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    [Chinese expert consensus on surgical treatment of primary glaucoma with cataract (2021)]. [Zhonghua yan ke za zhi] Chinese journal of ophthalmology Primary glaucoma with cataract is a common eye disease in China, and surgery is the main treatment. With the continuous advance of medical technology, the choice of surgical methods is controversial, and there is still a lack of consensus with general guiding significance in China. In order to standardize the clinical treatment, Chinese Glaucoma Society has formulated this consensus after a serious discussion. This consensus is aiming at guiding clinical practice and putting forward instructive opinions on the operation methods, perioperative and follow-up management of different types and stages of primary glaucoma with cataract surgery indications. . 10.3760/cma.j.cn112142-20200706-00455
    The syndrome of closed-angle glaucoma. Mapstone R The British journal of ophthalmology Closed-angle glaucoma is the result of two mechanisms acting either separately or in combination: 1. Pupil block creates a greater pressure in the posterior than in the anterior chamber, pushing the iris on to the cornea. 2. Increased trabecular meshwork outflow in the presence of pupil block creates a lower pressure in the anterior chamber than in the posterior, pulling the iris on to the cornea. Three main groups of eyes manifest closed-angle glaucoma: (i) Mechanism (I) is necessary and sufficient, but (2) precludes the development of angle closure. (ii) Mechanism (I) is necessary but insufficient. Mechanism (2) must also be present. (iii) Mechanism (I) is necessary and sufficient but (I) and (2) may combine to produce an acute attack. 10.1136/bjo.60.2.120
    New considerations on pupillary block mechanism. Cronemberger Sebastião,Calixto Nassim,de Andrade André Oliveira,Mérula Rafael Vidal Arquivos brasileiros de oftalmologia PURPOSE:To study the mechanisms of pupillary block in eyes with occludable angle by ultrasound biomicroscopy. METHODS:Initially, a pilot study of 13 eyes with acute primary angle-closure without medication was executed. Ultrasound biomicroscopy measurements of the angle, posterior chamber depth and iris thickness were performed in the temporal quadrant under light and dark conditions. Afterwards, ultrasound biomicroscopy measurements of iris-lens contact distance and iris-lens angle in the temporal quadrant and central anterior chamber depth were made in 32 eyes with acute primary angle-closure or intermittent primary angle-closure without medication, under light and dark conditions before and after laser peripheral iridectomy. RESULTS:In the pilot study, a significant decrease in the angle as well as a significant increase in the iris thickness occurred when comparing light to dark conditions. Before and after laser peripheral iridectomy (second study), significant differences were found in iris-lens contact distance (P<0.001) and iris-lens angle (P<0.001) under light and dark conditions. Also, significant differences were found in light and dark conditions, before laser peripheral iridectomy, in iris-lens angle (P=0.005), and after laser peripheral iridectomy, in iris-lens contact distance (P<0.001). No significant change occurred with anterior chamber depth. CONCLUSIONS:A decreased angle was correlated to an increase in iris thickness. After laser peripheral iridectomy, acute primary angle-closure or primary angle-closure eyes had an increased iris-lens contact distance and a decreased iris-lens angle. The anterior chamber depth did not change. These findings contradict the theory that pupillary block is the mechanism of acute primary angle-closure.
