Angle-closure glaucoma complicating ciliochoroidal detachment

Acute angle-closure glaucoma complicating ciliochoroidal detachment developed in eight eyes of six patients. The clinical presentation was uniform: extremely shallow central anterior chamber depth, flat peripheral anterior chamber, closed angle, and elevated intraocular pressure (IOP). There were three patients with uveal effusion syndrome, two with posterior scleritis, and one with an arteriovenous malformation. Cycloplegia, along with aqueous suppressants and corticosteroids, successfully resolved the acute glaucoma in all eyes. This rare, secondary glaucoma must be differentiated from primary angle-closure glaucoma, because the treatment is markedly different. Although primary angle-closure glaucoma is treated with miotics and peripheral iridectomy, such therapy may worsen the glaucoma in eyes with angle-closure glaucoma due to a ciliochoridal detachment.     

Acute angle-closure glaucoma from spontaneous massive hemorrhagic retinal detachment

PURPOSE: To report a case of acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment. METHODS: An 81-year-old woman visited our emergency room for severe ocular pain and vision loss in her left eye. Her intraocular pressures (IOPs) were 14 mmHg in the right eye and 58 mmHg in the left eye. Her visual acuity was 0.4 in the right eye but she had no light perception in the left eye. The left anterior chamber depth was shallow and gonioscopy of the left eye showed a closed angle. In comparison, the right anterior chamber depth was normal and showed a wide, open angle. Computed tomography and ultrasonography demonstrated retinal detachment due to subretinal hemorrhage. After systemic and topical antiglaucoma medications failed to relieve her intractable severe ocular pain, she underwent enucleation. RESULTS: The ocular pathology specimen showed that a large subretinal hemorrhage caused retinal detachment and pushed displaced the lens-iris diaphragm, resulting in secondary angle-closure glaucoma. CONCLUSIONS: Prolonged anticoagulant therapy may cause hemorrhagic retinal detachment and secondary angle-closure glaucoma. If medical therapy fails to relieve pain or if there is suspicion of an intraocular tumor, enucleation should be considered as a therapeutic option.     

Persistent hyperplastic primary vitreous--a case report of adult onset acute angle-closure glaucoma]

BACKGROUND: We report a patient with persistent hyperplastic primary vitreous(PHPV) who presented with acute angle-closure glaucoma in his adult life. CASE: A 30-year-old man had an attack of acute angle-closure glaucoma associated with retrolenticular fibrous tissue, atrophic retina, and elongated cilliary process in his right eye. RESULT: Ultrasound biomicroscopy(UBM) study showed iris bowing, shallow anterior chamber, and elongated cilliary body which were being pulled by the retrolenticular mass. The posterior chamber was normal. CONCLUSION: Although the mechanisms of secondary angle-closure glaucoma in PHPV are complicated, we suspected pupillary block resulting from constriction by the retrolenticular mass in this case.     

Ciliochoroidal effusion after remission of lens-induced glaucoma detected by ultrasound biomicroscopy

PURPOSE: To report the results of ultrasound biomicroscopy(UBM) cases of ciliochoroidal effusion after a lens-induced glaucoma attack. CASES: Case 1 was an 83-year-old female. She had shallow anterior chamber with expanded cataract with exfoliation in her right eye. Intraocular pressure(IOP) of the right eye was 64 mmHg. On the next day, IOP was reduced to 16 mmHg by conservative therapy. UBM showed circumference ciliochoroidal effusion in the right eye. On the 5th day, IOP increased to 38 mmHg. UBM was repeated and showed the disappearance of ciliochoroidal effusion. On the 9th day, phacoemulsification was done to treat the lens induced glaucoma attack. Two weeks after operation, IOP of the right eye was 6 mmHg and UBM showed ciliochoroidal effusion. Case 2 was an 85-year-old female. She had been diagnosed by an ophthalmologist as having an attack of lens-induced glaucoma in her left eye. IOP was 46 mmHg. When she was referred to us, IOP was decreased to 24 mmHg and ciliochoroidal effusion was observed in her left eye by UBM. CONCLUSION: We report two cases of ciliochoroidal effusion associated with lens-induced glaucoma attack. UBM is useful to observe changes in the ciliary body after lens-induced glaucoma attack.     

