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Dutra PEP, Quagliato LA, Horato N, de Souza CP, da Silva BDD, Nardi AE. You Shall Not Turn a Blind Eye to Intraocular Pressure: A Case Report of Comorbid Panic Disorder and Angle-Closure Glaucoma. J Clin Psychopharmacol 2024; 44:437-440. [PMID: 38829372 DOI: 10.1097/jcp.0000000000001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
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Moghadas Sharif N, Hoseini-Yazdi H, Daneshvar R, Radhakrishnan H, Shoeibi N, Ehsaei A, Collins MJ. Seasonal variations in anterior segment angle parameters in myopes and emmetropes. Clin Exp Optom 2024; 107:530-536. [PMID: 37751623 DOI: 10.1080/08164622.2023.2251478] [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: 11/19/2022] [Accepted: 04/17/2023] [Indexed: 09/28/2023] Open
Abstract
CLINICAL RELEVANCE Seasonal variations are known to occur in a range of ocular parameters and in conditions including refractive error and glaucoma. It is of clinical importance to know if seasonal changes also occur in anterior segment angle parameters, given that they can influence these conditions. BACKGROUND The study aimed to examine the seasonal variations in anterior segment angle parameters in healthy young adults. METHODS Twenty-three emmetropic participants with a mean age of 26.17 ± 4.43 years and 22 myopic participants with a mean age of 27.27 ± 4.47 years completed four seasons of data collection. Anterior segment angle parameters were measured using swept-source anterior segment optical coherence tomography. Intraocular pressure (IOP) and objective refraction were also measured. Repeated-measures analysis of variance was used to determine the effect of season and refractive error on the various ocular parameters. RESULTS A significant main effect of season was found for the majority of anterior segment angle parameters, including the angle opening distance at 500 and 750 µm from the scleral spur (p = 0.02, p = 0.006, respectively), angle recess area at 500 and 750 µm from the scleral spur (both p = 0.002), and trabecular iris space area at 500 and 750 µm from the scleral (p = 0.02, p = 0.008, respectively). However, measures of anterior chamber depth and trabecular iris angle did not exhibit statistically significant seasonal variations (all p > 0.05). A significant main effect of season was also found for the changes in IOP (p = 0.004) and objective refraction (p < 0.001). There was no season by refractive group interaction for any anterior segment angle parameter or IOP (all p > 0.05). CONCLUSION There is a small but significant seasonal changes in the anterior segment angle parameters, refractive error, and IOP in healthy young adult males, in which the anterior segment angle dimensions are narrower, the IOP is higher, and the refraction is more myopic during winter.
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Affiliation(s)
- Nasrin Moghadas Sharif
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Optometry and Visual Science, University of London, London, UK
| | - Hosein Hoseini-Yazdi
- Contact Lens and Visual Optics Laboratory, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ramin Daneshvar
- Eye Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Ophthalmology, University of Florida, Gainesville, FL, USA
| | | | - Nasser Shoeibi
- Eye Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Ehsaei
- Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Optometry and Visual Science, University of London, London, UK
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, Queensland University of Technology, Brisbane, Queensland, Australia
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Salem Mahjoubi Y, Dahmani I, Souilem I, Aouinti I, Kastalli S, Daghfous R, El Aidli S. Acute angle closure glaucoma following COVID-19 vaccination. Therapie 2024; 79:396-398. [PMID: 37321945 PMCID: PMC10246303 DOI: 10.1016/j.therap.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Yasmine Salem Mahjoubi
- National Center of Pharmacovigilance, Department of Collection and Analysis of Adverse Drug Reactions, 9, avenue Dr Zouhaier Essafi, 1006Tunis, Tunisia
| | - Israa Dahmani
- National Center of Pharmacovigilance, Department of Collection and Analysis of Adverse Drug Reactions, 9, avenue Dr Zouhaier Essafi, 1006Tunis, Tunisia; Research Unit, Faculty of Medicine of Tunis, University of Tunis El Manar, UR17ES12, 1006 Tunis, Tunisia.
| | - Ines Souilem
- National Center of Pharmacovigilance, Department of Collection and Analysis of Adverse Drug Reactions, 9, avenue Dr Zouhaier Essafi, 1006Tunis, Tunisia
| | - Imen Aouinti
- National Center of Pharmacovigilance, Department of Collection and Analysis of Adverse Drug Reactions, 9, avenue Dr Zouhaier Essafi, 1006Tunis, Tunisia; Research Unit, Faculty of Medicine of Tunis, University of Tunis El Manar, UR17ES12, 1006 Tunis, Tunisia
| | - Sarrah Kastalli
- National Center of Pharmacovigilance, Department of Collection and Analysis of Adverse Drug Reactions, 9, avenue Dr Zouhaier Essafi, 1006Tunis, Tunisia; Research Unit, Faculty of Medicine of Tunis, University of Tunis El Manar, UR17ES12, 1006 Tunis, Tunisia
| | - Riadh Daghfous
- National Center of Pharmacovigilance, Department of Collection and Analysis of Adverse Drug Reactions, 9, avenue Dr Zouhaier Essafi, 1006Tunis, Tunisia; Research Unit, Faculty of Medicine of Tunis, University of Tunis El Manar, UR17ES12, 1006 Tunis, Tunisia
| | - Sihem El Aidli
- National Center of Pharmacovigilance, Department of Collection and Analysis of Adverse Drug Reactions, 9, avenue Dr Zouhaier Essafi, 1006Tunis, Tunisia; Research Unit, Faculty of Medicine of Tunis, University of Tunis El Manar, UR17ES12, 1006 Tunis, Tunisia
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Vishwanath R, Soman S, Nagaraj AKM, Kamath AG, Penmetsa T. Acute Angle-closure Glaucoma Associated with Aripiprazole: A Case Report. Indian J Psychol Med 2024; 46:273-274. [PMID: 38699760 PMCID: PMC11062306 DOI: 10.1177/02537176231199210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Affiliation(s)
- Rashmi Vishwanath
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Savitha Soman
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anil Kumar Mysore Nagaraj
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Avinash G Kamath
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Tejaswi Penmetsa
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Aftab OM, Khan H, Khouri AS. Blind Spots in Therapy: Unveiling Drug-Induced Angle-Closure Glaucoma Through a National Analysis. Ophthalmol Glaucoma 2024:S2589-4196(24)00070-X. [PMID: 38679326 DOI: 10.1016/j.ogla.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To identify and quantify medications causing angle-closure glaucoma through the FDA Adverse Event Reporting System (FAERS). DESIGN National retrospective database analysis. SUBJECTS There were 11 737 133 total adverse event reports from the FDA Federal Adverse Event Reporting System (FAERS) database 2004 to third quarter of 2023 (2023Q3), which included 1629 reports of angle-closure glaucoma. METHODS Drugs associated with reports of angle-closure glaucoma were identified in FAERS through disproportionality analysis MAIN OUTCOME MEASURES: To ascertain if these reports yielded statistically significant signals, we used the proportional reporting ratio (PRR), reporting odds ratio (ROR), empirical Bayes geometric mean (EBGM), and information component (IC). We considered a signal to be detected when all 4 disproportionality analysis metrics were positive. RESULTS We identified a total of 1629 adverse event reports linked to 611 suspected drugs over the course of 20 years (2004-2023Q3). Frequently reported drugs included topiramate (520 reports) and citalopram (69 reports), amongst many others. Eighteen medications yielded a positive signal, including lesser-known medications like olanzapine, phentermine, and ranibizumab. Tropicamide exhibited the most robust statistical significance (n = 18; PRR: 164.263; ROR [95% confidence interval {CI}]: 167.95 [104.994-268.655]; EBGM [EBGM05]: 162.421 [109.5]; IC [IC05]: 7.344 [4.591]), while acetazolamide was the second strongest (n = 51; PRR: 113.088; ROR 95% CI: 114.782 [86.665-152.021]; EBGM [EBGM05]: 109.506 [86.501]; IC [IC05]: 6.775 [5.115]). CONCLUSIONS Drug-induced glaucoma included both well-known medications such as topiramate as well as lesser-known medications such as olanzapine, phentermine, and ranibizumab. Clinician awareness of these findings is important. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Owais M Aftab
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Hamza Khan
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Albert S Khouri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey.
