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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.
On 31 eyes (23 patients, average age 74 years) with cataract and primary open-angle or chronic angle-closure glaucoma modified trabeculectomy with lobelike iridencleisis was performed combined with cataract-extraction. They were followed up for periods between 6 months and 3 years. In 84% of cases the i.o. pressure continued to be normalized without further antiglaucomatous therapy, in 16% additional treatment with drugs achieved sufficient lowering of i.o. pressure. In nearly all of the cases I observed a diffuse, very flat filtering bleb. Gonioscopy shows, that filtering channels stay open along the margin of the imbedded iris flap. Complications were rare and demanded no further surgery.
Visual field, acuity, and optic nerve head were evaluated in 24 patients with transient but marked elevations in intraocular pressure. The patient population consisted of 16 patients with angle-closure glaucoma and 7 with high tensions following cataract surgery. In all cases, duration and extent of pressure elevation is documented as well as subsequent visual field, acuity, and fundus examinations. In selected cases, visual field determinations were made during the acute pressure elevation. Previous reports of patients with acute pressure elevation are reviewed. The general absence of glaucomatous field defects in this patient population is discussed with respect to the possible pathogenesis of field loss seen in chronic simple glaucoma.
Fifty diabetics with severe background retinopathy or early proliferative retinopathy underwent retinal scatter photocoagulation with either the argon laser or the xenon arc photocoagulators. Choroidal detachment, exudative retinal detachment, shallowing of the anterior chamber, and secondary angle-closure glaucoma were observed. Exudative retinal detachment and choroidal detachment subsided in two days to 2-1/2 weeks. Glaucoma secondary to choroidal detachment with angle closure was observed in 11 eyes, three of which required medical treatment, although surgical therapy was not needed. This secondary glaucoma was detected in the first two days and subsided in subsequent days, with intraocular pressure reaching pretreatment values at the fifth day. No long-term sequelae were observed in these complications, except in one eye that developed macular edema that lasted for four months with decreased visual acuity; nevertheless, vision returned to the pretreatment level one year after photocoagulation.
A "pulsed" argon laser was successful in 48 of 64 (75%) attempted laser iridotomies. Scanning and transmission electron microscopy performed on specimens taken at varying intervals following laser treatment revealed progressive scarring of iris tissue. The complications appear minimal at this time, but longer follow-up is required before it can be stated that laser and surgical peripheral iridectomies are comparable. However, the laser's simplicity and ease of administration appear to warrant its continued use at this time.
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The results of combined thermotrabeculocanalotomy-cataract extraction are reported on 9 cases, 7 of which are glaucoma cases controlled by medical therapy, one secondary glaucoma following chronic angle-closure, and one secondary glaucoma following trauma. The results were satisfactory both in terms of visual acuity and lessening reliance on medical therapy of the glaucoma following surgery. More importantly, the safety of the procedure is emphasized, which further indicates that the combined procedure should be considered as the procedure of choice when a cataract must be extracted in a patient with glaucoma.
Biometric measurements were performed in 67 patients after acute glaucoma and in 67 patients of a matched control group. For patients with acute glaucoma the subjective refraction was +0.91 +/- 2.82 dpt, ocular axial length was 21.73 +/- 0.96 mm, lens thickness was 4.95 +/- 0.63 mm and the ratio lens thickness to ocular axial length amounted to 2.27 +/- 0.29. There was a statistically significant difference between the glaucoma and the control group concerning the parameters subjective refraction, ocular axial length, lens thickness and the lens thickness to axial length ratio. A statistically significant positive correlation was found between corneal radius and axial length, both, in the control and the glaucoma group, a significant negative correlation between axial length and subjective refraction only in the control group. In contrast to other authors, who reported on patients with narrow angle glaucoma with and without acute attack; we found no significant difference. These results support the suggestion that biometric data do not allow a prediction whether a patient with narrow anterior chamber angle will suffer glaucoma attack or not. The etiology of this disease seems to have a multifactorial origin.
This paper reports an occurrence of angle closure glaucoma following a combined blepharoplasty and ectropion repair. We are unaware of any previous reports of such an incident. Specific to this case was the coexistence of a cataract that contributed to the narrowing of the anterior chamber. This condition, along with pupil dilation secondary to the anesthetic, precipitated a phacomorphic angle closure glaucoma attack, necessitating emergency cataract surgery. Because other procedures involve pupillary dilation as a potential side effect, we recommend an increased awareness of this potential postoperative complication.
