Phacoemulsification in Nanophthalmic Eye, a Way to Manage Glaucoma: Case Report.

A rare condition called nanophthalmos causes variable degrees of vision impairment. One may present with nanophthalmos as a hereditary or sporadic condition. There have been documented cases of nanophthalmos treated with bilateral cataract extraction and intraocular lens (IOL) implantation for intractable secondary glaucoma or chronic angle-closure glaucoma. We describe a case of closed-angle glaucoma in a nanophthalmic eye with increased intraocular pressure (IOP) on full medical treatment, along with concurrent drug side effects. As a first surgical procedure, we recommend phacoemulsification of the clear lens + IOL. The challenge in treating nanophthalmic eyes lies in managing the possibility of developing glaucoma in an eye where anatomical conditions make surgery extremely risky. This must be balanced against the advantages of lessening exposure contact in the trabecular meshwork and optimizing the anterior chamber for potential future glaucoma surgery, which can improve the prognosis in these cases. Lastly, it is critical to have a thorough conversation with the patient about the aims, risks, and advantages. The patient's understanding and expectations should also be crystal apparent. The primary objective should always be to enhance the circumstances for the most effective glaucoma therapy, not to perform refractive surgery.

Influence of preoperative dilation time on the effect of cataract ultrasonography combined with goniostomy in patients with primary closed angle glaucoma and its clinical significance.

OBJECTIVE: To evaluate the impact of preoperative pupil dilation time on the outcomes of cataract ultrasonoemulsification combined with goniostomy in patients with primary angle-closure glaucoma (PACG). METHODS: A retrospective analysis was conducted on 106 PACG patients who underwent cataract ultrasonoemulsification with goniostomy. Patients were divided into two groups based on pupil dilation times: group A (dilation time between 20 to 30 minutes) and group B (dilation time between 30 minutes to 1 hour). Pre- and postoperative intraocular pressure (IOP), visual acuity, pupil diameter, anterior chamber depth (ACD), and lens thickness (LT) were measured. Surgical time and cumulative dissipated energy (CDE) were also analyzed. Multivariate analysis was performed to identify independent risk factors for postoperative complications. RESULTS: Both groups showed significant postoperative improvement in visual acuity (P < 0.05). Group B exhibited significantly lower postoperative IOP than group A (P < 0.05). There were significant increases in ACD and pupil diameter and a decrease in LT post-dilation in both groups (all P < 0.05). Group B showed a deeper ACD, thinner LT, and larger pupil diameter compared to group A (all P < 0.05). While CDE was similar between groups, operation duration was longer in group A (P < 0.05). Disease course > 5.5 years, preoperative IOP > 25.14 mmHg, pupil diameter before dilation < 4.895 mm, ACD before dilation < 2.105 mm, and dilation time ≤ 30 minutes were independent risk factors for postoperative complications. CONCLUSION: Preoperative pupil dilation time > 30 minutes leads to better surgical outcome. Several preoperative factors, including dilation time ≤ 30 minutes, are independent risk factors for postoperative complications.

Glaucoma and Systemic Disease.

Glaucoma is the leading cause of irreversible blindness in the world. Due to its potential to cause permanent vision loss, it is important to understand how systemic conditions and their respective treatments can be associated with or increase the risk for developing glaucoma. In this review, we examined the literature for up-to-date discussions and provided commentary on glaucoma, its pathophysiology, and associated risk factors. We discuss systemic diseases and the impact, risk, and mechanism for developing glaucoma, including pharmacologically induced glaucoma; inflammatory and auto-immune conditions; infectious, dermatologic, cardiovascular, pulmonary, renal, urologic, neurologic, psychiatric and systemic malignancies: intraocular tumors; as well as pediatric, and genetic conditions. The goal of our discussion of systemic conditions including their commonality, mechanisms, treatments, and associations with developing glaucoma is to emphasize the importance of ocular examinations and follow-up with the multidisciplinary teams involved in the care of each patient to prevent unnecessary vision-loss.

[Optical coherence tomography and optical coherence tomography angiography for detecting glaucoma progression. Part 2. Clinical and functional correlations, monitoring of advanced glaucoma and limitations of the method]. / Opticheskaya kogerentnaya tomografiya i opticheskaya kogerentnaya tomografiya-angiografiya v opredelenii progressirovaniya glaukomy. Chast' 2. Kliniko-funktsional'nye korrelyatsii, monitoring na pozdnei stadii i ogranicheniya metoda.

