Fluorescein angiography of iris in primary and secondary angle closure glaucoma.
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Acute Disease↗
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[Trabeculectomy-iridencleisis combined with cataract extraction].
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.
Aged↗
Trabeculectomy.
In a critical review of trabeculectomy, some factors and steps that I consider important for its successful outcome are discussed. Trabeculectomy is a misnomer, because the success of this procedure does not depend on inclusion of trabecular meshwork or Schlemm's canal in the excised tissue. Furthermore, development of a conjunctival bleb is seen in most, if not all, eyes with successful trabeculectomy. Trabeculectomy is, then, a form of guarded filtering procedure. Several factors seem to determine the outcome of the final intraocular pressure control after trabeculectomy. In this study, intracameral air injection and gauging of the closure of the lamellar scleral flap according to an air test during trabeculectomy proved very useful in attaining optimal closure of the lamellar scleral flap. It was effective in preventing undesirable postoperative complications as well as in achieving a satisfactory success rate. Trabeculectomy, as reported by others, seems to be a remarkably successful and safe procedure. However, the results in aphakic glaucoma are disappointing. From all indications at the present time, trabeculectomy will stay with us as a primary procedure for open-angle and chronic angle-closure glaucomas in adult phakic eyes, although we do not yet know how many of the eyes with seemingly successful trabeculectomies will remain healthy in the future.
Adult↗
[The classification of secondary glaucomas].
After the presentation of the most important types of secondary glaucomas, the author classified these glaucomas used the same aspect known at the primary glaucomas classification the aspect of the iridocorneal angle. In this classification the open angle secondary glaucoma has three clinical forms: with pretrabecular, trabecular and post-trabecular obstacle. The closed angle secondary glaucoma has also three forms: anterior, posterior and congenital.
Glaucoma, Angle-Closure↗
Clinical studies of primary angle closure glaucoma.
The ocular anatomic features, pupil-blocking force, status of angle synechia closure and positivity of provocative tests were compared between the primary chronic angle closure glaucoma (PCACG) and primary acute angle closure glaucoma (PAACG) by ultrasonic biometry, computerized image processing technique of the anterior ocular segment, gonioscopy and provocative tests. The studies showed that the anterior chamber depth of PAACG was shallower than that of PCACG, the pupil-blocking force of PAACG was stronger than that of PCACG, the status of angle synechia closure of PCACG was mainly creeping synechia closure and the positivity of mydriasis test after iridectomy was much higher (37.93%) in PCACG than that (11.43%) in PAACG. These facts suggested that the mechanisms of the angle closure of more than half of PCACG cases be multiple, besides the mechanism of pupillary block. Therefore, the authors emphasize that the pupillary block must be eliminated as well as the other mechanisms for the treatment of PCACG. The criteria of diagnosis and principles of management of PCACG were proposed.
Adult↗
Mechanism and etiology of primary chronic angle closure glaucoma.
The ocular anatomic features, pupil-blocking force, status of angle synechiae closure and positivity of provocative tests were compared between the primary chronic angle closure glaucoma (PCACG) and primary acute angle closure glaucoma (PAACG) by using ultrasonic biometry, computerized anterior ocular segment image processing technique, gonioscopy and provocative tests. The studies showed that the anterior chamber depth of PAACG were shallower than that of PCACG; the pupil-blocking force of PAACG was stronger than that of PCACG; the status of angle synechiae closure of PCACG were mainly creeping synechiac closure; the positivity of mydriasis test was much higher (46.01%) in PCACG than that (6.8%) in PAACG after iridectomy. These facts suggest approximately half of the PCACG cases may be mult-mechanism to contribute to the angle closure besides the mechanism of pupillary block. Therefore, the authors emphasis that the pupillary block must be eliminated as well as the other mechanism for the treatment of PCACG and finally, a criteria of diagnosis and principles of management of PCACG were proposed.
Adult↗
[A method of measuring iris radius by computerized image analysis].
A new method of measuring the iris contour has been set up with a personal computer. The model of a parabolic curve, an approximate mimic iris contour curve, was traced to define the profile contour of the iris from a photograph. A radius measured from the apex of the curvature of the parabola, named iris radius (IR), was calculated by a computer to describe the degree of the curvature of the iris contour. The iris radius of 93 eyes of 68 cases with early pupillary block primary angle closure glaucoma were measured by this method. The results show that the mean iris radius of cases with glaucoma is shorter than that of the normal age matched controls (53 cases 106 eyes) and there is statistical significant difference (P < 0.01). This method of measurement can be an effective method to further study the early diagnosis and pathogenic mechanism of the pupillary block angle closure glaucoma.
