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Liang ZQ, Yang KY, Lv K, Ma Y, Sun C, Liang G, Yue YK, Qin JY, Zhao Y, Zhang JN, Yi Q, Sun XZ, Wu HJ. The Beijing angle closure progression study: design and methodology. Front Med (Lausanne) 2024; 11:1385060. [PMID: 39086940 PMCID: PMC11288979 DOI: 10.3389/fmed.2024.1385060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/09/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose The purpose of this study is to summarize the design and methodology of a large-scale trial in northern China, the Beijing Angle Closure Progression Study (BAPS). This trial is designed to explore the 5-year incidence of primary angle-closure suspect (PACS) progressing to primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) and to determine the possible risk factors of disease progression. Methods/design The BAPS is a clinic-based, multicenter, noninterventional trial conducted on a sample of urban Chinese adults. Consecutive eligible patients who meet PACS diagnostic criteria will be recruited from eight participating centers, with the trial commencing on August 4, 2022. The target sample size is set at 825 subjects, with follow up planned for a minimum period of 5 years. Baseline examination will include presenting visual acuity, best corrected visual acuity, intraocular pressure (IOP), undilated slit-lamp biomicroscopy, stereoscopic evaluation of the optic disc, visual field test, optical coherence tomography evaluation of retinal nerve fiber layer, ultrasound biomicroscopy and IOLMaster. Questionnaires will also be used to collect detailed personal history. Patients are scheduled to visit the glaucoma clinic every 12 months and may visit the emergency room in case of acute attack of angle closure. Study endpoints include acute PAC episodes, elevated IOP, peripheral anterior synechiae, glaucomatous visual field defect, or glaucomatous abnormality of optic nerve. Discussion The BAPS will provide data on the 5-year incidence of PACS progressing to PAC or PACG and determine the risk factors for disease progression. This study will also help redefine high-risk patients with PACS.
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Affiliation(s)
- Zhi-qiao Liang
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Kang-yi Yang
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Kun Lv
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yao Ma
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
| | - Cun Sun
- Department of Ophthalmology, Beijing Hui People's Hospital, Beijing, China
| | - Ge Liang
- Department of Ophthalmology, The PLA Rocket Force Characteristic Medical Center, Beijing, China
| | - Yan-kun Yue
- Department of Ophthalmology, Capital Medical University Fuxing Hospital, Beijing, China
| | - Jia-yin Qin
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
| | - Yao Zhao
- Department of Ophthalmology, Beijing Zhanlanlu Hospital, Beijing, China
| | - Jia-nan Zhang
- Department of Ophthalmology, Beijing Nuclear Industry Hospital, Beijing, China
| | - Qiong Yi
- Department of Ophthalmology, Beijing Hepingli Hospital, Beijing, China
| | | | - Hui-juan Wu
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing, China
- College of Optometry, Peking University Health Science Center, Beijing, China
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Pradhan S, Sah RK, Bhandari G, Bhandari S, Byanju R, Kandel RP, Thompson IJB, Stevens VM, Aromin KM, Oatts JT, Ou Y, Lietman TM, O'Brien KS, Keenan JD. Anterior Segment OCT for Detection of Narrow Angles: A Community-Based Diagnostic Accuracy Study. Ophthalmol Glaucoma 2024; 7:148-156. [PMID: 37611749 DOI: 10.1016/j.ogla.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE To assess the diagnostic accuracy of anterior segment OCT (AS-OCT) screening for detecting gonioscopically narrow angles. DESIGN Population-based cross-sectional study. PARTICIPANTS A stratified random sample of individuals aged ≥ 60 years, selected from a door-to-door census performed in low-lying Nepal. TESTING Participants underwent AS-OCT, posterior segment OCT, and intraocular pressure (IOP) testing in the community. Those meeting referral criteria in either eye were invited to have a comprehensive eye examination including gonioscopy. Referral criteria included (i) the lowest 2.5% of AS-OCT measurements, (ii) retinal OCT results suggestive of glaucomatous optic neuropathy, diabetic retinopathy, or age-related macular degeneration, and (iii) elevated IOP. MAIN OUTCOME MEASURES Sensitivity and specificity of 5 semiautomated AS-OCT parameters relative to gonioscopically narrow angles, defined as the absence of visible trabecular meshwork for ≥ 180° on nonindentation gonioscopy. RESULTS Of 17 656 people aged ≥ 60 years enumerated from 102 communities, 12 633 (71.6%) presented for AS-OCT testing. Referral was recommended for 697 participants based on AS-OCT criteria and 2419 participants based on other criteria, of which 858 had gonioscopy performed by a glaucoma specialist. Each of the 5 AS-OCT parameters offered good diagnostic information for predicting eyes with gonioscopically narrow angles, with areas under the receiver operating characteristic curve ranging from 0.85 to 0.89. The angle opening distance at 750 μm from the scleral spur (AOD750) provided the most diagnostic information, providing an optimal sensitivity of 87% (95% confidence interval [CI], 75%-96%) and specificity of 77% (71%-83%) at a cutpoint of 367 μm, and a sensitivity of 65% (95% CI, 54%-74%) when specificity was constrained to 90% (cutpoint, 283 μm). CONCLUSIONS On AS-OCT, the AOD750 parameter detected approximately two-thirds of cases of gonioscopically narrow angles when test specificity was set to 90%. Although such a sensitivity may not be sufficient when screening solely for narrow angles, AS-OCT requires little additional effort if posterior segment OCT is already being performed and thus could provide incremental benefit when performing OCT-based screening. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
| | | | | | | | | | | | - Isabel J B Thompson
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Valerie M Stevens
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Krisianne M Aromin
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Julius T Oatts
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California; Institute for Global Health Sciences, University of California San Francisco, San Francisco, California
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California San Francisco, San Francisco, California.
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Liao C, Quigley H, Jiang Y, Huang S, Huang W, Friedman D, Foster PJ, He M. Iris volume change with physiologic mydriasis to identify development of angle closure: the Zhongshan Angle Closure Prevention Trial. Br J Ophthalmol 2024; 108:366-371. [PMID: 37236768 DOI: 10.1136/bjo-2022-322981] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/05/2023] [Indexed: 05/28/2023]
Abstract
AIMS To assess dynamic change of iris area (Iarea) and volume (VOL) with physiologic pupil dilation for progression of primary angle closure suspects. METHODS Participants underwent baseline examinations including gonioscopy and anterior segment OCT (AS-OCT) as part of the Zhongshan Angle Closure Prevention Trial. The AS-OCT images were obtained both in the dark and light. Progression was defined as development of primary angle closure or an acute angle closure attack. Static ocular biometrics and dynamic changes were compared between progressors and non-progressors and multivariable logistic regression was developed to assess risk factors for progression. RESULTS A mean 16.8% decrease in Iarea and a mean 6.26% decrease in VOL occurred with pupil dilation, while 22.96% non-progressors and 40% progressors presented VOL increases with pupil dilation. Iarea in light and dark and VOL in light were significantly smaller in progressors. In a multivariable logistic model, older age (p=0.008), narrower horizontal angle opening distance (AOD) 250 µm from the scleral spur (AOD250, p=0.001), flatter iris curvature (IC, p=0.006) and lower loss of iris volume (ΔVOL, p=0.04) were significantly associated with progression. With receiver operating characteristic analysis, the area under the curve for ΔVOL alone was 0.621, while that for the combined index (age, AOD250, IC and ΔVOL) was 0.824. Eyes with elevated intraocular pressure had less VOL loss compared with progressors developing peripheral anterior synechiae alone (p=0.055 for ΔVOL adjusted for pupil enlargement). CONCLUSION A smaller change in ΔVOL is an additive risk factor to identify eyes more likely to develop angle closure disease. TRIAL REGISTRATION NUMBER ISRCTN45213099.
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Affiliation(s)
- Chimei Liao
- Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Guangzhou, China
| | - Harry Quigley
- Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Yuzhen Jiang
- Ophthalmology, National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Shengsong Huang
- Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
| | - Wenyong Huang
- Ophthalmology, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - David Friedman
- Ophthalmology, Harvard University, Boston, Massachusetts, USA
| | - Paul J Foster
- Division of Epidemiology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mingguang He
- Ophthalmology, Sun Yat-Sen University, Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
- Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
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Sener H, Gulmez Sevim D, Evereklioglu C, Uludag MT, Gunay Sener AB, Polat OA, Arda H, Horozoglu F. Efficacy and Safety of Different Types of Intraocular Pressure-Lowering Surgeries in Patients with Primary Angle Closure (PAC) or PAC Glaucoma: Systematic Review and Network Meta-Analysis of Randomized Clinical Trials. Semin Ophthalmol 2024; 39:17-26. [PMID: 37296113 DOI: 10.1080/08820538.2023.2223292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To compare the intraocular pressure (IOP)-lowering effect of different types of surgery available in the literature using a network meta-analysis (NMA) based on a systematic review. METHODS PubMed and the Cochrane database were searched. Randomized clinical trials involving surgical interventions for high IOP for PAC (primary angle closure) or PACG (primary angle closure glaucoma) were included. Descriptive statistics and outcomes were extracted. Bayesian NMA was performed to compare the IOP-lowering effect and the change in the number of antiglaucoma drugs required between baseline and endpoint, as well as success rates. RESULTS This NMA included 21 articles with 1237 eyes with PAC or PACG. Interventions were characterised as phacoemulsification (phaco), trabeculectomy, goniosynechialysis (GSL) with viscoelastic or blunt device, goniosurgery (GS) (trabeculotomy or goniotomy), micro-bypass stent (Istent®), endocyclophotocoagulation (ECPL) or various combinations of these procedures. Phaco+GSL [-1.73 (95%CrI: -3.53 to -0.13)] and phaco+GSL+GS [-3.92 (95%CrI: -6.91 to -1.31)] provided better IOP lowering effects than phaco alone. Phaco+trabeculectomy [-3.11 (95%CrI: -5.82 to -0.44)] was inferior to phaco+GSL+GS. Phaco+trabeculectomy [-0.45 (95%CrI: -0.81 to -0.13)] provided a better outcome in terms of reducing the need for antiglaucoma drug compared to phaco alone. There were no differences between the other surgeries in terms of reduction of antiglaucoma drug number and IOP lowering effect. Success rates were similar for all surgical procedures. CONCLUSIONS Phaco+GSL+GS showed the most promising results for lowering IOP. Phaco+trabeculectomy resulted in a significant reduction in the number of antiglaucoma drugs compared to phaco alone.
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Affiliation(s)
- Hidayet Sener
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Duygu Gulmez Sevim
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Cem Evereklioglu
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Muhammed Taha Uludag
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Ayse Busra Gunay Sener
- Department of Medical Informatics and Biostatistics, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Osman Ahmet Polat
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Hatice Arda
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
| | - Fatih Horozoglu
- Department of Ophthalmology, Division of Surgical and Medical Glaucoma, Erciyes University Medical Faculty, Kayseri, Türkiye
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Cho A, Xu BY, Friedman DS, Foster PJ, Jiang Y, Pardeshi AA, Jiang Y, Aung T, He M. Role of Static and Dynamic Ocular Biometrics Measured in the Dark and Light as Risk Factors for Angle Closure Progression. Am J Ophthalmol 2023; 256:27-34. [PMID: 37549818 PMCID: PMC10840898 DOI: 10.1016/j.ajo.2023.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE To assess the role of static and dynamic ocular biometric parameters measured in the dark and light for predicting progression of primary angle closure suspect (PACS) to primary angle closure (PAC). DESIGN Retrospective cohort study using prospective randomized controlled trial data from untreated, control eyes. METHODS Zhongshan Angle Closure Prevention Trial subjects underwent anterior segment optical coherence tomography (AS-OCT) imaging in the dark and light. Static biometric parameters were measured, consisting of angle, iris, lens, and anterior chamber parameters. Dynamic change parameters were calculated by subtracting light measurements from dark measurements. Cox proportional hazards regression models were developed to assess risk factors for PACD progression. RESULTS A total of 861 eyes of 861 participants were analyzed (36 progressors). On univariable analysis, TISA500 measurements in the light and dark were associated with progression (P < .001), whereas dynamic change parameters were not (P ≥ .08). In the primary multivariable model, older age (hazard ratio [HR] = 1.09 per year), higher intraocular pressure (IOP) (HR = 1.13 per mm Hg), and smaller TISA500 in the light (HR = 1.28 per 0.01 mm2) were significantly associated with greater risk of progression (P ≤ .04). Dark TISA500 had similar significance (HR = 1.28, P = .002) when replacing light TISA500. Risk of progression was more predictive among eyes in the lowest quartile of light TISA500 measurements (HR = 4.56, P < .001) compared to dark measurements (HR = 2.89, P = .003). CONCLUSION Static parameters measured in the light are as predictive, and possibly more so, of angle closure progression as those measured in the dark. Ocular biometrics measured under light and dark conditions may provide additional information for risk-stratifying patients for angle closure progression.
