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Waisberg E, Ong J, Masalkhi M, Lee AG, Berdahl J. Anatomical considerations for reducing ocular emergencies during spaceflight. Ir J Med Sci 2024; 193:505-508. [PMID: 37243845 PMCID: PMC10808690 DOI: 10.1007/s11845-023-03407-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE The privatization of space travel is opening civilian spaceflight to an unprecedented number of individuals now and in the immediate future. The increase in the number and diversity of space travelers will mean increased exposure to both physiologic and pathologic changes observed during acute and prolonged microgravity. AIMS In this paper, we describe the anatomic, physiologic, and pharmacologic factors to consider that impact acute angle-closure glaucoma risk during spaceflight. CONCLUSIONS Based on these factors, we elaborate upon areas of medical considerations and provide future recommendations that may aid in reducing the risk of acute angle-closure glaucoma in the next era of spaceflight.
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Affiliation(s)
- Ethan Waisberg
- University College Dublin School of Medicine, Belfield, Dublin, Ireland.
| | - Joshua Ong
- Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Mouayad Masalkhi
- University College Dublin School of Medicine, Belfield, Dublin, Ireland
| | - Andrew G Lee
- Center for Space Medicine, Baylor College of Medicine, Houston, TX, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- A&M College of Medicine, Bryan, TX, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Nüßle S, Reinhard T, Lübke J. Acute Closed-Angle Glaucoma-an Ophthalmological Emergency. Dtsch Arztebl Int 2021; 118:arztebl.m2021.0264. [PMID: 34551857 PMCID: PMC8841641 DOI: 10.3238/arztebl.m2021.0264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acute closed-angle glaucoma has an incidence of 2.2-4.1 cases per 100 000 persons per year in Europe. It is an ophthalmological emergency in which markedly elevated intraocular pressure can damage vision permanently. Because the acute symptoms are not always clearly referable to the eyes, patients often present to physicians who are not ophthalmologists. METHODS This review is based on pertinent articles retrieved by a selective search in PubMed. RESULTS The diverse symptoms of acute closed-angle glaucoma include eye redness, worsening of vision and other visual disturbances, headache, and nausea. Acute closed-angle glaucoma has multiple causes. Not all predisposing factors have been definitively identified; above all, there are certain anatomical configurations of the eye that make it more likely to arise. The goals of treatment are to reduce the elevated intraocular pressure rapidly, which usually leads to marked symptom relief, as well as to eliminate the situation that led to closed-angle glaucoma. For proper treatment, the patient should be seen by an ophthalmologist without delay, on the day of symptom onset if possible. CONCLUSION Primary prevention of acute closed-angle glaucoma is not always possible. Even physicians who are not ophthalmologists can diagnose markedly elevated intraocular pressure by palpation of the globe. Proper, specific treatment can help patients rapidly and lastingly.
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Affiliation(s)
- Simone Nüßle
- Department of Ophthalmology, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Thomas Reinhard
- Department of Ophthalmology, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
| | - Jan Lübke
- Department of Ophthalmology, University Hospital Freiburg, Faculty of Medicine, University of Freiburg
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Chan PP, Tang FY, Leung DY, Lam TC, Baig N, Tham CC. Ten-Year Clinical Outcomes of Acute Primary Angle Closure Randomized to Receive Early Phacoemulsification Versus Laser Peripheral Iridotomy. J Glaucoma 2021; 30:332-339. [PMID: 33769358 DOI: 10.1097/ijg.0000000000001799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/09/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To compare the 10-year clinical outcomes of eyes with acute primary angle closure (APAC) randomized to receive either early phacoemulsification or laser peripheral iridotomy (LPI). METHODS Sixty-two APAC patients, who underwent either early phacoemulsification (phaco group) or laser peripheral iridotomy (LPI group) in a previous randomized controlled trial, were invited for assessment 10 years after the interventions. The results of the 2 groups were compared. RESULTS Forty of 62 patients (64.5%; 19 in phaco group and 21 from LPI group) were examined. None of them underwent additional glaucoma procedure but 15 (71.4%) patients in the LPI group received lens extraction before this assessment. The mean follow-up duration was 10.7±0.7 years. The phaco group used less medication (0.16±0.37 vs. 0.76±1.09 bottle per eye, P=0.028), had less extensive anterior synechiae (120.0±116.12 vs. 244.3±139.8 degree, P=0.010), and greater mean Shaffer gonioscopy grading (1.79±0.84 vs. 1.40±0.87; P=0.021) than the LPI group. Five eyes had persistent intraocular pressure elevation of >21 mm Hg in 2 consecutive visits and 4 eyes had blindness (best-corrected visual acuity worse than 6/60 and/or central visual field of <20 degree) in the LPI group, compared with none in the phaco group (P=0.022 and 0.045, respectively). There was no significant difference in the mean intraocular pressure, best-corrected visual acuity, and the number of eyes with visual field progression. CONCLUSION At 10 years, APAC eyes that underwent early phacoemulsification required less medication, less peripheral anterior synechiae, lower incidence of intraocular pressure elevation and a lower incidence of blindness compared with APAC eyes that underwent initial LPI.
