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Zhao R, Du Q, Wu Y, Geng W, Zhang Z, Zhao B. Analysis of Indicators for Assessing the Risk of Progression from PACS to APAC and the Degree of Intraocular Pressure Elevation in APAC Using AS-OCT. J Ophthalmol 2024; 2024:8368315. [PMID: 39282097 PMCID: PMC11398953 DOI: 10.1155/2024/8368315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 08/11/2024] [Accepted: 08/24/2024] [Indexed: 09/18/2024] Open
Abstract
Objective The aim of this study is to quantify anterior chamber parameters to provide potential risk indicators for evaluating the progression of primary angle-closure suspect (PACS) eyes to acute primary angle closure (APAC) and the degree of intraocular pressure elevation in patients with APAC utilizing anterior segment optical coherence tomography (AS-OCT). Methods Tomey CASIA2 AS-OCT was used to quantitatively measure various anterior chamber parameters, including anterior chamber depth (ACD), anterior chamber volume (ACV), lens thickness (LT), lens vault (LV), iris-trabecular contact index (ITC), iris thickness (IT), iris volume (IV), iris curvature (IC), iris area (IA), and iris thickness (IT), in APAC eyes (30 eyes) and contralateral PACS eyes (30 eyes) of 30 patients. The differences in these parameters between the two groups and their relationship with intraocular pressure were analyzed. Results Compared to the PACS group, the APAC group exhibited significantly smaller IA and IC, and significantly larger pupil diameter (PD) and ITC (P < 0.05). There were no statistically significant differences in ACV, ACD, ACW, ACA, LV, IV, and IT750/2000 between the two groups. In APAC eyes, multivariable linear regression analysis showed a significant negative correlation between intraocular pressure and IV (β = -1.85; 95% confidence interval: -2.77 to -0.93; P=0.001), while no correlation was found in PACS eyes. In all 60 eyes, LT showed a negative correlation with ACV, ACD, ACA, and nasal IT750, and a positive correlation with LV and nasal IC. Conclusion AS-OCT has multiple advantages in evaluating various anterior chamber parameters in patients with glaucoma. IA may serve as a predictive indicator of the progression of eyes from PAC or APAC. A significant negative correlation was found between intraocular pressure and IV during APAC attacks. LT can be considered a predictive factor for the occurrence of primary angle-closure disease.
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Affiliation(s)
- Rumin Zhao
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Shandong Lunan Eye Hospital, Linyi, China
| | | | - Yunlong Wu
- Shandong Lunan Eye Hospital, Linyi, China
| | | | | | - Bojun Zhao
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- Department of Ophthalmology Shandong Provincial Hospital, Jinan, Shandong, China
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Pei XT, Wang SH, Qing GP, Yu XW, Shi Y, Yang WL, Wang NL, Fan ZG. Zonular instability-associated morphologic features in eyes with primary angle closure disease using the swept-source anterior segment - optical coherence tomography system. BMC Ophthalmol 2024; 24:203. [PMID: 38684941 PMCID: PMC11059700 DOI: 10.1186/s12886-024-03462-1] [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: 02/25/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND This study aims to investigate the morphologic features of the crystalline lens in Primary Angle Closure Disease (PACD) patients with zonular instability during cataract surgery using the swept-source CASIA 2 Anterior Segment-Optical Coherence Tomography (AS-OCT) system. METHODS A total of 398 eyes (125 PACD eyes with zonular instability, 133 PACD eyes with zonular stability, and 140 cataract patient controls) of 398 patients who underwent cataract surgery combined or not glaucoma surgery between January 2021 and January 2023 were enrolled. The crystalline lens parameters were measured by CASIA2 AS-OCT. Then, logistic regression was performed to evaluate the risk factors associated with zonular instability. RESULTS The results revealed that PACD eyes had a more anterior lens equator position, a steeper anterior curvature of lens, shorter Axial Length (AL), shallower Anterior Chamber Distance (ACD), higher Lens Vault (LV) and thicker Lens Thickness (LT), when compared to eyes in the cataract control group. Furthermore, PACD eyes in the zonular instability group had steeper front R, front Rs and Front Rf, flatter back Rf, thicker lens anterior part thickness, higher lens anterior-to-posterior part thickness ratios, shallower ACD, and greater LV, when compared to PACD eyes with zonular stability. The logistic regression analysis, which was adjusted for age and gender, revealed that zonular instability was positively correlated with anterior part thickness, lens anterior-to-posterior part thickness ratio, and LV, but was negatively correlated with lens anterior radius and ACD. CONCLUSION Steeper anterior curvature, increased lens anterior part thickness, higher anterior-to-posterior part thickness ratio, shallower ACD, and greater LV are the anatomic features of PACD eyes associated with zonular instability.
