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Yan C, Yu Y, Wang W, Han Y, Yao K. Long-term effects of mild cataract extraction versus laser peripheral iridotomy on anterior chamber morphology in primary angle-closure suspect eyes. Br J Ophthalmol 2024; 108:812-817. [PMID: 36746613 DOI: 10.1136/bjo-2022-322698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
AIM To compare lens extraction (LE) and laser peripheral iridotomy (LPI) on anterior segment morphology in primary angle-closure suspect (PACS) eyes. METHODS This prospective clinical trial included 144 patients with PACS who underwent either LPI or LE. Ultrasound biomicroscopy (UBM) and gonioscopy were performed before and 1 month and 2 years after operation. Main outcomes included UBM parameters and the percentage of residual angle closure. RESULTS At both 1 month and 2 years of follow-up, LE showed a better effect of relieving anterior chamber crowding and widening the drainage angle, as obtaining a larger anterior chamber depth (ACD), angle opening distance, trabecular iris angle (TIA), trabecular iris space area, trabecular ciliary process distance (TCPD) and a smaller iris curvature (I-Curv) and lens vault (LV) (p<0.001). In the LPI group, angle width increased (angle opening distance at 500 µm from the scleral spur, TIA and trabecular iris space area at 500 µm from the scleral spur) and I-Curv decreased (p<0.001) at 1 month postoperatively, with no significant changes in ACD, LV or TCPD. However, at 2 years after LPI, the angle narrowed with the increase in LV over time, and the proportion of residual angle closure also increased from 21.7% to 30.4% (p<0.001). In contrast, after LE, the widened angle width, flattened iris, deepened ACD, decreased LV and increased TCPD all showed good sustainability in the comparison between 1-month and 2-year follow-up. No residual angle closure was observed either at 1 month or 2 years after LE. CONCLUSIONS LE was prior to LPI in widening the drainage angle. After LPI, there was a narrowing of the angle and an increase in the proportion of residual angle closure over time. LE could achieve a wider angle with no residual angle closure, and the anterior segment parameters were sustainable. TRIAL REGISTRATION NUMBER ChiCTR1800016511.
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Affiliation(s)
- Chenxi Yan
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yibo Yu
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Wang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Han
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Ke Yao
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Pradhan S, Sah RK, Bhandari G, Bhandari S, Byanju R, Kandel RP, Thompson IJB, Stevens VM, Aromin KM, Oatts JT, Ou Y, Lietman TM, O'Brien KS, Keenan JD. Anterior Segment OCT for Detection of Narrow Angles: A Community-Based Diagnostic Accuracy Study. Ophthalmol Glaucoma 2024; 7:148-156. [PMID: 37611749 DOI: 10.1016/j.ogla.2023.08.005] [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: 07/07/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE To assess the diagnostic accuracy of anterior segment OCT (AS-OCT) screening for detecting gonioscopically narrow angles. DESIGN Population-based cross-sectional study. PARTICIPANTS A stratified random sample of individuals aged ≥ 60 years, selected from a door-to-door census performed in low-lying Nepal. TESTING Participants underwent AS-OCT, posterior segment OCT, and intraocular pressure (IOP) testing in the community. Those meeting referral criteria in either eye were invited to have a comprehensive eye examination including gonioscopy. Referral criteria included (i) the lowest 2.5% of AS-OCT measurements, (ii) retinal OCT results suggestive of glaucomatous optic neuropathy, diabetic retinopathy, or age-related macular degeneration, and (iii) elevated IOP. MAIN OUTCOME MEASURES Sensitivity and specificity of 5 semiautomated AS-OCT parameters relative to gonioscopically narrow angles, defined as the absence of visible trabecular meshwork for ≥ 180° on nonindentation gonioscopy. RESULTS Of 17 656 people aged ≥ 60 years enumerated from 102 communities, 12 633 (71.6%) presented for AS-OCT testing. Referral was recommended for 697 participants based on AS-OCT criteria and 2419 participants based on other criteria, of which 858 had gonioscopy performed by a glaucoma specialist. Each of the 5 AS-OCT parameters offered good diagnostic information for predicting eyes with gonioscopically narrow angles, with areas under the receiver operating characteristic curve ranging from 0.85 to 0.89. The angle opening distance at 750 μm from the scleral spur (AOD750) provided the most diagnostic information, providing an optimal sensitivity of 87% (95% confidence interval [CI], 75%-96%) and specificity of 77% (71%-83%) at a cutpoint of 367 μm, and a sensitivity of 65% (95% CI, 54%-74%) when specificity was constrained to 90% (cutpoint, 283 μm). CONCLUSIONS On AS-OCT, the AOD750 parameter detected approximately two-thirds of cases of gonioscopically narrow angles when test specificity was set to 90%. Although such a sensitivity may not be sufficient when screening solely for narrow angles, AS-OCT requires little additional effort if posterior segment OCT is already being performed and thus could provide incremental benefit when performing OCT-based screening. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | | | | | | | | | | | - Isabel J B Thompson
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Valerie M Stevens
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Krisianne M Aromin
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Julius T Oatts
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Institute for Global Health Sciences, University of California San Francisco, San Francisco, California
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California.
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Kim S, Park SH, Lee SM. Changes in Intraocular Pressure and Anterior Chamber Parameters Following Cataract Surgery, Vitrectomy, and Combined Surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:23-33. [PMID: 38104596 PMCID: PMC10869432 DOI: 10.3341/kjo.2023.0072] [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: 07/24/2023] [Revised: 10/22/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023] Open
Abstract
PURPOSE The aim of this study is to investigate changes in intraocular pressure (IOP) and anterior-segment parameters before and after cataract surgery, vitrectomy, and combined surgery. METHODS The records of patients who had undergone cataract surgery (cataract group), vitrectomy (vitrectomy group), or combined cataract surgery and vitrectomy (combined group) at our hospital were retrospectively examined. The vitrectomy group consisted of pseudophakic eyes. IOP and anterior-segment measurements, including anterior chamber depth (ACD), angle opening distance (AOD), trabecular-iris angle (TIA), and trabecular-iris space area (TISA), were measured using swept-source anterior-segment optical coherence tomography before and 6 months after surgery in 41, 15, and 40 eyes, respectively. RESULTS In the cataract and combined groups, there was a decrease in IOP (cataract group: from 15.8 to 13.4 mmHg, p <0.001; combined group: from 15.8 to 14.2 mmHg, p = 0.002) and an increase in the central corneal thickness after surgery (p <0.001). The ACD increased in all groups, with a smaller increase in the vitrectomy group (p <0.03). Postoperative AOD, TIA, and TISA were significantly increased in the cataract and combined groups (p <0.02). Higher preoperative IOP and larger IOP reduction after surgery were correlated with smaller preoperative AOD, TISA, and TIA in cataract and combined groups (p <0.034). A small preoperative ACD was related to smaller preoperative AOD, TISA, TIA (r > 0.649, p <0.001), and postoperative IOP reduction in the cataract and combined groups (r = 0.377, p = 0.018 and r = 0.559, p = 0.001, respectively). CONCLUSIONS Compared to the vitrectomy group, the cataract and combined groups showed reduced postoperative IOP and increased AOD, TISA, and TIA. In these two groups, patients with shallower preoperative ACDs showed greater changes in IOP after surgery. Changes in IOP after surgery are thought to be related to changes in the anterior segment caused by the removal of the crystalline lens.
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Affiliation(s)
- Sangyoon Kim
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan,
Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan,
Korea
| | - Su Hwan Park
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan,
Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan,
Korea
| | - Seung Min Lee
- Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan,
Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan,
Korea
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Kang E, Park JH, Yoo C, Kim YY. Comparison of intraocular pressure fluctuation and glaucoma progression rate between phakic and pseudophakic eyes in pseudoexfoliation glaucoma. Sci Rep 2024; 14:6. [PMID: 38168116 PMCID: PMC10761949 DOI: 10.1038/s41598-023-49099-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
The management of patients with concurrent pseudoexfoliation glaucoma (PXG) and cataract is challenging given its worse prognosis compared to other glaucoma types and the increased risk associated with cataract surgery. In this retrospective study, we investigated the long-term outcomes of cataract surgery in patients with PXG. We enrolled patients with PXG who had undergone cataract surgery at least 2 years previously and compared them with mean deviation (MD) matched patients with phakic eyes. The results showed that both groups experienced a decrease in MD, with the group of pseudophakic eyes exhibiting a significantly higher rate of decline (-2.15 ± 2.66 dB/year vs. -0.86 ± 0.95 dB/year; P = 0.040). Similarly, there was a trend towards more rapid thinning of the retinal nerve fiber layer in the pseudophakic group (-2.92 ± 2.34 μm/year vs. -1.79 ± 1.71 μm/year; P = 0.074). No significant differences in the intraocular pressure parameters were observed between the two groups. Multivariate analysis revealed that pseudophakic lens status was significantly associated with a faster rate of MD decline in patients with PXG (regression coefficient, -1.391; P = 0.022). These findings underscore the importance of close monitoring of patients with pseudophakic PXG to effectively manage glaucoma progression.
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Affiliation(s)
- Edward Kang
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
- Department of Ophthalmology, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, 15355, Gyeonggi-do, Korea.
| | - Chungkwon Yoo
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Yong Yeon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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Sakai D, Yamamoto S, Yoshimizu S, Hirose F, Fujihara M, Nakamura M, Kurimoto Y. Ten-year outcomes of cataract surgery for glaucoma management in patients with primary angle-closure disease. Jpn J Ophthalmol 2023; 67:129-137. [PMID: 36564597 DOI: 10.1007/s10384-022-00971-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/17/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the long-term outcomes of cataract surgery for glaucoma management in patients with primary angle-closure disease (PACD). STUDY DESIGN Retrospective case series. METHODS We reviewed the medical records of 87 eyes of 87 patients with PACD who underwent uncomplicated cataract surgery alone at the Kobe City Medical Center General Hospital. Only patients with a minimum follow-up of 10 years were included. The patients were divided into PACD spectrum categories: primary angle-closure glaucoma (PACG), primary-angle closure (PAC), and primary angle-closure suspect (PACS). The treatment outcomes were compared among the 3 groups. Intraocular pressure (IOP), number of glaucoma eye drops, requirement of additional glaucoma treatment, visual field progression, and progression to glaucoma during the follow-up period were evaluated. RESULTS Among the 87 patients, 39 had PACG; 26, PAC; and 22, PACS. Ten years after surgery, the IOP had significantly decreased from baseline in all 3 groups. The rate of requirement of additional glaucoma treatment during the follow-up period was significantly higher in the PACG group than in the other groups. Almost half of the patients with PACG required additional glaucoma treatment; of those patients, six (15.4%) underwent glaucoma surgery. Three patients (11.5%) with PAC required additional glaucoma medication. Visual field progression was observed in 28.1% of the patients with PACG. In 1 patient with PAC, the condition progressed to PACG, but there was no such progression in any of the patients with PACS. CONCLUSIONS We confirmed that cataract surgery had a long-term (> 10 years) effect on IOP reduction in eyes with PACD. Early intervention with cataract surgery may be preferable for glaucoma management in patients with PACD.
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Affiliation(s)
- Daiki Sakai
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8 Minatojima Minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan.
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan.
