with monotherapy, 1.8 (1.5 - 2.1) in the group with 2 drugs, 1.9 (1.5 - 2.2) in the group with 3 drugs, 3.4 (2.3 - 4.6) in the group with 4 drugs, and 3.3 (3.1 - 3.6) after antiglaucomatous surgery. The stage of AAK was significantly positively correlated with the number of pressure-lowering eye drops (p < 0.05) and prior pressure-lowering surgery (p < 0.05). Prostaglandin analogues were not correlated with a higher AAK stage compared to the other drug groups. CONCLUSIONS At the Homburg Aniridia Center, patients using topical antiglaucomatous quadruple therapy or who had previously undergone antiglaucomatous surgery had by far the highest AAK stage. The different drug groups had no influence on the AAK stage.
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Affiliation(s)
- Fabian Norbert Fries
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Annamária Náray
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Cristian Munteanu
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tanja Stachon
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Neil Lagali
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Saarland University, Homburg/Saar, Germany
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Muñoz-Negrete FJ, Teus MA, García-Feijoó J, Canut MI, Rebolleda G. Aniridic glaucoma: An update. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96 Suppl 1:52-59. [PMID: 34836589 DOI: 10.1016/j.oftale.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/20/2020] [Indexed: 06/13/2023]
Abstract
Aniridia is a congenital bilateral ocular disorder with dominant autosomal inheritance. More than 50% of patients will develop aniridic glaucoma (AG) during their lives. Open angle glaucoma is more common in aniridia, but a closed angle mechanism has been described in relation with anterior rotation of the rudimentary iris, occluding trabecular meshwork. Diagnosis and follow-up of AG is difficult in relation with the presence of keratopathy, nystagmus and foveal hypoplasia. Central corneal thickness usually measures more than 600 microns, which prevents achieving a reliable value of intraocular pressure. Medical treatment of AG is no different from the rest of glaucoma. It is recommended to use preservative free formulations, and combined therapy is often required. Surgical treatment is needed in many cases. There is no consensus on the first line surgery for AG, but in open angle AG, angle surgery is usually first choice, and glaucoma drainage devices are the next preferred surgical technique. In closed angle AG glaucoma drainage devices are usually the first choice, with trabeculectomy as the second preferred surgical technique.
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Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Spain; OFTARED.
| | - M A Teus
- Universidad de Alcalá, Alcalá de Henares, Spain; Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain; OFTARED
| | - J García-Feijoó
- Servicio de Oftalmología, Hospital Universitario Clínico San Carlos, IdISSC, Madrid, Spain; Universidad Complutense, Madrid, Spain; OFTARED
| | | | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Spain; OFTARED
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Sihota R, Selvan H, Azmira K, Dada T, Sharma A, Gupta A, Upadhyay A. Improving long-term intraocular pressure and visual outcomes in eyes with aniridic glaucoma. Graefes Arch Clin Exp Ophthalmol 2021; 259:3749-3755. [PMID: 34328551 DOI: 10.1007/s00417-021-05335-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/04/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To study the long-term intraocular pressure (IOP) and visual outcomes in treated aniridic glaucoma. METHODS A retrospective chart review of patients with aniridia and glaucoma, with ≥ 2-year follow-up, was performed. Eyes in early glaucomatous stages were medically managed, while moderate-severe stage eyes underwent a trabeculectomy with mitomycin-c (MMC). Success was termed 'complete' when average final IOP was ≤ 18 mmHg without usage of glaucoma medications, and 'qualified' when with/without topical glaucoma therapy. A significant change in vision was defined as > 2-line change on Snellen vision chart or > 0.2 change in logMAR units in in either direction (better or worse). RESULTS Thirty-five eyes of 20 patients were included. The mean duration of follow-up was 7.29 ± 5.75 years. Associated ocular anomalies were present in 19 eyes (54.29%). Twelve eyes (34.28%) were maintained on medical management, while 23 eyes (65.71%) had undergone a trabeculectomy with MMC. The mean baseline IOP was 31.46 ± 6.34 mmHg, and mean IOP on last follow-up was 13.25 ± 5.82 mmHg, p < 0.001. Seventy-five percent of the medically managed eyes achieved an IOP ≤ 18 mmHg. 52.17% and 95.65% of the surgically treated eyes achieved 'complete' and 'qualified' success respectively. The median best corrected visual acuity (BCVA) at baseline was 1.48(0.6-2) logMAR units and on final follow-up was 1.3 (0.48-5) logMAR units, p = 0.21. Fifty percent of the eyes remained stable, 35.71% showed an improvement and 14.29% a deterioration of > 0.2 logMAR units. Patients with a longer follow-up (> 10 years) and those who had undergone a trabeculectomy with MMC were more likely to show good IOP control (p = 0.003; p = 0.004 respectively). CONCLUSION Aniridic glaucoma can be managed efficiently by medications in early glaucomatous neuropathy, and with trabeculectomy augmented with mitomycin-C and releasable sutures for more advanced glaucomas, offering favourable long-term IOP control, visual stability and safety.