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Affiliation(s)
- Austin Cho
- Roski Eye Institute (A.C., B.Y.X., A.A.P.), Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Benjamin Y Xu
- Roski Eye Institute (A.C., B.Y.X., A.A.P.), Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
| | - David S Friedman
- Glaucoma Center of Excellence (D.S.F.), Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts, USA
| | - Paul J Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology (P.J.F.), London, England
| | - Yu Jiang
- State Key Laboratory of Ophthalmology (Y.J., Y.J., M.H.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Anmol A Pardeshi
- Roski Eye Institute (A.C., B.Y.X., A.A.P.), Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Yuzhen Jiang
- State Key Laboratory of Ophthalmology (Y.J., Y.J., M.H.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre (T.A.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mingguang He
- State Key Laboratory of Ophthalmology (Y.J., Y.J., M.H.), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
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Yu Z, Li N, Wang F, Fu J, Xue S, Wang L. Imaging analysis of the biological parameters of the lens in patients with cortical age-related cataracts using ultrasound biomicroscopy. BMC Ophthalmol 2023; 23:480. [PMID: 37993828 PMCID: PMC10666407 DOI: 10.1186/s12886-023-03227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND The spatial position of the lens in patients with cortical age-related cataract (CARC) is unclear. We investigated a basis for the assessment of visual quality after cataract surgery by analysing the ultrasound biomicroscopic characteristics of the biological parameters of the lens in patients with CARC. METHODS In this retrospective study, 119 patients (50 males and 69 females, totalling 238 eyes) with CARC who underwent simple cataract surgery were selected. The lens thickness (LT), axial length (AL), anterior chamber depth (ACD), lens vault (LV), trabecular-iris angle (TIA), iris-lens angle (ILA), iris-lens contact distance (ILCD) were measured by A-scan ultrasound and ultrasound biomicroscopy. The corresponding lens position (LP) and relative lens position (RLP) were calculated. RESULTS LP was greater in men than in women (P < 0.05), LV was smaller in men than in women (P = 0.002), ILA and ILCD were not statistically significant (P = 0.072 and P = 0.854, respectively). There were significant differences in TIA, ILA, and ILCD in the four quadrants (all P < 0.05), with a trend in the distribution of TIA: superior < inferior < nasal < temporal, ILA: nasal < inferior < temporal < superior, and ILCD: superior < temporal < inferior < nasal. CONCLUSIONS The lens protrudes more obviously in females than in males and the lens tilts to a certain extent with the increase of age and tends to be more upward and temporal in the supine position. Therefore, trends in lens-related parameters in patients with CARC should be taken seriously.
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Affiliation(s)
- Zhiying Yu
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Na Li
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fenglei Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Fu
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shasha Xue
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ling Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Filippopoulos T, Danias J, Karmiris E, Mégevand GS, Rhee DJ, Gazzard G, Topouzis F, Xu B. Rethinking Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects: A Review. Ophthalmol Glaucoma 2023; 6:657-667. [PMID: 37321374 DOI: 10.1016/j.ogla.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of primary angle-closure suspects (PACSs) that emerged as a result of recent randomized clinical trials challenging the widely accepted clinical practice of offering laser peripheral iridotomy (LPI) to PACS patients. To synthetize findings from these and other studies. DESIGN Narrative review. SUBJECTS Patients classified as PACS. METHODS The Zhongshan Angle-Closure Prevention (ZAP)-Trial and the Singapore Asymptomatic Narrow Angle Laser Iridotomy Study (ANA-LIS) along with accompanying publications were reviewed. Epidemiologic studies reporting on the prevalence of primary angle-closure glaucoma and other precursor forms of the disease were also analyzed along with publications reporting on the natural course of the disease or studies reporting on outcomes after prophylactic LPI. MAIN OUTCOME MEASURES Incidence of progression to more severe forms of angle closure. RESULTS Patients recruited in recent randomized clinical trials are asymptomatic, do not have cataracts, may be younger, and have, on average, deeper anterior chambers depth compared with patients treated with LPI in clinics. CONCLUSIONS The ZAP-Trial and ANA-LIS clearly represent the best available data on PACS management, additional parameters however may need to be considered when physicians face patients in clinic. PACS patients encountered at tertiary referral centers may represent more advanced cases with respect to ocular biometric parameters and may be at higher risk for disease progression compared with those recruited through population-based screening. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | - John Danias
- Department of Ophthalmology at SUNY Downstate Health Sciences University, New York, New York
| | | | | | - Douglas J Rhee
- University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom; Institute of Ophthalmology, University College London, United Kingdom
| | - Fotis Topouzis
- First Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Benjamin Xu
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
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Kurysheva NI, Rodionova OY, Pomerantsev AL, Sharova GA, Golubnitschaja O. Machine learning-couched treatment algorithms tailored to individualized profile of patients with primary anterior chamber angle closure predisposed to the glaucomatous optic neuropathy. EPMA J 2023; 14:527-538. [PMID: 37605656 PMCID: PMC10439872 DOI: 10.1007/s13167-023-00337-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023]
Abstract
Background Primary angle closure glaucoma (PACG) is still one of the leading causes of irreversible blindness, with a trend towards an increase in the number of patients to 32.04 million by 2040, an increase of 58.4% compared with 2013. Health risk assessment based on multi-level diagnostics and machine learning-couched treatment algorithms tailored to individualized profile of patients with primary anterior chamber angle closure are considered essential tools to reverse the trend and protect vulnerable subpopulations against health-to-disease progression. Aim To develop a methodology for personalized choice of an effective method of primary angle closure (PAC) treatment based on comparing the prognosis of intraocular pressure (IOP) changes due to laser peripheral iridotomy (LPI) or lens extraction (LE). Methods The multi-parametric data analysis was used to develop models predicting individual outcomes of the primary angle closure (PAC) treatment with LPI and LE. For doing this, we suggested a positive dynamics in the intraocular pressure (IOP) after treatment, as the objective measure of a successful treatment. Thirty-seven anatomical parameters have been considered by applying artificial intelligence to the prospective study on 30 (LE) + 30 (LPI) patients with PAC. Results and data interpretation in the framework of 3P medicine Based on the anatomical and topographic features of the patients with PAC, mathematical models have been developed that provide a personalized choice of LE or LPI in the treatment. Multi-level diagnostics is the key tool in the overall advanced approach. To this end, for the future application of AI in the area, it is strongly recommended to consider the following:Clinically relevant phenotyping applicable to advanced population screeningSystemic effects causing suboptimal health conditions considered in order to cost-effectively protect affected individuals against health-to-disease transitionClinically relevant health risk assessment utilizing health/disease-specific molecular patterns detectable in body fluids with high predictive power such as a comprehensive tear fluid analysis. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00337-1.
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Affiliation(s)
- Natalia I. Kurysheva
- The Ophthalmological Center of the Federal Medical and Biological Agency of the Russian Federation, 15 Gamalei Street, Moscow, Russian Federation 123098
| | - Oxana Y. Rodionova
- Federal Research Center for Chemical Physics RAS, 4, Kosygin Street, Moscow, Russian Federation 119991
| | - Alexey L. Pomerantsev
- Federal Research Center for Chemical Physics RAS, 4, Kosygin Street, Moscow, Russian Federation 119991
| | - Galina A. Sharova
- Ophthalmology Clinic of Dr. Belikova, 26/2, Budenny Avenue, Moscow, Russian Federation 105118
| | - Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
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Un Y, Imamoglu S, Tekcan H, Celik G, Ozturk Y, Mangan MS. Factors defining the intraocular pressure-lowering effect of phacoemulsification and laser peripheral iridotomy in patients with primary angle closure : Factors defining IOP lowering effect of PE and LPI in PAC. Lasers Med Sci 2023; 38:100. [PMID: 37059933 DOI: 10.1007/s10103-023-03772-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/08/2023] [Indexed: 04/16/2023]
Abstract
To identify whether gonioscopic ciliary body visibility and factors including anterior chamber depth (ACD), axial length (AL), acute attack history, and preoperative intraocular pressure (IOP) had any effect on IOP decrease in primary angle closure (PAC) and primary angle-closure glaucoma (PACG) after phacoemulsification (PE) and/or laser peripheral iridotomy (LPI). This retrospective-design study was conducted with 81 eyes with PAC and PACG; 33 eyes whose IOP was controlled with LPI and PE constituted group 1, and 48 eyes whose IOP was controlled using LPI alone comprised group 2. The effects on preoperative and last-visit IOP levels, ciliary body visibility, ACD, AL, and acute attacks were analyzed. Eyes within the groups were similar in AL, ACD, and preoperative IOP except for acute attack history, which was found to be higher in group 1. For group 1, none of the factors was found to have a differentiative effect on IOP decrease after PE, except eyes with preoperative IOP > 21 mm Hg, which had significantly more IOP reduction. For group 2, no difference was found in ciliary body visibility, and higher or lower ACD. However, eyes with AL ≥ 22 mm, positive acute attack history, and higher preoperative IOP were associated with significantly better IOP reduction. We found no relationship between ciliary body visibility and an IOP-reducing effect of PE and LPI. Although we found PE effective in IOP reduction in all eyes, we determined LPI to have a lesser IOP-reducing effect in eyes with IOP ≤ 21 mm Hg and AL < 22 mm.
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Affiliation(s)
- Yasemin Un
- Department of Ophthalmology, Istanbul Haydarpasa Numune Training and Research Hospital, Uskudar, 34668, Istanbul, Turkey.
| | - Serhat Imamoglu
- Department of Ophthalmology, Istanbul Haydarpasa Numune Training and Research Hospital, Uskudar, 34668, Istanbul, Turkey
| | - Hatice Tekcan
- Department of Ophthalmology, Istanbul Haydarpasa Numune Training and Research Hospital, Uskudar, 34668, Istanbul, Turkey
| | - Gokhan Celik
- Department of Ophthalmology, Zeynep Kamil Obstetric and Pediatric Hospital Uskudar, 34668, Istanbul, Turkey
| | - Yucel Ozturk
- Department of Ophthalmology, Istanbul Haydarpasa Numune Training and Research Hospital, Uskudar, 34668, Istanbul, Turkey
| | - Mehmet Serhat Mangan
- Department of Ophthalmology, Istanbul Haydarpasa Numune Training and Research Hospital, Uskudar, 34668, Istanbul, Turkey
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10
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Randhawa J, Chiang M, Porporato N, Pardeshi AA, Dredge J, Apolo Aroca G, Tun TA, Quah JH, Tan M, Higashita R, Aung T, Varma R, Xu BY. Generalisability and performance of an OCT-based deep learning classifier for community-based and hospital-based detection of gonioscopic angle closure. Br J Ophthalmol 2023; 107:511-517. [PMID: 34670749 PMCID: PMC9018872 DOI: 10.1136/bjophthalmol-2021-319470] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/02/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the generalisability and performance of a deep learning classifier for automated detection of gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images. METHODS A convolutional neural network (CNN) model developed using data from the Chinese American Eye Study (CHES) was used to detect gonioscopic angle closure in AS-OCT images with reference gonioscopy grades provided by trained ophthalmologists. Independent test data were derived from the population-based CHES, a community-based clinic in Singapore, and a hospital-based clinic at the University of Southern California (USC). Classifier performance was evaluated with receiver operating characteristic curve and area under the receiver operating characteristic curve (AUC) metrics. Interexaminer agreement between the classifier and two human examiners at USC was calculated using Cohen's kappa coefficients. RESULTS The classifier was tested using 640 images (311 open and 329 closed) from 127 Chinese Americans, 10 165 images (9595 open and 570 closed) from 1318 predominantly Chinese Singaporeans and 300 images (234 open and 66 closed) from 40 multiethnic USC patients. The classifier achieved similar performance in the CHES (AUC=0.917), Singapore (AUC=0.894) and USC (AUC=0.922) cohorts. Standardising the distribution of gonioscopy grades across cohorts produced similar AUC metrics (range 0.890-0.932). The agreement between the CNN classifier and two human examiners (Ҡ=0.700 and 0.704) approximated interexaminer agreement (Ҡ=0.693) in the USC cohort. CONCLUSION An OCT-based deep learning classifier demonstrated consistent performance detecting gonioscopic angle closure across three independent patient populations. This automated method could aid ophthalmologists in the assessment of angle status in diverse patient populations.
