Argon laser peripheral iridoplasty versus systemic intraocular pressure-lowering medications as immediate management for acute phacomorphic angle closure.

Background: The purpose of this study was to compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) and systemic intraocular pressure (IOP)-lowering medications in the immediate management of acute phacomorphic angle closure. Methods: Consecutive cases of acute phacomorphic angle closure were randomized to receive ALPI and an intravenous or oral carbonic anhydrase inhibitor as initial treatment. Intravenous mannitol was administered for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours posttreatment in both arms. Results: Of 10 consecutive cases, six received medical therapy and four received ALPI. Fifty percent in the medical group and none in the ALPI group required intravenous mannitol. The ALPI group took less time to achieve IOP < 25 mmHg (18.8 ± 7.5 minutes versus 115.0 ± 97.0 minutes, P = 0.001, F test); had a greater IOP reduction within 30 minutes (69.8% ± 7.7% versus 40.9 ± 23.9%, P = 0.03, t-test); and had a consistently smaller post-attack cup to disc ratio (0.50 ± 0.02 versus 0.60 ± 0.20, P = 0.002, F test). Conclusion: ALPI offers greater safety, consistency, and efficacy than systemic IOP-lowering medications as initial treatment for phacomorphic angle closure. © 2013 Lee et al, publisher and licensee Dove Medical Press Ltd.published_or_final_versio

Prospective study on retinal nerve fibre layer changes after an acute episode of phacomorphic angle closure

To investigate the retinal nerve fibre layer (RNFL) changes after an acute attack of phacomorphic angle closure. This prospective study involved ten cases of phacomorphic angle closure that underwent cataract extraction and intraocular lens insertion after intraocular pressure lowering. Apart from visual acuity and intraocular pressure (IOP), RNFL thickness and vertical cup disc ratio (VCDR) were measured by optical coherence tomography (OCT) at 3-9 months post attack. Humphrey visual field assessment was performed at 9 months post attack. All cases had mean phacomorphic duration of  0.2. Patients with <5 days duration of phacomorphic angle closure are likely to have reasonable postoperative vision. An acute episode of phacomorphic angle closure can trigger an accelerated RNFL thinning despite normal IOP and open angles, most noticeable in the superior and inferior quadrants, occurring between 3 and 9 months post attack. Glaucomatous optic neuropathy in the attack eye was evident by OCT but not by visual field assessment at the same time interval. © 2012 The Author(s).published_or_final_versio

Retinal Nerve Fiber Layer Thickness in Myopic, Emmetropic, and Hyperopic Children

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Inflammatory and intraocular pressure outcomes after trabeculectomy in active uveitic glaucoma in Chinese

AIM: To analyze the outcomes in uveitic activity and intraocular pressure(IOP)control after trabeculectomy for uveitis with uncontrolled IOP. METHODS: The medical records of consecutive uveitic glaucoma patients undergoing trabeculectomy between October 2006 to March 2011 were retrospectively reviewed. Uveitic activity, frequency of recurrence, steroid dependence, and intraocular pressure control were compared with paired t-test before and after trabeculectomy. RESULTS: In 29 eyes from 29 patients, 90% of eyes were on topical steroids at the time of trabeculectomy. The mean age was 58.3±14.0 years old with a pre-operative IOP of 35.7±8.9mmHg. The mean follow up time was 35.2±18.7mo. There was a reduction of anterior chamber activity grading of 0.4±0.6(P<0.01)at 3mo post-operatively. The uveitis recurrence rate was significantly reduced by 2.3±2.1 episodes/year(P<0.01)during the follow-up period. The mean 1y post-trabeculectomy IOP was 13.1±4.5mmHg with 44.8% of eyes with IOP≤21mmHg without medication. CONCLUSION: Uveitic activity and IOP control improved after trabeculectomy with a lower success rate to primary glaucomas. Trabeculectomy may be considered as a possible early intervention of active uveitis with high IOP for pressure and uveitic activity control.link_to_OA_fulltex

Acute primary angle closure

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Phacoemulsification Versus Combined Phacotrabeculectomy in Medically Controlled Chronic Angle Closure Glaucoma with Cataract

Objective: To compare phacoemulsification alone versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma (CACG) with coexisting cataract. Design: Randomized clinical trial. Participants: Seventy-two medically controlled CACG eyes with coexisting cataract. Intervention: Recruited patients were randomized into group 1 (phacoemulsification alone) or group 2 (combined phacotrabeculectomy with adjunctive mitomycin C). Postoperatively, patients were reviewed every 3 months for 2 years. Main Outcome Measures: Intraocular pressure (IOP) and requirement for topical glaucoma drugs. Results: Thirty-five CACG eyes were randomized into group 1, and 37 CACG eyes were randomized into group 2. There were no statistically significant differences (P>0.05) in mean IOP between the 2 treatment groups preoperatively and postoperatively, except at 1 month (P = 0.001) and 3 months (P = 0.008). Combined phacotrabeculectomy with adjunctive mitomycin C resulted in 0.80 less topical glaucoma drugs (P<0.001) in the 24-month postoperative period compared with phacoemulsification alone. The differences in IOP control were, however, not associated with differences in glaucomatous progression. Combined surgery was associated with more postoperative (P<0.001) complications compared with phacoemulsification alone. Conclusions: Combined phacotrabeculectomy with adjunctive mitomycin C may be marginally more effective than phacoemulsification alone in controlling IOP in medically controlled CACG eyes with coexisting cataract. Combined surgery may be associated with more complications and additional surgery in the postoperative period. Further study is needed to determine whether the marginally better IOP control of combined surgery justifies the potential additional risks of complications and further surgery. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. © 2008 American Academy of Ophthalmology.link_to_subscribed_fulltex