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Zhao R, Geng W, Wu Y, Zhang Z, Zhao B. Assessing the clinical efficacy of phacoemulsification cataract extraction in treating acute primary angle closure and fellow primary angle closure suspect eyes using AS-OCT. Front Med (Lausanne) 2024; 11:1436991. [PMID: 39380738 PMCID: PMC11458391 DOI: 10.3389/fmed.2024.1436991] [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: 05/23/2024] [Accepted: 09/12/2024] [Indexed: 10/10/2024] Open
Abstract
Purpose This study aimed to compare anterior segment parameters pre-and postoperatively in acute primary angle closure (APAC) and fellow primary angle closure suspect (PACS) eyes using anterior segment optical coherence tomography (AS-OCT) and evaluate the clinical effectiveness of cataract extraction in the treatment of APAC and fellow PACS eyes. Methods Quantitative measurements of various parameters, including anterior chamber depth (ACD), anterior chamber volume (ACV), lens vault (LV), iridocorneal angle contact index (ITCI), iris thickness (IT), iris volume (IV), and iris curvature (IC), were obtained using Tomey CASIA2 AS-OCT on 60 eyes from 30 patients (APAC eyes and their fellow PACS eyes) before and after surgery. Simultaneous analysis of the differences between the APAC eyes and fellow PACS eyes in these parameters, visual acuity (VA), and intraocular pressure (IOP) were performed. Results After surgery, both the APAC eyes and fellow PACS eyes (a total of 60 eyes) showed a significant increase in ACD and ACV, compared to preoperative measurements. Furthermore, LV and ITCI significantly decreased postoperatively. In the PACS group, IC significantly decreased postoperatively, while there was no statistically significant difference in the APAC group. In the APAC group, there was a significant decrease in IOP and improvement in VA at 1 day, 1 week, and the final follow-up compared to preoperative levels. The IOP values in the PACS group were within the normal range across various time points. VA in the PACS group showed significant improvement at 1 week postoperatively and at the final follow-up compared to preoperative levels. Significant differences of VA were observed in the initial, preoperative, first postoperative day, first postoperative week, and final follow-up, with better outcomes observed in the PACS group compared to the APAC group. Conclusion Lens extraction surgery can significantly improve anterior segment crowding in APAC and PACS eyes. For APAC eyes, combined cataract extraction with intraocular lens implantation and gonioscopy-assisted goniosynechialysis under direct visualization is feasible and safe. Further, in the fellow PACS eye of APAC patients with either significant or mild cataracts, phacoemulsification can maintain or improve preoperative visual acuity to varying degrees and stabilize IOP.
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Affiliation(s)
- Rumin Zhao
- Department of Glaucoma, Shandong Lunan Eye Hospital, Linyi, Shandong Province, China
| | - Wenhui Geng
- Department of Glaucoma, Shandong Lunan Eye Hospital, Linyi, Shandong Province, China
| | - Yunlong Wu
- Department of Glaucoma, Shandong Lunan Eye Hospital, Linyi, Shandong Province, China
| | - Zijian Zhang
- Department of Glaucoma, Shandong Lunan Eye Hospital, Linyi, Shandong Province, China
| | - Bojun Zhao
- Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Gao X, Lin F, Lu P, Xie L, Tang L, Zhu X, Zhang Y, Lv A, Tang G, Zhang H, Yan X, Song Y, Xu J, Huang J, Zhang Y, Hu K, Peng Y, Wang Z, Li X, Chen W, Wang N, Barton K, Park KH, Aung T, Weinreb RN, Lam DSC, Fan S, Tham CC, Zhang X. Efficacy and Safety of Surgical Peripheral Iridectomy, Goniosynechialysis, and Goniotomy for Advanced Primary Angle Closure Glaucoma Without Cataract: 1-Year Results of a Multicenter Study. J Glaucoma 2024; 33:632-639. [PMID: 38780279 DOI: 10.1097/ijg.0000000000002443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
PRCIS The combination of surgical peripheral iridectomy, goniosynechialysis, and goniotomy is a safe and effective surgical approach for advanced primary angle closure glaucoma without cataract. PURPOSE To evaluate the efficacy and safety of surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) in advanced primary angle closure glaucoma (PACG) eyes without cataract. PATIENTS AND METHODS A prospective multicenter observational study was performed for patients who underwent combined SPI, GSL, and GT for advanced PACG without cataract. Patients were assessed before and after the operation. Complete success was defined as achieving intraocular pressure (IOP) between 6 and 18 mm Hg with at least a 20% reduction compared with baseline, without the use of ocular hypotensive medications or reoperation. Qualified success adopted the same criteria but allowed medication use. Factors associated with surgical success were analyzed using logistic regression. RESULTS A total of 61 eyes of 50 advanced PACGs were included. All participants completed 12 months of follow-up. Thirty-six eyes (59.0%) achieved complete success, and 56 eyes (91.8%) achieved qualified success. Preoperative and postsurgical at 12 months mean IOPs were 29.7±7.7 and 16.1±4.8 mm Hg, respectively. The average number of ocular hypotensive medications decreased from 1.9 to 0.9 over 12 months. The primary complications included IOP spike (n=9), hyphema (n=7), and shallow anterior chamber (n=3). Regression analysis indicated that older age (odds ratio [OR]=1.09; P =0.043) was positively associated with complete success, while a mixed angle closure mechanism (OR=0.17; P =0.036) reduced success rate. CONCLUSIONS The combination of SPI, GSL, and GT is a safe and effective surgical approach for advanced PACG without cataract. It has great potential as a first-line treatment option for these patients.
