Paediatric glaucoma in Hong Kong: a multicentre retrospective analysis of epidemiology, presentation, clinical interventions, and outcomes.

PURPOSE: To document the epidemiology, presentation, clinical interventions, and outcomes of paediatric glaucoma in Hong Kong. METHODS: This multicentre territory-wide retrospective study was performed by reviewing charts of patients with paediatric glaucoma in six clusters of the Hong Kong Hospital Authority and The Chinese University of Hong Kong from 2006 to 2015. RESULTS: This study included 150 eyes of 98 patients with paediatric glaucoma (presenting age: 5.2±5.7 years). Of them, 35 eyes (23.3%) had primary congenital glaucoma, 22 eyes (14.7%) had juvenile open-angle glaucoma, and 93 eyes (62.0%) had secondary glaucoma. The most prevalent types of secondary glaucoma were lens-related after cataract extraction (18.0%), Axenfeld-Rieger anomaly (5.3%), uveitis (5.3%), Sturge-Weber syndrome (4.7%), and traumatic (3.3%). The most common clinical presentations were parental concerns (20.7%) including cloudy cornea (12.7%) and tearing/photophobia (8.0%), followed by poor visual acuity (18.0%), high intraocular pressure (13.3%), and strabismus (6.0%). The follow-up duration was 8.46±6.51 years. Furthermore, 63.2% of eyes with primary glaucoma and 45.2% of eyes with secondary glaucoma were treated surgically. The final visual acuity was 0.90±0.98 LogMAR; intraocular pressure was 18.4±6.6 mm Hg; and number of glaucoma medications was 2.22±1.61. CONCLUSION: Primary congenital glaucoma was most prevalent, followed by juvenile open-angle glaucoma and aphakic glaucoma. Most eyes with primary glaucoma required surgical treatment. Parental concerns were important clinical presentations. Basic assessments by healthcare providers to identify glaucoma signs (eg, poor visual acuity, high intraocular pressure, and strabismus) warranted prompt referral to an ophthalmologist.

Correlation of previous acute angle-closure attack with extent of synechial angle closure in chronic primary angle-closure glaucoma patients.

AIM: To document any correlation between previous acute angle-closure attack and the extent of synechial angle closure in chronic primary angle-closure glaucoma (PACG) patients. METHODS: Consecutive cases of chronic PACG with patent peripheral iridotomy had gonioscopy performed. The extents of synechial angle closure of those chronic PACG eyes with previous documented acute angle-closure attack were compared to those eyes without such a history. RESULTS: A total of 102 chronic PACG eyes of 102 patients were recruited. Twenty-seven eyes (26.5%) had a previous documented acute angle closure, while 75 eyes (73.5%) did not. The mean extent of synechial angle closure +/-1 SD was 307+/-68 degrees (range, 150-360 degrees) in those chronic PACG eyes with a history of previous acute angle closure, compared to 266+/-89 degrees (range, 90-360 degrees) in those chronic PACG eyes without such a history (P=0.03, Student's t-test). There were no statistically significant differences between the two groups in age, LogMAR visual acuity, intraocular pressure (IOP), number of glaucoma eye drops, vertical cup-to-disk ratio, mean deviation or pattern SD in Humphrey automated perimetry, and anterior chamber depth (P>0.05). CONCLUSION: Previous acute angle-closure attack correlated with more extensive synechial angle closure in chronic PACG patients in this study.

In vivo measurements of macular and nerve fibre layer thickness in retinal arterial occlusion.

AIM: To investigate the structure-function relationship in patients with retinal arterial occlusion by measuring the macular and the peripapillary retinal nerve fibre layer (RNFL) thickness and the visual sensitivity. METHODS: This is an observational case series with three patients with central retinal arterial occlusion (CRAO) and two patients with branch retinal arterial occlusion (BRAO). The macular/peripapillary RNFL thickness and the visual field were measured with Stratus optical coherence tomography (OCT) and Humphrey visual field analyzer, respectively, at least 1 year after the diagnosis of CRAO or BRAO. RESULTS: The macular thickness, in particular the inner retinal layer, and the peripapillary RNFL thickness were reduced in patients with retinal arterial occlusion. The decrease in the macular and the peripapillary RNFL thickness corresponded to the sites of retinal arterial occlusion with diffuse and segmental thinning found in CRAO and BRAO, respectively. Visual field defects were found in the corresponding locations of macular and RNFL thinning, and closely correlated with the degree of the structural damage. CONCLUSIONS: Structural damages in terms of reduction in the macular and peripapillary RNFL thickness were evident in patients with retinal arterial occlusion. A close structure-function correlation was found and a worse functional outcome is associated with a more extensive thinning of the macula and RNFL. OCT measurements of the macular/peripapillary RNFL thickness provide useful indicators to reflect the severity of the disease in retinal arterial occlusion and serve as a new paradigm to study and monitor the disease longitudinally.