The purpose of this study is to analyze the literature on the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in the diagnosis of glaucoma. This review considers the structural and functional correlations observed during the progression of glaucomatous optic neuropathy, as well as the capabilities of the method in late glaucoma, describes the strengths and weaknesses of OCT and OCTA, and pays particular attention to the role of OCT in assessing the effectiveness of treatment. Optical coherence tomography is the main method for determining the progression of glaucoma, which plays a key role in the choice of treatment algorithm. However, the use of OCT in far advanced glaucoma has certain particularities and limitations. OCTA can be helpful in overcoming this problem.

[Optical coherence tomography and optical coherence tomography angiography for detecting glaucoma progression. Part 1. Study methods, measurement variability and the role of age-related changes]. / Opticheskaya kogerentnaya tomografiya i opticheskaya kogerentnaya tomografiya-angiografiya v opredelenii progressirovaniya glaukomy. Chast' 1. Metody issledovaniya, variabel'nost' pokazatelei i rol' vozrastnykh izmenenii.

This paper reviews the literature on the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in the diagnosis of glaucoma and considers the significance of evaluating retinal nerve fiber layer and ganglion cell complex in assessment of glaucoma progression, variability and reproducibility of the method, as well as the influence of age-related retinal changes on the results, analyzes the role of OCTA in glaucoma monitoring. Optical coherence tomography is a modern standard for glaucoma diagnosis and monitoring, and OCTA shows high potential as an auxiliary diagnostic tool.

Modificaciones del segmento anterior ocular tras extracción del cristalino versus iridotomía periférica láser en el cierre angular primario / Modifications of the ocular anterior segment after lens extraction versus peripheral laser iridotomy in primary angle closure

RESUMEN Introducción: el tratamiento inicial para el cierre angular primario está dirigido a modificar el segmento anterior ocular y a estabilizar la enfermedad. Objetivo: evaluar si existen diferencias entre los pacientes tratados con facoemulsificación o iridotomía periférica láser, en cuanto a mejoría de los parámetros anatómicos del segmento anterior ocular. Materiales y métodos: se realizó un estudio cuasi experimental con un grupo de control histórico en la provincia Pinar del Río, entre enero de 2011 y enero de 2020. El mismo incluyó 196 ojos de 144 pacientes con cierre angular primario, tratados con facoemulsificación o iridotomía periférica láser. El análisis estadístico se realizó a través del programa SPSS. Resultados: en el preoperatorio no hubo diferencias significativas para la amplitud de la cámara anterior. En el postoperatorio sí existieron diferencias muy significativas (p < 0,001) entre los dos procedimientos quirúrgicos para ambos ojos. En la amplitud angular también existieron diferencias muy significativas (p < 0,001) entre el preoperatorio y el postoperatorio de ambos grupos. La presencia de sinequias anteriores periféricas fue escasa, sin diferencias entre los valores basales, y a los dos meses en ambos ojos para cada grupo. La evidencia de cierre angular, al final del período, entre el grupo de facoemulsificación y el de iridotomía, fue de 4,9 % vs. 23,2 % (p = 0,029) en el ojo derecho, y de 2,7 % vs. 29,0 % (p = 0,003) en el izquierdo. Conclusiones: tanto la extracción del cristalino como la iridotomía periférica láser mejoran los parámetros anatómicos del segmento anterior, aunque los resultados son superiores en ojos tratados con facoemulsificación.

ABSTRACT Introduction: initial treatment for the primary angle closure is aimed to modify the anterior ocular segment and to stabilize the disease. Objective: to assess if there are differences between patients treated with phacoemulsification or peripheral laser iridotomy, in terms of improvement of the anatomical parameters of the anterior ocular segment. Materials and methods: a quasi-experimental study was led with a historic control group in the province of Pinar del Rio, between January 2011 and January 2020. It included 196 eyes of 144 patients with primary angular closure, treated with phacoemulsification or laser peripheral iridotomy. The statistical analysis was carried out using SPSS program. Results: in the preoperative period there were not significant differences for the amplitude of the anterior chamber. In the postoperative there were very significant differences (p < 0.001) between the two surgical procedures for both ayes. In angular amplitude there were also very significant differences (p < 0.001) between preoperative y postoperative periods of both groups. The presence of peripheral anterior synechia was scarce, without differences between baseline values, and after two months in both eyes for each group. The evidence of angular closure, at the end of the period, between the phacoemulsification group and the iridotomy one was 4.9 % vs. 23.2 % (p = 0.029) in the right eye, and 2.7 % vs. 29.0 % (p = 0.003) in the left. Conclusions: both, crystalline lens extraction and laser peripheral iridotomy improve the anatomical parameters of the anterior segment, although the results are greater in ayes treated with phacoemulsification.

