Etiologies and clinical characteristics of young patients with angle-closure glaucoma: a 15-year single-center retrospective study

Abstract

Purpose To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese. Methods Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts. Results A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan’s syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat’s disease, and neurofibromatosis. Conclusions We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.

Racial and Sociodemographic Disparities in Blindness Associated with Primary Angle Closure Glaucoma in the United States: An IRIS® Registry Analysis

“…While age is a well-established risk factor for PACG, PACG tends to be rare in younger populations. 12,13,30,31 We speculate that the anatomical mechanisms underlying PACG differ between younger and older patients affected by blindness. [31][32][33] In older patients, cataract formation contributes to increased lens thickness and likely worsening of pupillary block and other lens-related mechanisms.…”

“…12,13,30,31 We speculate that the anatomical mechanisms underlying PACG differ between younger and older patients affected by blindness. [31][32][33] In older patients, cataract formation contributes to increased lens thickness and likely worsening of pupillary block and other lens-related mechanisms. 34 In younger patients, PACG may be attributed to other mechanisms of angle closure, such as severe forms of plateau iris syndrome, nanopthalmos, or other developmental or congenital anomalies, that contribute to more advanced disease and profound vision loss at first diagnosis.…”

“…34 In younger patients, PACG may be attributed to other mechanisms of angle closure, such as severe forms of plateau iris syndrome, nanopthalmos, or other developmental or congenital anomalies, that contribute to more advanced disease and profound vision loss at first diagnosis. 31,33 Although PACG is rare in younger patients, more effective detection and treatment of PACG in this subpopulation would have a longer-lasting benefit for patients and healthcare systems.…”

Combination of Trabeculectomy and Primary Pars Plana Vitrectomy in the Successful Treatment of Angle-Closure Glaucoma with BEST1 Mutations: Self-Controlled Case Series

“…Young patients with angle closure are very rare [ 14 ]. Recently, Gao et al [ 15 ] reviewed a large number of Chinese patients with ACG from 15-year records in a single center. The etiologies other than primary ACG could be identified in a large number of cases (67.4%).…”

Progressive myopia due to forward displacement of the spherophakic lens

“…Moreover, the highly convex lens allows a greater range of anterior movement of the iris-lens diaphragm. Consequently, lens subluxation or dislocation can occur, leading to pupillary-block glaucoma [1][2][3], which is rare in children [4].…”