Hereditary high hypermetropia in the Faroe Islands

PURPOSE: To characterize the phenotype of two families with high hypermetropia from the Faroe Islands. METHODS: Ophthalmologic evaluation including ultrasound oculometry and anthropometric measurements. RESULTS: Of the 40 examined family members, 15 individuals (8 males, 7 females; ages: 6-77 years; mean: 36.5 years) had small deep-set eyes with high hypermetropia (median: + 16.5 D; range: + 7.75 to + 22), short axial eye length (< 21 mm), and a thickened eye wall. The median corrected visual acuity was 0.4 (0.2-0.9). Ocular complications included angle-closure glaucoma in six eyes, uveal effusion in three eyes, cataract in two eyes, and esotropia with amblyopia in three eyes. An emergency case of uveal effusion and retinal detachment after Yag iridotomy eventually responded to systemic corticosteroids and scleral resection surgery with a slow visual recovery. No associated ocular or systemic malformations were found in the series. In addition to the two examined families, six smaller Faroese families with high hypermetropia are briefly reported. CONCLUSIONS: The study highlights the signs and symptoms of a rare hereditary phenotype characterized by a short axial length mainly confined to the posterior segment of the eye, a shallow anterior chamber, and a thickened eye wall. The morphological characteristics predispose for sight-threatening complications such as angle-closure glaucoma, chorioretinal pathology including uveal effusion, and amblyopia. Regular ophthalmic follow-up is therefore of obvious importance in families known to have small eyes/high hypermetropia. An endemic high prevalence in the Faroe Islands suggests the presence of a founder effect, and further genetic research would probably indicate pseudodominant rather than dominant transmission     

A case of acute angle-closure glaucoma secondary to annular ciliochoroidal detachment after unsutured cataract surgery

BACKGROUND: We report a patient with acute angle-closure glaucoma secondary to annular ciliochoroidal detachment after unsutured cataract surgery. CASE: An 82-year-old man was diagnosed with bilateral shallow central anterior chamber depth, flat peripheral anterior chamber, and elevated intraocular pressure. One day previously he had undergone uncomplicated unsutured cataract surgery in the right eye and eight days previously, in the left eye. Ultrasound biomicroscopy revealed annular ciliochoroidal detachment in both eyes. Treatment with intravenous methyl prednisolone deepened the anterior chamber and reduced intraocular pressure. CONCLUSION: Annular ciliochoroidal detachment may lead to anterior rotation of the ciliary body and angle-closure. This clinical entity is indistinguishable from malignant glaucoma when the fundus cannot be visualized.     

青光眼小梁切除术后并发症的临床分析

探讨原发性闭角型青光眼小梁切除术后并发症—浅前房和角膜后弹力层脱离的原因及防治措施。 方法:对160例187眼原发性闭角型青光眼小梁切除术后并发症—浅前房和角膜后弹力层脱离的治疗观察。 结果:患者160例187眼行小梁切除术后发生浅前房33眼,发生率为17.65%,其中1眼发生脉络膜脱离,经保守治疗治愈。在160例小梁切除术中,我科开展了5例6眼术毕向前房内注入适量透明质酸钠以预防术后浅前房,其中1例双眼发生角膜后弹力层脱离,右眼发生广泛后弹力层脱离经前房注气3次治愈,左眼脱离范围小于1/3未做处理。 结论:对于原发性闭角型青光眼小梁切除术时,手术要轻巧,操作要精细,以减少或避免严重并发症的发生     

