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.     

FD—OCT对原发性急性闭角型青光眼视网膜厚度和体积的测量

背景原发性急性闭角型青光眼（PAACG）大发作后可引起不同程度的视功能损害,了解PAACG发作眼视盘及黄斑区视网膜的结构改变对于判断患眼的预后具有重要的临床意义。傅里叶域OCT（FD-OCT）是测量视网膜结构的有用工具。目的采用FD—OCT对PAACG大发作后视盘区视网膜神经纤维层厚度（RNFLT）、黄斑区厚度以及黄斑区体积的变化进行测量,并与正常眼进行比较。方法采用病例对照临床试验方法。收集2011年4月至2012年2月在温州医学院眼视光医院确诊为PAACG且有一侧眼大发作的患者25例,并纳入同期年龄和性别相匹配的正常志愿者25人25眼为正常对照眼,于PAACG患眼大发作后2周由同一位操作熟练的检查者采用FD—OCT测量患者发作眼、对侧眼和正常对照眼RNFLT、黄斑区厚度及黄斑区体积。结果PAACG发作后2周内发作眼组视盘区平均RNFLT值为（125．72±28．57）μm,明显高于对侧眼组的（108．36±9．31）μm和正常对照眼组的（106．10±10．97）μm,差异均有统计学意义（P〈0．05）;此外,发作眼组视盘上方、下方、鼻侧象限RNFLT值均明显高于对侧眼组和正常对照眼组,差异均有统计学意义（P〈0．05）,而视盘颞侧象限和颞下象限RNFLT值的差异均无统计学意义（P=0．081、0．766）。发作眼组、对侧眼组和正常对照眼组黄斑区视网膜平均厚度分别（283．72±18．33）、（280．28±16．85）和（289．14±10．60）“m,3个组间黄斑区各象限视网膜厚度值差异无统计学意义（FH镕=2．048,P=0．136）,其中对侧眼组视网膜厚度值均明显低于正常对照眼组（P〈0．05）,发作眼组与正常对照眼组间差异无统计学意义（P=0．224）。发作眼组、对侧眼组和正常对照眼组黄斑区总体积分别为（5．589±O．355）、（5．532±0．325）和（5．720±0．241）mm。,黄斑区各象限体积比较差异无统计学意义（F＊。=1．027,P=0．363）。各组外环各象限厚度值均明显小于内环厚度值,内环及外环黄斑区视网膜厚度值均呈鼻侧〉上方〉下方〉颞侧的趋势。PAACG患者发作眼和对侧眼在视盘内环颞侧、上方、鼻侧、下方和外环颞侧、中央区黄斑区厚度值及其体积值均明显低于正常对照眼,差异均有统计学意义（P〈0．05）。结论PAACG发作眼发作2周内视盘区RNFL水肿比黄斑区更明显,发作眼和对侧眼的黄斑区视网膜均比正常对照眼变薄,其黄斑区体积均小于正常对照眼。     

11例急性闭角型青光眼双眼急性发作的诱因分析

目的探讨急性闭角型青光眼双眼急性发作患者的临床特点及诱因。方法对双眼发作的急性闭角型青光眼11例患者的诱因、视力、眼压、前房深度、周边前房、房角形态及屈光状态等进行分析比较。结果11例患者中7例曾用阿托品类药物治疗,2例因眼科检查时诱发,2例患者有剧烈情绪波动史;双眼前房深度:最浅眼为1.4mm,最深眼为1.9mm,每位患者双眼前房深度差别均小于0.2mm,周边前房深度均小于1/4CT或完全消失;双眼房角状态:22只眼静态下均为窄VI房角,动态下18只眼有不同程度的粘连闭合,4只眼呈完全开放状态。结论具有浅前房、窄房角解剖基础眼睛的患者,全身或局部应用阿托品类药物是急性闭角型青光眼双眼发作的重要诱因之一,不恰当的眼科眼科检查也会诱发双眼青光眼急性发作。     

Biometric study of the disc cup in open-angle glaucoma

Stereoscopic and photogrammetric study of the disc cup in open-angle glaucoma reveals several morphological changes.The ovalisation of the cup, upwards, downwards or on the temporal side, appears early. It can be detected at the onset of the disease, even in the absence of visual field defects. It results ina localised thinning of the nervous rim, which is a characteristic sign of beginning glaucoma, butthe depth of the cup is not increased even when perimetry already reveals important defects.The aim of this paper is to study, on the one hand, the morphological changes of the disc cup and on the other, the functional defects in open-angle glaucoma, and then to compare the results of the investigations.Research assistant of National Fund for Scientific Research, Belgium     

The retinal nerve fiber layer in normal eyes and in glaucoma. I. Semiquantitative data of 398 eyes with glaucoma