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Waisberg E, Ong J, Masalkhi M, Lee AG, Berdahl J. Anatomical considerations for reducing ocular emergencies during spaceflight. Ir J Med Sci 2024; 193:505-508. [PMID: 37243845 PMCID: PMC10808690 DOI: 10.1007/s11845-023-03407-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The privatization of space travel is opening civilian spaceflight to an unprecedented number of individuals now and in the immediate future. The increase in the number and diversity of space travelers will mean increased exposure to both physiologic and pathologic changes observed during acute and prolonged microgravity. AIMS In this paper, we describe the anatomic, physiologic, and pharmacologic factors to consider that impact acute angle-closure glaucoma risk during spaceflight. CONCLUSIONS Based on these factors, we elaborate upon areas of medical considerations and provide future recommendations that may aid in reducing the risk of acute angle-closure glaucoma in the next era of spaceflight.
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Affiliation(s)
- Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- A&M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Moshirfar M, Moin KA, Jaafar M, Han K, Omidvarnia S, Hoopes PC. Episodic Angle Closure after Visian™ Implantable Collamer Lens Implantation in a Patient Using Adderall ®. Case Rep Ophthalmol 2024; 15:565-571. [PMID: 39144640 PMCID: PMC11324241 DOI: 10.1159/000540080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 06/26/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Amphetamine-based medications such as Adderall®, used for the treatment of attention deficit-hyperactivity disorder (ADHD), may theoretically elicit angle closure through their adrenergic mechanisms. The relationship between the use of implantable collamer lenses (ICLs) and angle closure has been extensively investigated based on appropriate vault and lens sizing and postoperative changes in the anterior chamber angle (ACA) and corneal morphology. This case reflects a synergistic impact from both Adderall® use and ICL implantation for the proposed mechanism of angle closure. Case Presentation A 36-year-old myopic female with ADHD controlled with Adderall® underwent toric ICL implantation in the right eye after undergoing preoperative laser peripheral iridotomy. Shortly after, the patient developed episodic angle closure in the right eye, with episodes mainly occurring after taking an additional dose of Adderall® in a dimly lit environment. The patient later had an ICL exchange with a smaller sized EVO+ toric ICL in the right eye and remained asymptomatic after. Conclusion Additive mechanisms from both the ICL and Adderall® were present in our patient. The ICL caused crowding of the ACA through a pseudophacomorphic mechanism, and the Adderall® caused increased iridotrabecular contact secondary to pharmacologic mydriasis. This resulted in episodic angle closure with subsequent spikes in the intraocular pressure. There are no current reports or studies in the current literature describing the combined mechanisms of ICL implantation and Adderall® use in the potential development of angle closure. Further studies may be done to assess interactions of such medications in patients after ICL implantation.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
| | - Kayvon A. Moin
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
| | - Muhammed Jaafar
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Kenneth Han
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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Mackenbrock LHB, Labuz G, Baur ID, Yildirim TM, Auffarth GU, Khoramnia R. Cataract Classification Systems: A Review. Klin Monbl Augenheilkd 2024; 241:75-83. [PMID: 38242135 DOI: 10.1055/a-2003-2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Cataract is among the leading causes of visual impairment worldwide. Innovations in treatment have drastically improved patient outcomes, but to be properly implemented, it is necessary to have the right diagnostic tools. This review explores the cataract grading systems developed by researchers in recent decades and provides insight into both merits and limitations. To this day, the gold standard for cataract classification is the Lens Opacity Classification System III. Different cataract features are graded according to standard photographs during slit lamp examination. Although widely used in research, its clinical application is rare, and it is limited by its subjective nature. Meanwhile, recent advancements in imaging technology, notably Scheimpflug imaging and optical coherence tomography, have opened the possibility of objective assessment of lens structure. With the use of automatic lens anatomy detection software, researchers demonstrated a good correlation to functional and surgical metrics such as visual acuity, phacoemulsification energy, and surgical time. The development of deep learning networks has further increased the capability of these grading systems by improving interpretability and increasing robustness when applied to norm-deviating cases. These classification systems, which can be used for both screening and preoperative diagnostics, are of value for targeted prospective studies, but still require implementation and validation in everyday clinical practice.
