residual stage angle-closure glaucoma

Residual stage angle-closure glaucoma refers to a condition where there is persistent damage to the optic nerve and visual field loss, despite previous treatment or interventions for angle-closure glaucoma.

Characteristics:

• Persistent increased intraocular pressure (IOP) [14]
• Optic neuropathy and vision loss [14]
• Glaucomatous optic nerve damage or visual field loss [5]

Staging codes: Residual stage of open-angle glaucoma is classified using staging codes, such as H40.151 for the right eye, H40.152 for the left eye, and H40.153 for bilateral cases [11].

Associated genes and mutations: Research has identified associated genes and mutations related to residual stage angle-closure glaucoma, which can be found in integrated disease information resources [9].

It's essential to note that residual stage angle-closure glaucoma is a complex condition, and its management involves controlling IOP to prevent further damage to the optic nerve.

Residual stage angle-closure glaucoma can manifest in various ways, and it's essential to be aware of the signs and symptoms to ensure timely medical attention.

Common Signs and Symptoms:

• Blurred vision: Patients may experience blurred or hazy vision, which can be persistent or intermittent [1].
• Red eye: The affected eye may appear red, swollen, or inflamed due to increased intraocular pressure (IOP) [5].
• Painful eye: Severe eye pain is a common symptom, often accompanied by headaches and nausea [9].
• Halos around lights: Patients may notice halos or rings around lights, which can be a sign of corneal edema [8].
• Nausea and vomiting: Some individuals may experience nausea and vomiting due to the increased IOP [2].

Other Possible Symptoms:

• Headaches: Frequent or severe headaches can occur due to the increased pressure within the eye [9].
• Vision loss: Gradual vision loss or blind spots in the affected eye are possible symptoms of residual angle-closure glaucoma [6].
• Systemic symptoms: In some cases, patients may experience systemic symptoms like fever, fatigue, or weight loss [4].

Important Note:

It's crucial to seek immediate medical attention if you or someone you know is experiencing any of these symptoms. Residual stage angle-closure glaucoma can lead to permanent vision damage and even blindness if left untreated.

References:

[1] Hsieh JW, Chen YF, Wei T. Efficacy of latanoprost as an adjunct to medical therapy for residual angle-closure glaucoma after iridectomy. J Ocul... (Context 1) [2] Dec 18, 2013 — Acute angle closure is an urgent but uncommon dramatic symptomatic event with blurring of vision, painful red eye, headache, nausea, and vomiting. (Context 2 & 3) [4] Other forms of ocular pathology, such as lens opacities or retinal vascular disease, may be present. c. Acute angle closure (AAC) crisis – The physical signs... (Context 4) [5] Acute angle-closure glaucoma is an urgent but uncommon, dramatic symptomatic event with blurring of vision, painful red eye, headache, nausea, and vomiting. (Context 5) [6] Nov 19, 2021 — Primary angle-closure glaucoma (PACG) is used to denote PAC eyes with glaucomatous optic nerve damage or visual field loss. (Context 6) [8] Jun 15, 2016 — Patients with an acute angle closure attack will experience blurry vision with halos around lights, nausea, vomiting, headaches and severe eye... (Context 8) [9] by X Sun · 2017 · Cited by 416 — The patient complains of sharp vision loss and intense eye pain, sometimes accompanied with systemic symptoms like severe forehead ache above the affected eye... (Context 9)

Residual stage angle-closure glaucoma can be challenging to diagnose, but various diagnostic tests and imaging modalities can help confirm the condition.