Angle-closure glaucoma in teenagers

OBJECTIVE: To report the occurrence of angle-closure glaucoma in 2 teenagers. DESIGN: Observational case reports, review of literature. METHODS: Review of case histories, examinations, biometries, visual fields, and ultrasound biomicroscopy findings in 2 teenagers with angle-closure glaucoma. MAIN OUTCOME MEASURES: Intraocular pressure, gonioscopy, Humphrey 24-2 visual field (SITA Standard), and ultrasound biomicroscopy. RESULTS: The first case involved a 15-year-old white male who presented with an intraocular pressure of 60 mm Hg in the right eye and 24 mm Hg in the left eye and 360-degree appositional closure in both eyes. Ultrasound biomicroscopy revealed prominent bilateral ciliary pigment epithelial cysts pushing the iris anteriorly towards the angle. The second case involved a 14-year-old white male with a strong family history of primary angle-closure glaucoma. The patient had pupillary block and an intraocular pressure of 24 mm Hg in the right eye and 40 mm Hg in the left eye on routine eye examination. Gonioscopy and ultrasound biomicroscopy revealed appositional closure of the angle in all 4 quadrants bilaterally. CONCLUSION: Primary angle-closure glaucoma is uncommon in younger individuals. Therefore, the finding of angle-closure glaucoma in a young individual should alert the physician to the possibility of a secondary cause of angle closure, such as iris pigment epithelial cysts. In addition, special attention to family history is important as the configuration of an occludable anterior chamber angle may, in some instances, be inherited.     

A case of acute angle-closure glaucoma secondary to posterior scleritis in patient with Sturge-Weber syndrome

BACKGROUND: Sturge-Weber syndrome has been known to be frequently associated with facial cutaneous angioma and ipsilateral glaucoma. However, as far as we know, no cases accompanied by acute angle-closure glaucoma have been reported in patients with Sturge-Weber syndrome. CASE: A 14-year-old boy with unilateral acute angle-closure glaucoma secondary to posterior scleritis associated with Sturge-Weber syndrome is described. OBSERVATIONS: Slit-lamp examination revealed diffuse episcleral venous hemangioma in the right eye. With ultrasound biomicroscopy, a forward shift of the lens-iris diaphragm, a swelling of the ciliary body, and an anterior rotation of the ciliary processes with annular choroidal effusion were detected. The patient responded well to treatment with systemic corticosteroids and cycloplegics. CONCLUSIONS: In our patient, inflammatory changes of the sclera, including swelling of the ciliary body, choroidal effusion, an anterior rotation of the ciliary processes at the scleral spur, and swelling of the lens, leading to closure of the anterior chamber angle, were suggested to be the major mechanisms of intraocular pressure elevation.     

A case of angle closure glaucoma caused by plateau iris and adie's pupil

PURPOSE: To describe a case of plateau iris associated with bilateral Adie's pupil. DESIGN: Interventional case report. METHODS: A 54-year-old woman presented with pain in her right eye and headache. Intraocular pressure was 34 mm Hg in the right eye. Light reflex was defective bilaterally. RESULTS: Ultrasound biomicroscopic imaging revealed normal anterior chamber depth and narrow angle. The ciliary processes were situated anteriorly. The eyes showed supersensitivity to 0.125% pilocarpine. The patient was diagnosed as having bilateral angle-closure glaucoma induced by Adie's pupil and plateau iris. CONCLUSION: Mild pupillary dilation caused by Adie's pupil may have played a role in the development of angle closure in the plateau iris configuration of our patient.     

早期原发性闭角型青光眼合并白内障的手术治疗

目的：研究白内障超声乳化联合后房型人工晶状体植入术在合并白内障的早期原发性闭角型青光眼的应用安全性和有效性。 方法：将合并白内障的早期原发性闭角型青光眼患者随机分为两组,一组行激光周边虹膜切开术（周切组）,另一组行超声乳化白内障摘除联合后房型人工晶状体植入术（超声乳化组）;分析治疗前后的眼前段结构的变化,比较治疗前后视力及眼压;随访时间为3mo。 结果：激光组及超声乳化组的患者在治疗后都发生不同程度的周边前房加深、房角加宽;而激光组术后视力无提高、前房轴深较术前无变化,少部分房角加宽不明显。超声乳化组术后视力明显提高、前房轴深加深,房角均加宽,已经粘连关闭的房角也部分重新开放。 结论：超声乳化白内障摘除联合后房型人工晶状体植入术在合并白内障的早期原发性闭角型青光眼的应用安全,能有效控制青光眼的发生及发展,对于虹膜高褶构型的患者同样有效,同时能改善视力。     

New Management of Angle—closure Glaucoma by Phacoemulsification with Foldable Posterior Chamber Intraocular Lens Implantation