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Affiliation(s)
- Xue-Ting Pei
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shu-Hua Wang
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Guo-Ping Qing
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Xiao-Wei Yu
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yan Shi
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Wen-Li Yang
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ning-Li Wang
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zhi-Gang Fan
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Chen J, Chen S, Zheng Y, Xu Y, Zhong X, Huang Y, Ng TK, Huang C. Association of body mass index and PXDNL gene variants with acute primary angle closure in southern Chinese population. Heliyon 2023; 9:e22240. [PMID: 38034647 PMCID: PMC10686858 DOI: 10.1016/j.heliyon.2023.e22240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
This study aimed to evaluate the association of body mass index (BMI) and the weight-related gene, peroxidasin-like (PXDNL), with acute primary angle closure (APAC) and primary angle-closure glaucoma (PACG) in southern Chinese population. Total 4700 study subjects (1024 APAC, 781 PACG, and 2895 control subjects) with complete ophthalmic examinations were enrolled into this study. The association of BMI with APAC, PACG and ocular biometric parameters was evaluated. Three PXDNL missense variants were genotyped by TaqMan assay, and their association with APAC and PACG was also investigated. Multivariable logistic regression analysis showed that BMI and body weight were significantly associated with both APAC and PACG (P < 0.01). Multiple linear regression analysis demonstrated that each 1 kg/m2 increased in BMI was associated with 0.038 mm increase in axial length, 0.018 mm increase in central anterior chamber depth, 0.002 mm increase in lens position, 0.012 mm increase in corneal diameter and 0.014 mm decrease in lens thickness among the APAC subjects (P < 0.001), but not with PACG. Genetic association analysis identified that PXDNL rs11985241-rs16916207 CT haplotype conferred a higher risk to APAC (OR = 1.25, P = 0.004) than the TG haplotype, but not with PACG. The APAC subjects carrying the rs11985241 C or rs16916207 T alleles showed significantly lower weight than those carrying the corresponding protective alleles. In summary, this study revealed that lower BMI could be associated with higher risk of APAC. PXDNL could be a new associated gene for APAC.
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Affiliation(s)
- Jiawei Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Shaowan Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yuqian Zheng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yanxuan Xu
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Xin Zhong
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yuqiang Huang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong China
| | - Chukai Huang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
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Chen J, Zhang Y, Huang Y, Ng TK, Huang C. Relatively anterior lens position in primary angle-closure glaucoma eyes with long axial length. Indian J Ophthalmol 2023; 71:1941-1947. [PMID: 37203062 PMCID: PMC10391430 DOI: 10.4103/ijo.ijo_1890_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To evaluate the refractive status and ocular biometric parameters in primary angle-closure glaucoma (PACG) eyes with different axial lengths (ALs). Methods In total, 742 Chinese PACG subjects with complete ophthalmic examinations were enrolled. The refractive status was categorized as myopia (spherical equivalent [SE] ≤-0.5 D), emmetropia (-0.5 D < SE < +0.5 D), and hyperopia (SE ≥+0.5 D), whereas the AL was divided into short (AL <22.5 mm), regular (22.5 ≤ AL <23.5 mm), and long (AL ≥23.5 mm). The refractive status and ocular biometric parameters were compared among different AL groups. Results The mean AL of the PACG eyes was 22.53 ± 0.84 mm (range: 19.68-25.57 mm). The refractive status was significantly different among different AL groups (P < 0.001). Also, 92.6% of hyperopic PACG eyes showed AL <23.5 mm, and 19.0% of myopic PACG eyes showed AL ≥23.5 mm. The SE showed significant differences among different AL groups only in the hyperopic subjects (P = 0.012). The AL was significantly longer in myopic eyes (P < 0.001). The PACG eyes with longer AL exhibited lower keratometry, longer central anterior chamber depth and corneal diameter, and lens position and relative lens position closer to the anterior (P < 0.001). Conclusion Axial hyperopia was common in PACG eyes, and axial myopia was not uncommon. Relatively anterior lens position could explain the occurrence of PACG in the eyes with long AL.
