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PubMed1979

Transient ocular hypertension following trabeculectomy.

A study of the postoperative evolution of 70 eyes subjected to trabeculectomy over a 3-year period is reported. This is the operation of choice in our department in cases of chronic open-angle glaucoma and chronic angle-closure glaucoma. The study showed that in 35.7% of the operated eyes the intraocular pressure was increased on the second postoperative day and became normal within a week. This raised intraocular pressure did not influence the final result of the operation.

Follow-Up Studies↗
PubMed1977

[Biometry of the malignant glaucoma (author's transl)].

The survey of a population of 7 patients with malignant glaucoma, whose 3 were bilateral, showed that the total length of these eyes was weaker, the corneal radius shorter, the anterior chamber more shallow and the insertion of the lens more anterior than that of eyeballs with angle-closure glaucoma on the whole. These latter, we must remind, are already smaller than normal eyes. But this lessening of size does not affect the corneal diameter which remains always normal. And the lens, which is greater than normally in the angle-closure glaucoma, in the contrary is normal or smaller in the malignant glaucoma. The authors think that this little size of the lens allows it to be dislocated anteriorly through the limbal ring after the operation, and so is the cause of the post-surgical malignant glaucoma.

Biometry↗
PubMed1979

Anterior chamber volume. Its measurement and clinical application.

Measurement of anterior chamber volume is discussed and attention drawn to a new, convenient slit-image method, which was used to study anterior chamber depth and volume before and after prophylactic peripheral iridectomy in the fellow eyes of patients presenting with unilateral acute angle-closure glaucoma. There was no significant change in depth after iridectomy but the mean anterior chamber volume increased significantly (P less than 0.01), by nearly 3 per cent. This increase was due to elimination of peripheral iris bombé which was not present in two control groups of normal eyes, one matched for anterior chamber depth and the other for age and refraction. Peripheral iris bombé may be a quantifiable factor predisposing to the development of acute angle-closure glaucoma.

Adult↗
PubMed1979

Laser iridotomy in closed-angle glaucoma.

An argon laser iridotomy was performed on 53 eyes of 34 patients with closed-angle glaucoma. Technically, all of the iridotomies were successful. Blue irides were more resistant to treatment than brown irides. The iridotomies were performed with high energy of 2 W and a very short exposure time of 0.01 to 0.04 s, thus minimizing thermal damage to adjacent tissues. Patients with narrow angles who underwent preventive laser irodotomy benefited most from the procedure, and all the eyes of this group maintained a normal intraocular pressure (IOP) after the iridotomy. Of the 20 eyes with acute angle-closure glaucoma, 17 maintained a normal IOP after iridotomy, and only three were resistant to this treatment, calling for filtering operations later. The IOP of eyes with chronic closed-angle glaucoma did not change after the procedure, and the iridocorneal angles remained practically the same. Argon laser iridotomy by this technique is highly recommended as the procedure of choice for eyes with acute angle-closure glaucoma and for preventive iridotomy in the fellow eye. The procedure is simple, is performed in the outpatient clinic, and engenders no major complications.

Follow-Up Studies↗
PubMed2026

Incidence patterns and genetic validation of primary glaucoma subtypes among 1 million adults in China and the UK.

BACKGROUND/AIMS: Primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) are distinct diseases, yet many glaucoma cases in population-based datasets lack subtype specification. We assessed incidence patterns of glaucoma subtypes in China and the UK and used genetic evidence to infer the likely subtype composition of cases recorded as unspecified glaucoma. METHODS: Incident primary glaucoma was identified from linked inpatient records in the prospective China Kadoorie Biobank (CKB; n=512 504) and UK Biobank (UKB; n=492 329) studies. Cohort-specific phenotyping algorithms defined POAG, PACG and unspecified glaucoma. Adjusted incidence rates were estimated by direct standardisation. To support subtype inference, polygenic risk scores (PRSs) were constructed using ancestry-specific genome-wide association studies, including a new East Asian PACG meta-analysis, and tested for association with glaucoma phenotypes using multivariable logistic regression. RESULTS: Over 12 years of follow-up, 1658 primary glaucoma cases were identified in CKB and 7643 in UKB. Most (>68%) cases lacked subtype specification. Incidence increased with age and was twofold higher among women for PACG in both cohorts and for unspecified glaucoma in CKB. In UKB, POAG incidence was fivefold higher among Black than White participants, with a similar but attenuated pattern for unspecified glaucoma. PRS analyses indicated that unspecified glaucoma closely aligned with PACG in CKB but was more heterogeneous in UKB. CONCLUSION: Healthcare-recorded incidence patterns for POAG and PACG were consistent with established demographic risk factors, whereas unspecified glaucoma showed differences in subtype composition between populations. Integrating epidemiological and genetic evidence improves interpretation of glaucoma phenotypes when detailed clinical information is unavailable.

