The eye is generally considered to be the most important sensory organ of humans. Diseases and other degenerative conditions of the eye are therefore of great concern as they affect the function of this vital organ. With proper early diagnosis by experts and with optimal use of medicines and surgical techniques, these diseases or conditions can in many cases be either cured or greatly mitigated. Experts that perform the diagnosis are in high demand and their services are expensive, hence the appropriate identification of the cause of vision problems is either postponed or not done at all such that corrective measures are either not done or done too late. An efficient model to predict eye diseases using machine learning (ML) and ranker-based feature selection (r-FS) methods is therefore proposed which will aid in obtaining a correct diagnosis. The aim of this model is to automatically predict one or more of five common eye diseases namely, Cataracts (CT), Acute Angle-Closure Glaucoma (AACG), Primary Congenital Glaucoma (PCG), Exophthalmos or Bulging Eyes (BE) and Ocular Hypertension (OH). We have used efficient data collection methods, data annotations by professional ophthalmologists, applied five different feature selection methods, two types of data splitting techniques (train-test and stratified k-fold cross validation), and applied nine ML methods for the overall prediction approach. While applying ML methods, we have chosen suitable classic ML methods, such as Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), AdaBoost (AB), Logistic Regression (LR), k-Nearest Neighbour (k-NN), Bagging (Bg), Boosting (BS) and Support Vector Machine (SVM). We have performed a symptomatic analysis of the prominent symptoms of each of the five eye diseases. The results of the analysis and comparison between methods are shown separately. While comparing the methods, we have adopted traditional performance indices, such as accuracy, precision, sensitivity, F1-Score, etc. Finally, SVM outperformed other models obtaining the highest accuracy of 99.11% for 10-fold cross-validation and LR obtained 98.58% for the split ratio of 80:20.

Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. For example, contact between the iris and lens at the pupillary margin creates a pupillary block that increases resistance to aqueous outflow. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral iridotomy ('iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber, which is achieved by creating a hole in the iris using laser. Iridotomy is used to treat patients with primary angle-closure glaucoma, patients with primary angle-closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). However, the effectiveness of iridotomy on slowing progression of visual field loss is uncertain.

Superior vena cava syndrome is a set of symptoms resulting from partial or complete blockage of the superior vena cava. In the majority of cases, it develops secondary to lung tumors and lymphoma. It is characterized by edema of the head, neck, and upper limbs, large veins, and dyspnoea. Ophthalmological changes related to the syndrome rarely occur: eyelid swelling, conjunctival chemosis and suffusion have been described previously, and in one case, elevated episcleral pressure was also reported. Our 57-year-old female patient's superior vena cava syndrome was resolved with stent placement, and her small cell lung tumor was treated with chemotherapy. As part of the syndrome, he complained of bilateral blurred vision with a history of 4 months. During his examination, we found a bilateral closed angle, an intraocular pressure of 60 mmHg on both sides, and severe visual impairment. We performed a lens exchange combined with better semolysis, which achieved a significant reduction in intraocular pressure and managed to preserve the remaining visual acuity. After Nd:YAG laser iridotomy on the left eye, we started antiglaucoma drop treatment to reduce pain. After phacoemulsification, the morphology of the anterior chamber in the right eye improved significantly, which could be quantified by anterior segment optical coherence tomography. The ophthalmic parameters remained stable during the treatment of the underlying disease. The purpose of this publication is to draw attention to the ophthalmic symptoms of vena cava syndrome as well as to present the ophthalmic condition that sometimes accompanies the syndrome causing rapid, severe visual impairment, which, to our knowledge, has not been described before. Orv Hetil. 2022; 163(49): 1967-1971.

Glaucoma is a complex disease which when encountered in pregnancy poses a challenge to the woman's obstetrician and her ophthalmologist. The dilemma arises while opting the line of management, either medical or surgical which requires balancing the clinical disease of the mother with the potential threat of therapy to the growing child. Such was our case an elderly primigravida 10 weeks of gestation who had an acute episode of angle closure glaucoma with diminishing vision, who was managed both medically (anti-glaucoma drugs) and surgically (trabeculectomy). She recovered with a normal IOP, improved vision and anomaly scan of the fetus showing a structurally normal fetus. Thus, the fear of uncertain drug teratogenicity should not discourage doctors from prescribing treatments when their expected benefits to the mother are thought to outweigh the risk to the fetus.