Atrophy of the optic nerve is associated with changes of the retinal fiber layer (RNFL). Using red-free photographs the authors examined the RNFL of 398 eyes with chronic primary open-angle glaucoma and compared it with the RNFL of 234 normal eyes. The glaucoma group was divided into five stages and the fundus into four sectors. Differences between the normal and glaucoma eyes were: (1) The sequence of the sectors, with regard to the best visibility of the retinal nerve fiber bundles, was changed. In the normal eyes the nerve fiber bundles were most often best visible in the inferior temporal sector, followed by the superior temporal sector, the temporal horizontal area and finally the nasal region. In the glaucoma group the nerve fiber bundles were significantly more often best detectable in the superior temporal sector and the temporal horizontal area. (2) The degree of visibility of the retinal nerve fibers decreased significantly with increasing glaucoma stage. (3) Localized defects were seen in 15% of the eyes with glaucoma and none of the normal eyes. The specificity of this qualitative parameter was, therefore, 100%. The defects were found most often in the superior and inferior temporal regions. These differences between normal and glaucomatous eyes were also significant for the first glaucoma stage of this study. The localization of the foveola below the optic disk center (0.53 +/- 0.34 mm in the glaucoma group and 0.55 +/- 0.29 mm in the normal eyes) was not significantly different.     

Outflow changes in normal eyes after closed-angle glaucoma.

Twenty-four patients with spontaneous acute closed-angle glaucoma in one eye were selected for study. All 24 eyes had a peripheral iridectomy, were normotensive, and had no gonioscopically visible peripheral anterior synechiae. Of the 24 contralateral eyes 14 gave a positive response to provocative tests and had peripheral iridectomy. The remaining 10 eyes did not give positive responses to the tests and were on no treatment. The 24 pairs of eyes were provoked with pilocarpine and phenylephrine. Tonography was performed at the start of the test, 1 1/2 hours later, and at its termination. At the start of the test the 24 eyes that had had spontaneous closed-angle glaucoma showed a higher pressure and lower outflow facility than the 24 contralateral eyes. This difference disappeared as the test progressed. It is concluded that apparently normal eyes--after an acute attack--do none the less show a significant degree of damage to the outflow system. Ten pairs of eyes from 10 normal persons were provoked in a similar fashion and at no point did a significant difference appear between right and left eyes.     

闭角型青光眼急性发作合并睫状体脱离的UBM图像分析

目的探讨闭角型青光眼急性发作患者合并睫状体脱离的超声生物显微镜（UBM）图像特征。方法利用UBM对高眼压状态下的急性闭角型青光眼患者作前房角、前房深度、睫状体检查,对合并睫状体脱离UBM图像的形态进行分析。结果21例（29只眼）患者合并睫状体脱离,平均眼压为（34.84±9.37）mmHg,中央前房深度为（1.67±0.18）mm,眼轴长度为（23.10±1.25）mm。UBM图像分析示睫状体脱离双眼8例、单眼13例;脱离分级,1级11只眼、2级12只眼、3级6只眼;脱离范围2象限6只眼、3象限4只眼、全周脱离19只眼。结论UBM检查显示原发性急性闭角型青光眼高眼压状态的患者可合并睫状体上腔脱离,对该类患者的临床初期治疗,需重视降眼压药物及适量的皮质激素联合应用。     

The outcome of phacoemulsification in eyes after filtering glaucoma surgery

BACKGROUND: Our aim was to evaluate the outcome of phacoemulsification in eyes after filtering glaucoma surgery. PATIENTS AND METHODS: Thirty eyes of 30 patients with different forms of glaucoma in which phacoemulsification after filtering glaucoma surgery was done were included in this retrospective study. Intraocular pressure (IOP) was measured before and one week, 1, 3, 6, 12, 18, 24, 30, 36 and 42 months after phacoemulsification. The best corrected visual acuity (BCVA) and the number of antiglaucoma medications before phacoemulsification and at the end of follow-up were evaluated. Partial failure of IOP control was defined as the need for an increased number of antiglaucoma medications to maintain IOP < 21 mmHg or prevent a progression of visual field or optic disc damage. Complete failure of IOP control was defined as an IOP > 21 mmHg with an additional number of antiglaucoma medications or a progression of visual field or optic disc damage requiring filtering surgery. RESULTS: The mean interval between filtration surgery and phacoemulsification was 5.8 years (SD 3.8) and the mean follow-up after phacoemulsification was 23.4 months (SD 11.4). There were no differences between the mean IOP before and after phacoemulsification during the entire follow-up period (p > 0.05). The mean preoperative BCVA was 0.30 (SD 0.2), improving to a mean of 0.72 (SD 0.3) postoperatively at the end of follow-up (p < 0.0001). The mean number of antiglaucoma medications before phacoemulsification was 1.2 (SD 1.2), increasing after phacoemulsification to 1.5 (SD 1.2) at the end of follow-up (p > 0.05). In 9 eyes a partial failure of IOP control was assessed, so according to the Kaplan-Meier survival analysis the success rate after 12 months was 72 % and after 42 months 67 %. In 3 eyes a complete failure of IOP control was assessed, thus according to the Kaplan-Meier survival analysis the success rate after 22 months was 93 % and after 42 months 77 %. CONCLUSION: Phacoemulsification in eyes after filtering glaucoma surgery resulted in a stable IOP, a non-significant increase in the number of antiglaucoma medications and a significantly improved BCVA.     

