Angle-closure glaucoma: diagnosis

Revista da Associação Médica Brasileira, 2014

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize procedures to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Revista Da Associacao Medica Brasileira, 2014

The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

IOSR Journal of Dental and Medical Sciences, 2016

Introduction: At present 12 million Indians were affected by glaucoma accounting for 12.8% of the blindness of the country with 45 to 55% of primary glaucoma being PACG. The screening of patients with a high risk of iridotrabecular contact and subsequently primary angle closure is important. Early diagnosis and treatment is very much essential in dealing with high risk groups for angle closure glaucoma having occludable angle. The main aim of this study is to screen for Angle Closure Glaucoma in high risk groups with the Objectives:1) To know the incidence of occludable angles in high risk groups for angle closure glaucoma. 2) To highlight the importance of screening for angle closure suspects in high risk groups. Methodology: The present longitudinal study was conducted in the Dept. of ophthalmology, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation (Dr.PSIMS), Chinoutapalli, Krishna District, Andhra Pradesh with the institutional ethical committee clearance. A sample of 100 selected patients who attended ophthalmology opd as outpatients. Results: Out of 100 cases 18% patients had occludable angles, 72% patients had open angles.Degree of hypermetropia in the occludable angles: Out of 18 cases with occludable angles 4 eyes had hyperopic error between 0.50-1.00D, 9 cases had hyperopic error between 1.25-2.00D,5 cases had hyperopic error between 2.50-3.00D. In the present study, 20% cases were known Diabetics out of them 40% had occludable angles. Conclusion: Measurement of peripheral anterior chamber depth is believed to be useful for glaucoma screening and gonioscopy should make the final assessment. For primary angle closure (PAC) or early primary angle closure glaucoma, case detection presents the unique opportunity to prevent blindness from glaucoma.

Revista Brasileira de Oftalmologia, 2018

Objective: To evaluate the clinical and epidemiological profile of patients with primary open-angle glaucoma. Methods: This is a quantitative study with cross-sectional and analytical design, which sample consisted of 425 patients treated in an unit of Specialized Care in Ophthalmology, located in the northern state of Minas Gerais, from 2004 to 2015. We collected the data using formularies that addressed demographic and clinical aspects, risk factors and the presence of undercurrent diseases. We conducted an ophthalmological examination to evaluate anatomical and functional changes. We used statistical analysis, and the results are presented by mean, standard deviation and percentiles 25, 50 and 75. Results: Females predominate (56.8%), the age group of 60 years or older (44%) and mixed skin (81.7%). A minority of participants present risk factors such as high myopia (6.3%) and diabetes mellitus (17.9%). Regarding the clinical examination, there is a prevalence of increased optic nerve excavation (≥ 0.8) and low thickness of the corneas (≤ 535 microns). Conclusion: Most people develop advanced glaucoma, with increased optic nerve excavation and changed visual fields. Other common risk factors are: family history of glaucoma, decreased thickness of the cornea and hypertension. Early diagnosis and treatment can prevent vision loss. Primary care physicians should consider referring patients who have glaucoma risk factors, for an ophthalmologic examination.

Eye, 2006

Purpose To validate the applicability of a newly developed, noncontact scanning peripheral anterior chamber depth analyzer (SPAC) for screening eyes at the risk of angleclosure glaucoma (ACG). Subjects and methods All glaucoma patients who visited the University of Yamanashi Hospital from February through May 2003 were enrolled, except those with aphakic eye or pseudophakic eye. Of the 552 enrolled patients, 48 with ACG or narrow angles requiring laser iridotomy (LI) were categorized as patients with high-risk ACG eyes, and those with open angle were categorized as patients with control eyes. In all, 20 patients with ACG or narrow angles requiring prophylactic LI, who were followed up by an independent private ophthalmic clinic, were enrolled for threshold analysis. Nonophthalmologists measured anterior chamber depth and the averaged values of three measurements were employed for analysis. Threshold analysis and discriminant analysis were employed for determining the sensitivity and specificity of SPAC for diagnosing eyes with high-risk ACG. Results SPAC distinguished well the highrisk ACG eyes from the control eyes, and one of the most useful criteria for screening is as follows: any of the four measured points should exceed 95% confidence interval, and sensitivity and specificity should be 97.6 and 83.5%, respectively. Conclusion SPAC is thought to be useful for detecting eyes at the risk of ACG by nonophthalmologists.