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Affiliation(s)
- Jiawei Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou University Medical College, Shantou, Guangdong, China
| | - Yan Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou University Medical College, Shantou, Guangdong, China
| | - Yuqiang Huang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong; Shantou University Medical College, Shantou, Guangdong, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Chukai Huang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
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Yu B, Wang K, Zhang X, Xing X. Biometric indicators of anterior segment parameters before and after laser peripheral iridotomy by swept-source optical coherent tomography. BMC Ophthalmol 2022; 22:222. [PMID: 35578256 PMCID: PMC9109390 DOI: 10.1186/s12886-022-02448-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Primary angle closure glaucoma (PACG) is the most common type of glaucoma in China. Laser peripheral iridotomy (LPI) is the primary choice to treat PAC: We aim to evaluate the changes of biometric parameters of anterior segment and to find possible biometric predictors of the effect of laser peripheral iridotomy (LPI) in primary angle closure (PAC) eyes using swept-source optical coherent tomography (OCT). Methods LPI was performed in 52 PAC eyes of 28 participants. The change of intraocular pressure and anterior segment parameters, including angle opening distance (AOD500), AOD500 area, trabecular iris space area (TISA500), TISA500 volume, trabecular iris angle (TIA500), iridotrabecular contact (ITC) index, ITC area, anterior chamber volume (ACV), anterior chamber depth (ACD), lens vault (LV) and lens thickness (LT) before and 1 week after LPI were measured by Tomey CASIA2 anterior segment OCT. We also estimate and analyze potential associated factors possibly affecting the change of anterior chamber parameters. Results No post-laser complications were found. The ACD, LV and LT did not change significantly 1 week after LPI. AOD500, AOD500 area, TISA500, TISA500 volume, TIA500, ACV increased significantly after LPI. There was significant decrease in ITC index and ITC area. LT was positively correlated to the change of ITC index (β = 0.239, *p = 0.045). Conclusions The anterior segment architecture significantly changed after LPI in PAC spectrum eyes. Crystalline lens measurements remained unchanged before and after LPI. AS-OCT can be used to follow anterior chamber parameter changes in PAC spectrum eyes. LT may play a role in the therapeutic effect of LPI.
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Affiliation(s)
- Bo Yu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, No. 251, Fukang Road, Tianjin, 300384, China
| | - Kang Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, No. 251, Fukang Road, Tianjin, 300384, China
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, No. 251, Fukang Road, Tianjin, 300384, China.
| | - Xiaoli Xing
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, No. 251, Fukang Road, Tianjin, 300384, China.
