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Editors Selection IGR 19-4

Types of glaucoma: Angle closure glaucoma

Comment by Tin Aung on:

11959 Uveal effusion in primary angle-closure glaucoma, Sakai H; Morine-Shinjyo S; Shinzato M et al., Ophthalmology, 2005; 112: 413-419

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Primary angle-closure glaucoma (PACG) is a major form of glaucoma worldwide, particularly in Asia. Eyes with PACG often have anatomical risk factors such as shallow anterior chamber depth and short axial length. Uveal effusion has been described in eyes with nanophthalmos, after glaucoma surgery and in eyes with acute PACG. Recently, Quigley and colleagues have proposed that choroidal expansion with uveal effusion may be a mechanism for acute angle closure in anatomically predisposed eyes.¹ In this paper, Sakai et al. (225) aimed to determine the prevalence of uveal effusion in eyes with acute and chronic PACG and to compare this prevalence with open angle eyes. Using ultrasound biomicroscopy (UX02, Rion, Tokyo, Japan), subclinical uveal effusion was demonstrated in 58% of acute and 20% of chronic PACG eyes, compared to 1.3% of open angle controls. These findings are noteworthy as they raise the possibility that uveal effusions may contribute to PACG.

Subclinical uveal effusion was demonstrated in 58% of acute and 20% of chronic PACG eyes, compared to 1.3% of open angle controls

Of interest is that the uveal effusions were graded as grade 1 (slit like) in the majority of cases in this study, indicating the difficulty and variability of detecting such effusions. In order to image the effusions, the scans have to be done quite posteriorly, since the effusions can be missed if scans are cut off near the ciliary body. The cause of uveal effusion in PACG eyes is unknown, and it would be interesting to know if such effusions are intermittent or permanent, and how their extent or size influences the degree of angle closure. It is likely that the findings described in this paper will lead to further research into the role of uveal effusion in PACG.

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