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  1 / 2839 MEDLINE  
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PMID:29390365
Autor:Ryu SJ; Shin YU; Kang MH; Cho HY; Seong M
Endereço:Department of Ophthalmology, Hanyang University College of Medicine, Seongdong-gu, Seoul, Republic of Korea.
Título:Bilateral acute myopia and angle closure glaucoma induced by Ma-huang (Ephedra): A case report.
Fonte:Medicine (Baltimore); 96(50):e9257, 2017 Dec.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: Cases of bilateral acute angle closure have been reported after use of various drugs. PATIENT CONCERNS: A 52-year-old woman visited the emergency room and complained of acute bilateral ocular pain and decreased vision accompanied by headache, nausea, and vomiting. One day before, she had started a herbal medicine containing Ma-huang for weight loss. On examinations, myopic shift, edematous cornea, increased intraocular pressure, shallow anterior chamber, and thickened choroid on both eyes were observed. DIAGNOSES: Angle closure glaucoma induced by drug (Ma-huang). INTERVENTIONS: To promptly quit the offending drug and apply ocular hypotensives and cycloplegics. OUTCOMES: Her symptoms and signs were relieved after antiglaucoma medications and no significant recurrence has been occurred. LESSONS: Physicians prescribing weight loss medications containing Ma-huang must be aware of the potentially sight-threatening adverse effect of bilateral acute angle closure.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  2 / 2839 MEDLINE  
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PMID:29390338
Autor:Han J; Ji Y; Cao D; Kang Z; Zhu J
Endereço:Department of Neurology, Harrison International Peace Hospital.
Título:Miller Fisher syndrome with acute angle-closure glaucoma as the first manifestation: A case report.
Fonte:Medicine (Baltimore); 96(50):e9201, 2017 Dec.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: There were no reports of Miller Fisher syndrome (MFS) with acute angle-closure glaucoma as the first manifestation. PATIENT CONCERNS: A 78-year-old female patient was admitted to our hospital with pain in her left eye, blurred vision along with nausea, and vomiting for 2 days. It was extremely rare that ophthalmoplegia, loss of tendon reflexes, and ataxia, did not occur in the early stages of MFS, and initial presentation was only dilated pupis and an increase in intraocular pressure. DIAGNOSES: The final diagnosis of the patient was MFS. INTERVENTIONS: Intravenous immunoglobulins were administered. OUTCOMES: Ophthalmoplegia, walking instability, and ataxia gradually improved. At 3 months follow-up, there was no neurological deficit, and the patient could completely self-care. LESSONS: This is the first report of MFS patient with acute angle closure glaucoma as the first manifestation. Consideration should be given to the possibility of incorporating autonomic nervous system dysfunction, or even MFS, in patients with acute angle-closure glaucoma in order to reduce missed diagnosis rate.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE
Nome de substância:0 (Immunoglobulins, Intravenous)


  3 / 2839 MEDLINE  
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PMID:29194069
Autor:Napier ML; Azuara-Blanco A
Endereço:Ophthalmology Department, Royal Victoria Hospital.
Título:Changing patterns in treatment of angle closure glaucoma.
Fonte:Curr Opin Ophthalmol; 29(2):130-134, 2018 Mar.
ISSN:1531-7021
País de publicação:United States
Idioma:eng
Resumo:PURPOSE OF REVIEW: Angle closure glaucoma is a leading cause of blindness globally and trends of how best to treat this disease are evolving. The advent of anterior segment imaging aids our understanding of pathogenesis and allows more robust and objective measurement of treatment modalities. We will also review recent literature regarding the role of laser and surgical interventions for the treatment of primary angle closure disease. RECENT FINDINGS: Recent studies evaluating the efficacy of laser peripheral iridotomy (LPI) in primary angle closure suspects (PACs) show that while it is a safe intervention and initially anterior chamber angle widens following the laser treatment, the effect is lost with time. Only a small minority of PACs patients develop primary angle closure (PAC) or primary angle closure glaucoma (PACG). Trials evaluating argon laser peripheral iridoplasty (ALPI) have failed to show a substantial clinical benefit. In patients with early or moderate PACG and those with PAC with IOP over 30 mmHg, clear lens extraction is associated with better clinical and quality of life outcomes than LPI. SUMMARY: Recent evidence supports initial clear lens extraction in the context of PACG or primary angle closure with IOP more than 30 mmHg.
Tipo de publicação: JOURNAL ARTICLE; REVIEW