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Zhang H, Cao K, Jia H, Li L, Hu J, Liang J, Song J, Wang H, Zhao A, Duan X, Fan S, Wang F, Su Y, Ha S, Duan X, Yu J, Zhao C, Tang G, Su Y, Cai H, Gao J, Qu Y, Lu P, Xie X, Zhao J, Tang L, Liu D, Liu W, Zhang M, Fang A, Qu B, Dai W, Zhong H, Zhang X, Wu Z, Zhai G, Lyu H, Xie L, Li H, Zheng Y, Li N, Li K, Xie G, Qu H, Yu J, Liang L, Zhu M, Wang X, Ma X, Zeng L, Liu X, Zhang Y, Zhang Y, Yu F, Zhu Y, Cheng S, Yu M, Li J, Zhang Y, Liu P, Wu Z, Zhang X, Kuo D, Wang N, Qiao C. Clinical characteristics, rates of blindness, and geographic features of PACD in China. CANADIAN JOURNAL OF OPHTHALMOLOGY 2021; 56:299-306. [PMID: 33485841 DOI: 10.1016/j.jcjo.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To analyze the rates of blindness with the demographics and clinical characteristics of patients with primary angle-closure disease (PACD) to provide a comprehensive epidemiologic reference in China. METHODS A retrospective analysis was conducted in the Chinese Glaucoma Study Consortium database, which is a national multicenter glaucoma research alliance of 111 hospitals participating between December 21, 2015 and September 9, 2018. The diagnosis of PACD was made by qualified physicians through examination. Comparison of sex, age, family history, subtypes of PACD, and blindness were analyzed. RESULTS A total of 5762 glaucoma patients were included, of which 4588 (79.6%) had PACD. Of PACD patients, 72.1% were female with the sex ratio (F/M) of 2.6, and the average age of patients was 63.8±9.3 years with the majority between 60 and 70 years. Additionally, 30% of these patients had low vision in one eye, 8.8% had low vision in both eyes, 1.7% had blindness in one eye, and 0.3% had blindness in both eyes. There were statistical differences with regards to age between male and female patients with PACD, with male patients being older on average. Primary angle-closure glaucoma was more commonly diagnosed in males (60%) compared to females (35.9%), whereas acute primary angle closure (APAC) was more commonly diagnosed in females (54.3%) compared to males (37.7%). The visual acuity in APAC patients was lower and the rate of low vision and blindness was higher than other subtypes. CONCLUSION PACD was the major type of glaucoma in Chinese hospitals. There were more female patients with PACD, mostly between 60 and 70 years old, with higher rates of APAC in women. APAC resulted in the worst visual outcomes of all PACD subtypes.
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Affiliation(s)
- Hui Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Science Key Lab
| | - Kai Cao
- Beijing Institute of Ophthalmology
| | - Hongyan Jia
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Science Key Lab
| | - Liang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Science Key Lab
| | | | - Jing Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jing Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Science Key Lab
| | | | - Xiaoming Duan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Science Key Lab
| | - Sujie Fan
- Handan City Eye Hospital, Handan, China
| | - Feng Wang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Su
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shaoping Ha
- Department of Ophthalmology, Ning Xia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Xuanchu Duan
- The Second Xiangya Hospital of Central South University, Changsha, China
| | | | | | - Guangxian Tang
- The First Hospital of Shijiazhuang City, Shijiazhuang, China
| | - Yufang Su
- Baotou Chaoju Ophthalmic Hospital, Baotou, China
| | | | - Jianlu Gao
- Liaocheng People's Hospital, Liaocheng, China
| | - Yanbing Qu
- Yuncheng City Eye Hospital, Yuncheng City, China
| | - Peng Lu
- Lanzhou University Second Hospital, Lanzhou, China
| | - Xiaobin Xie
- Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | | | - Li Tang
- West China Hospital, Sichuan University, Chengdu, China
| | - Danyan Liu
- The Second Hospital of Heibei Medical University, Shijiazhuang, China
| | - Wei Liu
- The Second People's Hospital of Jinan, Jinan, China
| | - Min Zhang
- Dongguan People's Hospital, Dongguan, China
| | - Aiwu Fang
- The Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bo Qu
- The 4th Affiliated Hospital of China Medical University, the Eye Hospital of China Medical University, Shenyang, China