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Shogo Yamamoto
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8 Minatojima Minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Satoru Yoshimizu
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8 Minatojima Minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Fumitaka Hirose
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8 Minatojima Minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
- Shin-Kobe Hirose Eye Clinic, Kobe, Japan
| | - Masashi Fujihara
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8 Minatojima Minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasuo Kurimoto
- Department of Ophthalmology, Kobe City Eye Hospital, 2-1-8 Minatojima Minamimachi, Chuo-ku, Kobe-shi, Hyogo, 650-0047, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
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Shi Y, Oatts J, Tian J, Qiao C, Zhang Q, Han Y, Wang N. Low-dose transscleral cyclophotocoagulation with subsequent phacoemulsification in the treatment of prolonged acute primary angle closure. Br J Ophthalmol 2023; 107:221-226. [PMID: 34462269 PMCID: PMC9887366 DOI: 10.1136/bjophthalmol-2021-318880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND To explore the outcomes and mechanisms of intraocular pressure (IOP) control using low-dose transscleral cyclophotocoagulation (LDTSCP) followed by phacoemulsification in patients with prolonged acute primary angle closure (APAC). METHODS Patients with prolonged APAC refractory to all other treatment modalities were prospectively recruited, and underwent LDTSCP (10 shots, 2 s duration, 120° treatment with the energy starting at 1500 mW and titrated to the level with audible burst but not exceeding 2000 mW) and anterior chamber paracentesis 1 week prior to phacoemulsification with intraocular lens implantation and viscogoniosynechiolysis. Postoperative IOP, vision, anatomic changes on anterior segment optical coherence tomography and complications were recorded. RESULTS Twenty eyes with prolonged APAC were recruited. Median follow-up was 12 months (range 9-18), at which point the vision in all eyes had improved and IOP was ≤17 mm Hg on no antiglaucoma medications. Following LDTSCP at postoperative day (POD) 1, IOP decreased in all eyes to a median 15 mm Hg (range: 6-28 mm Hg). Post-LDTSCP supraciliary effusion (SCE) occurred in 90% of eyes on POD1 or POD7 and ciliary body defect (CBD) was detected in 30% of eyes and resolved in all cases by postoperative month 1. Lower post-LDTSCP IOP was associated with more number of bursts (r=-0.558, p=0.011) and higher grade of SCE (r=-0.877, p<0.001), but not with total energy (p=0.240). Eyes with CBD (p=0.018) and a higher number of bursts (r=0.657, p=0.002) had higher grade SCE. CONCLUSIONS LDTSCP-induced SCE may explain the post-LDTSCP IOP reduction seen in eyes with prolonged APAC. LDTSCP instead of traditional more extensive treatment, was sufficient to provide a relatively safe and effective bridge therapy prior to phacoemulsification. TRIAL REGISTRATION NUMBER Chinese Clinical Trials Registry (ChiCTR1900023567).
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Affiliation(s)
- Yan Shi
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Julius Oatts
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Jiaxin Tian
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chunyan Qiao
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qing Zhang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Ningli Wang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Anterior Segment Parameter Changes after Cataract Surgery in Open-Angle and Angle-Closure Eyes: A Prospective Study. J Clin Med 2022; 12:jcm12010327. [PMID: 36615126 PMCID: PMC9820897 DOI: 10.3390/jcm12010327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background: To investigate the anterior segment parameters before and after cataract surgery in open-angle eyes and different subtypes of primary angle-closure glaucoma (PACG) eyes and to further explore the potential relationship between the anterior rotation of the ciliary process and crystalline lens. Methods: An observational, prospective study was performed on 66 patients who had cataract surgery including 22 chronic PACG patients, 22 acute PACG patients, and 22 open-angle cataract patients. Anterior segment parameters including the trabecular-ciliary process distance, ciliary process area, trabecular-ciliary angle (TCA), maximum ciliary body thickness (CBTmax), and so on, were measured using ultrasound biomicroscopy preoperatively and 3 months postoperatively. Results: After the surgery, there were significant increases in TCA (p < 0.001) and CBTmax (p < 0.05) in all three groups, while there was no significant change in the trabecular-ciliary process distance (p > 0.05) in all three groups. No significant difference in the changes of ciliary process area, TCA, and CBTmax (p > 0.05) pre- and postoperatively among the three groups were identified. Conclusions: Extractions of crystalline lenses played similar roles in terms of decreasing the anterior rotation of ciliary processes in open-angle eyes and angle-closure eyes. A natural anatomical abnormality may be a more important factor in the anterior rotation of ciliary processes in PACG patients.
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Song WK, Sung KR, Kim KE. Assessment of Iridotrabecular Contact and Its Association With Intraocular Pressure After Phacoemulsification in Primary Angle Closure. Am J Ophthalmol 2022; 249:1-11. [PMID: 36586662 DOI: 10.1016/j.ajo.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the association between the quantitative assessment of iridotrabecular contact (ITC), measured by swept-source anterior segment optical coherence tomography (SS AS-OCT), and intraocular pressure (IOP) control after phacoemulsification in patients with primary angle closure disease (PACD). DESIGN Retrospective, clinical cohort study. METHODS Preoperative and postoperative anterior chamber angle parameters were measured using SS AS-OCT. IOP was measured preoperatively and until 6 months postoperatively. Percent IOP reduction and fluctuation after surgery were calculated, and their relationships with SS AS-OCT parameters were assessed by correlation analyses and locally weighted scatterplot smoothing (LOWESS) regression with change-point analysis. RESULTS A total of 51 eyes of 51 PACD patients were included. Preoperative ITC index and area (r = 0.626, r = 0.551), as well as changes in ITC index and area (r = 0.632, r = 0.543) after surgery, were significantly correlated with postoperative IOP reduction, after adjusting for age and gender (all P <.001). Higher postoperative ITC index (r = 0.405, P = .005) and ITC area (r = 0.460, P = 0.001) were associated with greater postoperative IOP fluctuations. Change points on LOWESS curves were observed for preoperative ITC index (33.0%) and change in ITC index (27.0%) and percent IOP reductions were significantly correlated with them above (β = 0.386, β = 0.664, all P < .001) but not below the change points. CONCLUSIONS Quantitative assessment of circumferential ITC can predict postoperative IOP control after phacoemulsification, and thus it may be used as a reference for determining lens extraction in PACD eyes.
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Affiliation(s)
- Woo Keun Song
- From the Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyung Rim Sung
- From the Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Ko Eun Kim
- From the Department of Ophthalmology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Yu X, Kline B, Han Y, Gao Y, Fan Z, Shi Y. Weill-Marchesani syndrome 4 caused by compound heterozygosity of a maternal submicroscopic deletion and a paternal nonsense variant in the ADAMTS17 gene: A case report. Am J Ophthalmol Case Rep 2022; 26:101541. [PMID: 35496767 PMCID: PMC9046107 DOI: 10.1016/j.ajoc.2022.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 03/26/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To retrospectively report a case of Weill-Marchesani syndrome 4 (WMS4) with compound heterozygous variants of ADAMTS17 gene. Observations The patient was a 7-year-old boy with progressively worsening eyesight and intermittent elevated intraocular pressure (IOP) for two years. His IOPs were temporarily controlled using anti-glaucoma drugs. At presentation he had a shallow anterior chamber, lens subluxation, spherophakia and extensive synechial angle closure with high myopia in both eyes. Ultrasound biomicroscopy (UBM) identified thickened zonule fibers and anteriorly rotated, flat and slender ciliary processes, both of which worsened and were accompanied by obvious iris bombe after miosis. Gene testing showed compound heterozygosity of a maternal submicroscopic deletion on chromosome 15q26.3 (0.774 Mb) affecting the sequences of ADAMTS17, LYSMD4 and CERS3 as well as a paternal nonsense variant (c.1051_1053delAAGinsTAA, P.K351X) in the ADAMTS17 gene in the proband. The diagnosis of WMS4 was confirmed by genetic testing. Phacoemulsification (Phaco), intraocular lens (IOL) implantation, and irido-zonulo-hyaloid-vitrectomy (IZHV) combined with Ahmed Glaucoma Valve (AGV) implantation as a staged or one-stage surgery effectively lowered IOP, deepened ACD, improved visual acuity, and resolved the configuration of the ciliary processes in both eyes. Conclusion and Importance Recessive ADAMTS17 variants are associated with WMS4. We report here compound heterozygous variants in ADAMTS17 causing WMS4, and anatomically highlighted the possible pathophysiology for its clinical phenotype. A modified surgical approach with Phaco, IOL implantation, and IZHV combined with AGV implantation could be used to treat these complicated cases.
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Ghadamzadeh M, Karimi F, Ghasemi Moghaddam S, Daneshvar R. Anterior Chamber Angle Changes in Primary Angle-closure Glaucoma Following Phacoemulsification Versus Phacotrabeculectomy: A Prospective Randomized Clinical Trial. J Glaucoma 2022; 31:147-155. [PMID: 35210384 DOI: 10.1097/ijg.0000000000001977] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
PRCIS We used anterior segment optical coherence tomography to investigate anterior chamber angle in primary angle-closure glaucoma (PACG) eyes following phacoemulsification and phacotrabeculectomy. Angle widening was significantly greater after phacoemulsification up to 6 months after the surgery. PURPOSE To compare anterior chamber angle following 2 common surgeries for PACG. METHODS One hundred ten glaucoma patients were evaluated in this single center, prospective, randomized clinical trial. Those with concomitant PACG and senile cataract and without a history of ocular surgery, trauma, or chronic miotic use were recruited. Monocular patients were also excluded. Finally, 52 eligible subjects were randomly assigned to phacoemulsification ("Phaco" group, 25 eyes) or phacotrabeculectomy ("Combined" group, 27 eyes) surgeries. A swept-source, anterior segment optical coherence tomography device (CASIA SS-1000 OCT) was used to image the anterior segment. Mask graders used the images to measure the following parameters before and 1 week, 1 month, and 6 months after surgery: angle opening distance at 500 µm, trabecular iris surface area at 500 µm, and trabecular iris angle at 500 µm. RESULTS There was no significant difference between study groups regarding best-corrected visual acuity, intraocular pressure (IOP), and the number of glaucoma medications in preoperative or postoperative visits (P>0.076). Also, the measured angle parameters were not statistically significantly different between the 2 groups before surgery (P>0.123). After surgery, all measured parameters were significantly increased in both groups (P<0.0001). At the 6-month follow-up, nasal angle opening distance at 500 µm was 0.383±0.027 vs. 0.349±0.017, trabecular iris surface area at 500 µm was 0.141±0.007 vs. 0.125±0.005, and trabecular iris angle at 500 µm was 40.1±12.9 vs. 34.6±3.1 in Phaco and Combined groups, respectively (P<0.0001 for all). CONCLUSIONS Anterior chamber angle widening by anterior segment optical coherence tomography was observed in PACG patients following surgery and was significantly greater after phacoemulsification compared with combined phacotrabeculectomy at all time points. Similar IOP and medication burden were noted for up to 6 months as secondary outcomes. The contribution of angle changes to the IOP-lowering effect of phacoemulsification in PACG eyes needs further study.