Primary angle-closure glaucoma (PACG) is a leading cause of blindness globally. It is a condition that is responsible for nearly half of patients who have a bilateral blindness caused by glaucoma. PACG is highly prevalent in Asian countries, as compared with Primary open-angle glaucoma (POAG), which is reported as the predominant disease among Whites, but prevalence of PACG in Europe has been underestimated previously. Early detection by effective screening and appropriate prophylaxis and treatment may prevent blindness from angle-closure glaucoma. The purpose of this study was to present through the cases of 3 patients with PACG the importance of each phase of glaucoma: diagnosis, treatment and follow-up.

BMJ, 2006

Angle closure glaucoma is a sight threatening ophthalmic emergency. Patients classically present with an acutely painful red eye and periocular headache, loss of vision, nausea, and vomiting, but sometimes the presentation is less dramatic or more systemic than ocular. The diagnosis may be missed in such cases, leading to unnecessary investigations, delayed treatment, and blindness. We describe three cases of angle closure glaucoma in which initial diagnostic uncertainty led to a delay in treatment and which highlight the need for a wider awareness of this condition. Case reports Case 1 A 66 year old woman was admitted to the orthopaedic ward for elective spinal canal decompression for spinal stenosis. She was otherwise healthy and was taking oral diclofenac, morphine, and amitriptyline. During the operation, she was placed prone for spinal laminectomy. Postoperatively, she received regular opiate analgesia. On the third postoperative day the patient developed severe headache, photophobia, and neck stiffness without focal neurological deficit. An urgent computed tomography scan of the head was normal. On the fourth postoperative day she complained of visual loss, a red eye was noted, and an ophthalmology referral was made. Her visual acuity was counting fingers for both eyes. Slit lamp examination was hampered by her immobility, but both eyes were red with cloudy corneas; shallow anterior chambers; fixed, middilated pupils; and high intraocular pressures of 45 mm Hg in the right eye and 33 mm Hg in the left eye (normal < 21 mm Hg). A diagnosis of bilateral angle closure glaucoma was made. She was treated immediately with the standard medical regimen (using eye drops to constrict the pupil and systemic acetazolamide to lower the intraocular pressure). Her amitriptyline was stopped, as it was a potential precipitating factor. Her response to medical treatment was partial, and, as she had coexistent cataracts, bilateral lens extraction, lens implantation, and surgical peripheral iridotomies were done. The anterior chambers deepened immediately, and the intraocular pressures normalised postoperatively. Two months later, intraocular pressures were normal without treatment. The best corrected Snellen visual acuity was only 6/12 in either eye, with bilateral visual field constriction and reduced colour vision associated with glaucomatous optic atrophy (fig 1).

Japanese Journal of Ophthalmology, 2004

Methods A nationwide questionnaire survey was conducted, targeting 1237 registered facilities to Japanese Ophthalmological Society. Results Valid replies were obtained from 754 of 1232 facilities (61.2%). Primary ACG comprised a small percentage of the glaucoma types diagnosed in outpatient examinations. More than 50% of the laser iridotomy (LI) procedures were prophylactic at 52.9% of the facilities. Gonioscopy was most frequently used for determining indications for prophylactic LI. Specular microscopy was always performed prior to LI in 7.8% of the facilities. Prophylactic LI resulted in complications at 20.5% of the surveyed facilities, although the incidence was low. The following residual complications were reported at 82.9% of the facilities when treating ACG attacks: cataract, persistent elevation of intraocular pressure, and bullous keratopathy. One-third of the facilities experienced inadequate treatment of an ACG attack by physicians other than ophthalmologists. Conclusions The incidence of LI-induced complications was higher in ACG eyes than in narrow-angle eyes. However, prophylactic LI sometimes results in persistent ocular complications. Jpn J Ophthalmol 2004;48:133–140 © Japanese Ophthalmological Society 2004

Objective: To evaluate the methodologic quality of 3 primary open-angle glaucoma (POAG) clinical practice guidelines (CPGs). Design: The CPGs were assessed with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Participants: Four authors (A.M.W., C.M.W., B.K.Y., D.J.W.) performed independent assessments of POAG CPGs.