| | - Weijia Dai
- Xuanwu Hospital, Capital Medical University
| | - Hua Zhong
- The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xueling Zhang
- The First People's Hospital of Xuzhou, Xuzhou, China
| | | | | | - Hongbin Lyu
- The Affiliated Hospital of Southwest Medical University, Chongqing, China
| | - Lin Xie
- The Third Medical Center of Chinese PLA General Hospital
| | - Haijun Li
- The Third Medical Center of Chinese PLA General Hospital
| | - Yajuan Zheng
- The Second Hospital of Jilin University, Changchun, China
| | - Ning Li
- Jinzhou Central Hospital, Jinzhou, China
| | | | | | | | | | | | - Min Zhu
- The First People's Hospital of Foshan, Foshan, China
| | - Xuemei Wang
- Harbin Ophthalmology Hospital, Harbin, China
| | - Xiang Ma
- Liuzhou People's Hospital, Liuzhou, China
| | - Liuzhi Zeng
- ChengDu First People's Hospital, Chengdu, China
| | | | - Yong Zhang
- Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yuyan Zhang
- Huashan Hospital of Fudan University, Shanghai, China
| | - Fanglei Yu
- The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yihua Zhu
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | | | - Min Yu
- Mian Yang Central Hospital, Mianyang, China
| | - Jingmin Li
- The Second Hospital of Dalian Medical University, Dalian, China
| | | | - Ping Liu
- Taian Central Hospital, Taian City, China
| | - Zhihong Wu
- The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | - Debbie Kuo
- Palo Alto Medical Foundation, San Francisco, the United States
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Science Key Lab; Beijing Institute of Ophthalmology
| | - Chunyan Qiao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Institute of Ophthalmology.
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Tanner L, Gazzard G, Nolan WP, Foster PJ. Has the EAGLE landed for the use of clear lens extraction in angle-closure glaucoma? And how should primary angle-closure suspects be treated? Eye (Lond) 2019; 34:40-50. [PMID: 31649349 DOI: 10.1038/s41433-019-0634-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 12/25/2022] Open
Abstract
Angle-closure glaucoma is an aggressive condition that causes millions to become blind worldwide. This review explores the use of prophylactic laser peripheral iridotomy (PI) in patients classified as primary angle-closure suspects (PACS), and additionally, the use of clear lens exchange as a primary treatment option in established angle-closure disease with or without glaucoma. As PI has a strong prophylactic effect in fellow eyes of patients who have had an acute attack, its use has been widely adopted in those patients classified as PACS, but with limited evidence to support this. A large randomised trial conducted in China has demonstrated that although PI reduces the risk of incident angle-closure disease, the incidence of disease that would threaten vision was much lower than anticipated. This suggests that the benefit of prophylactic PI is very limited. Health services data shows an association between rising cataract surgical rates and of decreasing rates of acute angle-closure. Age-related growth of the lens is a major component of angle-closure disease. Several studies have shown that clear lens extraction (CLE) effectively lowers IOP in angle-closure. The use of CLE as a primary treatment option has been tested against LPI in the EAGLE study, a large RCT that enroled people with angle-closure and an IOP > 30 mmHg, and those with angle-closure glaucoma. The trial showed CLE to be superior to PI both for IOP control and patient reported quality of life. On these grounds, CLE should be considered for first-line treatment of more advanced angle-closure disease.
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Affiliation(s)
- Luke Tanner
- University of Exeter Medical School, College of Medicine & Health, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.,UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Winifred P Nolan
- Glaucoma Service, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - Paul J Foster
- Glaucoma Service, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK. .,UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK. .,NIHR Biomedical Research Centre at Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, EC1V 2PD, UK.