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Affiliation(s)
- Lars H B Mackenbrock
- Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Grzegorz Labuz
- Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Isabella D Baur
- Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Timur M Yildirim
- Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerd U Auffarth
- Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ramin Khoramnia
- Department of Ophthalmology, Heidelberg University Hospital, Heidelberg, Germany
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Ribeiro M, Barbosa-Breda J, Gonçalves F, Faria Pereira A, Falcão-Reis F, Alves F, E Silva S, B Melo A. [Evaluation of the Manchester Triage System in Patients with Acute Primary Angle Closure Attack: A Retrospective Study]. ACTA MEDICA PORT 2023; 36:698-705. [PMID: 36929920 DOI: 10.20344/amp.19170] [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: 10/08/2022] [Accepted: 01/16/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Acute primary angle closure attack is an ophthalmological emergency. The aim of this study was to describe the cases diagnosed in the Emergency Department, by correlating the initial complaint with the Manchester triage level and ultimately the time needed until ophthalmological evaluation and iridotomy. MATERIAL AND METHODS Retrospective analysis of the electronic medical records of patients with acute primary angle closure attack that attended the Ophthalmology Emergency Department of our tertiary center between January 2010 and December 2020. Overall, 2228 Emergency Department episodes coded with the diagnoses glaucoma or ocular hypertension were retrieved, followed by screening of each episode for correct identification of true acute primary angle closure attacks. Clinical data was gathered, including Manchester triage level, presenting complaint, intraocular pressure at presentation, first medical specialty that observed the patient, time until observation by Ophthalmology and time until laser iridotomy. RESULTS Among the 120 patients identified, 84 (70%) were female and the mean age was 68 ± 12 years. Mean intraocular pressure at admission was 53.4 ± 12.4 mmHg, and 9.2% of patients presented only non-ocular complaints, while 9.2% presented mixed complaints (ocular and non-ocular). Most patients (68.1%) with only non-ocular or mixed complaints were triaged to a non-ophthalmologist (p < 0.001). Concerning the triage system, at admission, most patients (66.7%) were labelled yellow (urgent), while 9.2% and none were labelled as orange (very urgent) or red (emergent), respectively. Most patients (83.3%) were directly sent to Ophthalmology (properly triaged), while the remaining were incorrectly assigned to a non-ophthalmologist. Median time until observation by Ophthalmology was 49 minutes in the properly triaged group (min. 15, max. 404), while it was 288 minutes (min. 45, max. 871) in those who were incorrectly triaged (p < 0.001). Likewise, median time until treatment with laser iridotomy was 203 minutes in the properly triaged group (min. 22, max. 1440) and 353 minutes in the incorrectly triaged group (min.112, max. 947) (p < 0.001). CONCLUSION Most patients with acute primary angle closure attack were not properly triaged according to the level of the Manchester triage system. There was a significant delay in the diagnosis and treatment of those patients who were first assigned to non-ophthalmologists. There is a need to raise awareness regarding the presenting signs and symptoms of an acute primary angle closure attack in order to avoid preventable vision loss.
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Affiliation(s)
- Margarida Ribeiro
- Ophthalmology. Centro Hospitalar e Universitário de São João. Porto; Biomedicine Department. Unit of Farmacology and Therapeutics. Faculdade de Medicina. Universidade do Porto. Porto. Portugal
| | - João Barbosa-Breda
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; UnIC@RISE. Departmento of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal; KU Leuven. Research Group Ophthalmology. Department of Neurosciences. Leuven. Belgium
| | | | - Ana Faria Pereira
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| | - Flávio Alves
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto. Portugal
| | - Sérgio E Silva
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
| | - António B Melo
- Ophthalmology Service. Centro Hospitalar e Universitário de São João. Porto; Department of Surgery and Phisiology. Faculdade de Medicina. Universidade do Porto. Portugal
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Wang Y, Dong XX, Hou XW, Pan CW. Risk Factors for Primary Angle-closure Glaucoma: A Systematic Review and Meta-analysis of 45 Studies. Optom Vis Sci 2023; 100:606-613. [PMID: 37747945 DOI: 10.1097/opx.0000000000002050] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
SIGNIFICANCE This study summarized primary angle-closure glaucoma (PACG)-related factors across different dimensions. OBJECTIVES This review aimed at systematically summarizing the associated factors of PACG in published literatures. METHODS A systematic review and meta-analysis were conducted by searching the electronic databases including PubMed, EMBASE, and Web of Science from their inception to November 2021. The pooled risk estimates of continuous and categorical variables were calculated using weighted mean difference (WMD) and odds ratio (OR; 95% confidence intervals [CIs]), respectively. RESULTS We included 45 studies in this review. In the meta-analysis, intraocular pressure (WMD, 3.13; 95% CI, 2.37 to 3.89), anterior chamber depth (WMD, -0.52; 95% CI, -0.70 to -0.34), axial length (WMD, -0.77; 95% CI, -1.26 to -0.28), retinal nerve fiber layer (WMD, -21.23; 95% CI, -30.21 to -12.25), and spherical equivalent (WMD, 1.02; 95% CI, 0.66 to 1.38) were the most common ophthalmic anatomic factors, and lower body weight (WMD, -3.65; 95% CI, -6.48 to -0.82) was the most significant general morphological indicators. The presence of cataract (OR, 3.77; 95% CI, 3.46 to 4.11) and hyperlipidemia (OR, 1.10; 95% CI, 1.02 to 1.20) were significantly associated with PACG. Increased level of triglyceride (WMD, 0.17; 95% CI, 0.06 to 0.27) was associated with PACG. In addition, an association between short-term antidepressant exposure (OR, 1.36; 95% CI, 1.08 to 1.70) and acute angle-closure glaucoma was observed. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS This review identified a few consistent factors related to PACG, providing important information for primary care physicians, general ophthalmologists, and public health professionals to counsel their patients on PACG risks.
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Affiliation(s)
- Ying Wang
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xing-Xuan Dong
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xiao-Wen Hou
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
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Rojananuangnit K, Rojnueangnit K. Microspherophakic Angle Closure Glaucoma in a Patient with Coffin-Siris Syndrome: Case Report. Appl Clin Genet 2023; 16:165-170. [PMID: 37663124 PMCID: PMC10474847 DOI: 10.2147/tacg.s422312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
Background Bilateral secondary angle closure glaucoma is a presenting symptom of microspherophakia and ectopia lentis. Characterizing the associated syndrome and confirmation by genetic testing can identify associated systemic abnormalities and provide appropriate genetic counseling. Case Presentation A 42-year-old woman with severe intellectual disability presented with light perception visual acuity and glaucoma, with intraocular pressure (IOP) in her right and left eyes of 69 and 70 mmHg, respectively. She underwent two sessions of 270-degree laser diode transscleral cytophotocoagulation treatment at a 6-month interval and was prescribed topical anti-glaucoma medication. Her family noticed a progressive decrease in her vision while on treatment for 2 years. She was diagnosed with apparent Weill-Marchesani syndrome, accompanied by angle closure glaucoma and microspherophakia. Cataract surgery and intraocular lens implantation were successful in both eyes and post-operative IOP was controlled with anti-glaucoma medication but her vision did not improve from severe glaucomatous optic neuropathy. Her underlying syndrome was investigated genetically by whole exome sequencing. Results Sequencing showed a pathogenic variant in ARID1B, c.3955dupC (p.Gln1319Profs*14), diagnostic of Coffin-Siris syndrome. This is the first report of Coffin-Siris syndrome associated with microspherophakia and angle closure glaucoma. Conclusion Bilateral angle closure glaucoma from ectopia lentis in patients with genetic syndromes could be an indicator of microspherophakia in adulthood. Ophthalmological surveillance is important in patients with Coffin-Siris syndrome.
