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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 post-treatment 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. [ABSTRACT FROM AUTHOR]

Aim: To determine the risk factors for developing phacomorphic glaucoma in eyes with mature cataracts.Materials and Methods: This is a case-control study comprising of 90 eyes with phacomorphic glaucoma and 90 age- and sex-matched control eyes with mature cataracts without phacomorphic glaucoma. Patients with pre-existing glaucoma, previous intraocular surgery and /or absence of documented axial lengths were excluded from this study. Binary logistic regression analysis of the variables, axial length and anterior chamber depth, was performed. Anterior chamber depth of the contralateral eye was used as a proxy measure of the pre-phacomorphic state in the eye with phacomorphic glaucoma as majority of them first presented to our center during the phacomorphic attack without prior measurements of the pre-phacomorphic ACD or lens thickness; therefore, their anterior chamber depth would not be representative of their pre-phacomorphic state. Axial length of 23.7 mm was selected as a cut-off for dichotomized logistic regression based on the local population mean from published demographic data.Results: The mean age was 73.1 ± 10.2 years. All phacomorphic and control eyes were ethnic Chinese. The mean presenting intraocular pressures were 49.5 ± 11.8 mmHg and 16.7 ± 1.7 mmHg in the phacomorphic and control eyes respectively (P< 0.0001), whilst the median Snellen best corrected visual acuity were light perception and hand movement in the phacomorphic and control eyes respectively. Eyes with phacomorphic glaucoma had shorter axial length of 23.1 ± 0.9 mm median when compared with that of control eyes, 23.7 ± 1.5 mm (P = 0.0006). Eyes with AL ≤ 23.7 mm were 4.3 times as likely to develop phacomorphic glaucoma when compared with AL > 23.7 mm (P = 0.003).Conclusion: Axial length less than ≤ 23.7 mm was a risk factor for developing phacomorphic glaucoma. Eyes with AL shorter than the population mean were 4.3 times as likely to develop phacomorphic glaucoma compared with eyes with longer than average AL. In an area where phacomorphic glaucoma is prevalent and medical resources are limited, patients with AL shorter than their population mean may be considered for earlier elective cataract extraction as a preventive measure. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the correlation of anterior chamber depth (ACD) with the peripapillary retinal nerve fiber layer (RNFL) thickness, age, axial length (AL), and spherical equivalent in children., Subjects: Consecutive subjects aged 4 to 18 were recruited. Visually disabling eye conditions were excluded. Only the right eye was included for analysis. The ACD was correlated with RNFL thickness, age, spherical equivalent, and AL for all subjects. Subjects were then divided into 3 groups based on their postcycloplegic spherical equivalent: myopes (<-1.0 D), emmetropes (≥-1.0 to ≤+1.0 D), and hyperopes (>+1.0 D). The ACD was compared among the 3 groups before and after age adjustment., Results: In 200 subjects (mean age 7.6 ± 3.3 years), a deeper ACD was correlated with thinner global RNFL (r = -0.2, r(2) = 0.06, P = 0.0007), older age (r = 0.4, r(2) = 0.1, P < 0.0001), myopic spherical equivalent (r = -0.3, r(2) = 0.09, P < 0.0001), and longer AL (r = 0.5, r(2) = 0.2, P < 0.0001). The ACD was deepest in myopes (3.5 ± 0.4 mm, n = 67), followed by emmetropes (3.4 ± 0.3, n = 60) and then hyperopes (3.3 ± 0.2, n = 73) (all P < 0.0001). After age adjustment, myopes had a deeper ACD than the other 2 groups (all P < 0.0001)., Conclusions: In children, a deeper ACD was associated with thinner RNFL thickness, older age, more myopic spherical equivalent, and longer AL. Myopes had a deeper ACD than emmetropes and hyperopes.