  4 / 2839 MEDLINE  
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PMID:29218423
Autor:Chan JCW; Choy BNK; Chan OCC; Li KKW
Endereço:Department of Ophthalmology, United Christian Hospital, 130 Hip Wo Street, Kowloon, Hong Kong.
Título:Early intraocular pressure change after peripheral iridotomy with ultralow fluence pattern scanning laser and Nd:YAG laser in primary angle-closure suspect: Kowloon East Pattern Scanning Laser Study Report No. 3.
Fonte:Graefes Arch Clin Exp Ophthalmol; 256(2):363-369, 2018 Feb.
ISSN:1435-702X
País de publicação:Germany
Idioma:eng
Resumo:PURPOSE: Our purpose was to assess the early intraocular pressure (IOP) changes of ultralow fluence laser iridotomy using pattern scanning laser followed by neodymium:yttrium-aluminum-gamet (Nd:YAG) laser. METHODS: This is a prospective interventional study. Thirty-three eyes of 33 adult Chinese primary angle-closure suspect subjects were recruited for prophylactic laser peripheral iridotomy. Sequential laser peripheral iridotomy was performed using pattern scanning laser followed by Nd:YAG laser. Visual acuity (VA) and IOP were measured before treatment, at 1 h, 1 day, 1 week, 1 month, 3 months and 6 months after laser. Laser energy used and complications were documented. Corneal endothelial cell count was examined at baseline and 6 months. Patency of the iridotomy was assessed at each follow-up visit. RESULTS: All subjects achieved patent iridotomy in a single session. The mean energy used was 0.335+/-0.088 J for the pattern scanning laser, and 4.767+/-5.780 mJ for the Nd:YAG laser. The total mean energy was 0.339+/-0.089 J. None of the eyes developed a clinically significant IOP spike (≥ 8 mmHg) at 1 h and 1 day after laser use. Only four eyes developed higher IOP at 1 h and all were ≤3 mmHg compared to baseline. The mean IOP was 13.8+/-2.5 mmHg at 1 h and 11.5+/-2.2 mmHg at 1 day, both were significantly lower than baseline (15.8+/-2.1 mmHg) (P < 0.001). Mean VA (logMAR) was similar at 1 h post laser compared to baseline (0.23 vs 0.26). There was also no statistically significant difference in mean VA at other follow-up visits compared to baseline. Peripheral iridotomy closure was encountered in two (6.1%) eyes, one at 1 month and another at 6 months follow-up. There were no complications including hyphema, peripheral anterior synechia formation nor prolonged inflammation throughout the follow-up period. There was no significant loss in corneal endothelial cell counts at 6 months (2255+/-490) compared to baseline (2303+/-386) (P = 0.347). CONCLUSIONS: Sequential LPI using an ultralow fluence pattern scanning laser, followed by a Nd:YAG laser, is safe and efficacious, and produces no IOP spike in dark irides of primary angle-closure suspects. Further studies to investigate its role in the treatment of other angle-closure conditions are warranted.
Tipo de publicação: CLINICAL STUDY; JOURNAL ARTICLE