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Affiliation(s)
- Xinbo Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Lin Xie
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Li Tang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Xiaomin Zhu
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Yao Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Jiangang Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Yingzhe Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Kun Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Yuying Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Zhenyu Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Keith Barton
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, CA
| | - Dennis S C Lam
- International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
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Yan C, Yu Y, Wang W, Han Y, Yao K. Long-term effects of mild cataract extraction versus laser peripheral iridotomy on anterior chamber morphology in primary angle-closure suspect eyes. Br J Ophthalmol 2024; 108:812-817. [PMID: 36746613 DOI: 10.1136/bjo-2022-322698] [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: 10/07/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
AIM To compare lens extraction (LE) and laser peripheral iridotomy (LPI) on anterior segment morphology in primary angle-closure suspect (PACS) eyes. METHODS This prospective clinical trial included 144 patients with PACS who underwent either LPI or LE. Ultrasound biomicroscopy (UBM) and gonioscopy were performed before and 1 month and 2 years after operation. Main outcomes included UBM parameters and the percentage of residual angle closure. RESULTS At both 1 month and 2 years of follow-up, LE showed a better effect of relieving anterior chamber crowding and widening the drainage angle, as obtaining a larger anterior chamber depth (ACD), angle opening distance, trabecular iris angle (TIA), trabecular iris space area, trabecular ciliary process distance (TCPD) and a smaller iris curvature (I-Curv) and lens vault (LV) (p<0.001). In the LPI group, angle width increased (angle opening distance at 500 µm from the scleral spur, TIA and trabecular iris space area at 500 µm from the scleral spur) and I-Curv decreased (p<0.001) at 1 month postoperatively, with no significant changes in ACD, LV or TCPD. However, at 2 years after LPI, the angle narrowed with the increase in LV over time, and the proportion of residual angle closure also increased from 21.7% to 30.4% (p<0.001). In contrast, after LE, the widened angle width, flattened iris, deepened ACD, decreased LV and increased TCPD all showed good sustainability in the comparison between 1-month and 2-year follow-up. No residual angle closure was observed either at 1 month or 2 years after LE. CONCLUSIONS LE was prior to LPI in widening the drainage angle. After LPI, there was a narrowing of the angle and an increase in the proportion of residual angle closure over time. LE could achieve a wider angle with no residual angle closure, and the anterior segment parameters were sustainable. TRIAL REGISTRATION NUMBER ChiCTR1800016511.
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Affiliation(s)
- Chenxi Yan
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yibo Yu
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wei Wang
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Han
- Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA
| | - Ke Yao
- Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Cho HK, Kee C. Longitudinal Rates of Change in Structural Parameters of Optical Coherence Tomography in Primary Angle Closure Glaucoma following Laser Iridotomy along with Peripheral Iridoplasty. J Ophthalmol 2024; 2024:9978354. [PMID: 38445101 PMCID: PMC10914411 DOI: 10.1155/2024/9978354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 03/07/2024] Open
Abstract
Background This study aimed to investigate longitudinal rates of change (LRCs) of structural parameters from optical coherence tomography (OCT) in patients with primary angle closure glaucoma (PACG) after laser iridotomy (LI) along with laser peripheral iridoplasty (PI). Methods Among 146 patients diagnosed with PACG, thirty-two subjects (32 eyes) who underwent LI plus PI and accomplished more than five times of reliable OCT tests were included in the current retrospective study. Retinal nerve fiber layer (RNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) were measured by spectral-domain OCT with three month interval. LRCs of global and six Garway-Heath sectors were investigated using the linear mixed-effects model which adjusted BMO area, sex, and age. Imaging of dual Scheimpflug analyzer was performed before and at 1 week after LI with PI and yearly thereafter. Results The mean follow-up period was 32.28 ± 13.34 months with a mean number of 10.18 ± 3.33 OCT images. Baseline characteristics are as follows: age, 63 ± 7.9 years; female, 62.5%; intraocular pressure(IOP), 15.48 ± 4.79 mmHg; anterior chamber depth, 2.09 ± 0.18 mm; and mean deviation, -7.97 ± 8.48 dB. Global LRC of BMO-MRW was 0.86 ± 1.34 μm/yr and RNFL was -0.64 ± 0.22 μm/yr. IOP decreased significantly to 13.06 ± 2.21 mmHg (p=0.001) while anterior chamber volume (p=0.011) and mean anterior chamber angle (p=0.022) increased significantly after LI along with PI compared to the baseline at the final visit. Conclusions LRC of a new parameter, BMO-MRW, and LRC of RNFL were relatively low in patients with PACG, following LI along with PI. After widening of the anterior chamber angle and decrease of IOP due to LI plus PI, PACG might show stable structural prognosis assessed by OCT.