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Efficacy and Safety of Argon Laser Peripheral Iridoplasty and Systemic Medical Therapy in Asian Patients with Acute Primary Angle Closure: A Meta-Analysis of Randomized Controlled Trials. J Ophthalmol 2019; 2019:7697416. [PMID: 31192000 PMCID: PMC6525875 DOI: 10.1155/2019/7697416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/21/2019] [Accepted: 04/08/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this meta-analysis was to assess the percent reduction in the intraocular pressure (IOP) after argon laser peripheral iridoplasty (ALPI) and systemic medical therapy in patients with acute primary angle closure (APAC). METHODS We searched a number of electronic databases, including MEDLINE, EMBASE, PubMed, and Cochrane Library. We searched the electronic databases from the inception of the databases to August 2018. The primary outcomes included the IOP reduction (IOPR), percent reduction in IOP (IOPR%) from baseline to the endpoint and peripheral anterior synechiae (PAS). The secondary outcomes included the cup-to-disc ratio (CDR), mean endothelial count, and percent of patients requiring topical glaucoma medication. Summary weighted mean difference (WMD), odds ratio (OR), and 95% confidence intervals (CIs) were calculated. RESULTS Four eligible studies including 183 eyes (92 in the ALPI group and 91 in the medical therapy group) were identified. When comparing ALPI to medical therapy, the WMDs of the IOPR% were 30.03 (95% CI: 21.33 to 38.72, p < 0.00001) at 15 minutes, 27.39 (95% CI: 18.89 to 35.89, p < 0.00001) at 30 minutes, 18.15 (95% CI: 10.63 to 25.68, p < 0.00001) at 1 hour, and 12.91 (95% CI: 4.50 to 21.32, p=0.003) at 2 hours. There was no statistically significant difference between the two groups at 24 hours and at more than 6 months after therapy. Meanwhile, no significant difference was observed in the degree of PAS, CDR, mean endothelial count, and percent of patients requiring topical glaucoma medication after treatment between the two groups. CONCLUSIONS Both ALPI and systemic medications were effective with regard to decreasing the IOP. ALPI was more effective in lowering the IOP within the first two hours. Therefore, ALPI may be a better choice for rapidly lowering the IOP in patients with APAC within a short period.
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Wang N, Jia SB. Phacoemulsification with or without goniosynechialysis for angle-closure glaucoma: a global Meta-analysis based on randomized controlled trials. Int J Ophthalmol 2019; 12:826-833. [PMID: 31131244 DOI: 10.18240/ijo.2019.05.20] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/06/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the benefits and potential harms of routine phacoemulsification (phaco) alone and combined surgery with goniosynechialysis (GSL) for angle-closure glaucoma (ACG) and coexisting lens opacity, as shown in different randomized controlled trials (RCTs). METHODS A systematic review was conducted searching several databases including PubMed, Cochrane Library, EMBASE, ClinicalTrials.gov from the inception to September 2018 for RCTs with data published on the effects and safety of phaco and intraocular lens implantation combined with GSL or routine cataract surgery alone. Several studies were recruited which reported data at baselines and postoperative follow-up, including the mean values of postoperative intraocular pressure (IOP) and mean numbers of anti-glaucoma medications using postoperatively. The numbers of complications happening were also included. Fixed-effect and random-effect models were applied, and the quality of evidence was evaluated. RESULTS Analysis of the seven included RCTs, with a total number of 321 participants (358 eyes) diagnosed with ACG and cataract, received a solo procedure (phaco group) or a combined surgery (phaco-GSL group) randomly, and follow-up periods ranging from 2 to 12mo postoperatively. The involved studies showed that the mean value of IOP between the two groups at 3 (four studies, one study follow-up at 2mo postoperative was included), 6, 12mo postoperative were not significantly different. Only two studies reported the change in IOP value at 12mo compared with baseline but showed no significant differences between the two interventions. Although three studies did not have the significant difference in the number of medications using to reduce IOP at 3mo postoperatively, two studies reported that the participants using fewer anti-glaucoma medications at 12mo postoperative in the phaco group than in the phaco-GSL surgery group. CONCLUSION The analysis provides a low to moderate-quality evidence that phaco-GSL surgery lead to an equivalent IOP-lowering effect. The phaco-GSL surgery may not help patients to reduce the consumption of anti-glaucoma eyedrops in the long period. The results of this analysis suggested that additional GSL may not be necessary for primary angle closure glaucoma (PACG) patients. Further studies, especially RCTs with more participants and longer follow-up time were needed to provide more sufficient data.