Infections and glaucoma.

Glaucoma is an intraocular pressure-related ophthalmic disease with multiple causes that results in an optic neuropathy and vision loss. Intraocular pressure elevation is among its strongest risk factors. While glaucoma is mostly primary in etiology, secondary glaucoma is not infrequent. Recognizing its cause is imperative, since treatment is often different depending on the pathophysiologic mechanism. Numerous clinically relevant ophthalmic infections can result in robust inflammatory responses that may result in pressure elevation or intraocular anatomic configurations that predispose to pressure elevation. Knowing the mechanisms by which these infections can lead to glaucoma is critical in treating, and we consolidate what is currently known in regards to how infectious diseases lead to glaucoma.

Glaucoma in Adults-diagnosis, Management, and Prediagnosis to End-stage, Categorizing Glaucoma's Stages: A Review.

Importance: Most frequent worldwide cause of permanent blindness is glaucoma. Early in the course of the disease, glaucoma affects many patients without any symptoms. In order to examine for indications of glaucoma and to ascertain whether systemic illnesses or drugs can raise a patient's risk of developing glaucoma, primary care practitioners should be aware of which patients to send to an eye care specialist. A review of the pathogenesis, risk factors, screening, disease monitoring, and treatment options for open-angle and narrow-angle glaucoma are included. Observations: The optic nerve and retinal nerve fiber layer (rNFL) are damaged in glaucoma, a chronic, progressive optic neuropathy that can result in a permanent loss of peripheral or central vision. The only risk factor that is known to be controllable is intraocular pressure (IOP). A family history of glaucoma, older age, and non-white race are additional significant risk factors. Numerous systemic diseases and drugs, such as corticosteroids, anticholinergics, certain antidepressants, and topiramate, can put people at risk of developing glaucoma. Open-angle and angle-closure glaucoma are the two main types of disease. Measurement of IOP, perimetry, and optical coherence tomography are diagnostic procedures to evaluate glaucoma and track the course of the condition. In order to treat glaucoma, IOP must be decreased. This is possible with a variety of glaucoma medication classes, laser surgery, and incisional surgery. Verdicts and relevance: By identifying systemic illnesses and drugs that raise a patient's chance of developing glaucoma and referring high-risk individuals for a thorough ophthalmologic examination, vision loss from glaucoma can be reduced. Clinicians should make sure that patients continue taking their glaucoma drugs as prescribed and should keep an eye out for any negative side effects from any medical or surgical procedures used to treat glaucoma. How to cite this article: Joshi P, Dangwal A, Guleria I, et al. Glaucoma in Adults-diagnosis, Management, and Prediagnosis to End-stage, categorizing Glaucoma's Stages: A Review. J Curr Glaucoma Pract 2022;16(3):170-178.

Semi-supervised generative adversarial networks for closed-angle detection on anterior segment optical coherence tomography images: an empirical study with a small training dataset.

