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1.
BMC Ophthalmol ; 22(1): 222, 2022 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-35578256

RESUMO

BACKGROUND: Primary angle closure glaucoma (PACG) is the most common type of glaucoma in China. Laser peripheral iridotomy (LPI) is the primary choice to treat PAC: We aim to evaluate the changes of biometric parameters of anterior segment and to find possible biometric predictors of the effect of laser peripheral iridotomy (LPI) in primary angle closure (PAC) eyes using swept-source optical coherent tomography (OCT). METHODS: LPI was performed in 52 PAC eyes of 28 participants. The change of intraocular pressure and anterior segment parameters, including angle opening distance (AOD500), AOD500 area, trabecular iris space area (TISA500), TISA500 volume, trabecular iris angle (TIA500), iridotrabecular contact (ITC) index, ITC area, anterior chamber volume (ACV), anterior chamber depth (ACD), lens vault (LV) and lens thickness (LT) before and 1 week after LPI were measured by Tomey CASIA2 anterior segment OCT. We also estimate and analyze potential associated factors possibly affecting the change of anterior chamber parameters. RESULTS: No post-laser complications were found. The ACD, LV and LT did not change significantly 1 week after LPI. AOD500, AOD500 area, TISA500, TISA500 volume, TIA500, ACV increased significantly after LPI. There was significant decrease in ITC index and ITC area. LT was positively correlated to the change of ITC index (ß = 0.239, *p = 0.045). CONCLUSIONS: The anterior segment architecture significantly changed after LPI in PAC spectrum eyes. Crystalline lens measurements remained unchanged before and after LPI. AS-OCT can be used to follow anterior chamber parameter changes in PAC spectrum eyes. LT may play a role in the therapeutic effect of LPI.


Assuntos
Glaucoma de Ângulo Fechado , Terapia a Laser , Segmento Anterior do Olho/diagnóstico por imagem , Biometria , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Iridectomia/métodos , Iris/diagnóstico por imagem , Iris/cirurgia , Terapia a Laser/métodos , Lasers , Tomografia de Coerência Óptica/métodos
2.
BMC Ophthalmol ; 22(1): 144, 2022 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-35351034

RESUMO

BACKGROUND: Laser peripheral iridotomy (LPI) is effective in primary angle-closure suspects (PACS); however, predictors for anterior segment alterations after LPI are limited. We aimed to evaluate the anterior segment biometric parameters before and after LPI in PACS using the recently developed, CASIA 2 device of anterior segment optical coherence tomography (AS-OCT). METHODS: We performed LPI in 52 PACS. Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber width (ACW), anterior chamber volume (ACV), iris curvature (ICURVE), iridotrabecular contact (ITC), lens vault (LV), lens thickness (LT), radius of the lens, angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) at different distances (i.e., 500 µm from the sclera spur), were evaluated before and after LPI using CASIA 2. RESULTS: Eyes of PACS after LPI had a greater ACV, AOD, ARA, TISA, and TIA, and a lower ITC and ICURVE (all p < 0.001) than those before LPI. On a 360° scan, the anterior chamber angle in the superior quadrant increased the most after the LPI. A higher baseline LT was significantly associated with a greater postoperative increase in AOD 500, ARA 500, TISA 500, and TIA 500 (p = 0.001, p = 0.010, p = 0.004, and p < 0.001, respectively). CONCLUSIONS: We found that LPI widens the anterior chamber angle in the PACS, especially, in the superior quadrant around the iridotomy hole. Eyes with a thicker lens are more likely to experience angle opening because of the LPI.


Assuntos
Glaucoma de Ângulo Fechado , Tomografia de Coerência Óptica , Segmento Anterior do Olho/diagnóstico por imagem , Glaucoma de Ângulo Fechado/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Iridectomia/métodos , Lasers , Tomografia de Coerência Óptica/métodos
3.
Ophthalmology ; 129(7): 792-802, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35306094

