An Ultrasound Biomicroscopic Analysis of Angle-closure Glaucoma Secondary to Ciliochoroidal Effusion in IgA Nephropathy

doi:10.1016/S0002-9394(14)71351-0

American Journal of Ophthalmology

Volume 116, Issue 3, September 1993, Pages 341-345

https://doi.org/10.1016/S0002-9394(14)71351-0 Get rights and content

Immunoglobulin A nephropathy is a common glomerulonephritis of unknown cause. Episcleritis, scleritis, anterior uveitis, and keratoconjunctivitis sicca have been associated with this disease. We diagnosed angle-closure glaucoma secondary to ciliochoroidal effusion in a patient with IgA nephropathy confirmed by biopsy. High-frequency ultrasound biomicroscopy was used to determine internal relationships of angle structures and to follow changes with treatment. Supraciliary effusion undetected by B-scan ultrasound and retinal examination was easily imaged by ultrasound biomicroscopy. Glaucoma mechanisms included forward rotation of the ciliary processes, which caused direct angle closure in a manner similar to plateau iris. Ultrasound biomicroscopy showed that cycloplegia improved this mechanism by retracting the ciliary processes, but angle closure secondary to forward iris bowing from pupil block remained. Iridectomy was performed and immediately opened the angle. Ultrasound biomicroscopy proved a useful method of defining mechanisms and a helpful guide to treatment in this type of glaucoma.

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Cited by (62)