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Affiliation(s)
- Kulawan Rojananuangnit
- Glaucoma Unit, Department of Ophthalmology, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand
| | - Kitiwan Rojnueangnit
- Division of Genetics, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Sharif NA. Identifying new drugs and targets to treat rapidly elevated intraocular pressure for angle closure and secondary glaucomas to curb visual impairment and prevent blindness. Exp Eye Res 2023; 232:109444. [PMID: 36958427 DOI: 10.1016/j.exer.2023.109444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/23/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
A multitude of pharmacological compounds have been shown to lower and control intraocular pressure (IOP) in numerous species of animals and human subjects after topical ocular dosing or via other routes of administration. Most researchers have been interested in finding drug candidates that exhibit a relatively long duration of action from a chronic therapeutic use perspective, for example to treat ocular hypertension (OHT), primary open-angle glaucoma and even normotensive glaucoma. However, it is equally important to seek and characterize treatment modalities which offer a rapid onset of action to help provide fast relief from quickly rising IOP that occurs in certain eye diseases. These include acute angle-closure glaucoma, primary angle-closure glaucoma, uveitic and inflammatory glaucoma, medication-induced OHT, and other secondary glaucomas induced by eye injury or infection which can cause partial or complete loss of eyesight. Such fast-acting agents can delay or prevent the need for ocular surgery which is often used to lower the dangerously raised IOP. This research survey was therefore directed at identifying agents from the literature that demonstrated ocular hypotensive activity, normalizing and unifying the data, determining their onset of action and rank ordering them on the basis of rapidity of action starting within 30-60 min and lasting up to at least 3-4 h post topical ocular dosing in different animal species. This research revealed a few health authority-approved drugs and some investigational compounds that appear to meet the necessary criteria of fast onset of action coupled with significant efficacy to reduce elevated IOP (by ≥ 20%, preferably by >30%). However, translation of the novel animal-based findings to the human conditions remains to be demonstrated but represent viable targets, especially EP2-receptor agonists (e.g. omidenepag isopropyl; AL-6598; butaprost), mixed activity serotonin/dopamine receptor agonists (e.g. cabergoline), rho kinase inhibitors (e.g. AMA0076, Y39983), CACNA2D1-gene product inhibitors (e.g. pregabalin), melatonin receptor agonists, and certain K+-channel openers (e.g. nicorandil, pinacidil). Other drug candidates and targets were also identified and will be discussed.
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Affiliation(s)
- Najam A Sharif
- Institute of Ophthalmology, University College London (UCL), London, UK; Imperial College of Science and Technology, St. Mary's Campus, London, UK; Eye-ACP Duke-National University of Singapore Medical School, Singapore; Singapore Eye Research Institute (SERI), Singapore; Department of Pharmacy Sciences, Creighton University, Omaha, NE, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, Texas, USA; Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, Texas, USA; Ophthalmology Innovation Center, Santen Inc USA, Emeryville, CA, USA.
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13
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Sim ZJ, Jieyin X, Suhitharan T. Post-Operative Delirium Masking Acute Angle Closure Glaucoma. J Crit Care Med (Targu Mures) 2023; 9:187-191. [PMID: 37588183 PMCID: PMC10425924 DOI: 10.2478/jccm-2023-0016] [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: 01/11/2023] [Accepted: 04/27/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Acute angle closure glaucoma (AACG) is an ophthalmological emergency, and can lead to the devastating consequence of permanent vision loss if not detected and treated promptly. We present a case of an atypical presentation of unilateral AACG on post operative day (POD) 1, after a prolonged operation under general anaesthesia (GA). Case presentation A 65-year-old female underwent a 16 hour long operation for breast cancer and developed an altered mental status with a left fixed dilated pupil on POD 1. She was intubated to secure her airway in view of a depressed consciousness level and admitted to the intensive care unit. Initial blood investigations and brain imaging were unremarkable. On subsequent review by the ophthalmologist, a raised intraocular pressure was noted and she was diagnosed with acute angle closure glaucoma. She was promptly started on intravenous acetazolamide and pressure-lowering ophthalmic drops. Her intraocular pressure normalized in the next 24 hours with improvement in her mental status to baseline. Conclusion AACG needs to be consistently thought of as one of the top differentials in any post-operative patient with eye discomfort or abnormal ocular signs on examination. A referral to the ophthalmologist should be made promptly once AACG is suspected.
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Affiliation(s)
| | - Xing Jieyin
- Singapore General Hospital, Singapore, Singapore
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14
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Wu C, Pan H, Feng S, Wang X, Liu Z, Zhao B. Low-dose topiramate and hydrochlorothiazide-associated early acute myopia and angle narrowing: A case report. Front Med (Lausanne) 2023; 10:1062160. [PMID: 36844215 PMCID: PMC9944780 DOI: 10.3389/fmed.2023.1062160] [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: 12/10/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
Purpose To report a unique case of topiramate and hydrochlorothiazide associated with acute myopia and angle narrowing. Patients and methods A 34-year-old Asian woman presented with prominent binocular visual acuity decrease 6 h after taking only one dose of 25 mg topiramate, 25 mg hydrochlorothiazide, and 22.4 mg fluoxetine to lose weight. She was subsequently diagnosed with acute bilateral myopia and angle narrowing and was started on topical therapy. Results Initial examination revealed a decreased visual acuity of 20/100 bilaterally, an elevated intraocular pressure of 23 mmHg in the right eye and 24 mmHg in the left eye, suprachoroidal effusions, and angle narrowing. After the discontinuation of these drugs and the use of IOP-lowering medication, the patient made full recovery. Conclusion We speculate that there is a drug-drug interaction between topiramate and hydrochlorothiazide that may lead to the angle narrowing in a short time and at a low dose. Timely discontinuation of the drug usually leads to complete recovery within days to weeks.