RESUMO

PURPOSE: To determine the incidence and risk factors of primary angle-closure disease (PACD) over 6 years in a multi-ethnic Asian population. DESIGN: Population-based, longitudinal study. PARTICIPANTS: The Singapore Epidemiology of Eye Diseases study is a population-based cohort study conducted among adults aged 40 years or more. The baseline examination was conducted between 2004 and 2010, and the 6-year follow-up visit was conducted between 2011 and 2017. Of 6762 participants who attended the follow-up examination, 5298 at risk for primary angle-closure glaucoma (PACG) and 5060 at risk for PACD were included for analyses. METHODS: Standardized examinations including slit-lamp biomicroscopy, indentation gonioscopy, intraocular pressure (IOP) measurement, and static automated perimetry were performed. In this study, PACD includes primary angle-closure suspect (PACS), primary angle-closure (PAC), and PACG. MAIN OUTCOME MEASURES: The 6-year PACD incidence was evaluated among an at-risk population excluding adults with baseline glaucoma, PACS, PAC, pseudophakia at baseline or follow-up, or laser peripheral iridotomy or iridectomy at baseline visit. Logistic regression analysis adjusting for age, gender, and ethnicity was performed to evaluate associations between PACD development and demographic or ocular characteristics. Forward selection based on the Quasi-likelihood Information Criterion was used in multivariable analysis to reduce potential multicollinearity. RESULTS: The 6-year age-adjusted PACD incidence was 3.50% (95% confidence interval [CI], 2.94-4.16). In multivariable analysis, increasing age per decade (odds ratio [OR], 1.35; 95% CI, 1.15-1.59), higher IOP (OR, 1.04; 95% CI, 1.00-1.08), and shallower anterior chamber depth (OR, 1.11; 95% CI, 1.08-1.14) at baseline were associated with higher odds of PACD, whereas late posterior subcapsular cataract (PSC) (OR, 0.60; 95% CI, 0.48-0.76) was associated with lower odds of PACD. The 6-year age-adjusted incidences of PACG, PAC, and PACS were 0.29% (95% CI, 0.14-0.55), 0.46% (95% CI, 0.29-0.75), and 2.54% (95% CI, 2.07-3.12), respectively. CONCLUSIONS: Our study showed that the 6-year incidence of PACD was 3.50%. Increasing age, higher IOP, and shallower anterior chamber were associated with a higher risk of incident PACD, whereas late PSC was associated with a lower odds of PACD. These findings can aid in future projections and formulation of health care policies for screening of at-risk individuals for timely intervention.


Assuntos
Glaucoma de Ângulo Fechado , Adulto , Estudos de Coortes , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/epidemiologia , Glaucoma de Ângulo Fechado/cirurgia , Gonioscopia , Humanos , Incidência , Pressão Intraocular , Iridectomia/métodos , Estudos Longitudinais , Fatores de Risco , Singapura/epidemiologia
4.
J Glaucoma ; 31(4): 218-223, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35131983

RESUMO

PRCIS: In primary angle closure suspects (PACS), self-identified Black race was a risk factor for intraocular pressure (IOP) elevation and iritis following laser peripheral iridotomy (LPI). Laser type was not associated with either immediate post-LPI IOP elevation or iritis in multivariate analysis. PURPOSE: The aim was to determine the impact of laser type and patient characteristics on the incidence of IOP elevation and iritis after LPI in PACS. MATERIALS AND METHODS: The electronic medical records of 1485 PACS (2407 eyes) who underwent either neodymium-doped yttrium-aluminum-garnet or sequential argon and neodymium-doped yttrium-aluminum-garnet LPI at the University of Pennsylvania between 2010 and 2018 were retrospectively reviewed. Average IOP within 30 days before LPI (baseline IOP), post-LPI IOP within 1 hour, laser type, laser energy, and the incidence of new iritis within 30 days following the procedure were collected. Multivariate logistic regression accounting for intereye correlation was used to assess factors associated with incidence of post-LPI IOP elevation and iritis, adjusted by age, sex, surgeon, and histories of autoimmune disease, diabetes, and hypertension. RESULTS: The incidence of post-LPI IOP elevation and iritis were 9.3% (95% confidence interval: 8.1%-10.5%) and 2.6% (95% CI: 1.9%-3.2%), respectively. In multivariate analysis, self-identified Black race was a risk factor for both IOP elevation [odds ratio (OR): 2.08 compared with White; P=0.002] and iritis (OR: 5.07; P<0.001). Higher baseline IOP was associated with increased risk for post-LPI IOP elevation (OR: 1.19; P<0.001). Laser type and energy were not associated with either post-LPI IOP elevation or iritis (P>0.11 for all). CONCLUSIONS: The incidence of immediate IOP elevation and iritis following prophylactic LPI was higher in Black patients independent of laser type and energy. Heightened vigilance and increased medication management before and after the procedure are suggested to help mitigate these risks.


