Residual Stage Angle-closure Glaucoma
Disease Details
Family Health Simplified
- Description
- Residual stage angle-closure glaucoma is a condition where there is sustained increased intraocular pressure and optic nerve damage following an initial episode of angle closure that may have been partially treated.
- Type
- Residual stage angle-closure glaucoma is typically classified as a type of angle-closure glaucoma, which can be primary or secondary. It generally does not follow a clear pattern of genetic transmission. While there may be some familial predisposition, it is not inherited in a well-defined Mendelian manner. The condition is primarily influenced by anatomical factors such as the shape and size of the eye's anterior segment.
- Signs And Symptoms
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Residual stage angle-closure glaucoma is a condition where the angle between the iris and cornea remains partially or completely blocked, even after initial treatment for acute angle-closure glaucoma.
**Signs and Symptoms:**
1. **Intermittent Blurred Vision:** Episodes where vision becomes temporarily blurred.
2. **Halos Around Lights:** Experiencing halos or colored rings around light sources.
3. **Eye Pain or Discomfort:** Persistent mild to moderate eye pain.
4. **Headaches:** Recurrent headaches, often around the eye region.
5. **Nausea and Vomiting:** Typically seen if intraocular pressure is significantly elevated.
6. **Redness of the Eye:** Chronic or intermittent redness.
7. **Elevated Intraocular Pressure (IOP):** Measurable increase in eye pressure during eye exams.
8. **Gradual Vision Loss:** Progressive loss of peripheral (side) vision, which may be insidious.
It's important to monitor these symptoms and consult an eye care professional for accurate diagnosis and management. - Prognosis
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Residual stage angle-closure glaucoma is a phase where some degree of optic nerve damage and vision loss has already occurred due to previous episodes of angle-closure attacks.
Prognosis:
- Vision loss that has already occurred is generally irreversible.
- The focus in management is on preventing further damage and preserving the remaining vision.
- With appropriate treatment, such as medications to lower intraocular pressure, laser therapy (e.g., laser peripheral iridotomy), or surgical procedures, the progression of the disease can often be slowed or halted.
- Regular monitoring by an eye care professional is crucial to adjust treatment as needed and to manage any complications.
Prognosis can vary based on the extent of damage and the effectiveness of ongoing treatment. - Onset
- The onset of residual stage angle-closure glaucoma can vary. It often occurs after an acute episode of angle-closure glaucoma has been resolved, either spontaneously or through medical or surgical intervention. Patients may experience symptoms such as blurry vision, eye pain, and halos around lights, but in the residual stage, they may be asymptomatic and diagnosed during routine eye exams. It is crucial to monitor these patients to prevent further progression and optic nerve damage.
- Prevalence
- The prevalence of residual stage angle-closure glaucoma varies globally and is influenced by factors such as age, ethnicity, and geographic location. Generally, angle-closure glaucoma is more common in East Asian populations and less common in European and African populations. Precise statistics for the residual stage specifically are limited in the current literature, but angle-closure glaucoma, as a whole, affects around 0.5% to 1% of people over the age of 40 worldwide.
- Epidemiology
- Residual stage angle-closure glaucoma typically refers to the remaining glaucomatous condition after initial treatment to relieve angle closure. Epidemiological data specific to this residual stage is not well-documented; however, angle-closure glaucoma in general accounts for approximately 10-15% of all glaucoma cases worldwide. It is more prevalent in older adults, women, and individuals of Asian and Inuit descent. Factors such as hyperopia (farsightedness) and a shallow anterior chamber also increase the risk. The incidence tends to increase with age, and early intervention is critical to prevent progression to residual or chronic stages.
- Intractability
- Residual stage angle-closure glaucoma can often be intractable, meaning it can be difficult to manage or cure completely. This form of glaucoma involves progressive optic nerve damage due to elevated intraocular pressure resulting from previously untreated or inadequately treated angle-closure glaucoma. Management typically includes controlling intraocular pressure through medications, laser treatments, or surgical interventions, but the damage to the optic nerve can be irreversible, making the condition challenging to treat fully. Regular monitoring and ongoing treatment are crucial to manage the disease and preserve as much vision as possible.
- Disease Severity
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Residual stage angle-closure glaucoma often indicates that some angle closure remains even after initial treatment like laser peripheral iridotomy or other surgical interventions. The severity can vary:
1. **Mild**: Minor residual angle closure with minimal impact on intraocular pressure (IOP) and minimal optic nerve damage.
2. **Moderate**: More significant residual angle closure, moderate increase in IOP, mild to moderate optic nerve damage, and possibly some visual field loss.
3. **Severe**: Extensive residual angle closure, high IOP levels, significant optic nerve damage, and notable visual field loss.
Close monitoring and management by an ophthalmologist are crucial to prevent further progression and to maintain vision. - Healthcare Professionals
- Disease Ontology ID - DOID:1404
- Pathophysiology
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Residual stage angle-closure glaucoma is the phase after initial treatment when some anatomical predispositions or intraocular pressure (IOP) elevations remain. The pathophysiology primarily involves:
1. **Anatomical Compromise**: Even after interventions like laser peripheral iridotomy, the anterior chamber angle might remain partially closed or narrowed due to residual synechiae (adhesions) between the iris and trabecular meshwork.