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Affiliation(s)
| | - Farshid Karimi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ramin Daneshvar
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Ophthalmology, University of Florida, Gainesville, FL
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11
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Soleimani M, Tabatabaei S, Samadi M, Fonoodi H, Ghods S, Inanloo B. Accuracy of different lens power calculation formulas in patients with phacomorphic glaucoma. Taiwan J Ophthalmol 2022; 12:164-169. [PMID: 35813804 PMCID: PMC9262030 DOI: 10.4103/tjo.tjo_1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE: The purpose of the study was to determine the most accurate formula for intraocular lens (IOL) power calculation among five currently used formulas in eyes with phacomorphic glaucoma (PG) undergoing cataract extraction surgery. MATERIALS AND METHODS: In this prospective interventional case series Patients diagnosed with PG were undergone uneventful phacoemulsification and IOL implantation. After 3 months, the refractive outcome for each formula was evaluated with mean prediction error (PE), mean absolute error (MAE), and the percentages of eyes within 0.25 D and 0.5 D of predicted error. RESULTS: Twenty-three patients completed the study. PEs were significantly different among the 5 formulas (P = 0.019), and Holladay I had the least error (−0.02 ± 1.11). Haigis formula had the highest hyperopic shift (0.37 ± 1.22), highest MAE (0.99 ± 0.78) and the lowest percentages of desired PEs, while the SRK II produced the greatest percentages. The overall differences in MAE between the 5 formulas were statistically insignificant (P = 0.547). CONCLUSION: In some extreme situations like patients with PG, lower generation of IOL power calculation formulas may still produce more acceptable refractive outcomes.
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12
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Zheng Q, Hu M, Li ZL, Chang PJ, Zhao YE. Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT. Int J Ophthalmol 2021; 14:1527-1532. [PMID: 34667728 DOI: 10.18240/ijo.2021.10.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). CONCLUSION Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.
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Affiliation(s)
- Qian Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Man Hu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Zhang-Liang Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Ping-Jun Chang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Yun-E Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
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13
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Helmy H. Long-Term Effect of Early Phacoemulsification in Primary Angle Closure Glaucoma Patients with Cataract: A 10-Year Follow-Up Study. Clin Ophthalmol 2021; 15:3969-3981. [PMID: 34616141 PMCID: PMC8488041 DOI: 10.2147/opth.s333202] [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: 08/08/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the 10-year effects of early phacoemulsification with intraocular lens (IOL) implantation in primary angle closure glaucoma (PACG) patients with cataract. Patients and Methods This prospective cohort study included 102 eyes of 102 patients with PACG. All patients had coexisting cataracts compromising vision. Patients underwent phacoemulsification and foldable IOL implantation. The main outcome measures were anterior chamber depth (ACD), angle width, value of intraocular pressure (IOP), and number of medications needed postoperatively and during follow-up. Results Half (53%) of the patients were female, with ages ranging from 55 to 73 with a mean of 59.82±5.19 years. Mean IOP decreased significantly from 22.15±2.08 mmHg at baseline to 14.08±2.13 mmHg postoperatively (p˂ 0.05). The ACD increased from 2.2±0.21 preoperatively to 3.73±0.25 postoperatively (p˂0.001). Nasal angle width increased postoperatively to 40.05±2.09 compared to the preoperative value of 16.02±2.08 (p˂0.001). Temporal angle width increased from 13.05±2.07 to 41.9600±1.94 (p˂0.001). Anti-glaucoma treatment significantly decreased postoperatively (p˂0.001). A significant positive correlation was detected between ACD and angle width, while a negative correlation was detected between IOP and both ACD and angle width (p˂0.001). There was also a significant negative correlation between postoperative angle width and IOP (p˂0.001). Preoperative lens thickness was positively correlated with preoperative IOP and number of medications, while it was negatively correlated with preoperative AC depth and angle width. Preoperative lens thickness positively correlated with postoperative IOP and medications. Complete and qualified success was achieved in 69.65% and 30.4% of cases, respectively, while 2.9% failed to be controlled. Visual acuity significantly improved from 0.17±0.1 to 0.9±0.08 (p˂0.001). All parameters showed high stability throughout the follow-up period. Conclusion Phacoemulsification with IOL implantation is a safe and effective early modality for long-term control of IOP in PACG patients with coexisting cataract. The effects can persist for at least 10 years.
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Affiliation(s)
- Hazem Helmy
- Glaucoma and Optic Nerve Disease Department, Research Institute of Ophthalmology, Giza, Egypt
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14
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Gong H, Dong X, Zheng B, Gao X, Chen L, Zhang S, Zuo C, Lin M. Ultrasound Biomicroscopy Might Predict the Outcome of Phacoemulsification-Visco Dissection in Medically Controlled Primary Angle-Closure Glaucoma Eye With Extensive Peripheral Anterior Synechia. Front Med (Lausanne) 2021; 8:705864. [PMID: 34350200 PMCID: PMC8326522 DOI: 10.3389/fmed.2021.705864] [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: 05/06/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The treatment procedures of primary angle-closure glaucoma (PACG) with extensive peripheral anterior synechia (PAS) is a subject of debate. This study is to investigate the clinical features of phacoemulsification (Phaco)-visco dissection in medically controlled PACG patients with PAS > 180° and evaluate the predictability of Ultrasound Biomicroscopy (UBM) parameters on postoperative intraocular pressure (IOP). Methods: 48 eyes (48 patients) with acute angle-closure glaucoma (AACG) and 30 eyes (30 patients) with chronic angle-closure glaucoma (CACG) were prospectively included. All patients underwent phaco-viscogoniolysis and foldable lens implantation and were followed for 1 year after surgery. We analyzed preoperative and postoperative IOP, the numbers of anti-glaucoma medicine, the visual field value, the extent of PAS, and UBM parameters alterations, and evaluated the correlation between preoperative UBM parameters and one-year postoperative IOP. Results: IOP reduced significantly from 16.24 ± 4.33 to 14.49 ± 3.69 mmHg in AACG group and from 16.16 ± 3.69 mmHg to 14.31 ± 4.12 mmHg in CACG group, and PAS decreased significantly from 270 ± 60.33 to 171 ± 56.44° in AACG group and from 285 ± 70.46 to 168 ± 61.32° in CACG group, and the number of anti-glaucoma drugs decreased significantly in both groups. Several UBM parameters, including anterior chamber depth, trabecular iris angle, and peripheral iris thickness 500 increased while iris convex reduced considerably in the two groups, and angle opening distance 500 and trabecular-meshwork ciliary process angle increased significantly only in AACG group. One-year postoperative IOP correlated with preoperative angle opening distance 500 and trabecular iris angle negatively and iris convex positively. Conclusion: Phaco-visco dissection can effectively reduce IOP, the numbers of glaucomatous medications, and PAS in medically controlled PACG patients with extensive PAS. UBM parameters might be valuable for analyzing postoperative anterior segment structure and predicting postoperative IOP of Phaco-visco dissection in PACG patients with extensive PAS.
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Affiliation(s)
- Haijun Gong
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xu Dong
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,The Fourth People's Hospital of Shenyang, Shenyang, China
| | - Bingru Zheng
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xinbo Gao
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Liming Chen
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Simin Zhang
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chengguo Zuo
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingkai Lin
- State Key Laboratory of Ophthalmology, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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15
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Lee TE, Yoo C, Kim YY. The effects of peripheral anterior synechiae on refractive outcomes after cataract surgery in eyes with primary angle-closure disease. Medicine (Baltimore) 2021; 100:e24673. [PMID: 33832065 PMCID: PMC8036052 DOI: 10.1097/md.0000000000024673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/17/2021] [Indexed: 01/05/2023] Open
Abstract
Objective of the study was to investigate the effects of peripheral anterior synechiae (PAS) on refractive outcomes after cataract surgery in eyes with primary angle-closure disease (PACD).This is a retrospective, cross-sectional study. Seventy eyes of 70 PACD patients who underwent phacoemulsification and intraocular lens implantation. Patients were divided into 2 groups based on the presence of PAS on preoperative gonioscopy. The predictive power of the intraocular lens was calculated by the SRK/T, Hoffer Q, Haigis, and Holladay formulae. The mean absolute error (MAE) and predicted refractive errors were compared between PAS (+) and PAS (-) groups. We also evaluated the refractive errors with regards to the extent of PAS in the subanalyses.The mean MAE was greater in the PAS (+) group with all formulae (0.61-0.70 diopters [D] vs 0.33-0.45 D, all P < .05). The eyes with PAS tended towards myopia (-0.30 D to -0.51 D vs -0.05 D to +0.24 D, all P < .05). However, the MAEs or predicted refractive errors were not different, irrespective of the extent of PAS in the subanalyses (all, P > .05).The presence or absence of PAS may influence the postoperative refractive outcomes in PACD patients.
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Affiliation(s)
- Tae-Eun Lee
- Department of Ophthalmology, Jeonbuk National University Medical School and Hospital, Jeonju
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Chungkwon Yoo
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
| | - Yong Yeon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea
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16
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Triolo G, Barboni P, Savini G, De Gaetano F, Monaco G, David A, Scialdone A. The Use of Anterior-Segment Optical-Coherence Tomography for the Assessment of the Iridocorneal Angle and Its Alterations: Update and Current Evidence. J Clin Med 2021; 10:jcm10020231. [PMID: 33440631 PMCID: PMC7827616 DOI: 10.3390/jcm10020231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 11/16/2022] Open
Abstract
The introduction of anterior-segment optical-coherence tomography (AS-OCT) has led to improved assessments of the anatomy of the iridocorneal-angle and diagnoses of several mechanisms of angle closure which often result in raised intraocular pressure (IOP). Continuous advancements in AS-OCT technology and software, along with an extensive research in the field, have resulted in a wide range of possible parameters that may be used to diagnose and follow up on patients with this spectrum of diseases. However, the clinical relevance of such variables needs to be explored thoroughly. The aim of the present review is to summarize the current evidence supporting the use of AS-OCT for the diagnosis and follow-up of several iridocorneal-angle and anterior-chamber alterations, focusing on the advantages and downsides of this technology.
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Affiliation(s)
- Giacinto Triolo
- Ophthalmic Institute, ASST Fatebenefratelli-Sacco, 20121 Milan, Italy; (F.D.G.); (G.M.); (A.D.); (A.S.)
- Correspondence:
| | - Piero Barboni
- San Raffaele Scientific Institute, University Vita-Salute, 20133 Milan, Italy;
- Studio Oculistico D’Azeglio, 40123 Bologna, Italy
| | | | - Francesco De Gaetano
- Ophthalmic Institute, ASST Fatebenefratelli-Sacco, 20121 Milan, Italy; (F.D.G.); (G.M.); (A.D.); (A.S.)
| | - Gaspare Monaco
- Ophthalmic Institute, ASST Fatebenefratelli-Sacco, 20121 Milan, Italy; (F.D.G.); (G.M.); (A.D.); (A.S.)
| | - Alessandro David
- Ophthalmic Institute, ASST Fatebenefratelli-Sacco, 20121 Milan, Italy; (F.D.G.); (G.M.); (A.D.); (A.S.)
| | - Antonio Scialdone
- Ophthalmic Institute, ASST Fatebenefratelli-Sacco, 20121 Milan, Italy; (F.D.G.); (G.M.); (A.D.); (A.S.)