Assuntos
Glaucoma de Ângulo Fechado , Irite , Terapia a Laser , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Pressão Intraocular , Iridectomia/métodos , Iris/cirurgia , Irite/cirurgia , Terapia a Laser/métodos , Estudos Retrospectivos , Fatores de Risco
6.
BMC Ophthalmol ; 22(1): 23, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35031016

RESUMO

BACKGROUND: Peripheral iridectomy (PI), routinely performed during glaucoma filtration surgery, may contribute to scarring. This study aims to determine whether PI alters the concentrations of VEGF-A and TGF-ß isoforms in the rabbit aqueous humour. METHODS: Anterior chamber paracentesis (ACP) was performed in both eyes of six New Zealand white rabbits, with additional surgical PI performed in the right eyes. Eyes were examined on postoperative days (PODs) 1, 7, 30 and 60 by means of the tonopen, slit-lamp biomicroscopy, and bead-based cytokine assays for TGF-ß and VEGF-A concentrations in the aqueous humor. RESULTS: ACP caused a significant reduction in intraocular pressure (IOP) from mean preoperative 11.47 ± 1.01 mmHg to 5.67 ± 1.63 mmHg on POD 1 while PI did not cause further IOP reduction. Limbal conjunctival vasculature appeared slightly increased on POD 1 in both ACP and PI eyes with PI also causing mild bleeding from damaged iris vessels. Two PI eyes developed fibrinous anterior chamber reaction and/ or peripheral anterior synechiae. Aqueous VEGF-A levels were not significantly different between eyes treated with ACP and PI. Aqueous TGF-ß concentrations distributed in the ratio of 4:800:1 for TGF-ß1:TGF-ß2:TGF-ß3 respectively. While aqueous TGF-ß2 was not significantly induced by either procedure at any time point, TGF-ß1 and TGF-ß3 were significantly induced above baseline levels by PI on POD 1. CONCLUSION: PI increases the risk of inflammation. The combined induction of aqueous TGF-ß1 and TGF-ß3 by PI in glaucoma surgery may impact surgery success in glaucoma subtypes sensitive to these isoforms.


Assuntos
Humor Aquoso , Fator A de Crescimento do Endotélio Vascular , Animais , Pressão Intraocular , Iridectomia , Iris/cirurgia , Coelhos
8.
J Fr Ophtalmol ; 45(2): 201-206, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34980515

RESUMO

PURPOSE: To assess the utility of UBM in the management of primary angle closure (PAC) and assessing the predictability of peripheral iridotomy (PI) in re-opening the closed angle. DESIGN: Retrospective clinical study. SUBJECTS: Patients with suspicion of PAC. METHODS: This study obtained the consent of all patients and adhered to the Declaration of Helsinki. It was conducted in two ocular imaging centers and based on patients with suspected PAC. Each patient underwent UBM and Visante OCT at each visit, before and after PI when PAC was confirmed. MAIN OUTCOME MEASURE: Irido-corneal angle. RESULTS: Out of 202 eyes (101 patients) with a mean age of 62 years and 69.3% female predominance, we found 186 eyes with PAC. In most cases (77.4%), the iridocorneal angle was open after a single PI at the second visit, and only 14% eyes remained closed at the third visit, regardless of any additional treatment performed (complementary PI, iridoplasty, surgical lens extraction). Mechanisms involved in persistent angle closure after PI were: imperforate PI (45.2% of eyes), iris plateau syndrome (8.6% of eyes), significant lens vaulting (30.9% of eyes) and mixed mechanisms (2.3% of eyes). CONCLUSION: PI remains effective as a first-line treatment in most cases of PAC, even when associated with mechanisms other than pupillary block. Nevertheless, the PI must be completely patent, and UBM can help in understanding underlying mechanisms, hence guiding the treatment in these eyes.


Assuntos
Glaucoma de Ângulo Fechado , Terapia a Laser , Câmara Anterior , Feminino , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Pressão Intraocular , Iridectomia , Iris/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Arch. Soc. Esp. Oftalmol ; 97(1): 3-8, ene.,2022. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-202725

RESUMO

ObjetivoComunicar los resultados de una serie de casos con anomalía de Peters, y proponer el manejo y sugerencias terapéuticas según alteraciones asociadas.Material y métodosSe analizaron las historias clínicas de 27 pacientes (32 ojos) con diagnóstico clínico de anomalía de Peters, los cuales fueron sometidos a diferentes tratamientos. Distintos parámetros y condiciones asociadas fueron evaluadas: presión intraocular (PIO), agudeza visual (AV), técnica quirúrgica y complicaciones postoperatorias.ResultadosDe los 27 pacientes (32 ojos), 74% sexo masculino y 26% femenino. El promedio de años de seguimiento fue de 10,2 años. La PIO preoperatoria fue de 23 ± 9,21 mmHg y al último control fue de 18,81 ± 7,45 mmHg. El resultado de AV a largo plazo se correlaciona directamente con el tipo de anomalía de Peters. Para el total los resultados de AV fueron LogMAR 1,71 ± 1,04 y por grupos: Tipo I sólo con seguimiento médico LogMAR 0,3 ± 0, Tipo I sólo con iridectomía periférica LogMAR 0,97 ± 0,78, Tipo I con queratoplastia penetrante (QPP) LogMAR 1,22 ± 0,97, Tipo II sin compromiso de polo posterior LogMAR 2,41 ± 0,80 y Tipo II con compromiso de polo posterior LogMAR 2,56 ± 0,48.ConclusionesEl resultado de AV y fracaso del injerto corneal a largo plazo se correlaciona directamente al tipo de anomalía de Peters, con mejor pronóstico la Tipo I en que se realizó sólo seguimiento médico, luego en los que se practicó iridectomía periférica, en los que se realizó QPP los que presentan peor pronóstico visual son con anomalía de Peters Tipo II con compromiso de polo posterior (p = 0.0087).