  5 / 2839 MEDLINE  
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PMID:29208826
Autor:Sachdev R; Gupta A; Narula R; Deshmukh R
Endereço:Centre for Sight, New Delhi, India.
Título:Limited vitrectomy in phacomorphic glaucoma.
Fonte:Indian J Ophthalmol; 65(12):1422-1424, 2017 Dec.
ISSN:1998-3689
País de publicação:India
Idioma:eng
Resumo:One of the challenging situations for a cataract surgeon is phacoemulsification in the shallow anterior chamber like cases of phacomorphic glaucoma. Some of the main concerns of operating in a narrow space include endothelial decompensation, descemet's detachment, and posterior capsular rents. High vitreous pressure predisposes to posterior capsular rents owing to a reduced concavity of the posterior capsule and increasing the proximity of phaco-tip to the posterior capsule. We describe a technique of limited vitrectomy in such cases. A small gauge 23-G/25-G trocar cannula is passed transconjunctivally, and the liquefied vitreous is allowed to egress. Vitrectomy is done extraocularly till the vitreous pressure lowers down. This technique helps to debulk the vitreous and decompress the globe in a controlled manner. The resultant posterior displacement of iris-lens diaphragm causes a deepening of the anterior chamber to facilitate phacoemulsification.
Tipo de publicação: JOURNAL ARTICLE; TECHNICAL REPORT; VIDEO-AUDIO MEDIA


  6 / 2839 MEDLINE  
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PMID:29217027
Autor:Ozturker ZK; Munro K; Gupta N
Endereço:Glaucoma Unit, University of Toronto, Toronto, Ont.; Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ont.
Título:Optic disc hemorrhages in glaucoma and common clinical features.
Fonte:Can J Ophthalmol; 52(6):583-591, 2017 Dec.
ISSN:1715-3360
País de publicação:England
Idioma:eng
Resumo:OBJECTIVE: To analyze optic nerve head stereophotographs for the presence of optic disc hemorrhages, and to describe bleeding patterns and patient characteristics. DESIGN: Retrospective, cross-sectional study. PARTICIPANTS: 1113 optic nerve stereophotograph pairs of 562 consecutive patients. METHODS: Stereophotographs were systematically reviewed for the presence of a disc hemorrhage with careful documentation of optic nerve head features. All charts of patients with hemorrhage were subsequently studied for demographic information and clinical data. RESULTS: Disc hemorrhages were observed in 7.1% of patients with optic disc photography. Most patients had open-angle glaucoma (57.5%) with focal ischemic phenotype of the optic disc (66.7%). The mean vertical and horizontal cup-disc ratios were 0.82 ± 0.14 and 0.76 ± 0.14, respectively. The ß-zone peripapillary atrophy was observed in 48.9% of patients. The most common location was the inferotemporal region of the disc (60.8%), and most were flame or splinter shaped (70.6%). Disc hemorrhages were found either superficial to or within the retinal nerve fibre layer (72.5%), and in association with a notch (64.4%). The average intraocular pressure was 17.3 ± 4.9 mm Hg, and most hemorrhages were associated with early visual field defects (42.5%). CONCLUSIONS: Optic disc hemorrhages in patients with glaucoma were most frequently observed inferiorly in association with a notch. Most eyes with a disc hemorrhage had an intraocular pressure within normal range and had either early or no visual field loss. These findings highlight the importance of careful examination of the optic nerve head to look for the presence of a disc hemorrhage as an important biomarker of glaucoma damage.
Tipo de publicação: JOURNAL ARTICLE