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Affiliation(s)
- Jasmeen Randhawa
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Michael Chiang
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Natalia Porporato
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Anmol A Pardeshi
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Justin Dredge
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Galo Apolo Aroca
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tin A Tun
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | | | - Marcus Tan
- Ophthalmology, National University of Singapore, Singapore
| | | | - Tin Aung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
- Ophthalmology, National University of Singapore, Singapore
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, USA
| | - Benjamin Y Xu
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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11
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Kurysheva NI, Sharova GA. [Predictors of the success of laser peripheral iridotomy and lensectomy in the early stages of primary angle closure disease]. Vestn Oftalmol 2023; 139:98-105. [PMID: 37379115 DOI: 10.17116/oftalma202313903198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The article reviews literature data on the search for predictors of the success of laser peripheral iridotomy (LPI) and lensectomy in the early stages of primary angle closure disease (PACD) and presents a trend analysis of the studies conducted on individuals identified as primary angle closure suspects (PACs) and those with primary angle closure (PAC). The concept of the review was determined by the ambiguous choice of treatment for patients at the stage of PAC onset. Determining the success predictors of LPI or lensectomy plays a key role in optimizing the treatment of PACD. The results of literature analysis are contradictory, which indicates the need for further research taking into account modern methods of visualization of the eye structures such as optical coherence tomography (OCT), Swept Source OCT (SS-OCT), and the use of uniform criteria for evaluating the effectiveness of treatment.
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Affiliation(s)
- N I Kurysheva
- Medical Biological University of Innovations and Continuing Education of the Federal Biophysical Center named after A.I. Burnazyan, Moscow, Russia
- Ophthalmological Center of the Federal Medical-Biological Agency - Federal Medical Biophysical Center named after A.I. Burnazyan, Moscow, Russia
| | - G A Sharova
- OOO Glaznaya klinika doktora Belikovoj, Moscow, Russia
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12
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Lv K, Liang Z, Yang K, Chen X, Ma Y, Wu H. Novel Discoveries of the Relationship Between the Vitreous Zonule and the Anterior Segment Characteristics in Eyes With Primary Angle-Closure Disease. Invest Ophthalmol Vis Sci 2022; 63:16. [PMID: 36520454 PMCID: PMC9769030 DOI: 10.1167/iovs.63.13.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose To investigate the presence of the vitreous zonule (VZ) in different subtypes of primary angle-closure disease (PACD) and to explore the relationship between VZ and anterior chamber angle characteristics. Methods Patients with clinical diagnoses of acute primary angle-closure (PAC)/PAC glaucoma (APAC[G]) or chronic PAC/PAC glaucoma (CPAC[G]) and healthy subjects were enrolled. A total of 300 eyes of 180 subjects were included. Anterior segment parameters and the presence of the VZ were assessed by ultrasound biomicroscopy. The presence of VZ was compared among different subtypes of PACD. Anterior segment parameters were compared between eyes in vitreous zonule group (VZG) and no vitreous zonule group (NVZG). Logistic regression analysis was conducted to identify factors associated with the presence of VZ. Results APAC(G) eyes had lower VZ presence compared to the fellow eyes of APAC(G) (P < 0.001). VZ was more likely to be seen in the eyes of healthy subjects and PAC suspect than in the eyes of PAC and PAC glaucoma (PACG) (P < 0.05). NVZG had shorter angle opening distance 500/750 (P < 0.001), smaller trabecular iris angle 500/750 (P < 0.001), smaller trabecular-iris space area 500/750 (P < 0.001), smaller trabecular-ciliary angle (P = 0.009), smaller iris area (P = 0.010), and greater lens vault (P = 0.004) compared to VZG. Greater lens vault (LV) was independently associated with absence of VZ (odds ratio = 0.253; 95% confidence interval, 0.109-0.586; P = 0.001). Conclusions VZ was less likely to be observed in PAC/PACG eyes. PACD eyes with less VZ had narrower angle, more anteriorly rotated ciliary body, and greater LV.
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Affiliation(s)
- Kun Lv
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Zhiqiao Liang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Kangyi Yang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Xuanzhu Chen
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Yao Ma
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
| | - Huijuan Wu
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, China
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13
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Palanisamy S, Raja V, Senthilkumar VA, Mani I, Krishnadas R. Correlation of pattern of visual field loss by perimetry and anterior chamber angle parameters by anterior segment optical coherence tomography in primary angle-closure glaucoma. Indian J Ophthalmol 2022; 70:2895-2901. [PMID: 35918939 DOI: 10.4103/ijo.ijo_232_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose To correlate and analyze the pattern of the visual field (VF) defects by perimetry and anterior chamber angle parameters by AS-OCT in primary angle-closure glaucoma (PACG) across varied severity levels on presentation to a tertiary eye care center. Methods This was a cross-sectional study, which included 323 eyes of clinically diagnosed cases of PACG. Glaucoma severity was categorized according to mean deviation (MD) as mild (-6.00 dB or more), moderate (-6.01 to -12.00 dB), and severe (-12.01 to -30.00 dB). AS-OCT measured the nasal (N) and temporal (T) angle opening distance at 500 μm (AOD 500) and 750 μm (AOD 750), anterior chamber angle (ACA), lens vault (LV), and anterior chamber width (ACW). The VF severity was then correlated with the AS-OCT parameters using statistical analysis. Results The mean age ± standard deviation (SD) of the patients included in the study was 56.03 ± 8.6 years, with a 1:1.2 gender ratio. The number of eyes with mild, moderate, and severe VFs were 140 (43.3%), 88 (27.24%), and 95 (29.41%), respectively. There was no statistically significant correlation in the mean anterior chamber angle parameters (AOD 500, AOD 750, ACA 500, ACA 750, LV, ACW, and axial length (AL)) among the groups. However, the correlation between AOD 500 and LV thickness was found to be significant (P = 0.0000) with a negative Spearman's rank correlation coefficient (r = -0.3329). Conclusion The ACA parameters obtained by AS-OCT along the horizontal axis after elimination of pupillary block by laser peripheral iridotomy do not correlate and cannot be used to assess the disease severity of PACG.
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Affiliation(s)
- Sreeramyaa Palanisamy
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamilnadu, India
| | - Vidya Raja
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamilnadu, India
| | | | - Iswarya Mani
- Department of Biostatistics, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamilnadu, India
| | - R Krishnadas
- Department of Glaucoma, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tamilnadu, India
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14
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Chakrabarti K, Samant S, Mohapatra R, Mishra S, Das S, Chakrabarti M. A comparison of lens parameters in patients with various subtypes of primary angle-closure disease and the normal population: A prospective study. Indian J Ophthalmol 2022; 70:2889-2894. [PMID: 35918938 PMCID: PMC9672764 DOI: 10.4103/ijo.ijo_3007_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To assess the role of lens parameters in the detection and progression of primary angle-closure disease (PACD) by combining A-scan and A-scan optical coherence tomography (AS-OCT) parameters. Methods: A cross-sectional study was conducted in a tertiary health-care center in eastern India. A total of 91 study subjects including cases and controls were included in the study. The parameters studied were lens thickness (LT), lens axial factor (LAF), relative lens position (RLP), and lens vault (LV). Anterior chamber depth (ACD) and axial length (AL) were also analyzed using A-scan. Results: The LT was significantly more in all subtypes of PACD (from 4.24 ± 0.84 to 5.02 ± 0.18 mm) than in controls (4.04 ± 0.46 mm; P < 0.01). Similarly, LAF was significantly less among all subtypes of PACD compared to controls (P < 0.001). The RLP, calculated using the formula (ACD + 0.5 LT)/AL × 10, showed no significant difference (P > 0.05) between various study groups. The LV in acute angle-closure glaucoma (AcCG) patients was significantly higher compared to the control population (P < 0.01). Ocular parameters like ACD decreased, whereas LT and LAF increased from normal through primary angle closure (PAC) to primary angle-closure glaucoma (PACG). Logistic regression analysis found a significant association between a decrease in ACD and an increased risk of PACG (P-value was 0.0001) and an increase in LT and LAF with increased risk of PACG (P = 0.040 and P = 0.006, respectively). Conclusion: Inclusion of lens parameter assessment in the workup of a patient with PACD helps in detection and close monitoring of the progression from suspected to disease state.
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Affiliation(s)
- Keya Chakrabarti
- Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Swati Samant
- Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Ramesh Mohapatra
- Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Suchismita Mishra
- Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
| | - Suprava Das
- Institute of Medical Science and SUM Hospital, Kalinga Nagar, Ghatikia, Bhubaneswar, Odisha, India
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15
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Porporato N, Chong R, Xu BY, Tun TA, Quah JH, Tan M, Baskaran M, Cheng CY, Aung T. Angle closure extent, anterior segment dimensions and intraocular pressure. Br J Ophthalmol 2022:bjophthalmol-2021-320453. [PMID: 35236713 DOI: 10.1136/bjophthalmol-2021-320453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
AIM To investigate the association between the extent of iridotrabecular contact and other quantitative anterior segment dimensions measured by swept-source optical coherence tomography (SS-OCT; CASIA SS-1000, Tomey, Nagoya, Japan) with intraocular pressure (IOP). METHODS Cross-sectional study. All subjects who were ≥50 years with no history of glaucoma, ocular surgery or trauma, underwent SS-OCT imaging (eight equally spaced radial scans), Goldman applanation tonometry and gonioscopy on the same day. We measured iridotrabecular contact (ITC) index and area, total volume of trabeculo-iris space area and angle opening distance at 500 and 750 from the scleral spur (TISA 500 and 750, AOD 500 and 750, respectively), anterior chamber depth (ACD), volume, area and width, pupil diameter, lens vault and iris volume.Their relationship with IOP (dependent variable) was assessed by locally weighted scatterplot smoothing (Lowess) regression with change-point analysis and generalised additive models adjusted for confounders. RESULTS 2027 right eyes of mostly Chinese Singaporeans (90%) were analysed. ITC index above a threshold of ~60% (95% CI 34% to 92%) was significantly associated with higher IOP. Independent of the extent of ITC, ACD was also significantly associated with higher IOP below a threshold of 2.5 mm (95% CI 2.33 mm to 2.71 mm). Greater ITC index and shallower ACD had a joint association with IOP. A model including ACD and ITC index was more predictive of IOP than a model considering these variables separately, particularly for women with gonioscopically closed angles (R2 52.7%, p<0.05). CONCLUSIONS The extent of angle closure and the ACD below a certain threshold had a significant joint association with IOP. These parameters, as biometrical surrogates of mechanical obstruction of the aqueous outflow, may jointly contribute to elevated IOP, particularly in women with gonioscopic angle closure.
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Affiliation(s)
- Natalia Porporato
- Glaucoma, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,DUKE-NUS Medical School, Singapore
| | - Rachel Chong
- Glaucoma, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,DUKE-NUS Medical School, Singapore
| | - Benjamin Y Xu
- Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Tin A Tun
- Glaucoma, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,DUKE-NUS Medical School, Singapore
| | | | - Marcus Tan
- Ophthalmology, National University Hospital, National University of Singapore, Singapore
| | - Mani Baskaran
- Glaucoma, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ching Yu Cheng
- Glaucoma, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.,DUKE-NUS Medical School, Singapore
| | - Tin Aung
- Glaucoma, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore .,DUKE-NUS Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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16
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Xu BY, Friedman DS, Foster PJ, Jiang Y, Porporato N, Pardeshi AA, Jiang Y, Munoz B, Aung T, He M. Ocular Biometric Risk Factors for Progression of Primary Angle Closure Disease: The Zhongshan Angle Closure Prevention Trial. Ophthalmology 2022; 129:267-275. [PMID: 34634364 PMCID: PMC8863620 DOI: 10.1016/j.ophtha.2021.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC). DESIGN Prospective, observational study. PARTICIPANTS Six hundred forty-three mainland Chinese with untreated PACS. METHODS Participants underwent baseline clinical examinations, including gonioscopy, anterior segment OCT (AS-OCT) imaging, and A-scan ultrasound biometry as part of the Zhongshan Angle Closure Prevention (ZAP) Trial. Primary angle closure suspect was defined as an inability to visualize pigmented trabecular meshwork in 2 or more quadrants based on static gonioscopy. Primary angle closure was defined as development of intraocular pressure above 24 mmHg or peripheral anterior synechiae. Progression was defined as development of PAC or an AAC attack. Multivariable logistic regression models were developed to assess biometric risk factors for progression. MAIN OUTCOME MEASURES Six-year progression from PACS to PAC or AAC. RESULTS Six hundred forty-three untreated eyes (609 nonprogressors, 34 progressors) of 643 participants were analyzed. In a multivariable model with continuous parameters, narrower horizontal angle opening distance of 500 μm from the scleral spur (AOD500; odds ratio [OR], 1.10 per 0.01-mm decrease; P = 0.03), flatter horizontal iris curvature (IC; OR, 1.96 per 0.1-mm decrease; P = 0.01), and older age (OR, 1.11 per 1-year increase; P = 0.01) at baseline were associated significantly with progression (area under the receiver operating characteristic curve [AUC], 0.73). Smaller cumulative gonioscopy score was not associated with progression (OR, 1.03 per 1-modified Shaffer grade decrease; P = 0.85) when replacing horizontal AOD500 in the multivariable model. In a separate multivariable model with categorical parameters, participants in the lowest quartile of horizontal AOD500 (OR, 3.10; P = 0.002) and IC (OR, 2.48; P = 0.014) measurements and 59 years of age or older (OR, 2.68; P = 0.01) at baseline showed higher odds of progression (AUC, 0.72). CONCLUSIONS Ocular biometric measurements can help to risk-stratify patients with early angle closure for more severe disease. Anterior segment OCT measurements of biometric parameters describing the angle and iris are predictive of progression from PACS to PAC or AAC, whereas gonioscopy grades are not.
