Angle closure in highly myopic eyes.
OBJECTIVE
Patients with angle-closure glaucoma and high myopia are uncommon. We evaluated the clinical characteristics of all patients with angle closure and high myopia in our database and propose possible mechanisms for angle closure in these atypical patients.


METHODS
Retrospective noncomparative case series.


METHODS
Our database of 17938 patients was searched for patients with myopia of spherical equivalent of more than -6.0 diopters and angle closure. Data recorded included age at time of initial consultation, gender, slit-lamp examination results, gonioscopy results, biometric parameters, ultrasound biomicroscopy results (from 1993 onward), clinical diagnosis, and therapy.


RESULTS
Twenty patients (11 females, 9 males) were identified. Mean age at the time of consultation was 52.9+/-19.3 years. Angle-closure diagnoses included primary pupillary block (9 patients), pupillary block in an eye with keratoconus (1 patient), pupillary block secondary to a pupillary membrane associated with retinopathy of prematurity (1 patient), plateau iris configuration and syndrome (3 patients), phacomorphic glaucoma in Weill-Marchesani syndrome (2 patients), malignant glaucoma secondary to a scleral buckle (2 patients), miotic-induced angle closure (1 patient), and Marfan syndrome (1 patient).


CONCLUSIONS
Angle closure can occur in eyes with high myopia. Causes of angle closure other than relative pupillary block are more common than in the general angle-closure glaucoma population. Careful gonioscopy accompanied by biometry and ultrasound biomicroscopy can lead to the correct diagnosis and individualized management in these eyes.
Barkana
Yaniv
Y
Department of Ophthalmology, The New York Eye and Ear Infirmary, New York, New York 10003, USA.
Shihadeh
Wisam
W
Oliveira
Cristiano
C
Tello
Celso
C
Liebmann
Jeffrey M
JM
Ritch
Robert
R
D000328:Adult; D000368:Aged; D000869:Anterior Eye Segment / Q000000981:diagnostic imaging; D002648:Child; D002924:Ciliary Body / Q000000981:diagnostic imaging; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000150:complications* / Q000000981:diagnostic imaging; D006068:Gonioscopy; D006801:Humans; D007498:Iris / Q000000981:diagnostic imaging; D008297:Male; D033401:Microscopy, Acoustic; D008875:Middle Aged; D009216:Myopia / Q000150:complications* / Q000000981:diagnostic imaging; D012189:Retrospective Studies