PurposeTo report the results in a series of Peters Anomaly cases, and propose management and treatment approaches according to the alterations associated with each case.Material and methodsA retrospective analysis was performed on the records of 27 patients (32 eyes) clinically diagnosed with Peters Anomaly. Each patient was subjected to different treatment modalities according to the type of Peters Anomaly, anywhere from medical follow-up clinics to a Penetrating Keratoplasty procedure (PKP).ResultsOf the 27 patients (32 eyes), 74% were male and 26% female, with 18.5% (5) being bilateral and 81.5% (22) unilateral. The mean number of years of follow-up was 10.2 years (Range: 3.5 to 18 years). The results of long-term VA correlate directly with the type of Peters Anomaly. For the total number of patients, the VA results were LogMAR 1.71 ± 1.04. The results by groups were: Type I with only medical monitoring LogMAR 0.3 ± 0, Type I with only Optical Iridectomy (OI) LogMAR 0.97 ± 0.78, Type I with PKP LogMAR 1.22 ± 0.97, Type II without a compromised posterior pole with PKP LogMAR 2.41 ± 0.80, and Type II with a compromised posterior pole with PKP LogMAR 2.56 ± 0.48.ConclusionsThe result of VA and long-term corneal failure is directly related to the type of Peters Anomaly. Patients with Type I who only required medical follow-ups had the most favourable prognosis. Patients who underwent Peripheral Iridectomy followed and patients in which PKP was performed had an inferior prognosis.


Assuntos
Humanos , Ciências da Saúde , Oftalmologia , Anormalidades do Olho , Iridectomia , Ceratoplastia Penetrante , Opacidade da Córnea
10.
Eur J Ophthalmol ; 32(1): NP71-NP75, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33176499

RESUMO

BACKGROUND: Management of secondary glaucoma in nanophthalmos has always been challenging, especially for patients with extremely short axial length and extensive angle synechia. This case report discusses a nanophthalmic patient with secondary glaucoma and extensive angle synechia. CASE PRESENTATION: A 60-year-old woman was referred to our hospital with uncontrolled intraocular pressure (IOP) in her left eye (LE). Slitlamp examination revealed small cornea and shallow anterior chamber (AC) in both eyes. Extensive angle synechia was seen on gonioscopy, and the IOP and axial length were 36 mmHg/15.79 mm in the left eye. She was diagnosed with nanophthalmos and secondary angle-closure glaucoma LE. Laser peripheral iridectomy (LPI) was performed, but the IOP LE remained elevated and uncontrolled on brinzolamide and brimonidine. The IOP LE was then normalized with the application of 2% pilocarpine. During the follow-up period, the AC of the LE showed progressive shallowing, and 5 months post LPI the IOP became uncontrollable. Goniosynechialysis combined with phacoemulsification, lamellar sclerectomy, sclerostomy, peripheral iridectomy, capsulotomy, and anterior vitrectomy were performed LE. Immediately after surgery, the AC deepened and the IOP stabilized. However, the IOP rose again post-surgically at 1 week and again at 2 months. A generally shallow AC and obstructed capsule hole were present. YAG laser capsulotomy was performed, and the IOP normalized and the AC deepened. Eighteen months after surgery, the IOP LE was 12 mmHg and the AC remained stable. CONCLUSION: Goniosynechialysis combined with multiple surgical procedures could be considered an alternative treatment regimen for nanophthalmos patients with secondary glaucoma and extensive angle synechia.