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Affiliation(s)
- Hyun-Kyung Cho
- Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Gyeongsang National University, School of Medicine, Changwon, Republic of Korea
- Institute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - Changwon Kee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Anbar MA, Mahmoud HA, Abdellah MM. Angle, anterior chamber parameters, and intraocular pressure changes after early phacoemulsification in acute angle-closure glaucoma. J Cataract Refract Surg 2023; 49:1147-1152. [PMID: 37586101 DOI: 10.1097/j.jcrs.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/06/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of phacoemulsification as a first line treatment of acute angle closure glaucoma (AACG) and to evaluate the preoperative and postoperative anterior chamber angle width and anterior chamber parameters using anterior segment OCT(AS-OCT) and Pentacam. SITTINGS Sohag University Hospital, Sohag city, Egypt. DESIGN Prospective comparative interventional case series study. METHODS Patients presented with AACG. After control of high intraocular pressure (IOP), all participants were scheduled for phacoemulsification within a week after the attack. Preoperative and postoperative angle width, anterior chamber volume and anterior chamber depth was measured by AS-OCT and Pentacam to evaluate angle changes. RESULTS Fifty eyes with AACG were enrolled in the study. The mean IOP was lowered significantly from 40.23 ± 10.4 mmHg preoperatively to 11.4 ± 3.3 mmHg 3 months after surgery. The mean preoperative temporal angle widened from 18.13 ± 3.65 degree to 36.16 ± 4.46 3 months after phacoemulsification. Also, the mean preoperative nasal angle widened from 17.80 ± 3.45 preoperatively to 36.18 ± 4.47 3-month postoperative. The mean preoperative AC volume was 49.4 ± 5.73 μL. After surgery the AC volume increased significantly to 138.2 ± 29.78 μL. The mean preoperative ACD was 1.58 ± 0.12 mm that deepened significantly after surgery to 3.19 ± 0.43 mm. CONCLUSION Early phacoemulsification is very effective in treatment of AACG cases immediately after medical control of high IOP and resolution of corneal oedema. This was proved by imaging and measuring the angle width, anterior chamber volume and anterior chamber depth using AS- OCT and Pentacam.
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Affiliation(s)
- Mohamed A Anbar
- From the Department of Ophthalmology, Sohag University, Sohag, Egypt
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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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Supakontanasan W, Suwan Y, Nilphatanakorn S, Teekhasaenee C, Tantraworasin A, Petpiroon P. Twenty-Four-Hour Intraocular Pressure in Chronic Primary Angle-Closure Disease. J Glaucoma 2023; 32:854-859. [PMID: 37566875 PMCID: PMC10538605 DOI: 10.1097/ijg.0000000000002280] [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: 02/07/2023] [Accepted: 07/16/2023] [Indexed: 08/13/2023]
Abstract
PRCIS Primary angle closure and primary angle closure glaucoma may exhibit normal intraocular pressure. Twenty-four-hour intraocular pressure fluctuation is highest in primary angle closure glaucoma. The degree of peripheral anterior synechiae was associated with a 24-hour intraocular pressure pattern in primary angle-closure disease without laser iridotomy. PURPOSE The purpose of this study was to study 24-hour intraocular pressure (IOP) patterns in eyes with chronic primary angle-closure disease and evaluate associations between peripheral anterior synechiae (PAS) and 24-hour IOP pattern. PATIENTS AND METHODS In this prospective cohort study, 59 eyes of 35 Asian patients with chronic primary angle-closure disease underwent complete ocular examinations at Ramathibodi Hospital, Mahidol University. Twenty-four-hour IOP records were obtained using Goldmann applanation tonometry at 2-hour intervals. Peak, mean, and trough 24-hour IOP values and 24-hour IOP fluctuation (difference between peak and trough values) were compared among groups. None of the participants received any treatment before complete data collection. RESULTS Even univariable analysis demonstrated a significant difference in peak, mean, and trough IOP and 24-hour IOP fluctuation between the 3 groups; the magnitude of trough IOP was not higher than 21 mmHg in all groups. In multivariable analysis, PAC and PACG eyes showed significantly higher peak IOP ( P =0.020 and 0.006, respectively) and 24-hour IOP fluctuation ( P =0.048 and 0.001, respectively) compared with PACS eyes. In comparison between combined PACS and PAC eyes versus PACG eyes, PACG eyes revealed significantly higher 24-hour IOP fluctuation. The degree of PAS was associated with peak and mean IOP values and with 24-hour IOP fluctuation in PAC and PACG eyes. CONCLUSIONS Twenty-four-hour IOP fluctuation was highest in PACG eyes. Although PAC and PACG eyes showed higher peak IOP and 24-hour IOP fluctuation values, compared with PACS eyes, trough IOP in PAC and PACG eyes were mostly below 21 mmHg. In addition, the degree of PAS was associated with a 24-hour IOP pattern in either PAC or PACG eyes.