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Affiliation(s)
- Chao Wu
- Department of Ophthalmology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Hong Pan
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Shijun Feng
- Department of Ophthalmology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Xiaokun Wang
- Department of Ophthalmology, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Zhaoqiang Liu
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,*Correspondence: Zhaoqiang Liu,
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital, Shandong University, Jinan, China,Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,*Correspondence: Zhaoqiang Liu,
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15
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Orman B, Benozzi G. Pharmacological Treatments for Presbyopia. Drugs Aging 2023; 40:105-116. [PMID: 36670320 DOI: 10.1007/s40266-022-01002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/22/2023]
Abstract
Accommodation is the change in dioptric power of the eye. It is a dynamic process that allows focusing on an object at all distances. In order to focus sharply, three physiological responses, known as the triad of accommodation, are produced by a change in pupil size, a change in shape and position of the lens, and ocular convergence. This is modulated by the autonomic nervous system, mainly the parasympathetic nervous system. Presbyopia is a refractive condition that occurs with aging, usually manifesting around 40-50 years of age, and is a result of the loss of accommodation in the eye, causing loss of visual performance when focusing on objects placed at different distances, starting with near vision. Glasses, contact lenses, surgical approaches and now pharmacological treatments are accepted methods of treating presbyopia. Pharmacological treatment is a promising new noninvasive option for treating presbyopia. Currently there are three pharmacological approaches to the treatment of presbyopia. The first one aims to produce miosis and, from a pinhole effect, increase depth of focus, and therefore improve uncorrected near visual acuity (UNVA). The second one addresses rehabilitating accommodation in a binocular way, allowing good vision at all distances. Finally, the third strategy uses lipoic acid to restore the lost elasticity of the lens. All of these pharmacological treatments are topical non-invasive eyedrops, with no serious adverse effects having been reported with any of the strategies, and require the right patient selection process to fulfill expectations and needs. The aim of this article is to provide an update on recent advances in this field.
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Affiliation(s)
- Betina Orman
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Farmacología, Buenos Aires, Argentina.
| | - Giovanna Benozzi
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
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16
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Purohith AN, Ramesh P, Vaidya BP, Shenoy S, Sharma PSVN. Olanzapine-Associated Chronic Urinary Retention and Ciliochoroidal Effusion: Rare Adverse Effects of a Commonly Prescribed Antipsychotic. Indian J Psychol Med 2023; 45:96-97. [PMID: 36778624 PMCID: PMC9896110 DOI: 10.1177/02537176221111581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Abhiram Narasimhan Purohith
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Priyanka Ramesh
- Ramesh Eye Clinic and Ophthalmic Microsurgical Centre, Bengaluru, Karnataka, India
| | - Bhuvana Prakash Vaidya
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sonia Shenoy
- Dept. of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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17
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Kellner U, Kellner S, Weinitz S, Farmand G. [Exogenously induced retinopathies]. Klin Monbl Augenheilkd 2022; 239:1493-1511. [PMID: 36395811 DOI: 10.1055/a-1961-8166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Exogenously induced retinopathies can be caused by consumation of stimulating substances, systemic or ocular medications, vaccinations, light or irradiation. Some of the effects are transient, whereas other effects induce irreversible toxic reactions. Retinal damage may develop either acutely with obvious relation to the damaging cause, but often may take a long duration of repeated use of a substance or medication. External stimulants (e.g. nicotine, alcohol, poppers, methanol) are the most frequent cause of exogenously induced retinal damage. Side effects from systemic drugs (e.g. hydroxychloroquine, ethambutol, MEK-, ERK-, FLT3-, checkpoint inhibitors, didanosin, pentosanpolysulfat sodium) or intravitreally applied drugs (e.g. antibiotics, VEGF-inhibitors) are less frequent. Ocular side effects associated with vaccinations are rare. Ambient light sources induce no damaging effects on the retina. Incorrect use of technical or medical light sources (e.g. laser pointers) without adherence to safety recommendations or unshielded observation of the sun might induce permanent retinal damage. Local or external irradiation might induce retinal vascular damage resulting in radiation retinopathy.
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18
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Kellner U, Kellner S, Weinitz S, Farmand G. Exogen bedingte Retinopathien. AUGENHEILKUNDE UP2DATE 2022. [DOI: 10.1055/a-1879-7221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
ZusammenfassungExogen bedingte Retinopathien werden am häufigsten durch externe Stimulanzien, seltener durch unerwünschte Arzneimittelwirkungen systemisch oder intravitreal eingesetzter Medikamente und
noch seltener durch Impfungen oder die Einwirkung von Lichtstrahlung verursacht. Die Kenntnis exogener Ursachen und ihre mögliche Symptomatik ist zur Prophylaxe oder zur Früherkennung
schädigender Wirkungen und zur adäquaten Beratung der Patienten wichtig.
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19
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Roth S, Moss HE, Vajaranant TS, Sweitzer B. Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery. Anesthesiology 2022; 137:620-643. [PMID: 36179149 PMCID: PMC9588701 DOI: 10.1097/aln.0000000000004338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors reviewed perioperative ocular complications and implications of ocular diseases during nonocular surgeries. Exposure keratopathy, the most common perioperative eye injury, is preventable. Ischemic optic neuropathy, the leading cause of perioperative blindness, has well-defined risk factors. The incidence of ischemic optic neuropathy after spine fusion, but not cardiac surgery, has been decreasing. Central retinal artery occlusion during spine fusion surgery can be prevented by protecting eyes from compression. Perioperative acute angle closure glaucoma is a vision-threatening emergency that can be successfully treated by rapid reduction of elevated intraocular pressure. Differential diagnoses of visual dysfunction in the perioperative period and treatments are detailed. Although glaucoma is increasingly prevalent and often questions arise concerning perioperative anesthetic management, evidence-based recommendations to guide safe anesthesia care in patients with glaucoma are currently lacking. Patients with low vision present challenges to the anesthesia provider that are becoming more common as the population ages.
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Affiliation(s)
- Steven Roth
- Department of Anesthesiology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Heather E Moss
- Departments of Ophthalmology and Neurology & Neurologic Sciences, Stanford University, Palo Alto, California
| | - Thasarat Sutabutr Vajaranant
- Department of Ophthalmology and Visual Science, University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - BobbieJean Sweitzer
- University of Virginia, Charlottesville, Virginia; Perioperative Medicine, Inova Health System, Falls Church, Virginia
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20
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Baj J, Forma A, Teresińska B, Tyczyńska M, Zembala J, Januszewski J, Flieger J, Buszewicz G, Teresiński G. How Does SARS-CoV-2 Affect Our Eyes-What Have We Learnt So Far about the Ophthalmic Manifestations of COVID-19? J Clin Med 2022; 11:3379. [PMID: 35743449 PMCID: PMC9225256 DOI: 10.3390/jcm11123379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/21/2022] [Accepted: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has become a worldwide threat resulting in a pandemic in 2020. SARS-CoV-2 infection manifests itself as coronavirus disease 2019 (COVID-19) that is evidenced in a vast number of either specific or nonspecific symptoms. Except for typical (but nonspecific) symptoms such as fever, dry cough, or muscle weakness, the infected patients might also present atypical symptoms including neurological, dermatological, or ophthalmic manifestations. This paper summarizes the current state of knowledge regarding the onset, progression, and types of ophthalmic symptoms induced by SARS-CoV-2 infection recognized amongst the infected patients.