BACKGROUND: Semi-supervised learning algorithms can leverage an unlabeled dataset when labeling is limited or expensive to obtain. In the current study, we developed and evaluated a semi-supervised generative adversarial networks (GANs) model that detects closed-angle on anterior segment optical coherence tomography (AS-OCT) images using a small labeled dataset. METHODS: In this cross-sectional study, a semi-supervised GANs model was developed for automatic closed-angle detection training on a small labeled and large unsupervised training dataset collected from the Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong (JSIEC). The closed-angle was defined as iris-trabecular contact beyond the scleral spur in AS-OCT images. We further developed two supervised deep learning (DL) models training on the same supervised dataset and the whole dataset separately. The semi-supervised GANs model and supervised DL models' performance were compared on two independent testing datasets from JSIEC (515 images) and the Department of Ophthalmology (84 images), National University Health System, respectively. The diagnostic performance was assessed by evaluation matrices, including the accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). RESULTS: For closed-angle detection using clinician grading of AS-OCT imaging as the reference standard, the semi-supervised GANs model showed comparable performance, with AUCs of 0.97 (95% CI, 0.96-0.99) and 0.98 (95% CI, 0.94-1.00), compared with the supervised DL model (using the whole dataset) [AUCs of 0.97 (95% CI, 0.96-0.99), and 0.97 (95% CI, 0.94-1.00)]. When training on the same small supervised dataset, the semi-supervised GANs achieved performance at least as well as, if not better than, the supervised DL model [AUCs of 0.90 (95% CI: 0.84-0.96), and 0.92 (95% CI, 0.86-0.97)]. CONCLUSIONS: The semi-supervised GANs method achieves diagnostic performance at least as good as a supervised DL model when trained on small labeled datasets. Further development of semi-supervised learning methods could be useful within clinical and research settings. TRIAL REGISTRATION NUMBER: ChiCTR2000037892.

Outcomes of baervedlt implant surgery in 17 dogs (20 eyes) with primary closed-angle glaucoma (2013-2019).

OBJECTIVE: To report outcomes and follow-up of Baerveldt implant surgery in dogs with primary closed-angle glaucoma (PCAG). MATERIALS AND METHODS: Record review of client-owned dogs with PCAG that underwent Baerveldt implant surgery during a 6-year period. Postoperative intraocular pressure (IOP), vision and daily number of anti-glaucoma drops at fixed time points (3, 12, and 24 months) were compared with preoperative values; complications were recorded. Success was defined as IOP <20 mm Hg and a positive menace response and navigation/tracking ability. RESULTS: Twenty eyes (17 dogs) were included. Mean follow-up was 575 days (range 30-1767 days) from implant surgery to last examination. Three months postoperatively 15/20 (75%) eyes had IOP <20 mm Hg and 14/20 (70%) eyes had vision. Twelve months postoperatively 11/17 (65%) eyes had IOP <20 mm Hg and 12/19 (63%) eyes had vision. Twenty-four months postoperatively 8/14 (57%) eyes had IOP <20 mm Hg and 7/15 (47%) eyes had vision. Denominators differ between time points as eyes were included when duration after surgery reached the relevant postoperative time point or failure was documented earlier. Within 3 months postoperatively 16/20 (80%) eyes had ≥1 complication, including transient IOP >20 mm Hg (14/20; 70% eyes), fibrin (12/20; 60% eyes), and hypotony (4/20; 20% eyes). After 3 months, postoperatively 13/16 (81%) eyes had ≥1 complication, including cataracts (13/16; 81% eyes), bleb fibrosis (3/16; 19% eyes), and conjunctival wound breakdown (1/16; 6% eyes). One patient (1 eye) was euthanized for blindness and 5/20 (25%) eyes were enucleated. CONCLUSIONS: The technique was effective in controlling IOP and maintaining vision in most dogs in this study.

Efecto de la extracción del cristalino en la presión intraocular de pacientes con glaucoma por cierre angular primario / Effect of crystalline lens extraction on intraocular pressure in patients with primary angle closure glaucoma

Objetivo: Describir el efecto de la extracción del cristalino transparente en la presión intraocular de pacientes con glaucoma por cierre angular primario. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo en la provincia de Pinar del Río, entre enero del año 2013 y diciembre de 2019, que incluyó a 54 ojos de 54 pacientes con glaucoma por cierre angular primario y cristalino transparente, tratados con facoaspiración. El análisis estadístico se realizó a través del programa SPSS. Resultados: Hubo diferencias muy significativas (p< 0,001) en los valores de presión intraocular media entre el preoperatorio y el posoperatorio. El número de medicamentos no mostró diferencias significativas (p= 0,317) y el porcentaje de reducción promedio de la presión intraocular fue de 33,9 ± 4,3. Al final del período de seguimiento el 68,5 por ciento manifestó valores de 18 mmHg o más. El estadio glaucomatoso, la existencia o no de sinequias anteriores periféricas, el valor medio de la presión intraocular preoperatoria y del número de medicamentos mostraron diferencias significativas (p= 0,006; p= 0,001; p= 0,001 y p= 0,045 respectivamente) entre las categorías de control de la presión intraocular. Conclusión: La extracción del cristalino transparente reduce la presión intraocular en pacientes con glaucoma por cierre angular primario, lo que se corrobora a mediano plazo; aunque la mayoría de los ojos tratados no alcanzan un control total y mantienen el número de medicamentos sin variación(AU)