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Affiliation(s)
- Wasu Supakontanasan
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
| | - Yanin Suwan
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
| | - Suthaphat Nilphatanakorn
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
| | - Chaiwat Teekhasaenee
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
| | - Apichat Tantraworasin
- Department of Surgery and Clinical Epidemiology, Clinical Statistic Center, Faculty of Medicine
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Purit Petpiroon
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
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Yang H, Qian D, Chan G, Wang J, Sun X, Chen Y. Influence of miosis and laser peripheral iridotomy on intraocular lens power calculation in patients with primary angle closure disease. Eye (Lond) 2023; 37:2744-2752. [PMID: 36707639 PMCID: PMC10482892 DOI: 10.1038/s41433-023-02408-z] [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: 08/07/2022] [Revised: 11/28/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To evaluate the effect of miosis and laser peripheral iridotomy (LPI) on intraocular lens (IOL) power prediction and ocular biometry in eyes with primary angle closure disease (PACD). METHODS In this prospective observational study, primary angle closure suspects (PACS), and subjects classified with primary angle closure (PAC)/primary angle-closure glaucoma (PACG) undergoing LPI were enrolled. Ocular biometric parameters were measured with IOLMaster700 at baseline (T0), one week after pilocarpine instillation (T1), and another week post LPI (T2). Biometric changes and the IOL power predicted for emmetropia using Barrett Universal II, Haigis, Holladay2, Hoffer Q and SRK/T formulae were analysed and compared among different time points. RESULTS 100 eyes of 50 PACS and 50 PAC/PACG patients were enrolled. Following pilocarpine-induced miosis, lens thickness (LT) increased and anterior chamber depth (ACD) decreased (all groups p < 0.01), while white-to-white diameter decreased and central corneal thickness increased significantly only in the PACS cohort (both p < 0.01). Compared to baseline, LPI induced an increase of ACD and a slight decrease of LT in PACS (both p < 0.01), whereas only axial length changed significantly (p = 0.012) in the PAC/PACG cohort. Regardless of the formula used, no significant difference to the predicted IOL power for emmetropia existed among the three time points in each group (all p > 0.1). CONCLUSION We report the changes of anterior segment parameters induced by miosis and LPI in PACD. These interventions do not significantly affect the IOL power calculation predicted for emmetropia in Chinese eyes when common third-, fourth-and new generation IOL formulae are used.
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Affiliation(s)
- Hongfang Yang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Dongjin Qian
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Geoffrey Chan
- Lions Eye Institute, University of Western Australia, Perth, WA, Australia
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, WA, Australia
| | - Jiajian Wang
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China.
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China.
| | - Yuhong Chen
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China.
- Department of Ophthalmology & Visual Science, Shanghai Medical College, Fudan University, Shanghai, China.
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China.
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Parajuli S, Sharma S, Adhikary R, Malla D, Shrestha R, Shakya P, Parajuli S. Comparative study of the effects of laser peripheral iridotomy and cataract surgery on anterior chamber angle parameters in primary angle closure suspect patients. BMJ Open Ophthalmol 2023; 8:e001339. [PMID: 37620109 PMCID: PMC10450083 DOI: 10.1136/bmjophth-2023-001339] [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: 05/16/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Prophylactic laser peripheral iridotomy (LPI) and cataract surgery are considered the primary treatments for primary angle closure suspect (PACS) as they have proven effectiveness in widening the iridocorneal angle and addressing the underlying anatomical issues associated with this condition. The objective of this study is to compare the impact of LPI and cataract surgery on anterior chamber angle parameters, aiming to fill the existing research gap. METHODOLOGY A prospective comparative study was conducted, involving 76 eyes of 61 patients. The study focused on patients diagnosed with PACSs and early cataract. The patients received treatment either through LPI or cataract surgery. Comprehensive eye examination was performed, including gonioscopy and anterior segment parameters were measured using anterior segment ocular coherence tomography (ASOCT). Follow-up examinations were conducted at 1 week and 1 month after the procedures, which included ASOCT and gonioscopy performed during the 1-month follow-up. RESULTS All anterior chamber angle parameters increased significantly after treatment in both groups, including trabecular iris angle (TIA), angle opening distance at 250, 500 and 750 µm (AOD 250, AOD500, AOD750), trabecular iris surface area at 500 and 750 µm (TISA500, TISA750) and angle recess area at 500 and 750 µm from scleral spur (ARA500, ARA750) (p<0.05 for all). Moreover, all these parameters were greater after cataract surgery than after LPI (p<0.05 for all). CONCLUSION Compared with LPI, cataract extraction resulted in a wider anterior chamber angle. Moreover, no residual angle closure was observed after cataract extraction, which could morphologically prevent the progress of angle closure. Thus, cataract extraction is superior to LPI in PACSs with early cataract in widening the anterior chamber angle.
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Affiliation(s)
- Sanket Parajuli
- Ophthalmology, Reiyukai Eiko Masunaga Eye Hospital, Banepa, Nepal
| | - Sadhana Sharma
- Department of Vitreo-retinal surgery, B.P Koirala lions center for Ophthalmic studies,Institute of Medicine, Kathmandu, Nepal
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Yuan Y, Wang W, Xiong R, Zhang J, Li C, Yang S, Friedman DS, Foster PJ, He M. Fourteen-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle-Closure Prevention Study: Extended Follow-up of a Randomized Controlled Trial. Ophthalmology 2023; 130:786-794. [PMID: 37030454 DOI: 10.1016/j.ophtha.2023.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/21/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023] Open
Abstract
PURPOSE This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC). DESIGN Extended follow-up of the Zhongshan Angle-Closure Prevention Study. PARTICIPANTS Eight hundred eighty-nine Chinese patients 50 to 70 years of age with bilateral PACS. METHODS Each patient received LPI in 1 randomly selected eye, with the fellow untreated eye serving as a control. Because the risk of glaucoma was low and acute angle closure (AAC) occurred only rarely, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit. MAIN OUTCOME MEASURES Incidence of PAC, a composite end point including peripheral anterior synechiae, intraocular pressure (IOP) of > 24 mmHg, or AAC. RESULTS During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary end points (P < 0.01). Within them, 1 LPI-treated eye and 5 control eyes progressed to AAC. Primary angle-closure glaucoma was found in 2 LPI-treated eyes and 4 control eyes. The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21-0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes showed more severe nuclear cataract, higher IOP, and larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and greater central anterior chamber depth (CACD) were associated with an increased risk of end points developing in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after the darkroom prone provocative test (DRPPT) were more likely to demonstrate PAC after LPI. CONCLUIONS Despite a two-third decrease in PAC occurrence after LPI, the cumulative risk of progression was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and to guide clinical practice. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Yixiong Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China.
