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At least 1,045 records · Page 58Linked to original sources
PubMed2005

Progression of peripheral anterior synechiae after laser iridotomy.

PURPOSE: To determine the incidence and to characterize the risk factors of peripheral anterior synechiae (PAS) progression after laser iridotomy (LI). DESIGN: Retrospective observational cohort study. METHODS: The extents of pre- and postlaser PAS and ocular and systemic data were obtained from the charts of 54 primary angle-closure glaucoma patients (59 eyes), all of whom had undergone LI. RESULTS: PAS progressed in 19 of the 59 eyes (32.2%), during a mean follow-up period of 34.4 months (range, 6-95 months). Multivariate analysis showed that the presence of plateau iris (P = .024), and a high intraocular pressure 1 hour before LI (P = .042) were risk factors of PAS progression. CONCLUSION: Approximately one of three of the eyes showed PAS progression during a 3-year follow-up period after LI. The probability of progression was found to be higher in the eyes that exhibited plateau iris and in eyes that proved to be relatively unresponsive to medication before LI.

Aged↗
PubMed2005

High-speed optical coherence tomography of laser iridotomy.

PURPOSE: To describe high-speed (4000 axial scans/s) optical coherence tomography (OCT) findings in a patient with narrow angles. DESIGN: Interventional case report. METHODS: A 56-year-old woman was found to have occludable narrow angles on OCT screening. This was confirmed by gonioscopy. Bilateral iridotomy was performed. Imaging of the angles was performed with a high-speed OCT prototype before and after iridotomy. RESULTS: OCT showed narrow angle bilaterally. Cornea, sclera, scleral spur, trabecula, iris, and iris recess were visualized. After iridotomy, the OCT showed reduction of iris concavity and patent iridotomies. Quantitative measurements of trabecula-iris space area on the OCT images showed widening of the angles to nonoccludable values. CONCLUSIONS: A 1.3-microm wavelength OCT allows noncontact quantitative assessment of the angle and may be useful in the management of narrow-angle glaucoma.

Diagnostic Techniques, Ophthalmological↗
PubMed2006

Small ciliary body tumors: ultrasound biomicroscopic assessment and follow-up of 42 patients.

PURPOSE: Detecting and following small tumors of the ciliary body is a particular challenge because of their location. Recently high-frequency ultrasound biomicroscopy (UBM) has been used to assist in this task. The aim of this study was to evaluate this subset of small ciliary body tumors through the use of UBM. DESIGN: Retrospective, noncomparative case series. METHODS: Forty-two patients with small ciliary body tumors (less than 4 mm) from our institution were included in the study with a median follow-up of 4.3 years. UBM was used to assess tumor characteristics including height, location, and internal and external features. The data were collected longitudinally, and statistical analysis was performed. RESULTS: Median initial tumor height was 2.05 mm (range 1.1 to 3.8 mm) as measured by UBM. By 5 years after diagnosis, five tumors (12%) exhibited growth. The overall mean growth rate was 0.026 mm per year (P = .00007). The most rapid period of growth was in the first year after diagnosis (growth rate 0.128 mm per year), after which the mean tumor size appeared to stabilize. CONCLUSIONS: UBM is a valuable tool for detecting and following small ciliary body tumors (less than 4 mm), as these lesions may go undetected by other methods. Despite the potential for local extension into the iris or choroid, few of the tumors in this study exhibited growth, suggesting that many of these tumors can be managed conservatively. UBM can be used to assess various internal tumor features; however, arriving at a specific diagnosis without histologic correlation is difficult.

Adolescent↗
PubMed2006

Inferior corneal decompensation following laser peripheral iridotomy in the superior iris.

PURPOSE: To describe a previously unreported clinical entity of inferior corneal decompensation occurring as a long-term complication of superior laser peripheral iridotomy. DESIGN: Retrospective, non-comparative observational case series. METHODS: Chart review of 14 subjects (16 eyes) with inferior corneal decompensation. RESULTS: All patients were Chinese, most were females (71.4%), and the mean age was 69.5 +/- 8.1 year. The mean interval from iridotomy to the onset of inferior corneal decompensation was 66.1 +/- 34.0 months. The most common indication for laser iridotomy was for prophylaxis, either in the fellow eye of acute angle closure (43.8%) or for occludable angles (12.5%). CONCLUSIONS: Corneal decompensation in the inferior part of the cornea at a site remote from the iridotomy is a rare but important complication of laser iridotomy. Because many of the laser iridotomies were performed prophylactically in eyes without glaucoma, patients may need to be warned of this risk.

