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Mueller A, Lam I, Kishor K, Lee RK, Bhattacharya S. Secondary glaucoma: Toward interventions based on molecular underpinnings. WIREs Mech Dis 2024; 16:e1628. [PMID: 37669762 DOI: 10.1002/wsbm.1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023]
Abstract
Glaucoma is a heterogeneous group of progressive diseases that leads to irreversible blindness. Secondary glaucoma refers to glaucoma caused by a known underlying condition. Pseudoexfoliation and pigment dispersion syndromes are common causes of secondary glaucoma. Their respective deposits may obstruct the trabecular meshwork, leading to aqueous humor outflow resistance, ocular hypertension, and optic neuropathy. There are no disease-specific interventions available for either. Pseudoexfoliation syndrome is characterized by fibrillar deposits (pseudoexfoliative material) on anterior segment structures. Over a decade of multiomics analyses taken together with the current knowledge on pseudoexfoliative glaucoma warrant a re-think of mechanistic possibilities. We propose that the presence of nucleation centers (e.g., vitamin D binding protein), crosslinking enzymes (e.g., transglutaminase 2), aberrant extracellular matrix, flawed endocytosis, and abnormal aqueous-blood barrier contribute to the formation of proteolytically resistant pseudoexfoliative material. Pigment dispersion syndrome is characterized by abnormal iridolenticular contact that disrupts iris pigment epithelium and liberates melanin granules. Iris melanogenesis is aberrant in this condition. Cytotoxic melanogenesis intermediates leak out of melanosomes and cause iris melanocyte and pigment epithelium cell death. Targeting melanogenesis can likely decrease the risk of pigmentary glaucoma. Skin and melanoma research provides insights into potential therapeutics. We propose that specific prostanoid agonists and fenofibrates may reduce melanogenesis by inhibiting cholesterol internalization and de novo synthesis. Additionally, melatonin is a potent melanogenesis suppressor, antioxidant, and hypotensive agent, rendering it a valuable agent for pigmentary glaucoma. In pseudoexfoliative glaucoma, where environmental insults drive pseudoexfoliative material formation, melatonin's antioxidant and hypotensive properties may offer adjunct therapeutic benefits. This article is categorized under: Neurological Diseases > Molecular and Cellular Physiology.
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Affiliation(s)
- Anna Mueller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Isabel Lam
- Idaho College of Osteopathic Medicine, Meridian, Idaho, USA
| | - Krishna Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sanjoy Bhattacharya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Zhang Z, Niu L, Liu T, Shen Y, Shang J, Zhao J, Wei R, Zhou X, Yao P. Primary observations of EVO ICL implantation for high myopia with concave iris. EYE AND VISION (LONDON, ENGLAND) 2023; 10:18. [PMID: 37005642 PMCID: PMC10068169 DOI: 10.1186/s40662-023-00335-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE To investigate the morphological changes of concave iris in myopic patients after EVO implantable collamer lens (ICL) implantation. METHODS EVO ICL candidates with posterior bowing iris were observed using ultrasound biometric microscopy (UBM) in this prospective nonrandomized observational study. Forty patients were enrolled, with 20 patients in the concave iris group and the other 20 patients in the control group. None of the patients underwent laser peripheral iridotomy. All patients received preoperative and postoperative examinations, which included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), subjective manifest refraction and intraocular pressure. UBM was used to observe iris curvature (IC), irido-corneal angle (ICA), posterior chamber angle (PCA), iris-lens contact distance (ILCD), iris-zonule distance (IZD) and ciliary process length (CPL). Anterior chamber angle pigment was observed by gonioscopy. The preoperative and postoperative data were analyzed using SPSS. RESULTS The average follow-up period was 13.3 ± 5.3 months. The mean efficacy indices were 1.10 ± 0.13 and 1.07 ± 0.11 (P = 0.58), and the safety indices were 1.19 ± 0.09 and 1.18 ± 0.17 in the control group and the concave iris group (P = 0.93), respectively. The IOP postoperatively were 14.13 ± 2.02 mmHg and 14.69 ± 1.59 mmHg in control and concave iris groups (P = 0.37). Preoperatively, the concave iris group was presented with greater IC (P < 0.0001), longer ILCD (P < 0.0001), wider ICA (P = 0.004), narrower PCA (P = 0.01), and shorter IZD (P = 0.03) than the control group. In the concave iris group, IC, ILCD and ICA were significantly decreased after ICL implantation (P < 0.0001), while PCA and IZD were significantly increased (P = 0.03 and P = 0.04, respectively). Postoperative IC, ILCD, ICA, PCA and IZD were not statistically different between groups (P > 0.05). There was no significant difference in pigment deposition grades between the two groups (P = 0.37). CONCLUSION After EVO ICL implantation, the morphology of concave iris was significantly improved, which may reduce the risk of intraocular pigment dissemination caused by iris concavity. The concave iris has no impact on the safety of EVO ICL surgery during the follow-up.
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Affiliation(s)
- Zhe Zhang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Lingling Niu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Tingting Liu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yang Shen
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ruoyan Wei
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Peijun Yao
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Fudan University, 19 Baoqing Road, Xuhui District, Shanghai, China.
- NHC Key Laboratory of Myopia, Fudan University, Shanghai, China.
- Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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Simcoe MJ, Shah A, Fan B, Choquet H, Weisschuh N, Waseem NH, Jiang C, Melles RB, Ritch R, Mahroo OA, Wissinger B, Jorgenson E, Wiggs JL, Garway-Heath DF, Hysi PG, Hammond CJ. Genome-Wide Association Study Identifies Two Common Loci Associated with Pigment Dispersion Syndrome/Pigmentary Glaucoma and Implicates Myopia in its Development. Ophthalmology 2022; 129:626-636. [PMID: 35031440 DOI: 10.1016/j.ophtha.2022.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To identify genetic variants associated with pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) in unrelated patients and to further understand the genetic and potentially causal relationships between PDS and associated risk factors. DESIGN A 2-stage genome-wide association meta-analysis with replication and subsequent in silico analyses including Mendelian randomization. PARTICIPANTS A total of 574 cases with PG or PDS and 52 627 controls of European descent. METHODS Genome-wide association analyses were performed in 4 cohorts and meta-analyzed in 3 stages: (1) a discovery meta-analysis was performed in 3 cohorts, (2) replication was performed in the fourth cohort, and (3) all 4 cohorts were meta-analyzed to increase statistical power. Two-sample Mendelian randomization was used to determine whether refractive error and intraocular pressure exert causal effects over PDS. MAIN OUTCOME MEASURES The association of genetic variants with PDS and whether myopia exerts causal effects over PDS. RESULTS Significant association was present at 2 novel loci for PDS/PG. These loci and follow-up analyses implicate the genes gamma secretase activator protein (GSAP) (lead single nucleotide polymorphism [SNP]: rs9641220, P = 6.0×10-10) and glutamate metabotropic receptor 5 (GRM5)/TYR (lead SNP: rs661177, P = 3.9×10-9) as important factors in disease risk. Mendelian randomization showed significant evidence that negative refractive error (myopia) exerts a direct causal effect over PDS (P = 8.86×10-7). CONCLUSIONS Common SNPs relating to the GSAP and GRM5/TYR genes are associated risk factors for the development of PDS and PG. Although myopia is a known risk factor, this study uses genetic data to demonstrate that myopia is, in part, a cause of PDS and PG.
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Affiliation(s)
- Mark J Simcoe
- Department of Ophthalmology, Kings College London, London, United Kingdom; Department of Twins Research and Genetic Epidemiology, Kings College London, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom
| | - Ameet Shah
- Department of Ophthalmology, Royal Free Hospital NHS Foundation Trust, Pond Street, London, United Kingdom
| | - Baojian Fan
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Hélène Choquet
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Nicole Weisschuh
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Naushin H Waseem
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Chen Jiang
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Ronald B Melles
- Kaiser Permanente Northern California, Department of Ophthalmology, Redwood City, California
| | - Robert Ritch
- Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Omar A Mahroo
- Department of Ophthalmology, Kings College London, London, United Kingdom; Department of Twins Research and Genetic Epidemiology, Kings College London, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom
| | - Bernd Wissinger
- Institute for Ophthalmic Research, Centre for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Eric Jorgenson
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Janey L Wiggs
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - David F Garway-Heath
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Pirro G Hysi
- Department of Ophthalmology, Kings College London, London, United Kingdom; Department of Twins Research and Genetic Epidemiology, Kings College London, London, United Kingdom
| | - Christopher J Hammond
- Department of Ophthalmology, Kings College London, London, United Kingdom; Department of Twins Research and Genetic Epidemiology, Kings College London, London, United Kingdom.