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17
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Li Y, Guo C, Huang C, Jing L, Huang Y, Zhou R, Qiu K, Zhang M. Development and Evaluation of the Prognostic Nomogram to Predict Refractive Error in Patients With Primary Angle-Closure Glaucoma Who Underwent Cataract Surgery Combined With Goniosynechialysis. Front Med (Lausanne) 2021; 8:749903. [PMID: 34977061 PMCID: PMC8714900 DOI: 10.3389/fmed.2021.749903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/18/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: To evaluate the accuracy of different intraocular lens (IOL) power calculation formulas and develop prognostic nomograms to predict the risk of postoperative refractive error in primary angle-closure glaucoma (PACG) patients. Methods: A total of 111 eyes with PACG underwent goniosynechialysis combined with phacoemulsification and IOL implantation were included. SRK/T, Barrett II, Hoffer Q, and Kane formulas were used to predict postoperative refraction. Prediction error (PE) and absolute predictive error (APE) produced by the four formulas were calculated and compared. An APE >0.50 D was defined as the event. Binary logistic regression analysis and prognostic nomogram models were conducted to investigate reliable predictors associated with postoperative refraction. Results: The Kane (-0.06 D) and Barrett II (-0.07 D) formulas had mean prediction error close to zero (p = 0.44, p = 0.41, respectively). The Hoffer Q and SRK/T produced significantly myopic outcomes (p = 0.003, p = 0.013, respectively). The percentage of eyes within ± 0.5 D was 49.5% (55/111), 44.1% (49/111), 43.2% (48/111), and 49.5% (54/111), for the Kane, Barrett II, Hoffer Q, and SRK/T formula, respectively. Nomogram showed that AL had the greatest impact on the refractive outcomes, indicating a shorter preoperative AL is associated with a greater probability of refractive error event. The area under the receiver operator curve (AUC) of the nomogram for the Kane, Barrett II, Hoffer Q, and SRK/T was 0.690, 0.701, 0.708, and 0.676, respectively. Conclusions: The Kane and Barrett II formulas were comparable, and they outperformed Hoffer Q and SRK/T in the total eyes with PACG receiving cataract surgery combined with goniosynechialysis. The developed nomogram models can effectively predict the occurrence of postoperative refractive error events.
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Affiliation(s)
- Yuancun Li
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Chengyao Guo
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Chukai Huang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China
| | - Liu Jing
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Yingzi Huang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Ruiqing Zhou
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China
- Shantou University Medical College, Shantou, China
| | - Kunliang Qiu
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China
- Kunliang Qiu ; orcid.org/0000-0003-4414-9758
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University, The Chinese University of Hong Kong, Shantou, China
- *Correspondence: Mingzhi Zhang ; orcid.org/0000-0001-9032-7274
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Nongpiur ME, Verma S, Tun TA, Wong TT, Perera SA, Aung T. Plateau Iris and Severity of Primary Angle Closure Glaucoma. Am J Ophthalmol 2020; 220:1-8. [PMID: 32735788 DOI: 10.1016/j.ajo.2020.07.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the distribution of plateau iris in eyes across varying severity of primary angle closure glaucoma (PACG) using standardized ultrasound biomicroscopy (UBM) criteria. DESIGN Cross-sectional study. METHODS UBM was performed on 210 patients with PACG who had previously undergone laser peripheral iridotomy. Plateau iris was defined as the presence of all the following UBM criteria in ≥2 quadrants of the angle: anteriorly directed ciliary body, absent ciliary sulcus, iris angulation, flat iris plane, and iridotrabecular contact. Disease severity was based on the visual field mean deviation (MD) and classified as early-to-moderate (MD ≥ -12 dB), advanced (-12.01 dB to -20 dB), and severe (MD < -20 dB). RESULTS Of 210 subjects recruited, 23 were excluded because of poor quality UBM images. The remaining 187 patients were categorized as having early-to-moderate (n = 103), advanced (n = 38), and severe PACG (n = 46). Of these subjects, 48.1% were male, and 90.9% were of Chinese ethnicity. The overall proportion of plateau iris was 36.9%, with 32.0% (33/103) in early-to-moderate, 34.2% (13/38) in advanced, and 50% (23/46) in severe PACG (P = .03, comparing severe PACG with early-to-moderate groups). Among the severe PACG group, those with plateau iris configuration had significantly smaller anterior chamber area (P = .03) and volume (P = .01) compared with those without plateau iris. CONCLUSION The higher proportion of plateau iris configuration in eyes with severe PACG compared with early-to-moderate PACG suggest that this may be a contributory factor for disease severity.
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Shi Y, Tian J, Han Y, Oatts J, Wang N. Pathogenic role of the vitreous in angle-closure glaucoma with autosomal recessive bestrophinopathy: a case report. BMC Ophthalmol 2020; 20:271. [PMID: 32646389 PMCID: PMC7346445 DOI: 10.1186/s12886-020-01543-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Autosomal recessive bestrophinopathy (ARB) is caused by homozygous or compound heterozygous mutations in the BEST1 gene and always accompanied with refractory angle-closure glaucoma (ACG). The exact mechanism for the pan-ocular abnormalities in ARB is still unknown and the management of ACG in these cases is challenging. Case presentation A 26-year-old patient with a novel autosomal–recessively inherited c.1 A > G variant in BEST1 diagnosed as ARB and ACG, presented as widespread vitelliform deposits in the posterior pole, retinoschisis in the macula, vitreoretinal interface abnormalities, shallow anterior chamber depth (ACD) and angle closure with uncontrolled intraocular pressure (IOP). Combined phacoemulsification, intraocular lens implantation and goniosynechialysis did not improve any clinical presentation. However, low dose transscleral cyclophotocoagulation with subsequent vitreous liquefaction effectively lowered IOP, deepened ACD, and rehabilitated retinoschisis in both eyes. Conclusions This case implied vitreous condition may play a pathogenic role in formation of retinoschisis and ACG in the patients with ARB. Treatments that induce vitreous liquefaction could be used to treat young ACG patients with ARB or other kinds of ACG to avoid vision-threatening post-operative complications.
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Affiliation(s)
- Yan Shi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, 100730, China
| | - Jiaxin Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, 100730, China
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Julius Oatts
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, 100730, China. .,Beijing Tongren Hospital, 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
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Microcornea and Thickened Lens in Angle Closure following Nonsurgical Treatment of Retinopathy of Prematurity. J Ophthalmol 2020; 2020:7510903. [PMID: 32454993 PMCID: PMC7225864 DOI: 10.1155/2020/7510903] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To characterize the clinical features in young patients with angle closure and to determine the characteristics associated with acquired anterior segment abnormality following retinopathy of prematurity (ROP) treatment. Methods We performed two retrospective case-control series. In the first series, we identified consecutive young angle closure patients without prior surgeries, with and without a history of ROP treatment; in the second series we identified consecutive patients who underwent ROP treatment, without and without anterior segment changes. Results In the first series, 25 eyes of 14 consecutive angle closure patients were included: 19 eyes (11 patients, 78.6%) had a history of treated ROP, while 6 eyes (3 patients) belonged to full-term patients. The treated ROP eyes had significantly shallower anterior chambers (1.77 ± 0.17 mm vs 2.72 ± 0.18 mm, P < 0.0001) and thicker lenses (5.20 ± 0.54 mm vs 3.98 ± 0.20 mm, P = 0.0002) compared to the full-term controls. In the second series, 79 eyes of 40 patients were included, with median gestational age of 24.6 weeks. Acquired iridocorneal adhesion was noted in the eight eyes (10.1%) at a mean age of 4.7 years and was associated with prior zone 1 and plus disease (P = 0.0013), a history of initial intravitreal bevacizumab treatment (IVB, P = 0.0477) and a history of requiring additional IVB after initial treatment (P = 0.0337). Conclusions Many young angle closure patients may have a history of treated ROP and may present with the triad of increased lens thickness, microcornea, and angle closure.
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Vu AT, Bui VA, Vu HL, Quyet D, Thai TV, Nga VT, Dinh TC, Bac ND. Evaluation of Anterior Chamber Depth and Anterior Chamber Angle Changing After Phacoemulsification in the Primary Angle Close Suspect Eyes. Open Access Maced J Med Sci 2019; 7:4297-4300. [PMID: 32215081 PMCID: PMC7084008 DOI: 10.3889/oamjms.2019.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: Phacoemulsification surgery has the ability to deeply alter the segment anterior morphology, especially in eye with shallow anterior chamber (AC), narrow anterior chamber angle (ACA). However, the changes of anterior chamber depth (ACD) and ACA on the close angle suspect eyes after phacoemulsification have not been mentioned in many studies. So, we conduct this research. AIM: To evaluate the alteration in the ACA and ACD after phacoemulsification in the close angle suspect eyes. METHODS: Interventional study with no control group. Subjects were the primary angle closure suspect (PACS) eyes, that were operated by phacoemulsification with intraocular lens (IOL) at Glaucoma Department of VNIO from December 2017 to October 2018. RESULTS: 29 PACS eyes with cataract were operated by phacoemulsification with intraocular lens. After 3 months of monitoring, the average ACD augmented from 2.082 ± 0.244 to 3.673 ± 0.222 mm. AOD500 increase from 0.183 ± 0.088 to 0.388 ± 0.132 μm, AOD750 increased from 0.278 ± 0.105 to 0.576 ± 0.149 μm. The TISA500 enlarged from 0.068 ± 0.033 to 0.140 ± 0.052 mm2, TISA750 enlarged from 0.125 ± 0.052 to 0.256 ± 0.089 mm2 at the third month (p < 0.01). CONCLUSION: Phacoemulsification surgery increases the ACD and enlarged the angle in the PACS eyes.
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Affiliation(s)
- Anh Tuan Vu
- Deparment of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam
| | - Van Anh Bui
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Hai Long Vu
- Deparment of Ophthalmology, Hanoi Medical University, Hanoi, Vietnam
| | - Do Quyet
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
| | - Than Van Thai
- NTT Hi-tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Toi Chu Dinh
- Department of Human and Animal Physiology, Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Nguyen Duy Bac
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
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Bourdon H, Aragno V, Baudouin C, Labbé A. Iridoplasty for plateau iris syndrome: a systematic review. BMJ Open Ophthalmol 2019; 4:e000340. [PMID: 31592025 PMCID: PMC6757510 DOI: 10.1136/bmjophth-2019-000340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/17/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022] Open
Abstract
Plateau iris syndrome (PIS) is a frequent cause of angle closure. Argon laser peripheral iridoplasty (ALPI) has been proposed in PIS to widen the iridocorneal angle. The objective of the present study was to perform a systematic review of the available studies evaluating the efficacy of ALPI on intraocular pressure (IOP), iridocorneal angle opening and the number of medications in patients with chronic angle-closure associated with PIS. One prospective and seven retrospective studies with a minimum 1 month of follow-up were included. Although ALPI seemed to lower IOP, to decrease the number of topical antiglaucoma medications and widen the iridocorneal angle shortly after the procedure, there is no current evidence of long-term efficacy. To date, there is no robust scientific evidence to advocate ALPI as a treatment for chronic angle-closure caused by PIS.
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Affiliation(s)
- Hugo Bourdon
- III, CHNO, Paris, France.,Ophthalmology, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Vittoria Aragno
- III, CHNO, Paris, France.,Ophthalmology, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Christophe Baudouin
- III, CHNO, Paris, France.,INSERM-DGOS Clinical Investigation Center (CIC) 1423, CHNO, Paris, France
| | - Antoine Labbé
- III, CHNO, Paris, France.,INSERM-DGOS Clinical Investigation Center (CIC) 1423, CHNO, Paris, France
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Lee H, Zukaite I, Juniat V, Dimitry ME, Lewis A, Nanavaty MA. Changes in symmetry of anterior chamber following routine cataract surgery in non-glaucomatous eyes. EYE AND VISION 2019; 6:19. [PMID: 31309126 PMCID: PMC6607582 DOI: 10.1186/s40662-019-0144-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/12/2019] [Indexed: 11/26/2022]
Abstract
Background To assess minimum and maximum changes in anterior chamber dimensions following routine cataract surgery in non-glaucomatous eyes. Methods Forty-two eyes (42 participants) underwent routine cataract surgery with same surgeon and were assessed preoperatively, 1, 3, 6 and 12 months postoperatively. Primary outcome measure: Angle-to-angle diameter (AAD) (at 0-180o, 45-225o, 90-270o, 135-315o), Anterior-chamber-angle (ACA) (at 0o, 45o, 90o, 135o, 180o, 225o, 270o and 315o) and central anterior chamber depth (ACD) at all visits. Secondary outcome measures: relationship to axial length (AL). Results The mean AAD and ACA increased post-operatively in all meridians at all visits postoperatively. At 12 months, there was a maximum change in AAD in horizontal meridian (506.55 ± 468.71 μm) and least in vertical meridian (256.31 ± 1082.3 μm). The mean percentage increase in ACA postoperatively was least at 90o (5% increase compared to 29–35% elsewhere). Central ACD deepened at all postoperative visits and this did not change over 12 months. There was no correlation between AAD, ACA and ACD with AL at any visit. Conclusion The AAD, ACA and ACD increases following cataract surgery in non-glaucomatous eyes, but at 12 months increase in AAD is least in vertical compared to horizontal meridian. Also, ACA was narrower (only 5% increase) superiorly compared to elsewhere (29–35% increase in ACA). This may have implications with regards to surgeries performed in the anterior chamber and corneal endothelial cell loss.