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Affiliation(s)
- Ramanjit Sihota
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Harathy Selvan
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Kishan Azmira
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Tanuj Dada
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ajay Sharma
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Amisha Gupta
- Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ashish Upadhyay
- Department of Bio-Statistics, All India Institute of Medical Sciences, New Delhi, India
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Farah CJ, Fries FN, Latta L, Käsmann-Kellner B, Seitz B. An attempt to optimize the outcome of penetrating keratoplasty in congenital aniridia-associated keratopathy (AAK). Int Ophthalmol 2021; 41:4091-4098. [PMID: 34324101 PMCID: PMC8572819 DOI: 10.1007/s10792-021-01982-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022]
Abstract
Purpose To propose an optimized microsurgical and medical approach to reduce the risk of complications after penetrating keratoplasty (PKP) in patients with aniridia-associated keratopathy (AAK). Methods Retrospective observational case series of 25 PKP performed in 16 patients with AAK. Preoperative indications were endothelial decompensation and vascularized scars (68%) or graft failure (32%) due to limbal stem cell deficiency. The optimized approach included a combination of a small corneal graft size (around 7.0 mm), interrupted 10–0nylon sutures, simultaneous AMT as a patch, large bandage contact lens, temporary lateral tarsorrhaphy, postoperative autologous serum eye drops, and systemic immunosuppression. Main outcome measures included: visual acuity, transplant survival, and complications encountered during follow-up of 107 weeks on average. Results A complete modified keratoplasty scheme was used in 10 of 25 PKP (group 1), while at least one of the modifications was missing in the other 15 PKP (group 2). After 8 weeks of follow-up, the epithelium was closed in 23 eyes. Visual acuity improved in 19 eyes at 6 months of follow-up, and remained stable in six eyes. None of the eyes showed a decrease in visual acuity. At the last post-operative follow-up, this visual improvement persisted in 14 eyes and graft survival rate after 156 weeks (3 years) was 69% in group 1 versus 44% in group 2 (p = 0.39, log-rank test). Secondary corneal neovascularization (8%), scarring (4%), ulcer (4%), or graft rejection (8%) happened mostly in the second group which was missing at least one of the suggested modifications. Conclusions PKP in congenital aniridia must be considered as a high-risk keratoplasty. An optimized therapeutic approach seems to be promising in order to reduce the postoperative complication rate in these most difficult eyes.
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Affiliation(s)
- C J Farah
- Department of Ophthalmology, Saarland University Medical Center, 100 Kirrbergerstr., Building 22, 66421, Homburg, Saar, Germany.
| | - F N Fries
- Department of Ophthalmology, Saarland University Medical Center, 100 Kirrbergerstr., Building 22, 66421, Homburg, Saar, Germany
| | - L Latta
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell Research and Congenital Aniridia, Saarland University Medical Center, Homburg, Saar, Germany
| | - B Käsmann-Kellner
- Department of Ophthalmology, Saarland University Medical Center, 100 Kirrbergerstr., Building 22, 66421, Homburg, Saar, Germany
| | - B Seitz
- Department of Ophthalmology, Saarland University Medical Center, 100 Kirrbergerstr., Building 22, 66421, Homburg, Saar, Germany
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Senthil S, Uche NJ, Mohamed A, Krishnamurthy R, Badakere S, Mandal AK, Garudadari C. Outcomes of Primary Combined Trabeculotomy and Trabeculectomy in Early-Onset Glaucoma in Children with Congenital Aniridia. Ophthalmol Glaucoma 2021; 4:305-311. [PMID: 32966898 DOI: 10.1016/j.ogla.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To report clinical features and treatment outcomes of primary combined trabeculotomy with trabeculectomy (CTT) in congenital aniridia with glaucoma in children 3 years of age or younger. DESIGN Retrospective study. PARTICIPANTS Sixty-six eyes of 35 children with congenital aniridia and early-onset glaucoma who underwent CTT between May 1997 and June 2015 were included. METHODS Success was defined as complete when intraocular pressure (IOP) was more than 5 mmHg and less than or equal to 21 or 16 mmHg without antiglaucoma medications (AGMs), and qualified when AGMs were required. Eyes needing repeat surgery for IOP control were considered as failures. MAIN OUTCOME MEASURES IOP control and number of AGMs. RESULTS The median age at presentation of 35 children was 26 days (interquartile range [IQR], 7-106 days). There were 22 males (62.9%) and 13 females (37.1%). Parental consanguinity was noted in 11 children (31.4%). Aniridia was total in 52 eyes and partial in 14 eyes. At presentation, there was corneal edema