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Affiliation(s)
- Jacek Baj
- Chair and Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (M.T.); (J.J.)
| | - Alicja Forma
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (B.T.); (G.B.); (G.T.)
| | - Barbara Teresińska
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (B.T.); (G.B.); (G.T.)
| | - Magdalena Tyczyńska
- Chair and Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (M.T.); (J.J.)
| | - Julita Zembala
- Department of Ophthalmology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Jacek Januszewski
- Chair and Department of Anatomy, Medical University of Lublin, 20-090 Lublin, Poland; (M.T.); (J.J.)
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Grzegorz Buszewicz
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (B.T.); (G.B.); (G.T.)
| | - Grzegorz Teresiński
- Chair and Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland; (B.T.); (G.B.); (G.T.)
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21
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Lübke J. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:352. [PMID: 35974464 PMCID: PMC9468472 DOI: 10.3238/arztebl.m2022.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Jan Lübke
- *Klinik für Augenheilkunde, Freiburg, Germany
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22
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Abstract
BACKGROUND: Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. OBJECTIVES: To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. METHODS: We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. RESULTS: Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. CONCLUSION: Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.
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Affiliation(s)
- Patrick T. Quaid
- Head of Optometry, VUE Cubed Vision Therapy Clinics, ON, Canada
- College of Optometrists of Ontario (Regulatory Body), ON, Canada
| | - Eric L. Singman
- Ophthalmology & Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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23
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Soulis D, Papaioannou TG, Zozolou M, Daskalopoulou S, Vlachopoulos C, Bethanis D, Triantafyllou D. The effect of atropine used in dobutamine stress echocardiography on pupil diameter. Eur J Ophthalmol 2022; 32:3685-3692. [PMID: 35088615 DOI: 10.1177/11206721221076310] [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: 11/15/2022]
Abstract
BACKGROUND The use of atropine during dobutamine stress echocardiography (DSE) is contraindicated in persons with narrow angle glaucoma though there is limited evidence that low doses of intravenous atropine do not cause pupillary dilation. OBJECTIVE The aim of this study is to investigate whether atropine when administered in persons without glaucoma during dobutamine stress echocardiography causes pupillary dilation. METHODS AND RESULTS Out of 144 patients without a history of glaucoma referred for DSE for clinical indications, 105 patients received intravenous atropine doses ranging from 0.1 mg to 1.25 mg (most patients received 0.25-0.75 mg). Pupil diameter of both eyes was measured under the same light conditions before and after the DSE using a CP-30 Optical Digital PD Ruler. For the total of 210 examined eyes pupil diameter remained unaltered after each DSE test (3.65 ± 0.799 mm before vs 3.63 ± 0.766 mm after, p = .737). Similarly, pupil diameter remained unchanged when left and right eyes were assessed separately (right eye: 3.770 ± 0.812 before vs 3.752 ± 0.745 mm after, p = .821 and left eye: 3.521 ± 0.770 before vs 3.499 ± 0.770 mm after, p = .806). Diameter of right and left pupil were also unaltered after grouping patients by sex and iris pigmentation. Age, weight, atropine dose and propranolol dose were not correlated with changes in pupil diameter. CONCLUSION Intravenous atropine in usual doses administered in DSE does not cause mydriasis in adults without glaucoma. Future studies need to confirm our findings and expand the investigation regarding safety of atropine use during DSE in patients with narrow angle glaucoma.
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Affiliation(s)
| | - Theodore G Papaioannou
- First Department of Cardiology, Hippokration Hospital, Medical School, 68993National and Kapodistrian University of Athens, Athens, Greece
| | | | - Stella Daskalopoulou
- Division of Internal Medicine, Department of Medicine, 5620McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Charalampos Vlachopoulos
- First Department of Cardiology, Hippokration Hospital, Medical School, 68993National and Kapodistrian University of Athens, Athens, Greece
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24
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Anderssen-Nordahl E, Riera-Arnau J, Perelló Carrascosa M, Gómez Muñoz A. Application of pharmacovigilance tools in a case of subacute anterior angle narrowing while under furosemide exposure. BMJ Case Rep 2022; 15:e244581. [PMID: 35078871 PMCID: PMC8796215 DOI: 10.1136/bcr-2021-244581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/04/2022] Open
Abstract
Sulfonamides have been related to drug-induced acute angle closure of the eye, but scarce reports exist concerning furosemide. We describe the second case of acute chamber narrowing (ACN) during furosemide exposure. A 65-year-old man with a renal transplant presented with ACN, after 3 months of furosemide intake. Finally, the patient required a bilateral iridotomy and right lens replacement. ACN has been associated with drugs containing sulfonamide derivatives, but an evaluation with pharmacovigilance scales for adverse drug reaction (ADR)-standardised causality assessment has not been provided. We use this case to illustrate how medicines and an ADR should be evaluated and reported. The spreading of pharmacovigilance information on what should be a rare and unexpected condition related to a drug could mean that other reports emerge about ADR with this drug and regulatory agencies perform consequently, as happened with topiramate.
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Affiliation(s)
- Emilie Anderssen-Nordahl
- Department of Clinical Pharmacology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalunya, Spain
| | - Judit Riera-Arnau
- Department of Clinical Pharmacology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalunya, Spain
- Immune Mediated Diseases and Innovative Therapies Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manel Perelló Carrascosa
- Department of Nephrology, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalunya, Spain
| | - Alicia Gómez Muñoz
- Department of Glaucoma, Institut Català de la Retina (ICR), Barcelona, Spain
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25
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Sekimitsu S, Wang J, Elze T, Segrè AV, Wiggs JL, Zebardast N. Interaction of background genetic risk, psychotropic medications, and primary angle closure glaucoma in the UK Biobank. PLoS One 2022; 17:e0270530. [PMID: 35763501 PMCID: PMC9239437 DOI: 10.1371/journal.pone.0270530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND/AIMS Psychotropic medications have been reported as a risk factor for angle closure disease. However, the interaction between background genetic risk for primary angle closure glaucoma (PACG) and susceptibility to angle closure disease among psychotropic medication users has not been investigated. Here we demonstrate the utility of a genome-wide polygenic risk score (PRS) in identifying and risk-stratifying subjects with PACG and investigate the association between PACG genetic burden and exposure to psychotropic medications on prevalent angle closure. METHODS This analysis used the UK Biobank dataset, a prospective cohort study of 502,506 UK residents. We constructed a PACG PRS for participants using genome-wide association study summary statistics from a multiethnic meta-analysis using the Lassosum method. RESULTS Among the 441,054 participants, 959 (0.22%) were identified as PACG cases. Individuals with PACG had higher PRS compared to those without PACG (0.24±1.03 SD vs. 0.00±1.00 SD, p<0.001) and PACG prevalence increased with each decile of higher PRS. Among individuals using psychotropic medication, those with PACG had higher average PRS (0.31±1.00 SD vs. 0.00±1.00 SD, p<0.001) and were more likely to have a PRS in upper deciles of polygenic risk (p = 0.04). At each decile of PRS, psychotropic medication use was associated with increased risk of PACG. These effects were more pronounced and significant in higher deciles. CONCLUSION We demonstrate the utility of a PRS for identifying individuals at higher risk of PACG. Additionally, we demonstrate an important relationship where the association between psychotropic medications use and PACG diagnosis varies across the polygenic risk spectrum.
