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Li M, Zhu W, Fan X, Sun X, Kong X. Outcomes of Filtering Surgery Versus Clear Lens Extraction in Young Patients With Angle-Closure Glaucoma. Am J Ophthalmol 2024; 258:145-157. [PMID: 37543298 DOI: 10.1016/j.ajo.2023.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/29/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE To compare the effect of filtering surgery versus clear lens extraction in young patients with medically uncontrolled angle-closure glaucoma (ACG). DESIGN Retrospective, nonrandomized, comparative, interventional study. METHODS We reviewed the medical charts of patients with the following scenarios: (1) age ≤40 years; (2) diagnosis of ACG without cataract, including primary angle-closure glaucoma (PACG), nanophthalmic ACG, and ACG combined with retinal dystrophies; and (3) ACG undergoing filtering surgery or clear lens extraction. The main outcomes including intraocular pressure (IOP), number of medications, best-corrected visual acuity, and severe complications were extracted at the postoperative early (within 1 week) and late stage (>3 months) follow-up. RESULTS Data from 160 eyes of 130 young patients with ACG were available. Eyes with 76 PACG, 12 nanophthalmic ACG, and 26 ACG with retinal diseases underwent filtering surgery, whereas eyes with 22 PACG, 12 nanophthalmic ACG, and 12 ACG with retinal diseases received clear lens extraction. Overall, filtering surgery and clear lens extraction resulted in significant but comparable IOP and drug reductions at the postoperative late stage in each ACG subgroup, with similar complete success rates between 2 treatments (all P > .05). Regarding the safety, filtering surgery and patients with retinal diseases were independent factors associated with postoperative malignant glaucoma (P < .05 in both multivariable logistic regression models). CONCLUSIONS This study highlights that the efficacy of clear lens extraction is comparable to that of filtering surgery in medically uncontrolled ACG in young patients, but clear lens extraction is safer, especially for young patients with ACG comorbid with retinal diseases.
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Affiliation(s)
- Mengwei Li
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China (M.L., W.Z., X.F., X.S., X.K.); NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China (M.L., W.Z., X.F., X.S., X.K.)
| | - Wenqing Zhu
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China (M.L., W.Z., X.F., X.S., X.K.); NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China (M.L., W.Z., X.F., X.S., X.K.)
| | - Xintong Fan
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China (M.L., W.Z., X.F., X.S., X.K.); NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China (M.L., W.Z., X.F., X.S., X.K.)
| | - Xinghuai Sun
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China (M.L., W.Z., X.F., X.S., X.K.); NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China (M.L., W.Z., X.F., X.S., X.K.); State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China (X.S.).
| | - Xiangmei Kong
- From the Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China (M.L., W.Z., X.F., X.S., X.K.); NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China (M.L., W.Z., X.F., X.S., X.K.).
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Suzuki T, Ueta Y, Tachi N, Okamoto Y, Fukutome T, Sasajima H. Refractive outcomes after immediate primary phacoemulsification for acute primary angle closure. Sci Rep 2023; 13:13283. [PMID: 37587217 PMCID: PMC10432382 DOI: 10.1038/s41598-023-40585-9] [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: 02/27/2023] [Accepted: 08/13/2023] [Indexed: 08/18/2023] Open
Abstract
This study investigated the refractive outcomes of 64 eyes overall including 32 immediate primary phacoemulsification in acute primary angle closure (APAC) eyes and 32 of their fellow eyes. We investigated best-corrected visual acuity, intraocular pressure (IOP), average keratometric diopter (K), spherical equivalent, axial length (AL), central corneal thickness, and anterior chamber depth (ACD) at preoperative examination (Pre) and more than 1-month post-phacoemulsification (1 m), and changes in values. Using SRK/T, Barrett Universal II (Barrett), Hill-Radial Basis Function Version 3.0 (RBF 3.0), and Kane formulas, we calculated and compared refractive prediction error (PE), absolute value of PE (AE), and changes in K, AL, and ACD from Pre to 1 m between APAC and fellow eyes. From Pre to 1 m, K remained similar in APAC and fellow eyes (p = 0.069 and p = 0.082); AL significantly decreased in APAC and in fellow eyes (both p < 0.001); and ACD significantly increased in APAC and in fellow eyes (both p < 0.001). The change in AL differed significantly between the two groups (p = 0.007). Compared to the fellow eyes, PE with SRK/T and Barret formulas (p = 0.0496 and p = 0.039) and AE with Barrett and RBF 3.0 formula (p = 0.001 and p = 0.024) were significantly larger in the APAC eyes. Thus, attention should be paid to refractive prediction error in immediate primary phacoemulsification for APAC eyes caused by preoperative AL elongation due to high IOP.