    Acute primary angle closure-treatment strategies, evidences and economical considerations. Eye (London, England) Acute primary angle closure requires emergency management that involves a rapid lowering of the intraocular pressure and resolution of relative pupil block - the most common mechanism of angle closure. Emergency strategies for lowering intraocular pressure include medical treatment and argon laser peripheral iridoplasty. Anterior chamber paracentesis and diode laser transcleral cyclophotocoagulation may be considered in special situations. Relative pupil block can be relieved by peripheral laser iridotomy and primary lens extraction; the latter is a more effective treatment according to the results of clinical trials. However, primary lens extraction can be technically demanding in the acute setting. Peripheral laser iridotomy has a role in relieving pupil block and should also be considered in most cases. Lens extraction may be combined with procedures such as goniosynechialysis, trabeculectomy or endoscopic cyclophotocoagulation. In this review, we aim to discuss the available evidence regarding the different treatment modalities. We also discuss the economic consideration, including cost-effectiveness and life expectancy, in the management of acute primary angle closure. 10.1038/s41433-018-0278-x
    Multimodal etiology of drug induced angle closure with topical glaucoma therapy. American journal of ophthalmology case reports PURPOSE:We present a case of acute onset of bilateral choroidal effusions leading to angle closure glaucoma attributed to multiple mechanism of actions causing ciliary body and aqueous flow disruption in the setting of topical glaucoma therapy with latanoprost, brimonidine 0.2%, and Brinzolamide 0.1%. OBSERVATION:The patient presented with ocular hypertension in the setting of bilateral choroidal effusions, leading to angle closure without pupillary block. After cessation of the glaucoma drops and starting steroids and cycloplegics, the patient's symptoms resolved. CONCLUSIONS AND IMPORTANCE:This case report highlights the various physiological mechanisms of action that can induce angle closure glaucoma from commonly used topical medications for glaucoma treatment. Thus, a keen awareness is warranted of this idiosyncratic reaction in order to avoid morbidity and long term vision loss. 10.1016/j.ajoc.2021.101152
    Pharmacological and environmental factors in primary angle-closure glaucoma. Subak-Sharpe Ian,Low Sancy,Nolan Winifred,Foster Paul J British medical bulletin INTRODUCTION OR BACKGROUND:A large number of drug classes have now been reported to provoke angle closure in high-risk individuals. The mechanism of action can be generalized into three main categories: sympathomimetic, parasympatholytic and idiosyndratic reactions. SOURCES OF DATA:This review of the ophthalmic literature provides a clinical summary of primary angle-closure glaucoma (PACG) and its management. AREAS OF AGREEMENT:External stimuli (pharmacological and environmental) may induce acute, and more often, asymptomatic angle closure, which carries a significant risk of glaucoma. GROWING POINTS:Whenever in doubt, patients at risk of PACG who are starting on drug therapy known to provoke angle closure or aggravate the condition should be referred for detailed gonioscopic examination of the anterior chamber by an ophthalmologist. AREAS FOR DEVELOPING RESEARCH: The use of new imaging methods such as anterior segment optical coherence tomography to assess the presence or risk of angle closure is gaining popularity, and may offer a more rapid method of identifying people who are at risk of sight loss from angle-closure glaucoma precipitated by non-ophthalmological medication. 10.1093/bmb/ldp042
    Primary acute angle-closure glaucoma complicating ciliochoroidal detachment: report of four cases and review of the literature. Zhang Yan,Wang Chao,Liu Li,Lei Yingqing,He Yue,Yu Ling International ophthalmology PURPOSE:To describe the ultrasound biomicroscopy (UBM) and B-scan ultrasonography findings and therapeutic approach for ciliochoroidal detachment secondary to acute primary angle-closure glaucoma (APACG) in four patients. We also reviewed the literature. METHODS:Case report and systematic literature review. RESULTS:The four patients were referred to our department for further management of APACG. The UBM and B-scan ultrasonography examinations were conducted 2 days after the beginning of medical treatment and demonstrated ciliochoroidal detachment in four eyes of the four patients. The patients all received intravenous infusion of corticosteroid therapy (10 mg dexamethasone once daily for 5-7 days). We reviewed the UBM findings, which confirmed that the ciliochoroidal detachment disappeared. The patients then underwent trabeculectomy combined with peripheral iridotomy surgery. The patients all ultimately recovered very well. CONCLUSION:APACG with ciliochoroidal detachment is rare and has hidden clinical manifestations, and the pathophysiological mechanism is not yet fully understood. Anti-glaucoma surgery may increase the detachment. UBM and B-scan ultrasounds are useful tools for ciliochoroidal detachment diagnosis in APACG patients before operative treatment. 10.1007/s10792-017-0769-y