Objective: Describe the effect of clear lens extraction on intraocular pressure in patients with primary angle closure glaucoma. Methods: A prospective longitudinal descriptive study was conducted in the Province of Pinar del Río from January 2013 to December 2019. The study included 54 eyes of 54 patients with primary angle closure glaucoma and clear lens treated with phacoaspiration. Statistical analysis was based on SPSS software. Results: Very significant differences were found (p< 0.001) between preoperative and postoperative intraocular pressure values. Significant differences were not observed in the number of drugs indicated (p= 0.317). Average intraocular pressure reduction percentage was 33.9 ± 4.3. By the end of the follow-up period, 68.5 percent displayed values of 18 mmHg or higher. Significant differences were found between the intraocular pressure control categories with respect to the stage of the disease, the existence or non-existence of previous peripheral synechiae, the mean preoperative intraocular pressure value, and the number of drugs (p= 0.006; p= 0.001; p= 0.001 and p= 0.045, respectively). Conclusion: Clear lens extraction reduces intraocular pressure in patients with primary angle closure glaucoma, a fact corroborated in the medium term, though most of the eyes treated do not achieve total control and the number of drugs remains unaltered(AU)

Potentially inappropriate prescriptions of anticholinergic medications in patients with closed-angle glaucoma.

PURPOSE: Glaucoma is the leading cause for blindness after cataracts worldwide. The aim was to identify anticholinergic drugs prescribed to patients diagnosed with closed-angle glaucoma in Colombia. METHODS: This cross-sectional study identified the prescribing patterns of cholinergic antagonists related to the increased intraocular pressure in patients diagnosed with closed-angle glaucoma from a Colombian database. The Anticholinergic Drug Scale was used to quantify the anticholinergic burden. RESULTS: We identified 1958 patients with closed-angle glaucoma, with a mean age of 70.5 ± 10.3 years, 72.9% of whom were women. Cholinergic antagonists were prescribed in at least 32.4% of cases. An age range between 75 and 84 years (odds ratio (OR) 2.35, 95% confidence interval (CI) 1.366-4.059) and being aged 85 years or older (OR 3.40, 95% CI 1.809-6.425) were associated with a greater probability of receiving an anticholinergic burden between 1 and 2 points. Females (OR 1.54, 95% CI 1.096-2.181) had a higher probability of receiving an anticholinergic burden ≥ 3 points. Interactions between antiglaucoma medications and anticholinergic treatments were identified in 32.1% of the patients. CONCLUSIONS: Most patients were prescribed multiple antiglaucoma medications, reflecting a large number of potentially inappropriate prescriptions, with anticholinergic drugs, related to the increased intraocular pressure.

Glaucoma de ângulo fechado devido a síndrome de íris em platô / Primary angle closure glaucoma due to plateau íris syndrome

Resumo Objetivo: Descrever um caso de glaucoma de ângulo fechado devido a síndrome de íris em platô. Descrição do caso: Paciente do sexo feminino, de 50 anos de idade, que há 13 meses foi tratada de fechamento angular primário a esquerda com sucesso com iridotomia periféria com Nd:YAG laser, compareceu ao serviço com queixa de embaçamento visual e dor intermitentes no olho esquerdo. Ao exame, observou-se fechamento angular à esquerda que se desfazia à gonioscopia de identação e pressão intraocular (PIO) de 16 e 42mmHg. O exame do ângulo da câmara anterior pela tomografia de coerência óptica evidenciou iridotomia patente em ambos os olhos e à esquerda o fechamento aposicional. Pelo estudo das imagens do ângulo foi possível identificar a configuração íris em platô, caracterizando a síndrome de íris em platô à esquerda. Foi procedida a goniosplastia com laser de argônio em ambos os olhos, o que permitiu a correção da configuração da íris e controle da PIO. Após o tratamento, foi realizado exame de campo visual que foi normal à direita e à esquerda identificou escotoma arqueado superior. O fundo de olho mostrou disco óptico normal a direita (0,2),e glaucomatoso à esquerda (0,6). Um ano após a gonioplastia, a acuidade visual foi de 20/30 sem correção por ambos os olhos, PIO de 12 e 13mmHg, sem medicações, com fundo de olho e campos visuais inalterados. Conclusão: A configuração íris em platô deve sempre ser considerada frente a casos de fechamento angular primário, sendo a tomografia de coerência óptica valiosa ferramenta para corroborar no seu diagnóstico.