Epidemiology↗
PubMed1978

[The effect of low concentrations of pilocarpine with phenylephrine on intraocular pressure in glaucoma (author's transl)].

Orientating preliminary trials showed that the reducing action of pilocarpine on intraocular pressure is considerably enhanced by adding the alpha-receptor stimulant phenylephrine. Pilocarpine eyedrops 1% and pilocarpine drops 1% with phenylephrine 0.25% were compared in two double-blind crossover studies. Pressure reduction was more pronounced after administering the combination, the width of the pupil remaining unchanged. Attention is drawn to the advantages of pressure reduction without narrowing of the pupils in the treatment of all types of open-angle glaucoma. Miosis is of therapeutical advantage only in angle-closure glaucoma; hence, for reasons of safety, administration of phenylephrine should be avoided.

Clinical Trials as Topic↗
PubMed1979

Recurrent orbital and metastatic melanoma in a patient undergoing previous glaucoma surgery.

A 61-year-old woman had unilateral acute angle-closure glaucoma and subsequently underwent a Scheie filtering operation. After a two-week interval, a large choroidal and ciliary body melanoma in the glaucomatous eye was found. No evidence of metastatic disease was found and the eye was enucleated. Histopathologic sections did not show extrascleral extension. Two and one-half years later the patient developed local orbital recurrence of the melanoma and fatal metastatic disease. We hypothesized a possible causal relationship between the filtering surgery and the local and systemic recurrence of the tumor.

Choroid Neoplasms↗
PubMed1979

A decision-making schema for the detection of glaucoma.

A schema is proposed for management of optometrical patients who may have glaucoma or any of 22 risk factors of glaucoma. The assessment system has established decision points and management pathways based on risk factors in glaucoma which employ only clinical procedures appropriate to current optometrical practice. This schema is particularly designed to permit diagnosis of early angle-closure glaucoma while the disease is in the symptomless phase, prior to chronic elevation of intraocular pressure and the development of damage to the optic disc and visual fields. A recommendation is made for inclusion of the Van Herick test as routine and in the assessment of patients entering the schema. Gonioscopy should form part of the diagnostic workup, but an alternative pathway is established for use when this technique is omitted.

Adult↗
PubMed1976

Thymoxamine hydrochloride: effects on the facility of outflow and intraocular pressure.

Eleven subjects with normal eyes and sixteen subjects with open-angle glaucoma had a selective alpha-adrenergic blocking agent, thymoxamine hydrochloride 0.5 per cent eyedrop, applied to one of their eyes. This consistently produced miosis, but did not significantly alter the intraocular pressure or the tonographically determined facility of aqueous outflow. Because we find that thymoxamine can selectively induce miosis without significant accompanying effect on the ciliary muscle or facility of outflow, we expect that this drug may prove to be a useful diagnostic adjunct to gonioscopy in distinguishing between angle-closure glaucoma and open-angle glaucoma with narrow angle. It seems worthwhile proceeding with clinical evaluation of this possibility.

Adult↗
PubMed1979

[Clinical experiences with timolol eye drops].

Three groups of chronic simple glaucoma (group I: newly adjusted patients; group II: previously satisfactorily pressure-regulated patients; group III: previously notsatisfactorily pressure-regulated patients) received treatment with Timolol eye drops for 4 months. In 34 eyes the intra-ocular pressure could be lowered below 22 mm Hg by Timolol alone, whereas 10 eyes additionally had to be treated with 1% epinephrine. The higher the initial pressure effect, the more pronounced the pressure-lowering properties of Timolol became. Especially in the first 2 weeks, less in the following 14 weeks, Timolol showed a loss in effectiveness. The application of Timolol instead of carbonic anhydrase inhibitors with acute angle-closure glaucoma and secondary glaucoma was successful. Timolol eye drops were tolerated very well. There were no local or systemic side effects.

Adult↗
PubMed2023

The Use of ChatGPT to Assist in Diagnosing Glaucoma Based on Clinical Case Reports.