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Bierlein ER, Smith JC, Van Hook MJ. Mechanism for altered dark-adapted electroretinogram responses in DBA/2J mice includes pupil dilation deficits. Curr Eye Res 2022; 47:897-907. [PMID: 35179406 DOI: 10.1080/02713683.2022.2044055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The DBA/2J (D2) mouse is an established model of pigmentary glaucoma, a type of primary open angle glaucoma. Prior studies have documented defects in flash electroretinogram (ERG) responses in D2 mice, but the origin of those defects is not clear. The purpose of this study was to understand the origin of these A-wave and B-wave changes in D2 ERGs.Materials & Methods: To accomplish this, we analyzed the differences between 9-month-old DBA/2J-Gpnmb+ (D2-control) and D2 mouse eyes in relation to ERG responses, intraocular pressure (IOP), outer nuclear layer thickness, and pupil area. RESULTS D2 scotopic ERGs showed lower A-wave amplitude and longer implicit time as well as a significant rightward shift in the intensity-response curve. D2 IOP increased at approximately seven months of age and had a weak correlation with the ERG A-wave sensitivity. Outer nuclear layer thickness was not significantly different in D2s compared to D2-control retinas. D2 mouse pupils also showed abnormal pupillary shape and no dilation following treatment with tropicamide eye drops. The pupil size moderately correlated with the A-wave sensitivity and this was pharmacologically replicated in C57Bl/6J mice following administration of pilocarpine to constrict the pupils. However, pilocarpine treatment did not affect ERG amplitudes. CONCLUSIONS These data suggest that the smaller pupil sizes prevented light from reaching the photoreceptors and thus contributed to reduced ERG sensitivity in D2 mice. The reduced ERG A-wave amplitude in D2 mice likely results from dysfunctional photoreceptor responses.
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Affiliation(s)
- Elizabeth R Bierlein
- Truhlsen Eye Institute, Department of Ophthalmology & Visual Sciences, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pharmacology & Experimental Neuroscience, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jennie C Smith
- Truhlsen Eye Institute, Department of Ophthalmology & Visual Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Matthew J Van Hook
- Truhlsen Eye Institute, Department of Ophthalmology & Visual Sciences, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Cellular & Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
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Zhou R, Tang Q, Pu L, Qing G. Changes of trabecular meshwork pigmentation in patients with pigment dispersion syndrome: A 15-year study. Medicine (Baltimore) 2021; 100:e26567. [PMID: 34397796 PMCID: PMC8341214 DOI: 10.1097/md.0000000000026567] [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: 01/27/2021] [Accepted: 06/10/2021] [Indexed: 01/04/2023] Open
Abstract
To report the changes of trabecular meshwork (TM) pigmentation and clinical outcomes of patients with pigment dispersion syndrome (PDS) after resolution of reverse pupillary block.Twenty one eyes of 11 PDS patients were followed up periodically for 15 years after resolution of reverse pupillary block with either Nd: YAG laser peripheral iridotomy (LPI) or trabeculectomy. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP), Humphrey visual field analysis (VFA), gonioscopy and stereoscopic funduscopy were performed on admission and every 6 months postoperatively. TM pigmentation was quantitatively evaluated and graded every 5 years after the treatment, in which the circumference of anterior chamber angle was divided into 4 quadrants: superior, inferior, nasal and temporal. Postoperative IOP, VA, BCVA, VFA, TM pigmentation and adjunctive anti-glaucoma medications were main outcome measurements and compared with baseline.Eleven patients (9 males, 2 females) were identified as PDS according to the diagnostic criteria, with average age of 38.25 ± 6.93 years (range, 31-55 years) at initial diagnosis. The mean IOP level was 33.1 ± 9.8 mmHg (range, 22-56 mmHg) at diagnosis. Ten PDS eyes received LPI, and the other eleven eyes underwent uneventful trabeculectomy. The median TM pigmentation score of the 21 PDS eyes was 16 (interquartile range [IQR], 15-16) on admission, which changed to 14 (IQR, 13-15), 13 (IQR, 12-14), 12(IQR, 10.5-12) at 5-, 10-, 15-year follow-up visits respectively. The decrease rate of TM pigmentation was 37% in inferior quadrant, while in nasal, temporal, and superior quadrant the reduction rate was 28%, 23%, and 18%, respectively, at the last follow-up visit. Majority of these enrolled eyes (19/21) had stable VA and BCVA with average endpoint IOP of 15.1 ± 3.4 mmHg.TM pigmentation in PDS patients attenuates with time after reverse pupillary block was resolved, in which the inferior quadrant seems faster than the other quadrants.
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Cozzupoli GM, Salgarello T, Giudiceandrea A, Rizzo S. Transient visual blurring during a sexual intercourse in a young woman with surgically corrected myopia and unrecognized pigmentary glaucoma: A rare case report. Eur J Ophthalmol 2020; 32:NP83-NP88. [PMID: 33339478 DOI: 10.1177/1120672120980689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To present a rare case of unilateral visual loss episodes occurred during sexual intercourse in a young patient affected by unrecognized pigmentary glaucoma and previously undergone myopic refractive surgery. CASE DESCRIPTION The patient presented surgically flattened corneas and markedly asymmetric pigmentary glaucoma. CONCLUSIONS Previous refractive surgery, sexual intercourse, and athletic lifestyle might be risk factors for acute pigment dispersion and chronic progression of pigmentary glaucoma in young myopic patients. During their ophthalmic examination prior to refractive surgery, greater attention should be paid to detect early signs of pigmentary dispersion, and awareness of these dangerous situations should be raised in affected patients.
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Affiliation(s)
- G M Cozzupoli
- Institute of Ophthalmology, Università Cattolica del S. Cuore, Roma, Italia
| | - T Salgarello
- U.O.C. Oculistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - A Giudiceandrea
- Institute of Ophthalmology, Università Cattolica del S. Cuore, Roma, Italia.,U.O.C. Oculistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - S Rizzo
- Institute of Ophthalmology, Università Cattolica del S. Cuore, Roma, Italia.,U.O.C. Oculistica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
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Canaloplasty in Pigmentary Glaucoma: Long-Term Outcomes and Proposal of a New Hypothesis on Its Intraocular Pressure Lowering Mechanism. J Clin Med 2020; 9:jcm9124024. [PMID: 33322842 PMCID: PMC7763242 DOI: 10.3390/jcm9124024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 11/24/2022] Open
Abstract
This study presents the long-term results on canaloplasty in a group of patients affected by pigmentary glaucoma, and studies the progression of the disease after surgery. Material and methods: Twenty-nine eyes of 25 patients with pigmentary glaucoma in maximum tolerated medical therapy with significant visual field damage progression underwent canaloplasty and were followed up to 11 years (mean 59.8 ± 30.1 months). All patients underwent a complete ophthalmic examination every 6 months. Results: The pre-operative mean intraocular pressure (IOP) was 31.8 mmHg ± 10.9 (range 21–70) with an average of 3.3 medications. After 1, 2, 3, and 4 years, the mean IOP was 15.9 ± 4.0, 14.4 ± 7.3, 14.1 ± 2.1, and 15.7 mmHg, respectively, with 0.4, 0.5, and 0.7 medications, respectively. Four patients underwent trabeculectomy after 3 to 30 months due to uncontrolled IOP. Gonioscopy showed a significant reduction of pigment in trabecular meshwork in all cases, starting from the sixth month. In some cases, the pigment was almost completely reabsorbed after two years, suggesting an accelerated transit and escape of the granules through the trabecular spaces. Conclusions: Canaloplasty seems to be a reasonable option in treating patients affected by progressive pigmentary glaucoma. The reabsorption of pigment granules from the trabecular meshwork could, at least in part, explain the relatively high success rate observed after this surgical procedure.