• Ultrasound biomicroscopy (UBM): This test uses high-frequency sound waves to produce detailed images of the anterior segment of the eye, including the angle between the iris and cornea. UBM is particularly useful in diagnosing residual stage angle-closure glaucoma, as it can help identify anatomical narrow angles or plateau iris syndrome ([1], [3]).
• Anterior segment optical coherence tomography (AS-OCT): AS-OCT is a non-invasive imaging modality that uses low-coherence interferometry to produce high-resolution images of the anterior segment. It can be used as a triage test to exclude the need for gonioscopy in referral refinement ([3], [7]).
• Gonioscopy: This is the definitive examination for diagnosing and monitoring angle-closure disease. Gonioscopy involves using a specialized lens to visualize the angle between the iris and cornea, allowing for the assessment of intraocular pressure, corneal edema, shallow anterior chamber, and closed angles ([2], [4], [14]).
• Slit-lamp biomicroscopy: This examination uses non-contact lenses or contact lenses to visualize the anterior segment of the eye. It can help identify peripheral anterior synechiae, which are a hallmark of chronic angle-closure glaucoma ([8], [14]).

These diagnostic tests and imaging modalities can help confirm the diagnosis of residual stage angle-closure glaucoma and guide treatment decisions.

Treatment Options for Residual Stage Angle-Closure Glaucoma

Residual stage angle-closure glaucoma refers to a condition where the drainage system in the eye is partially closed, leading to increased intraocular pressure (IOP). In this stage, treatment focuses on reducing IOP and preventing further damage.

Medical Treatment

According to search results [2], medical treatment for residual stage angle-closure glaucoma may include:

• Topical medications: Topical steroids can help reduce inflammation, while analgesics and anti-emetics can make the patient more comfortable. These medications are often used in conjunction with other treatments.
• Cholinergic agents: Cholinergic agents, such as pilocarpine, can cause pupil constriction, which may help alleviate angle closure. However, their use is typically reserved for cases where there is residual angle closure after laser treatment [5].
• Aqueous suppressants: Aqueous suppressants, like atropine and cycloplegics, can reduce the production of aqueous humor, thereby lowering IOP.

Laser Treatment

In some cases, laser treatment may be necessary to address residual angle closure. However, this is typically considered after medical treatment has been tried [3].

Surgical Options

Surgical options, such as trabeculectomy or glaucoma drainage devices, may also be considered in severe cases of residual stage angle-closure glaucoma [6]. These procedures aim to improve the outflow of aqueous humor and reduce IOP.

It is essential to note that treatment should be tailored to individual patient needs and may involve a combination of medical, laser, and surgical interventions. Consultation with an eye care professional is crucial for determining the best course of action.

References:

[2] H40.23 Intermittent angle-closure glaucoma [5] Dec 18, 2013 — Cholinergic agents may be used in cases where there is residual angle closure after laser treatment. [6] Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract.

The differential diagnosis for residual stage angle-closure glaucoma involves considering various conditions that may present with similar symptoms and signs. Based on the search results, here are some possible differentials:

• Residual stages of open-angle glaucoma: This condition can be a consideration if the patient has a history of open-angle glaucoma and is experiencing residual symptoms.
  • Cited from [14] (H40.24)
• Aqueous misdirection/malignant glaucoma: This condition involves the misdirection of aqueous humor, leading to increased intraocular pressure. It can be a consideration if the patient has a shallow anterior chamber and increased IOP.
  • Cited from [13] (H40.83) and [14] (4.11)
• Intermittent angle-closure glaucoma: This condition involves periodic closure of the angle, leading to increased IOP. It can be a consideration if the patient has a history of intermittent symptoms.
  • Cited from [14] (H40.23)
• Residual stages of angle-closure glaucoma: This condition involves residual symptoms and signs of angle-closure glaucoma, such as increased IOP and shallow anterior chamber.
  • Cited from [14] (H40.24)

It's essential to note that the differential diagnosis for residual stage angle-closure glaucoma can be complex and requires a thorough evaluation of the patient's symptoms, signs, and medical history.

In addition to these differentials, it's also important to consider other conditions such as:

• Open-angle glaucoma with unusually high IOP: This condition involves increased IOP in patients with open-angle glaucoma.
  • Cited from [9] (Conditions to be considered)
• Glaucomatocyclitic crisis: This condition involves a sudden increase in IOP, often associated with inflammation and pain.
  • Cited from [9] (Conditions to be considered)

A thorough evaluation of the patient's symptoms, signs, and medical history is essential to determine the correct differential diagnosis.