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Affiliation(s)
- Benjamin Y. Xu
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David S. Friedman
- Glaucoma Center of Excellence, Massachusetts Eye and Ear, Harvard University, Boston, MA, USA
| | - Paul J. Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, England
| | - Yu Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Natalia Porporato
- Singapore Eye Research Institute and Singapore National Eye Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anmol A. Pardeshi
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Yuzhen Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Beatriz Munoz
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tin Aung
- Singapore Eye Research Institute and Singapore National Eye Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China
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17
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Hamad AE, Elmaria AF, Hussein TR, Shalaby SM. Prevalence of Plateau Iris in Primary Angle Closure Glaucoma: An Egyptian Hospital Based Ultrasound Biomicroscopy Study. Clin Ophthalmol 2022; 16:541-550. [PMID: 35241909 PMCID: PMC8887914 DOI: 10.2147/opth.s356106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/18/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose To determine the distribution and the anatomical characteristics of plateau iris (PI) in primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). Methods Fifty UBM images of PACG cases were studied over one year by retrospective analysis. The data from UBM images including angle opening distance at 500 and 750 μm (AOD500 and AOD750), trabecular-iris angle (TIA), angle recess area at 750 μm (ARA750), maximum ciliary body thickness (CBTmax), anterior placement of ciliary processes (APCP), central anterior chamber depth (CACD), axial lens thickness (ALT), and ciliary sulcus status were analyzed and compared between the PI and non-PI cases. Results Eighteen cases had PI (36%). The mean AOD500, AOD750, and TIA were significantly smaller in PI than in non-PI eyes (P = 0.01; P = 0.046; and P = 0.026). Values of the ARA750 and CBTmax were not significantly different between the two groups (P = 0.208 and P = 0.368). CACD was deeper in the PI group (P = 0.011). ALT was higher in the non-PI group (P = 0.001). The mean APCP of the PI group was more than those of the non-PI group (P < 0.001). The number of cases with obliterated ciliary sulcus in more than two quadrants was significantly more in the PI group (P < 0.001). Conclusion Around one-third of PACG eyes were found to have PI on UBM imaging. The number of obliterated ciliary sulcus and APCP were important UBM parameters that help in PI diagnosis.
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Affiliation(s)
- Amira E Hamad
- Tanta Ophthalmology Hospital, Ministry of Health, Tanta, Elgharbia Province, Egypt
| | - Ahmed F Elmaria
- Department of Ophthalmology, Tanta University, Tanta, Elgharbia Province, Egypt
- Correspondence: Ahmed F Elmaria, Department of Ophthalmology, Tanta University, Tanta, Elgharbia Province, 31527, Egypt, Tel +20 1020306017, Email
| | - Tarek R Hussein
- Department of Ophthalmology, Tanta University, Tanta, Elgharbia Province, Egypt
| | - Said M Shalaby
- Department of Ophthalmology, Tanta University, Tanta, Elgharbia Province, Egypt
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18
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Anterior Lens Curvature Matters in the Course of Primary Angle Closure: An Analysis Based on Ultrasound Biomicroscopic Imaging. J Ophthalmol 2022; 2022:5570633. [PMID: 35132362 PMCID: PMC8817843 DOI: 10.1155/2022/5570633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose. To evaluate the effect of anterior lens curvature in primary angle closure (PAC) and find additional anatomical features of crystalline lens that may predispose primary angle closure to the acute course. Methods. 435 eyes (263 subjects) were enrolled in this study. Four groups of eyes were included based on angle configurations and clinical features: (i) acute primary angle closure (APAC, 140 eyes); (ii) chronic primary angle closure (CPAC, 116 eyes); (iii) primary angle closure suspect (PACS, 84 eyes); and (iv) normal controls (95 eyes). All patients underwent thorough ophthalmic exams including applanation tonometry, gonioscopy, low-coherence interferometry, and ultrasound biomicroscopic imaging. Based on the panoramic anterior segment images from ultrasound biomicroscopic imaging measurements, the radius of anterior lens curvature (ALR) was calculated using the least-squares curve fitting technique. ALR, in addition to axial length (AL), anterior chamber depth (ACD), and lens thickness (LT), was compared among different groups using univariate and multivariate analysis with mixed effects linear model. Results. APAC, CPAC, and PACS groups all had steeper ALR, shorter AL, shallower ACD, and thicker LT than normal control group. ACD and LT further differ between APAC and CPAC or PACS eyes. Moreover, a steeper ALR was also found in the APAC group as compared to CPAC, PACS, and normal control groups. Conclusions. A steeper ALR may predispose the acute attack of PAC. In addition to the relative lens position and size, lens curvature is another variable that contributes to the pathophysiological mechanisms of primary angle closure.
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Kurysheva NI, Sharova GA. [Primary anterior chamber angle closure: progression from suspect to glaucoma. Part 2. Predictors of primary angle closure]. Vestn Oftalmol 2022; 138:108-116. [PMID: 36004599 DOI: 10.17116/oftalma2022138041108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To review the literature devoted to the search of predictors of primary angle closure (PAC) progression as an important link in the pathogenesis of primary angle-closure glaucoma. This part presents a cluster analysis, describes the mechanisms of PAC development, and considers the studies aimed at discovering the risk factors for the progression of primary angle closure suspect into true angle closure. The results of the analyzed literature are ambiguous, indicating the need for further research that would involve strict inclusion criteria, and a standard approach to defining the primary angle closure disease and expanding the diagnostic parameters, in which a key role belongs to anterior segment optical coherence tomography (AS-OCT).
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Affiliation(s)
- N I Kurysheva
- Medical and Biological University of Innovations and Continuing Education of the State Research Center - Burnasyan Federal Biophysical Center, Moscow, Russia
- Ophthalmological Center of the State Research Center - Burnasyan Federal Biophysical Center, Moscow, Russia
| | - G A Sharova
- Eye Clinic of Doctor Belikova LLC, Moscow, Russia
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20
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Tañá-Rivero P, Ruiz-Mesa R, Aguilar-Córcoles S, Tello-Elordi C, Ramos-Alzamora M, Montés-Micó R. Lens-vault analysis and its correlation with other biometric parameters using swept-source OCT. JOURNAL OF OPTOMETRY 2022; 15:88-99. [PMID: 34736867 PMCID: PMC8712587 DOI: 10.1016/j.optom.2021.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/10/2021] [Accepted: 04/06/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To measure lens vault (LV) and to assess its correlation with various ocular parameters in healthy eyes, using for all measurements the same high-resolution swept-source optical coherence tomographer (SS-OCT). METHODS We prospectively recruited 67 Caucasian healthy patients whose mean age was 41.9 ± 12.4 years; only their right eye was included in the study. Data were all recorded with the ANTERION SS-OCT and comprised, for each patient, 5 consecutive measurements of LV, anterior chamber depth (ACD), lens thickness (LT), axial length (AL), white-to-white (WTW) distance, central corneal thickness (CCT), anterior chamber volume (ACV) and spur-to-spur (STS) distance. RESULTS Mean LV was 0.26 ± 0.23 mm (ranging from -0.24 to 0.78 mm). Data analysis revealed a statistically significant negative correlation between LV and ACD (R=-0.80, p < 0.001), AL (R = -0.36, p = 0.002), and ACV (R = -0.68, p < 0.001), and a positive correlation between LV and LT (R = 0.67, p < 0.001), and age (R = 0.53, p < 0.001). In contrast, no statistically significant correlation was found between LV and WTW (R=-0.17, p = 0.15), CCT (R = 0.11, p = 0.36) or STS (R=-0.10, p = 0.41). CONCLUSIONS Taking into account our findings about intra-parameter correlation levels, we believe that LV should be measured and analyzed together with other ocular parameters in clinical routine practice both for diagnosis and for some refractive surgeries.
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Affiliation(s)
| | | | | | | | | | - Robert Montés-Micó
- Oftalvist Clinic, Alicante, Spain; University of Valencia, Valencia, Spain.
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21
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You S, Liang Z, Yang K, Zhang Y, Oatts J, Han Y, Wu H. Novel Discoveries of Anterior Segment Parameters in Fellow Eyes of Acute Primary Angle Closure and Chronic Primary Angle Closure Glaucoma. Invest Ophthalmol Vis Sci 2021; 62:6. [PMID: 34730791 PMCID: PMC8572512 DOI: 10.1167/iovs.62.14.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To investigate the biometric differences of anterior segment parameters between fellow eyes of acute primary angle closure (F-APAC) and chronic primary angle closure glaucoma (F-CPACG) to get information about differences between APAC and CPAC. Methods Patients with F-APAC and F-CPACG without prior treatment were enrolled from glaucoma clinics. Parameters were measured on ultrasound biomicroscopy images, including pupil diameter, lens vault (LV), anterior chamber depth, anterior chamber width, iris area, iris thickness (IT 750 and 2000), angle-opening distance (AOD 500 and 750), trabecular-iris space area (TISA 500 and 750), trabecular iris angle (TIA 500 and 750), trabecular–ciliary angle, and ciliary process area. Multivariate logistic regression analysis was performed to determine the most important parameters associated with F-APAC compared with F-CPACG. Results Fifty-five patients with APAC and 55 patients with CPACG were examined. The anterior chamber depth, IT 750, AOD 750, trabecular iris angle 750, and trabecular–ciliary angle were smaller, and LV and ciliary process area were greater in F-APAC as compared with F-CPACG (P ≤ 0.01). Multivariate logistic regression showed that thinner IT 750, smaller AOD 750, and larger LV were significantly associated with F-APAC (P < 0.01). IT 750 (area under the curve, 0.703) performed relatively better than AOD 750 (area under the curve, 0.696) in distinguishing F-APAC from F-CPACG, with the best cutoff of 0.404 mm and 0.126 mm, respectively. Conclusions Compared with F-CPACG, F-APAC had thinner peripheral iris, narrower anterior chamber angle, shallower anterior chamber depth, greater LV, larger and anteriorly positioned ciliary body. IT 750, AOD 750, and LV played important roles in distinguishing eyes predisposed to APAC or CPAC.
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Affiliation(s)
- Shuqi You
- Department of Ophthalmology, Peking University People's Hospital; College of Optometry, Beijing, China.,University Health Science Center; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China.,Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Zhiqiao Liang
- Department of Ophthalmology, Peking University People's Hospital; College of Optometry, Beijing, China.,University Health Science Center; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Kangyi Yang
- Department of Ophthalmology, Peking University People's Hospital; College of Optometry, Beijing, China.,University Health Science Center; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University People's Hospital; College of Optometry, Beijing, China.,University Health Science Center; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
| | - Julius Oatts
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Huijuan Wu
- Department of Ophthalmology, Peking University People's Hospital; College of Optometry, Beijing, China.,University Health Science Center; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, Beijing, China
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22
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Wang B, Cao K, Wang Z, Zhang Y, Congdon N, Wang T. Analyzing Anatomical Factors Contributing to Angle Closure Based on Anterior Segment Optical Coherence Tomography Imaging. Curr Eye Res 2021; 47:256-261. [PMID: 34569390 DOI: 10.1080/02713683.2021.1978098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To analyze anatomical factors contributing to angle closure based on anterior segment optical coherence tomography (AS-OCT) imaging. METHODS A total of 238 patients with angle closure and 1122 normal controls were consecutively recruited for this study. Participants' eyes were imaged using AS-OCT under the same darkened ambient light conditions. The following parameters were analyzed: central anterior chamber depth (ACD); anterior chamber area (ACA); anterior chamber volume (ACV), anterior chamber width (ACW); corneal diameter (CD); posterior cornea curvature (PCC); anterior cornea curvature (ACC); maximum iris thickness (ITM); iris thickness at 750 um (IT750) and 2000 um (IT2000) from the scleral spur; iris curvature (IC); iris area (IA); lens vault (LV); angle opening distance (AOD); trabecular iris space area at 500 um (TISA500) and 750 um (TISA750) from the scleral spur; angle recess area (ARA). Lasso regression models were used to detect the collinearity of parameters. The multivariable logistic regression was performed to determine the independent association between angle closure and those parameters included in Lasso regression model. Also Factor analysis was performed to extract a few underlying factors (components) from these parameters. RESULTS Lasso regression showed that ACD, ACV, PCC, IT750, IT2000 and LV were screened in the model. The multivariable logistic regression indicated that ACV, PCC, IT750 and LV were significantly associated with angle closure. Factor analyses revealed that 4 factors, each with its closely associated clusters of variables, produced the best results: ACA, ACV and ACD (Factor 1); LV, tIC and nIC, (Factor 2); ACW, CD and PCC (Factor 3); and tITM, tIT2000, tIT750, nIT2000 and nIT750 (Factor 4). CONCLUSIONS Four separate mechanisms were showed to be involved in the pathogenesis of angle closure, from anterior chamber dimensions, lens, iris and cornea respectively. The parameters ACV, PCC, IT750, and LV are more predominant in determining angle closure.