Objective: To investigate the management oi angle-closure glaucoma byphacoemulsification with foldable posterior chamber intraocular lens (PC-IOL)implantation.Design: Retrospective, noncontrolled interventional case series.Participants: In 36 eyes with angle-closure glaucoma (ACG) , there were 18 eyes withprimary acute angle-closure glaucoma (PACG) , 14 eyes with primary chronicangle-closure glaucoma (PCCG) , 3 eyes with secondary acute angle-closure glaucoma(SACG) and 1 eye with secondary chronic angle-closure glaucoma (SCCG).Intervention: Phacoemulsification with posterior chamber intraocular lens implantation.Main Outcome Measures: Postoperative visual acuity, IOP, axial anterior chamberdepth.Results: After a mean postoperative follow-up time of 8. 81±7. 45 months, intraocularpressure was reduced from a preoperative mean of 23. 81 ±17. 84 mmHg to apostoperative mean of 12. 54 4. 73 mmHg ( P =0. 001). Mean anterior chamber depthwas 1. 75 ± 0. 48 mm preoperatively and 2. 29 ?0. 38 mm postoperatively     

Mechanism of topiramate-induced acute-onset myopia and angle closure glaucoma

DESIGN: Interventional case report. METHODS: In an institutional practice setting, two women, aged 25 and 45, developed acute myopia after starting topiramate for epilepsy. One patient also developed bilateral angle closure glaucoma. RESULTS: Topiramate was discontinued. Anterior chamber shallowing was noted in both patients at presentation. Ultrasonography showed ciliochoroidal effusion. Baseline measurements of anterior chamber depth and lens thickness were obtained. CONCLUSIONS: Topiramate may be associated with ciliochoroidal effusion with forward displacement of the lens-iris diaphragm and anterior chamber shallowing, resulting in acute myopia and angle-closure glaucoma. Increased lens thickness contributes only minimally (9%-16%) to anterior chamber shallowing.     

Laser and unsutured sclerotomy in nanophthalmos

Among 30 eyes with nanophthalmos, 21 had angle-closure glaucoma and two had open-angle glaucoma associated with pseudoexfoliation of the lens capsule. Laser iridotomies, sometimes combined with laser iridoplasty, were sufficient to control, or to allow medical control of, the glaucoma in 15 of 18 eyes. Four eyes with uveal effusion underwent an unsutured sclerotomy or sclerectomy, and all had resolution of the choroidal detachment within two weeks. Cataract extraction improved the vision in seven of nine eyes. Previous or simultaneous sclerotomy or sclerectomy was performed on all nine eyes that underwent cataract extraction and in two eyes at the time of glaucoma surgery; no eye had postoperative uveal effusion or other major complications. Laser iridotomy and iridoplasty, sometimes with supplemental medical therapy, are often sufficient in the treatment of angle-closure glaucoma in nanophthalmos and are safer than surgery. Nanophthalmic uveal effusion can be prevented or treated with an unsutured sclerotomy or sclerectomy.     

Bilateral angle-closure glaucoma associated with uveal effusion: presenting sign of HIV infection.

A 40-year-old homosexual man presented with acute myopia and bilateral angle-closure glaucoma. Recognition of an anterior chamber configuration of a modestly shallowed central chamber with marked peripheral shallowing clinically suggested uveal effusion. B-scan echography provided definitive, confirmatory evidence of diffuse choroidal thickening with ciliochoroidal effusion. Treatment with aqueous suppressants, cycloplegics, and topical steroids resulted in complete resolution of the angle closure and reversal of induced myopia. The patient, who was systemically well without signs of AIDS or AIDS-related complex, was later tested and found to be serologically-positive for the human immunodeficiency virus.     

Presumed topiramate-induced bilateral acute angle-closure glaucoma.

PURPOSE: We describe a case of bilateral angle-closure glaucoma associated with oral topiramate therapy. METHODS: Interventional case report. Case report with echographic illustration. RESULTS: A 51-year-old man developed bilateral acute angle-closure glaucoma 2 weeks after beginning topiramate therapy for bipolar affective disorder. Laser peripheral iridotomy was performed in the right eye without resolution of the acute attack. Echography revealed lens thickening and ciliochoroidal detachments in both eyes. Visual acuity, intraocular pressure, and anterior and posterior segment anatomy normalized 2 weeks after cessation of topiramate therapy. CONCLUSION: Topiramate, a new sulfa-derivative antiepileptic medication, may cause idiosyncratic ciliochoroidal detachments and ciliary body edema leading to anterior displacement of the lens-iris diaphragm, lens thickening, and acute angle-closure glaucoma.     

