Kowloon West, Hong Kong
Kowloon West, Hong Kong

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Lee J.W.Y.,University of Hong Kong | Lai J.S.M.,University of Hong Kong | Yick D.W.F.,The Caritas Medical Center | Yuen C.Y.F.,The Caritas Medical Center
Clinical Ophthalmology | Year: 2012

Background: The purpose of this study was to compare the efficacy and safety of argon laser peripheral iridoplasty (ALPI) and systemic intraocular pressure (IOP)-lowering medications in the immediate management of acute phacomorphic angle closure. Methods: Consecutive cases of acute phacomorphic angle closure were randomized to receive ALPI and an intravenous or oral carbonic anhydrase inhibitor as initial treatment. Intravenous mannitol was administered for presenting IOP > 60 mmHg or IOP > 40 mmHg 2 hours posttreatment in both arms. Results: Of 10 consecutive cases, six received medical therapy and four received ALPI. Fifty percent in the medical group and none in the ALPI group required intravenous mannitol. The ALPI group took less time to achieve IOP < 25 mmHg (18.8 ± 7.5 minutes versus 115.0 ± 97.0 minutes, P = 0.001, F test); had a greater IOP reduction within 30 minutes (69.8% ± 7.7% versus 40.9 ± 23.9%, P = 0.03, t-test); and had a consistently smaller post-attack cup to disc ratio (0.50 ± 0.02 versus 0.60 ± 0.20, P = 0.002, F test). Conclusion: ALPI offers greater safety, consistency, and efficacy than systemic IOP-lowering medications as initial treatment for phacomorphic angle closure. © 2013 Lee et al, publisher and licensee Dove Medical Press Ltd.


PubMed | The Caritas Medical Center
Type: Journal Article | Journal: Eye (London, England) | Year: 2010

To analyse the long-term visual acuity (VA) and intraocular pressure (IOP) outcomes in phacomorphic glaucoma.A retrospective analysis of 100 consecutive, acute phacomorphic glaucoma cases from January 2000 to April 2009 was conducted at The Caritas Medical Centre in Hong Kong. All cases underwent cataract extraction after IOP control with medication and/or laser.During a 3.12.6-year follow-up, the mean visual improvement was 1.10.9 LogMAR units with improvements in 81.7% of cases. A shorter duration from symptoms to cataract extraction resulted in greater visual improvement (r(2)=0.1, P=0.001). In all, 80.5% of the cases had IOP21mmHg without any glaucoma treatment; 19.5% required 1.60.7 glaucoma eye drops; and 3.7% required additional laser iridotomy or trabeculectomy for IOP control at 1.82.3 years. The vertical cup-disc ratio (VCDR) of the index eye was 0.60.3. Gonioscopy revealed an averaged Shaffer grading of 3.01.0 and 9990 degrees of peripheral anterior synechiae (PAS). The Humphrey automated perimetry mean deviation was 5.22.7 and the pattern standard deviation was -15.910.Over 80% of phacomorphic patients had long-term visual improvements and normalization of IOP after cataract extraction. A shorter attack seemed to offer better VA. Post-operatively, most have open angles with some degree of PAS formation, and glaucomatous optic neuropathy is evident from enlarged VCDRs and visual field defects. At least 2 years of follow-up is useful to detect a 20% glaucoma progression possibly requiring additional glaucoma treatments.

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