Aged↗
PubMed2004

Pupillary block glaucoma secondary to posterior chamber phakic intraocular lens implantation for high myopia.

We describe a complication of posterior chamber phakic intraocular lens (PCP IOL) implantation for high myopia. Both eyes of a 44-year-old patient were treated prophylactically with a neodymium:YAG laser iridotomy before PCP IOL implantation. Bilateral PCP IOL implantation was performed uneventfully, although a peripheral iridotomy was required immediately after implantation in the right eye because of early pupillary block glaucoma. Two months later, the left eye developed pupillary block glaucoma despite apparently patent iridotomies. The PCP IOLs were subsequently removed.

Adult↗
PubMed2004

Unusual presentation of angle-closure glaucoma treated by phacoemulsification.

We report the case of a 70-year-old woman with a history of acute primary angle-closure glaucoma (PACG) in the left eye who, 2 hours after a fundus examination and mydriasis, experienced acutely elevated intraocular pressure (IOP) up to 40 mm Hg in the presence of fully dilated pupil and a patent iridotomy. Gonioscopy revealed appositional angle closure in 3 quadrants. After medical control of the IOP, sutureless cataract surgery was performed, including clear corneal incision, phacoemulsification, and soft acrylic posterior chamber intraocular lens (IOL) implantation. Eighteen months after the operation, improvement of visual acuity, widening of anterior chamber angle, and deepening of anterior chamber depth were found. Intraocular pressures are now normal without medication, even after mydriasis. Modern cataract surgery is an effective treatment for selected patients with appositional angle closure and IOP elevation after acute PACG.

Acute Disease↗
PubMed2005

Pupil block glaucoma after neodymium:YAG capsulotomy in a patient with a partially subluxated posterior chamber intraocular lens.

A 73-year-old-woman presented following neodymium:YAG capsulotomy for posterior capsular opacification with acute glaucoma. Previous cataract surgery had left her with a subluxated lens. Cornea edema obscured detail of the anterior chamber, but the edge of the lens could be seen clearly within the pupillary space. This produced a diagnostic dilemma because no obvious cause for pupil block could be seen. She failed to respond to medical therapy and had a laser iridotomy, following which her symptoms resolved. We believe this case demonstrates the importance of a laser iridotomy to exclude pupil block glaucoma when adequate visualization of the pupillary space is obscured.

Aged↗
PubMed2005

Brimonidine 0.15% versus apraclonidine 0.5% for prevention of intraocular pressure elevation after anterior segment laser surgery.

PURPOSE: To compare the efficacy and safety of brimonidine 0.15% with those of apraclonidine 0.5% in preventing intraocular pressure (IOP) elevations after anterior segment laser surgery. SETTING: Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts, USA. METHODS: This double-masked randomized trial 80 eyes of 80 patients who had laser peripheral iridotomy, argon laser trabeculoplasty, or neodymium:YAG laser capsulotomy. Eyes received 1 drop of brimonidine 0.15% or apraclonidine 0.5% before laser surgery. Intraocular pressure, heart rate, and blood pressure were measured before laser surgery and at 1 hour, 3 hours, 24 hours, and 1 week after laser surgery. RESULTS: Before laser treatment, 41 patients received brimonidine 0.15% and 39 received apraclonidine 0.5%. Thirteen (31.7%) patients in the brimonidine group and 11 (28.2%) in the apraclonidine group had postoperative IOP elevations of 5 mm Hg or more (P = .5). Four patients (9.8%) in the brimonidine group and 3 (7.7%) in the apraclonidine group had IOP increases of 10 mm Hg or more (P = .5). There were no statistically significant changes in mean heart rate or blood pressure in either group except a slight reduction in diastolic blood pressure at 1 hour in the brimonidine group (-4.7 +/- 9.2 mm Hg) compared with that in the apraclonidine group (-0.1 +/- 9.1 mm Hg) (P = .01). No clinically significant side effects were noted in either group. CONCLUSION: A single preoperative drop of brimonidine 0.15% had similar efficacy and safety as apraclonidine 0.5% in preventing IOP elevations immediately after anterior segment laser surgery.

Adrenergic alpha-Agonists↗
PubMed2006

Phacoemulsification and intraocular lens implantation for acute angle closure not treated or previously treated by laser iridotomy.