Adult↗
[The intraocular pressure depressive effect of puerarin].
The IOP depressive effect of puerarin, a beta-receptor blocker, was found to be optimal at the concentration of 1% in animal experiments. Clinical trial use on glaucoma patients (80 cases, 143 eyes) demonstrated good IOP depressive effect on primary open--or closed-angle glaucoma and secondary glaucoma. For all types of glaucoma not satisfactorily controlled by conventional drugs such as timolol and pilocarpine or by operation, the addition of puerarin also yielded favorably results. The total effective rate was 70.63%. The raw herb is produced in quantity, hence puerarin is a promising agent for the treatment of glaucoma in China.
Adrenergic beta-Antagonists↗
[Determination of thyroid hormones in patients with glaucoma].
Patients with closed-angle glaucoma develop dysthyrosis which is characterized by reduced blood serum levels of triiodothyronine (T3). Patients with an acute attack of primary closed-angle glaucoma present with oppositely changed levels of T3 and thyroxine (T4) as functions of acute attack duration. Arrest of an attack and subsequent therapy were conductive to normalization of T3 and T4 levels. Increased T4 level parallelled by reduced T3 concentration appears to be due to a significant stress of the thyroid system.
Adult↗
[Narrow angle type of chronic simple glaucoma: a report of 9 cases].
Nine patients (16 eyes) with narrow angle type of chronic simple glaucoma were evaluated. Besides the general definition, narrow angle type of chronic simple glaucoma is a special type of primary open angle glaucoma which has a narrow and open angle on goniogscopy, no obvious difference on angle configuration at low or high IOP. Laser peripheral iridectomy may be a method of differential diagnosis in this type of glaucoma and may be relatively effective in preventing further attacks of acute angle closure glaucoma which is due to the lens continues to enlarge with age and causes pupillary block. The medical treatment is the first choice to deal with this type of glaucoma, while it can not be controlled, the filtering operations should be used in time.
Diagnosis, Differential↗
[Laser gonioplasty in the treatment of primary chronic closed angle glaucoma].
The aim of the study was to evaluate of Nd:YAG laser gonioplasty performed together with iridectomy in the patients with primary chronic closed angle glaucoma. The results were compared with those achieved in patients with the same disease in whom only Nd:YAG laser iridectomy was done. In the first group normalization of the intraocular pressure was achieved in 64% and in the second only in 29% of the eyes. The best results were observed in cases with duration of the glaucoma less than 2 years and with intraocular pressure before treatment lower than 38 mmHg.
Adult↗
[Efficacy of argon and Nd:YAG laser combined in the treatment of primary chronic closed-angle glaucoma].
22 cases (29 eyes) of primary chronic closed-angle glaucoma were treated with Argon laser gonioplasty (ALG) and Nd:YAG laser iridectomy. Among 8 eyes in which the closed-angle was not opened by ALG, Nd:YAG laser gonioplasty was added, and 6 eyes became successful. For 9 eyes in which the IOP failed to drop inspite of the opened anterior chamber angle, Argon laser trabeculoplasty was added to bring remarkable curative effects to 7 eyes. During a follow-up of 5 to 14 months, 25 eyes (86%) obtained satisfactory results.
Chronic Disease↗
Ultrasonic evaluation of the lens thickness to axial length factor in primary closure angle glaucoma.
Ultrasonic biometry was done in 232 normal eyes and 138 eyes with primary angle closure glaucoma (ACG), using Ultrascan Digital B System IV (10 MHz). The ratio between the lens thickness and the axial length (lens thickness to axial length factor, LAF) was evaluated as a biometric index for assessing the eye with primary ACG in Chinese. LAF of 2.00 was found to be ideal point of demarcation between ACG and normal eyes (i.e., lens thickness equals to 1/5 of axial length). It appears that LAF is helpful in screening primary ACG eyes from eyes of the general population. This is similar to the anterior chamber depth of 2.5 mm which is recognized as a threshold for the occurrence of primary angle closure glaucoma.