Objective: To compare phacoemulsification alone versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma (CACG) with coexisting cataract., Design: Randomized clinical trial., Participants: Seventy-two medically controlled CACG eyes with coexisting cataract., Intervention: Recruited patients were randomized into group 1 (phacoemulsification alone) or group 2 (combined phacotrabeculectomy with adjunctive mitomycin C). Postoperatively, patients were reviewed every 3 months for 2 years., Main Outcome Measures: Intraocular pressure (IOP) and requirement for topical glaucoma drugs., Results: Thirty-five CACG eyes were randomized into group 1, and 37 CACG eyes were randomized into group 2. There were no statistically significant differences (P>0.05) in mean IOP between the 2 treatment groups preoperatively and postoperatively, except at 1 month (P = 0.001) and 3 months (P = 0.008). Combined phacotrabeculectomy with adjunctive mitomycin C resulted in 0.80 less topical glaucoma drugs (P<0.001) in the 24-month postoperative period compared with phacoemulsification alone. The differences in IOP control were, however, not associated with differences in glaucomatous progression. Combined surgery was associated with more postoperative (P<0.001) complications compared with phacoemulsification alone., Conclusions: Combined phacotrabeculectomy with adjunctive mitomycin C may be marginally more effective than phacoemulsification alone in controlling IOP in medically controlled CACG eyes with coexisting cataract. Combined surgery may be associated with more complications and additional surgery in the postoperative period. Further study is needed to determine whether the marginally better IOP control of combined surgery justifies the potential additional risks of complications and further surgery., Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Purpose: To report the technique and surgical outcomes of microincision bimanual phacotrabeculectomy in eyes with glaucoma and coexisting cataract., Setting: Glaucoma Service, Hong Kong Eye Hospital, Hong Kong SAR, China, Methods: Microincision bimanual phacoemulsification with a sleeveless phaco needle and irrigating chopper was performed in combination with trabeculectomy. Phacoemulsification was performed through 2 small clear corneal wounds, sparing the trabeculectomy site from trauma. The intraocular lens (IOL) was then implanted through the trabeculectomy site, so no corneal wound larger than 1.5 mm was required for IOL implantation., Results: The first 10 consecutive eyes of 10 patients who had combined phacotrabeculectomy by a microincision bimanual technique had significantly reduced intraocular pressure. There was a 10.5% reduction in the mean corneal endothelial cell count. There were no other complications up to 6 months after surgery., Conclusion: Microincision bimanual phacotrabeculectomy appeared to be an effective and safe option in patients with glaucoma and coexisting cataract.

Aim: To assess the safety and efficacy of fornix-based tra-beculectomy with the 'anchoring' corneal suture technique in Chinese patients., Methods: A retrospective non-comparative case series of 66 eyes of 63 Chinese patients who underwent fornix-based trabeculectomy combined with intraoperative mitomycin C (MMC) 0.4 mg/mL for 2-5 min were studied. Conjunctival wound closure of all eyes was with the anchoring corneal suture technique using a 9-0 nylon suture to prevent leakage at the corneolimbal interface. The success rate, with or without anti-glaucoma medication, the complication rate and the longevity of the drainage blebs were analyzed., Results: At a mean follow-up period of 447.36 +/- 337.98 days, the mean intraocular pressure decreased from 26.83 +/- 7.90 mmHg to 17.74 +/- 8.74 mmHg (P < 0.001). The mean glaucoma medication decreased from 2.95 +/- 0.98 preoperatively to 1.23 +/- 1.41 postoperatively (P < 0.001). Thirty-one eyes (47.0%) required no anti-glaucoma medication postoperatively. Twenty eyes (30.3%) had qualified success postoperatively. Eight eyes (12.1%) had early wound leakage that resolved with conservative treatment. Three eyes (4.5%) required surgical repair. One eye (1.5%) had hypotonous maculopathy. No other major complications were encountered., Conclusion: Fornix-based trabeculectomy with adjunctive mitomycin C employing the anchoring corneal suture technique appears to be both safe and effective in Chinese patients.