Changes in the RNFL.
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Antihypertensive Agents↗
SEARCH · PubMed Health
Results for “IRIDECTOMY”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
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Cataract surgery for residual angle closure after peripheral laser iridotomy.
PURPOSE: To investigate the frequency of residual angle closure after resolution of pupillary blocking by laser peripheral iridotomy and the effects of subsequent cataract surgery to resolve angle closure completely. DESIGN: Retrospective, consecutive, interventional study. PARTICIPANTS: Among 70 eyes treated with laser iridotomy, 13 with residual angle closure were treated with cataract surgery. METHODS: The provocative test of angle closure by prone position in a dark room for 1 hour was performed; increases in tension of > or =8 mmHg, 6 or 7 mmHg, and < or =5 mmHg were considered to be positive, suspected positive, and negative, respectively. Configuration of the anterior chamber was examined using ultrasound biomicroscopy (UBM). MAIN OUTCOME MEASURES: Intraocular pressure (IOP), response to the dark room prone position test, and morphologic analysis by UBM were evaluated before and 3 months after cataract surgery. RESULTS: Residual angle closure after iridotomy was seen in 27 (38.6%) of 70 eyes; this was confirmed functionally by the dark room prone position test and morphologically by UBM. Eyes with IOP of > or =20 mmHg or with a glaucomatous visual field defect before iridotomy had a significantly higher incidence of residual angle closure after iridotomy than eyes without these findings (P<0.05). In all the eyes with residual angle closure after iridotomy, the response to the prone position test became negative after cataract surgery, with significant lowering of IOP (P<0.01). CONCLUSIONS: Residual angle closure after iridotomy was common, especially in eyes with primary angle closure and poorly controlled IOP or glaucomatous optic neuropathy. Cataract surgery was effective to resolve completely the residual angle closure after iridotomy and lower IOP.
Adult↗
Acute primary angle closure.
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Acute Disease↗
Visualization of anterior chamber angle dynamics using optical coherence tomography.
PURPOSE: To describe the technology of optical coherence tomography (OCT) in imaging the anterior chamber angles and its impact on understanding the pathophysiology of angle-closure glaucoma (ACG). DESIGN: Observational case series. PARTICIPANTS: Three subjects with, respectively, impending angle-closure attack, plateau iris syndrome, and phacomorphic glaucoma were recruited. METHODS: The anterior chamber angle in each patient was imaged with a commercially available OCT unit. The angle configurations were assessed and compared before and after laser peripheral iridotomy (LPI) and argon laser peripheral iridoplasty (ALPI). MAIN OUTCOME MEASURES: Visualization of the changes in the anterior chamber angle configurations and normalization of the intraocular pressure (IOP). RESULTS: A patient with impending angle-closure attack precipitated by a topical mydriatic agent was treated with LPI. Optical coherence tomography imaging of the anterior chamber angles was performed before and after the laser procedure. Conversion of anterior iris bowing and angle crowding to iris straightening and angle opening after LPI was demonstrated. Intraocular pressure became normalized with the change in angle configuration. The second patient presented with symptoms of intermittent angle-closure attacks and was initially diagnosed with primary ACG. Despite successful LPI, the angles remained occludable, and the IOP continued to be elevated. Optical coherence tomography was used to review the anterior chamber angle configuration and demonstrated a typical pattern compatible with the diagnosis of plateau iris syndrome. Subsequent ALPI converted the plateau configuration to open angle, with normalization of IOP and disappearance of symptoms. The third patient presented with an acute angle-closure attack and was diagnosed with phacomorphic glaucoma. Argon laser peripheral iridoplasty was performed successfully to open the angle, as evident by the OCT images, and the IOP was brought under control, together with relief of symptoms. CONCLUSIONS: The commercially available OCT unit can be practically employed for anterior chamber angle imaging. The different patterns of angle configurations are correlated with the underlying pathophysiology in different forms of ACG.
Aged↗
Cataract progression after prophylactic laser peripheral iridotomy: potential implications for the prevention of glaucoma blindness.