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Affiliation(s)
- Hanbin Lee
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Ieva Zukaite
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Valerie Juniat
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Maria E Dimitry
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Amanda Lewis
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
| | - Mayank A Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF UK
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Abstract
PRECIS Schlemm canal (SC) expands after cataract extraction (CE), both in the area and in volume by 25% as was measured using enhanced-depth imaging optical coherent tomography (EDI-OCT) in patients before and 1 week after CE. PURPOSE This study aims to characterize the structural and volume changes on the microstructure of SC in patients before and after uneventful phacoemulsification CE by using EDI-OCT. MATERIALS AND METHODS Forty-one serial horizontal EDI-OCT B-scans (interval between B-scans, 69 µm) were obtained in the nasal corneoscleral limbus before and 1 week after CE. The structure of aqueous channels, conjunctival blood vessels and iris anatomy in each scan were used as landmarks to select for overlapping scans taken before and following CE. The SC cross-section area was measured in each of the selected scans and SC volume was determined following a 3-dimensional reconstruction. RESULTS Eleven eyes (6 females and 5 males) were imaged successfully before and after CE. Mean age was 70.54±11.38 years. The mean axial length was 23.10±0.87 mm. After CE, the mean best-corrected visual acuity in logMAR improved from 0.4±0.13 to 0.2±0.13 (P=0.028). There was no significant change in the mean intraocular pressure before and after CE (15.09±1.33 to 15.0±2.16 mm Hg; P=0.39). The mean SC cross-section area increased by 25%, from 4744±376 to 5941±1048 μm (P<0.001). SC volume in the analyzed region increased by 25% from 6,641,473±585,954 to 8,317,909±1,328,809 μm (P<0.001). CONCLUSION CE expands SC dimensions in healthy eyes. EDI-OCT imaging of SC may prove useful in the evaluation of the SC dimensions in vivo before and after CE.
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Tian T, Li M, Pan Y, Cai Y, Fang Y. The effect of phacoemulsification plus goniosynechialysis in acute and chronic angle closure patients with extensive goniosynechiae. BMC Ophthalmol 2019; 19:65. [PMID: 30832600 PMCID: PMC6399882 DOI: 10.1186/s12886-019-1070-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with primary angle closure/glaucoma (PAC/PACG) with extensive peripheral anterior synechiae (PAS), and coexisting cataract, increasingly have been treated with phacoemulsification combined with goniosynechialysis (Phaco-GSL). Since the mechanisms of acute and chronic PAC/PACG may differ, the treatment effect of this procedure also may differ. The purpose of this study was to establish whether there was a difference in the therapeutic effect of Phaco-GSL on these two groups of patients, the results of which could provide clinical evidence for improvement in treatment protocols for patients with PAC/PACG and extensive PAS. METHODS This study was a retrospective cohort study. Twenty-seven patients, 13 with acute PAC/PACG and 14 with chronic PAC/PACG, were treated surgically by Phaco-GSL. The intraocular pressure (IOP), surgical success rate, the need of medication, the extent of PAS, the time and the rate of recurrence of PAS (re-PAS) and other indicators were observed post-operatively for at least 3 months. RESULTS After surgery, IOP decreased (preoperative vs postoperative: 29.77 ± 11.55 mmHg vs 14.92 ± 1.66 mmHg in the acute group and 26.00 ± 11.2 mmHg vs 14.93 ± 2.7 mmHg in the chronic group), the extent of PAS reduced (preoperative vs. postoperative: 314.23 ± 49.07° vs 116.54 ± 73.78° in the acute group and 285.00 ± 53.28° vs 156.43 ± 56.35° in the chronic group), the topical and systemic anti-glaucoma drug requirements decreased, in both groups and in the acute group, respectively. Compared with the acute group, the success rate (acute vs chronic: 100% vs 64.3%) was lower in the chronic group, while the incidence of re-PAS (acute vs chronic: 30% vs 83.3%) were higher in the chronic group. All differences mentioned above were statistically significant (p < 0.05). In addition, there were five patients in total who showed re-PAS of more than 90° (4 in chronic group and 1 in acute group) and all these re-PASs formed within 1 week postoperatively. CONCLUSION Although Phaco-GSL is effective in both groups, there may be differences in the effect between the two groups. Chronic patients are more susceptible to re-PAS. Thus, these patients should be observed closely and treated appropriately in the early post-surgical time period.
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Affiliation(s)
- Tian Tian
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034 People’s Republic of China
| | - Mei Li
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034 People’s Republic of China
| | - Yingzi Pan
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034 People’s Republic of China
| | - Yu Cai
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034 People’s Republic of China
| | - Yuan Fang
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034 People’s Republic of China
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Baek SU, Kwon S, Park IW, Suh W. Effect of Phacoemulsification on Intraocular Pressure in Healthy Subjects and Glaucoma Patients. J Korean Med Sci 2019; 34:e47. [PMID: 30787680 PMCID: PMC6374551 DOI: 10.3346/jkms.2019.34.e47] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/16/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We investigated how cataract surgery might influence long-term intraocular pressure (IOP) change in both healthy subjects and glaucoma patients. METHODS A retrospective analysis of patients who had had clear corneal phacoemulsification with a minimum of 12 months of follow up was performed. Glaucoma patients with medically controlled open-angle glaucoma and healthy subjects with no glaucoma were included in the analysis. The change of IOP after phacoemulsification and factors associated with postoperative IOP change were investigated. RESULTS In total, 754 eyes of 754 patients, specifically 106 patients with glaucoma and 648 patients with no glaucoma (i.e., healthy subjects) were enrolled. The phacoemulsification effected a reduction of IOP: 1.03 ± 3.72 mmHg in healthy subjects and 1.08 ± 3.79 mmHg in glaucoma patients at postoperative 1 year (P = 0.656). There were negative coefficients of IOP until 1 year of follow up (all P < 0.001), but the IOP change gradually showed a less steeply decreasing slope (correlation coefficient: -0.993), compared with those for 1 week and 1 month of follow up (correlation coefficients: -1.893 and -1.540, respectively). In the multivariate analysis, age and preoperative IOP showed significant associations with postoperative IOP change (regression coefficients: -0.034 and 0.419 respectively, all P < 0.001). CONCLUSION Phacoemulsification resulted in IOP reduction, which effect regressed in healthy subjects and glaucoma patients over the course of long-term follow up. Therefore, long-term monitoring of IOP change is needed. In cases of higher preoperative IOP and young patients, phacoemulsification alone is a reliable option for IOP control.
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Affiliation(s)
- Sung Uk Baek
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Soonil Kwon
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - In Won Park
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Wool Suh
- Department of Ophthalmology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
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Chelerkar V, Parekh P, Kalyani VKS, Deshpande M, Khandekar R. Comparative Clinical Study of Medically Controlled Nonsevere Chronic Primary Angle-closure Glaucoma with Coexisting Cataract Surgically Managed by Phacoemulsification as against Combined Phacotrabeculectomy. Middle East Afr J Ophthalmol 2019; 25:119-125. [PMID: 30765948 PMCID: PMC6348945 DOI: 10.4103/meajo.meajo_204_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE: Comparative clinical study of medically controlled non-severe chronic Primary Angle Closure Glaucoma (PACG) with co-existing cataract surgically managed by phacoemulsification as against combined phacotrabeculectomy. METHODS: This randomized clinical trial was conducted between December 2011 and December 2013. Patients were randomly assigned to Phacoemulsification (PE) and Phacotrabeculectomy (PT) groups for surgery. Intraocular pressure, anti-glaucoma medications, Best Corrected Visual Acuity, anterior chamber angle widening and post-operative complications in both groups were compared after 12 months. RESULTS: There were 46 eyes with PACG in PE group and 45 in PT group. The IOP at 12 months in PE group was 11.5±1.3mmHg and 11.8±1.2mmHg in PT gr. (p = 0.28). The eyes requiring single anti-glaucoma medications at 12months in PE group was 0, PT group was 1 (p = 0. 495). The post op BCVA at 12months in PE group 0.3+-0.12 and 0.33±0.15 in PT group (p = 0.22). 3 cases in PT group required additional intervention whereas no additional intervention was required in PE group and this difference was statistically significant (p = 0.116). CONCLUSION: Phacoemulsification is equally effective in terms of intraocular pressure control and visual outcome as phacotrabeculectomy with better safety and less post-operative complication.
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Affiliation(s)
- Vidya Chelerkar
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India
| | - Puja Parekh
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India
| | - V K S Kalyani
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India
| | - Madan Deshpande
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Hwang HS, Kim DY, Kim HT, Chae JB, Hyung S. Refractory Outcomes after Cataract Surgery in Acute Primary Angle-closure Glaucoma Patients Treated with Laser Iridotomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.5.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hye Seong Hwang
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dong Yoon Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hyun Tae Kim
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju Byung Chae
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sungmin Hyung
- Department of Ophthalmology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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Zhang Y, Zong Y, Jiang Y, Jiang C, Lu Y, Zhu X. Clinical Features and Efficacy of Lens Surgery in Patients with Lens Subluxation Misdiagnosed as Primary Angle-Closure Glaucoma. Curr Eye Res 2018; 44:393-398. [PMID: 30426797 DOI: 10.1080/02713683.2018.1548130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the clinical features and efficacy of lens surgery in patients with lens subluxation misdiagnosed as primary angle-closure glaucoma. METHODS In total, 2054 inpatients with primary angle-closure glaucoma were consecutively recruited. Eighty-five of the patients were rediagnosed as lens subluxation following ultrasound biomicroscopy after hospitalization. Lens surgeries were performed in all patients, and 35 had a follow-up of at least 12 months. Risk factors of postoperative intraocular pressure control were identified with multivariate logistic regression analysis. RESULTS Eighty-five inpatients (4.1%, 85/2054) with lens subluxation were misdiagnosed as primary angle-closure glaucoma, of which 71.8% (2.97% of all cases, 61 out of 2054 subjects) had ocular blunt trauma and 18.8% (0.78% of all cases, 16 out of 2054 subjects) had spontaneous dislocation. Lens surgery significantly decreased the intraocular pressure and improved best-corrected visual acuity, meanwhile increased the anterior chamber depth (all P < 0.001). Postoperatively, the intraocular pressure was controlled with antiglaucomatous eye drops administration in 17 eyes, in which greater range of preoperative angle closure and zonular dialysis, and longer operation time delay were detected. Risk factors for poor postoperative IOP control were more quadrants of angle closure (P = 0.038) and operation time delay (P = 0.045). CONCLUSION Lens subluxation was the major cause of the misdiagnosed cases as primary angle-closure glaucoma. Misdiagnosed patients could benefit from the lens surgery, while more angle-closure quadrants and operation time delay indicated worse postoperative intraocular pressure control.