A woman aged mid 70s with mild learning difficulty presented with eye symptoms, headache and shoulder pains. She was found to have bilateral posterior scleritis secondary to giant cell arteritis. Posterior scleritis is a potentially blinding condition, with ambiguous symptoms and signs, therefore diagnosis is commonly delayed. This patient was seen in General Practice as well as in Accident and Emergency, where diagnoses of acute angle closure glaucoma as well as iritis were rightfully considered. Her symptoms persisted for 11 days before ophthalmic opinion was sought. Thorough assessment of a painful red eye as well as knowledge of these red-flag signs may allow early treatment and a better outcome for patients. The Royal College of Ophthalmologists has published guidance on how to assess and manage visual loss in people with learning difficulties, including recognising 'symptoms' such as hesitancy on steps, eye rubbing and loss of interest in activities.

Glaucoma is the leading cause of blindness throughout the world (after cataracts); therefore, general physicians should be familiar with the diagnosis and management of affected patients. Glaucomas are usually categorized by the anatomy of the anterior chamber angle (open vs narrow/closed), rapidity of onset (acute vs chronic), and major etiology (primary vs secondary). Most glaucomas are primary (ie, without a contributing comorbidity); however, several coexisting ophthalmic conditions may serve as the underlying etiologies of secondary glaucomas. Chronic glaucoma occurs most commonly; thus, regular eye examinations should be performed in at-risk patients to prevent the insidious loss of vision that can develop before diagnosis. Glaucoma damages the optic nerve and retinal nerve fiber layer, leading to peripheral and central visual field defects. Elevated intraocular pressure (IOP), a crucial determinant of disease progression, remains the only modifiable risk factor; thus, all current treatments (medications, lasers, and operations) aim to reduce the IOP. Pharmacotherapy is the usual first-line therapy, but noncompliance, undesirable adverse effects, and cost limit effectiveness. Laser and surgical treatments may lower IOP significantly over long periods and may be more cost effective than pharmacotherapy, but they are plagued by greater procedural risks and frequent treatment failures. Traditional incisional procedures have recently been replaced by several novel, minimally invasive glaucoma surgeries with improved safety profiles and only minimal decreases in efficacy. Minimally invasive glaucoma surgeries have dramatically transformed the surgical management of glaucoma; nevertheless, large, randomized trials are required to assess their long-term efficacy.

Acute primary angle closure glaucoma is a potentially blinding ophthalmic emergency requiring prompt treatment to lower the elevated intraocular pressure in humans and dogs. The PACG in most of canine breeds is epidemiologically similar to humans with older and female patients overrepresented with the condition. The American Cocker Spaniel (ACS) is among the most common breeds observed with PACG development in dogs. This study initially sought to identify genetic risk factors to explain the high prevalence of PACG in ACSs by using a case-control breed-matched genome-wide association study. However, the GWAS failed to identify candidate loci associated with PACG in this breed. This study then assessed intrinsic ocular morphologic traits that may relate to PACG susceptibility in this breed. Normal ACSs without glaucoma have a crowded anterior ocular segment and narrow iridocorneal angle and ciliary cleft, which is consistent with anatomical risk factors identified in humans. The ACSs showed unique features consisting of posterior bowing of iris and longer iridolenticular contact, which mirrors reverse pupillary block and pigment dispersion syndrome in humans. The ACS could hold potential to serve as an animal model of naturally occurring PACG in humans.

Posner and Schlossman first published a series of nine patients with the characteristic presentation of unique glaucoma, with open anterior angles of the anterior chamber, associated with unilateral acute elevations in intraocular pressure (IOP) in 1948.[1][2] This disease later became known as the Posner Schlossman syndrome (PSS). PSS is also called the glaucomatocyclitic crisis.[3] It is a unilateral ocular disease characterized by recurrent episodes of acute non-granulomatous anterior uveitis and increased intraocular pressure (IOP).[3][4]  PSS is therefore classified as inflammatory glaucoma. These episodes or attacks could eventually result in secondary chronic glaucoma.[5] It is a rare disease, and initial attacks may go undetected because of the mild nature of the uveitis. PSS could be misdiagnosed as an acute angle-closure glaucoma episode early in the disease because of the acute marked elevation in intraocular pressure and unnoticed inflammatory reaction in the anterior chamber.[6]  The clinical course of the disease tends to exhibit a variable pattern, and a patient could have frequent attacks with shorter symptom-free intervals or less frequent attacks with more prolonged symptom-free intervals. In-between episodes, the patient has a normal IOP. Whatever the case, the symptoms are self-limiting, with spontaneous resolution within days or weeks, even without treatment.[3][7] Management during an episode is aimed at controlling the IOP and minimizing intraocular inflammation.[3] The purpose of this review is to summarize information on the diagnosis and treatment of PSS.