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Pathophysiology and management of glaucoma and ocular hypertension related to trauma. Surv Ophthalmol 2020; 65:530-547. [PMID: 32057763 DOI: 10.1016/j.survophthal.2020.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
Ocular trauma is a significant cause of blindness worldwide, particularly if associated with glaucoma. Direct damage from blunt or penetrating trauma, bleeding, inflammation, lens-related problems, orbital and brain vascular pathologies related to trauma, and chemical injuries may increase intraocular pressure and lead to traumatic glaucoma. Treatment may be as simple as eliminating the underlying cause in some conditions or management can be challenging, depending on the mechanism of damage. If proper management is not undertaken, visual outcomes can be poor. We discuss a broad spectrum of trauma-related mechanisms of intraocular pressure elevation, as well as their management.
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Scuderi G, Contestabile MT, Scuderi L, Librando A, Fenicia V, Rahimi S. Pigment dispersion syndrome and pigmentary glaucoma: a review and update. Int Ophthalmol 2018; 39:1651-1662. [PMID: 29721842 DOI: 10.1007/s10792-018-0938-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/23/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Pigment dispersion syndrome (PDS) is a condition where anomalous iridozonular contact leads to pigment dispersion throughout the anterior segment and the released pigment is abnormally deposited on various ocular structures. CLINICAL PRESENTATION The clinical presentation of PDS is defined by the presence of pigmented cells on the corneal endothelium, an increase of pigmentation of the trabecular meshwork, and mid-periphery transillumination defects of the iris. This syndrome, more common in myopes, is usually bilateral and can be associated with ocular hypertension or glaucoma. Secondary open-angle pigmentary glaucoma (PG) can develop due to reduction of the outflow of aqueous humour and consequent increase in intraocular pressure leading to glaucomatous optic neuropathy. Diagnosis of PG is commonly between 40 and 50 years of age, occurring more frequently in men. The advent of ultrasound biomicroscopy and anterior segment optical coherence tomography has contributed to enhancing our knowledge on the condition. Typical alterations of the anterior segment are the posterior insertion of the iris and iris concavity. Treatment of PG should be initiated early to hinder disease progression, glaucomatous damage, and vision loss. Management is based on medical therapy, laser iridotomy, selective laser trabeculoplasty, and filtration procedures. CONCLUSIONS The differential diagnosis of PDS with other disorders can be challenging and awareness of the condition together with meticulous ophthalmologic examination allows early diagnosis followed by appropriate management strategies. The present review is a comprehensive report on the clinical characteristics, pathogenesis, current management, and status quo of PDS and PG.
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Affiliation(s)
- Gianluca Scuderi
- Ophthalmology Unit, St. Andrea Hospital, Faculty of Medicine and Psychology, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Maria Teresa Contestabile
- Ophthalmology Unit, St. Andrea Hospital, Faculty of Medicine and Psychology, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome "Sapienza", Viale del Policlinico 155, Rome, 00161, Italy.
| | - Aloisa Librando
- Ophthalmology Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, University of Rome "Sapienza", Viale del Policlinico 155, Rome, 00161, Italy
| | - Vito Fenicia
- Ophthalmology Unit, St. Andrea Hospital, Faculty of Medicine and Psychology, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Siavash Rahimi
- Pathology Centre-Histopathology, Queen Alexandra Hospital, School of Pharmacy and Biomedical Science, University of Portsmouth, Portsmouth, UK
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10
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Dang Y, Waxman S, Wang C, Loewen RT, Sun M, Loewen NA. A porcine ex vivo model of pigmentary glaucoma. Sci Rep 2018; 8:5468. [PMID: 29615741 PMCID: PMC5882895 DOI: 10.1038/s41598-018-23861-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 03/16/2018] [Indexed: 11/11/2022] Open
Abstract
Pigment dispersion can lead to pigmentary glaucoma, a poorly understood condition of younger myopic eyes with fluctuating high intraocular pressure. It has been difficult to investigate its pathogenesis without a model similar to human eyes in size and behavior. Here we present a porcine ex vivo model that recreates several features of pigmentary glaucoma, including intraocular hypertension, accumulation of pigment in the trabecular meshwork, and declining phagocytosis. We found that trabecular meshwork cells regulate outflow, form actin stress fibers, and have a decreased phagocytic activity. Gene expression microarrays and a pathway analysis of TM monolayers as well as ex vivo anterior segment perfusion cultures indicated that RhoA plays a central role in regulating the cytoskeleton, motility, and phagocytosis in the trabecular meshwork, providing new insights and targets to investigate in pigmentary glaucoma.
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Affiliation(s)
- Yalong Dang
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, United States of America
| | - Susannah Waxman
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, United States of America
| | - Chao Wang
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, United States of America
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China
| | - Ralitsa T Loewen
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, United States of America
| | - Ming Sun
- Department of Cell Biology, School of Medicine, University of Pittsburgh, Pittsburgh, United States of America
| | - Nils A Loewen
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, United States of America.
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11
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Molecular Genetics of Pigment Dispersion Syndrome and Pigmentary Glaucoma: New Insights into Mechanisms. J Ophthalmol 2018; 2018:5926906. [PMID: 29780638 PMCID: PMC5892222 DOI: 10.1155/2018/5926906] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 02/22/2018] [Indexed: 12/20/2022] Open
Abstract
We explore the ideas and advances surrounding the genetic basis of pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG). As PG is the leading cause of nontraumatic blindness in young adults and current tailored interventions have proven ineffective, a better understanding of the underlying causes of PDS, PG, and their relationship is essential. Despite PDS being a subclinical disease, a large proportion of patients progress to PG with associated vision loss. Decades of research have supported a genetic component both for PDS and conversion to PG. We review the body of evidence supporting a genetic basis in humans and animal models and reevaluate classical mechanisms of PDS/PG considering this new evidence.
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Kalogerou M, Kolovos P, Prokopiou E, Papagregoriou G, Deltas C, Malas S, Georgiou T. Omega-3 fatty acids protect retinal neurons in the DBA/2J hereditary glaucoma mouse model. Exp Eye Res 2017; 167:128-139. [PMID: 29258748 DOI: 10.1016/j.exer.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 11/15/2017] [Accepted: 12/11/2017] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to evaluate the neuroprotective effects of omega-3 polyunsaturated fatty acid (ω3-PUFA) supplementation, alone or in combination with timolol eye drops, in a mouse model of hereditary glaucoma. DBA/2J mice (8.5-month-old) were assigned to an ω3-PUFAs + timolol, ω3-PUFAs only, timolol only, or an untreated group. Treated mice received a daily gavage administration of eicosapentaenoic acid (EPA) and docosahexaenoic acid and/or topical instillation of timolol (0.5%) once a day for 3 months. Blood was analysed regularly to determine ω3-PUFA levels and retinas were histologically analysed. Real-time PCR and Western blot were performed for retinal pro-inflammatory cytokines and macrophages. Blood arachidonic acid/EPA ratio gradually decreased and reached the desired therapeutic range (1-1.5) after 4 weeks of daily gavage with ω3-PUFAs in the ω3-PUFAs + timolol and ω3-PUFAs only groups. Retinal ganglion cell densities were significantly higher in the ω3-PUFAs + timolol (1303.77 ± 139.62/mm2), ω3-PUFAs only (768.40 ± 52.44/mm2) and timolol only (910.57 ± 57.28/mm2) groups than in the untreated group (323.39 ± 95.18/mm2). ω3-PUFA supplementation alone or timolol alone, significantly increased protein expression levels of M1 macrophage-secreted inducible nitric oxide synthase and M2 macrophage-secreted arginase-1 in the retina, which led to significant decreases in the expression levels of tumour necrosis factor-α (TNF-α). ω3-PUFA supplementation alone also resulted in significantly reduced expression of interleukin-18 (IL-18). ω3-PUFA + timolol treatment had no effect on the expression level of any of the aforementioned mediators in the retina. Supplementation with ω3-PUFAs has neuroprotective effect in the retinas of DBA/2J mice that is enhanced when combined with timolol eye drops. The continued inflammation following ω3-PUFAs + timolol treatment suggests that downregulation of IL-18 and TNF-α may not be the only factors involved in ω3-PUFA-mediated neuroprotection in the retina.