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Affiliation(s)
- Nuo Wang
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
| | - Song-Bai Jia
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha 410011, Hunan Province, China
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Razeghinejad MR, Myers JS. Contemporary approach to the diagnosis and management of primary angle-closure disease. Surv Ophthalmol 2018; 63:754-768. [PMID: 29777727 DOI: 10.1016/j.survophthal.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.
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Affiliation(s)
- M Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Poostchi Ophthalmology Research Center, Shiraz University of Medcial Sciences, Shiraz, Iran.
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Rao A, Padhy D, Sarangi S, Das G. Angle Closure Scoring System (ACSS)-A Scoring System for Stratification of Angle Closure Disease. PLoS One 2016; 11:e0160209. [PMID: 27788183 PMCID: PMC5082952 DOI: 10.1371/journal.pone.0160209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/16/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the angle closure scoring system (ACSS) for stratifying primary angle course disease. Methods This observational cross sectional institutional study included patients with primary open angle glaucoma suspects (n = 21) and primary angle closure disease (primary angle closure, PAC, n = 63 and primary angle course glaucoma, PACG, n = 58 (defined by International society of Geographical and Epidemiological Ophthalmology, ISGEO). Two independent examiners blinded to clinical details, graded good quality pre-laser goniophotographs of the patients incorporating quadrants of peripheral anterior synechieae (PAS), non-visibility of posterior trabecular meshwork (PTM) and blotchy pigments (ranging from 1–4 quadrants), iris configuration, angle recess (sum of above depicting ACSSg) and lens thickness/axial length ratio (LT/AL), cup disc ratio and baseline intraocular pressure (IOP) to give total score (ACSSt). Result There were significant differences in ACSSg scores within the same ISGEO stage of PAC and PACG between eyes that required nil or >1medicines after laser iridotomy, p<0.001. The ACSSg was associated with need for >1 medicines in both PAC and PACG eyes, p<0.001. An ACSSg score>12 and 14 in PAC (odds ratio = 2.7(95% CI-1.7–5.9) and PACG (Odds ratio = 1.6(95%CI-1.19–2.2) predicted need for single medicines while ACSSg scores >14 and 19 predicted need for ≥2 medicines in PAC and PACG eyes, respectively. The LT/Al ratio, IOP score or cup disc score did not influence the need for medical treatment independently. Conclusion The ACSS can be a useful clinical adjunct to the ISGEO system to predict need for medicines and prognosticate each stage more accurately.
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Affiliation(s)
- Aparna Rao
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, India
- * E-mail:
| | - Debananda Padhy
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, India
| | - Sarada Sarangi
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, India
| | - Gopinath Das
- Glaucoma Service, LV Prasad Eye Institute, Patia, Bhubaneswar, India
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Li B, Wang FY, Lv TL, Zhu Y. Effects of phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract. Exp Ther Med 2016; 12:2501-2504. [PMID: 27698750 PMCID: PMC5038496 DOI: 10.3892/etm.2016.3634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022] Open
Abstract
The aim of the present study was to examine the effects of phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract in the elderly. A total of 68 patients were consecutively selected and divided into the control group with 33 cases (48 eyes) and the observation group with 35 cases (53 eyes). Cataract surgery combined with trabeculectomy was performed on the patients in the control group and phacoemulsification cataract extraction combined with ciliarotomy was performed on the subjects in the observation group, to compare postoperative effects and complications. Following surgery, the visual acuity of patients in the two groups significantly improved, intraocular pressure decreased, and improvement of the observation group was more evident (P<0.05). Following surgery, the depth of central anterior chamber and width of chamber angle of patients in two groups was increased, and improvement of the observation group was significantly more evident (P<0.05). Additionally, the incidence of complications, including corneal swelling, shallow of anterior chamber, fibrinous exudate in iris, and filtering bleb leaking and following cataract removal, of patients in the observation group was significantly reduced compared to the control group (P<0.05). In summary, the results of the present study show that, phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract in the elderly is a safe and effective method and should be applied in the clinic.