Assuntos
Glaucoma de Ângulo Fechado , Glaucoma , Microftalmia , Facoemulsificação , Feminino , Glaucoma/cirurgia , Glaucoma de Ângulo Fechado/complicações , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Pressão Intraocular , Iridectomia , Microftalmia/complicações , Microftalmia/cirurgia , Pessoa de Meia-Idade
11.
Med Klin Intensivmed Notfmed ; 117(2): 137-143, 2022 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33580819

RESUMO

BACKGROUND: The symptoms of acute angle closure, an emergency event that can lead to irreversible blindness without timely treatment, are diverse. Initially, these can be interpreted as internal or neurological diseases if headaches, pupil rigidity or nausea are in the foreground. The aim of our study was to assess the rate of harming and invasive diagnostics after primary presentation of patients with acute primary angle closure to nonophthalmologists. METHODS: Retrospective single center study of patients with acute primary angle closure. To analyze these patients, all patients who were treated by surgical iridectomy (5-133.0) or iridotomy by laser (5-136.1) in the period 2014-2018 at the Eye Center at Medical Center, University of Freiburg (Germany), were identified. Subsequently, data analysis was carried out through file inspection to check the inclusion and exclusion criteria and the course of the disease. RESULTS: In total, 91 patients with acute primary angle closure were included. Of these, 28% (n = 25) initially presented to nonophthalmological disciplines. In this patient group 56% (n = 11) received nontargeted diagnostics, with cranial imaging in 32% (n = 8) and lumbar puncture in 8% (n = 2). CONCLUSION: Acute primary angle closure is associated with a high rate of nontargeted diagnostics by nonophthalmologists. Therefore, the clinical picture of acute angle closure should be in mind across all disciplines. With unspecific symptoms such as headaches, nausea and vomiting as well as pupil rigidity, the possibility of an acute increase in intraocular pressure caused by acute angle closure must be considered and early consultation with an ophthalmologist is recommended.


Assuntos
Glaucoma de Ângulo Fechado , Terapia a Laser , Serviço Hospitalar de Emergência , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Iridectomia/métodos , Terapia a Laser/métodos , Estudos Retrospectivos
12.
Ophthalmology ; 129(2): 147-158, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34453952

RESUMO

PURPOSE: To examine the efficacy of laser peripheral iridotomy (LPI) in patients who received a diagnosis of primary angle-closure suspect (PACS). DESIGN: Prospective, randomized controlled trial. PARTICIPANTS: This multicenter, randomized controlled trial (ClinicalTrials.gov identifier, NCT00347178) enrolled 480 patients older than 50 years from glaucoma clinics in Singapore with bilateral asymptomatic PACS (defined as having ≥2 quadrants of appositional angle closure on gonioscopy). METHODS: Each participant underwent prophylactic LPI in 1 randomly selected eye, whereas the fellow eye served as a control. Patients were followed up yearly for 5 years. MAIN OUTCOME MEASURES: The primary outcome measure was development of primary angle closure (PAC; defined as presence of peripheral anterior synechiae, intraocular pressure [IOP] of >21 mmHg, or both or acute angle closure [AAC]) or primary angle-closure glaucoma (PACG) over 5 years. RESULTS: Of the 480 randomized participants, most were Chinese (92.7%) and were women (75.8%) with mean age of 62.8 ± 6.9 years. Eyes treated with LPI reached the end point less frequently after 5 years (n = 24 [5.0%]; incidence rate [IR], 11.65 per 1000 eye-years) compared with control eyes (n = 45 [9.4%]; IR, 21.84 per 1000 eye-years; P = 0.001). The adjusted hazard ratio (HR) for progression to PAC was 0.55 (95% confidence interval [CI], 0.37-0.83; P = 0.004) in LPI-treated eyes compared with control eyes. Older participants (per year; HR, 1.06; 95% CI, 1.03-1.10; P < 0.001) and eyes with higher baseline IOP (per millimeter of mercury; HR, 1.35; 95% CI, 1.22-1.50; P < 0.0001) were more likely to reach an end point. The number needed to treat to prevent an end point was 22 (95% CI, 12.8-57.5). CONCLUSIONS: In patients with bilateral asymptomatic PACS, eyes that underwent prophylactic LPI reached significantly fewer end points compared with control eyes over 5 years. However, the overall incidence of PAC or PACG was low.