PURPOSE: To evaluate changes in lens opacity in the first year after prophylactic laser peripheral iridotomy (LPI) performed in fellow eyes of subjects with acute primary angle closure (APAC). DESIGN: Prospective observational case series. PARTICIPANTS: Sixty Asian subjects with unilateral APAC. METHODS: All fellow eyes underwent prophylactic LPI within the first week of presentation, followed by 1 week of topical steroids. The degree of lens opacity was graded at the slit-lamp examination using the Lens Opacity Classification System III (LOCS III) with standard color photographs as the reference for grading of lens opacity. This was performed 2 weeks, 4 months, and 12 months after LPI. Progression in lens opacity was defined as an increase in LOCS III grade by 2 or more units in any lens region. MAIN OUTCOME MEASURES: Lens Opacity Classification Sytem III grades in nuclear, cortical, and posterior subcapsular (PSC) regions. RESULTS: Most patients were Chinese (85%) and female (63.3%), with an average age of 61.5 +/- 10.6 years. The mean baseline LOCS grades in the nuclear, cortical, and PSC regions were 3.58 +/- 0.74, 0.57 +/- 1.08, and 0.23 +/- 0.72, respectively. With 12 months of follow-up, 14 of the 60 eyes (23.3%; 95% confidence interval, 16.9-29.7%) showed significant progression in any lens region. Progression in the nuclear, cortical, and PSC regions was documented in 5%, 6.7%, and 16.7% of cases, respectively. By use of logistic regression, the following factors were not found to be significant for cataract progression in any lens region: age, race, gender, history of hypertension or diabetes, presence of peripheral anterior synechiae or angle width at baseline, and total laser energy delivered. CONCLUSIONS: In fellow eyes of APAC, prophylactic LPI is complicated by significant cataract progression, mainly in the posterior subcapsular region. These findings may have implications for the role of prophylactic LPI in the prevention of angle-closure blindness.
Acute Disease↗
Changes in the optic disc after acute primary angle closure.
PURPOSE: To evaluate the changes in optic disc morphology in the first 4 months after an episode of acute primary angle closure (APAC) using stereoscopic optic disc photography and computer-assisted planimetry. DESIGN: Prospective observational case series. PARTICIPANTS: Forty-seven Asian subjects with unilateral APAC who were successfully treated with laser peripheral iridotomy (LPI). MAIN OUTCOME MEASURES: Cup-to-disc ratio (CDR) and optic cup and neuroretinal rim areas. METHODS: Stereoscopic optic disc photographs were taken 2 and 16 weeks after LPI, and the images were analyzed by computer-assisted planimetry. The overall, quadrantic, and 30 degrees sector areas of the optic disc, CDR, and neuroretinal rim area were analyzed by 2 independent masked graders, and the mean of the readings was used to calculate changes in optic disc parameters. RESULTS: The majority of the subjects were female (66%) and Chinese (90%), and the mean age was 67.6+/-11.2 years (range, 40-94). In APAC eyes from week 2 to week 16, the mean CDR increased from 0.56+/-0.05 to 0.59+/-0.03 (P<0.001), and the mean neuroretinal rim area decreased from 1.74+/-0.31 mm2 to 1.59+/-0.27 mm2 (P<0.001). Quadrantic and sector analysis showed preferential loss of neuroretinal rim area at the superotemporal and inferotemporal areas. There was no significant change in optic disc parameters in the fellow eyes over the study period. CONCLUSIONS: This study demonstrated changes in optic disc morphology from week 2 to week 16 after an episode of APAC. The pattern of optic nerve damage demonstrated in our study was comparable with that seen in primary open-angle glaucoma and experimental glaucoma models.
Acute Disease↗
Cataract after laser iridotomy.
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Acute Disease↗
Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes.
OBJECTIVE: To evaluate noncontact anterior segment optical coherence technology (AS-OCT) as a qualitative method of imaging the anterior chamber angle and to determine its ability to detect primary angle closure when compared with gonioscopy in Asian subjects. DESIGN: Prospective observational case series. PARTICIPANTS: Two hundred three subjects were recruited from glaucoma clinics in Singapore with diagnoses of primary angle closure, primary open-angle glaucoma, ocular hypertension, or cataract. Both eyes (if eligible) of each patient were included in the study. Exclusion criteria were pseudophakia or previous glaucoma surgery. METHODS: Images of the nasal, temporal, and inferior angles were obtained with AS-OCT in dark and then light conditions. Gonioscopic angle width was graded using the Spaeth classification for each quadrant in low lighting conditions. MAIN OUTCOME MEASURES: Angle closure was defined by AS-OCT as contact between the peripheral iris and angle wall anterior to the scleral spur and by gonioscopy as a Spaeth grade of 0 degree (posterior trabecular meshwork not visible). Comparison of the 2 methods in detecting angle closure was done by eye and by individual. Sensitivities and specificities of AS-OCT were calculated using gonioscopy as the reference standard. RESULTS: Complete data were available for 342 eyes of 200 patients. Of the patients, 70.9% had a clinical diagnosis of treated or untreated primary angle closure. Angle closure in > or =1 quadrants was detected by AS-OCT in 142 (71%) patients (228 [66.7%] eyes) and by gonioscopy in 99 (49.5%) patients (152 [44.4%] eyes). The inferior angle was closed more frequently than the nasal or temporal quadrants using both AS-OCT and gonioscopy. When performed under dark conditions, AS-OCT identified 98% of those subjects found to have angle closure on gonioscopy (95% confidence interval [CI], 92.2-99.6) and led to the characterization of 44.6% of those found to have open angles on gonioscopy to have angle closure as well. With gonioscopy as the reference standard, specificity of AS-OCT in the dark was 55.4% (95% CI, 45.2-65.2) for detecting individuals with angle closure. CONCLUSION: Anterior segment OCT is a rapid noncontact method of imaging angle structures. It is highly sensitive in detecting angle closure when compared with gonioscopy. More persons are found to have closed angles with AS-OCT than with gonioscopy.