The purpose of this study is to report a case of cyclodialysis clefts associated with microinvasive glaucoma surgery (MIGS) having two distinct consecutive IOP spikes during cleft closure. A 65-year-old female with a history of primary open angle glaucoma was evaluated for right eye blurry vision since cataract surgery 11 months prior. She reported a MIGS procedure that resulted in a cyclodialysis cleft, with resultant hypotony without resolution. On gonioscopy, two clock hours of widened angle were noted nasally, with small clefts (0.5 clock hour) inferonasally and superonasally. Conservative therapy with cycloplegia was unsuccessful. Argon laser photocoagulation was performed for cleft closure. Initially, while there was visible improvement in the cleft size, it did not close completely, and IOP remained low. Additional laser was performed, one week following, she presented with an acute IOP increase to 55 mmHg. On gonioscopy, it was noted that despite the IOP spike indicating inferonasal closure, the superonasal cleft remained small but open. She was started on IOP-lowering therapy. Her IOP normalized shortly thereafter. Two weeks later, she experienced another acute IOP spike to 54 mmHg. On gonioscopy, the residual cleft had closed. Again, her IOP normalized shortly after and has remained normal since. While IOP spikes after cyclodialysis cleft closure have been reported many times, two consecutive IOP spikes of similar magnitude during sequential closure of two concurrent cyclodialysis clefts have not been reported in the literature. This case raises interesting questions about the physiology underlying an acute increase in IOP following cleft closure.

To compare the concentrations of protein markers in aqueous humor (AH) of patients with primary open-angle glaucoma (POAG), chronic angle-closure glaucoma (CACG), acute primary angle closure (APAC), and cataract without glaucoma as the control group. AH samples were collected at the beginning of surgery from 82 eyes of 82 patients who were divided into POAG (n = 23), CACG (n = 21), APAC (n = 19), and cataract groups (n = 19). The expression levels of interferon-gamma (IFN-γ), interleukin-2 (IL-2), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-17A (IL-17A), lymphotoxin-alpha (LT-α), monocyte chemotactic protein-1 (MCP-1), matrix metalloproteinase-2 (MMP-2), brain derived neurotrophic factor (BDNF), basic fibroblast growth factor (bFGF), platelet-derived growth factor-AA (PDGF-AA), vascular endothelial growth factor (VEGF), tissue inhibitor of metalloproteinases-1 (TIMP-1), and tumor necrosis factor-alpha (TNF-α) in AH were detected using a microsphere-based immunoassay. The AH levels of TNF-α, MMP-2, MCP-1, IFN-γ, and TIMP-1 in the APAC and CACG groups were significantly higher than those in control eyes. Additionally, the AH levels of interleukin-6 (IL-6) and VEGF in the APAC group were significantly higher than those in the control group (CG). The interleukin-8 (IL-8) levels in patients with POAG were significantly higher than those in control eyes, whereas the LT-α levels were significantly lower than those in control eyes. IL-6 levels were significantly correlated with the coefficient of variation (CV), whereas IL-6 levels were significantly negatively correlated with the frequency of hexagonal cells (HEX) and corneal endothelial cell density (CD). The levels of TNF-α, MMP-2, MCP-1, IFN-γ, TIMP-1, IL-6, IL-8, VEGF, and LT-α were different among the three types of glaucoma. These different types of glaucoma may be caused by various pathogeneses, which opens avenues for further investigation into the pathogenesis of glaucoma and discoveries new targets and pathways for the treatment of glaucoma.