Adult↗
[A histological study on peripheral iris in primary angle closure glaucoma].
Iris specimens obtained during the peripheral iridectomy in 12 cases (18 eyes) of primary angle closure glaucoma were studied histologically. The iris specimens taken during the senile cataract extraction in otherwise normal eyes were used as controls. The remarkable differences of the two groups are the changes of the quality and quantity of the mitochondria in the cells of iris tissue. The changes in primary glaucoma, especially in the intermittent stage of the angle closure glaucoma, were found in the mitochondria of the cells.
Glaucoma, Angle-Closure↗
Common eye disorders: six patients to refer.
Thorough ocular history taking and physical examination are essential to establish a diagnosis in patients presenting with eye conditions. Some conditions require ophthalmologic referral to avoid serious complications and even vision loss. These include corneal ulcers, retinal detachment, iritis, glaucoma, retinal artery occlusion, and endophthalmitis. Because primary open-angle glaucoma can have an insidious onset and cause irreversible damage, funduscopic examination should be a part of every complete physical examination.
Adult↗
[Predisposing factors in angle closure].
The authors present the study of 443 cases of closed-angle glaucoma patients, hospitalized between 1989-1995, which represent 2.45% of the patients hospitalized in this period. The particular anatomic configuration of the anterior pole of the ocular globe (small anterior chamber and big lens), especially in women's case, explains the great number of female patients. According to the age, the greatest incidence was noticed at the age group 61-70 years (170 cases). Only 12 cases were registered for the age group under 40 years. The greater incidence was also remarked during months with low sun lighting 57 in November, 48 in December, 59 in January), due to the mydriasis. The study of 130 cases of closed-angle glaucoma through intumescent lens shows that the increase of antero-posterior lens diameter is just a starting factor for a potential primary closed-angle glaucoma.
Adult↗
[Mode of progression of visual field defects and risk factors in glaucoma patients].
A study of glaucoma was conducted at 17 institutions to clarify the mode of progression of visual field defects in specific types of glaucoma, including primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG), and normal tension glaucoma (NTG). Staging of glaucoma was done by the Kosaki Classification or the Aulhorn Classification and the mode of progression was assessed by life-stable method. The progressive and non-progressive groups of patients in each glaucoma stage were compared with respect to age, intraocular pressure, refraction, and optic disc cupping. A total of 656 eyes were investigated in 656 patients (301 men and 355 women) with a mean age of 58.0 years. The average follow-up period was 5.8 years for the study using the Kosaki Classification and 4.0 years for that done with the Aulhorn Classification. The progression of visual field defects was rapid in the early stage but slow in the middle and late stages in the study by the Kosaki Classification, and it was slow in the late stages in the study by the Aulhorn Classification. The time for progression from stage Ia to stage VI was 43.3 years in the study by the Kosaki Classification and the time for progression from stage 0 to stage 6 was 47.2 years in the study by the Aulhorn Classification. The progressive and non-progressive groups differed significantly with respect to intraocular pressure at various stages.
Female↗
[A role of oblique flashlight test in screening for primary angle closure glaucoma].
PURPOSE: To study the effect of oblique flashlight test in screening for primary angle closure glaucoma. METHOD: Two hundred adults over 50 years old were sampled randomly at Doumen county of Guangdong province in 1995. 390 eyes were measured by oblique flashlight test according to grading standard photos of oblique flashlight test. Other ocular examinations consisted of intraocular-pressure measurement with Schiotz tonometer, gonioscopy, and optic disc appearance. RESULTS: The result showed 25.2% of the examined eyes had the oblique flashlight grade < or = 2, and tended to be increasing with age (x2 = 8.597, P < 0.05) and in females (x2 = 14.89, P < 0.01). Based on temporal anterior chamber angle < or = 2 (Shaffer's grade), the obligue flashlight grade < or = 2 found that occludable angle sensitivity was 91.7%, specificity was 91.5%, and 8.16% of the eyes had primary closure angle glaucoma. No patient was found in oblique flashlight grades > or = 3. CONCLUSION: This study shows that oblique flashlight test conforms to screening test needs, and plays an important role in screening for primary closure angle glaucoma. We suggest that oblique flashlight grades < or = 2 as cutoff point of screening for occludable angle.
Aged↗