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Affiliation(s)
- Yinglei Zhang
- a Department of Ophthalmology, Eye and ENT Hospital , Fudan University , Shanghai , China.,b Eye Institute , Eye and ENT Hospital of Fudan University , Shanghai , People's Republic of China.,c Key NHC Key Laboratory of Myopia , Fudan University , Shanghai , People's Republic of China.,d Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , People's Republic of China.,e Shanghai Key Laboratory of Visual Impairment and Restoration , Shanghai , People's Republic of China
| | - Yuan Zong
- a Department of Ophthalmology, Eye and ENT Hospital , Fudan University , Shanghai , China.,b Eye Institute , Eye and ENT Hospital of Fudan University , Shanghai , People's Republic of China.,c Key NHC Key Laboratory of Myopia , Fudan University , Shanghai , People's Republic of China.,d Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , People's Republic of China.,e Shanghai Key Laboratory of Visual Impairment and Restoration , Shanghai , People's Republic of China
| | - Yongxiang Jiang
- a Department of Ophthalmology, Eye and ENT Hospital , Fudan University , Shanghai , China.,b Eye Institute , Eye and ENT Hospital of Fudan University , Shanghai , People's Republic of China.,c Key NHC Key Laboratory of Myopia , Fudan University , Shanghai , People's Republic of China.,d Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , People's Republic of China.,e Shanghai Key Laboratory of Visual Impairment and Restoration , Shanghai , People's Republic of China
| | - Chunhui Jiang
- a Department of Ophthalmology, Eye and ENT Hospital , Fudan University , Shanghai , China.,b Eye Institute , Eye and ENT Hospital of Fudan University , Shanghai , People's Republic of China.,c Key NHC Key Laboratory of Myopia , Fudan University , Shanghai , People's Republic of China.,d Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , People's Republic of China.,e Shanghai Key Laboratory of Visual Impairment and Restoration , Shanghai , People's Republic of China
| | - Yi Lu
- a Department of Ophthalmology, Eye and ENT Hospital , Fudan University , Shanghai , China.,b Eye Institute , Eye and ENT Hospital of Fudan University , Shanghai , People's Republic of China.,c Key NHC Key Laboratory of Myopia , Fudan University , Shanghai , People's Republic of China.,d Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , People's Republic of China.,e Shanghai Key Laboratory of Visual Impairment and Restoration , Shanghai , People's Republic of China
| | - Xiangjia Zhu
- a Department of Ophthalmology, Eye and ENT Hospital , Fudan University , Shanghai , China.,b Eye Institute , Eye and ENT Hospital of Fudan University , Shanghai , People's Republic of China.,c Key NHC Key Laboratory of Myopia , Fudan University , Shanghai , People's Republic of China.,d Laboratory of Myopia , Chinese Academy of Medical Sciences , Shanghai , People's Republic of China.,e Shanghai Key Laboratory of Visual Impairment and Restoration , Shanghai , People's Republic of China
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Chansangpetch S, Lau K, Perez CI, Nguyen N, Porco TC, Lin SC. Efficacy of Cataract Surgery With Trabecular Microbypass Stent Implantation in Combined-Mechanism Angle Closure Glaucoma Patients. Am J Ophthalmol 2018; 195:191-198. [PMID: 30098352 DOI: 10.1016/j.ajo.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/27/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate the effectiveness of trabecular microbypass stent (iStent) implantation in combined mechanism glaucoma (CMG). DESIGN Retrospective cohort study. METHODS We reviewed the medical charts of patients with the following scenarios: (1) primary open-angle glaucoma (POAG) undergoing phacoemulsification (PE), (2) POAG undergoing PE with iStent (POAG-PE/iStent), (3) CMG undergoing PE (CMG-PE), and (4) CMG undergoing PE with iStent (CMG-PE/iStent). CMG was defined as narrow-angle glaucoma patients whose angle had opened after iridotomy. Linear mixed-effects models were performed to determine the effect of iStent on postoperative 1-year success rate (intraocular pressure [IOP] ≤ 18 without medication), IOP, and number of medications. RESULTS Data from 301 eyes were available. The number of eyes (subjects) was 61 (45) in the POAG-PE, 60 (50) in POAG-PE/iStent, 93 (76) in CMG-PE, and 87 (70) in CMG-PE/iStent group. Success criteria were achieved in 13.1% for POAG-PE, 33.3% for POAG-PE/iStent (POAG-PE vs POAG-PE/iStent B 3.01; P < .001), 37.6% for CMG-PE, and 43.7% for CMG-PE/iStent (CMG-PE vs CMG-PE/iStent B 2.25; P < .001). There was no difference in the IOP between POAG-PE and POAG-PE/iStent, and between CMG-PE and CMG-PE/iStent. The iStent significantly reduced number of medications in the POAG (B -0.70; P < .001) and CMG group (B -0.52; P < .001). Comparing the effect of iStent on POAG and CMG, the analysis showed similar iStent efficacy in terms of the success rate, IOP, and number of medications (P > .05). CONCLUSIONS Combined PE/iStent significantly increased success rate and reduced number of medications in CMG patients compared to PE alone. The effects of iStent were comparable between POAG and CMG groups.
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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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32
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Baek SU, Kim KH, Lee JY, Lee KW. Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:108-115. [PMID: 29560619 PMCID: PMC5906395 DOI: 10.3341/kjo.2017.0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/17/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess long-term changes in intraocular pressure (IOP) and the development of glaucoma after early phacoemulsification in acute primary angle closure. METHODS Retrospective chart review of acute primary angle closure patients treated with phacoemulsification in attack eyes versus fellow eyes. Within a month after the angle closure attack, all subjects underwent cataract surgery and were divided into two groups: group A received cataract surgery on their attack eyes. Group B also received cataract surgery on their fellow eye after phacoemulsification of the attack eyes. Study outcomes were the prevalence of IOP rise (occurrence of IOP >21 mmHg) and the incidence of newly developed glaucoma. RESULTS Eighty-nine eyes were included, with 62 attack eyes in group A and 27 fellow eyes in group B. Group A (14 eyes, 22.58%) had a higher cumulative rate of IOP rise than group B (3 eyes, 11.11%) at 12 months (p = 0.001). Newly developed glaucoma was not observed in group B; however, 6 patients in group A developed glaucoma during the 12-month follow-up period (p < 0.001). CONCLUSIONS The attack eyes treated with phacoemulsification showed a significantly higher prevalence of IOP rise and newly developed glaucoma than fellow eyes that received phacoemulsification. These findings suggest that there is a possibility of IOP rise and development of glaucoma even when angle closure and successful IOP control have apparently been achieved after phacoemulsification.
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Affiliation(s)
- Sung Uk Baek
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Kwang Hyun Kim
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea
| | - Joo Yeon Lee
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Wha Lee
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea.
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Qureshi A, Chen H, Saeedi O, Kaleem MA, Stoleru G, Margo J, Kalarn S, Alexander JL. Anterior segment ultrasound biomicroscopy image analysis using ImageJ software: Intra-observer repeatability and inter-observer agreement. Int Ophthalmol 2018. [PMID: 29516316 DOI: 10.1007/s10792-018-0882-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE In this novel study, we demonstrate a standardized imaging and measurement protocol of anterior segment (AS) structures with reliability analysis using ultrasound biomicroscopy (UBM) and ImageJ software. METHODS Ten pediatric and young adult patients undergoing examination under anesthesia for AS pathology were imaged using UBM. Four trained observers analyzed 20 images using ImageJ. Forty-five structural parameters were measured. Those that relied on the trabecular-iris angle (TIA) as a reference landmark were labeled TIA-dependent (TD) and all others were labeled non-TIA dependent (NTD). Intra-observer repeatability (IOR) and inter-observer agreement (IOA) of measurements were determined using coefficient of variation (CV) and intra-class correlation (ICC) followed by assessment of Bland-Altman plots (BAP) for each pair of observers, respectively. RESULTS For NTD parameters, non-ciliary body (CB) related measurements showed CV range 0.60-16.22% and ICC range 0.84-0.89, whereas CB-related parameters showed CV range 2.86-23.40% and ICC range 0.29-0.92. For TD parameters, parameters < 2 degrees removed from reference showed CV range 0.02-5.40% and ICC range 0.89-1.00, whereas parameters > 1 degree removed showed CV range 0.63-27.44% and ICC range 0.22-1.00. No systematic proportional bias was detected by BAPs. CONCLUSIONS Preplaced landmarks yielded good IOR and IOA in quantitative assessment of AS structures that were NTD and non-CB-related or less removed from the reference. CB-related NTD measurements varied greatly in IOR and IOA, indicating protocol modifications or CB qualitative assessments needed to improve accuracy. Variability in TD measurements increased the further removed from the reference, which supports implementation of a reliable reference landmark to minimize variation.
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Affiliation(s)
- Azam Qureshi
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Haoxing Chen
- University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Osamah Saeedi
- University of Maryland Eye Associates, Baltimore, MD, USA.,Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Mona A Kaleem
- University of Maryland Eye Associates, Baltimore, MD, USA.,Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Gianna Stoleru
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jordan Margo
- University of Maryland Eye Associates, Baltimore, MD, USA.,Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Sachin Kalarn
- Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
| | - Janet L Alexander
- University of Maryland Eye Associates, Baltimore, MD, USA.,Department of Ophthalmology, University of Maryland, Baltimore, MD, USA
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Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure. Eur J Ophthalmol 2018; 22:714-8. [DOI: 10.5301/ejo.5000101] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2011] [Indexed: 11/20/2022]
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Combined Phacoemulsification and Goniosynechialysis under an Endoscope for Chronic Primary Angle-Closure Glaucoma. J Ophthalmol 2018; 2018:8160184. [PMID: 29576881 PMCID: PMC5822755 DOI: 10.1155/2018/8160184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/28/2017] [Accepted: 01/02/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the clinical efficacy and safety of combined phacoemulsification with goniosynechialysis (GSL) under an ophthalmic endoscope for chronic primary angle-closure glaucoma and coexisting cataract. Methods This is a retrospective study. The intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of glaucoma medications at baseline and each postoperative follow-up visit were recorded. Other measurements included supraciliochoroidal fluid measured by anterior segment optical coherence tomography, corneal endothelial cell density (ECD), and peripheral anterior synechia (PAS). All patients were followed for more than a year. Results Thirty-eight eyes of 31 patients were included. The mean follow-up duration was 16.3 ± 3.9 months. The IOP decreased from 22.2 ± 9.3 mmHg at baseline to 15.4 ± 4.2 mmHg at the last follow-up (P < 0.001). The mean number of glaucoma medications (0.1 ± 0.6) at the last follow-up was significantly lower than the preoperative number (2.3 ± 1.1) (P < 0.001). All patients achieved improved or stable visual acuity after surgery. All patients achieved a complete opened angle after GSL. The postoperative complications included hyphema (7.9%), exudation (5.3%), transiently elevated IOP (55.3%), and supraciliochoroidal fluid (40%). Conclusions Combined phacoemulsification and GSL under an endoscope can completely reopen PAS and is an effective and safe method for patients with chronic primary angle-closure glaucoma and coexisting cataract.