Drusen and Other Retinal Findings in People With IgA Glomerulonephritis
2024, American Journal of Ophthalmology
Purpose: Retinal drusen have been described in people with IgA nephropathy. We examined the frequency of drusen in IgA nephropathy and compared their location and composition with those for drusen in age-related macular degeneration.
Design: Immunohistological case series of eyes of patients with IgA nephropathy, and a comparison eye with age-related macular degeneration.
Methods: Donor eyes from 4 individuals (3 male, 1 female, aged 40-80 years) with biopsy-proven IgA nephropathy and kidney failure were examined for the presence of drusen, and location and composition using antibodies for vitronectin, IgA, IgM, IgG, C3, and C1q. Results were compared with those for drusen in macular degeneration without IgA nephropathy.
Results: All 4 donors had sparse, subretinal pigment epithelium drusen of 55-65 mm diameter that stained for vitronectin but not for IgA or complement. All donors had retinal capillaries and choriocapillaris staining for IgA. The youngest donor (female, 40) had rare deposits in the outer nuclear layer that stained for IgA, but not for vitronectin. The oldest donor (male, 82) had large cystlike spaces in the inner nuclear and plexiform layers, and smaller cysts in the outer nuclear layer, with no staining for IgA or complement.
Conclusions: Retinal drusen are uncommon in IgA nephropathy, even with kidney failure. Drusen in IgA nephropathy resemble drusen found in age-related macular degeneration. IgA-staining deposits in the outer nuclear layer were likely due to systemic deposition of IgA and complement activation. The nature of cystic spaces is unknown. Further analysis of the retinas of people with glomerulonephritis is recommended.
Ocular manifestations in IgA nephropathy
2023, Survey of Ophthalmology
Citation Excerpt :
Ultrasound biomicroscopy diagnosed a clinically undetectable anterior ciliochoroidal effusion that was most significant at the posterior margin of the ciliary body. The patient was treated with non-steroid anti-inflammatory drugs, beta-blockers, and cycloplegics and underwent 2 peripheral YAG laser iridotomies44; however, it is unclear whether IgAN is associated with angle closure, as the attack was triggered by an upper respiratory tract infection (URTI). URTI and antitussive agents may cause an acute primary angle-closure attack.29
Immunoglobulin A nephropathy (IgAN) is a rare but important systemic disease with or without ocular manifestations. We describe 4 cases of IgAN presenting with scleritis and review the various ocular manifestations in patients with IgAN.
We found 55 cases with ocular manifestations in patients with prior or newly-diagnosed IgAN described in 38 publications. The most common ocular manifestations of IgAN were episcleritis (23.6%), scleritis (16.4%), hypertensive retinopathy or retinal vasculopathy (20.0%), and uveitis (14.5%). The median age at presentation was 36.5 years, with 54.5% female patients. 61.8% had history of IgAN prior to ocular involvement, while 29.1% had ocular presentations as the first manifestation of IgAN. The majority received systemic corticosteroids and/or immunosuppressants. Additionally, we report 4 women with anterior scleritis and previous diagnosis of IgAN. All 4 were treated with topical and systemic corticosteroids. Three out of 4 patients had no recurrence for at least 1 year since the first presentation.
IgAN is a rare but important systemic association to be considered in ocular inflammatory conditions. Timely recognition and comanagement of the disease with nephrologist could reduce disease morbidity.
Secondary Angle Closure: Imaging, Diagnosis, Etiology, and Treatment
2017, Advances in Ophthalmology and Optometry
Citation Excerpt :
Sulfa-based compounds, such as hydrochlorothiazide, carbonic anhydrase inhibitors, and topiramate, can induce transient ciliary body edema, anterior rotation of the ciliary processes, and myopic shift, leading to bilateral, secondary angle closure [1,12] Other medications implicated in inducing a shallow anterior chamber include venlafaxine, fluvoxamine, and bupropion. Immunoglobulin A nephropathy [13], systemic lupus erythematosus [14], and Korean hemorrhagic fever [15] are examples of inflammatory conditions that have been reported to present with acute angle closure secondary to choroidal effusion, as initial manifestations of the disease. Retinal pathologies and surgeries that may induce this condition include retinal vein occlusions, panretinal photocoagulation, and scleral buckling procedures.
Drainage and analysis of suprachoroidal fluid in a patient with acute systemic lupus erythematous
2017, American Journal of Ophthalmology Case Reports
Citation Excerpt :
Choroidal effusions are associated with several systemic conditions including systemic lupus erythematous (SLE),1–3 leukemia,4 lymphoma,5 IgA nephropathy,6 HIV,7 and idiopathic pulmonary arterial hypertension.8
To describe a case of a patient with acute systemic lupus erythematous (SLE) causing choroidal effusions and to report a novel technique for evaluation of the choroidal fluid which sheds light on effusion pathogenesis.
A 37 year-old woman was referred for decreased vision, eye pain and shortness of breath. The patient had bilateral angle closure glaucoma from choroidal effusions and bilateral pleural effusions. Work-up revealed new onset acute SLE. A technique for obtaining suprachoroidal fluid is described, and the fluid was analyzed using Light's criteria and found to be exudative in nature.
There has been speculation as to pathogenesis of choroidal effusions in a variety of conditions, and many authors believe the most likely process to be transudative. The exudative nature of the fluid in our patient suggests that choroidal effusions in acute SLE are likely caused by inflammation, and not secondary to hypoalbuminemia or another transudative process. Similar analyses of suprachoroidal fluid in other disease processes may help elucidate the underlying pathogenesis and may possibly guide treatment.
Imaging of the iridocorneal angle in glaucoma
2013, Journal Francais d'Ophtalmologie
L’évaluation de l’angle iridocornéen (AIC) est un temps indispensable dans le bilan des glaucomes et la gonioscopie demeure l’examen de référence pour son analyse. Elle reste cependant un examen de réalisation et d’interprétation parfois difficile. L’échographie de très haute fréquence (UBM), puis plus récemment l’OCT de segment antérieur (OCT-SA) ou la caméra Scheimpflug ont contribué à une meilleure connaissance des mécanismes de fermeture de l’AIC et au dépistage des angles à risque mais aussi à la compréhension anatomique de certains glaucomes à angle ouvert. Non contact, l’OCT-SA a rendu cette analyse plus simple et plus facile d’acquisition que l’UBM, mais elle est limitée par sa plus mauvaise pénétration au travers des tissus iriens.
Iridocorneal angle assessment is essential in glaucoma diagnosis and management, and gonioscopy remains the clinical reference standard for its evaluation. However, performance and interpretation of gonioscopy requires experience and has several limitations. Ultrasound biomicroscopy (UBM) and more recently anterior segment OCT (AS-OCT) and Scheimpflug camera have contributed to a better understanding of the mechanisms of angle-closure, screening of patients at risk for angle-closure glaucoma, and understanding of angle structures in secondary open angle glaucomas. Rapid and non-contact, AS-OCT has made this analysis easier than with UBM, but it is limited by its weak penetration through iris and scleral tissues.
The Eye and Orbit
2011, Clinical Ultrasound

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This study was supported in part by the National Cancer Institute of Canada, Toronto, Ontario, Canada (Dr. Foster); the Ontario Cancer Research and Treatment Foundation, Toronto, Ontario, Canada (Dr. Foster); and Zeiss-Humphrey, San Leandro, California (Drs. Foster and Pavlin).

Reprint requests to Charles J. Pavlin, M.D., F.R.C.S.(Can.), Ocular Oncology Clinic, Princess Margaret Hospital, 500 Sherbourne St., Toronto, Ontario, Canada M4X 1K9.

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An Ultrasound Biomicroscopic Analysis of Angle-closure Glaucoma Secondary to Ciliochoroidal Effusion in IgA Nephropathy

Am. J. Ophthalmol.

Ophthalmology

Ophthalmology

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Surv. Ophthalmol.

Ophthalmology