| | - Ruilin Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Cong Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shaopeng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Paul J Foster
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom, London, United Kingdom
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia; School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
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Kurysheva NI, Pomerantsev AL, Rodionova OY, Sharova GA. Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning. J Glaucoma 2023; 32:e43-e55. [PMID: 36730130 DOI: 10.1097/ijg.0000000000002145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
PRCIS Treatment strategy of primary angle closure (PAC) is not clear due to the large number of clinical and anatomic-topographic parameters in PAC, influencing the treatment algorithm. Using the machine learning method DD-SIMCA, we justify the expediency of early lens extraction (LE) in PAC. PURPOSE To compare the anatomic and functional efficacy of LE and laser peripheral iridotomy (LPI) in patients with PAC using Machine Learning. MATERIALS AND METHODS This prospective study included 120 patients aged 41-80 years: 60 eyes with PAC, 30 with PAC suspects, and 30 with healthy eyes (control). Thirty PAC eyes with intraocular pressure (IOP) up to 30 mm Hg were treated using LE with intraocular lens implantation and 30 eyes with LPI. All subjects underwent Swept Source optical coherence tomography. We analyzed 35 parameters of each eye including the lens vault, the choroidal thickness, the anterior chamber angle, and iris specifications such as iris curvature. Considering the correlations between them, the machine learning method DD-SIMCA 1-class classification was applied: the proximity of each sample to the target class (control) was characterized by the total distance to it. RESULTS After LE, IOP was significantly lower than after LPI ( P =0). Every third eye with PAC after LE reached the target class: specificity according to DD-SIMCA equals 0.67. This was not observed for the eyes after LPI: specificity equals 1.0. After LE, all parameters of the anterior chamber angle did not differ from the control (all P >0.05). After LPI, there was an increase in anterior chamber depth ( P =0) and a decrease in lens vault ( P =0), but results comparable to the control were achieved only for iris curvature ( P =1.000). CONCLUSION The efficacy of LE in PAC is higher than LPI due to the better postoperative anterior chamber topography and lower IOP. This study lends further clinical and anatomic support to the emerging notion of LE as an effective treatment for PAC.
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Qin J, Zhang Y, Zhang C, Niu Y, Yang F, Wang X, Li X, Yu Y. Efficacy and safety of laser peripheral iridoplasty with different energy levels and locations in the treatment of primary angle closure disease assessed by swept-source anterior segment optical coherence tomography. BMC Ophthalmol 2023; 23:149. [PMID: 37041488 PMCID: PMC10088107 DOI: 10.1186/s12886-023-02899-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To explore the efficacy and safety of laser peripheral iridoplasty (LPIp) with different energy levels and locations in the treatment of primary angle closure disease (PACD) assessed by swept-source anterior segment optical coherence tomography (AS-OCT). METHODS We enrolled patients with PACD following best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber gonioscopy, ultrasound biomicroscopy(UBM), optic disc OCT, and visual field examinations. After Pentacam and AS-OCT measurements, the patients were randomly divided into four treatment groups for LPIp with two different energy levels (high vs. low energy) and two locations (far from the periphery vs. near the periphery) and combined with laser peripheral iridotomy. BCVA, IOP, pupil diameter, central anterior chamber depth, anterior chamber volume, anterior opening distance (AOD)500, AOD750, trabecular iris angle (TIA)500, and TIA750 in four quadrants before and after laser treatment were compared. RESULTS We followed up 32 patients (64 eyes; average age, 61.80 ± 9.79 years; 8 patients/16 eyes per group) for up to 2 years. The IOP of all enrolled patients was decreased after surgery compared to that before (t = 3.297, P = 0.002), the volume of the anterior chamber was increased (t=-2.047, P = 0.047), and AOD500, AOD750, TIA500, and TIA750 were increased (all P < 0.05). Within-group comparisons showed that BCVA in the low-energy/far-periphery group was improved after surgery (P < 0.05). After surgery, the IOP was decreased in the two high-energy groups, whereas the volume of the anterior chamber, AOD500, AOD750, TIA500, and TIA750 were increased in all groups (all P < 0.05). However, when comparing every two groups, the high-energy/far-periphery group showed a stronger effect on pupil dilation than the low-energy/near-periphery group (P = 0.045). The anterior chamber volume in the high-energy/near-periphery group was larger than that in the high-energy/far-periphery group (P = 0.038). The change in TIA500 was for 6 points smaller in the low-energy/near-periphery group than in the low-energy/far-periphery group (P = 0.038). Other parameters showed no significant group differences. CONCLUSION LPIp combined with iridotomy can effectively reduce IOP, increase anterior chamber volume, increase chamber angle opening distance, and widen the trabecular iris angle. Intraoperatively, high-energy laser spots positioned one spot diameter from the scleral spur can obtain the best effect and safety. Swept-source AS-OCT can safely and effectively quantify the anterior chamber angle.
