An update on therapeutic modalities for the prevention of angle closure glaucoma

Global, regional and national burden of Glaucoma: an update analysis from the Global Burden of Disease Study 2019

PURPOSE

As the epidemiological and burden trends of glaucoma are changing, it is extremely necessary to re-investigate geographical differences and trends. Here we use data from the 2019 Global burden of Disease, which aims to report the prevalence and disability-adjusted life years of glaucoma injury to assess the latest epidemiological models and trends from 1990 to 2019.

METHOD

Annual case numbers, age-standardized rates of prevalence, DALYs, and their estimated annual percentage changes (EAPCs) for glaucoma between 1990 and 2019 were derived from the GBD 2019 study. The relationship between glaucoma disease burden and social demographic index (SDI) was also investigated in this study.

RESULTS

In 2019, there were 7.47 million prevalent cases and 0.75 million DALYs cases, which increased by 92.53% and 69.23% compared with 1990 respectively. The global age-standardized rate of prevalence (ASPR) and age-standardized rate of DALYs (ASDR) decreased during 1990-2019 (EAPC =  - 0.55 and - 1, respectively). In 2019, the highest ASPR and ASDR of Glaucoma were all observed in Mali, whereas the lowest occurred in Taiwan (Province of China). In terms of gender, males were more likely to suffer from glaucoma than females, especially the elderly.

CONCLUSIONS

The global prevalence and DALYs of glaucoma had an absolute increase during the past 30 years. The disease burden caused by glaucoma is closely related to socioeconomic level, age, gender, and other factors, and these findings provide a basis for policymakers from the perspective of social management.

[Angle closure-glaucoma]

Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can lead to severe visual disturbances and even blindness within a short time. It is divided into primary and secondary forms and can be further categorized depending on the presence of a pupillary block. In all cases, therapy is initially based on resolving the cause of the angle-closure and treating any underlying disease that may be present. In addition, intraocular pressure reduction must be achieved. This can be effectuated conservatively or surgically. Depending on the specific subtype of angle-closure, different treatments are promising.

Iridoschisis: visual outcome in treated versus untreated eye

A 67-year-old man was referred for iris color change. He was noted to have narrow angles with atrophic iris appearance and visually significant cataracts. The iris findings were consistent with iridoschisis. The patient was recommended to have cataract surgery. Unfortunately, he was lost to follow-up. One year later, he presented with chronic angle closure glaucoma on the right eye with very high pressure and very poor remaining vision. Left-eye vision was also compromised with cataract. Despite the presence of small pupil, abnormal iris stroma, and dense cataract, the patient underwent successful cataract surgery and achieved 20/20 vision post-operatively. Iridoschisis can cause substantial ocular morbidity if not treated timely.

Transscleral versus endoscopic cyclophotocoagulation outcomes for refractory glaucoma

OBJECTIVES

Evaluate the efficacy of transscleral cyclophotocoagulation versus endoscopic cyclophotocoagulation to reduce intraocular pressure.

METHODS

A retrospective, non-randomized cohort study with 1 year of follow-up included 62 eyes of 62 refractory glaucoma patients who underwent transscleral cyclophotocoagulation or endoscopic cyclophotocoagulation.

RESULTS

Thirty-two patients were enrolled in transscleral cyclophotocoagulation group and 30 patients in endoscopic cyclophotocoagulation group, and the follow-up period was 1 year. The mean preoperative intraocular pressure was 35.6 ± 12.9 mm Hg in the transscleral cyclophotocoagulation group and 31.8 ± 8.8 mm Hg in the endoscopic cyclophotocoagulation group without significant difference (p = 0.18). When we compare both groups, there was no difference at 1 month (p = 0.46) and 3 months (p = 0.21) after surgery. However, there was a statistically significant difference at month 6 (p = 0.0055) and 1 year (p = 0.0019), finding lower intraocular pressure in the transscleral cyclophotocoagulation group. Cumulative success for intraocular pressure <21 mm Hg was 93.8% in transscleral cyclophotocoagulation group and 83.3% in endoscopic cyclophotocoagulation group after 1 year (p = 0.2). For intraocular pressure <18 mm Hg, the success rate was 78.1% in transscleral cyclophotocoagulation group and 63.3% in endoscopic cyclophotocoagulation group (p = 0.06), and for intraocular pressure <16 mm Hg, the success rate was 62.5% in transscleral cyclophotocoagulation group and 43.3% in endoscopic cyclophotocoagulation group (p = 0.02). Hypotony (p = 0.01) and vision loss of two lines (p = 0.01) were statistically significant lower in endoscopic cyclophotocoagulation group.

CONCLUSION

This study demonstrates that both transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation are effective at decreasing intraocular pressure. However, transscleral cyclophotocoagulation is related to more complications than endoscopic cyclophotocoagulation, whereas endoscopic cyclophotocoagulation shows lower intraocular pressure decrease than transscleral cyclophotocoagulation.

Efficacy of selective laser trabeculoplasty in primary angle closure disease

BACKGROUND

To study the role of selective laser trabeculoplasty (SLT) in intraocular pressure (IOP) reduction in post-laser iridotomy primary angle-closure disease patients with inadequately controlled IOP.

METHODS

In this prospective cross-sectional study, 34 patients with primary angle-closure disease with post-laser iridotomy open angles up to at least 180° were recruited. Following SLT, patients were examined at 1 day, 1 week, 1 and 3 months, 6 months and 1 year post SLT.

RESULTS

Data of 34 patients (34 eyes; 8 males and 26 females), with a mean age of 57.80 ± 6.44 years, were analysed. The reduction in IOP at each follow-up visit was significant (p < 0.001). The maximum reduction in IOP was noticed on post-laser day 1 and the least reduction was noticed 1 week post laser. Post-SLT range of IOP reduction varied from 9 to 46% at 1 year, which indicates the variability of a response to SLT. Mean IOP in both primary angle closure (PAC) and primary angle closure glaucoma (PACG) groups was comparable at all visits except at post-SLT week 1 when IOP in the PACG group was significantly higher than that in the PAC group (p = 0.035). None of the patients complained of pain and/or discomfort or had any clinically significant anterior segment inflammation on any of the follow-up visits. None of the patients underwent repeat SLT or surgery. The mean pre-SLT and post-SLT visual field index at 1-year follow-up was 95.47 ± 3.58 and 95.90 ± 4.13, respectively, which was not significant (p = 0.84).

CONCLUSIONS

High baseline IOP significantly correlated with reduction in IOP. Our results suggest that SLT is a safe, cost-effective modality for reducing IOP in primary angle-closure disease with patent laser iridotomy with a visible trabecular meshwork.

Goniosynechialysis combined with cataract extraction for iridoschisis: A case report

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.