To explore the clinical efficacy of quadruple surgery (anterior segment pars plana vitrectomy + phacoemulsification + posterior capsulorhexis + intraocular lens (IOL) implantation + trabeculectomy) and dual surgery (phacoemulsification + IOL implantation + trabeculectomy) to treat medically uncontrolled acute primary angle-closure glaucoma (APACG). The clinical data of 44 patients (45 eyes) with APACG treated in the Department of Ophthalmology of Taihe Hospital were retrospectively analyzed. They were divided into 2 groups based on quadruple surgery and dual surgery. There were 20 patients (20 eyes) underwent quadruple surgery in group A. And there were 24 patients (25 eyes) dual surgery in group B. The changes in intraocular pressure (IOP), visual improvement, and complications were observed between the 2 groups preoperatively and 1 month, 3 months, and 6 months postoperatively. Preoperative best corrected visual acuity (BCVA) was the influencing factor of postoperative BCVA at 1 month, 3 months and 6 months. Before surgery, the mean IOP of group A was significantly higher than that of group B (P < .001), and no significant difference was found in the BCVA, age, gender, eyes, axial length (AL), anterior chamber depth (ACD) (PBCVA = 0.12, Page = 0.76, Peyes = 0.20, Pgender = 0.37, PAL = 0.94, PACD = 0.08). On comparison at postoperative 1week, there was no significant difference in the IOP and BCVA between the 2 groups (PIOP = 0.64, PBCVA = 0.66). The mean IOP of group A was significantly lower than that of group B 1 month, 3 months, and 6 months postoperatively (P1month = 0.002, P3months < 0.001, P6months < 0.001). The degree of visual acuity recovery was significantly higher in group A at 1 month, 3 months, and 6 months postoperatively (P1month = 0.03, P3months = 0.02, P6months = 0.02). During treatment, the incidence of complications in group B was significantly higher than that in group A (P < .01). The clinical efficacy of anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification, and trabeculectomy elicits clinical safety in treating medically uncontrolled APACG. It has remarkable effects and leads to a significant decrease in the occurrence of complications.

The authors reviewed perioperative ocular complications and implications of ocular diseases during nonocular surgeries. Exposure keratopathy, the most common perioperative eye injury, is preventable. Ischemic optic neuropathy, the leading cause of perioperative blindness, has well-defined risk factors. The incidence of ischemic optic neuropathy after spine fusion, but not cardiac surgery, has been decreasing. Central retinal artery occlusion during spine fusion surgery can be prevented by protecting eyes from compression. Perioperative acute angle closure glaucoma is a vision-threatening emergency that can be successfully treated by rapid reduction of elevated intraocular pressure. Differential diagnoses of visual dysfunction in the perioperative period and treatments are detailed. Although glaucoma is increasingly prevalent and often questions arise concerning perioperative anesthetic management, evidence-based recommendations to guide safe anesthesia care in patients with glaucoma are currently lacking. Patients with low vision present challenges to the anesthesia provider that are becoming more common as the population ages.

Lens-induced glaucoma (LIG) was originally described by Gifford in 1900 as glaucoma associated with hyper-mature senile cataracts (HMSC). Von Ruess independently described LIG as glaucoma with spontaneous absorption of lens matter through an intact capsule.[1] The literature has a multitude of similar entities described over the decades. LIG is secondary glaucoma mimicking acute angle-closure glaucoma (ACG), with normal intraocular pressure (IOP) and open-angles in the contralateral eye, and prompt relief of symptoms following cataract extraction.  Based on the pathogenesis, LIG is further classified as: 1. Lens protein-related: Leakage of lens protein across an intact or a breached lens capsule. This form includes: Phacolytic glaucoma (PLG). Lens-particle induced glaucoma (LPIG). Phacoanaphylactic glaucoma (PAG). 2. Aqueous flow obstruction: Anatomical obstruction of aqueous flow from the posterior to the anterior chamber. This type includes: Phacomorphic glaucoma (PMG). Pupillary block glaucoma (PBG). Some causes like pseudo-exfoliation glaucoma and ciliary block glaucoma are debatable entities under LIG.

Acute angle closure glaucoma is an ophthalmic emergency that can lead to blindness in some cases. The presenting signs are often suggestive, like ocular pain and blurred vision accompanied by headache, nausea and vomiting. These symptoms must be recognized as soon as possible, and the patient must be addressed, urgently, to an ophthalmologist for treatment. Many drugs may lead to an acute angle closure glaucoma in patients with risk factors. This article aims to remind the anatomical risk factors as well as the drugs that may induce an acute angle closure glaucoma. For a better understanding, this article will provide a brief reminder of the pathophysiological mechanism of acute angle closure glaucoma.

A total of 170 consecutive patients (181 eyes) who were diagnosed with primary angle-closure glaucoma (PACG) and underwent phacoemulsification and intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) with an instrument under a gonioscope in the Eye Hospital, Wenzhou Medical University from January 1, 2017 to December 31, 2019 were observed. Anterior chamber angle synechiae of 0 (0, 2) clock hour were released after PEI, while after combined goniosynechialysis, synechiae of 6 (3, 8) clock hours were further released. No matter in chronic PACG and acute PACG with cornea edema, the extent of anterior chamber angle synechiae was different before surgery and after PEI, and so was it in post-PEI and PEI-GSL prospectively (all P<0.01). Phacoemulsification alone can reopen the synechial anterior chamber angle in both chronic PACG and acute PACG in part, but not sufficiently. Combined goniosynechialysis under a gonioscope with an instrument is essential and effective.