June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Clinical characteristics of autosomal recessive bestrophinopathy (ARB) with angle-closure glaucoma (ACG) and surgical outcomes of trabeculectomy and iriotomy
Author Affiliations & Notes
  • Xing Liu
    Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  • Jingyi Luo
    Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  • Yimin Zhong
    Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  • Hui Xiao
    Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
  • Footnotes
    Commercial Relationships   Xing Liu, None; Jingyi Luo, None; Yimin Zhong, None; Hui Xiao, None
  • Footnotes
    Support  Fundamental Research Funds of the State Key Laboratory of Ophthalmology, China, 2015KF03; and Natural Science Foundation of Guangdong Province, China, S2012010008387
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4946. doi:
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      Xing Liu, Jingyi Luo, Yimin Zhong, Hui Xiao; Clinical characteristics of autosomal recessive bestrophinopathy (ARB) with angle-closure glaucoma (ACG) and surgical outcomes of trabeculectomy and iriotomy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4946.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : About 42.8~50% patients with ARB have ACG. Few studies analyze the clinical characteristics of ACG and glaucoma treatment in ARB patients. The purpose of this study is to analyze the clinical characteristics of 15 patients of ARB with ACG and to compare the surgical outcomes of trabeculectomy and iriotomy.

Methods : Thirty eyes of 15 unrelated ARB patients with ACG (angle closure > 180°, evaluated by gonioscope) were recruited. Biallelic mutations in BEST1 gene were confirmed in all patients. Intraocular pressure (IOP), central anterior chamber depth (ACD), axial length (AL), fundus photography were performed. Subfoveal choroidal thickness was measured using enhanced depth imaging (EDI) of spectral domain optical coherence tomography (SD-OCT). Fourteen eyes underwent trabeculectomy (Group A) and 16 eyes underwent iriotomy (Group B). All patients were followed up for at an average of 18 months.

Results : All patients had macular cystoid edema, RPE irregularity, extensive serous retinal detachment with multifocal subretinal vitelliform deposits at the posterior poles. All preoperative parameters, including baseline IOP, ACD, AL, C/D ratio and choroidal thickness, were not significantly different between the two groups (all P > 0.05, Figure 1). At 1-year postoperative follow-up, IOP was 10.67 ± 0.81 mmHg in Group A, compared to 15.25 ± 1.10 mmHg in Group B (P = 0.008). All eyes in Group A had persistent flatten anterior chamber for at least 2 months, and none of the eyes in Group B had any surgical complications (P < 0.001, Figure 2).

Conclusions : ARB patients often have characteristics of shallow anterior chamber angles and short axial lengths, causing high risk of developing secondary angle-closure glaucoma. Trabeculectomy is more likely to result in persistent flatten anterior chamber postoperatively. Iriotomy may be a safer option for these patients.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

 

Fig. 1 Preoperative data in Group A and Group B

Fig. 1 Preoperative data in Group A and Group B

 

Fig. 2 (A) A 29-year-old male (BCVA 20/50, IOP 36 mmHg, angle closure 300°) underwent trabeculectomy. A1–A3, preoperative imaging; A4, flatten anterior chamber postoperatively. (B) 22-year-old female (BCVA 20/40, IOP 34 mmHg, angle closed = 240°) underwent iriotomy. B1–B3, preoperative imaging; B4, deep anterior chamber postoperatively. A1 & B1, color fundus photographs; A2 & B2, autofluorescence images; A3 & B3, OCT images.

Fig. 2 (A) A 29-year-old male (BCVA 20/50, IOP 36 mmHg, angle closure 300°) underwent trabeculectomy. A1–A3, preoperative imaging; A4, flatten anterior chamber postoperatively. (B) 22-year-old female (BCVA 20/40, IOP 34 mmHg, angle closed = 240°) underwent iriotomy. B1–B3, preoperative imaging; B4, deep anterior chamber postoperatively. A1 & B1, color fundus photographs; A2 & B2, autofluorescence images; A3 & B3, OCT images.

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