  7 / 2839 MEDLINE  
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PMID:29228915
Autor:Suwan Y; Jiamsawad S; Tantraworasin A; Geyman L; Supakontanasan W; Teekhasaenee C
Endereço:From the Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Título:Qualitative and quantitative evaluation of acute angle-closure mechanisms.
Fonte:BMC Ophthalmol; 17(1):246, 2017 Dec 11.
ISSN:1471-2415
País de publicação:England
Idioma:eng
Resumo:BACKGROUND: To evaluate ocular biometric parameters in different subtypes of acute angle closure and compared to fellow eyes of AAC and PACS eyes. METHODS: This is a retrospective chart review study. A total of 167 eyes (96 patients) consisting of 71 AAC eyes, 71 fellow eyes of AAC, and 25 PACS eyes were recruited. All patients underwent ocular examination and biometry. The mechanism of AAC was confirmed by ultrasound biomicroscopy. We then subdivided AAC eyes into four subgroups: crowded-angle (CR), lens subluxation (LS) pupillary block (PB), and plateau iris syndrome (PL). Outcome variables included anterior chamber depth (ACD), lens thickness (LT), vitreal length (VL), axial length (AL), lens position and relative lens position (LP and RLP, respectively), and lens axial length factor (LAF). RESULTS: Among the three groups, ACD was shallower in AAC eyes than fellow eyes of AAC and PACS eyes (p < 0.01 for both) and AAC eyes demonstrated a lesser LP and RLP. The LT, VL, AL, and LAF were not significantly different among the three groups. Among the four subgroups, LS displayed the most shallow ACD (p = 0.01). The lens position in PL was greater than in CR and LS (p < 0.05 and <0.01, respectively). CONCLUSIONS: AAC eyes had a more anterior lens position than fellow eyes and PACS eyes, though lens thickness did not differ among the groups. As such, an anterior lens position may offer more sensitive prognostication regarding future development of AAC compared to lens thickness.
Tipo de publicação: JOURNAL ARTICLE


  8 / 2839 MEDLINE  
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PMID:29193925
Autor:Ulloa-Padilla EP; Dávila PJ; Izquierdo NJ
Título:Klinefelter Syndrome (49, XXXXY/48, XXXY) associated with narrow angle glaucoma: A case report.
Fonte:Bol Asoc Med P R; 108(1):83-8, 2016.
ISSN:0004-4849
País de publicação:Puerto Rico
Idioma:eng
Resumo:INTRODUCTION: Previous studies have described Klinefelter syndrome as a genetic disorder characterized by at least one extra X chromosome and at least 47 chromosomes. It is the most common sex chromosome aneuploidy among men. Patients may present with large height, gynecomastia, low testosterone levels, infertility, hypogonadism and diseases usually more common in females such as osteoporosis, breast cancer and auto-immune disorders. Other rare ophthalmic associations have been described, such as diffuse choroidal atrophy, microphtalmia, cataracts, juvenile glaucoma, choroid colobomas and goniodysgenesis. OBJECTIVES: To report on the ocular findings in a Puerto Rican patient with Klinefelter syndrome (XXXXY/XXXY). PATIENTS AND METHODS: A patient with Klinefelter syndrome with revious history of elevated intraocular pressure underwent a comprehensive ocular examination, Humphrey visual fields and Stratus optical coherence tomography (OCT) tests. Patient had inreased intraocular pressure, visual field loss and OCT findings compatible with glaucoma. After laser YAG laser iridotomies, high IOP persisted. Brimonidine 0.2 % drops three times a day drops were prescribed to lower IOP. CONCLUSIONS: A patient with Klinefelter syndrome had poor visual acuity, high intraocular pressure, visual fields and OCT results, all compatible with angle closure glaucoma as part of the syndrome.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE
Nome de substância:0 (Antihypertensive Agents); 4S9CL2DY2H (Brimonidine Tartrate)