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MESH Headings
- Administration, Ophthalmic
- Adrenergic beta-Antagonists/therapeutic use
- Animals
- Arachidonic Acid/blood
- Arginase/metabolism
- Blotting, Western
- Cell Survival
- Disease Models, Animal
- Drug Combinations
- Eicosapentaenoic Acid/blood
- Fatty Acids, Omega-3/administration & dosage
- Female
- Glaucoma, Open-Angle/genetics
- Glaucoma, Open-Angle/metabolism
- Glaucoma, Open-Angle/prevention & control
- Interleukin-18/metabolism
- Intraocular Pressure/drug effects
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Inbred DBA
- Nitric Oxide Synthase Type II/metabolism
- Ophthalmic Solutions
- Optic Nerve Diseases/genetics
- Optic Nerve Diseases/metabolism
- Optic Nerve Diseases/prevention & control
- Real-Time Polymerase Chain Reaction
- Retinal Ganglion Cells/drug effects
- Timolol/therapeutic use
- Tonometry, Ocular
- Tumor Necrosis Factor-alpha/metabolism
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Affiliation(s)
- Maria Kalogerou
- Ophthalmos Research and Educational Institute, Morfou 48, Egkomi, 2417 Nicosia, Cyprus.
| | - Panagiotis Kolovos
- Ophthalmos Research and Educational Institute, Morfou 48, Egkomi, 2417 Nicosia, Cyprus.
| | - Ekatherine Prokopiou
- Ophthalmos Research and Educational Institute, Morfou 48, Egkomi, 2417 Nicosia, Cyprus.
| | - Gregory Papagregoriou
- Molecular Medicine Research Centre and Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Kallipoleos 75, 1678 Nicosia, Cyprus.
| | - Constantinos Deltas
- Molecular Medicine Research Centre and Laboratory of Molecular and Medical Genetics, Department of Biological Sciences, University of Cyprus, Kallipoleos 75, 1678 Nicosia, Cyprus.
| | - Stavros Malas
- Developmental and Functional Genetics Group, The Cyprus Institute of Neurology and Genetics, 1683 Nicosia, Cyprus.
| | - Tassos Georgiou
- Ophthalmos Research and Educational Institute, Morfou 48, Egkomi, 2417 Nicosia, Cyprus.
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A Severe Case of Pigmentary Glaucoma in a Child With a Family History of Pigment Dispersion Syndrome. J Glaucoma 2017; 25:e745-7. [PMID: 27175994 DOI: 10.1097/ijg.0000000000000439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of severe pigmentary glaucoma (PG) in a 13-year-old boy of a family affected by pigment dispersion syndrome (PDS). PATIENTS AND METHODS A 13-year-old child was referred to our hospital for severe bilateral glaucoma. A complete ophthalmologic evaluation including refraction, intraocular pressure, central corneal thickness, slit-lamp biomicroscopy, gonioscopy, fundus examination, and ultrasound biomicroscopy was performed. Family members were also examined and a family pedigree was obtained. RESULTS Ophthalmologic examination revealed a severe bilateral PG with Krukenberg spindle and a widely open heavily pigmented iridocorneal angle. Ultrasound biomicroscopy showed a deep anterior chamber with pronounced iris concavity in both eyes. Within his family, his 15-year-old sister and 7-year-old brother were both affected by PDS diagnosed on gonioscopy findings. CONCLUSIONS We report for the first time a severe case of pediatric PG with a family history of PDS. This case demonstrates that accurate screening is necessary in cases of familial PDS and PG, even in the pediatric population.
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14
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Steeper Iris Conicity Is Related to a Shallower Anterior Chamber: The Gutenberg Health Study. J Ophthalmol 2017; 2017:2190347. [PMID: 29085672 PMCID: PMC5612323 DOI: 10.1155/2017/2190347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/14/2017] [Accepted: 07/16/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To report the distribution of iris conicity (steepness of the iris cone), investigate associated factors, and test whether pseudophakia allows the iris to sink back. METHODS A population-based cross-sectional study was carried out. Ophthalmological examination including objective refraction, biometry, noncontact tonometry, and Scheimpflug imaging (Pentacam®, Oculus) was performed including automated measurement of iris conicity. 3708 phakic subjects, 144 subjects with bilateral and 39 subjects with unilateral pseudophakia were included. Multivariable analyses were carried out to determine independently associated systemic and ocular factors for iris conicity in phakic eyes. RESULTS Mean iris conicity was 8.28° ± 3.29° (right eyes). Statistical analysis revealed associations between steeper iris conicity and shallower anterior chamber depth, thicker human lens and higher corneal power in multivariable analysis, while older age was related to a flatter iris conicity. Refraction, axial length, central corneal thickness, pupil diameter, and intraocular pressure were not associated with iris conicity. Pseudophakia resulted in a 5.82° flatter iris conicity than in the fellow phakic eyes. CONCLUSIONS Associations indicate a correlation between iris conicity with risk factors for angle-closure, namely, shallower anterior chamber depth and thicker human lens. In pseudophakic eyes, iris conicity is significantly lower, indicating that cataract surgery flattens the iris.
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15
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Role of laser peripheral iridotomy in pigmentary glaucoma and pigment dispersion syndrome: A review of the literature. J Fr Ophtalmol 2017; 40:e315-e321. [DOI: 10.1016/j.jfo.2017.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/30/2017] [Accepted: 09/04/2017] [Indexed: 11/18/2022]
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16
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Buffault J, Leray B, Bouillot A, Baudouin C, Labbé A. [Role of laser peripheral iridotomy in pigmentary glaucoma and pigment dispersion syndrome: A review of the literature [French version]]. J Fr Ophtalmol 2017; 40:889-897. [PMID: 29050926 DOI: 10.1016/j.jfo.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Pigment dispersion syndrome (PSD) is characterized by a structural abnormality of the posterior surface of the iris causing contact with the zonular fibers. It can lead to an open-angle glaucoma secondary to pigment dispersion into the trabecular meshwork. Laser peripheral iridotomy (PI) has been proposed as a treatment for pigmentary glaucoma (PG) and pigment dispersion syndrome (PDS) by reducing the dispersion of pigment. The goal of this review was to assess the effects of PI for PSD and PG. METHODS We included six randomized controlled trials and two cohort studies (286 eyes of 218 participants). Four trials included participants with PG, and 4 trials enrolled participants with PSD with or without elevated intraocular pressure (IOP). RESULTS Among patients with PG, at an average of 9 months of follow-up, the mean difference in IOP between groups was 2.69mmHg less in the PI group (95 % CI: -6.05 to 0.67; 14 eyes). In patients with PDS, the average IOP was statistically lower after PI as compared to baseline (Student test, t=11.49, P<0.01). With regard to visual field progression in participants with GP, after an average follow-up of 28 months, the risk of progression was not influenced by PI (RR 1.00 95 %: CI 0.16 to 6.25; 32 eyes). No trials that enrolled patients with PSD showed a diminution of the risk of glaucoma conversion at mid- and long-term. CONCLUSION PI decreases the biomechanical factor causing contact between the iris and zonular fibers and may lower IOP over the long-term. Nevertheless, the effects of PI on visual field changes or progression have not been established in PG and PDS. There is no scientific evidence as of yet to advocate PI as a treatment for PDS or PG.