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Affiliation(s)
- Poemen P Chan
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong
- Hong Kong Eye Hospital
| | - Fang Y Tang
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong
| | - Dexter Y Leung
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong, Hong Kong SAR
| | - Thomas C Lam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong
- Hong Kong Eye Hospital
| | - Nafees Baig
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong
- Department of Ophthalmology, Caritas Medical Centre
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Hong Kong, Hong Kong SAR
| | - Clement C Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong
- Hong Kong Eye Hospital
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Shatin
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Nuessle S, Luebke J, Boehringer D, Reinhard T, Anton A. [Acute angle closure : An ophthalmological emergency in the emergency room]. Med Klin Intensivmed Notfmed 2021; 117:137-143. [PMID: 33580819 PMCID: PMC8897352 DOI: 10.1007/s00063-021-00790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/22/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Die Symptome des akuten Winkelblocks, ein Notfallereignis, das ohne rechtzeitige Therapie zur irreversiblen Erblindung führen kann, sind vielfältig. Diese können initial als internistische oder neurologische Erkrankungen gedeutet werden, wenn Kopfschmerzen, Pupillenstarre oder Übelkeit im Vordergrund stehen. Ziel unserer Studie war es, die Rate belastender und invasiver Diagnostik durch primäre Vorstellung bei Nichtophthalmologen bei akutem primären Winkelblock zu erfassen. Methode Retrospektive Single-Center-Studie von Patienten mit akutem primärem Winkelblock. Zur Identifizierung dieser wurden alle Patienten erfasst, bei denen im Universitätsklinikum Freiburg, Klinik für Augenheilkunde im Zeitraum 2014–2018 eine chirurgische Iridektomie (5-133.0) oder Iridotomie durch Laser (5-136.1) durchgeführt wurde. Anschließend erfolgte durch Akteneinsicht die Datenanalyse zur Prüfung der Ein- und Ausschlusskriterien sowie des Krankheitsverlaufs. Ergebnisse Eingeschlossen wurden 91 Patienten mit akutem primären Winkelblock. Davon stellten sich 28 % (n = 25) initial bei nichtophthalmologischen Fachdisziplinen vor. In dieser Patientengruppe erhielten 56 % (n = 11) eine nichtzielführende Diagnostik, wobei bei 32 % (n = 8) eine kraniale Bildgebung und bei 8 % (n = 2) eine Lumbalpunktion durchgeführt wurde. Schlussfolgerung Bei akutem primären Winkelblock zeigt sich eine hohe Rate an nicht wegweisender Diagnostik durch Nichtophthalmologen, weshalb dieses Krankheitsbild fächerübergreifend präsent sein sollte. Bei unspezifischen Symptomen, wie Kopfschmerzen, Übelkeit und Erbrechen sowie Pupillenstarre, muss an die Möglichkeit eines akuten Augeninnendruckanstiegs durch einen akuten Winkelblock gedacht und das frühzeitige Hinzuziehen eines Ophthalmologen erwogen werden.
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Affiliation(s)
- S Nuessle
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
| | - J Luebke
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - D Boehringer
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - T Reinhard
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - A Anton
- Klinik für Augenheilkunde, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
- ADMEDICO Augenzentrum, Olten, Schweiz
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Chan PP, Pang JC, Tham CC. Acute primary angle closure-treatment strategies, evidences and economical considerations. Eye (Lond) 2019; 33:110-9. [PMID: 30467424 DOI: 10.1038/s41433-018-0278-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/23/2018] [Accepted: 09/30/2018] [Indexed: 11/08/2022] Open
Abstract
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.