2. **Intraocular Pressure**: Residual angle closure can lead to elevated IOP due to impaired aqueous humor outflow through the trabecular meshwork.
3. **Chronic Damage**: Continuing high IOP or previous damage may result in further optic nerve damage, leading to loss of visual fields over time.
Understanding and monitoring these underlying mechanisms are essential for managing and preventing further progression of glaucoma in such patients. Regular follow-ups with detailed gonioscopy and IOP measurements are critical for effective management. - Carrier Status
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Residual stage angle-closure glaucoma is a condition affecting the angle of the eye, where the iris meets the cornea, leading to impaired drainage of aqueous humor and increased intraocular pressure. This condition typically occurs after an initial acute or subacute attack of angle-closure glaucoma has been managed. The "residual stage" indicates that despite initial treatment, some degree of angle closure or damage persists.
In terms of carrier status, it is important to note that glaucoma, including angle-closure glaucoma, is generally not a simple genetic condition with a carrier state as seen in some other hereditary diseases. Instead, it often involves multiple genetic and environmental factors. There is no specific "carrier status" for angle-closure glaucoma because it is not inherited in a straightforward manner like autosomal recessive or autosomal dominant conditions. However, having a family history of angle-closure glaucoma may increase one's risk of developing the disease. Consult an eye care specialist for personalized risk assessment and management. - Mechanism
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Residual-stage angle-closure glaucoma refers to a condition where there remains some degree of angle-closure in the eye despite previous treatments to open the angle.
**Mechanism:**
Angle-closure glaucoma occurs when the iris is pushed or pulled forward, blocking the trabecular meshwork drainage pathway, leading to increased intraocular pressure (IOP). Over time, this elevated pressure can cause optic nerve damage and vision loss.
**Molecular Mechanisms:**
1. **TGF-β Pathway**: Transforming growth factor-beta (TGF-β) has been implicated in the fibrotic processes that contribute to structural changes in the trabecular meshwork, leading to impaired aqueous humor outflow and increased IOP.
2. **MMP Dysfunction**: Matrix metalloproteinases (MMPs) are involved in the remodeling of the extracellular matrix in the trabecular meshwork. Dysregulation of MMP activity can contribute to extracellular matrix accumulation, further obstructing aqueous humor outflow.
3. **Genetic Factors**: Mutations in genes such as MYOC (myocilin) and CYP1B1 have been associated with increased risk of developing glaucoma, impacting both aqueous outflow pathways and optic nerve health.
4. **Inflammatory Mediators**: Cytokines and other inflammatory mediators can alter the function and structure of the trabecular meshwork, leading to decreased outflow and increased IOP.
5. **Oxidative Stress**: Oxidative damage to trabecular meshwork cells and optic nerve tissues can impair their function, promoting IOP elevation and neurodegeneration.
Understanding these mechanisms aids in developing targeted therapies to manage residual-stage angle-closure glaucoma and prevent further vision loss. - Treatment
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Treatment for residual stage angle-closure glaucoma typically includes:
1. **Medications:**
- **Topical eye drops:** These may include beta-blockers, prostaglandin analogs, alpha agonists, or carbonic anhydrase inhibitors to lower eye pressure.
- **Oral medications:** Acetazolamide may be used to reduce intraocular pressure.
2. **Laser Therapy:**
- **Laser peripheral iridotomy:** Creates a small hole in the iris to improve fluid drainage within the eye.
- **Laser peripheral iridoplasty:** Aims to open the angle by shrinking part of the peripheral iris.
3. **Surgical Procedures:**
- **Trabeculectomy:** Creates a new drainage path for the aqueous humor.
- **Drainage implants:** Devices implanted to facilitate fluid drainage.
4. **Regular Monitoring:**
- Ophthalmic exams to monitor eye pressure and optic nerve health.
Treatment plans should be individualized based on the severity and specific characteristics of the disease in each patient. Prompt and effective management is crucial to preserving vision. - Compassionate Use Treatment
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For residual stage angle-closure glaucoma, compassionate use treatments, and off-label or experimental treatments may include:
1. **Compassionate Use Treatments**:
- **Medications**: Certain medications that are not yet approved but are in the trial phase may be available under compassionate use. This typically requires special approval from regulatory bodies.
2. **Off-label Treatments**:
- **Systemic Carbonic Anhydrase Inhibitors**: These are sometimes used off-label to reduce intraocular pressure.
- **Prostaglandin Analogues**: Although primarily used for open-angle glaucoma, they may be used off-label for angle-closure glaucoma.
3. **Experimental Treatments**:
- **New Laser Procedures**: Experimental laser procedures like newer types of laser peripheral iridotomy or laser iridoplasty may be investigated.
- **Minimally Invasive Glaucoma Surgery (MIGS)**: Emerging MIGS devices are being studied for their potential benefits in angle-closure glaucoma.
