OBJECTIVE:To investigate the correlative anterior segment parameters of positive darkroom provocative test in patients with narrow anterior chamber angles.METHODS:It was a retrospective case series study. Two hundred and sixty patients [36 males and 224 females, mean age (59.6 ± 9.3) years] with narrow anterior chamber angles underwent darkroom provocative test and UBM scan were analyzed retrospectively. Anterior segment parameters including anterior chamber depth (ACD), pupil diameter (PD), lens vault (LV), peripheral iris thickness (IT), iris convex (IC), anterior chamber angle open distance (AOD), trabecular-meshwork ciliary process angle (TCPA) and the number of appositional angle closure (NPAC) were quantitatively analyzed. Correlative factors of positive results were analysis by both single factor and multiple-factor analysis.RESULTS:Seventy-one (27.3%) of the 260 patients had positive results in the darkroom provocative test. Males (15 out of 36) had statistically higher positive result rate than females (56 out of 224) (M: 41.7% vs. F:25.0%, χ(2) = 4.340, P = 0.037). In single factor analysis, male (OR = 2.14), AOD (OR = 0.98), IT (OR = 1.68) and NPAC (OR = 2.24) were correlative factors for positive results. In multiple-factor analysis, only IT (OR = 1.47) and NPAC (OR = 1.70) were independent risk factors of positive results.CONCLUSIONS:Positive darkroom provocative test is correlated to parameters of anterior chamber angle and iris, while IT and NPAC are independent correlative factors in patients with narrow anterior chamber angle.

【Objective】 To investigate the relationship of positive dark-room provocative test and anterior segment parameters measured by ultrasound biomicroscopy(UBM) in the patients with narrow anterior chamber angle. 【Methods】 Dark-room provocative test and anterior segment parameters measured by UBM were analyzed retrospectively in two hundred and sixty cases with narrow anterior chamber angle. Anterior chamber depth(ACD), pupil diameter(PD), lens vault(LV), peripheral iris thickness(IT), iris convex(IC), anterior chamber angle open distance(AOD), trabecular-meshwork ciliary process angle(TCPA), number of positional angle closure(NPAC) were quantitatively analyzed. All cases underwent provocative test. Difference of anterior parametres between eyes with positive and negative provocative test and parametres correlated with IOP elevation were analyzed. 【Results】 Seventy-one out of 260 patients had IOP elevation more than 8 mmHg at least in one eye. The total positive rate were 27.3%. IOP elevation in dark room provocative test was negatively correlated with AOD(r =-0.249, P 0.001) and IC(r =-0.125, P = 0.043), and positively correlated with IT(r = 0.188, P = 0.002) and NPAC(r = 0.305, P 0.001). IT(449.91 vs 422.36 μm; P 0.001) and NPAC(1.59 vs 0.62; P 0.001) were greater and AOD(60.24° vs 98.7°; P 0.001) was smaller in patients with positive results than those with negative results. 【Conclusions】 Parameters of anterior chamber angle and iris were related with positive dark room test. Narrower chamber angle, appositional angle closure and thicker iris were risk factors for positive results in dark room provocative test.

OBJECTIVE:To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation in the early stage of glaucoma secondary to contusion injuries.METHODS:A retrospective case series study. The study was made in 29 consecutive patients with glaucoma secondary to blunt trauma who were uncontrolled by multiple medications and then performed AGV implantations in less than 2 months after the trauma. The duration from injury to IOP elevation was 1 to 30 (6.10 ± 1.13) days. The time from injury to AGV implantation was 16 to 60 (40.03 ± 2.97) days. The patients were followed-up for a period of 6 to 42 (20.75 ± 1.66) months. The main outcome measures included intraocular pressure (IOP), visual acuity (VA), number of glaucomatous medications, intra- and postoperative complications. IOPs were analyzed by repeated measures analysis of variance, numbers of medication assessed by Kruskal-Wallis rank sum test followed by Bonferroni test, and VA comparison was performed using paired Student t-test.RESULTS:The absolute success rate was 86.21% and the conditional success rate was 13.79% after AGV implantation. Compared with pre-operation, the IOP was significantly(F = 124.09, P < 0.05) lowered at the last following-up of post-operation(42.59 ± 1.82)vs (15.12 ± 0.56) mm Hg(1 mm Hg = 0.133 kPa), the numbers of glaucomatous medications were significantly (H = 131.73, P < 0.05) reduced post-operatively (3.93 ± 0.15) vs (0.21 ± 0.12) species, and the VA was significantly (t = -3.466, P < 0.05) improved post-operatively (logMAR 0.40 vs logMAR 0.70). Two cases with shallow anterior chamber and three cases with hyphema were observed in the early stage after the surgery. No persistent hypotony, tube exposure or other serious complications were noted.CONCLUSION:AGV implantation is safe and effective in the management of intractable secondary glaucoma at early stage of contusion injuries.

PURPOSE:To investigate the efficacy and safety of slit-lamp needle revision with subconjunctival interferon injection in eyes with encapsulated blebs.PATIENTS AND METHODS:We reviewed a series of 25 cases (27 eyes) in which primary needling with 5×105 IFN α-2b injection was performed for bleb encapsulation and analysed the results over a follow-up period of at least 12 months.RESULTS:The mean time to development of encapsulated blebs after the surgery was 23.85 ± 10.66 days (9 to 60 days). The mean IOP decreased significantly from 22.51 ± 5.30 mm Hg at diagnosis of encapsulated blebs to 17.26±7.72 mmHg at the last visit (P = 0.009). Of the 27 eyes, 15 (55.56%) achieved a successful result, 10 (37.04%) were qualified for success and the remaining 2 (7.4%) were considered as failure. The qualified success group took 1.70 ± 0.67 antiglaucoma medications. No serious complications were detected.CONCLUSION:The needling procedure associated with subconjuctival injection of IFN α-2b is a safe and effective method in treating encapsulated blebs.

Purpose:To report the clinical manifestations and treatment of a case of secondary glaucoma evolving from bilateral anterior chamber flattening caused by Marfan′s syndrome. Methods:The ophthalmic and systemic features,B-scan and UBM characteristics were recorded.Therapy and efficacy were analyzed. Results:Marfans syndrome,in this case,caused bilateral iris-lens diaphragm anterior dislocation,anterior chamber flattening, pupillary block, angle closure,and finally resulted in persistent increased intraocular pressure （IOP）. After undergoing pars plana vitrectomy and lensectomy combined with anterior chamber reformation, the visual acuity of the patient’s right eye increased from 6/150 to 6/7.5.（best-corrected） and that of the left eye was improved from 6/100 to 6/10 （best-corrected）. The IOP of the right eye fell to 18 mm Hg, and the left eye to 12 mm Hg. Conclusion:Marfan′s syndrome can cause bilateral anterior chambers flattening,and induce secondary angle closure glaucoma.Combined pars plana vitrectomy, lensectomy and anterior chamberplasty can re-form the anterior chamber, control IOP and maintain visual function.