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Affiliation(s)
- Sayuri Sekimitsu
- Tufts University School of Medicine, Boston, MA, United States of America
| | - Jiali Wang
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America
- Ocular Genomics Institute, Harvard Medical School, Boston, MA, United States of America
| | - Tobias Elze
- Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States of America
| | - Ayellet V. Segrè
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America
- Ocular Genomics Institute, Harvard Medical School, Boston, MA, United States of America
| | - Janey L. Wiggs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America
- Ocular Genomics Institute, Harvard Medical School, Boston, MA, United States of America
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
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26
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Chang YW, Sung FC, Tzeng YL, Mou CH, Tien PT, Su CW, Teng YK. Risk of Glaucoma Associated with Components of Metabolic Disease in Taiwan: A Nationwide Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:305. [PMID: 35010564 PMCID: PMC8744805 DOI: 10.3390/ijerph19010305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/08/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE This retrospective cohort study was conducted to determine the glaucoma risk associated with metabolic disease (MetD) using insurance claims data of Taiwan. METHODS From the database, we identified patients with newly diagnosed hypertension, diabetes and/or hyperlipidemia from the years 2000 to 2002 as the MetD cohort (N = 42,036) and an age-gender-diagnosis-date matched control cohort without MetD with a two-fold sample size than that of the MetD cohort. Both cohorts were followed until the development of glaucoma, death, or withdrawal, until 31 December 2013. The incidence of glaucoma, and the Cox method estimated hazard ratio (HR) of glaucoma were calculated. Results showed that the incidence of glaucoma was two-fold higher in the MetD cohort than in the controls (1.99 versus 0.99 per 1000 person-years), with an adjusted HR of 1.66 (95% CI: 1.50-1.85). The glaucoma incidence was higher in patients with diabetes than those with hypertension and hyperlipidemia (2.38 versus 1.95 and 1.72 per 1000 person-years, respectively). The incidence increased to 5.67 per 1000 person-years in patients with all three comorbidities, with an aHR of 4.95 (95% CI: 2.35-10.40). We also found higher incidence rates of primary open-angle glaucoma and primary angle-closure glaucoma with aHRs of 2.03 and 1.44, respectively. It was concluded that glaucoma risk increased with the number of MetD. Health providers need to monitor patients with MetD to prevent glaucoma.
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Affiliation(s)
- Ya-Wen Chang
- School of Nursing, China Medical University, Taichung 406040, Taiwan; (Y.-W.C.); (Y.-L.T.)
| | - Fung-Chang Sung
- Department of Health Services Administration, China Medical University, Taichung 406040, Taiwan;
- Management Office for Health Data, China Medical University Hospital, Taichung 404332, Taiwan;
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung 41354, Taiwan
| | - Ya-Ling Tzeng
- School of Nursing, China Medical University, Taichung 406040, Taiwan; (Y.-W.C.); (Y.-L.T.)
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Cheng-Wen Su
- Department of Ophthalmology, Asia University Hospital, Taichung 41354, Taiwan;
| | - Yu-Kuei Teng
- School of Nursing, China Medical University, Taichung 406040, Taiwan; (Y.-W.C.); (Y.-L.T.)
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27
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Abstract
Patient: Male, 59-year-old
Final Diagnosis: Acute angle closure
Symptoms: Pain • red eye
Medication: —
Clinical Procedure: —
Specialty: Ophthalmology
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Affiliation(s)
- Motazz A Alarfaj
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah I Almater
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Nüßle S, Reinhard T, Lübke J. Acute Closed-Angle Glaucoma-an Ophthalmological Emergency. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:arztebl.m2021.0264. [PMID: 34551857 PMCID: PMC8841641 DOI: 10.3238/arztebl.m2021.0264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute closed-angle glaucoma has an incidence of 2.2-4.1 cases per 100 000 persons per year in Europe. It is an ophthalmological emergency in which markedly elevated intraocular pressure can damage vision permanently. Because the acute symptoms are not always clearly referable to the eyes, patients often present to physicians who are not ophthalmologists. METHODS This review is based on pertinent articles retrieved by a selective search in PubMed. RESULTS The diverse symptoms of acute closed-angle glaucoma include eye redness, worsening of vision and other visual disturbances, headache, and nausea. Acute closed-angle glaucoma has multiple causes. Not all predisposing factors have been definitively identified; above all, there are certain anatomical configurations of the eye that make it more likely to arise. The goals of treatment are to reduce the elevated intraocular pressure rapidly, which usually leads to marked symptom relief, as well as to eliminate the situation that led to closed-angle glaucoma. For proper treatment, the patient should be seen by an ophthalmologist without delay, on the day of symptom onset if possible. CONCLUSION Primary prevention of acute closed-angle glaucoma is not always possible. Even physicians who are not ophthalmologists can diagnose markedly elevated intraocular pressure by palpation of the globe. Proper, specific treatment can help patients rapidly and lastingly.
