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Hidden mechanisms beyond the pupillary block in acute angle closure: ultrasound biomicroscopic study. 2017

Yanin Suwan, and Sunpong Jiamsawad, and Wasu Supakontanasan, and Chaiwat Teekhasaenee
Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

BACKGROUND To evaluate the mechanisms of acute angle closure (AAC) other than the pupillary block using ultrasound biomicroscopy. METHODS Retrospective chart review. METHODS All patients who were diagnosed with AAC in Ramathibodi Hospital, Bangkok, Thailand, between June 2011 and February 2015 were enrolled. METHODS Seventy-two patients who were diagnosed with AAC underwent a detailed ocular examination. The diagnosed mechanism of AAC was confirmed by UBM and ocular biometry. METHODS Primary mechanism responsible for acute angle closure. RESULTS In 72 patients, the mean age was 62.33 ± 10.4 years, 18 (25%) patients were male and 54 (75%) patients were female. The primary mechanism of AAC was iridolenticular wrapping (crowded-angle (CR) plus anterior lens subluxation (LS)) in 49 eyes (68.1%), pupillary block (PB) in 17 (23.6%) eyes, and plateau iris (PL) in 6 (8.3%) eyes. Thirty (41.7%) out of 72 eyes without previous iridotomy before UBM examination were analyzed. The most common primary mechanism in this group was iridolenticular wrapping (20 eyes, 66.7%). There were seven (23.3%) eyes that had a pupillary block, and only three (10.0%) eyes had plateau iris syndrome as the primary mechanism of AAC. There was a single mechanism in 14 (46.7%) eyes, and there were combined mechanisms in 16 (53.3%) eyes. CONCLUSIONS The most common mechanism contributing to AAC development in this Thai population was iridolenticular wrapping. From this study, we suggest that iridolenticular wrapping was the most common hidden mechanism beyond pupillary block among Thai patients.

UI MeSH Term Description Entries
D007429 Intraocular Pressure The pressure of the fluids in the eye. Ocular Tension,Intraocular Pressures,Ocular Tensions,Pressure, Intraocular,Pressures, Intraocular,Tension, Ocular,Tensions, Ocular
D007499 Iris Diseases Diseases, dysfunctions, or disorders of or located in the iris. Disease, Iris,Diseases, Iris,Iris Disease
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011681 Pupil Disorders Conditions which affect the structure or function of the pupil of the eye, including disorders of innervation to the pupillary constrictor or dilator muscles, and disorders of pupillary reflexes. Afferent Pupillary Defect,Efferent Pupillary Defect,Marcus-Gunn Pupil,Pupil Reaction Absent,Pupillary Functions, Abnormal,Deformed Pupil,Ectopic Pupil,Fixed Pupils,Keyhole Pupil,Non-Syphilitic Argyll-Robertson Pupil,Occluded Pupils,Pupil Malformations,Pupillary Anomaly,Pupillary Disorders,Pupillary Occlusion,Pupillary Paralysis,Pupillary Sector Paralysis,Pupillary Sphincter Rupture,Sector Pupil Palsy,Wernicke Hemianopic Pupil,Wernicke's Hemianopic Pupil,Abnormal Pupillary Function,Abnormal Pupillary Functions,Afferent Pupillary Defects,Anomalies, Pupillary,Anomaly, Pupillary,Argyll-Robertson Pupil, Non-Syphilitic,Deformed Pupils,Ectopic Pupils,Efferent Pupillary Defects,Fixed Pupil,Hemianopic Pupil, Wernicke,Hemianopic Pupil, Wernicke's,Keyhole Pupils,Malformation, Pupil,Malformations, Pupil,Marcus Gunn Pupil,Non Syphilitic Argyll Robertson Pupil,Occluded Pupil,Occlusion, Pupillary,Occlusions, Pupillary,Paralyses, Pupillary,Paralyses, Pupillary Sector,Paralysis, Pupillary,Paralysis, Pupillary Sector,Pupil Disorder,Pupil Malformation,Pupil, Deformed,Pupil, Ectopic,Pupil, Fixed,Pupil, Keyhole,Pupil, Marcus-Gunn,Pupil, Non-Syphilitic Argyll-Robertson,Pupil, Occluded,Pupil, Wernicke Hemianopic,Pupil, Wernicke's Hemianopic,Pupillary Anomalies,Pupillary Defect, Afferent,Pupillary Defect, Efferent,Pupillary Defects, Afferent,Pupillary Defects, Efferent,Pupillary Disorder,Pupillary Function, Abnormal,Pupillary Occlusions,Pupillary Paralyses,Pupillary Sector Paralyses,Pupillary Sphincter Ruptures,Pupils, Deformed,Pupils, Ectopic,Pupils, Fixed,Pupils, Keyhole,Pupils, Occluded,Reaction Absent, Pupil,Reaction Absents, Pupil,Rupture, Pupillary Sphincter,Ruptures, Pupillary Sphincter,Sector Paralyses, Pupillary,Sector Paralysis, Pupillary,Sphincter Rupture, Pupillary,Sphincter Ruptures, Pupillary,Wernickes Hemianopic Pupil
D003937 Diagnosis, Differential Determination of which one of two or more diseases or conditions a patient is suffering from by systematically comparing and contrasting results of diagnostic measures. Diagnoses, Differential,Differential Diagnoses,Differential Diagnosis
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000208 Acute Disease Disease having a short and relatively severe course. Acute Diseases,Disease, Acute,Diseases, Acute
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective

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