INTRODUCTION: The purpose of this study was to evaluate the capabilities of large language models such as Chat Generative Pretrained Transformer (ChatGPT) to diagnose glaucoma based on specific clinical case descriptions with comparison to the performance of senior ophthalmology resident trainees. METHODS: We selected 11 cases with primary and secondary glaucoma from a publicly accessible online database of case reports. A total of four cases had primary glaucoma including open-angle, juvenile, normal-tension, and angle-closure glaucoma, while seven cases had secondary glaucoma including pseudo-exfoliation, pigment dispersion glaucoma, glaucomatocyclitic crisis, aphakic, neovascular, aqueous misdirection, and inflammatory glaucoma. We input the text of each case detail into ChatGPT and asked for provisional and differential diagnoses. We then presented the details of 11 cases to three senior ophthalmology residents and recorded their provisional and differential diagnoses. We finally evaluated the responses based on the correct diagnoses and evaluated agreements. RESULTS: The provisional diagnosis based on ChatGPT was correct in eight out of 11 (72.7%) cases and three ophthalmology residents were correct in six (54.5%), eight (72.7%), and eight (72.7%) cases, respectively. The agreement between ChatGPT and the first, second, and third ophthalmology residents were 9, 7, and 7, respectively. CONCLUSIONS: The accuracy of ChatGPT in diagnosing patients with primary and secondary glaucoma, using specific case examples, was similar or better than senior ophthalmology residents. With further development, ChatGPT may have the potential to be used in clinical care settings, such as primary care offices, for triaging and in eye care clinical practices to provide objective and quick diagnoses of patients with glaucoma.

Artificial intelligence (AI)↗
PubMed1979

Mydriatic effect of anticholinergic drugs used during reversal of nondepolarizing muscle relaxants.

Large doses of anticholinergic drugs (atropine, glycopyrrolate) produced mydriasis in a group of adults with no eye abnormalities except strabismus, though the usual intramuscular and intravenous doses of these drugs do not have this tendency. Such large doses are often given intravenously during general anesthesia to prevent the side effects of neostigmine methylsulfate, which is used to reverse the effect of nondepolarizing muscle relaxants. Neostigmine methylsulfate (Prostigmin) reduced the mydriatic effect when given intravenously in conjunction with atropine or glycopyrrolate. Mydriasis was more likely to occur in lightly pigmented eyes than in eyes with dark irides. Pilocarpine eyedrops instilled at the beginning of anesthesia caused miosis that persisted after the large intravenous doses of atropine or glycopyrrolate were given. To prevent an attack of acute angle-closure glaucoma in any patient who is to receive large doses of anticholinergic drugs during general anesthesia, miotic drug therapy should be continued before, during, and after anesthesia at the same frequency as when awake.

Adolescent↗
PubMed1979

Clinical experiences with the use of an automated perimeter (Octopus) in the diagnosis and management of patients with glaucoma and neurologic diseases.

This is a study of 59 patients, 42 with glaucoma and 17 with neurological disease, to compare the Octopus automated perimeter with the conventional Goldmann and Tubinger perimeters for detection and assessment of visual field defects. We believe the Octopus automated perimeter is an excellent method for screening patients suspected of glaucoma and can be expected to identify over 90% of the patients actually having visual field loss due to glaucoma. In patients with neurological disease, the Goldmann perimeter was superior to either the Octopus or Tubinger perimeters in providing clinically useful information.

Adolescent↗
PubMed1977

Ultrasonographic study of the effect of different miotics on the eye components.

The effect of topical instillations of carbachol 3%, pilocarpine 2%, aceclidine 2%, aceclidine 2%-adrenaline 1%, and of the Ocusert delivery system was determined and compared in 151 eyes. The depth of the anterior chamber, the thickness and the position of the lens, the length of the vitreous and the refraction were studied. Aceclidine has negligible side effects on the ocular components (maximal change of the anterior chamber 0.20 mm; maximal change of the lens thickness 0.14 mm; maximal myopisation: -1.5 delta. Carbachol has the strongest side effects (maximal change of the anterior chamber 0.80 mm; maximal change of the lens thickness 0.80 mm; maximal myopisation -11.50 delta). Carbachol and pilocarpine may cause an important forward displacement of the lens with the risk of an angle-closure glaucoma in an eye with shallow anterior chamber.

Administration, Topical↗
PubMed1978

[Contusion and permeability of the hemato-aqueous barrier to fluorescein. Effect of a pretreatment by local indometacine (author's transl].

An experimental study, by angiography of the anterior segment of rabbit's eye, estimates the permeability of the hemato-aqueous barrier, using fluorescein. A trauma of the eye (contusion) leads to a rapid and significant increase in this permeability. However, local pretreatment, using an ophthalmic solution of 0,33% indometacine, almost completely stabilizes the hemato-aqueous barrier, even for elements as diffusible as fluorescein. These results suggest that application of a similar preparation to the human eye could be useful in the treatment of ocular contusions, chemical burns and angle-closure glaucoma. But the best perspective could be the application of the indometacine solution to the eye, before an operation, to reduce the sideeffects of surgery relative to the surgical break of the hemato-aqueous barrier.

Animals↗
PubMed1979

Blindness due to illicit use of topical cocaine.

A drug abuser developed simultaneous bilateral corneal ulcerations after the use of topical cocaine. One eye was enucleated because of secondary angle-closure glaucoma and the other developed a dense central corneal scar.

Administration, Topical↗