Adult↗
Evaluation and management of plateau iris syndrome: case report and review.
BACKGROUND: This article documents a case of plateau iris syndrome and provides a review of the current concepts regarding the pathogenesis, diagnosis, and management of this condition. CASE REPORT: A patient who had patent peripheral iridotomies O.D. and O.S. to treat previous episodes of acute angle closure came to clinic with unilaterally elevated intraocular pressures, narrow anterior chamber angles, and a flat iris configuration. The patient was diagnosed with plateau iris syndrome. CONCLUSIONS: The clinician must be aware of, and be able to distinguish, the clinical signs that are characteristic of plateau iris syndrome. An understanding of the mechanisms involved in the development of this type of primary angle closure may facilitate its appropriate diagnosis and management.
Anterior Chamber↗
Prevalence of ciliochoroidal effusion after prophylactic laser iridotomy.
PURPOSE: To study the prevalence of ciliochoroidal effusion (CE) after prophylactic laser iridotomy (LI). METHODS: An ultrasound biomicroscope (UBM) examination was performed before, 2, and 24 hours after LI to investigate the changes in supraciliary-choroidal space after LI in circumference of 38 eyes in 23 chronic primary angle-closure patients. Subjects were divided randomly into two groups based on LI settings: 21 eyes by argon laser (Ar-LI group) and argon combined with yttrium-aluminum-garnet (YAG) laser in 17 eyes (Ar-YAG-LI group). Ciliochoroidal effusion was observed predominantly in the inferior sector (12 of 12 eyes, 100%) and rare in nasal part of the eyes (4 of 12 eyes, 33%). Ciliochoroidal effusion appeared more often in the Ar-LI group (10 eyes, 52%) than in the Ar-YAG-LI group (2 eyes, 12%). All CE disappeared 7 days after by UBM observation. CONCLUSIONS: Subclinical CE observed by UBM frequently occurs after LI.
Body Fluids↗
Anterior chamber depth in plateau iris syndrome and pupillary block as measured by ultrasound biomicroscopy.
PURPOSE: To quantitatively analyze the anterior chamber depth (ACD) in patients with pupillary block and plateau iris syndrome. DESIGN: Retrospective, consecutive, observational case series. METHODS: We measured the ACD in 318 eyes of 318 patients who had been diagnosed by ultrasound biomicroscopy as having either pupillary block or plateau iris syndrome. Pupillary block patients were all preiridotomy and plateau iris patients were all postiridotomy. Anterior chamber depth was measured axially from the internal corneal surface to the lens surface using the ultrasound instrument's internal measuring capability. RESULTS: The mean ACD in patients with plateau iris syndrome (n = 181) was significantly smaller than the hypothesized normal ACD (2.04 +/- 0.30 mm vs 3.0 mm, P =.0001). The mean ACD in patients with pupillary block (n = 137) was also significantly smaller than the hypothesized normal ACD (2.17 +/- 0.30 mm vs 3.0 mm, P =.0001). The mean ACD in patients with plateau iris syndrome was significantly smaller than the ACD in patients with pupillary block (2.04 +/- 0.30 mm vs 2.17 +/- 0.30 mm, P =.001). CONCLUSIONS: Review of the literature suggests that patients with plateau iris have a normal or deeper axial ACD compared with pupillary block. This study found that the ACD associated with plateau iris syndrome is shallower than normal and also shallower than in pupillary block.
Adult↗
Intractable secondary glaucoma from hyphema following YAG iridotomy.
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Female↗
Photoreceptor synaptic protein HRG4 (UNC119) interacts with ARL2 via a putative conserved domain.
Human retinal gene 4 (HRG4) (UNC119) is a photoreceptor synaptic protein of unknown function, shown when mutated to cause retinal degeneration in a patient and in a confirmatory transgenic model. ADP-ribosylation factor-like protein 2 (ARL2) was identified as an interactor of HRG4 by the yeast two-hybrid strategy. The presence of ARL2 in the retina and co-localization with HRG4 was confirmed by Western blot and double immunofluorescence analysis, respectively. The interaction of ARL2 with HRG4 was further confirmed by co-immunoprecipitation and direct binding analysis. Phosphodiesterase delta (PDEdelta) is an ARL2-binding protein homologous to HRG4. Amino acid residues of PDEdelta involved in binding ARL2 and forming a hydrophobic pocket were shown to be highly conserved in HRG4, suggesting similarity in binding mechanism and function.