To compare argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure: mid-term results.

PURPOSE: To compare the clinical outcome of argon laser peripheral iridoplasty (ALPI) against systemic medications in treatment of acute primary angle-closure (APAC). METHODS: Consecutive patients with APAC were recruited and randomized to receive one of two treatment options: immediate ALPI or systemic acetazolamide +/- mannitol. All eyes were followed up for at least 6 months after laser iridotomy. Main outcome measures were intraocular pressure (IOP) and requirement for glaucoma medications. RESULTS: A total of 41 eyes (39 patients) were randomized into the ALPI group, and 38 eyes (32 patients) into the medical treatment group. There were no significant differences between the two groups in sex, age, presenting IOP, and duration of attack. Mean follow-up duration +/- SD was 15.7 +/- 5.8 months. There were no significant differences between the two groups in mean final IOP and requirement for glaucoma medications. CONCLUSIONS: There were no statistically significant differences in mean IOP and requirement for glaucoma drugs between APAC eyes treated with ALPI and systemic medications.

Immediate argon laser peripheral iridoplasty (ALPI) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study.

PURPOSE: To study the safety and efficacy of immediate argon laser peripheral iridoplasty (ALPI) as initial treatment of acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction. METHODS: In all, 10 consecutive patients with acute phacomorphic angle-closure and intraocular pressure (IOP) > or =40 mmHg were recruited into the study. Each patient received topical atropine (1%) and timolol (0.5%), and immediate ALPI as initial treatment. The IOP at 15, 30, 60, and 120 min, and then 1 day, after ALPI were documented by applanation tonometry. Systemic IOP-lowering drugs were only started if IOP remained above 40 mmHg at 2 h after ALPI. Cataract extraction was subsequently performed as definitive treatment. RESULTS: In total, 10 patients (five male, five female), with a mean age+/-SD of 73.1+/-10.3 years were recruited. Mean duration of symptomatic attack was 128+/-232 h. After ALPI, the mean IOP was reduced from 56.1+/-12.5 to 45.3+/-14.5 mmHg at 15 min, 37.6+/-7.5 mmHg at 30 min, 34.2+/-9.7 mmHg at 60 min, 25.5+/-8.7 mmHg at 120 min, and 13.6+/-4.2 mmHg at 1 day. In one patient, systemic acetazolamide was administered, because the IOP remained above 40 mmHg at 2 h after ALPI. All 10 patients had uncomplicated cataract extraction performed within 4 days after ALPI. No complications from the laser procedure were encountered. CONCLUSION: Immediate ALPI, replacing systemic antiglaucomatous medications, appeared to be safe and effective as first-line treatment of acute phacomorphic angle-closure.

Preoperative latanoprost to prevent ocular hypertension after phacoemulsification and intraocular lens implantation.

PURPOSE: To evaluate the efficacy of latanoprost given 2 hours preoperatively to prevent ocular hypertension in the early period after phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation. SETTING: Departments of Ophthalmology, United Christian Hospital and Prince of Wales Hospital, Hong Kong, China. METHODS: Sixty-four eyes of 64 patients with uncomplicated cataract having phacoemulsification with PC IOL implantation were included in this prospective randomized double-masked clinical trial. The eyes were randomly assigned to 1 of 2 groups: application of latanoprost 0.005% 2 hours before surgery or no latanoprost (control). Intraocular pressure (IOP) was measured 3 and 24 hours postoperatively. The anterior chamber was examined for the level of cells and flare using a slitlamp biomicroscope. The level of significance was 5%. RESULTS: The decrease in the mean IOP was not statistically significantly different between eyes receiving latanoprost 2 hours preoperatively and control eyes 3 hours (P =.843) and 24 hours (P =.721) postoperatively. CONCLUSION: A single application of latanoprost given 2 hours before phacoemulsification and PC IOL implantation did not produce a statistically significant IOP-lowering effect when compared with a control group in the first 24 hours after surgery.

The efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma.

