We used anterior segment optical coherence tomography to investigate anterior chamber angle in primary angle-closure glaucoma (PACG) eyes following phacoemulsification and phacotrabeculectomy. Angle widening was significantly greater after phacoemulsification up to 6 months after the surgery.Purpose: To compare anterior chamber angle following 2 common surgeries for PACG.Methods: One hundred ten glaucoma patients were evaluated in this single center, prospective, randomized clinical trial. Those with concomitant PACG and senile cataract and without a history of ocular surgery, trauma, or chronic miotic use were recruited. Monocular patients were also excluded. Finally, 52 eligible subjects were randomly assigned to phacoemulsification ("Phaco" group, 25 eyes) or phacotrabeculectomy ("Combined" group, 27 eyes) surgeries. A swept-source, anterior segment optical coherence tomography device (CASIA SS-1000 OCT) was used to image the anterior segment. Mask graders used the images to measure the following parameters before and 1 week, 1 month, and 6 months after surgery: angle opening distance at 500 µm, trabecular iris surface area at 500 µm, and trabecular iris angle at 500 µm.Results: There was no significant difference between study groups regarding best-corrected visual acuity, intraocular pressure (IOP), and the number of glaucoma medications in preoperative or postoperative visits (P > 0.076). Also, the measured angle parameters were not statistically significantly different between the 2 groups before surgery (P > 0.123). After surgery, all measured parameters were significantly increased in both groups (P < 0.0001). At the 6-month follow-up, nasal angle opening distance at 500 µm was 0.383 ± 0.027 vs. 0.349 ± 0.017, trabecular iris surface area at 500 µm was 0.141 ± 0.007 vs. 0.125 ± 0.005, and trabecular iris angle at 500 µm was 40.1 ± 12.9 vs. 34.6 ± 3.1 in Phaco and Combined groups, respectively (P < 0.0001 for all).Conclusions: Anterior chamber angle widening by anterior segment optical coherence tomography was observed in PACG patients following surgery and was significantly greater after phacoemulsification compared with combined phacotrabeculectomy at all time points. Similar IOP and medication burden were noted for up to 6 months as secondary outcomes. The contribution of angle changes to the IOP-lowering effect of phacoemulsification in PACG eyes needs further study.
Purpose The aim of this study was to determine the prevalence and risk factors of near decompensated heterophoria in a population of university students. Methods In a randomized study, 406 students of six schools of Mashhad University of Medical Sciences were selected and classified into symptomatic and non symptomatic groups. Visual acuity (VA), near point of convergence (NPC), Near point of accommodation (NPA), dissociated and associated phoria, suppression, stereopsis, accommodative facility, relative accommodation, accommodative convergence/accommodation ( AC/A ratio and fusional reserves were measured in two groups. The data were analysed by using SPSS software, version 11.5o. Results The prevalence of symptoms and binocular disorders in students were 41.6% and 21.8% respectively . Of the students,9.1% had near decompensated heterophoria (heterophoria with symptoms). The results of this study showed that VA, NPC, NPA, heterophoria, stereopsis, accommodative facility, relative accommodation, AC/A ratio and fusional reserves were different in symptomatic and asymptomatic subjects and were worsen in students with decompensated heterophoria (P<0.05). Conclusion The results of this study indicated relatively high prevalence of symptomatic students, binocular dysfunction and decompensated heterophoria in university students. Students with decompensated heterophoria failed in more visual skills which can be risk factors for decompensating the heterophoria.
Purpose: To compare retinal vascular density changes following phacoemulsification vs. phacotrabeculectomy for primary angle-closure glaucoma(PACG).Materials and methods: Sixty-seven glaucoma patients were evaluated in a single center, and those with concomitant PACG and senile cataracts and without a history of prior ocular surgeries, trauma, or monocular status use were recruited. Finally, 59 eligible subjects were assigned to phacoemulsification (‘Phaco’ group, 29 eyes) or phacotrabeculectomy (‘Combined’ group, 30 eyes) surgeries based on the clinical situation. A commercial optical coherence tomography angiography (OCTA) device was used to measure the retinal vascular density and retinal nerve fiber layer thickness before, one week, one month after surgery.Results: For the RNFL thickness in different areas, a significant difference was found between the pre- and postoperative value only in the nasal area in the 'Combined' group (P<0.05). Among different vascular parameters, ‘inside disc vessel density’ had a significant difference for both ‘all vessels’ and ‘capillaries’ (p<0.05). Furthermore, ‘superficial hemifield vessel density for all vessels’ significantly changed after combined surgery (p=0.049).Conclusions: Despite similar IOP control, the vascular changes following phaco and combined surgery in PACG patients may be different, contributing to functional outcomes of these therapeutic modalities.
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