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Affiliation(s)
- J Buffault
- Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France; DHU Sight Restore, université de Versailles Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France
| | - B Leray
- Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France; DHU Sight Restore, université de Versailles Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France; Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - A Bouillot
- Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France; DHU Sight Restore, université de Versailles Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France; Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - C Baudouin
- Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France; DHU Sight Restore, université de Versailles Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France; Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| | - A Labbé
- Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France; DHU Sight Restore, université de Versailles Saint-Quentin-en-Yvelines, Saint-Quentin-en-Yvelines, France; Service d'ophtalmologie 3, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
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17
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Bang SP, Joo CK, Jun JH. Reverse pupillary block after implantation of a scleral-sutured posterior chamber intraocular lens: a retrospective, open study. BMC Ophthalmol 2017; 17:35. [PMID: 28356143 PMCID: PMC5372338 DOI: 10.1186/s12886-017-0427-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/20/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND To report the clinical features of patients with reverse pupillary block (RPB) after scleral-sutured posterior chamber intraocular lens (PC IOL) implantation and biometric changes after laser peripheral iridotomy (LPI). METHODS Eight patients attending our hospital's ophthalmology outpatient clinic, who developed RPB after implantation of a scleral-sutured PC IOL due to subluxation of the crystalline lens or IOL, were investigated in this retrospective, observational study. RESULTS Preoperative evaluations showed angle pigmentation in all cases and iridodonesis in 2 cases. Two subjects had used an α1A-adrenoceptor antagonist for benign prostatic hyperplasia. Pars plana or anterior partial vitrectomy was performed in all cases. All eyes showed an extremely deep anterior chamber, a concave iris configuration, and contact between the IOL optic and the iris at the pupillary margin. Pupil capture was detected in 2 cases. The mean (± SD) anterior chamber angle (ACA) was 89.91 ± 10.06°, and the anterior chamber depth (ACD) was 4.42 ± 0.16 mm before LPI. After LPI, the iris immediately became flat with a decreased ACA (51.70 ± 2.59°; P = 0.018) and ACD (4.14 ± 0.15 mm; P = 0.012). After LPI, the intraocular pressure decreased from 19.75 ± 3.77 mmHg to 15.63 ± 4.30 mmHg (P = 0.011), and the spherical equivalent decreased from -0.643 ± 0.385 D to - 0.875 ± 0.505 D (P = 0.016). CONCLUSION Concomitant vitrectomy, angle pigmentation, and iridodonesis may be risk factors for RPB after scleral-sutured PC IOL implantation. LPI is effective for relieving the RPB.
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Affiliation(s)
- Seung Pil Bang
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, #56, Dalseong-ro, Jung-gu, 41931 Daegu South Korea
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jong Hwa Jun
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, #56, Dalseong-ro, Jung-gu, 41931 Daegu South Korea
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18
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Abstract
PURPOSE OF REVIEW The present article reviews the clinical features and pathogenesis of pigment dispersion syndrome and pigmentary glaucoma and provides an update regarding their diagnosis and management. RECENT FINDINGS Newer imaging modalities including ultrasound biomicroscopy and anterior segment optical coherence tomography facilitate visualization of the iris concavity characteristic of eyes with pigment dispersion syndrome and pigmentary glaucoma. Patients with pigmentary glaucoma may be distinguished from those with other glaucoma types by the presence of typical symptoms, personality type, and patterns of diurnal intraocular pressure fluctuation. Although laser iridotomy has been shown to alter iris anatomy in pigmentary glaucoma, it is not proven to slow visual field progression. Multiple trials have validated the safety and efficacy of filtering surgery in treating pigmentary glaucoma, with fewer studies published on the role of micro-invasive glaucoma surgery. SUMMARY Literature from the review period has further defined the unique clinical characteristics of pigment dispersion syndrome and pigmentary glaucoma. Laser surgery has a limited role in the management of these entities, whereas trabeculectomy remains an acceptable first-line surgical treatment. Further studies are needed to define the potential application of the newer micro-invasive glaucoma procedures in pigmentary glaucoma.
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19
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Schuster AK, Fischer JE, Vossmerbaeumer U. Curvature of iris profile in spectral domain optical coherence tomography and dependency to refraction, age and pupil size - the MIPH Eye&Health Study. Acta Ophthalmol 2017; 95:175-181. [PMID: 27488961 DOI: 10.1111/aos.13184] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 06/03/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Optical coherence tomography (OCT) of the anterior segment allows quantitative analysis of the geometry of the iris. We performed spectral domain OCT examinations in healthy emmetropic, hyperopic and myopic subjects to investigate iris curvature and its associations. METHODS In a cross-sectional study, out of 4617 eyes (2309 subjects) those with refractive errors of <-4 or >+3 dioptres were identified by objective refraction. The iris was examined using the anterior segment mode of a spectral domain 3D OCT-2000 (Topcon Inc., Japan) in the temporal meridian, and OCT scans were investigated with respect to presence and amount of convex and concave iris configuration. Ninety-three eyes of 50 subjects served as emmetropic group (-0.5 ≤ x ≤+0.5 dioptres). Previous ocular surgery was exclusion criterion. RESULTS Six hundred and sixty-eight eyes of 398 persons [292 male (76%); age range; 18-66 years] were included in the study. In the myopic group, 105 eyes had a concave iris configuration (26%), while in the hyperopic group, no eye had this configuration (0%) and in the emmetropic group five eyes (5%). Convex iris configuration was found in 96% of hyperopic, in 85% of the emmetropic and in 67% of the myopic eyes. There was an association between concave iris configuration and myopia, younger age and male gender, and with anterior chamber angle width. CONCLUSION Spectral domain OCT images can be used for analysis of the iris structure and geometry. Our results are limited to the properties of the study population having an age range from 18 to 66 years and consisting mainly of men.
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Affiliation(s)
- Alexander K. Schuster
- Mannheim Institute of Public Health, Social and Preventive Medicine; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Department of Ophthalmology; Mainz University Medical Center; Mainz Germany
| | - Joachim E. Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
| | - Urs Vossmerbaeumer
- Mannheim Institute of Public Health, Social and Preventive Medicine; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Department of Ophthalmology; Mainz University Medical Center; Mainz Germany
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20
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Aptel F, Weinreb RN, Chiquet C, Mansouri K. 24-h monitoring devices and nyctohemeral rhythms of intraocular pressure. Prog Retin Eye Res 2016; 55:108-148. [PMID: 27477112 DOI: 10.1016/j.preteyeres.2016.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 01/26/2023]
Abstract
Intraocular pressure (IOP) is not a fixed value and varies over both the short term and periods lasting several months or years. In particular, IOP is known to vary throughout the 24-h period of a day, defined as a nyctohemeral rhythm in humans. In clinical practice, it is crucial to evaluate the changes in IOP over 24 h in several situations, including the diagnosis of ocular hypertension and glaucoma (IOP is often higher at night) and to optimize the therapeutic management of glaucoma. Until recently, all evaluations of 24-h IOP rhythm were performed using repeated IOP measurements, requiring individuals to be awakened for nocturnal measurements. This method may be imperfect, because it is not physiologic and disturbs the sleep architecture, and also because it provides a limited number of time point measurements not sufficient to finely asses IOP changes. These limitations may have biased previous descriptions of physiological IOP rhythm. Recently, extraocular and intraocular devices integrating a pressure sensor for continuous IOP monitoring have been developed and are available for use in humans. The objective of this article is to present the contributions of these new 24-h monitoring devices for the study of the nyctohemeral rhythms. In healthy subjects and untreated glaucoma subjects, a nyctohemeral rhythm is consistently found and frequently characterized by a mean diurnal IOP lower than the mean nocturnal IOP, with a diurnal bathyphase - usually in the middle or at the end of the afternoon - and a nocturnal acrophase, usually in the middle or at the end of the night.
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Affiliation(s)
- Florent Aptel
- Inserm U1042, Hypoxia and Physiopathology Laboratory, University Grenoble Alpes, Grenoble, France; Department of Ophthalmology, University Hospital, CHU Grenoble, Grenoble, France
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Center and Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Christophe Chiquet
- Inserm U1042, Hypoxia and Physiopathology Laboratory, University Grenoble Alpes, Grenoble, France; Department of Ophthalmology, University Hospital, CHU Grenoble, Grenoble, France
| | - Kaweh Mansouri
- Glaucoma Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland; Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA.