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Affiliation(s)
- Jiayin Qin
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China.
| | - Yan Zhang
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Chengxia Zhang
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Yaqian Niu
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Fei Yang
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Xijuan Wang
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Xiaochun Li
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
| | - Yang Yu
- Department of Ophthalmology, Peking University International Hospital, Life Park Road No. 1, Life Science Park of Zhong Guancun, Changping District, Beijing, 102206, China
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Savur S, Kaup S, Dinesh A, Shivalli S, Kondal D. Can ultrasonic biometric indices with optimal cut-offs be a potential screening tool for primary angle closure disease? A case-control study. Eye (Lond) 2023; 37:1284-1289. [PMID: 35624303 PMCID: PMC10101967 DOI: 10.1038/s41433-022-02118-y] [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: 11/11/2021] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES Despite a significant disease burden and potential to cause blindness, primary angle closure disease (PACD) does not have a population-based screening programme. Biometric indices using ultrasound A-scan is a potential tool for glaucoma case-detection. Given that genetic and environmental factors influence these parameters and paucity of data on their discrimination thresholds in Indian populace, we conducted a matched case-control study to determine the biometric indices and their discrimination thresholds associated with PACD. METHODS We studied 172 eyes of 86 participants (43 cases; 43 controls). We compared the following biometric parameters of cases (PACD, occludable angle ≥180° ± raised intraocular pressure) with age and gender-matched controls (1:1): Anterior chamber depth (ACD), lens thickness (LT), axial length (AXL), lens position (LP), relative lens position (RLP), lens axial factor (LAF), simple crowding value (Cs), ACD/AXL). We performed conditional logistic regression (to identify factors associated with PACD) and Receiver operating characteristic (ROC) analysis (to determine discrimination thresholds). RESULTS Reduced ACD (Adj OR 0.01; 95% CI: 0.0003-0.15, p < 0.001) and increased LT (Adj OR 10.3; 95% CI:2.42-43.93, p < 0.001) were associated with PACD. On ROC analysis, ACD, Cs, and ACD/AXL had optimum sensitivity/specificity at ≤3.015, ≥0.056 and ≤0.1303, respectively. ACD (88.4%) and Cs (94.2%) had highest sensitivity and specificity, respectively. CONCLUSION Ultrasonic biometric parameters differed significantly between PACD and controls. ACD and Cs (at discrimination thresholds of ≤3.015 mm and ≥ 0.056, respectively) using ultrasound A-scan could be a potential tool for PACD case-detection that requires evaluation of its diagnostic yield and cost-effectiveness.
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Affiliation(s)
- Sheetal Savur
- Department of Ophthalmology, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, India
| | - Soujanya Kaup
- Department of Ophthalmology, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, India.
| | - Anagha Dinesh
- Department of Ophthalmology, Yenepoya Medical College, Yenepoya Deemed to be University, Mangalore, India
| | - Siddharudha Shivalli
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Dimple Kondal
- Public Health Foundation of India, Gurgaon, India
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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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: 12] [Impact Index Per Article: 12.0] [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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Shen A, Chiang M, Pardeshi AA, McKean-Cowdin R, Varma R, Xu BY. Anterior segment biometric measurements explain misclassifications by a deep learning classifier for detecting gonioscopic angle closure. Br J Ophthalmol 2023; 107:349-354. [PMID: 34615666 PMCID: PMC8983788 DOI: 10.1136/bjophthalmol-2021-319058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To identify biometric parameters that explain misclassifications by a deep learning classifier for detecting gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images. METHODS Chinese American Eye Study (CHES) participants underwent gonioscopy and AS-OCT of each angle quadrant. A subset of CHES AS-OCT images were analysed using a deep learning classifier to detect positive angle closure based on manual gonioscopy by a reference human examiner. Parameter measurements were compared between four prediction classes: true positives (TPs), true negatives (TNs), false positives (FPs) and false negatives (FN). Logistic regression models were developed to differentiate between true and false predictions. Performance was assessed using area under the receiver operating curve (AUC) and classifier accuracy metrics. RESULTS 584 images from 127 participants were analysed, yielding 271 TPs, 224 TNs, 77 FPs and 12 FNs. Parameter measurements differed (p<0.001) between prediction classes among anterior segment parameters, including iris curvature (IC) and lens vault (LV), and angle parameters, including angle opening distance (AOD). FP resembled TP more than FN and TN in terms of anterior segment parameters (steeper IC and higher LV), but resembled TN more than TP and FN in terms of angle parameters (wider AOD). Models for detecting FP (AUC=0.752) and FN (AUC=0.838) improved classifier accuracy from 84.8% to 89.0%. CONCLUSIONS Misclassifications by an OCT-based deep learning classifier for detecting gonioscopic angle closure are explained by disagreement between anterior segment and angle parameters. This finding could be used to improve classifier performance and highlights differences between gonioscopic and AS-OCT definitions of angle closure.