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Zhang X, Liu Y, Wang W, Chen S, Li F, Huang W, Aung T, Wang N. Why does acute primary angle closure happen? Potential risk factors for acute primary angle closure. Surv Ophthalmol 2017; 62:635-647. [DOI: 10.1016/j.survophthal.2017.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 12/14/2022]
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Wu SC, Lee YS, Wu WC, Chang SHL. Anterior chamber depth and angle-closure glaucoma after central retinal vein occlusion. BMC Ophthalmol 2016; 16:68. [PMID: 27245223 PMCID: PMC4886398 DOI: 10.1186/s12886-016-0256-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 05/26/2016] [Indexed: 12/30/2022] Open
Abstract
Background The purpose of this study was to report the anterior chamber (AC) depth and the attack of angle-closure glaucoma (ACG) in eyes with the recent onset of central retinal vein occlusion (CRVO). Methods This retrospective case series included 24 patients with recent onset of CRVO (within one month of attack) from July 2001 to December 2002. The mean follow-up period of the patients was 46 months (range: 3 to 92 months). AC depth was measured using an ultrasound biomicroscopy. Clinical data, including systemic disorders, intraocular pressure, and visual outcomes were recorded. The main outcome measures were AC depth in the diseased eye and the fellow eye of the same patient and the attack of ACG after CRVO. Results The mean AC depth in the diseased eyes was significantly shallower than in the unaffected fellow eyes (2.43 ± 0.45 mm vs. 2.55 ± 0.46 mm; p < 0.001). Four patients (17 %) developed ACG after the onset of CRVO within one month of the CRVO attack. In these four patients, the mean AC depth in the diseased eyes was 1.91 ± 0.21 mm, which was much shallower than the eyes without ACG attack (2.53 ± 0.40 mm). Conclusions AC depth is significantly shallower following the onset of CRVO. ACG can occur in patients after the onset of CRVO.
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Affiliation(s)
- Shiu-Chen Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan, 333, Taoyuan, Taiwan.,Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yung-Sung Lee
- Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan, 333, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan, 333, Taoyuan, Taiwan.,Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Shirley H L Chang
- Department of Ophthalmology, Chang Gung Memorial Hospital, 5 Fu-Hsin Rd., Kweishan, 333, Taoyuan, Taiwan. .,Chang Gung University, College of Medicine, Taoyuan, Taiwan.
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Theinert C, Wiedemann P, Unterlauft JD. Laser peripheral iridotomy changes anterior chamber architecture. Eur J Ophthalmol 2017; 27:49-54. [PMID: 27198636 DOI: 10.5301/ejo.5000804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE The pressure gradient between anterior and posterior chamber in acute angle closure (AAC) and primary angle closure suspects is balanced by a sufficient laser peripheral iridotomy (LPI). The anterior chamber changes induced by LPI in patients with unilateral AAC were examined and compared to healthy eyes to define threshold values, which may help to discriminate between healthy and diseased eyes. METHODS Using Scheimpflug photography, anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), and central corneal thickness (CCT) were measured before and after LPI in both eyes of unilateral AAC cases. These measurements were compared to a group of healthy control eyes to determine threshold values for ACD, ACV, and ACA. RESULTS The ACD, ACV, and ACA increased significantly in the 25 AAC eyes after LPI. The ACD, ACV, ACA, and CCT values in the AAC eyes obtained before LPI were compared to a control group of 59 healthy eyes with wide open chamber angles. The cutoff values revealed by receiver operating characteristic analysis were 2.1 mm for ACD, 90.5 mm2 for ACV, and 27.25° for ACA. CONCLUSIONS Our results confirm the significant changes of the anterior segments architecture induced by LPI in AAC eyes. The found threshold values for ACD, ACV, and ACA may help in daily clinical routine to discriminate between healthy eyes and those in need for a prophylactic LPI.
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Unterlauft JD, Yafai Y, Wiedemann P. Changes of anterior chamber architecture induced by laser peripheral iridotomy in acute angle closure crisis. Int Ophthalmol 2014; 35:549-56. [DOI: 10.1007/s10792-014-9982-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 07/20/2014] [Indexed: 11/28/2022]
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Abstract
PURPOSE In acute angle-closure glaucoma a laser iridotomy (IO) is performed to balance the intraocular pressure between the anterior and posterior chambers. The changes induced in the anterior chamber architecture were analyzed using Scheimpflug photography. MATERIAL AND METHODS Scheimpflug photography was performed in eyes with acute angle closure and in the contralateral eyes before and after IO. RESULTS In a group of 10 patients (8♀, 2♂, average age71.2 ± 5.3 years) 10 eyes with acute angle closure and 10 contralateral eyes were analyzed. The anterior chamber depth, central corneal thickness and anterior chamber angle did not change significantly after IO. The mean anterior chamber volume showed a statistically significant increase in the 10 eyes with acute angle closure and in the 10 contralateral eyes. CONCLUSION Anterior chamber volume increases due to IO but not anterior chamber depth, central corneal thickness and anterior chamber angle in eyes with acute angle closure.
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Laser literature watch. Photomed Laser Surg 2006; 24:537-71. [PMID: 16942439 DOI: 10.1089/pho.2006.24.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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