in 30 eyes (45.4%), enlarged corneal diameter in 32 eyes (48.5%), nystagmus in 15 children (23%), limbal stem cell deficiency in 1 eye, cataract in 9 eyes (13.6%), and foveal hypoplasia in 4 eyes. After CTT, median IOP was reduced significantly (P < 0.0001). Corneal edema cleared in 12/30 eyes and cleared with scar in 18/30 eyes. Median follow-up was 5.33 (IQR, 3.05-7.59) years. At latest follow-up, median number of AGMs was 1 (IQR, 0-2) and median visual acuity in logarithm of minimum angle of resolutions (n = 34 eyes) was 1.35 (IQR, 0.80-2.78). The probability of complete success for IOP ≤ 21 mmHg was 79.9% at 1 year and 62.3% between 2 and 10 years; for IOP ≤ 16 mmHg, it was 78.6% at 1 year and decreased to 51.9% at 10 years. Qualified success for IOP ≤ 21 mmHg at 1 year was 82.6% and 81% over 10 years; for IOP ≤ 16 mmHg, it was 81.4% at 1 year and decreased to 63.1% at 10 years. Seven eyes (10.6%) required repeat intervention for IOP control with median time of 3.17 years (IQR, 0.92-6.56) from first surgery. CONCLUSIONS CTT showed good success in children with congenital aniridia with early-onset glaucoma.
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Affiliation(s)
- Sirisha Senthil
- VST Glaucoma Center, L. V. Prasad Eye Institute, Hyderabad, India.
| | | | - Ashik Mohamed
- Ophthalmic Biophysics, L. V. Prasad Eye Institute, Hyderabad, India; Center of Excellence for Rare Eye Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | | | - Swathi Badakere
- VST Glaucoma Center, L. V. Prasad Eye Institute, Hyderabad, India; Center of Excellence for Rare Eye Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | - Anil K Mandal
- VST Glaucoma Center, L. V. Prasad Eye Institute, Hyderabad, India; Center of Excellence for Rare Eye Diseases, L. V. Prasad Eye Institute, Hyderabad, India
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Muñoz-Negrete FJ, Teus MA, García-Feijoó J, Canut MI, Rebolleda G. Aniridic glaucoma: An update. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:S0365-6691(20)30428-7. [PMID: 33531163 DOI: 10.1016/j.oftal.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/22/2023]
Abstract
Aniridia is a congenital bilateral ocular disorder with dominant autosomal inheritance. More than 50% of patients will develop aniridic glaucoma (AG) during their lives. Open angle glaucoma is more common in aniridia, but a closed angle mechanism has been described in relation with anterior rotation of the rudimentary iris, occluding trabecular meshwork. Diagnosis and follow-up of AG is difficult in relation with the presence of keratopathy, nystagmus and foveal hypoplasia. Central corneal thickness usually measures more than 600 microns, which prevents achieving a reliable value of intraocular pressure. Medical treatment of AG is not different from the rest of glaucoma. It is recommended to use preservative free formulations, and combined therapy is often required. Surgical treatment is needed in many cases. There is no consensus on the first line surgery for AG, but in open angle AG, angle surgery is usually first choice, and glaucoma drainage devices are the next preferred surgical technique. In closed angle AG glaucoma drainage devices are usually the first choice, with trabeculectomy as the second preferred surgical technique.
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Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España; Universidad de Alcalá, Alcalá de Henares, España; OFTARED.
| | - M A Teus
- Universidad de Alcalá, Alcalá de Henares, España; Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; OFTARED
| | - J García-Feijoó
- Servicio de Oftalmología, Hospital Universitario Clínico San Carlos. IdISSC, Madrid, España; Universidad Complutense, Madrid, España; OFTARED
| | - M I Canut
- Clínica Barraquer, Barcelona, España
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España; Universidad de Alcalá, Alcalá de Henares, España; OFTARED
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Abstract
The posttraumatic ocular hypotony (3% after ocular contusion, 50-74% after open globe injury) can lead to severe secondary damage of the eyeball. In addition to corneal folds, ciliary body and choroidal detachment, papilledema e vacuo and macular folds, the shrinking of the eye can lead to substantial visual impairment. Subsequently, the contralateral eye may react with ocular hypertension. The cause of the hypotony must be identified and causally treated. A preservation of the globe is possible if more than 210 ° of the ciliary body are intact. One of the major causes of posttraumatic hypotony is cyclodialysis. Smaller cyclodialysis clefts respond to a cycloplegic treatment, larger clefts require a surgical approach. The direct cyclopexy can be combined with primary wound repair or pole to pole surgery. An alternative consists of silicone oil endotamponade or occlusion of Schlemm's canal. The posttraumatic ocular hypotony is complex and requires exact diagnostics to be able to differentially and specifically treat the causes of hypotony.