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Affiliation(s)
- Alice Shen
- Department of Ophthalmology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Michael Chiang
- Department of Ophthalmology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Anmol A Pardeshi
- Department of Ophthalmology, USC Keck School of Medicine, Los Angeles, California, USA
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California, USA
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, USA
| | - Benjamin Y Xu
- Department of Ophthalmology, USC Keck School of Medicine, Los Angeles, California, USA
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Rouse B, Le JT, Gazzard G. Iridotomy to slow progression of visual field loss in angle-closure glaucoma. Cochrane Database Syst Rev 2023; 1:CD012270. [PMID: 36621864 PMCID: PMC9827451 DOI: 10.1002/14651858.cd012270.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Primary angle-closure glaucoma is a type of glaucoma associated with a physically obstructed anterior chamber angle. For example, contact between the iris and lens at the pupillary margin creates a pupillary block that increases resistance to aqueous outflow. Obstruction of the anterior chamber angle blocks drainage of fluids (aqueous humor) within the eye and may raise intraocular pressure (IOP). Elevated IOP is associated with glaucomatous optic nerve damage and visual field loss. Laser peripheral iridotomy ('iridotomy') is a procedure to eliminate pupillary block by allowing aqueous humor to pass directly from the posterior to anterior chamber, which is achieved by creating a hole in the iris using laser. Iridotomy is used to treat patients with primary angle-closure glaucoma, patients with primary angle-closure (narrow angles and no signs of glaucomatous optic neuropathy), and patients who are primary angle-closure suspects (patients with reversible obstruction). However, the effectiveness of iridotomy on slowing progression of visual field loss is uncertain. OBJECTIVES To assess the effects of iridotomy compared with no iridotomy for primary angle-closure glaucoma, primary angle-closure, and primary angle-closure suspect. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 10), which contains the Cochrane Eyes and Vision Trials Register; MEDLINE Ovid; Embase Ovid; PubMed; LILACS; ClinicalTrials.gov; and the WHO ICTRP. The date of the most recent search was 10 October 2021. SELECTION CRITERIA Randomized or quasi-randomized controlled trials that compared iridotomy with no iridotomy in primary angle-closure suspects, people with primary angle-closure, or people with primary angle-closure glaucoma in one or both eyes were eligible. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and assessed the certainty of the body of evidence for prespecified outcomes using the GRADE approach. MAIN RESULTS We identified four studies (3086 eyes of 1543 participants) that compared iridotomy with no iridotomy in participants (range of mean age 59.6 to 62.9 years) who were primary angle-closure suspects from China, Singapore, or the UK. Study investigators randomized one eye of each participant to iridotomy and the other to no iridotomy. Two studies provided long-term (five or more years) results. We judged the certainty of the evidence as moderate to low across the prespecified outcomes, downgrading for high risk of bias (e.g. performance and detection biases) and imprecision of results. Meta-analyses of data from two studies suggest that iridotomy probably results in little to no difference in IOP compared with no iridotomy at one year (mean difference (MD) 0.04 mm Hg, 95% confidence interval (CI) -0.17 to 0.24; I2 = 65%; 2598 eyes of 1299 participants; moderate certainty evidence) and five years (MD 0.12 mm Hg, 95% CI -0.11 to 0.35; I2 = 0%; 2016 eyes of 1008 participants), and in best-corrected visual acuity measured as logMAR at one year (MD 0.00, 95% CI -0.01 to 0.01; I2 = 69%; 2596 eyes of 1298 participants; moderate certainty evidence) and five years (MD 0.01, 95% CI -0.01 to 0.03; I2 = 0%; 2002 eyes of 1001 participants). In terms of gonioscopic findings, eyes treated with iridotomy likely had wider angles in Shaffer grading scale (MD 4.93 units, 95% CI 4.73 to 5.12; I2 = 59%; 2598 eyes of 1299 participants at one year; MD 5.07, 95% CI 4.78 to 5.36; I2 = 97%; 2016 eyes of 1008 participants at five years; moderate certainty evidence) and experienced fewer peripheral anterior synechiae (PAS) than eyes that received no iridotomy at five years (risk ratio (RR) 0.41, 95% CI 0.24 to 0.67; I2 = 28%; 2 studies, 2738 eyes of 1369 participants), but the evidence was less conclusive at one year (RR 0.62, 95% CI 0.25 to 1.54; I2 = 57%; 3 studies, 2896 eyes of 1448 participants; low certainty evidence). No studies reported data on the proportion of participants with progressive visual field loss during follow-up (the primary outcome of this review), mean number of medications to control IOP, or quality of life outcomes. Low certainty evidence suggests that iridotomy may result in little to no difference in the incidence of acute angle-closure (RR 0.29, 95% CI 0.07 to 1.20; I2 = 0%; 3 studies, 3006 eyes of 1503 participants). Other ocular adverse events (e.g. eye pain, dry eye, redness of eyes, and ocular discomfort), although rare, were more common in eyes treated with iridotomy than in eyes in the control group. AUTHORS' CONCLUSIONS: We did not find sufficient evidence to draw any meaningful conclusions on the use of iridotomy for the purpose of slowing progression of visual field loss. No study reported on progressive visual field loss, the primary outcome of this review. Although there is moderate certainty evidence that iridotomy results in improved gonioscopic findings, in is unclear if these findings translate to clinically meaningful benefits.