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Affiliation(s)
- Bingsong Wang
- Beijing Tongren Eye Center, Beijnng Tongren Hospital, Capital Medical University, Beijing, China
| | - Kai Cao
- Beijing Institute of Opthalmology, Beijnng Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhiheng Wang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Ye Zhang
- Beijing Tongren Eye Center, Beijnng Tongren Hospital, Capital Medical University, Beijing, China
| | - Nathan Congdon
- Centre for Public Health, Queen's University, Belfast, UK
| | - Tao Wang
- Beijing Tongren Eye Center, Beijnng Tongren Hospital, Capital Medical University, Beijing, China
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Li F, Huo Y, Ma L, Yan X, Zhang H, Geng Y, Zhang Q, Tang G. Clinical observation of macular choroidal thickness in primary chronic angle-closure glaucoma. Int Ophthalmol 2021; 41:4217-4223. [PMID: 34333686 DOI: 10.1007/s10792-021-01988-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To comparatively analyze differences in macular choroidal thickness and volume in primary chronic angle-closure glaucoma (PACG) eyes. METHODS Thirty-one PACG patients were sequentially selected for this case-control study. Thirty-one eyes with PACG were included in group A, 31 fellow eyes were included in group B, and group C included 67 normal eyes. Enhanced-depth imaging optical coherence tomography (EDI-OCT) was used to measure choroidal thickness and volume. RESULTS The choroidal thicknesses and volumes of the central subfield macula (CSM), nasal inner macula (NIM), temporal inner macula (TIM), inferior inner macula (IIM), temporal outer macula (TOM), inferior outer macula (IOM), and mean macula (MM) in group A were all higher than those in group C (P < 0.05). The choroidal thicknesses and volumes of the NIM, superior inner macula (SIM), IIM, nasal outer macula (NOM), and MM in group B were all higher than those in group C (P < 0.05). No statistically significant differences were found between groups A and B (P > 0.05). The choroidal thicknesses of different macular regions in group A were not correlated with the mean defect (MD). CONCLUSION Increased macular choroidal thickness may be a common anatomical characteristic of PACD eyes. Macular choroidal thickness is not a good marker for assessing PACG severity.
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Affiliation(s)
- Fan Li
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365 Jianhua Street, Shijiazhuang city, Hebei Province, People's Republic of China
| | - Yiming Huo
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365 Jianhua Street, Shijiazhuang city, Hebei Province, People's Republic of China
| | - Lihua Ma
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365 Jianhua Street, Shijiazhuang city, Hebei Province, People's Republic of China
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365 Jianhua Street, Shijiazhuang city, Hebei Province, People's Republic of China
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365 Jianhua Street, Shijiazhuang city, Hebei Province, People's Republic of China
| | - Yulei Geng
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365 Jianhua Street, Shijiazhuang city, Hebei Province, People's Republic of China
| | - Qing Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365 Jianhua Street, Shijiazhuang city, Hebei Province, People's Republic of China
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, No. 365 Jianhua Street, Shijiazhuang city, Hebei Province, People's Republic of China.
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Zhang Y, Dong Z, Zhang Q, Li L, Thomas R, Li SZ, He MG, Wang NL. Detection of primary angleclosure suspect with different mechanisms of angle closure using multivariate prediction models. Acta Ophthalmol 2021; 99:e576-e586. [PMID: 32996707 PMCID: PMC8359395 DOI: 10.1111/aos.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 08/01/2020] [Accepted: 09/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE We had found that a multivariate prediction model used for the detection of primary angle-closure suspects (PACS) by combining multiple static and dynamic anterior segment optical coherence tomography (ASOCT) parameters had an area under the receiver operating characteristic curve (AUC) of 0.844. We undertook this study to evaluate this method in screening of PACS with different dominant mechanisms of angle closure (AC). METHODS The right eyes of subjects aged ≥40 years who participated in the 5-year follow-up of the Handan Eye Study and had undergone gonioscopy and ASOCT examinations under light and dark conditions were included. All ASOCT images were analysed by the Zhongshan Angle Assessment Program. The dominant AC mechanism in each eye was determined to be pupillary block (PB), plateau iris configuration (PIC) or thick peripheral iris roll (TPIR). Backward logistic regression (LR) was used for inclusion of variables in the prediction models. LR, Naïve Bayes' classification (NBC) and neural network (NN) were evaluated and compared using the AUC. RESULTS Data from 796 subjects (413 PACS and 383 normal eyes) were analysed. The AUCs of LR, NBC and NN in the PB group were 0.920, 0.918 and 0.917. The AUCs of LR, NBC and NN in the PIC group were 0.715, 0.708 and 0.707. The AUCs of LR, NBC and NN in TPIR group were 0.867, 0.833 and 0.886. CONCLUSIONS Prediction models showed the best performance for detection of PACS with PB mechanism for AC and have potential for screening of PACS.
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Affiliation(s)
- Ye Zhang
- Beijing Tongren Eye Center Beijing Key Laboratory of Ophthalmology and Visual Science Beijing Tongren Hospital Capital Medical University Beijing China
| | - Zhe Dong
- Beijing Tongren Eye Center Beijing Key Laboratory of Ophthalmology and Visual Science Beijing Tongren Hospital Capital Medical University Beijing China
| | - Qing Zhang
- Beijing Institute of Ophthalmology Beijing China
| | - Lei Li
- Beijing Tongren Eye Center Beijing Key Laboratory of Ophthalmology and Visual Science Beijing Tongren Hospital Capital Medical University Beijing China
| | - Ravi Thomas
- Queensland Eye Institute Brisbane Australia
- University of Queensland Brisbane Australia
| | | | - Ming Guang He
- State Key Laboratory of Ophthalmology Zhongshan Ophthalmic Center Sun Yat‐sen University Guangzhou China
- Department of Surgery University of Melbourne Melbourne Australia
- Ophthalmology Centre for Eye Research Australia Melbourne Australia
| | - Ning Li Wang
- Beijing Tongren Eye Center Beijing Key Laboratory of Ophthalmology and Visual Science Beijing Tongren Hospital Capital Medical University Beijing China
- Beijing Institute of Ophthalmology Beijing China
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Huang W, Li X, Gao X, Zhang X. The anterior and posterior biometric characteristics in primary angle-closure disease: Data based on anterior segment optical coherence tomography and swept-source optical coherence tomography. Indian J Ophthalmol 2021; 69:865-870. [PMID: 33727449 PMCID: PMC8012975 DOI: 10.4103/ijo.ijo_936_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Obtaining a better understanding of the pathogenesis of primary angle-closure disease (PACD) still requires studies that provide measurements of anterior and posterior biometric characteristics together and that assess the relationship between them. Methods: In total, 201 eyes were enrolled in this cross-sectional study: 50 normal controls, 49 primary angle-closure suspect (PACS), 38 primary angle closure (PAC), and 64 primary angle-closure glaucoma (PACG) eyes. The anterior and posterior structural features were measured by anterior segment optical coherence tomography and swept-source optical coherence tomography. Results: All PACD groups had smaller anterior chamber depth (ACD), anterior chamber area (ACA), anterior chamber volume (ACV), angle opening distance at 750 μm from the scleral spur (AOD750), trabecular–iris space area at 750 μm from the scleral spur (TISA750), and angle recess area (ARA), as well as a larger lens vault (LV), than controls (all P < 0.001). The PACS and PAC groups had thicker iris thickness at 750 μm from the scleral spur (IT750) than controls (P = 0.017 and P = 0.002, respectively). Choroidal thickness (CT) was not statistically different among normal, PACS, PAC, and PACG eyes. Univariate and multivariate linear regression analysis revealed a significant association between thinner IT750 and increased CT in PACD eyes (P = 0.031, univariate analysis; P = 0.008, multivariate analysis). Conclusion: Thinner iris thickness was associated with increased CT in PACD eyes; however, the underlying mechanism needs further investigation.
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Affiliation(s)
- Wenbin Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou; Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, People's Republic of China
| | - Xingyi Li
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xinbo Gao
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiulan Zhang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Liu YM, Hu D, Zhou LF, Lan J, Feng CC, Wang XY, Pan XJ. Associations of lens thickness and axial length with outcomes of laser peripheral iridotomy. Int J Ophthalmol 2021; 14:714-718. [PMID: 34012886 DOI: 10.18240/ijo.2021.05.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the association of axial length (AL), lens thickness (LT), and lens vault (LV) with postoperative anterior chamber angle metrics after laser peripheral iridotomy (LPI). METHODS Prospective observational study of 69 patients (97 eyes) were diagnosed as primary angle-closure suspect (PACS), primary angle closure (PAC) or primary angle-closure glaucoma (PACG). AL, LT, anterior central chamber depth (ACD), angle opening distance (AOD), trabecular iris angle (TIA), and angle recess area (ARA) were measured before and 1wk after LPI. The association between AL, LT, LV with ACD, AOD, TIA, ARA were analyzed by comparing the differences between preoperative and postoperative measurements for anterior segment biometric parameters. RESULTS ACD, AOD, TIA, and ARA were significantly increased after LPI (all P<0.05). Greater LT was significantly associated with greater postoperative increases in ACD, AOD, TIA, and ARA (all P<0.05). AL was not significantly associated with changes of anterior segment biometric parameters. Greater LV was significantly associated with greater postoperative increases in ACD, AOD, and TIA (all P<0.05), but was not significantly associated with changes of ARA. CONCLUSION Greater baseline LT and LV measurements are associated with greater increases in anterior segment biometric parameters after laser peripheral iridotomy. AL are not associated with the change of anterior segment biometric parameters.
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Affiliation(s)
- Ya-Meng Liu
- Weifang Medical University, Weifang 261021, Shandong Province, China.,State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Die Hu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Long-Fang Zhou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Jie Lan
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Cheng-Cheng Feng
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Xiao-Yun Wang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
| | - Xiao-Jing Pan
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China.,Qingdao Eye Hospital of Shandong First Medical University, Qingdao 266071, Shandong Province, China
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Han F, Li J, Zhao X, Li X, Wei P, Wang Y. Distribution and analysis of intraocular pressure and its possible association with glaucoma in children. Int Ophthalmol 2021; 41:2817-2825. [PMID: 33842987 DOI: 10.1007/s10792-021-01838-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/29/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To analyze intraocular pressure (IOP) and glaucoma-associated factors in children. METHODS A total of 4438 children aged 7-16 years (2321 boys and 2117 girls) were included in this study. Various ophthalmologic [IOP, central corneal thickness (CCT), etc.] and demographic (body mass index, etc.) parameters were evaluated. RESULTS IOP increased between the ages of 7 and 9 years, peaking at 9 years. IOP increased after reaching a trough at 11 years and subsequently stabilized after 14 years. Girls exhibited thinner CCT (534.28 ± 30.84 µm vs. 537.04 ± 31.33 µm, P = 0.003), thicker lens thickness (3.56 ± 0.21 mm vs. 3.54 ± 0.20 mm, P = 0.001), shorter axial length (22.91 ± 0.93 mm vs. 23.32 ± 0.89 mm, P < 0.001), shallower anterior chamber depth (2.92 ± 0.27 mm vs. 3.00 ± 0.26 mm, P < 0.001), higher refraction (- 0.57 ± 1.48 D vs. 0.16 ± 1.35 D, P < 0.001), and higher mean corneal curvature (43.77 ± 1.39 vs. 43.03 ± 1.35, P < 0.001). Multivariable analysis assessed the following IOP-associated factors: thicker CCT [standardized correlation coefficient (SRC) = 0.201, P < 0.001), deeper anterior chamber depth (SRC = 0.059, P = 0.009), shorter axial length (SRC = - 0.086, P = 0.036), lower mean corneal curvature (SRC = - 0.123, P < 0.001), higher refraction (SRC = - 0.090, P < 0.001). CONCLUSION IOP fluctuated in children, and a trend toward a higher mean IOP between the ages of 9 and 11 years, which stabilized after 14 years, was observed. IOP was associated with CCT, anterior chamber depth, axial length, lens thickness, mean corneal curvature, spherical equivalent, and systolic blood pressure.