Assuntos
Glaucoma de Ângulo Fechado/cirurgia , Iridectomia/métodos , Iris/cirurgia , Lasers de Estado Sólido/uso terapêutico , Idoso , Feminino , Seguimentos , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Singapura , Tonometria Ocular , Resultado do Tratamento , Acuidade Visual/fisiologia
13.
Am J Ophthalmol ; 235: 120-130, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34197780

RESUMO

PURPOSE: To assess changes in intraocular pressure (IOP) 1 hour after pharmacological dilation in eyes treated with laser peripheral iridotomy (LPI) and untreated fellow eyes of primary angle closure suspects (PACS). DESIGN: A prospective randomized, fellow-eye controlled trial. METHODS: A total of 889 participants with PACS aged 50 to 70 years with LPI in 1 randomly selected eye and a fellow untreated eye were included. All participants underwent comprehensive examinations before and at 2 weeks, 6 months, 18 months, 36 months, 54 months, and 72 months after LPI. The IOP was measured using Goldmann applanation tonometry before and 1 hour after pharmacological dilation. RESULTS: The mean predilation IOP in the untreated eyes was 14.8 ± 2.7 mm Hg, which increased to 16.4 ± 2.7 mm Hg after pharmacological dilation (P < .001). The treated and untreated eyes had similar predilation and postdilation IOP (all P > 0.05). The average postdilation IOP elevation was 1.5 mm Hg in the treated eyes and 1.6 mm Hg in the untreated eye, without significant differences (P = .802). Lower predilation IOP (P < .001), smaller AOD500 (P = 0.001), smaller ARA500 (P = .030), smaller TISA500 (P = .043), and larger Iarea (P < 0.001) were associated with postdilation IOP elevation of 5 mm Hg and greater. Three untreated eyes (1.04 per 1000 pupil dilation) and 1 treated eye (0.34 per 1000 pupil dilation) developed acute angle closure (AAC) after dilation during the 72-month follow-up. CONCLUSIONS: Postdilation IOP elevation was similar among treated and untreated eyes, and the risk of developing AAC was very low, even among patients with PACS. Routine LPI before pupil dilation for people with PACS is not recommended.


Assuntos
Glaucoma de Ângulo Fechado , Terapia a Laser , Idoso , Dilatação , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/tratamento farmacológico , Glaucoma de Ângulo Fechado/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Iridectomia , Iris , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Middle East Afr J Ophthalmol ; 28(2): 137-139, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759673

RESUMO

In aqueous misdirection, the interval between diagnosis and surgical intervention is inversely proportional to the success of the surgery. Here, we report a successful outcome of pars plana vitrectomy (PPV) with irido-zonulo-hyaloidectomy 4 years after the onset of the disease. A 34-year-old female, known to have primary angle closure glaucoma, underwent trabeculectomy with mitomycin C in the right eye for uncontrolled intraocular pressure (IOP). Six weeks after the surgery, the patient presented with a shallow anterior chamber centrally and peripheral iridocorneal touch along with a patent peripheral iridectomy. Ultrasound biomicroscopy showed a shallow AC centrally with peripheral iridocorneal touch, and the ciliary body was rotated forward confirming the diagnosis of aqueous misdirection. The patient refused surgical management and was managed medically, which was unsuccessful. Four years after the diagnosis, the patient underwent PPV with irido-zonulo-hyaloidectomy because of progressive shallowing of the AC and corneal edema. One month postoperatively, visual acuity improved from 20/200 to 20/60, and the AC maintained appropriate depth. In conclusion, PPV with irido-zonulo-hyaloidectomy may result in a complete resolution of a chronic low-grade form of aqueous misdirection.


Assuntos
Glaucoma de Ângulo Fechado , Glaucoma , Adulto , Feminino , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Iridectomia , Vitrectomia
15.
J AAPOS ; 25(5): 305-307.e3, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34582958

RESUMO

We report the clinical features, treatments, and outcomes of 9 infants with glaucoma secondary to congenital fibrovascular pupillary membrane. The clinical features included unilateral low vision, high intraocular pressure (IOP), enlarged and cloudy cornea, loss of anterior chamber, and pupillary membrane. All patients underwent membranectomy, peripheral iridectomy, pupilloplasty, and goniosynechialysis as primary treatment. The membranes were posterior to the iris in all 9 eyes. In 5 eyes, the membrane covered the ciliary processes, and in 1 eye the membrane reached the posterior lens capsule. Following primary surgery, 3 patients developed membrane recurrence, 4 had refractory elevated IOP, and 2 developed lens opacities. All 4 eyes with poor postoperative IOP control had iris root insertion anterior to the scleral spur. Five patients received additional surgeries including membranectomy, pupilloplasty, goniosynechialysis, cyclocryotherapy, ciliary photocoagulation, Amhed valve implantation, and lensectomy. One patient had refractory elevated IOP at last follow-up. IOP in the other 8 eyes was well controlled. None of the affected eyes was able to fix and follow at last follow-up.