Abstract Objective: To present a case of closed-angle glaucoma due to Plateau iris syndrome. Case Description: Female Patient, 50 years old, that 13 months ago was treated for primary angular closure to the left successfully with iridotomy with Nd: YAG Laser. She attended the service complaining of visual haze and intermittent pain in the left eye. On examination, it was observed angle closure in the left that could be openned with identation. Intraocular pressure (IOP) of 16 and 42mmHg respectively. The examination of the anterior chamber angle by optical coherence tomography showed patent iridotomy in both eyes and on the left the apositional angle closure. By studying the angle images it was possible to identify plaeau iris configuration, characterizing the iris syndrome of plateau iris. Gonioplasty with argon laser was performed in both eyes, which allowed the correction of iris configuration and control of IOP. After treatment, visual field examination was performed, which was normal to the right and to the left identified superior arcuate scotoma. The Fundus showed a normal right optical disc (0.2), and glaucomatous left (0.6). One year after gonioplasty, visual acuity was 20/30 without correction by both eyes, PIO of 12 and 13mmHg, without medications, with unaltered visual fields and optic discs. Conclusion: The Iris configuration in Plateau should always be considered in front of cases of primary angle closure, being the optical coherence tomography valuable tool to corroborate in its diagnosis.

Contemporary approach to the diagnosis and management of primary angle-closure disease.

The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.

Interobserver reliability when using the Van Herick method to measure anterior chamber depth.

INTRODUCTION: The Van Herick method is a quick and easy way to estimate anterior chamber depth, which allows grading of patients according to the likelihood of having primary acute closed-angle glaucoma. However, as the test is highly subjective, measurements and thus grading may vary between observers. AIM: The aim of this study was to investigate the degree of variation of Van Herick scores among observers and to investigate agreement between temporal and nasal scores. MATERIALS AND METHODS: A total of 15 observers measured the temporal and nasal Van Herick scores from 18 patients, grouped into cohorts at outpatient glaucoma and corneal clinic. Analysis of data involved assigning a patient to a Van Herick grade based on the median score and then determining the mean standard deviation and percentage consistency for each grade. RESULTS: We found that Grades 1 and 4 had a high mean percentage consistency (80% and 84.6%, respectively) and a low mean standard deviation (0.45 and 0.26, respectively). Grades 2 and 3 had low mean percentage consistencies (57.5 and 5, respectively) and high mean standard deviations (0.71 and 0.89, respectively). The temporal and nasal scores showed good agreement (κ = 0.61P < 0.001). CONCLUSION: The Van Herick score has a good interobserver reliability for Grades 1 and 4; however, Grades 2 and 3 require further tests such as gonioscopy or ocular coherence tomography. Temporal and nasal scores demonstrated good agreement; therefore, if the nasal score cannot be measured due to nasal bridge size, the temporal can be used as an approximation.

Bilateral acute closed angle glaucoma associated with the discontinuation of escitalopram: a case report.

A 45-year-old woman presented to the Emergency Department complaining of severe headache for 3 hours duration associated with bilateral blurred vision, photophobia, and one attack of vomiting. Her clinical examination revealed normal vital signs and decrease in visual acuity with hazy cornea bilaterally. There were no signs of increased intracranial pressure and no neck rigidity or meningeal signs. The patient was diagnosed with bilateral acute closed angle glaucoma (AACG) with intraocular pressure of 60 mmHg in both eyes. She was using escitalopram for the treatment of depression, which was the only known risk factor for her condition. Standard treatment for AACG was provided. It included topical ß-blocker, α agonists, and acetazolamide. This was followed by bilateral peripheral iridotomy. Follow-up intraocular pressure measurement revealed a value of 5 mmHg after 24 hours, indicating complete recovery. To the best of our knowledge, this is the first case to describe AACG after stopping the medication. It is highly important that clinicians be aware of this risk factor for AACG and have high index of suspicion in such patients with vision-threatening condition even after discontinuing the medication, because the risk persists for some time.