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Affiliation(s)
- Fang Han
- Clinical College of Ophthalmology, Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300020, China.,Department of Ophthalmology, The 1St People's Hospital of Yunnan Province, 157 Jinbi Road, Kunming, China.,Department of Ophthalmology, The Affiliated Hospital of Kunming Science and Technology University, 157 Jinbi Road, Kunming, China
| | - Jun Li
- Department of Ophthalmology, The Second People's Hospital of Yunnan Province, 176 Qingnian Road, Kunming, China
| | - Xinheng Zhao
- Clinical College of Ophthalmology, Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300020, China
| | - Xiaoliang Li
- Department of Ophthalmology, The 1St People's Hospital of Yunnan Province, 157 Jinbi Road, Kunming, China.,Department of Ophthalmology, The Affiliated Hospital of Kunming Science and Technology University, 157 Jinbi Road, Kunming, China
| | - Pinghui Wei
- Clinical College of Ophthalmology, Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300020, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, No. 4 Gansu Road, Heping District, Tianjin, 300020, China. .,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Tianjin, China.
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Effect of Pharmacological Pupil Dilatation on Angle Configuration in Untreated Primary Angle Closure Suspects: A Swept Source Anterior Segment Optical Coherence Tomography Study. J Glaucoma 2020; 29:521-528. [PMID: 32224802 DOI: 10.1097/ijg.0000000000001506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRECIS Angle-closure worsens with pharmacological dilatation in about 50.0% of the subjects diagnosed as primary angle-closure suspects (PACSs). PURPOSE The purpose of this study was to evaluate the changes in angle configuration with swept-source anterior segment optical coherence tomography before and after pharmacological pupil dilatation in untreated PACSs. PATIENTS AND METHODS A total of 106 subjects over the age of 50 years and diagnosed as PACSs were included in this cross-sectional cohort study. 360-degree scans of the angles were captured using swept-source optical coherence tomography before and 1 hour after pharmacological dilatation. The angle scans from swept-source optical coherence tomography were analyzed to calculate the iris-trabecular contact (ITC) index. The main outcome measure was to evaluate the change in ITC index after dilatation. Multivariate linear and logistic regression analysis were performed to identify factors influencing change of ITC index and to identify factors associated with increase in ITC index after dilatation. RESULTS Majority of subjects were Chinese (93.4%) and female (79.2%). The overall mean predilatation ITC index was 45.3% (±23.7) and postdilatation ITC index was 46.05% (±25.9) with a mean change of 0.78% (±16.5; P=0.62). Fifty-three eyes (50.0%) showed an increase in ITC index (angle narrowing) after dilatation. An increase in ITC index was associated with shallower anterior chamber depth (odds ratio: 0.18; 95% confidence interval: 0.04-0.77) and bigger lens vault (odds ratio: 14.31; 95% confidence interval: 1.55-132.34). CONCLUSIONS Pharmacological pupil dilatation worsened angle closure in 50.0% of subjects with narrow angles. Shallower anterior chamber and bigger lens vault were associated with greater angle narrowing in these subjects.
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Costa VP, Leung CK, Kook MS, Lin SC, Al-Aswad LA, Araie M, Baudouin C, Coupal DJ, Fechtner R, Tee Khaw P, Khaderi KR, Khawaja A, Mattox C, Miller-Ellis E, Nagori S, Olivier M, Pfeiffer N, Serle J, Stalmans I, Varma DK. Clear lens extraction in eyes with primary angle closure and primary angle-closure glaucoma. Surv Ophthalmol 2020; 65:662-674. [DOI: 10.1016/j.survophthal.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
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Xu BY, Liang S, Pardeshi AA, Lifton J, Moghimi S, Lewinger JP, Varma R. Differences in Ocular Biometric Measurements among Subtypes of Primary Angle Closure Disease: The Chinese American Eye Study. Ophthalmol Glaucoma 2020; 4:224-231. [PMID: 32942063 DOI: 10.1016/j.ogla.2020.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/10/2020] [Accepted: 09/10/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To assess differences in ocular biometric measurements between primary angle closure suspect (PACS) eyes and primary angle closure (PAC) and primary angle closure glaucoma (PACG) eyes. DESIGN Cross-sectional study. PARTICIPANTS Patients with primary angle closure disease (PACD) were identified from the Chinese American Eye Study, a population-based study in Los Angeles, California. METHODS Patients previously underwent complete ocular examinations including gonioscopy and anterior segment (AS)-OCT imaging with the Tomey CASIA SS-1000 (Tomey Corporation). Four AS-OCT images were analyzed per eye. Averaged and sectoral measurements of biometric parameters, including angle recess area (ARA), trabecular iris space area (TISA), iris area, iris curvature, lens vault, anterior chamber depth, and anterior chamber area, were compared between early PACD (PACS) and late PACD (PAC and PACG) groups. Machine learning classifiers that attempt to differentiate between early and late PACD eyes were developed by applying different regression algorithms to a training dataset of sectoral parameter measurements. Classifier performance was assessed using an independent test dataset. MAIN OUTCOME MEASURES Averaged and sectoral measurements of biometric parameters. RESULTS Two hundred ninety-eight eyes (231 PACS, 67 PAC or PACG) of 298 patients were analyzed. No difference was found in averaged biometric measurements between the 2 groups before (P > 0.09) or after (P > 0.14) adjusting for age and gender. Differences (P < 0.04) between the 2 groups were found for 11 sectoral parameter measurements, including ARA and TISA. The performance of machine learning classifiers developed using sectoral parameter measurements was poor on the independent test dataset for all regression algorithms (area under the receiver operating characteristic curve, 0.529-0.628). CONCLUSIONS Differences in biometric measurements between subtypes of PACD eyes were small in a population-based cohort of Chinese Americans. The poor performance of classifiers based on these measurements highlights potential challenges of developing quantitative methods to detect late PACD.
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Affiliation(s)
- Benjamin Y Xu
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California.
| | - Siqi Liang
- Department of Computer Science, University of Southern California, Los Angeles, California
| | - Anmol A Pardeshi
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Jacob Lifton
- Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, California
| | - Juan Pablo Lewinger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
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Loh CC, Kamaruddin H, Bastion MLC, Husain R, Mohd Isa H, Md Din N. Evaluation of Refractive Status and Ocular Biometric Parameters in Primary Angle Closure Disease. Ophthalmic Res 2020; 64:246-252. [PMID: 32810853 DOI: 10.1159/000510925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to evaluate the refractive status and ocular biometric parameters in subjects with angle closure in Malaysia. METHODS This cross-sectional study was conducted on 171 primary angle closure patients (268 eyes). Visual acuity, refraction, and ocular biometry (central anterior chamber depth [ACD], axial length [AL], and lens thickness) were recorded. Vitreous cavity length (VL) and relative lens position (RLP) were calculated. RESULTS A total of 92 Primary Angle Closure Suspect (PACS), 30 Primary Angle Closure (PAC), and 146 Primary Angle Closure Glaucoma (PACG) eyes were included. Chinese ethnicity formed the majority (n = 197, 73.5%), followed by Malay (n = 57, 21.3%) and Indian (n = 14, 5.2%). There was a significant female preponderance with a female to male ratio of 1.85. Mean age was 65.7 ± 7.7 years. Mean spherical equivalent was +0.33 ± 1.29 D. Approximately half (n = 137, 51%) of the eyes were hyperopic (spherical power ≥+0.5), with PACG having the highest percentage of hyperopia (n = 69, 50.4%). Myopia and emmetropia were present in 48 (17.9) and 83 (31%) eyes, respectively. Although AL and VL in myopia patients were significantly longer than emmetropic and hyperopic eyes (p < 0.001), the ACD was not significantly different (p = 0.427). While the RLP is smaller in myopic eyes, lens thickness was increased in hyperopic eyes. PACG was significantly higher in elderly patients compared to PACS and PAC (p = 0.005). A total of 37 (13.8%) eyes were blind (vision worse than 3/60) and 19 of them (51.3%) were female patients. CONCLUSION A decrease in RLP is predictive of angle closure disease in myopic eyes, whereas increased lens thickness contributes to angle closure disease in hyperopic eyes.
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Affiliation(s)
- Chow Chin Loh
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Malaysia.,Department of Ophthalmology, Hospital Selayang Lebuh Raya, Batu Caves, Malaysia
| | - Haireen Kamaruddin
- Department of Ophthalmology, Hospital Selayang Lebuh Raya, Batu Caves, Malaysia
| | - Mae-Lynn Catherine Bastion
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Malaysia
| | - Rahat Husain
- Singapore National Eye Centre, Singapore, Singapore
| | | | - Norshamsiah Md Din
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Cheras, Malaysia,
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Anterior Segment Optical Coherence Tomography: Is There a Clinical Role in the Management of Primary Angle Closure Disease? J Glaucoma 2020; 29:60-66. [PMID: 31490798 DOI: 10.1097/ijg.0000000000001355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Primary angle closure disease (PACD) covers a spectrum that includes primary angle closure suspect, primary angle closure, primary angle closure glaucoma, and acute primary angle closure. Accumulating evidence suggests that the pathogenesis of PACD is complex, with multiple contributory factors including variations in the anatomic or biometric characteristics of the angle segment structures. Advances in anterior segment optical coherence tomography technology have further enhanced our understanding of the risk factors and mechanisms involved in the disease process. This review discusses the potential clinical role of the anterior segment optical coherence tomography in the diagnosis, mechanistic evaluation, and as a predictor for future clinical outcomes of patients with PACD.
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Moghimi S, Weinreb RN. Response to: Comparison of Fellow Eye of Acute Primary Angle Closure and Phacomorphic Angle Closure. J Glaucoma 2020; 29:e35-e36. [DOI: 10.1097/ijg.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Henriquez MA, Mejías JA, Rincon M, Izquierdo L, Binder PS. Correlation between lens thickness and lens density in patients with mild to moderate cataracts. Br J Ophthalmol 2020; 104:1350-1357. [PMID: 31949096 DOI: 10.1136/bjophthalmol-2019-314171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 10/17/2019] [Accepted: 12/19/2019] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine the relationships between lens thickness (LT), lens density and anterior segment parameters in patients with mild to moderate cataracts. SETTING Oftalmosalud Instituto de Ojos, Lima, Perú. DESIGN Prospective, single-centre, cross-sectional study. METHODS 169 eyes with age-related mild to moderate cataracts had lens density assessed using the Lens Opacification Classification System III, the built-in Pentacam HR Nucleus Staging software and ImageJ software. LT and axial length (AL) were measured with the IOLMaster 700, and angle parameters were measured using anterior segment optical coherence tomography. Pearson correlation coefficients and Kruskal-Wallis tests were used for statistical analyses. RESULTS Nuclear colour score was the only clinical parameter with a weak significant correlation with LT (r=0.24, p=0.003) after accounting for age, AL, gender and anterior chamber depth (ACD). The maximum value of average lens density and the mean nuclear density were significantly correlated with LT (r=0.24, p=0.003 and -0.17, p=0.03, respectively) after controlling for the same factors. Central LT greater than 4.48 mm was present in 54.5% of the eyes with a nuclear opalescence grade 1. CONCLUSIONS LT is independent of lens density in mild to moderate cataracts after accounting for age, AL, ACD and gender contrary to previous studies.
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Affiliation(s)
| | | | - Mirel Rincon
- Research Department, Oftalmosalud Instituto de Ojos, Lima, Peru
| | - Luis Izquierdo
- Research Department, Oftalmosalud Instituto de Ojos, Lima, Peru
| | - Perry S Binder
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, California, USA
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Trends in the characteristics of acute primary angle closure in Korea over the past 10-years. PLoS One 2019; 14:e0223527. [PMID: 31596882 PMCID: PMC6785132 DOI: 10.1371/journal.pone.0223527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/23/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose To investigate the changes in the demographic, clinical, and biometric characteristics of APAC patients in South Korea during the last decade. Methods Medical records of patients with APAC who visit the emergency department or the glaucoma clinic of Chonnam National University Hospital, a tertiary referral center in Gwangju, South Korea in 2007 and 2017 were analyzed. Demographics, clinical characteristics, and treatment modality were compared between the APAC patients in 2007 and 2017. Results The number of patients with APAC increased from 54 in 2007 to 68 in 2017. Female patients in their 60s were most common in both groups and there was no significant difference in IOP, cataract grade, gonioscopic grading, PAS, or optic nerve damage between the two groups at baseline visit (all P > 0.05). However, APAC eyes in 2017 had a shallower ACD (1.74 ± 0.28 mm vs 1.87 ± 0.35 mm; P = 0.024) and greater LV (1.05 ± 0.26 mm vs 0.93 ± 0.19 mm; P = 0.001) than those of APAC eyes in 2007. During one year follow-up, 25 patients (51.02%) received LPI only, and 18 patients (36.73%) required LE, and 6 patients (12.24%) required phacotrabeculectomy or sequential LE and trabeculectomy. However, in 2017, LPI alone was sufficient in 23 patients (38.33%), 29 patients (48.33%) required further LE, and 8 patients (13.33%) required phacotrabeculectomy or sequential LE and trabeculectomy for the treatment of APAC (P = 0.015). Conclusions Compared to older cases of APAC, recent cases received LE more frequently, which suggests an increasing trend of LE as a treatment option for APAC. In addition, recent cases had a greater LV and shallower ACD than older cases and these biometric differences may be one of the reasons for increasing rate of LE in this study.