  9 / 2839 MEDLINE  
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PMID:29049230
Autor:You Z; Qin Y; Li G; Shi K
Endereço:Department of Ophthalmology, the Second Affiliated Hospital, Nanchang University, Nanchang, Peoples' Republic of China.
Título:Goniosynechialysis combined with cataract extraction for iridoschisis: A case report.
Fonte:Medicine (Baltimore); 96(42):e8295, 2017 Oct.
ISSN:1536-5964
País de publicação:United States
Idioma:eng
Resumo:RATIONALE: Iridoschisis is a rare eye disease. In this case report, we described the examination and diagnosis of a case of iridoschisis accompanied by secondary glaucoma. We also observed the effects of treating the patient with a combination of goniosynechialysis and cataract removal. PATIENT CONCERN: A 67-year-old female patient presented with decreased vision in both eyes. An eye examination indicated that visual acuities (VAs) were 20/100 and light perception in the right and left eyes, respectively. Both eyes exhibited shallow anterior chambers and narrow angles. The lower portion of the iris was loosened, and cable-like tissue was visible. The intraocular pressures in the right and left eyes were 22 mmHg and 58 mmHg, respectively. At the time of presentation, no medication was being used. DIAGNOSES: The patient was diagnosed with iridoschisis [oculus sinister (OU), indicates left eye], secondary glaucoma (OU), senile cataract (OU), and pterygium (oculus uterque, indicates both eyes). INTERVENTION: After relevant examinations were conducted, goniosynechialysis and phacoemulsification with intraocular lens implantation were performed on the right eye under local anesthesia. OUTCOMES: Two days after surgery, the right eye had VA of 20/40 and a transparent cornea. The anterior chamber was deeper, and intraocular pressure had decreased to 16 mmHg. Three months after surgery, the patient exhibited improved VA in the right eye and a lower IOP of 11 mmHg. LESSONS: Relative to other approaches, goniosynechialysis combined with cataract removal is a better treatment option for iridoschisis complicated with closed-angle glaucoma triggered by peripheral anterior synechiae.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


  10 / 2839 MEDLINE  
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PMID:28986594
Autor:Verma S; Nongpiur ME; Oo HH; Atalay E; Goh D; Wong TT; Perera SA; Aung T
Endereço:Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
Título:Plateau Iris Distribution Across Anterior Segment Optical Coherence Tomography Defined Subgroups of Subjects With Primary Angle Closure Glaucoma.
Fonte:Invest Ophthalmol Vis Sci; 58(12):5093-5097, 2017 Oct 01.
ISSN:1552-5783
País de publicação:United States
Idioma:eng
Resumo:Purpose: We previously identified three distinct subgroups of patients with primary angle closure glaucoma (PACG) based on anterior segment optical coherence tomography (ASOCT) imaging. Group 1 was characterized by a large iris area with deepest anterior chambers, group 2 by a large lens vault (LV) and shallow anterior chamber depth (ACD), and group 3 displayed intermediate values across iris area, LV, and ACD. The purpose of the present study was to determine the distribution of plateau iris in these subgroups using ultrasound biomicroscopy (UBM) features. Methods: UBM images of the 210 subjects who were previously enrolled for the ASOCT subgrouping analysis and had undergone laser peripheral iridotomy were assessed and graded by a single glaucoma fellowship trained clinician. Plateau iris was defined as the presence of all the following UBM criteria in at least two quadrants: anteriorly directed ciliary body, absent ciliary sulcus, iris angulation, flat iris plane, and iridoangle touch. Results: Of 210 subjects, 23 were excluded due to poor-quality images. Based on standardized UBM criteria, the overall prevalence of plateau iris was 36.9% (n = 187). The proportion of plateau iris was similar across the three groups (subgroup 1:35.4% (n = 29); subgroup 2:39.0% (n = 32); subgroup 3:34.8% (n = 8), P = 0.87). On multiple logistic regression analysis, iris thickness at 750 µm from the scleral spur (IT750) was the only variable associated with plateau iris (odds ratio: 1.5/100 µm increase in iris thickness [IT], P = 0.04). Conclusions: The proportion of plateau iris was similar across the three ASOCT-based PACG subgroups and more than one-third of subjects with PACG were diagnosed with plateau iris based on standardized UBM criteria. In addition, we noted that eyes with increased peripheral IT have an increased likelihood of plateau iris.
Tipo de publicação: JOURNAL ARTICLE; OBSERVATIONAL STUDY



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