PURPOSE: To determine the effect of phacoemulsification, aspiration, and intraocular lens (IOL) implantation in eyes with acute angle closure or eyes with prior laser iridotomy for acute angle closure. SETTING: Department of Ophthalmology, Oita Prefectural Hospital, Oita, Japan. METHODS: Eighteen eyes with acute angle closure and 8 eyes with cataracts that had a prior acute angle closure treated by laser iridotomy had phacoemulsification, aspiration, and IOL. A third group that had phacoemulsification, aspiration, and IOL for cataracts only served as controls. The preoperative and postoperative intraocular pressures (IOPs), visual acuities, and number of antiglaucoma medications were compared between these 3 groups. RESULTS: The mean IOPs in the eyes with phacoemulsification, aspiration, and IOL alone and the eyes with prior acute angle closure treated by laser iridotomy were decreased significantly after phacoemulsification, aspiration, and IOL. The mean IOPs in the control group also decreased, but not significantly. There was no significant difference in the postoperative IOP between the 3 groups. The postoperative visual acuities were improved significantly in the 3 groups, and the differences in the final visual acuities were not significant. Postoperatively, the antiglaucoma medication was not needed in the phacoemulsification, aspiration, and IOL-alone group, but medication was necessary in eyes treated previously with laser iridotomy. CONCLUSION: Phacoemulsification with IOL implantation lowered IOP, improved visual acuity, and diminished the need for antiglaucoma medication in eyes with acute angle closure and with a prior acute angle closure treated by laser iridotomy.

Acute Disease↗
PubMed2006

Iris and trabecular meshwork pigment changes after posterior chamber phakic intraocular lens implantation.

PURPOSE: To evaluate the changes in laser iridotomies, intraocular pressure (IOP), angle structures, and pupil diameter after implantable contact lens (ICL) (Version 4 Staar Surgical) implantation in myopic Asian eyes. SETTING: Department of Ophthalmology, Chung-Ang University Yongsan Hospital, Seoul, Korea. METHODS: The ICL was implanted in 81 eyes of 43 patients with spherical equivalent greater than -6.00 diopters. Gonioscopy examination was performed 1 day after laser iridotomy and 6 and 12 months after ICL implantation. The changes in laser iridotomy sites, IOP, and pupil diameter were also evaluated. RESULTS: Ten eyes (12.3%) had occlusion or narrowing of the laser iridotomy sites. The angle width was more than 30 degrees in all cases preoperatively but narrowed to less than 20 degrees in 16 eyes (19.8%) 6 months postoperatively. The mean pigment, measured by the semiquantitative method (grade 0 to 4), was 2.03 in the inferior angle, 0.18 in the nasal angle, 0.12 in the temporal angle, and 0.00 in the superior angle 12 months postoperatively. The pigment in all quadrants increased temporally as a result of the laser iridotomy or iris rubbing by the ICL; however, the pigments absorbed gradually and decreased to values before laser iridotomy 12 months postoperatively. There was a temporary increase in IOP from the instillation of steroid eyedrops 1 week and 1 month postoperatively; IOP returned to the preoperative level and remained there 12 months postoperatively. There was a significant decrease in pupil diameter 1 and 3 months postoperatively; the diameter returned to the preoperative size at 6 and 12 months. Pigment dispersion syndrome and pigmentary glaucoma were not seen. CONCLUSION: Implantation of the ICL narrowed the angle width but did not increase trabecular pigmentation compared with values after laser iridotomy, indicating ICL implantation is safe regardless of the pigmentary changes in the trabecular meshwork.

Adult↗
PubMed2007

Malignant glaucoma after phacoemulsification: treatment with diode laser cyclophotocoagulation.

Phacoemulsification was performed in an 84-year-old woman with ocular hypertension and narrow drainage angles, previously treated by neodymium:YAG (Nd:YAG) laser peripheral iridotomy. Despite temporal zonular weakness, the surgery was uneventful. An intraocular lens (IOL) was placed and centered in the capsular bag. Two months later, the patient presented with malignant glaucoma. The IOL optic was anteriorly displaced in the capsular bag, and the IOL shift correlated with a -4.0 diopter myopic refractive error. There was no response after medical treatment or Nd:YAG hyaloidotomy. One week later, a single treatment with transscleral diode laser cyclophotocoagulation was performed. The intraocular pressure normalized and the anterior chamber deepened within 48 hours. The patient's condition has remained stable for 3 months with no further treatment; the Snellen visual acuity is 6/9. If medical therapy fails to control malignant glaucoma, cyclodiode laser treatment may be more effective and have fewer risks than current laser and surgical interventions.