Prevalence of pectinate ligament dysplasia and associations with age, sex and intraocular pressure in the Basset hound, Flatcoated retriever and Dandie Dinmont terrier.

BACKGROUND: The aims of this study were to: determine the prevalence of pectinate ligament dysplasia (PLD) in populations of Basset hounds (BH), Flatcoated retrievers (FCR) and Dandie Dinmont terriers (DDT) resident in the UK; investigate possible associations between the degree of PLD and age, sex and intraocular pressure (IOP) and; investigate possible associations between IOP and age and sex. Gonioscopy was performed in both eyes of 198 BH, 170 FCR and 95 DDT and the percentage of iridocorneal angle affected by PLD was estimated and classified as unaffected (0 %), mildly affected (<20 %), moderately affected (20-90 %) or severely affected (>90 %). Rebound tonometry was performed bilaterally in the majority of enrolled dogs. RESULTS: Seventy-six of 198 (38.4 %) BH, 36/170 (21.2 %) FCR and 21/95 (22.1 %) DDT were moderately or severely affected by PLD. The prevalence of PLD was significantly higher in BH than both FCR and DDT. In all breeds there was a significant positive correlation between PLD and age. In the BH only there was a significant association between PLD and sex. In the DDT only there was a weak negative correlation between PLD and IOP and a moderately strong negative correlation between IOP and age. CONCLUSIONS: PLD is prevalent and significantly associated with age in all three breeds we investigated. The linear relationship between PLD and age can be explained by the progression of PLD over time which would contribute to the high prevalence of PLD despite widespread screening.

Definition, Classification, and Pathophysiology of Canine Glaucoma.

Glaucoma is a common ocular condition in humans and dogs leading to optic nerve degeneration and irreversible blindness. Primary glaucoma is a group of spontaneous heterogeneous diseases. Multiple factors are involved in its pathogenesis and these factors vary across human ethnic groups and canine breeds, so the clinical phenotypes are numerous and their classification can be challenging and remain superficial. Aging and oxidative stress are major triggers for the manifestation of disease. Multiple, intertwined inflammatory and biochemical cascades eventually alter cellular and extracellular physiology in the optic nerve and trabecular meshwork and lead to vision loss.

Genetics of Canine Primary Glaucomas.

Primary glaucomas are a leading cause of incurable vision loss in dogs. Based on their specific breed predilection, a genetic cause is suspected to be responsible, and affected dogs should be excluded from breeding. Despite the high prevalence of primary glaucomas in dogs, their genetics have been studied in only a small number of breeds. The identification of canine glaucoma disease genes, and the development of genetic tests, will help to avoid the breeding of affected dogs in the future and will allow for earlier diagnosis and potentially more effective therapy.

Unilateral Acute Closed-Angle Glaucoma After Elective Lumbar Surgery Reveals Multiple Intracranial Aneurysms. A Case Report and Discussion on Workup of Differential Diagnoses.

The purpose of our paper is to present a case of a rare complication of posterior lumbar surgery. Our patient presented for elective lumbar decompression, which was complicated by durotomy. She then developed sudden headache and right eye pain once upright on postoperative day 2. Then on postoperative day 3, she developed a dilated nonreactive pupil with extraocular movements intact. A computed tomography scan of the head was negative for subarachnoid hemorrhage. Magnetic resonance angiography showed a possible right posterior communicating artery aneurysm. She was transferred to a tertiary center with a severe headache and a nonreactive pupil, raising concern for evolving third nerve palsy due to aneurysm. A cerebral angiogram was performed and showed multiple aneurysms. Aneurysm location did not explain the patient's symptoms, and ophthalmology was consulted. Elevated intraocular pressure was noted, and the patient was diagnosed with acute angle-closure glaucoma (AACG). Our patient was medically treated and subsequently underwent laser peripheral iridotomy. She has had improved vision and pupillary function at 1 month follow-up. The diagnosis is complicated by a durotomy, which led to cascade in the differential diagnosis to rule out intracranial pathology. Her age and home medications, which had sympathomimetic effects, placed her at increased risk, but lying prone in the dark under the drapes was likely the lead causative factor. In conclusion, a postoperative posterior spine patient with eye pain and changes in vision and pupils should be evaluated with AACG in mind due to the devastating consequences if left untreated or treatment is delayed.