Evolving Paradigms in Classification of Primary Angle Closure Glaucoma

Quantification of Retinal Microvascular Density Using Optic Coherence Tomography Angiography in Primary Angle Closure Disease

Purpose: To evaluate the microvascular density of the peripapillary and parafoveal areas of the eyes with primary angle closure disease (PACD) using optical coherence tomography angiography (OCTA).Materials and methods: An observational study was conducted with 76 PACD patients (29 eyes with primary angle closure suspect, 22 eyes with primary angle closure [PAC], and 25 eyes with primary angle closure glaucoma [PACG]) and 27 control eyes. OCTA was performed for all subjects to acquire a 4.5 × 4.5 mm scanning area centered on the optic discs and a 3 × 3 mm parafoveal cubes. Peripapillary and parafoveal vessel density (VD) were compared between these four groups, and the relationship between VD values and structural and functional changes was evaluated.Results: Among all four groups, the peripapillary VD of the PACG eyes was the lowest in all six sections (all P < .01), while the parafoveal VD was lower than that of the normal group only in the average, superior, and inferior areas (all P < .05). The PAC group had lower peripapillary VD than the normal group (62.6[55.2-67.4] vs. 66.7[54.7-69.3], P = .01), while their retinal nerve fiber layer (RNFL) and ganglion cell complex thickness were not significantly different than those of the control group (all P > .05). In addition, the stages of PACD, visual field mean deviation, and RNFL thickness were shown to be predictors of the peripapillary VD in the multiple linear regression analysis.Conclusions: The PAC eyes had lower peripapillary VD than normal eyes when their RNFL and GCC thickness did not differ. This suggests that a reduction in retinal VD may occur before structural loss in PAC eyes. Retinal VD measurement may be a useful tool for the assessment of PACD.

Differential diagnosis of acute ocular pain: Teleophthalmology during COVID-19 pandemic - A perspective

Ocular pain is a common complaint which forces the patient to seek immediate medical attention. It is the primeval first response of the body to any severe condition of the eye such as trauma, infections and inflammation. The pain can be due to conditions directly affecting the eye and ocular adnexa; or indirect which would manifest as referred pain from other organ structures such as the central nervous system. Paradoxically, there are several minor and non-sight threatening conditions, which also leads to ocular pain and does not merit urgent hospital visits. In this perspective, we intend to provide guidelines to the practising ophthalmologist for teleconsultation when a patient complains of pain with focus on how to differentiate the various diagnoses that can be managed over teleconsultation and those requiring emergency care in the clinic. These guidelines can decrease unnecessary hospital visits, which is the need of the hour in the pandemic era and also beyond. Patients who are under quarantine and those who are unable to travel would be benefitted, and at the same time, the burden of increased patient load in busy hospital systems can be reduced.

Modified phacoemulsification plus goniosynechialysis compared with conventional surgery for cataract and glaucoma

Optic nerve damage and visual impairment caused by glaucoma affect 66.8 million people worldwide, and causing bilateral blindness in 6.7 million people. Surgery is the main method for the treatment of cataract with glaucoma. In recent years, clinicians have increasingly paid attention to and applied phacoemulsification and intraocular lens implantation combined with goniosynechialysis for the treatment of cataract with angle-closure glaucoma. However, for patients with complicated cataract, the high ultrasonic energy of traditional phacoemulsification can largely damage the corneal endothelium. Modified phacoemulsification (lower ultrasonic energy) and intraocular lens implantation have now achieved certain efficacy. The efficacy and safety of modified phacoemulsification plus goniosynechialysis compared with conventional surgery for cataract and glaucoma was investigated. A total of 125 patients who underwent goniosynechialysis combined with phacoemulsification and intraocular lens implantation were enrolled in the control group, while 179 patients treated by modified phacoemulsification and intraocular lens implantation combined with goniosynechialysis were enrolled in the research group. The visual acuity and intraocular pressure were observed before and 6 months after surgery in both groups, and the incidence of complications was analyzed. After treatment, there were more patients with visual acuity of 0.2-0.4 and >0.4 in the research group than in the control group (P<0.05). The incidence of corneal edema and anterior chamber inflammation was lower in the research group than in the control group (both P<0.05), while the preoperative and postoperative intraocular pressure, central anterior chamber depth, angle-opening distance, and peripheral iridocorneal adhesions were not significantly different between the two groups (all P>0.05). Modified phacoemulsification and intraocular lens implantation plus goniosynechialysis for cataract with glaucoma can better improve the visual acuity, as well as effectively reduce corneal edema and anterior chamber inflammation.