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Shen L, Melles RB, Metlapally R, Barcellos L, Schaefer C, Risch N, Herrinton LJ, Wildsoet C, Jorgenson E. The Association of Refractive Error with Glaucoma in a Multiethnic Population. Ophthalmology 2016; 123:92-101. [PMID: 26260281 PMCID: PMC4695304 DOI: 10.1016/j.ophtha.2015.07.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/24/2015] [Accepted: 07/05/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the association between refractive error and the prevalence of glaucoma by race or ethnicity. DESIGN Cross-sectional study. PARTICIPANTS Kaiser Permanente Northern California Health Plan members with refractive error measured at 35 years of age or older between 2008 and 2014 and with no history of cataract surgery, refractive surgery, or a corneal disorder. METHODS We identified 34 040 members with glaucoma or ocular hypertension (OHTN; cases) and 403 398 members without glaucoma (controls). Glaucoma cases were classified as primary angle-closure glaucoma (PACG); 1 of the 4 forms of open-angle glaucoma: primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), pigmentary glaucoma (PIGM), and pseudoexfoliation glaucoma (PEX); or OHTN. Refractive error, expressed as spherical equivalent (SE), was coded as a continuous trait and also as categories. Logistic regression analyses were used to estimate the association between refractive error and the prevalence of glaucoma overall and in specific racial or ethnic groups. MAIN OUTCOME MEASURES The association between refractive error and glaucoma subtypes evaluated as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS In controls, the mean SE was -0.59 diopters (D) (standard deviation, 2.62 D). Each 1-D reduction in SE was associated with a 22% decrease in the odds of PACG (OR, 0.78; 95% CI, 0.77-0.80) and with increases in the odds of open-angle glaucoma ranging from 1.23 (95% CI, 1.20-1.26) for PIGM, to 1.07 (95% CI, 1.03-1.11) for PEX, and to 1.05 (95% CI, 1.04-1.06) for OHTN. In addition, we observed a stronger association between myopia and POAG among non-Hispanic whites (OR, 1.12; 95% CI, 1.11-1.13) and NTG among Asians (OR, 1.17; 95% CI, 1.15-1.20) and non-Hispanic whites (OR, 1.19; 95% CI, 1.15-1.22). CONCLUSIONS Myopia was associated with an increased prevalence of all forms of open-angle glaucoma and OHTN, whereas hyperopia was associated with a substantially increased prevalence of PACG. Although high myopia is a strong risk factor for glaucoma subtypes, low and moderate myopia also have a significant effect on glaucoma risk. Additionally, there were moderate racial differences in the association of myopia with the risk of POAG and NTG.
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Affiliation(s)
- Ling Shen
- Division of Research, Kaiser Permanente Northern California, Oakland, California; Division of Epidemiology, School of Public Health, University of California - Berkeley, Berkeley, California
| | - Ronald B Melles
- Department of Ophthalmology, Redwood City Medical Center, Kaiser Permanente Northern California, Redwood City, California
| | - Ravikanth Metlapally
- School of Optometry/Vision Science Program, University of California - Berkeley, Berkeley, California
| | - Lisa Barcellos
- Division of Epidemiology, School of Public Health, University of California - Berkeley, Berkeley, California
| | - Catherine Schaefer
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Neil Risch
- Institute for Human Genetics, University of California San Francisco - San Francisco, California; Department of Epidemiology and Biostatistics, University of California - San Francisco, San Francisco, California
| | - Lisa J Herrinton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Christine Wildsoet
- School of Optometry/Vision Science Program, University of California - Berkeley, Berkeley, California
| | - Eric Jorgenson
- Division of Research, Kaiser Permanente Northern California, Oakland, California.
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Mierlo CV, Pinto LA, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015; 9:28-32. [PMID: 26997830 PMCID: PMC4741142 DOI: 10.5005/jp-journals-10008-1180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/04/2014] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Iatrogenic pigment dispersion syndrome generally originates from a repetitive, mechanical trauma to the pigmented posterior epithelium of the iris. This trauma can arise after intraocular surgery, most commonly due to an abnormal contact between the intraocular lens (IOL) and the iris. Whether surgical removal of this primary insult can lead to a successful intraocular pressure (IOP) control remains unclear. METHODS Case-series. Patients with IOP elevation and clinical signs of pigment dispersion were screened for a diagnosis of iatrogenic IOL-related pigment dispersion. RESULTS Three patients in which the IOL or the IOL-bag complex caused a pigment dispersion through a repetitive iris chafing were selected. In two cases, replacement of a sulcus-based single-piece IOL (patient 1) or a sub-luxated in-the-bag IOL (patient 2) by an anterior-chamber (AC) iris-fixed IOL led to a sustained decrease in IOP. In the third case, extensive iris atrophy and poor anatomical AC parameters for IOL implantation precluded further surgical intervention. CONCLUSION IOL-exchange appears to be a useful tool in the management of iatrogenic pigment dispersion glaucoma due to inappropriate IOL implantation. This cause-oriented approach seems to be effective in controlling IOP, but should be offered only if safety criteria are met. How to cite this article: Van Mierlo C, Abegao Pinto L, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015;9(1):28-32.
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Affiliation(s)
- Camille Van Mierlo
- Resident, Department of Ophthalmology, University Hospitals of Leuven Leuven, Belgium
| | - Luis Abegão Pinto
- Assistant Professor, Department of Ophthalmology, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Ingeborg Stalmans
- Professor, Department of Ophthalmology, University Hospitals of Leuven Leuven, Belgium
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Simple technique to treat pupillary capture after transscleral fixation of intraocular lens. J Cataract Refract Surg 2015; 41:14-7. [PMID: 25532631 DOI: 10.1016/j.jcrs.2014.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/27/2014] [Accepted: 07/28/2014] [Indexed: 11/21/2022]
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24
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Flügel-Koch CM, Tektas OY, Kaufman PL, Paulsen FP, Lütjen-Drecoll E. Morphological alterations within the peripheral fixation of the iris dilator muscle in eyes with pigmentary glaucoma. Invest Ophthalmol Vis Sci 2014; 55:4541-51. [PMID: 24938519 DOI: 10.1167/iovs.13-13765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To analyze the peripheral fixation of the iris dilator muscle in normal eyes and in eyes with pigmentary glaucoma (PG). METHODS Using 63 control eyes (age 18 months-99 years), the peripheral iris dilator was investigated by light microscopy, immunohistochemistry, and electron microscopy. Development was studied using 18 differently aged fetal eyes stained immunohistochemically against α-smooth muscle (SM) actin. The peripheral iris dilator muscle in PG was analyzed using semithin and ultrathin sections of six glutaraldehyde-fixed eyes from three donors aged 38, 62, and 74 years. RESULTS In normal eyes, the peripheral end of the iris dilator muscle is arranged in a sphincter-like manner. Arcade-shaped tendinous connections associated with myofibroblasts (iridial strands) anchor the iris dilator within the elastic-fibromuscular ciliary meshwork that also serves as fixation area for the elastic tendons of the inner ciliary muscle portions. The iridial strands are innervated and can adapt their length during accommodation. The PG eyes show incomplete circular bundles and iridial strands that are mainly anchored to the iris stroma and the flexible uveal parts of the trabecular meshwork. CONCLUSIONS The normal anchorage of the peripheral iris dilator and its presumably neuronally regulated length adaptation stabilize the peripheral iris during accommodation. Insufficient fixation in PG could promote posterior bowing of the iris with rubbing against the zonular fibers and pigment liberation from the iris pigmented epithelium.