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Affiliation(s)
- Simone Nüßle
- Department of Ophthalmology, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Thomas Reinhard
- Department of Ophthalmology, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Jan Lübke
- Department of Ophthalmology, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
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Ahmad R, Mehta H. The ocular adverse effects of oral drugs. Aust Prescr 2021; 44:129-136. [PMID: 34421178 PMCID: PMC8377292 DOI: 10.18773/austprescr.2021.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Some commonly prescribed drugs have ocular adverse effects. Many parts of the eye can be affected by oral drugs. Some ocular adverse effects may be reversed with medical or surgical intervention whereas other drugs may cause irreversible loss of vision The risk of visual loss can be reduced by a number of approaches, including monitoring for ocular toxicity, reducing the drug dose, or stopping the drug and looking for an alternative. This can be supported by good communication between the prescribing clinician and ophthalmologist Infrequent or delayed ocular adverse effects may not be identified in clinical trials of new drugs. Reporting adverse events is therefore important
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Affiliation(s)
| | - Hemal Mehta
- Strathfield Retina Clinic, Sydney.,Save Sight Registries, University of Sydney
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Barosco G, Morbio R, Chemello F, Tosi R, Marchini G. Bilateral angle-closure during hospitalization for coronavirus disease-19 (COVID-19): A case report. Eur J Ophthalmol 2021; 32:NP75-NP82. [PMID: 33885335 PMCID: PMC9111899 DOI: 10.1177/11206721211012197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose: This report describes a case of bilateral primary angle closure (PAC)
progressing to unilateral end-stage primary angle closure glaucoma (PACG)
associated with treatment for coronavirus disease-19 (COVID-19)
infection. Methods: A 64-year-old man came to our attention because of blurred vision after a
2-month hospital stay for treatment of COVID-19 infection. Examination
findings revealed PACG, with severe visual impairment in the right eye and
PAC in the left eye due to plateau iris syndrome. The patient’s severe
clinical condition and prolonged systemic therapy masked the symptoms and
delayed the diagnosis. Medical chart review disclosed the multifactorial
causes of the visual impairment. Ultrasound biomicroscopy (UBM) aided in
diagnosis and subsequent therapy. Results: The cause behind the primary angle closure and the iridotrabecular contact
was eliminated by bilateral cataract extraction, goniosynechialysis, and
myotic therapy. Conclusions: COVID-19 treatment may pose an increased risk for PAC. Accurate recording of
patient and family ophthalmic history is essential to prevent its onset.
Recognition of early signs of PAC is key to averting its progression to
PACG.
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Affiliation(s)
- Guido Barosco
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Roberta Morbio
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Francesca Chemello
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Roberto Tosi
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Giorgio Marchini
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
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Abstract
This article provides a practical review of the diagnosis and management of angle closure induced by psychotropic agents, including tricyclic antidepressants, antipsychotics and anticonvulsants. Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, monoamine oxidase inhibitors and antipsychotics may trigger angle closure by influencing pupil configuration through adrenergic, anticholinergic, serotonergic or dopaminergic mechanisms. Patients with narrow iridocorneal angles are at risk, and these are more common in people with hypermetropia (near-sightedness), older people and individuals with an Asian background. These patients may benefit from a laser peripheral iridotomy, either prophylactically or to relieve an acute angle-closure episode. An idiosyncratic reaction to medications such as topiramate may lead to angle closure through an alternate mechanism, leading to a uveal effusion. Ophthalmological review may be considered prior to commencing medications in high-risk patients.
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32
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Orduna-Hospital E, Cordón B, Vilades E, Garcia-Martin E, Garcia-Campayo J, López-Del-Hoyo Y, Polo V, Larrosa JM, Pablo LE, Satue M. Ganglion Cell and Retinal Nerve Fiver Layers Correlated with Time Disease of Bipolar Disorder Using 64 Cell Grid OCT Tool. Curr Eye Res 2021; 46:1214-1222. [PMID: 33455447 DOI: 10.1080/02713683.2021.1877313] [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: 10/22/2022]
Abstract
MATERIALS AND METHODS Twenty-five eyes of 25 patients with bipolar disorder and 74 eyes of 74 healthy controls underwent retinal measurements of retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness. Measurements were obtained using the Spectralis-OCT device with the new Posterior Pole protocol which assesses the macular area by analyzing retinal thickness in a grid of 64 (8*8) cells. RESULTS Significant differences (p < 0.05) in RNFL and GCL thickness were found between BD patients and healthy controls, in parafoveal and perifoveal cells respectively. Significant inverse correlations were found between RNFL and GCL thinning at their thickest location and the duration of bipolar disorder. Several predictive variables were observed with a binary logistic regression for the presence/absence of BD: cell 1.3 RNFL (p = 0.028) and GCL in cells 7.8 (p = 0.012), 2.7 (p = 0.043) and 1.3 (p = 0.047). CONCLUSION Posterior Pole OCT protocol is a useful tool to assess changes in the inner retinal layers in bipolar disorder. These observed changes, especially those affecting the GCL, may be associated with disease evolution and may be predictive of the presence of the disease. OCT data could potentially be a useful tool for clinicians to diagnose and monitor BD patients.
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Affiliation(s)
- Elvira Orduna-Hospital
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Beatriz Cordón
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Elisa Vilades
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Elena Garcia-Martin
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | | | - Yolanda López-Del-Hoyo
- Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - Vicente Polo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Jose M Larrosa
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Luis E Pablo
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - Maria Satue
- Miguel Servet Ophthalmology Research and Innovative Group (GIMSO), Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain.,Ophthalmology Department, Miguel Servet University Hospital, Zaragoza, Spain
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Toxische Retinopathien. Ophthalmologe 2020; 117:1247-1266. [DOI: 10.1007/s00347-020-01260-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW Eye pain is one of the most common presenting symptoms in ophthalmology. It can range from bothersome to debilitating for patients, and it can be vexing for clinicians, especially in the white and quiet eye. The purpose of this review is to provide updates of recent literature regarding eye pain and to communicate our current understanding regarding the evaluation and management of conditions that cause eye pain with a relatively normal examination. RECENT FINDINGS This review concerns recent literature regarding eye pain in the white and quiet eye. It is arranged by cause of pain and discusses dry eye syndrome, recurrent corneal erosion, postrefractive surgical pain, eye strain, intermittent angle closure, benign essential blepharospasm, trochleodynia, trochleitis and trochlear headache, and posterior scleritis. SUMMARY Eye pain in the white and quiet eye remains a difficult-to-navigate topic for practitioners. However, a careful history and focused physical examination can elucidate the diagnosis in many cases. Recent updates to the literature have advanced our knowledge of how to identify and treat the underlying causes of eye pain.
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Affiliation(s)
- Jerome Kulenkamp
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN
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Abstract
PURPOSE To describe a case of zonisamide-induced bilateral choroidal effusion. CASE REPORT A 72-year-old woman presented with a 4-day history of bilateral blurred vision 9 days after initiating oral zonisamide for essential tremor. Clinical examination revealed an asymmetric choroidal detachment with open anterior chamber angle and intraocular pressure within the normal range. Posterior segment ultrasonography and ultrasound biomicroscopy both confirmed the presence of bilateral ciliochoroidal effusion. Zonisamide treatment was discontinued. One month after treatment discontinuation, the ophthalmological examination was normal and no further treatment was needed. CONCLUSION Zonisamide can cause an idiosyncratic reaction leading to choroidal effusion with or without acute angle closure. Early withdrawal of the causative agent is the key to reversing this condition. These findings indicate that zonisamide and other sulfa-derived drugs must be ruled out in the differential diagnosis of choroidal effusion of unknown cause.
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