3',5'-Cyclic-GMP Phosphodiesterases↗
A prospective ultrasound biomicroscopy evaluation of changes in anterior segment morphology after laser iridotomy in Asian eyes.
PURPOSE: To prospectively quantify changes in anterior segment morphology after laser iridotomy using gonioscopy and ultrasound biomicroscopy (UBM). DESIGN: Prospective comparative observational case series. PARTICIPANTS: Fifty-five fellow eyes of patients presenting with acute primary angle closure (APAC). METHODS: The fellow eyes of patients presenting with APAC were examined with UBM, A-scan ultrasonography, and optical pachymetry at presentation and 2 weeks after sequential argon/neodymium yttrium-aluminum-garnet laser peripheral iridotomy (LPI). UBM images were analyzed using UBM Pro 2000 software. Baseline measurements were made both under standard lighting conditions and in darkness to look for changes in anterior segment findings. MAIN OUTCOME MEASURES: The degree of angle opening was measured using the angle-opening distance (AOD) at 250 and 500 microm from the scleral spur (AOD250 and AOD500, respectively) and angle recess area (ARA). RESULTS: Fifty-five Asian patients were examined; AOD250, AOD500, and ARA all significantly increased after sequential laser iridotomy (P < 0.002). Gonioscopic grading of the angle opening significantly increased in all 4 quadrants (P < 0.001). The Van Herick grade of limbal anterior chamber depth increased (P < 0.001), whereas the number of eyes classified as occludable decreased (73%-33%, P < 0.001). Anterior chamber depth did not change significantly (2.41 mm +/- 0.28 mm vs. 2.42 mm +/- 0.30 mm, P = 0.43) as measured with optical pachymetry. Increased illumination increased the angle-opening measures, but induced a different alteration in peripheral iris morphology. Illumination-induced changes were greater after iridotomy than before laser treatment. CONCLUSIONS: In Asian eyes at high risk of developing APAC, sequential LPI produced a significant widening of the anterior chamber angle without deepening the anterior chamber centrally. LPI produces changes in iris morphology that are different from those caused by an increase in illumination, indicating that different mechanisms account for angle opening under these 2 conditions.
Acute Disease↗
[Ultrabiomicroscopy and glaucoma].
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Ciliary Body↗
Phakic posterior chamber intraocular lens pupillary block.
A 49-year-old woman developed bilateral pupillary block after implantation of a phakic posterior chamber intraocular lens despite patent-appearing but nonfunctional peripheral iridotomies. This case serves as a basis to identify clinical signs that distinguish this diagnosis from other causes of elevated intraocular pressure and types of pupillary block.
Critical Pathways↗
Goniosynechialysis with lens aspiration and posterior chamber intraocular lens implantation for glaucoma in spherophakia.
A 17-year-old girl presented with bilateral angle-closure glaucoma associated with spherophakia. A previous bilateral laser iridotomy failed to control intraocular pressure (IOP). Goniosynechialysis with lens aspiration and posterior chamber intraocular lens implantation were performed in both eyes. Peripheral iridoplasty was performed 3 days later. The postoperative IOP was controlled without medication for 12 months in the right eye and 24 months in the left eye. By restructuring the physiologic aqueous outflow route, goniosynechialysis safely and effectively treated secondary glaucoma from spherophakia.
Adolescent↗
Choroidal effusion and shallowing of the anterior chamber after adjunctive therapy with latanoprost in a trabeculectomized patient with angle closure glaucoma.
PURPOSE: Choroidal effusion and anterior chamber loss can occur in a trabeculectomized eye either spontaneously or following aqueous suppressant drug use. METHODS: A 50 year-old women with complaints of pain in the left eye (LE) was diagnosed as angle closure glaucoma. She was treated medically and underwent bilateral laser iridotomy. Because of high intraocular pressure it was decided to perform trabeculectomy. During the follow up period, the bleb became flat and after 3 months the IOP was again 24 mmHg with timolol maleate 0.5% and dorzolamide twice a day. Latanoprost was added to the therapy of the LE. RESULTS: 12 days later the patient returned with pain and vision loss in her LE. The anterior chamber was diffusely narrow and ophthalmoscopy showed massive choroidal effusion. CONCLUSION: The possible mechanisms of this complication were discussed.
Anterior Chamber↗