Assuntos
Glaucoma , Corpo Ciliar , Glaucoma/etiologia , Glaucoma/cirurgia , Humanos , Lactente , Pressão Intraocular , Iridectomia , Iris/cirurgia , Pupila
16.
J Fr Ophtalmol ; 44(9): 1413-1418, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34565658

RESUMO

PURPOSE: To determine the need to measure intraocular pressure one hour after laser peripheral iridotomy in patients with narrow angles, to determine the significance of the immediate IOP spike after LPI, and to assess risk factors associated with these. METHODS: A review of the literature on IOP measurements after LPI was conducted using the PubMed databases in January 2020. RESULTS: The proportion of treated eyes with an IOP spike one hour after treatment was between 6 and 9.8% depending on the study. Fewer than 1% of the eyes had an immediate post-treatment IOP of 30mmHg or more. Risk factors associated with IOP spikes include hyphema, pigment dispersion, and high pretreatment IOP. Patients of Asian descent, who possess thick irides, or any patient having thick irides, also exhibited increased risk of IOP spikes. CONCLUSIONS: The majority of the studies that have evaluated this complication were conducted in an Asian population, which affects the generalisability of these results to a wider population, considering anatomical differences. Although it is not uncommon to observe IOP spikes following LPI, the majority will not experience an increase of 10mmHg from baseline or a post-LPI IOP of 30mmHg or more. Even though it has been recommended to measure the IOP of all patients one hour after an LPI in order to avoid missing a spike, we suggest measuring IOP one hour after an LPI in patients who possess at least one risk factor or if there is any preexisting damage to the optic nerve.


Assuntos
Glaucoma de Ângulo Fechado , Terapia a Laser , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Humanos , Pressão Intraocular , Iridectomia , Iris/cirurgia , Lasers
17.
Sci Rep ; 11(1): 16528, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34400702

RESUMO

Epithelial cysts run a high risk of recurrence and conversion to sheet-like ingrowth after surgical intervention. In this retrospective study, we introduced a modified iridectomy for treatment of secondary epithelial iris cysts (EICs) in the anterior chamber. Twenty-nine patients (29 eyes) aged 2-61 years received "open iridectomy" for EICs between April 1995 and July 2019. After viscodissection, most of the cyst wall was cut using a 20-gauge aspiration cutter via a 2.5-mm clear corneal incision. The residue closely adhering to the iris stroma was remained to avoid photophobia and diplopia. At 3 months, best corrected visual acuity was ≥ 20/100 in 55.5% (15/27, except two pediatric patients with poor cooperation) of patients. Among the eight patients suffering partial corneal edema preoperatively, six patients received surgery treatment at 3-6.5 months, and the cornea in the other two patients became transparent after medication. In a mean follow-up of 47.4 months, recurrence occurred in 3 patients at 7, 37, and 118 months, respectively. The percentage of treatment success was 96%, 87%, and 65% at 1, 5, and 10 years, respectively. "Open iridectomy" was effective for EICs, with a minimal invasion, less damage to the corneal endothelium, and a low recurrence rate.


Assuntos
Oftalmopatias Hereditárias/cirurgia , Iridectomia/métodos , Iris/anormalidades , Epitélio Pigmentado Ocular/anormalidades , Adolescente , Adulto , Assistência ao Convalescente , Câmara Anterior/cirurgia , Criança , Pré-Escolar , Oftalmopatias Hereditárias/etiologia , Oftalmopatias Hereditárias/patologia , Ferimentos Oculares Penetrantes/complicações , Feminino , Seguimentos , Humanos , Iris/patologia , Iris/cirurgia , Masculino , Pessoa de Meia-Idade , Epitélio Pigmentado Ocular/patologia , Epitélio Pigmentado Ocular/cirurgia , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
BMC Ophthalmol ; 21(1): 314, 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34454461

RESUMO

BACKGROUND: Ectopic thyroid tissue in the iris, also known as a thyroid glandular epithelial choristoma of the iris, has only been described twice in the literature. In both cases it remained asymptomatic. CASE PRESENTATION: A 67-year-old female patient presented for the first time in mid-2017 with corneal endothelial decompensation, with a history of complicated cataract surgery and IStent® implantation. Slit lamp microscopy showed endothelial decompensation, pseudophakia, anterior synechiae and a whitish iris tumour adhering to the endothelium. The latter had existed since childhood. Given these findings, reduced visual acuity of hand movement perception and an intraocular pressure of 23 mmHg, we performed a keratoplasty combined with an en bloc resection of the iris tumour at 9 o'clock and sector iridectomy at the end of 2019. Histological and immunohistological examination of the iris tumour unexpectedly revealed thyroid tissue. After the procedure described above, the patient had an increase in visual acuity while the graft stayed clear and the eye showed no evidence of tumour recurrence or other complications. CONCLUSIONS: We report a third case of ectopic thyroid tissue in the iris. Both previous cases remained asymptomatic, whereas in our case, size and location of the ectopic thyroid tissue contributed to a more complex cataract surgery resulting in endothelial decompensation. Therefore, in such cases appropriate patient information should be provided prior to cataract surgery. Furthermore, careful histological examination and examination of the thyroid is important to exclude malignant diagnoses such as a metastasis of a follicular thyroid carcinoma.