PURPOSE: To report the efficacy and safety of combined phacoemulsification, intraocular lens implantation, and limited goniosynechialysis, followed by diode laser peripheral iridoplasty, in the treatment of cataract and chronic angle-closure glaucoma. METHODS: Patients with chronic angle-closure glaucoma with total synechial angle closure and intraocular pressures higher than 21 mm Hg on maximally tolerated medications, and concurrent cataract, underwent phacoemulsification with posterior chamber intraocular lens implantation and goniosynechialysis followed by diode laser peripheral iridoplasty to the inferior half of the angle. Intraoperative complications, postoperative visual acuity, intraocular pressures, and complications were evaluated. RESULTS: Seven eyes of seven patients received the operation, and the mean follow-up was 8.9 months (range, 2-16 months). The mean preoperative intraocular pressure was 33.0 +/- 4.8 mm Hg. The mean postoperative intraocular pressure at most recent follow-up was 13.3 +/- 2.9 mm Hg. The absolute success rate (intraocular pressure less than 21 mm Hg without medication) was 100%. The visual acuity of all eyes improved by more than two Snellen lines. Postoperative complications included intraocular pressure spike, hyphema, and transient corneal decompensation. CONCLUSION: It appears that phacoemulsification with intraocular lens implantation combined with inferior 180 degree goniosynechialysis followed by diode laser peripheral iridoplasty is an effective and safe surgical procedure for treating chronic angle-closure glaucoma with total synechial angle closure and cataract.

Epidemiology of acute primary angle-closure glaucoma in the Hong Kong Chinese population: prospective study.

OBJECTIVES: To determine the incidence of acute primary angle-closure glaucoma in the Hong Kong Chinese population, and to identify risk factors for this condition. DESIGN: Prospective study. SETTING: University teaching hospital, Hong Kong. PARTICIPANTS: Patients with acute primary angle-closure glaucoma presenting between 1 March 1998 and 29 February 2000. MAIN OUTCOME MEASURES: Demographic data, presenting symptoms and signs, temporal details of the presentation, and precipitating factors. The crude regional incidence was calculated according to the Hong Kong population census of 1991 and the age-specific incidence was calculated. RESULTS: Seventy-two cases (72 eyes of 72 patients) of acute primary angle-closure glaucoma were recruited. The crude incidence was 10.4 per 100,000 per year in the population aged 30 years and older. Patients at higher risk of attacks were those aged 70 years or older (age-specific incidence, 58.7 per 100,000 per year) and females, who had a relative risk of 3.8 compared with males (95% confidence interval, 1.7-8.4). Only four (5.6%) patients had a positive family history of acute primary angle-closure glaucoma. Seventeen (23.6%) patients were noted to have an upper respiratory tract infection before the attack, and 25 (34.7%) patients had taken antitussive agents. There was a statistically significant inverse correlation between the monthly attack rate and the monthly rate of influenza (Spearman's rank correlation coefficient = -0.388; P=0.031). CONCLUSION: There is a high incidence of acute primary angle-closure glaucoma among Chinese residents of Hong Kong, with elderly females at highest risk. A significant proportion of patients reported upper respiratory tract infection or the use of antitussive medication prior to attacks.

Ultrasound biomicroscopy of conventional and sutureless pars plana sclerotomies: a comparative and longitudinal study.

PURPOSE: To report the rate of ultrasonically visible vitreous incarceration and longitudinal changes of incarcerated vitreous in pars plana sclerotomies after conventional suturing or sutureless technique using ultrasound biomicroscopy. METHODS: Twenty-five consecutive eyes (25 patients) undergoing primary three-port pars plana vitrectomy participated. The first 16 pars plana vitrectomies were performed with standard conventional sutured sclerotomies, and the following nine pars plana vitrectomies were performed with modified sutureless sclerotomies. Patient demographics, diagnoses, procedures, and complications were recorded. Each patient had ultrasound biomicroscopy performed 1 week before surgery, and also after surgery at 1 week, 2 weeks, 3 weeks, 4 weeks, 2 months, 3 months, and 6 months. Visible vitreous incarceration was graded as 0 to 3. RESULTS: Vitreous incarceration was seen in 41 of 48 sclerotomies (85.4%) in the conventionally sutured group, and in 23 of 27 sclerotomies (85.2%) in the sutureless group, with no significant difference in severity among sclerotomies within each group and between the two groups. There was a significant difference in the rate of vitreous incarceration between diabetic patients with proliferative retinopathy and others (P =.002). No progressive change of visible vitreous incarceration was noted in any eye during the 6-month postoperative period. No sclerotomy-related complications occurred during the study period. CONCLUSIONS: Ultrasound biomicroscopy showed no difference in the amount of visible vitreous incarceration in conventionally sutured or sutureless sclerotomies. There was no visible longitudinal change in the incarcerated vitreous during the 6 months of follow-up in uncomplicated cases.