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Affiliation(s)
- Bo Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China; Department of Ophthalmology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science Technology, Luoyang, Henan 471003, P.R. China
| | - Feng-Yun Wang
- Department of Ophthalmology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science Technology, Luoyang, Henan 471003, P.R. China
| | - Tai-Liang Lv
- Department of Ophthalmology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250001, P.R. China
| | - Yu Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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Abstract
BACKGROUND Glaucoma is the second leading cause of blindness in the world. Angle closure glaucoma accounts for 25% of all glaucoma, with Asia having the highest rate. Angle closure is an anatomical variation, making the Inuit, Chinese, and other Asians more susceptible. Current treatments include medical, laser, and surgical modalities. PURPOSE To identify the current treatment protocols for primary angle closure. DISCUSSION The current general protocol to treat angle closure is to lower the intraocular pressure with medications and perform laser iridotomy. However, cataract surgery, laser iridoplasty, goniosynechiolysis, diode cyclophotocoagulation, and filtering surgery are additional treatment modalities used for primary angle closure. CONCLUSION Primary angle closure occurs due to various anatomical angle variations. Laser iridotomy is not the sole method of treatment. Specifically, cataract surgery can be particularly effective in the treatment and prevention of angle closure. Recalcitrant cases can be treated with trabeculectomy and shunt implants, although these are not usually first-line treatments.
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Affiliation(s)
- Farihah Anwar
- a Massachussetts Eye and Ear Infirmary , Boston , MA , USA
| | - Angela Turalba
- a Massachussetts Eye and Ear Infirmary , Boston , MA , USA
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14
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Li SF, Wu GW, Chen CX, Shen L, Zhang ZB, Gao F, Wang NL. Association between choroidal thickness and anterior chamber segment in eyes with narrow or open-angle. Int J Ophthalmol 2016; 9:1143-7. [PMID: 27588269 DOI: 10.18240/ijo.2016.08.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 07/06/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the relationship between choroidal thickness and anterior chamber segment in subjects with eyes with narrow or open-angle. METHODS The subfoveal choroidal thickness was measured with enhanced depth-imaging optical coherence tomography and anterior chamber parameters were measured with ultrasound biomicroscopy in one eye of 23 subjects with open-angle eyes and 38 subjects with narrow-angle eyes. The mean age was 59.52±7.04y for narrow-angle subjects and 60.76±7.23y for open-angle subjects (P=0.514). Multivariate linear regression analysis was performed to assess the association between choroidal thickness and narrow-angle parameters. RESULTS There were no differences in subfoveal choroidal thickness between open- and narrow-angle subjects (P=0.231). Anterior chamber parameters, including central anterior chamber depth, trabecular iris angle, iris thickness 500 µm from the scleral spur (IT500), and ciliary body thickness at 1 mm and 2 mm from the scleral spur (CBT1, CBT2) showed significant differences between the two groups (P<0.05). Subfoveal choroidal thickness showed negative correlation (β=-0.496, P=0.016) only with anterior chamber depth in the open-angle group and with age (β=-0.442, P=0.003) and IT500 (β=-0.399, P=0.008) in the narrow-angle group. However, subfoveal choroidal thickness was not correlated with trabecular iris angle, anterior chamber depth, ciliary body thickness, or central corneal thickness in the narrow-angle group. CONCLUSION Choroidal thickness does not differ in the two groups and has not correlated with anterior chamber parameters in narrow-angle subjects, suggesting a lack of relationship between choroidal thickness and primary angle-closure glaucoma.
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Affiliation(s)
- Song-Feng Li
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ge-Wei Wu
- Department of Ophthalmology, Beijing Shi Jing Shan Hospital, Beijing 100000, China
| | - Chang-Xi Chen
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ling Shen
- Department of Ophthalmology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Zhi-Bao Zhang
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Fei Gao
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Ning-Li Wang
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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