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Affiliation(s)
- Cassandra M Flügel-Koch
- Department of Anatomy II, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ozan Y Tektas
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Paul L Kaufman
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - Friedrich P Paulsen
- Department of Anatomy II, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Elke Lütjen-Drecoll
- Department of Anatomy II, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
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Klingenstein A, Kernt M, Seidensticker F, Kampik A, Hirneiss C. Anterior-segment morphology and corneal biomechanical characteristics in pigmentary glaucoma. Clin Ophthalmol 2014; 8:119-26. [PMID: 24403816 PMCID: PMC3883583 DOI: 10.2147/opth.s53088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of the study reported here was to evaluate characteristics of the anterior-segment via anterior-segment optical coherence tomography (AS-OCT) and corneal biomechanical properties using an ocular response analyzer and their changes by peripheral laser iridotomy (PI) in patients with pigmentary glaucoma (PG). Materials and methods Seventeen eyes with PG were included consecutively. AS-OCT and ocular response analyzer measurements were taken before and 3 months after PI. Baseline morphology and change in morphology were analyzed by correlation and multiple linear regression analysis. The main parameters assessed were anterior-chamber (AC) angles and volume as well as corneal hysteresis (CH) and corneal resistance factor. Results AC angles were found to have decreased significantly in each quadrant after PI (P<0.001), with the highest effect seen in the temporal quadrant, which decreased from 57.0°±9.6° to 44.1°±5.2° (± standard deviation). Mean AC volume decreased significantly from 213.1±36.4 to 187.0±23.4 mm3 (P<0.001). CH and corneal resistance factor did not change after PI. CH was found to correlate with the preoperative superior and inferior angle width (Spearman’s rho 0.553 and 0.615, respectively, P<0.05). Biomechanical parameters showed no predictive value on the change of AC angles or volume. Conclusion PI in eyes with PG results in a highly significant reduction in the AC angles and volume as visualized by AS-OCT, with the largest effect seen in the temporal quadrant. CH is strongly positively correlated with the superior and inferior preoperative AC angles, emphasizing the importance of the biomechanical properties of the cornea for glaucoma pathogenesis in PG, but corneal biomechanical properties cannot predict PI-related AC changes.
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Affiliation(s)
- Annemarie Klingenstein
- Department of Ophthalmology, University of Munich Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Marcus Kernt
- Department of Ophthalmology, University of Munich Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Florian Seidensticker
- Department of Ophthalmology, University of Munich Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Anselm Kampik
- Department of Ophthalmology, University of Munich Hospital, Ludwig-Maximilians University, Munich, Germany
| | - Christoph Hirneiss
- Department of Ophthalmology, University of Munich Hospital, Ludwig-Maximilians University, Munich, Germany
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Abstract
Despite theoretical considerations concerning the advantage of iridotomy in eyes with pigment dispersion syndrome or early pigment glaucoma, there is a lack of clinical evidence that this procedure has a long-term effect in preventing glaucoma damage under these circumstances. However, several factors may contribute to this lack of evidence, e.g. the statistical problem of a low conversion rate from pigment dispersion syndrome to pigment glaucoma or the inclusion criteria in the studies treating patients older than 40 years or genetic dispositions in pigment glaucoma that are not yet fully clear. On the basis of current data the decision for YAG iridotomy should only be taken in patients younger than 40 years, if the midperipheral iris shows an inverse bowing and the intraocular pressure is normal or slightly increased with no progressive signs of optic nerve damage. In cases of insufficient intraocular pressure and visual defects due to glaucomatous optic nerve damage, incisional glaucoma surgery is usually necessary especially in younger patients with a long life expectancy.
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Bower KS, Sia RK, Ryan DS, Mines MJ, Stutzman RD, Kuzmowych CP, Eaddy JB, Coe CD, Wroblewski KJ. Visual and IOP Outcomes After PRK in Pigment Dispersion Syndrome. J Refract Surg 2011; 27:686-90. [DOI: 10.3928/1081597x-20110324-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Aptel F, Beccat S, Fortoul V, Denis P. Biometric analysis of pigment dispersion syndrome using anterior segment optical coherence tomography. Ophthalmology 2011; 118:1563-70. [PMID: 21531465 DOI: 10.1016/j.ophtha.2011.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 12/06/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare anterior chamber volume (ACV), iris volume, and iridolenticular contact (ILC) area before and after laser peripheral iridotomy (LPI) in eyes with pigment dispersion syndrome (PDS) using anterior segment optical coherence tomography (AS OCT) and image processing software. DESIGN Cross-sectional study. PARTICIPANTS Eighteen eyes of 18 patients with PDS; 30 eyes of 30 controls matched for age, gender, and refraction. METHODS Anterior segment OCT imaging was performed in all eyes before LPI and 1, 4, and 12 weeks after LPI. At each visit, 12 cross-sectional images of the AS were taken: 4 in bright conditions with accommodation (accommodation), 4 in bright conditions without accommodation (physiological miosis), and 4 under dark conditions (physiologic mydriasis). Biometric parameters were estimated using AS OCT radial sections and customized image-processing software. MAIN OUTCOME MEASURES Anterior chamber volume, iris volume-to-length ratio, ILC area, AS OCT anterior chamber depth, and A-scan ultrasonography axial length. RESULTS Before LPI, PDS eyes had a significantly greater ACV and ILC area than control eyes (P<0.01) and a significantly smaller iris volume-to-length ratio than the controls (P<0.05). After LPI, ACV and ILC area decreased significantly in PDS eyes, but iris volume-to-length ratio increased significantly (P<0.02) and was not significantly different from that of controls. These biometric changes were stable over time. Iris volume-to-length ratio decreased significantly from accommodation to mydriasis and from miosis to mydriasis, both in PDS and control eyes (P<0.01). In PDS eyes, ILC area decreased significantly from accommodation to mydriasis, both before and after LPI (P<0.01). On multivariate analysis, greater anterior chamber (AC) volume (P<0.02) and larger AC depth (P<0.05) before LPI were significant predictors of a larger ILC area. CONCLUSIONS Pigment dispersion syndrome eyes do not have an iris that is abnormally large, relative to the AS size, but have a weakly resistant iris that is stretched and pushed against the lens when there is a pressure difference across the iris. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Florent Aptel
- Hospices Civils de Lyon, Department of Ophthalmology, Hôpital Edouard Herriot, Lyon, France.
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Scott A, Kotecha A, Bunce C, Balidis M, Garway-Heath DF, Miller MH, Wormald R. YAG Laser Peripheral Iridotomy for the Prevention of Pigment Dispersion Glaucoma. Ophthalmology 2011; 118:468-73. [PMID: 21035866 DOI: 10.1016/j.ophtha.2010.07.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 07/14/2010] [Accepted: 07/29/2010] [Indexed: 11/29/2022] Open
Affiliation(s)
- Andrew Scott
- Glaucoma Service, Moorfields Eye Hospital, London, United Kingdom.
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Higashide T, Shimizu F, Nishimura A, Sugiyama K. Anterior segment optical coherence tomography findings of reverse pupillary block after scleral-fixated sutured posterior chamber intraocular lens implantation. J Cataract Refract Surg 2009; 35:1540-7. [DOI: 10.1016/j.jcrs.2009.04.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/04/2009] [Accepted: 04/11/2009] [Indexed: 11/27/2022]
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Niyadurupola N, Broadway DC. Pigment dispersion syndrome and pigmentary glaucoma - a major review. Clin Exp Ophthalmol 2008; 36:868-82. [PMID: 19278484 DOI: 10.1111/j.1442-9071.2009.01920.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nuwan Niyadurupola
- Department of Ophthalmology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK.
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Carroll SC, Gaskin BJ, Goldberg I, Danesh-Meyer HV. Glaucoma prescribing trends in Australia and New Zealand. Clin Exp Ophthalmol 2006; 34:213-8. [PMID: 16671900 DOI: 10.1111/j.1442-9071.2006.01196.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To summarize current practice styles and patterns associated with glaucoma management in ophthalmologists of Australia and New Zealand as derived from a survey. METHOD A questionnaire was sent to all Australian and New Zealand ophthalmologists, which anonymously assessed demographic characteristics and prescribing patterns for each major class of glaucoma medication. RESULTS A total of 761 questionnaires were sent with a response rate of 51%. Of respondents 14% were glaucoma subspecialists. In 69%, the first-line drug-class of choice was a prostaglandin analogue. New Zealand ophthalmologists favoured beta-blockers as their first-line agent because of cost, government restrictions and familiarity. Most respondents stated "hypotensive efficacy" as the most important factor in class choice. Alpha-2-agonists, carbonic anhydrase inhibitors and miotics were considered second-line agents, because of side-effects and lack of hypotensive potency. CONCLUSIONS The choice of first-line agent for the treatment of glaucoma differed between Australian and New Zealand ophthalmologists, in part as the result of government restriction of prostaglandin-class drugs. Practice patterns seen in Australasia parallel the current evidence base reported in peer-reviewed literature.