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Cui Y, Yang X, Zhang G, Guo H, Zhang M, Zhang L, Zeng J, Liu Q, Zhang L, Meng Q. Intraocular Pressure in General and Diabetic Populations From Southern China: the Dongguan Eye Study. Invest Ophthalmol Vis Sci 2019; 60:761-769. [PMID: 30793208 DOI: 10.1167/iovs.18-25247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the distribution and risk factors for intraocular pressure (IOP) among general and diabetic populations in Southern China. Methods The study participants aged 40 years or older were enrolled from the Dongguan Eye Study, a population-based cross-sectional study from September 2011 to February 2012. Systemic and ophthalmic examinations were performed, and diabetes status was screened based on the American Diabetes Association diagnostic criteria (2010). IOP was measured by a noncontact tonometer per standardized protocol. Regression analyses were used to assess the association between potential risk factors and IOP. Results A total of 2112 subjects were included with a median age of 55 years. IOP for general population showed a near normal distribution with an average of 15.58 ± 3.27 mm Hg. Multiple regression analyses revealed that higher IOP was significantly correlated with younger age, higher body mass index (BMI), shorter height, higher blood pressure (BP), higher fasting blood glucose (FBG), higher low-density lipoprotein cholesterol (LDL-C), lower high-density lipoprotein cholesterol (HDL-C), and thicker central corneal thickness (CCT). There was no association between diabetes status and IOP after adjusting for possible confounders. IOP for diabetic participants showed a right-skewed distribution. Risk factors for IOP elevation in diabetes included female, younger age, higher BP, higher LDL-C, lower HDL-C, and thicker CCT. Conclusions The present study identifies risk factors for elevated IOP in general and diabetic populations. Younger age and lower HDL-C, as well as higher BP, LDL-C, and CCT were significant factors contributing to higher IOP, especially in the female diabetic population.
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Affiliation(s)
- Ying Cui
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Xiaohong Yang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Guanrong Zhang
- Information and Statistical Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Haike Guo
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,Xiamen Eye Centre of Xiamen University, Xiamen, China
| | - Min Zhang
- Department of Ophthalmology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Lixin Zhang
- Department of Ophthalmology, Hengli Hospital, Dongguan, Guangdong, China
| | - Jin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Qingyang Liu
- Department of Ophthalmology, Dongguan People's Hospital, Dongguan, Guangdong, China
| | - Liang Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Qianli Meng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Relationship between ocular biometry and severity of primary angle-closure glaucoma: relevance for predictive, preventive, and personalized medicine. EPMA J 2019; 10:261-271. [PMID: 31462943 DOI: 10.1007/s13167-019-00174-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/26/2019] [Indexed: 10/26/2022]
Abstract
Background Several ocular factors have been identified for primary angle-closure glaucoma (PACG), such as a small cornea, elevated intraocular pressure (IOP), shallow anterior chamber, and short axial length (AL). However, the relationship between the severity of PACG and various ocular parameters [IOP, anterior chamber depth, AL, central corneal thickness] is not fully understood. Methods A 7-year cross-sectional study. A total of 2254 eyes of 1312 PACG patients (females = 856 [1479 eyes] and males = 456 [775 eyes]) were included. A detailed eye examination was performed. The participants were categorized into gender subgroups followed by subdivision into three different severity groups according to their mean deviation (MD) of the visual fields results as follows: mild (MD ≤ 6 dB), moderate (MD 6-12 dB), and severe (MD > 12 dB) PACG. The associations of ocular biometry with severity of PACG were analyzed using paired Student's t test, multivariate linear regression, and logistic regression analysis. Results There was a significant positive correlation between the MD and AL in the female subgroup (B = 0.663, p = 0.001, 95%CI = 1.070 to 1.255) but not in the male subgroup. Increased AL levels (mild [OR = 1], moderate [OR = 1.047, p = 0.062, 95%CI = 0.947 to 2.462], and severe [OR = 1.274, p < 0.001, 95%CI = 1.114 to 1.457]) were only associated with the severity of PACG in females. Paired Student's t tests showed that the long AL female eyes have a higher MD value than in the short AL female eyes (mean difference = 3.09, t = 6.846, p < 0.001) in the same subjects, but not in the male subgroup (p = 0.648). Conclusions The AL was positively and significantly related to the severity of PACG in female but not male subjects. This finding refers to the PACG pathogenesis and suggests the use of AL assessment in glaucoma monitoring, diagnosis, and progression. This may contribute to further development of personalized strategies in preventive medicine.
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Weinreb RN, Moghimi S. Prophylactic laser iridotomy in primary angle-closure suspects. Lancet 2019; 393:1572-1574. [PMID: 30878227 DOI: 10.1016/s0140-6736(18)33059-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA.
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, University of California San Diego, La Jolla, CA 92093, USA
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Comparison of Fellow Eyes of Acute Primary Angle Closure and Phacomorphic Angle Closure. J Glaucoma 2019; 28:194-200. [DOI: 10.1097/ijg.0000000000001167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yoshimizu S, Hirose F, Takagi S, Fujihara M, Kurimoto Y. Comparison of pretreatment measurements of anterior segment parameters in eyes with acute and chronic primary angle closure. Jpn J Ophthalmol 2019; 63:151-157. [DOI: 10.1007/s10384-019-00651-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 12/21/2018] [Indexed: 11/24/2022]
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Changes in Iridocorneal Angle and Anterior Chamber Structure in Eyes With Anatomically Narrow Angles: Laser Iridotomy Versus Pilocarpine. J Glaucoma 2018; 27:1073-1078. [PMID: 30256278 DOI: 10.1097/ijg.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effects of laser iridotomy (LI) and pilocarpine on iridocorneal angle and anterior chamber structure in anatomically narrow angles (ANAs). MATERIALS AND METHODS Temporal LI was performed 90 minutes after 2% pilocarpine administration in patients with occludable ANA. Swept-source optical coherence tomography B-scans of the anterior segment were obtained at baseline, 60 minutes after 2% pilocarpine administration, and 1 week after LI. Angle-opening distance (AOD), trabecular-iris surface area (TISA), and angle recess area (ARA) were measured at the temporal, superior, nasal, and inferior quadrants. Anterior chamber depth (ACD) and lens vault (LV) were also measured. AOD, TISA, ARA, ACD, and LV were compared among 3 time points: at baseline, 60 minutes after 2% pilocarpine administration, and 1 week after LI. RESULTS Twenty-four eyes (24 patients; mean age, 55 y) were included. In all 4 quadrants and globally, AOD, TISA, and ARA increased from baseline after pilocarpine and after LI (all P<0.010). The increase in AOD, TISA, and ARA was greater after LI than after pilocarpine globally and in the temporal and superior quadrants (all P<0.040). ACD decreased and LV increased from baseline after pilocarpine (both P<0.001). Postpilocarpine anterior chambers were shallower with higher LV than post-LI (both P<0.016). CONCLUSION LI is more effective than pilocarpine in widening the iridocorneal angle without significant shallowing the anterior chamber in eyes with ANA.
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Chansangpetch S, Nguyen A, Mora M, Badr M, He M, Porco TC, Lin SC. Agreement of Anterior Segment Parameters Obtained From Swept-Source Fourier-Domain and Time-Domain Anterior Segment Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2018; 59:1554-1561. [PMID: 29625479 PMCID: PMC5863688 DOI: 10.1167/iovs.17-23574] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose To assess the interdevice agreement between swept-source Fourier-domain and time-domain anterior segment optical coherence tomography (AS-OCT). Methods Fifty-three eyes from 41 subjects underwent CASIA2 and Visante OCT imaging. One hundred eighty–degree axis images were measured with the built-in two-dimensional analysis software for the swept-source Fourier-domain AS-OCT (CASIA2) and a customized program for the time-domain AS-OCT (Visante OCT). In both devices, we examined the angle opening distance (AOD), trabecular iris space area (TISA), angle recess area (ARA), anterior chamber depth (ACD), anterior chamber width (ACW), and lens vault (LV). Bland-Altman plots and intraclass correlation (ICC) were performed. Orthogonal linear regression assessed any proportional bias. Results ICC showed strong correlation for LV (0.925) and ACD (0.992) and moderate agreement for ACW (0.801). ICC suggested good agreement for all angle parameters (0.771–0.878) except temporal AOD500 (0.743) and ARA750 (nasal 0.481; temporal 0.481). There was a proportional bias in nasal ARA750 (slope 2.44, 95% confidence interval [CI]: 1.95–3.18), temporal ARA750 (slope 2.57, 95% CI: 2.04–3.40), and nasal TISA500 (slope 1.30, 95% CI: 1.12–1.54). Bland-Altman plots demonstrated in all measured parameters a minimal mean difference between the two devices (−0.089 to 0.063); however, evidence of constant bias was found in nasal AOD250, nasal AOD500, nasal AOD750, nasal ARA750, temporal AOD500, temporal AOD750, temporal ARA750, and ACD. Among the parameters with constant biases, CASIA2 tends to give the larger numbers. Conclusions Both devices had generally good agreement. However, there were proportional and constant biases in most angle parameters. Thus, it is not recommended that values be used interchangeably.
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Affiliation(s)
- Sunee Chansangpetch
- Department of Ophthalmology, University of California, San Francisco, California, United States.,Department of Ophthalmology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Anwell Nguyen
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Marta Mora
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Mai Badr
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Centre of Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Travis C Porco
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco, California, United States
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Moghimi S, Torkashvand A, Mohammadi M, Yaseri M, Saunders LJ, Lin SC, Weinreb RN. Classification of primary angle closure spectrum with hierarchical cluster analysis. PLoS One 2018; 13:e0199157. [PMID: 30036362 PMCID: PMC6056027 DOI: 10.1371/journal.pone.0199157] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 06/02/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To classify subjects with primary angle closure into clusters based on features from anterior segment optical coherence tomography (ASOCT) imaging and to explore how these clusters correspond to disease subtypes, including primary angle closure suspect (PACS), primary angle closure glaucoma(PACG), acute primary angle closure (APAC) and fellow eyes of APAC and reveal the factors that become more predominant in each subtype of angle closure. METHOD A cross-sectional study of 248 eyes of 198 subjects(88 PACS eyes, 53 PACG eyes, 54 APAC eyes and 53 fellow eyes of APAC) that underwent complete examination including gonioscopy, A-scan biometry, and ASOCT. An agglomerative hierarchical clustering method was used to classify eyes based on ASOCT parameters. RESULTS Statistical clustering analysis produced three clusters among which the anterior segment parameters were significantly different. Cluster 1(43 eyes) had the smallest anterior chamber depth(ACD) and area, as well as the greatest lens vault (p<0.001 for all). Cluster 2(113 eyes) had the thickest iris at 2000 microns(p = 0.048), and largest iris area(p<0.001), and the deepest ACD (p<0.001). Cluster 3(92 eyes) was characterized by elements of both clusters 1 and 2 and a higher iris curvature(p<0.001). There was a statistically significant difference in the distribution of clusters among subtypes of angle closure eyes(p<0.001). Although the patterns of clusters were similar in PACS and PACG eyes, with the majority of the eyes classified into cluster 2(55%, and 62%, respectively), the highest proportion of APAC and fellow eyes were assigned to clusters 1(44%) and 3 (51%), respectively. CONCLUSION Hierarchical cluster analysis identified three clusters with different features. Predominant anatomical components are different among subtypes of primary angle closure.
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Affiliation(s)
- Sasan Moghimi
- Hamilton Glaucoma Center, Department of Ophthalmology, Shiley Eye Institute, University of California-San Diego, La Jolla, California, United States of America
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California, United States of America
- Tehran University Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Ali Torkashvand
- Tehran University Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Massood Mohammadi
- Tehran University Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Luke J. Saunders
- Hamilton Glaucoma Center, Department of Ophthalmology, Shiley Eye Institute, University of California-San Diego, La Jolla, California, United States of America
| | - Shan C. Lin
- Koret Vision Center, University of California, San Francisco Medical School, San Francisco, California, United States of America
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, Shiley Eye Institute, University of California-San Diego, La Jolla, California, United States of America
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
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Razeghinejad MR, Myers JS. Contemporary approach to the diagnosis and management of primary angle-closure disease. Surv Ophthalmol 2018; 63:754-768. [PMID: 29777727 DOI: 10.1016/j.survophthal.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.
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Affiliation(s)
- M Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Poostchi Ophthalmology Research Center, Shiraz University of Medcial Sciences, Shiraz, Iran.