Inner nuclear layer of the retina in eyes with secondary angle-block glaucoma]

Glaucomatous changes have been known to occur in the inner retinal layer all over the fundus and in the deep retinal layer and retinal pigment epithelium close at the optic disc border. This study was conducted to address the question as to whether the middle retinal layers are altered by the glaucomatous process. The study included histological slides of 23 eyes enucleated due to painful secondary traumatic angle-closure glaucoma and 14 nonglaucomatous eyes removed because of a malignant choroidal melanoma. We evaluated the cell count and thickness of the inner nuclear layer via histomorphometry. The inner nuclear layer contained significantly fewer cells and was thinner (P < 0.05) in the glaucoma group compared to the control group. Since this study contains eyes with possible secondary changes due to the initial trauma, further investigations on eyes with primary open-angle glaucoma are necessary to confirm the results. This could be important for psychophysical testing in glaucoma.     

Macular cystoid edema in eyes with secondary glaucoma after surgery

The authors a case of a 53 year old patient who has been under observation of the Ophthalmologic Department from lassy Railway Hospital since September 2000. The the diagnosis was on both eyes: Operate Inflammatory Secondary Glaucoma. Incipient Cataract. Anterior Uveiti Sechelae. Cicatricial Corioretinitis. In January 2001 this patient came in our clinic on the right eye with acute decrease of visual acuity from 1/6 to 1/25 on white, unpainful eye, with marked ocular hipotony. The suspected etiologic diagnosis was initially RE: Intermediate Uveitis. After local and general treatment with corticosteroid antiinflammatory agents the inflammatory phenomena was decreased but the visual acuity remained unchanged. After that we suspected macular cystoid edema. The cause of the visual acuity decrease remains obscure and this case underlines the difficulties meeting on the therapeutic management of the glaucoma on an eye with numerous associated diseases.     

白内障手术前后闭角型青光眼前房角镜观察

目的观察单纯超声乳化吸出术治疗伴有白内障的闭角型青光眼手术前后前房角的改变。方法单纯用白内障超声乳化吸出后房人工晶状体植入术治疗闭角型青光眼并发白内障16例(25眼)。术前术后常规做视力、裂隙灯显微镜、非接触眼压计检查、前房深度检查及Goldmann前房角镜检查。随访3~18月。结果前房角镜检查:16例(25眼)术前前房角关闭粘连<1/4圆周者4眼,1/4~1/2圆周者7眼,3/4圆周者5眼,>3/4圆周者9眼。术后前房角均有增宽,前房角关闭及周边虹膜前粘连范围减小,部分患眼前房角重新开放,其中前房角全部开放12眼,仍存1/4~1/2圆周前房角粘连4眼,小于1/4圆周前房角粘连9眼。随访3~18月未见前房角关闭粘连范围扩大。术后视力均有不同程度提高,前房深度增加,眼压正常。结论超声乳化吸出术治疗闭角型青光眼伴白内障术后前房角增宽或开放,原关闭粘连范围减小,眼压正常,效果良好。     

Vogt-Koyanagi-Harada disease presenting as acute angle closure glaucoma at onset

Background: To investigate the clinical features of Vogt‐Koyanagi‐Harada (VKH) disease presenting as acute angle closure glaucoma at onset. Design: Retrospective non‐comparative case series. Participants: Four hundred and eighty‐six VKH patients seen from February 2001 to March 2010. Methods: The history and clinical findings of all patients were reviewed. Auxiliary examinations, including ultrasound biomicroscopy, fundus fluorescein angiography and optical coherence tomography, were performed in certain cases. Corticosteroids with or without cyclosporine A were used to treat these patients. Main Outcome Measure: Patients' demographics, clinical presentation and auxiliary examination findings. Results: Eight out of 486 VKH patients were misdiagnosed as acute angle closure glaucoma. The mean age of these eight patients was 55.6 years. Six patients were female. The mean intraocular pressure (IOP) at disease onset was 32.9 mmHg. All of these patients had a shallow anterior chamber and a narrow or closed angle at their first visit. The complaints of these patients were mostly headache and sudden decreased vision in both eyes. Alterations shown on ultrasound biomicroscopy included detachment of the ciliary body and peripheral choroid. The increased IOP did not respond to anti‐glaucoma therapy, but resolved following treatment with corticosteroids. The eye of one patient was enucleated after failed trabeculectomies prior to referral to our uveitis centre. Conclusion: VKH disease presenting with a bilateral increased IOP mostly occurs in older women. The strikingly decreased visual acuity associated with mild to moderate increased IOP is a clue to the diagnosis. The increased IOP responded well to corticosteroids but not to anti‐glaucoma treatment.