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Is combined mechanism glaucoma a distinct entity?

Ramanjit Sihota1, Sailesh Kumar2, Talvir Sidhu2

  • 1Glaucoma Services, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute Of Medical Sciences, Room no 494, 4th floor, New Delhi, 110029, India. rjsihota@gmail.com.

Graefe'S Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie
|June 21, 2018
PubMed
Summary

Combined mechanism glaucoma (CMG) presents distinct anatomical features compared to primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). These differences in ocular structures confirm CMG as a unique glaucoma entity.

Keywords:
Anterior segment OCT in glaucomaCombined mechanism glaucomaMixed mechanism glaucomaOpen-angle glaucoma with narrow recess

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Ocular Anatomy

Background:

  • Primary adult glaucomas with occludable angles and insufficient peripheral anterior synechiae to explain elevated intraocular pressure (IOP) are classified as combined mechanism glaucoma (CMG).
  • Distinguishing CMG from primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) is crucial for accurate diagnosis and management.

Purpose of the Study:

  • To compare the clinical and anatomical characteristics of combined mechanism glaucoma (CMG) with age, sex, and refraction-matched POAG and chronic PACG eyes.
  • To elucidate the unique features of CMG in relation to other primary adult glaucomas.

Main Methods:

  • Consecutive adult glaucoma patients with moderate visual field loss and IOP > 22 mmHg were categorized into POAG, PACG, and CMG groups.
  • CMG was defined by occludable angles with < 90° of goniosynechiae.
  • Detailed clinical examination, ocular biometry, and anterior segment optical coherence tomography (ASOCT) were performed.

Main Results:

  • Combined mechanism glaucoma (CMG) eyes exhibited distinct anterior chamber depth, lens thickness, and iridotrabecular contact compared to POAG and PACG.
  • ASOCT revealed intermediate anatomical parameters for CMG eyes between POAG and PACG.
  • Significant differences (p < 0.0001) were observed across all measured parameters between the three glaucoma types.

Conclusions:

  • Combined mechanism glaucoma (CMG) possesses significantly different anatomical parameters compared to POAG and PACG.
  • Gonioscopy and iridotrabecular contact findings further support CMG as a distinct clinical entity.
  • These findings highlight the unique nature of CMG, necessitating specific diagnostic and therapeutic considerations.