Aged, 80 and over↗
PubMed2004

Changes in retinal nerve fiber layer thickness after acute primary angle closure.

PURPOSE: To evaluate the changes in retinal nerve fiber layer (RNFL) thickness in the first 16 weeks after acute primary angle closure (APAC) using scanning laser polarimetry (SLP). DESIGN: Prospective, observational case series. PARTICIPANTS: Thirty-seven Asian subjects with APAC. METHODS: For all cases, APAC had resolved after treatment, and the study was conducted during the follow-up period after the acute episode. Using the GDx Nerve Fiber Analyzer (Laser Diagnostic Technologies, San Diego, CA), the RNFL was assessed in both eyes 2 weeks after APAC, and again after 16 weeks. The SLP parameters were compared between week 2 and week 16 within affected and fellow eyes. A multiple logistic regression analysis was carried out to analyze factors likely to influence RNFL outcome. MAIN OUTCOME MEASURES: Superior and inferior average RNFL thickness. RESULTS: The mean age of study subjects was 60.1+/-10.3 years (range, 46-91 years), and most subjects were female (68%) and Chinese (86%). In APAC eyes, the superior average RNFL thickness decreased from 63.8+/-13.6 microm to 61.4+/-11.2 microm (P = 0.04) and the inferior average RNFL thickness decreased from 69.5+/-14.4 microm to 66.3+/-12.6 microm (P = 0.005). There was also a decrease in inferior ratio (P = 0.008) and ellipse modulation (P = 0.02). In the fellow eyes, there was no difference found between week 2 and week 16 for any of the SLP parameters studied. Logistic regression analysis showed no significant association between developing a 10% reduction in either superior or inferior RNFL thickness with age, gender, history of ischemic risk factors, duration of symptoms during APAC, the level of presenting intraocular pressure (IOP), or the development of a rise in IOP between study visits. CONCLUSIONS: After an episode of APAC, superior and inferior average RNFL thickness was found to decrease significantly from week 2 to week 16.

Acute Disease↗
PubMed2004

Acute primary angle closure: configuration of the drainage angle in the first year after laser peripheral iridotomy.

PURPOSE: To evaluate the changes in the configuration of the drainage angle in the first year after acute primary angle closure (APAC). DESIGN: Prospective observational case series. PARTICIPANTS: Forty-four Asian subjects with APAC. METHODS: Acute primary angle closure cases were treated with medical therapy followed by laser peripheral iridotomy (LPI). Static and dynamic gonioscopies were performed in APAC-affected and fellow eyes before LPI (baseline) and then at 2 weeks, 4 months, and 12 months after presentation. The angles were graded in each quadrant according to the Shaffer scheme, and the number of clock hours of peripheral anterior synechiae (PAS) was recorded. Patients who underwent intraocular surgery at any point during follow-up were excluded from the study. Intraocular pressure (IOP) and medical treatment were documented at each visit, and gonioscopic changes were correlated with the development of elevation in IOP requiring medical treatment. MAIN OUTCOME MEASURES: Average Shaffer grade and the number of clock hours of PAS. RESULTS: The majority of subjects were Chinese (84%) and female (64%), and the mean age was 60.2+/-10.7 years. At presentation, 73% of both affected and fellow eyes had very narrow angles (average Shaffer grade < or = 1), with affected eyes having more extensive PAS (P<0.001), a third of whom had > or =8 clock hours of PAS. In APAC eyes, there was a significant increase in angle width from baseline to 2 weeks after LPI (P = 0.045), but no change in angle width subsequently. Fellow eyes showed a widening of the angle between baseline and week 2 (P = 0.01) and from week 2 to month 4 (P = 0.001). There was no significant change in PAS in either affected or fellow eyes over the 12 months of follow-up. Of the 44 subjects, 19 (41.3%) subsequently developed IOP elevation during follow-up that required treatment. However, there was no difference in angle width or amount of PAS between eyes with and without a subsequent rise in IOP, and the angle configuration did not change significantly in either group over 1 year. CONCLUSION: In Asian eyes with APAC, the angle widened in the first 2 weeks after LPI, but did not change thereafter over 1 year, and the amount of PAS remained stable throughout. The results indicate the effectiveness of LPI in preventing progressive closure of the angle in the first year after APAC.

Acute Disease↗