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Affiliation(s)
- Takafumi Suzuki
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan.
- Department of Ophthalmology, The University of Tokyo Hospital, 7-3-1 Hongō, Bunkyō-ku, Tokyo, 113-8655, Japan.
| | - Yoshiki Ueta
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Naoko Tachi
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
- Tachi Eye Clinic, Toyama, Japan
| | - Yasuhiro Okamoto
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Takao Fukutome
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
| | - Hirofumi Sasajima
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, Japan
- Yamada Eye Clinic, Nagano, Japan
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Safety and Efficacy of Rapid Primary Phacoemulsification on Acute Primary Angle Closure with and without Preoperative IOP-Lowering Medication. J Clin Med 2023; 12:jcm12020660. [PMID: 36675587 PMCID: PMC9866465 DOI: 10.3390/jcm12020660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/02/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
This study aimed to investigate the safety and efficacy of rapid primary phacoemulsification in patients with acute primary angle closure (APAC) (n = 41), with or without preoperative IOP-lowering medication. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of corneal endothelial cells (CECs), and number of IOP-lowering medications at the preoperative examination (Pre), postoperative day 1 (1d), week 1 (1w), and month 1 (1m) were used as indicators and compared. BCVA significantly improved at 1d, 1w, and 1m compared with Pre (p < 0.05) and significantly improved at 1m compared to 1d (p < 0.05) for all eyes. IOP significantly decreased at 1d, 1w, and 1m compared with Pre (p < 0.05). CECs were not significantly different between Pre and 1m; the number of IOP-lowering medications decreased significantly from Pre to 1m (p < 0.05). BCVA and IOP were not significantly different between the two groups for all periods. CECs were not significantly different between the two groups at Pre and 1m. Rapid primary phacoemulsification improved visual acuity due to improvement of corneal edema without central visual field defects and good IOP control without reoperation or IOP-lowering medication and maintained the number of corneal endothelial cells with or without preoperative IOP-lowering medication in patients with APAC.
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Yoshida S, Yoshida M, Himori N, Kunimatsu-Sanuki S, Nakazawa T. Acute Primary Angle Closure Caused by Plateau Iris After Ritodrine Use in a Primigravid Woman Successfully Treated With Clear-Lens Extraction: A Case Report. Cureus 2022; 14:e22036. [PMID: 35340488 PMCID: PMC8912943 DOI: 10.7759/cureus.22036] [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] [Accepted: 02/08/2022] [Indexed: 11/05/2022] Open
Abstract
Acute primary angle closure (APAC) is rare in young adults (those under approximately 40 years old) and pregnant women. Here, we report the case of a 37-year-old primigravid woman with APAC caused by plateau iris after the use of ritodrine (a β2 stimulator) that was successfully resolved by clear-lens extraction five months after delivery. The patient presented with pain in her right eye after ritodrine infusion for threatened premature labor at 23 weeks of gestation. Her visual acuity was 20/40, and her intraocular pressure (IOP) was 31 mmHg in her right eye. The patient was diagnosed as having APAC with plateau iris based on ultrasound biomicroscopy (UBM) findings of irido-angle touch, anterior dislocation of the ciliary process, and an absent ciliary sulcus. The effectiveness of treatment with pilocarpine eyedrops was limited, and argon laser peripheral iridoplasty did not succeed in reducing IOP. An immediate resolution was achieved with clear-lens extraction. IOP has since stayed within 14-16 mmHg without any medication for seven years. This is the first reported case of APAC complicated with plateau iris after ritodrine use in a pregnant woman. This condition is rare in young adults, making it difficult to diagnose; however, UBM can be of great help. In this case, clear-lens extraction led to a successful outcome. Our case suggests that attention should be paid to drug associations when APAC occurs with plateau iris.
