What's the Choroid Got to Do With Angle Closure?

Quigley, Harry A.

doi:10.1001/archophthalmol.2009.80

Cited by 54 publications

(33 citation statements)

References 14 publications

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“…We hypothesize that choroidal expansion may contribute to the process of AC by causing an immediate increase in IOP. [26][27][28] This would likely lead to increased outflow from the trabecular meshwork so as to restore the IOP toward normal, leading to a posterior to anterior pressure differential. [26][27][28] As fluid leaves the anterior chamber under this pressure differential, aqueous volume in the anterior chamber would decrease, and the lens would move forward, narrowing the iris-lens channel and intensifying resistance to aqueous movement through the pupil (pupillary block).…”

Section: Discussionmentioning

confidence: 99%

“…[26][27][28] This would likely lead to increased outflow from the trabecular meshwork so as to restore the IOP toward normal, leading to a posterior to anterior pressure differential. [26][27][28] As fluid leaves the anterior chamber under this pressure differential, aqueous volume in the anterior chamber would decrease, and the lens would move forward, narrowing the iris-lens channel and intensifying resistance to aqueous movement through the pupil (pupillary block). [26][27][28] Hypothetically, in the AC eye, even anterior lens movement of a few micrometers would produce a rapid increase in the trans-iris pressure differential, bowing the iris forward to make contact with the meshwork.…”

Section: Discussionmentioning

confidence: 99%

“…25 Hypothetically, expansion of the choroid would raise IOP in the short term, leading to increased exit of aqueous from the anterior chamber to return IOP to its equilibrium level. [26][27][28] Because this would decrease anterior chamber volume, there would be a compensatory forward movement of the iris and lens. [26][27][28] This could increase resistance for aqueous movement through the iris-lens channel (pupil block) and contribute to the development of angle closure (AC) in predisposed eyes.…”

mentioning

confidence: 99%

“…[26][27][28] Because this would decrease anterior chamber volume, there would be a compensatory forward movement of the iris and lens. [26][27][28] This could increase resistance for aqueous movement through the iris-lens channel (pupil block) and contribute to the development of angle closure (AC) in predisposed eyes. [26][27][28] A given expansion of the choroid would likely have a disproportionately greater effect in altering IOP in smaller eyes, which are known to be at greater risk for AC.…”

mentioning

confidence: 99%

“…[26][27][28] This could increase resistance for aqueous movement through the iris-lens channel (pupil block) and contribute to the development of angle closure (AC) in predisposed eyes. [26][27][28] A given expansion of the choroid would likely have a disproportionately greater effect in altering IOP in smaller eyes, which are known to be at greater risk for AC. Therefore, we seek to develop methods that would measure dynamic changes in CT, as the individual tendency to choroidal expansion may be a predictive parameter for later development of angle closure glaucoma (ACG).…”

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confidence: 99%

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Choroidal Thickness Change after Water Drinking Is Greater in Angle Closure than in Open Angle Eyes

Arora

Jefferys

Maul

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To study change in choroidal thickness (CT) after water drinking test (WDT), comparing angle closure (AC) to open angle (OA) eyes.METHODS. Before and 30 minutes after drinking 1 L of water, 88 glaucoma subjects underwent measurements of CT by spectral domain-optical coherence tomography, IOP, blood pressure (BP), axial length (AL), and anterior chamber depth (ACD). RESULTS.Baseline CT was significantly greater in AC than in OA eyes (P ¼ 0.002). After WDT, BP, IOP, and AL increased significantly (all P 0.0001). Mean CT increased significantly in the AC group (5.6 lm, P ¼ 0.04, n ¼ 40) and among 80 subjects whose IOP rose > 2 mm Hg (responders; 3.2 lm, P ¼ 0.048), but not in the OA group or among all subjects (2.5 lm increase overall, <1% of baseline CT, P ¼ 0.10). ACD decreased in AC (À18 lm, P ¼ 0.07), but not in OA eyes (þ3 lm, P ¼ 0.74). AC eyes had a significantly greater IOP increase after WDT than OA eyes (P ¼ 0.002, multivariate regression). Among responders, CT increased more in those with larger diastolic perfusion pressure increase and in AC compared to OA eyes (P ¼ 0.04 and P ¼ 0.053, respectively, multivariate regression).CONCLUSIONS. A significant increase in CT and a decrease in ACD after WDT were observed in AC but not in OA eyes, and IOP increased significantly more in AC than in OA eyes, suggesting that the dynamic behavior of the choroid may play a role in the AC process. IOP increase after the WDT was not fully explained by CT increase. (Invest Ophthalmol Vis Sci. 2012; 53:6393-6402)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Choroidal Thickness Change after Water Drinking Is Greater in Angle Closure than in Open Angle Eyes

Arora

Jefferys

Maul

et al. 2012

Invest. Ophthalmol. Vis. Sci.

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Angle Closure and Glaucoma

Faschinger

Hommer²

2012

Gonioscopy

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Myopia and diabetes mellitus as modificatory factors of glaucomatous optic neuropathy

Chihara¹

2013

Jpn J Ophthalmol

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Myopic deformation of the eye and metabolic alterations of the nerve tissue of patients with diabetes may modify glaucomatous optic neuropathy (GON). Blockage of axonal transport of neurotrophic factors (NTFs) is the event crucial to understanding the factors that affect GON. The primary, but not sole, blockage site is at the lamina cribrosa (LC). Other than this primary site of damage at the LC, 7 other factors may explain atypical nerve fiber layer (NFL) defects and the vulnerability of the nerve fibers in eyes with high myopia and glaucoma: a second point of blockage at the edge of the posterior scleral foramen; ectatic strain on the NFL; ectasia and distortion of the LC; association of a hypoplastic optic disc; thin and weak collagen fibers; peripapillary chorioretinal atrophy; and myopic neuropathy. Among diabetic patients, diabetic neuropathy in the retinal NFL is present initially, and increased resistance to aqueous outflow leads to ocular hypertension. Superimposition of GON on diabetic neuropathy and ocular hypertension in patients with diabetes may enhance their susceptibility to nerve damage. Results of a meta-analysis study suggested a positive association between diabetes mellitus and glaucoma whereas other reports suggested that leakage of vascular endothelial growth factor, a survival mechanism of ischemic neural tissue, and enhanced stiffness of the LC as a result of diabetic glycation may protect neurons from apoptosis. Thus, modification of GON as a result of diabetes remains controversial.

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What's the Choroid Got to Do With Angle Closure?

Cited by 54 publications

References 14 publications

Choroidal Thickness Change after Water Drinking Is Greater in Angle Closure than in Open Angle Eyes

Choroidal Thickness Change after Water Drinking Is Greater in Angle Closure than in Open Angle Eyes

Angle Closure and Glaucoma

Myopia and diabetes mellitus as modificatory factors of glaucomatous optic neuropathy

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