Consultation with a specialist and approval from regulatory authorities are required for accessing these treatments. - Lifestyle Recommendations
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For residual-stage angle-closure glaucoma, lifestyle recommendations include:
1. **Regular Eye Check-ups:** Ensure consistent monitoring by an ophthalmologist to manage intraocular pressure and other symptoms effectively.
2. **Medication Adherence:** Follow prescribed medication regimes strictly to control eye pressure.
3. **Healthy Diet:** Consume a balanced diet rich in green leafy vegetables, fruits, and omega-3 fatty acids that support overall eye health.
4. **Hydration:** Drink water consistently throughout the day but avoid consuming large amounts at once, as it can temporarily increase eye pressure.
5. **Exercise:** Engage in moderate physical activities like walking or swimming, which can help lower intraocular pressure. Avoid exercises that involve heavy lifting or inverted positions.
6. **Stress Management:** Practice stress-reducing techniques such as meditation or yoga, as stress can affect eye health.
7. **Avoid Smoking and Limit Alcohol:** Smoking can exacerbate eye conditions, and excessive alcohol consumption can affect overall health.
8. **Protect Eyes:** Wear sunglasses to protect eyes from UV rays and avoid environments with severe glare.
9. **Avoid Caffeine:** Limit caffeine intake as it can temporarily raise intraocular pressure.
10. **Mind Positioning:** Be cautious with head-down positions which can increase eye pressure.
Adhering to these recommendations can help manage residual-stage angle-closure glaucoma more effectively. - Medication
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For residual stage angle-closure glaucoma, medications commonly used include:
1. **Topical Beta-blockers:** e.g., Timolol, to reduce aqueous humor production.
2. **Prostaglandin analogs:** e.g., Latanoprost, to increase outflow of aqueous humor.
3. **Alpha agonists:** e.g., Brimonidine, to reduce aqueous humor production and increase outflow.
4. **Carbonic anhydrase inhibitors:** e.g., Dorzolamide, to decrease aqueous humor production.
5. **Miotic agents:** e.g., Pilocarpine, to constrict pupils and open the angle.
6. **Hyperosmotic agents:** e.g., Mannitol, used in acute situations to reduce intraocular pressure rapidly.
Regular follow-ups with an ophthalmologist are necessary to manage and adjust treatment effectively. - Repurposable Drugs
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Residual stage angle-closure glaucoma (ACG) is a condition where the intraocular pressure (IOP) remains elevated despite initial treatment for angle-closure. Repurposable drugs that are sometimes considered to manage IOP in these cases include:
1. **Acetazolamide** - A carbonic anhydrase inhibitor that decreases aqueous humor production.
2. **Pilocarpine** - A cholinergic agent that can help in opening the angle by causing miosis.
3. **Timolol** - A beta-blocker that reduces aqueous humor production.
4. **Latanoprost** - A prostaglandin analog that increases the outflow of aqueous humor.
These drugs are typically used in combination with other therapies to manage IOP and prevent further optic nerve damage. However, the selection of medication should be individualized based on the patient's overall health, tolerance, and response to treatment. - Metabolites
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For residual stage angle-closure glaucoma, metabolites specific to this condition are not well-documented. However, common metabolites involved in glaucoma pathology in general include:
1. **Amino Acids:** Such as glutamate, which has been implicated in neurotoxicity.
2. **Reactive Oxygen Species (ROS) and Antioxidants:** Imbalances can contribute to cellular damage in the trabecular meshwork and optic nerve.
3. **Lipid Metabolites:** Altered lipid metabolism has been noted in glaucoma patients.
4. **Neurotrophic Factors:** Including brain-derived neurotrophic factor (BDNF), which may be reduced in glaucoma.
More specific details may require targeted metabolic profiling and research. - Nutraceuticals
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Nutraceuticals for residual-stage angle-closure glaucoma are not well-defined or universally endorsed within clinical practice. However, some studies suggest that antioxidants, omega-3 fatty acids, and certain vitamins and minerals may support overall eye health. Common nutrients considered include:
1. **Antioxidants:** Vitamins C and E, and beta-carotene may help reduce oxidative stress in ocular tissues.
2. **Omega-3 Fatty Acids:** Found in fish oil, these may support ocular health by reducing intraocular pressure and improving blood flow to the eye.
3. **Lutein and Zeaxanthin:** These carotenoids are thought to support retinal health and protect against light-induced damage.
4. **Zinc and Selenium:** Important for maintaining the metabolic functions of the eye.
Consult with a healthcare provider before introducing any nutraceuticals, as they should complement, not replace, conventional treatments or medical advice specifically tailored for glaucoma management. - Peptides
- Residual-stage angle-closure glaucoma refers to a condition where there is persistent or recurrent closure of the angle between the iris and the cornea, which can impede the outflow of aqueous humor and lead to increased intraocular pressure. Peptides and nanoparticles (nan) are being researched for their potential therapeutic benefits in managing glaucoma. Specifically, peptides can be designed to target specific pathways involved in intraocular pressure regulation, while nanoparticles can serve as delivery systems for drugs, enhancing their stability, efficacy, and targeted release. These innovative approaches aim to improve treatment outcomes for patients with angle-closure glaucoma.