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Chansangpetch S, Rojanapongpun P, Lin SC. Anterior Segment Imaging for Angle Closure. Am J Ophthalmol 2018; 188:xvi-xxix. [PMID: 29352976 DOI: 10.1016/j.ajo.2018.01.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/01/2018] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To summarize the role of anterior segment imaging (AS-imaging) in angle closure diagnosis and management, and the possible advantages over the current standard of gonioscopy. DESIGN Literature review and perspective. METHODS Review of the pertinent publications with interpretation and perspective in relation to the use of AS-imaging in angle closure assessment focusing on anterior segment optical coherence tomography and ultrasound biomicroscopy. RESULTS Several limitations have been encountered with the reference standard of gonioscopy for angle assessment. AS-imaging has been shown to have performance in angle closure detection compared to gonioscopy. Also, imaging has greater reproducibility and serves as better documentation for long-term follow-up than conventional gonioscopy. The qualitative and quantitative information obtained from AS-imaging enables better understanding of the underlying mechanisms of angle closure and provides useful parameters for risk assessment and possible prediction of the response to laser and surgical intervention. The latest technologies-including 3-dimensional imaging-have allowed for the assessment of the angle that simulates the gonioscopic view. These advantages suggest that AS-imaging has a potential to be a reference standard for the diagnosis and monitoring of angle closure disease in the future. CONCLUSIONS Although gonioscopy remains the primary method of angle assessment, AS-imaging has an increasing role in angle closure screening and management. The test should be integrated into clinical practice as an adjunctive tool for angle assessment. It is arguable that AS-imaging should be considered first-line screening for patients at risk for angle closure.
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Affiliation(s)
- Sunee Chansangpetch
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California
| | - Prin Rojanapongpun
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco Medical School, San Francisco, California.
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Baek SU, Kim KH, Lee JY, Lee KW. Long-term Intraocular Pressure Elevation after Primary Angle Closure Treated with Early Phacoemulsification. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:108-115. [PMID: 29560619 PMCID: PMC5906395 DOI: 10.3341/kjo.2017.0077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/17/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess long-term changes in intraocular pressure (IOP) and the development of glaucoma after early phacoemulsification in acute primary angle closure. METHODS Retrospective chart review of acute primary angle closure patients treated with phacoemulsification in attack eyes versus fellow eyes. Within a month after the angle closure attack, all subjects underwent cataract surgery and were divided into two groups: group A received cataract surgery on their attack eyes. Group B also received cataract surgery on their fellow eye after phacoemulsification of the attack eyes. Study outcomes were the prevalence of IOP rise (occurrence of IOP >21 mmHg) and the incidence of newly developed glaucoma. RESULTS Eighty-nine eyes were included, with 62 attack eyes in group A and 27 fellow eyes in group B. Group A (14 eyes, 22.58%) had a higher cumulative rate of IOP rise than group B (3 eyes, 11.11%) at 12 months (p = 0.001). Newly developed glaucoma was not observed in group B; however, 6 patients in group A developed glaucoma during the 12-month follow-up period (p < 0.001). CONCLUSIONS The attack eyes treated with phacoemulsification showed a significantly higher prevalence of IOP rise and newly developed glaucoma than fellow eyes that received phacoemulsification. These findings suggest that there is a possibility of IOP rise and development of glaucoma even when angle closure and successful IOP control have apparently been achieved after phacoemulsification.
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Affiliation(s)
- Sung Uk Baek
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Korea
| | - Kwang Hyun Kim
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea
| | - Joo Yeon Lee
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea
| | - Kyung Wha Lee
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea.
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Li M, Chen Y, Chen X, Zhu W, Chen X, Wang X, Fang Y, Kong X, Dai Y, Chen J, Sun X. Differences between fellow eyes of acute and chronic primary angle closure (glaucoma): An ultrasound biomicroscopy quantitative study. PLoS One 2018; 13:e0193006. [PMID: 29447247 PMCID: PMC5814014 DOI: 10.1371/journal.pone.0193006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 02/03/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To compare various biometric parameters between fellow eyes of acute primary angle closure (glaucoma) [APAC(G)] and fellow eyes of chronic primary angle closure (glaucoma) [CPAC(G)]. METHODS Ultrasound biomicroscopy examinations were performed on 47 patients with unilateral APAC(G) and 41 patients with asymmetric CPAC(G) before laser peripheral iridotomy and pilocarpine treatment. Anterior chamber depth and width (ACD and ACW), lens vault (LV), iris curvature (IC), iris root distance (IRD), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), trabecular-ciliary angle (TCA), and other biometric parameters were compared between fellow eyes of APAC(G) and fellow eyes of CAPC(G). RESULTS Compared with fellow eyes of CPAC(G), fellow eyes of APAC(G) had smaller ACD (P < 0.001), ACW (P = 0.007), TCPD (P = 0.016), ICPD (P = 0.008), and TCA (P = 0.006), as well as larger LV (P = 0.002), IC (P = 0.012), and IRD (P = 0.003). On multivariate logistic regression analyses, a 0.1 mm decrease in ACD (odds ratio [OR]: 0.705, 95%CI: 0.564-0.880, P = 0.002), ICPD (OR: 0.557, 95%CI: 0.335-0.925, P = 0.024), and a 0.1 mm increase in IRD (OR: 2.707, 95%CI: 1.025-7.149, P = 0.045), was significantly associated with occurrence of acute angle closures. CONCLUSIONS Fellow eyes of APAC(G) had smaller anterior segment dimensions, higher LV, more posterior iris insertion, greater IC, and more anteriorly rotated ciliary body compared with fellow eyes of CPAC(G). ACD, ICPD, and IRD were the three most important parameters that distinguish eyes predisposed to APAC(G) or CPAC(G).
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Affiliation(s)
- Mengwei Li
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yuhong Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
- * E-mail: (XHS); (YHC)
| | - Xiaoxiao Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Wenqing Zhu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Xueli Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Xiaolei Wang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yuan Fang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Xiangmei Kong
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Yi Dai
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Junyi Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China
- Key Laboratory of Myopia, Ministry of Health (Fudan University) and Key Laboratory of Visual Impairment and Restoration of Shanghai, Shanghai, China
- State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
- * E-mail: (XHS); (YHC)
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Moghimi S, Bijani F, Chen R, Yasseri M, He M, Lin SC, Weinreb RN. Anterior Segment Dimensions Following Laser Iridotomy in Acute Primary Angle Closure and Fellow Eyes. Am J Ophthalmol 2018; 186:59-68. [PMID: 29191661 DOI: 10.1016/j.ajo.2017.11.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the change in anterior segment morphology after laser peripheral iridotomy (LPI) in acute primary angle closure (APAC) and their fellow eyes. DESIGN Prospective, fellow eye-matched case series. METHODS In this study 42 individuals with unilateral episode of APAC were enrolled and the anterior segment optical coherence tomography (ASOCT) images were obtained in both eyes at baseline and at 6 weeks after LPI. A linear mixed-effects model was used to compare changes in anterior chamber and angle variables with consideration of laterality as the random effect and pupil diameter as the fixed effect. RESULTS APAC eyes had smaller angle parameters (P = .013 for all), less central anterior chamber depth (cACD) (P < .001), and lower anterior chamber area (ACA) (P < .001), as well as greater lens vault (LV) (P = .007), compared with fellow eyes. LPI resulted in angle widening with a significant increase in opening distance (P < .01 for all) in both APAC and fellow eyes. cACD (P = .003) and ACA (P < .001) increased and LV (P = .002) decreased in APAC eyes. However, there was no significant change in cACD (P = .190) and LV (P = .430) in fellow eyes. In both APAC eyes and fellow eyes, iris curvature decreased after LPI (P < .001). The changes in angle parameters, ACA, and iris curvature were not significantly different between the 2 groups. CONCLUSION In APAC eyes and their fellow eyes, LPI resulted in significant anterior chamber angle widening and increased anterior chamber area. In APAC eyes, the iris flattened, cACD deepened, and the lens shifted posteriorly after resolution of the attack. However, in fellow eyes, the increase in ACA was mainly owing to decreased iris curvature.
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Affiliation(s)
- Sasan Moghimi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Hamilton Glaucoma Center, Department of Ophthalmology, and Shiley Eye Institute, University of California-San Diego, La Jolla, California
| | - Faezeh Bijani
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Rebecca Chen
- Koret Vision Center, University of California, San Francisco Medical School, San Francisco, California
| | - Mehdi Yasseri
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mingguang He
- Department of Ophthalmology, University of Melbourne, Melbourne, Australia
| | - Shan C Lin
- Koret Vision Center, University of California, San Francisco Medical School, San Francisco, California
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Department of Ophthalmology, and Shiley Eye Institute, University of California-San Diego, La Jolla, California.
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Masis Solano M, Lin SC. Cataract, phacoemulsification and intraocular pressure: Is the anterior segment anatomy the missing piece of the puzzle? Prog Retin Eye Res 2018; 64:77-83. [PMID: 29374584 DOI: 10.1016/j.preteyeres.2018.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 12/19/2022]
Abstract
Cataract extraction is a safe and effective surgery that has a lowering effect on the intraocular pressure. The specific mechanisms for this effect are still unclear. A direct inflammatory effect on the trabecular meshwork, alteration of the blood aqueous barrier, changes in the ciliary body and mechanical changes of the anterior segment anatomy are the key to understand cataract surgery and it's effects on aqueous humor dynamics. Additionally, with the advent of AS OCT, changes in the anterior segment of the eye have been studied and several parameters (such as lens vault, angle opening distance and anterior chamber depth) have been identified as predictors of intraocular pressure change. In eyes with narrow angles there is a greater drop in intraocular pressure after cataract surgery and it is correlated with parameters related to anterior chamber space. It is safe to affirm that cataract surgery is an important part of the modern glaucoma treatment and evidence should be analyzed as part of a bigger picture in order to more accurately understand its clinical relevance.
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Affiliation(s)
- Marisse Masis Solano
- Koret Vision Center, Department of Ophthalmology, University of California, San Francisco Medical School, 10 Koret Way, San Francisco, CA 94143, United States
| | - Shan C Lin
- Koret Vision Center, Department of Ophthalmology, University of California, San Francisco Medical School, 10 Koret Way, San Francisco, CA 94143, United States.
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Kang JM, Baek SU, Chansangpetch S, Perez CI, Wang D, He M, Nguyen A, Park KH, Lin SC. Comparison of Anterior Segment Parameters among Koreans, Chinese, and White Persons. Ophthalmol Glaucoma 2018; 1:182-188. [PMID: 32672651 DOI: 10.1016/j.ogla.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To evaluate anterior segment (AS) parameters obtained by AS OCT within an urban Korean population and to compare them with measurements seen in Chinese and white participants. DESIGN Prospective, cross-sectional, clinic-based study. PARTICIPANTS Three gender- and age-matched cohorts of Korean, Chinese, and white participants recruited from general ophthalmology clinics in urban academic hospital settings. METHODS Anterior segment OCT (Visante OCT; Carl Zeiss Meditec, Dublin, CA) was used to image the AS of all participants. Customized software was used to calculate AS parameters. MAIN OUTCOME MEASURES Five angle parameters (AOD500, AOD750, TISA500, TISA750, ARA), 5 iris parameters (IT750, IT2000, ITCM, Iarea, Icurv), and 5 anterior chamber parameters (ACD, ACW, ACA, ACV, LV) were compared. Anterior vault (AV), relative AV, and relative LV were also calculated. These parameters were compared across all cohorts using a Kruskal-Wallis test. General linear models were built to assess pairwise comparison between Korean and Chinese and between Korean and white cohorts. Two-sided P values less than 0.05 were considered statistically significant. We also considered Bonferroni correction to control family-wise type 1 error (ɑFW = 0.05 / 18 = 0.003). RESULTS The study included 132, 124, and 112 participants in the Korean, Chinese, and white cohorts, respectively. Korean participants showed AS parameters similar to those of Chinese participants, with the exception of having a smaller average ACW and a larger average IT2000. Compared with white persons, Koreans showed smaller angle parameters (trabecular-iris space area measured at 500 μm and 750 μm from the SS and angle recess area), anterior chamber parameters (ACD, ACW, ACA, ACV), and thicker irises (iris thickness measured at 750 μm and 2000 μm from the SS, maximum IT at the middle one third of the iris). The Korean cohort also was noted to show a smaller average LV compared with both Chinese and white cohorts. CONCLUSIONS The Korean cohort demonstrated smaller average LV and relative LV.
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Affiliation(s)
- J Minjy Kang
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
| | - Sung Uk Baek
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sunee Chansangpetch
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Claudio I Perez
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Fundación Oftalmológica los Andes, Universidad de los Andes, Santiago, Chile
| | - Dandan Wang
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre of Eye Research Australia, University of Melbourne, Royal Victoria Eye and Ear Hospital, East Melbourne, Australia
| | - Anwell Nguyen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Shan C Lin
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California; Glaucoma Center of San Francisco, San Francisco, California
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