原发性急性闭角型青光眼双眼眼前段相关结构的对比研究

目的研究原发性急性闭角型青光眼双眼眼前段相关结构特征。方法采用超声生物显微镜（UBM）眼前段活体结构检查技术、UBM眼前段图像处理技术,对10例原发性急性闭角型青光眼患者的双眼（一眼急性发作期,对侧眼临床前期）房角状态、房角相关解剖结构进行了定量观察及对比研究。结果UBM检查发现：双眼前房深浅（轴深）、房角开放距离500、小梁睫状突夹角、睫状体大小均有显著性差异。结论急性闭角型青光眼急性发作眼较临床前期眼前房更浅,房角关闭,睫状体前位和增大使眼前段更拥挤。采用UBM检查能从解剖学上进一步认识急性闭角型青光眼的发病机制。     

闭角型青光眼伴有深前房的常见原因

目的 分析闭角型青光眼伴深前房的常见原因，提供临床参考。方法 研究我院青光眼专科门诊及住院患者中深前房伴闭角型青光眼的患眼24例，进行眼压、房角镜和超声生物显微镜检查。结果 发现主要有4种类型：继发于炎症(4例)或新生血管(6例)的青光眼，伴有虹膜一睫状体囊肿的青光眼(5例)，巩膜扣带术后所致的青光眼(5例)和高褶虹膜型青光眼(4例)。结论 闭角型青光眼伴深前房是闭角型青光眼中的特殊类型，多为继发性闭角型青光眼且尽管中央前房不浅但周边前房大多变浅。     

Ciliochoroidal Effusion Syndrome Associated with Posterior Scleritis

Background

To determine the cause of angle-closure glaucoma in a case of posterior scleritis.

Case

The patient was a 65-year-old woman with unilateral acute angle-closure glaucoma who did not respond to laser iridotomy.

Observations

Slit-lamp examination demonstrated a shallow anterior chamber in the left eye. Intraocular pressure was 22?mmHg even after application of two antiglaucoma eye-drop preparations. B-scan ultrasonography demonstrated scleral thickening and choroidal detachment in the left eye. Ultrasound biomicroscopy showed a shallow anterior chamber with angle closure, annular ciliochoroidal effusion with ciliary body edema, and an anterior rotation of the ciliary body. After instillation of cycloplegics, the ciliary body and ciliary processes rotated posteriorly, resulting in the release of the pressure on the iris. These changes led to the opening of the angle and subsequent normalization of intraocular pressure. A diagnosis was made of ciliochoroidal effusion syndrome associated with posterior scleritis.

Conclusions

Patients with posterior scleritis can develop ciliochoroidal effusion syndrome, which can lead to angle-closure glaucoma. The therapeutic strategy for acute angle-closure glaucoma induced by ciliochoroidal effusion syndrome differs completely from that for acute angle-closure glaucoma with pupillary block. In the case of ciliochoroidal effusion syndrome, it is important to relieve the compression of the angle by the iris by displacing the lens–iris diaphragm posteriorly by cycloplegics.?Jpn J Ophthalmol 2007;51:49–52 © Japanese Ophthalmological Society 2007

     

Suprachoroidal effusion following argon laser trabeculoplasty

Purpose: This is first report of suprachoroidal effusion occurring subsequent to argon laser trabeculoplasty (ALT).
Methods: Review of the records of the patient in question.
Results: A 77-year-old woman with bilateral pseudophakia and primary open-angle glaucoma was treated with ALT when her visual fields deteriorated despite topical timolol therapy. Although ALT was initially performed without complication in one eye, treatment of the other eye led to a choroidal detachment. This was associated with temporary reduction in visual acuity, shallowing of the anterior chamber and hypotony.
Conclusion: Suprachoroidal effusion appears to be another complication of ALT. In the reported case, this complication and its effects were temporary and resolved with conservative management.