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Explore the source record for details and available documents.
We present a previously unreported series of five cases of acute angle closure glaucoma associated with watching the Australia soap opera "Neighbours". Two cases were bilateral and associated with watching two episodes of "Neighbours" on the same day. The pathogenesis, and possible role of watching soap operas in the causation of primary angle closure glaucoma is discussed.
Three hundred and fifty-two eyes (230 patients) with various diseases were treated with the first China-made YAG laser therapy instruments. The success rate was 100%. Two hundred and seventy-six eyes with primary angle closed glaucoma were treated by peripheral iridotomy. Postoperatively, the IOP was lowered by 0.267 kPa (2.43 mmHg). The dose and frequency of medication could then be lowered. The closed chamber angle index improved. Forty-nine eyes with membranous cataract were treated by posterior capsulotomy: Visual acuity was improved by 95%. The main complications during or immediately after operation were as follows: transient elevation of IOP, hyphema, anterior uveitis and corneal edema. All of these were well controlled.
Patients with nanophthalmos are prone to develop a chronic painless type of glaucoma in middle age, probably due to the natural increase in the size of the lens which is already relatively too large for the small eye. Although the underlying mechanism is obscure, a slowly progressive "creeping" chronic angle-closure is postulated, but gonioscopic evaluation is difficult due to the shallow anterior chamber, with grade I and slit angles. Response to medical treatment is poor and miotics may even make the condition worse by producing relative pupillary block and by relaxing the lens zonule. Ordinary glaucoma surgery is to be avoided in nanophthalmos because of the fear of postoperative ciliary-block malignant glaucoma. Periopheral iridectomy performed in five eyes at an advanced stage of the chronic angle-closure did not facilitate glaucoma control in three eyes, and in two eyes in which the operation was combined with posterior sclerotomy, the eyes became blind from vitreous hemorrhage. Lenx extraction in five eyes controlled the glaucoma but was followed by choroidal effusion and nonrhegmatogenous retinal detachements in two eyes and blindness in another eye when combined with a posterior sclerotomy. No firm therapeutic recommendations can be made on the basis of the author's experience in the six reported cases. Conventional medical therapy seems ineffectual even when begun early in the glaucoma. Conventional glaucoma surgery must be performed early, before permanent damage to the outflow mechanism occurs but removal of the lens must be anticipated. The surgeon must also remain aware of the high incidence of serious posterior-segment complications which inexplicably follow glaucoma or lens surgery in nanophthalmos, as described by Brockhurst.
Two sets of multiple regression equations (prediction systems) were derived from the analysis of ocular biometric data obtained from glaucoma patients (16 open angle; 16 angle-closure) and 75 normal subjects. Discriminant scores were established for both sets of equations which minimised the number of false negatives. One set, the 'Glaucoma Equations' was applied to the data to segregate the glaucoma from the normal subjects. The other prediction system, the 'Classification Equations,' was then applied to the group defined as glaucomatous to discriminate between patients in the angle-closure and open angle categories. The performance of these equations, obtained by comparing the predicted and actual classifications for this sample, was such that between 9 and 12% of false positives and 0 and 3% false negatives were found on the 'Glaucoma Equations' and between 6 and 12% of false positives with no false negatives on the 'Classification Equations.'
Family histories were taken from 124 index patients, who had presented with either angle-closure or open angle glaucoma to the University Department of Ophthalmology, Manchester, between 1967 and 1972. Their first-degree relatives numbered 886, i.e. siblings, offspring and parents. Relatives were contacted by post and asked to attend for eye examination. Out of a total of 886 relatives, only 187 relatives were actually examined. The reasons for this low attendance rate are discussed; e.g. 423 relatives had already died.
The postoperative course of 309 eyes subjected to trabeculectomy has been studied over a 7-year period. The results have been compiled with regard to effectiveness to maintain a normal range of intraocular pressure with and without postoperative medication. The figures have been assessed in toto and for 3 groups of glaucoma, namely, open angle, chronic angle-closure, and acute angle-closure. Results support those of other reports to show that trabeculectomy gives satisfactory control over the years in a reasonably high proportion of eyes and with relatively few postoperative complications. There is also a small group of combined trabeculectomy with cataract extraction.