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Masis Solano M, Lin SC. Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle? Prog Retin Eye Res 2018; 64:77-83. [PMID: 29374584 DOI: 10.1016/j.preteyeres.2018.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 12/19/2022]
Abstract
Cataract extraction is a safe and effective surgery that has a lowering effect on the intraocular pressure. The specific mechanisms for this effect are still unclear. A direct inflammatory effect on the trabecular meshwork, alteration of the blood aqueous barrier, changes in the ciliary body and mechanical changes of the anterior segment anatomy are the key to understand cataract surgery and it's effects on aqueous humor dynamics. Additionally, with the advent of AS OCT, changes in the anterior segment of the eye have been studied and several parameters (such as lens vault, angle opening distance and anterior chamber depth) have been identified as predictors of intraocular pressure change. In eyes with narrow angles there is a greater drop in intraocular pressure after cataract surgery and it is correlated with parameters related to anterior chamber space. It is safe to affirm that cataract surgery is an important part of the modern glaucoma treatment and evidence should be analyzed as part of a bigger picture in order to more accurately understand its clinical relevance.
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Affiliation(s)
- Marisse Masis Solano
- Koret Vision Center, Department of Ophthalmology, University of California, San Francisco Medical School, 10 Koret Way, San Francisco, CA 94143, United States
| | - Shan C Lin
- Koret Vision Center, Department of Ophthalmology, University of California, San Francisco Medical School, 10 Koret Way, San Francisco, CA 94143, United States.
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Effect of Phacoemulsification on Drainage Angle Status in Angle Closure Eyes with or without Extensive Peripheral Anterior Synechiae. Eur J Ophthalmol 2018; 23:70 - 79. [DOI: 10.5301/ejo.5000191] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2012] [Indexed: 11/20/2022]
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Long-term Outcome of Argon Laser Peripheral Iridoplasty in the Management of Plateau Iris Syndrome Eyes. J Glaucoma 2017; 26:780-786. [PMID: 28767461 DOI: 10.1097/ijg.0000000000000731] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report long-term (>5 y) outcomes of plateau iris syndrome patients treated with argon laser peripheral iridoplasty (ALPI). PATIENTS AND METHODS A retrospective chart review was performed on all patients with plateau iris syndrome treated with ALPI from 1996 to 2007. The study included 22 eyes from 22 patients with plateau iris after peripheral iridotomy that were followed for at least 1 year after ALPI. The primary outcome was incidence of needing any intraocular pressure (IOP)-lowering medications or surgery (either a filtering procedure or phacoemulsification). Demographic and baseline clinical data were summarized by mean (±SD) or frequency (percentage). Snellen best-corrected visual acuity was converted to logMAR. The paired t test was used to compare IOP changes, number of IOP-lowering medications, and best-corrected visual acuity from baseline to annual follow-up. RESULTS Mean follow-up was 76 months. Only 2 (9%) eyes maintained an IOP<21 mm Hg without requiring medication or surgery. Seventeen (77%) eyes underwent surgery at an average of 49.1±7.9 months after ALPI. Eight (36%) eyes underwent filtering surgery, and 9 (41%) eyes underwent phacoemulsification. Three months after cataract extraction, no eyes required IOP-lowering medication. CONCLUSIONS The beneficial effects of ALPI last for <4 years, with the majority of patients (77%) requiring surgery. Phacoemulsification alone was a successful treatment for plateau iris in our patient population.
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Lee RY, Chen RI, Kasuga T, Cui QN, Porco TC, Lin SC. The Effect of Cumulative Dissipated Energy on Changes in Intraocular Pressure After Uncomplicated Cataract Surgery by Phacoemulsification. J Glaucoma 2017; 25:565-70. [PMID: 26317481 DOI: 10.1097/ijg.0000000000000311] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the association between ultrasound energy, expressed as cumulative dissipated energy (CDE), and changes in intraocular pressure (IOP) after uncomplicated cataract surgery by phacoemulsification. METHODS In this prospective study, nonglaucomatous subjects underwent cataract surgery by phacoemulsification. IOP was compared by clustered linear regression at 4 separate time-points: preoperative, 1 day, 1 month, and 3 months after cataract surgery. Changes in the IOP were evaluated as a function of CDE using univariate and multivariate clustered linear regression models, which adjusted for sex, ethnicity, age, axial length, spherical equivalent, mean preoperative Shaffer gonioscopy grade of all 4 quadrants, cataract grade, preoperative IOP, central corneal thickness, and use of both eyes in the same subject. RESULTS One hundred sixty-one eyes (89 Asian, 49 white, 12 African, and 11 Hispanic) from 116 nonglaucomatous subjects were analyzed. The 161 eyes included 81 right and 80 left eyes. The 89 Asian eyes included 46 Chinese, 35 Filipino, and 8 Vietnamese. Preoperative IOP was 14.9±3.2 mm Hg. Postoperative IOP significantly increased to 16.0±4.9 mm Hg at 1 day (P=0.037) and decreased to 12.4±3.1 and 12.3±3.0 mm Hg at 1 and 3 months, respectively (both P<0.0001). IOP changes at 1 day, 1 month, and 3 months did not demonstrate significant associations with CDE measurements in either univariate or multivariate clustered linear regression analyses (all P>0.05). CONCLUSIONS The amount of ultrasound energy delivered to the eye during phacoemulsification, expressed as CDE, was not associated with postoperative changes in IOP.
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Affiliation(s)
- Roland Y Lee
- *Department of Ophthalmology, University of California San Francisco School of Medicine, San Francisco, CA †Wake Forest University School of Medicine, Winston-Salem, NC ‡Case Western Reserve University School of Medicine, Cleveland, OH §Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan
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Teoh CS, Aquino MC, Loon SC, Chew P, Koh V. Comparing the use of phacoemulsification and combined surgery in angle-closure glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1379901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- CS Teoh
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - MC Aquino
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - SC Loon
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - P Chew
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
| | - V Koh
- Department of Ophthalmology, National University Hospital of Singapore, Singapore, Singapore
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Park JH, Yoo C, Song JS, Lin SC, Kim YY. Effect of cataract surgery on intraocular pressure in supine and lateral decubitus body postures. Indian J Ophthalmol 2017; 64:727-732. [PMID: 27905333 PMCID: PMC5168912 DOI: 10.4103/0301-4738.195000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: To investigate the effect of phacoemulsification on intraocular pressure (IOP) in different recumbent body postures including supine and lateral decubitus (LD) positions. Materials and Methods: This prospective, observational study included patients who had no glaucoma and who had planned to undergo phacoemulsification and intraocular lens implantation in one eye. Before and 1 month after cataract surgery, IOP was measured in both eyes using the Tono-Pen AVIA. We measured IOP in the sitting, supine, and LD (with the operated eye placed on the lower side) positions. IOP was measured 10 min after assuming each position in a randomized sequence. The Wilcoxon signed-rank test was used to compare the IOP changes before and 1 month after phacoemulsification in all postures. Results: Twenty-nine patients participated in this study. Postoperative IOP was lower than the preoperative IOP when measured by Goldmann applanation tonometry in the sitting position (13.8 ± 1.9 mmHg vs. 12.6 ± 2.1 mmHg, P = 0.007). The postoperative IOP was lower than the preoperative IOP for the supine and LD positions. The average IOP reduction of the operated eye was 0.6 mmHg, 1.7 mmHg, and 3.0 mmHg in the sitting, supine, and LD positions, respectively (sitting vs. supine, P = 0.048; sitting vs. LD, P = 0.001; supine vs. LD, P = 0.028). In the nonoperated eye, IOP did not change significantly after surgery (all P > 0.05). Conclusions: Cataract surgery lowered IOP in the sitting position as well as in the supine and LD positions. Such postoperative IOP reductions were greater in the recumbent positions than in the sitting position.
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Affiliation(s)
- Ji-Hye Park
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Chungkwon Yoo
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Yong Yeon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
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Cetinkaya S, Dadaci Z, Yener HI, Acir NO, Cetinkaya YF, Saglam F. The effect of phacoemulsification surgery on intraocular pressure and anterior segment anatomy of the patients with cataract and ocular hypertension. Indian J Ophthalmol 2016; 63:743-5. [PMID: 26632135 PMCID: PMC4705715 DOI: 10.4103/0301-4738.171020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We evaluated the effect of phacoemulsification surgery on intraocular pressure (IOP), anterior chamber depth (ACD), iridocorneal angle (ICA), and central corneal thickness (CCT) of the patients with cataract and ocular hypertension. The decrease in IO P values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in ACD and ICA values of the 1 st week, 1 st month, 3 rd month, 6 th month, and 1 st year was statistically significant, but that of the 2 nd year was not significant. The increase in CCT values of 1 st week and 1 st month was statistically significant, but those of 3 rd month, 6 th month, 1 st year, and 2 nd year were not significant. In conclusion, phacoemulsification surgery decreases IOP and increases ACD and ICA in the short-term. However, in the long-term it does not cause any significant changes.
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Affiliation(s)
- Servet Cetinkaya
- Department of Ophthalmology, Ophthalmology Clinics, Turkish Red Crescent Hospital, Konya, Turkey
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Azuara-Blanco A, Burr J, Ramsay C, Cooper D, Foster PJ, Friedman DS, Scotland G, Javanbakht M, Cochrane C, Norrie J. Effectiveness of early lens extraction for the treatment of primary angle-closure glaucoma (EAGLE): a randomised controlled trial. Lancet 2016; 388:1389-1397. [PMID: 27707497 DOI: 10.1016/s0140-6736(16)30956-4] [Citation(s) in RCA: 297] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Primary angle-closure glaucoma is a leading cause of irreversible blindness worldwide. In early-stage disease, intraocular pressure is raised without visual loss. Because the crystalline lens has a major mechanistic role, lens extraction might be a useful initial treatment. METHODS From Jan 8, 2009, to Dec 28, 2011, we enrolled patients from 30 hospital eye services in five countries. Randomisation was done by a web-based application. Patients were assigned to undergo clear-lens extraction or receive standard care with laser peripheral iridotomy and topical medical treatment. Eligible patients were aged 50 years or older, did not have cataracts, and had newly diagnosed primary angle closure with intraocular pressure 30 mm Hg or greater or primary angle-closure glaucoma. The co-primary endpoints were patient-reported health status, intraocular pressure, and incremental cost-effectiveness ratio per quality-adjusted life-year gained 36 months after treatment. Analysis was by intention to treat. This study is registered, number ISRCTN44464607. FINDINGS Of 419 participants enrolled, 155 had primary angle closure and 263 primary angle-closure glaucoma. 208 were assigned to clear-lens extraction and 211 to standard care, of whom 351 (84%) had complete data on health status and 366 (87%) on intraocular pressure. The mean health status score (0·87 [SD 0·12]), assessed with the European Quality of Life-5 Dimensions questionnaire, was 0·052 higher (95% CI 0·015-0·088, p=0·005) and mean intraocular pressure (16·6 [SD 3·5] mm Hg) 1·18 mm Hg lower (95% CI -1·99 to -0·38, p=0·004) after clear-lens extraction than after standard care. The incremental cost-effectiveness ratio was £14 284 for initial lens extraction versus standard care. Irreversible loss of vision occurred in one participant who underwent clear-lens extraction and three who received standard care. No patients had serious adverse events. INTERPRETATION Clear-lens extraction showed greater efficacy and was more cost-effective than laser peripheral iridotomy, and should be considered as an option for first-line treatment. FUNDING Medical Research Council.