Assuntos
Neoplasias da Íris , Disgenesia da Tireoide , Idoso , Criança , Feminino , Humanos , Iridectomia , Iris/cirurgia , Neoplasias da Íris/diagnóstico , Neoplasias da Íris/cirurgia , Recidiva Local de Neoplasia
19.
Arq. bras. oftalmol ; 84(3): 275-278, May-June 2021. graf
Artigo em Inglês | LILACS | ID: biblio-1248969

RESUMO

ABSTRACT Pseudoexfoliation syndrome is more frequent in people aged >50 yeears, and its prevalence increases with age. Few reports have described cases in younger patients, all with a history of ocular surgery, especially iris resection. Herein, we describe the case of a 27-year old man with bilateral advanced glaucoma and pseudoexfoliation material in OS. He had undergone cataract surgeries OU and a penetrating keratoplasty OD during childhood. Currently, he presented with an intraocular pressure of 40 mmHg OU. The OS showed a white flaky material in the pupillary rim and anterior capsule and a Sampaolesi line as a gonioscopic finding. Trabeculectomy was performed OU, and intraocular pressure control was achieved. Unlike other previously reported cases, this patient did not present any apparent iris manipulation in the affected eye. However, he did undergo an iridectomy in the contralateral eye. This is also the first case to be accompanied by bilateral glaucoma at the time of detection of the pseudoexfoliation material.(AU)


RESUMO A síndrome de pseudoesfoliação é mais frequente em pessoas com mais de 50 anos e sua prevalência aumenta com a idade. Poucos relatos descrevem casos em pacientes mais jovens, todos com história de cirurgia ocular, especialmente ressecção da íris. Descrevemos o caso de um homem de 27 anos com glaucoma bilateral avançado e material de pseudoesfoliação no OE. O paciente foi submetido a cirurgias de catarata em AO e a uma ceratoplastia penetrante no OD durante a infância. Atualmente, ele apresentou PIOs de 40 mmHg em AO. O OE apresentou material escamoso branco na borda pupilar e cápsula anterior, e linha Sampaolesi como achado gonioscópico. A trabeculectomia foi realizada em AO e obteve-se o controle da pressão intraocular. Diferentemente de outros casos relatados, o paciente não apresentou qualquer manipulação aparente da íris no olho afetado. No entanto, ele foi submetido a uma iridectomia no olho contralateral. Além disso, este é o primeiro caso a ser acompanhado de glaucoma bilateral no momento da detecção do material de pseudoesfoliação.(AU)


Assuntos
Humanos , Adulto , Extração de Catarata , Glaucoma/complicações , Síndrome de Exfoliação/fisiopatologia , Iridectomia/instrumentação
20.
Optom Vis Sci ; 98(5): 446-449, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33967251

RESUMO

SIGNIFICANCE: This report details how a case with degenerative myopia and symptoms secondary to laser peripheral iridotomies is managed with a modified piggyback contact lens system. The benefits of using a system with tinted and gas-permeable (GP) lenses are discussed. PURPOSE: This study aimed to report the positive outcome of a modified piggyback system in the treatment of degenerative myopia and iris abnormalities. CASE REPORT: A patient with degenerative myopia presented with visual disturbances secondary to laser peripheral iridotomies in both eyes. A modified piggyback system was trialed using a corneal GP lens overlaying a tinted soft contact lens to provide optimal vision and visual comfort in both eyes. After optimizing the fit, there was a reduction in glare and improved vision. CONCLUSIONS: Hard contact lenses often provide superior optics and vision compared with soft lenses, especially to patients with high refractive errors. Patients who require hard lenses and also have visual disturbances secondary to iris abnormalities could be managed with a modified piggyback contact lens systems using a corneal GP lens and tinted soft lens.


Assuntos
Lentes de Contato Hidrofílicas , Iridectomia , Doenças da Íris/terapia , Miopia Degenerativa/terapia , Humanos , Doenças da Íris/fisiopatologia , Terapia a Laser , Masculino , Pessoa de Meia-Idade , Miopia Degenerativa/fisiopatologia , Transtornos da Visão/fisiopatologia , Transtornos da Visão/terapia , Acuidade Visual/fisiologia
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