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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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Garza-Leon M, Fuentes-de la Fuente HA, García-Treviño AV. Repeatability of ocular biometry with IOLMaster 700 in subjects with clear lens. Int Ophthalmol 2016; 37:1133-1138. [DOI: 10.1007/s10792-016-0380-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/17/2016] [Indexed: 12/01/2022]
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Leffler CT, Schwartz SG, Giliberti FM, Young MT, Bermudez D. What was Glaucoma Called Before the 20th Century? OPHTHALMOLOGY AND EYE DISEASES 2015; 7:21-33. [PMID: 26483611 PMCID: PMC4601337 DOI: 10.4137/oed.s32004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Glaucoma involves a characteristic optic neuropathy, often with elevated intraocular pressure. Before 1850, poor vision with a normal eye appearance, as occurs in primary open-angle glaucoma, was termed amaurosis, gutta serena, or black cataract. Few observers noted palpable hardness of the eye in amaurosis. On the other hand, angle-closure glaucoma can produce a green or gray pupil, and therefore was called, variously, glaucoma (derived from the Greek for glaucous, a nonspecific term connoting blue, green, or light gray) and viriditate oculi. Angle closure, with palpable hardness of the eye, mydriasis, and anterior prominence of the lens, was described in greater detail in the 18th and 19th centuries. The introduction of the ophthalmoscope in 1850 permitted the visualization of the excavated optic neuropathy in eyes with a normal or with a dilated greenish-gray pupil. Physicians developed a better appreciation of the role of intraocular pressure in both conditions, which became subsumed under the rubric “glaucoma”.
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Affiliation(s)
| | - Stephen G Schwartz
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Matthew T Young
- Department of Ophthalmology, Virginia Commonwealth University, Richmond, VA, USA
| | - Dennis Bermudez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Sng CCA, Aquino MCD, Liao J, Zheng C, Ang M, Chew PTK. Anterior segment morphology after acute primary angle closure treatment: a randomised study comparing iridoplasty and medical therapy. Br J Ophthalmol 2015; 100:542-8. [PMID: 26294102 DOI: 10.1136/bjophthalmol-2015-307087] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/26/2015] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the effect of argon laser peripheral iridoplasty (ALPI) and conventional medical therapy in the immediate treatment of acute primary angle closure (APAC) using anterior segment optical coherence tomography (ASOCT). METHODS In this single tertiary centre, prospective comparative study, we randomised 30 consecutive patients with unilateral APAC into two groups: ALPI and medical treatment (n=15 each). Immediately before and 1 h after either intervention, ASOCT imaging was performed. Custom software was used to measure pupil diameter, anterior chamber depth, iris curvature (I-Curv), iris area (I-Area), and the angle opening distance (AOD750), trabecular iris space area (TISA750) and the iris thickness at 750 µm from the scleral spur. The main outcome measure was the change in anterior segment biometrical parameters. RESULTS The mean age of the patients was 62.8±7.7 years; 13 (43.3%) were male. APAC eyes treated with ALPI had a larger increase in AOD750 (p=0.002) and TISA750 (p=0.006); a smaller increase in I-Area (p=0.004) and a decrease in I-Curv (p=0.001) after treatment compared with those eyes which received medical therapy. An optimal model consisting of age, gender, pretreatment and post-treatment pupil diameter, treatment modality and pretreatment I-Curv explained 53.2% of the variance in AOD750 change after treatment, with the treatment modality accounting for 35.0% and I-Curv accounting for 12.4% of the variability. CONCLUSIONS We observed a greater increase in angle width after ALPI compared with after medical treatment in eyes with APAC. Treatment modality and pretreatment I-Curv were the most significant predictors of angle width change after treatment.
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Affiliation(s)
- Chelvin C A Sng
- Department of Ophthalmology, National University Health System, Singapore, Singapore Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
| | | | - Jiemin Liao
- Department of Ophthalmology, National University Health System, Singapore, Singapore
| | - Ce Zheng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Kowloon, Hong Kong
| | - Marcus Ang
- Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
| | - Paul T K Chew
- Department of Ophthalmology, National University Health System, Singapore, Singapore Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
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