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Affiliation(s)
| | - Jennifer Burr
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital and University College London, UK
| | | | - Graham Scotland
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK; Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Mehdi Javanbakht
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Claire Cochrane
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK; Centre for Health Care Randomised Trials, University of Aberdeen, Aberdeen, UK
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Şimşek A, Bilgin B, Çapkın M, Bilak Ş, Güler M, Reyhan AH. Evaluation of Anterior Segment Parameter Changes Using the Sirius after Uneventful Phacoemulsification. KOREAN JOURNAL OF OPHTHALMOLOGY 2016; 30:251-7. [PMID: 27478351 PMCID: PMC4965599 DOI: 10.3341/kjo.2016.30.4.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/12/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate changes in anterior chamber depth (ACD), corneal volume (CV), anterior chamber angle (ACA), anterior chamber volume (ACV), central corneal thickness (CCT), horizontal visible iris diameter (HVID), pupil diameter (PD), and intraocular pressure (IOP) after uneventful phacoemulsification cataract surgery with intraocular lens implantation. Methods A total of 132 eyes of 132 patients (87 men and 45 women) that underwent uneventful phacoemulsification cataract surgery and intraocular lens implantation were prospectively studied. The mean age of the patients was 63.68 ± 12.51 years. All patients were evaluated preoperatively and at 1 month postoperatively with the Sirius 3D Rotating Scheimpflug camera topography system. The ACD, CV, ACA, ACV, CCT, HVID, and PD measurements were recorded. IOP was measured using the Goldmann applanation tonometer, which was corrected for CCT of the Sirius device using Ehlers' formula. Results The preoperative mean ACD, ACV, ACA, CCT, CV, PD, HVID, and IOP were 2.79 ± 0.45 mm, 124.73 ± 25.72 mm3, 42.09 ± 7.490, 523.87 ± 41.97 microns, 55.37 ± 4.89 mm3, 3.98 ± 1.23 mm, 11.72 ± 0.67 mm, and 14.74 ± 2.59 mmHg, respectively. Three months postoperatively, the mean ACD, ACV, ACA, CCT, CV, PD, HVID, and IOP were 3.45 ± 0.6 mm, 162.52 ± 23.79 mm3, 51.46 ± 5.630, 526.21 ± 44.45 microns, 56.23 ± 5.12 mm3, 2.87 ± 0.45 mm, 11.91 ± 0.75 mm, and 12.02 ± 1.83 mmHg, respectively. There was a statistically significant increase in mean postoperative ACD, ACV, ACA, CV, and HVID compared with the corresponding preoperative values (p < 0.05). CCT remained stable after surgery. Postoperative PD and IOP were significantly decreased compared to corresponding preoperative values (p < 0.05). Conclusions Preoperative measurements by the Sirius 3D Rotating Scheimpflug camera topography system might help surgeons to predict postoperative changes resulting from phacoemulsification and intraocular lens implantation. This is a noncontact, noninvasive, and comfortable system for patients that is highly reliable and repeatable for anterior segment measurements.
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Affiliation(s)
- Ali Şimşek
- Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey
| | - Burak Bilgin
- Department of Ophthalmology, Adıyaman Gozde Hospital, Adiyaman, Turkey
| | - Musa Çapkın
- Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey
| | - Şemsettin Bilak
- Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey
| | - Mete Güler
- Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey
| | - Ali Hakim Reyhan
- Department of Ophthalmology, Adıyaman University School of Medicine, Adiyaman, Turkey
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Seo S, Lee CE, Kim YK, Lee SY, Jeoung JW, Park KH. Factors affecting refractive outcome after cataract surgery in primary angle-closure glaucoma. Clin Exp Ophthalmol 2016; 44:693-700. [DOI: 10.1111/ceo.12762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/03/2016] [Accepted: 04/08/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Sam Seo
- Department of Ophthalmology; Cheil Eye Hospital; Daegu Korea
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Chong Eun Lee
- Department of Ophthalmology; Keimyung University Dongsan Medical Center; Daegu Korea
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Young Kook Kim
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Sang Yoon Lee
- Department of Ophthalmology; Jeju National University Hospital; Jeju Korea
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
| | - Ki Ho Park
- Department of Ophthalmology; Seoul National University Hospital, Seoul National University College of Medicine; Seoul Korea
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Functional evaluation of an iridotomy in primary angle closure eyes. Graefes Arch Clin Exp Ophthalmol 2016; 254:1141-9. [DOI: 10.1007/s00417-016-3298-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/07/2015] [Accepted: 12/17/2015] [Indexed: 11/26/2022] Open
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Baek SU, Choi DC, Lee KW. Clinical Outcomes of Early Phacoemulsification after Laser Iridotomy in Acute Angle-closure Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.7.1126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Uk Baek
- Department of Ophthalmology, Armed Forces DaeGu Hospital, Gyeongsan, Korea
| | - Dong Chul Choi
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon, Korea
| | - Kyung Wha Lee
- Department of Ophthalmology, Hallym University College of Medicine, Chuncheon, Korea
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Measurement of early changes in anterior chamber morphology after cataract extraction measured by anterior segment optical coherence tomography. Graefes Arch Clin Exp Ophthalmol 2015; 253:1751-6. [DOI: 10.1007/s00417-015-3135-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 08/02/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022] Open
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Li SW, Chen Y, Wu Q, Lu B, Wang WQ, Fang J. Angle parameter changes of phacoemulsification and combined phacotrabeculectomy for acute primary angle closure. Int J Ophthalmol 2015; 8:742-7. [PMID: 26309873 DOI: 10.3980/j.issn.2222-3959.2015.04.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/17/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the difference in angle parameters and clinical outcome following phacoemulsification and combined phacotrabeculectomy in patients with acute primary angle closure (APAC) using ultrasound biomicroscopy (UBM). METHODS Patients (n=23, 31 eyes) were randomized to receive phacoemulsification or combined phacotrabeculectomy (n=24, 31 eyes). Best-corrected visual acuity (BCVA), intraocular pressure (IOP), the main complications following surgery, and indentation gonioscopy and angle parameters measured using UBM were documented preoperatively and postoperatively. RESULTS The improvement in BCVA in the phacoemulsification group was significantly greater than in the combined group (P<0.05). IOP in the phacoemulsification group was slightly higher than in the combined group following 1wk of follow-up (P<0.05), whereas there was no significant difference between the two groups at the latter follow-up (P>0.05). Phacoemulsification alone resulted in a slight increase in the trabecular ciliary processes distance compared with the combined surgery (P<0.05), whereas the other angle parameters showed no significant difference between the groups. Complications in combined group were greater than phacoemulsification only group. CONCLUSION Both surgeries effectively opened the drainage angle and deepened the anterior chamber, and IOP was well controlled postoperatively. However, phacoemulsification showed better efficacy in improving visual function and showed reduced complications following surgery.
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Affiliation(s)
- Shi-Wei Li
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Yan Chen
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Qiang Wu
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Bin Lu
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Wen-Qing Wang
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
| | - Jian Fang
- Department of Ophthalmology, the Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai 200233, China
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Zhang ML, Hirunyachote P, Jampel H. Combined surgery versus cataract surgery alone for eyes with cataract and glaucoma. Cochrane Database Syst Rev 2015; 2015:CD008671. [PMID: 26171900 PMCID: PMC4730948 DOI: 10.1002/14651858.cd008671.pub3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cataract and glaucoma are leading causes of blindness worldwide, and their co-existence is common in elderly people. Glaucoma surgery can accelerate cataract progression, and performing both surgeries may increase the rate of postoperative complications and compromise the success of either surgery. However, cataract surgery may independently lower intraocular pressure (IOP), which may allow for greater IOP control among patients with co-existing cataract and glaucoma. The decision between undergoing combined glaucoma and cataract surgery versus cataract surgery alone is complex. Therefore, it is important to compare the effectiveness of these two interventions to aid clinicians and patients in choosing the better treatment approach. OBJECTIVES To assess the relative effectiveness and safety of combined surgery versus cataract surgery (phacoemulsification) alone for co-existing cataract and glaucoma. The secondary objectives include cost analyses for different surgical techniques for co-existing cataract and glaucoma. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2014), EMBASE (January 1980 to October 2014), PubMed (January 1948 to October 2014), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to October 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 October 2014.We checked the reference lists of the included trials to identify further relevant trials. We used the Science Citation Index to search for references to publications that cited the studies included in the review. We also contacted investigators and experts in the field to identify additional trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) of participants who had open-angle, pseudoexfoliative, or pigmentary glaucoma and age-related cataract. The comparison of interest was combined cataract surgery (phacoemulsification) and any type of glaucoma surgery versus cataract surgery (phacoemulsification) alone. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, collected data, and judged risk of bias for included studies. We used standard methodological procedures expected by the Cochrane Collaboration. MAIN RESULTS We included nine RCTs, with a total of 655 participants (657 eyes), and follow-up periods ranging from 12 to 30 months. Seven trials were conducted in Europe, one in Canada and South Africa, and one in the United States. We graded the overall quality of the evidence as low due to observed inconsistency in study results, imprecision in effect estimates, and risks of bias in the included studies.Glaucoma surgery type varied among the studies: three studies used trabeculectomy, three studies used iStent® implants, one study used trabeculotomy, and two studies used trabecular aspiration. All of these studies found a statistically significant greater decrease in mean IOP postoperatively in the combined surgery group compared with cataract surgery alone; the mean difference (MD) was -1.62 mmHg (95% confidence interval (CI) -2.61 to -0.64; 489 eyes) among six studies with data at one year follow-up. No study reported the proportion of participants with a reduction in the number of medications used after surgery, but two studies found the mean number of medications used postoperatively at one year was about one less in the combined surgery group than the cataract surgery alone group (MD -0.69, 95% CI -1.28 to -0.10; 301 eyes). Five studies showed that participants in the combined surgery group were about 50% less likely compared with the cataract surgery alone group to use one or more IOP-lowering medications one year postoperatively (risk ratio (RR) 0.47, 95% CI 0.28 to 0.80; 453 eyes). None of the studies reported the mean change in visual acuity or visual fields. However, six studies reported no significant differences in visual acuity and two studies reported no significant differences in visual fields between the two intervention groups postoperatively (data not analyzable). The effect of combined surgery versus cataract surgery alone on the need for reoperation to control IOP at one year was uncertain (RR 1.13, 95% CI 0.15 to 8.25; 382 eyes). Also uncertain was whether eyes in the combined surgery group required more interventions for surgical complications than those in the cataract surgery alone group (RR 1.06, 95% CI 0.34 to 3.35; 382 eyes). No study reported any vision-related quality of life data or cost outcome. Complications were reported at 12 months (two studies), 12 to 18 months (one study), and two years (four studies) after surgery. Due to the small number of events reported across studies and treatment groups, the difference between groups was uncertain for all reported adverse events. AUTHORS' CONCLUSIONS There is low quality evidence that combined cataract and glaucoma surgery may result in better IOP control at one year compared with cataract surgery alone. The evidence was uncertain in terms of complications from the surgeries. Furthermore, this Cochrane review has highlighted the lack of data regarding important measures of the patient experience, such as visual field tests, quality of life measurements, and economic outcomes after surgery, and long-term outcomes (five years or more). Additional high-quality RCTs measuring clinically meaningful and patient-important outcomes are required to provide evidence to support treatment recommendations.
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Affiliation(s)
- Mingjuan Lisa Zhang
- Johns Hopkins University School of Medicine929 N. Wolfe St, Apt. 615BaltimoreMarylandUSA21205
| | | | - Henry Jampel
- Johns Hopkins University School of MedicineWilmer Eye Institute600 N. Wolfe StreetMaumenee B‐110BaltimoreMarylandUSA21287‐9205
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