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Affiliation(s)
- Stuart C Carroll
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Pseudoexfoliations- und Pigmentglaukom. SPEKTRUM DER AUGENHEILKUNDE 2004. [DOI: 10.1007/bf03163179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Pigmentary glaucoma is a common secondary glaucoma that results from pigment being liberated from the posterior iris with subsequent buildup in the trabecular mesh-work. Following this, there is a decrease in aqueous outflow and resultant rise in intraocular pressure. PURPOSE While this presentation typically occurs in white myopic males, there is a distinct subtype that occurs in patients of African descent. While there are similarities between the races, there are also significant differences in the clinical presentation of pigmentary glaucoma in white patients and patients of African descent. Iris transillumination defects, corneal endothelial pigment accumulation, and a concave iris-common in whites-are typically absent in patients of African descent. METHOD The literature is reviewed in order to summarize pigment dispersion syndrome and pigmentary glaucoma.
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Affiliation(s)
- Joseph Sowka
- Nova Southeastern University, College of Optometry, Ft. Lauderdale, Florida 33328, USA.
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Christen R, Pache M, Teuchner B, Meyer P, Prünte C, Flammer J. Iris transillumination defects in patients with primary open angle glaucoma. Eur J Ophthalmol 2003; 13:365-9. [PMID: 12872793 DOI: 10.1177/112067210301300406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the incidence and pattern of iris transillumination defects in patients with primary open angle glaucoma (POAG) with and without vascular dysregulation, in comparison to controls. METHODS We prospectively examined 24 patients with POAG (M/F 10:14; mean age 59 +/- 14, range 21-76 years) and 23 controls (M/F 10:13; mean age 52 +/- 15, range 25-86 years). Vascular dysregulation was presumed if patients had a typical medical history of vasospasm and a pathological result in nailfold capillaroscopy. Iris transillumination defects were visualized by video-taped, digitized diaphanoscopy and assessed by two blinded observers. RESULTS We found significantly more iris transillumination defects in POAG than in controls (54.2% vs. 8.7%; chi2 = 8.85; df = 1; p = 0.002). The defects in POAG showed a characteristic radially-streaked pattern different from those described, for instance, in pigment dispersion syndrome, pseudoexfoliation syndrome, and acute glaucoma. Glaucoma patients with vascular dysregulation had a tendency to a higher incidence of transillumination defects than non-vasospastic patients, though this finding was not significant. CONCLUSIONS Patients with POAG have a higher incidence of iris transillumination defects than controls. The underlying mechanisms are not yet clear and call for further investigation.
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Affiliation(s)
- R Christen
- University Eye Clinic, Basel, Switzerland
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Balidis MO, Bunce C, Sandy CJ, Wormald RPL, Miller MH. Iris configuration in accommodation in pigment dispersion syndrome. Eye (Lond) 2002; 16:694-700. [PMID: 12439661 DOI: 10.1038/sj.eye.6700115] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2001] [Accepted: 01/16/2002] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study was conducted in order to investigate the effect of accommodation on the iris morphology and iridolenticular contact, in eyes with Pigment Dispersion Syndrome and Pigmentary Glaucoma, using high-resolution ultrasound. METHODS We performed a prospective observational study, examining a group of 30 Pigment Dispersion Syndrome and Pigmentary Glaucoma patients (49 eyes) and a smaller group of eight 'normals' non-Pigment Dispersion Syndrome patients (8 eyes). All patients underwent ultrasound biomicroscopy, before and during accommodation. RESULTS The iris profile before accommodation was found convex in 48.5%, flat in 19.7% and concave in 31.8%. Following accommodation the iris configuration remained unchanged in 66.2%, increased in concavity in 20.3% and decreased in concavity in 13.5%. CONCLUSIONS The effect of accommodation on iris configuration and accommodation is highly variable. From our experience the measurement of iris configuration using ultrasound biomicroscopy may not be a useful method of evaluating the effect of different treatments on iris configuration.
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Lord FD, Pathanapitoon K, Mikelberg FS. Keratometry and axial length in pigment dispersion syndrome: a descriptive case-control study. J Glaucoma 2001; 10:383-5. [PMID: 11711834 DOI: 10.1097/00061198-200110000-00003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Pigment dispersion syndrome and pigmentary glaucoma are characterized by loss of pigment from the posterior surface of the iris due to reverse pupillary block. This may be due to an anomalous relation between the position of the globe within the orbit, the axial length of the globe, and the corneal curvature. The authors compared axial length, keratometry, and exophthalmometry in patients with pigment dispersion syndrome and pigmentary glaucoma and in healthy controls. METHODS Thirteen pigment dispersion syndrome and pigmentary glaucoma and 17 controls underwent refraction, keratometry, A-scan and exophthalmometry. Patients with pigment dispersion syndrome and pigmentary glaucoma were selected in a university glaucoma practice, and controls were selected for their age and refraction from the staff of the hospital. Both groups were comparable in age and refraction. RESULTS Mean age of pigment dispersion syndrome patients and healthy controls was 46.54 and 41.82 years (P = 0.30), respectively, and mean refraction (spherical equivalent) was -4.53 and -4.32 diopters, (P = 0.84), respectively. No statistical differences were noted in axial length measured with A-scan (25.98 and 25.14, P = 0. 15) or anterior chamber depth and lens thickness. The pigment dispersion syndrome and pigmentary glaucoma group had flatter keratometry than the myopic controls. Mean keratometry was 42.39 +/- 1.77 and 44.34 +/- 1.50 (P = 0.003), respectively. CONCLUSION The results show that patients with pigment dispersion syndrome have flatter keratometry of approximately 2 diopters compared with age-matched myopic controls. This finding suggests a difference in architecture of the anterior segment.
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Affiliation(s)
- F D Lord
- Department of Ophthalmology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Jacobi PC, Dietlein TS, Krieglstein GK. Effect of trabecular aspiration on intraocular pressure in pigment dispersion syndrome and pigmentary glaucoma. Ophthalmology 2000; 107:417-21. [PMID: 10711875 DOI: 10.1016/s0161-6420(99)00091-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVE Recently, we described a new form of nonfiltering glaucoma surgery-trabecular aspiration-designed to increase trabecular outflow in pseudoexfoliation glaucoma. This study was carried out to investigate whether trabecular aspiration is equally safe and effective in the treatment of pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG). STUDY DESIGN Prospective, nonrandomized comparative trial with historical control. PARTICIPANTS Twenty eyes of 20 patients with medically uncontrolled intraocular pressure (IOP) caused by PDS or PG were treated by trabecular aspiration. INTERVENTION Trabecular pigment particles were cleared with a pressure of 100 to 200 mmHg using a specially designed aspiration probe. MAIN OUTCOME MEASURES The IOP and number of medications before and after surgery were measured. Intraoperative and postoperative complications were analyzed. Surgical success was defined as IOP < or = 21 mmHg with no more than one topical medication. Results were compared with those previously reported with similar treatment of pseudoexfoliative glaucoma. RESULTS Mean pretreatment IOP averaged 27.0 (standard deviation [SD], 3.3) mmHg and was significantly reduced to 23.7 (SD, 3.9) mmHg at last follow-up (20.1 +/- 8.6 months). However, the cumulative life-table success rates were only 42% and 15% at 3 and 12 months, respectively. Considering both groups separately, the success rates in the PDS group were 63% and 18% at 3 and 12 months compared with a success rate of 12% in the PG group as early as 1 month after surgery. CONCLUSIONS Eyes with PDS responded better to trabecular aspiration than do those with PG, indicating that PDS and PG are two successive stages of the same disease process. Altogether, trabecular aspiration failed to achieve long-term pressure control in either of the two groups.
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Affiliation(s)
- P C Jacobi
- University of Cologne, Department of Ophthalmology, Germany
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