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Affiliation(s)
- Arne Viestenz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle UKH, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
| | - Andrea Huth
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle UKH, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - Jens Heichel
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Halle UKH, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str., Geb. 22, 66424, Homburg/Saar, Deutschland
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Bajwa A, Burstein E, Grainger RM, Netland PA. Anterior chamber angle in aniridia with and without glaucoma. Clin Ophthalmol 2019; 13:1469-1473. [PMID: 31496636 PMCID: PMC6689658 DOI: 10.2147/opth.s217930] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/12/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose We performed a retrospective, comparative study to determine if patients with aniridia and glaucoma had open angles on high-resolution anterior segment optical coherence tomography (OCT) and clinical gonioscopy. Patients and methods Forty-three patients (86 eyes) with aniridia had recorded anterior segment OCTs, gonioscopy, or both. Of these patients, 27 (54 eyes) were diagnosed with glaucoma and 16 (32 eyes) had no evidence of glaucoma. All patients had either anterior segment OCT, gonioscopy, or both. Results The 43 patients with aniridia had average age of 32±17 years, and 27 (62%) were female. Anterior segment OCT and gonioscopy were recorded in 25 (58%) of the patients and 18 (42%) of the patients had gonioscopy alone. Of the 54 eyes with aniridia and glaucoma, 4 (7%) eyes in 3 patients (11%) had partial or completely closed angles. Of the 32 eyes without glaucoma, all (100%) had open angles. The proportion of open angles in the aniridia with glaucoma eyes was not significantly different compared with the aniridia without glaucoma eyes (P=0.32). Of the 4 eyes with closed angles, all had a history of prior surgery for cataract, glaucoma, and/or keratopathy. The proportion of eyes with prior surgery was significantly higher in eyes with open-angle glaucoma and angle-closure glaucoma compared with eyes without glaucoma (P<0.001 and P=0.002, respectively). Conclusion The majority of eyes with aniridia and glaucoma have open anterior chamber angles, similar to patients with aniridia without glaucoma. All eyes with aniridia and glaucoma that had closed angles had a prior history of ocular surgery.
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Affiliation(s)
- Asima Bajwa
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Eitan Burstein
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Robert M Grainger
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Biology, University of Virginia , Charlottesville, VA, USA
| | - Peter A Netland
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Expression of retinoic acid signaling components ADH7 and ALDH1A1 is reduced in aniridia limbal epithelial cells and a siRNA primary cell based aniridia model. Exp Eye Res 2019; 179:8-17. [DOI: 10.1016/j.exer.2018.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/29/2018] [Accepted: 10/03/2018] [Indexed: 01/31/2023]
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Käsmann‐Kellner B, Latta L, Fries FN, Viestenz A, Seitz B. Diagnostic impact of anterior segment angiography of limbal stem cell insufficiency in PAX6‐related aniridia. Clin Anat 2018; 31:392-397. [DOI: 10.1002/ca.22987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/26/2017] [Accepted: 09/11/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Barbara Käsmann‐Kellner
- Department of OphthalmologySaarland University Medical Center UKS, Section Pediatric Ophthalmology, Orthoptics, Low Vision & Neuroophthalmology, Homburg/Saar, Kirrbergerstr, 100, 66424Homburg Saar Germany
| | - Lorenz Latta
- Department of OphthalmologySaarland University Medical Center UKS, Homburg/Saar, Kirrbergerstr, 100Homburg Saar66424 Germany
| | - Fabian N. Fries
- Department of OphthalmologySaarland University Medical Center UKS, Homburg/Saar, Kirrbergerstr, 100Homburg Saar66424 Germany
| | - Arne Viestenz
- Department of OphthalmologyUniversity Medical Center of Martin Luther University Halle‐Wittenberg, Ernst‐Grube‐Straße 40Halle (Saale)06120 Germany
| | - Berthold Seitz
- Department of OphthalmologySaarland University Medical Center UKS, Homburg/Saar, Kirrbergerstr, 100Homburg Saar66424 Germany
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