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Affiliation(s)
- Benjamin Rouse
- Center for Clinical Excellence, ECRI, Plymouth Meeting, PA, USA
| | - Jimmy T Le
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gus Gazzard
- Glaucoma Service & NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Yang S, Zhang J, Tan Y, Wang Y. Unraveling the mechanobiology of cornea: From bench side to the clinic. Front Bioeng Biotechnol 2022; 10:953590. [PMID: 36263359 PMCID: PMC9573972 DOI: 10.3389/fbioe.2022.953590] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
The cornea is a transparent, dome-shaped structure on the front part of the eye that serves as a major optic element and a protector from the external environment. Recent evidence shows aberrant alterations of the corneal mechano-environment in development and progression of various corneal diseases. It is, thus, critical to understand how corneal cells sense and respond to mechanical signals in physiological and pathological conditions. In this review, we summarize the corneal mechano-environment and discuss the impact of these mechanical cues on cellular functions from the bench side (in a laboratory research setting). From a clinical perspective, we comprehensively review the mechanical changes of corneal tissue in several cornea-related diseases, including keratoconus, myopia, and keratectasia, following refractive surgery. The findings from the bench side and clinic underscore the involvement of mechanical cues in corneal disorders, which may open a new avenue for development of novel therapeutic strategies by targeting corneal mechanics.
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Affiliation(s)
- Shu Yang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin, China
- Department of Ophthalmology, The First People’s Hospital of Huzhou, Huzhou, Zhejiang, China
| | - Jing Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin, China
- School of Optometry, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Youhua Tan
- Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
- Department of Biomedical Engineering, Hong Kong Polytechnic University, Hong Kong SAR, China
- *Correspondence: Youhua Tan, ; Yan Wang,
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin, China
- *Correspondence: Youhua Tan, ; Yan Wang,
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18
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Angle Closure Glaucoma—Update on Treatment Paradigms. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Yu B, Wang K, Zhang X, Xing X. Biometric indicators of anterior segment parameters before and after laser peripheral iridotomy by swept-source optical coherent tomography. BMC Ophthalmol 2022; 22:222. [PMID: 35578256 PMCID: PMC9109390 DOI: 10.1186/s12886-022-02448-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
Background Primary angle closure glaucoma (PACG) is the most common type of glaucoma in China. Laser peripheral iridotomy (LPI) is the primary choice to treat PAC: We aim to evaluate the changes of biometric parameters of anterior segment and to find possible biometric predictors of the effect of laser peripheral iridotomy (LPI) in primary angle closure (PAC) eyes using swept-source optical coherent tomography (OCT). Methods LPI was performed in 52 PAC eyes of 28 participants. The change of intraocular pressure and anterior segment parameters, including angle opening distance (AOD500), AOD500 area, trabecular iris space area (TISA500), TISA500 volume, trabecular iris angle (TIA500), iridotrabecular contact (ITC) index, ITC area, anterior chamber volume (ACV), anterior chamber depth (ACD), lens vault (LV) and lens thickness (LT) before and 1 week after LPI were measured by Tomey CASIA2 anterior segment OCT. We also estimate and analyze potential associated factors possibly affecting the change of anterior chamber parameters. Results No post-laser complications were found. The ACD, LV and LT did not change significantly 1 week after LPI. AOD500, AOD500 area, TISA500, TISA500 volume, TIA500, ACV increased significantly after LPI. There was significant decrease in ITC index and ITC area. LT was positively correlated to the change of ITC index (β = 0.239, *p = 0.045). Conclusions The anterior segment architecture significantly changed after LPI in PAC spectrum eyes. Crystalline lens measurements remained unchanged before and after LPI. AS-OCT can be used to follow anterior chamber parameter changes in PAC spectrum eyes. LT may play a role in the therapeutic effect of LPI.
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Affiliation(s)
- Bo Yu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, No. 251, Fukang Road, Tianjin, 300384, China
| | - Kang Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, No. 251, Fukang Road, Tianjin, 300384, China
| | - Xiaomin Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, No. 251, Fukang Road, Tianjin, 300384, China.
| | - Xiaoli Xing
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Nankai District, No. 251, Fukang Road, Tianjin, 300384, China.
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20
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Wanichwecharungruang B, Amornpetchsathaporn A, Wongwijitsook W, Kongsomboon K, Chantra S. Evaluation of ocular biometry in primary angle-closure disease with two swept source optical coherence tomography devices. PLoS One 2022; 17:e0265844. [PMID: 35312733 PMCID: PMC8936461 DOI: 10.1371/journal.pone.0265844] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
To investigate agreement between 2 swept source OCT biometers, IOL Master700 and Anterion, in various ocular biometry and intraocular lens (IOL) calculations of primary angle-closure disease (PACD).
Setting
Rajavithi Hospital, Bangkok, Thailand.
Design
Prospective comparative study.
Methods
This study conducted in a tertiary eye care center involving biometric measurements obtained with 2 devices in phakic eye with diagnosis of PACD. Mean difference and intraclass correlation coefficient (ICC) with confidence limits were assessed, and calculations of estimated residual refraction of the IOL were analysed using Barrett’s formula.
Results
Sixty-nine eyes from 45 PACD patients were enrolled for the study. Excellent agreement of various parameters was revealed, with ICC (confidence limits) of K1 = 0.953 (0.861–0.979), K2 = 0.950 (0.778–0.98), ACD = 0.932 (0.529–0.978), WTW = 0.775 (0.477–0.888), and LT = 0.947 (0.905–0.97). Mean difference of axial length (AL) was -0.01 ± 0.02 mm with ICC of 1.000. IOL calculation was assessed with Barrett’s formula, and Bland-Altman plot showed excellent agreement in the results of the 2 devices for the IOL power and estimated post-operative residual refraction (EPR).
Conclusions
Mean differences of biometric parameters, obtained with IOL Master700 and Anterion, were small, and ICC showed excellent concordance. No clinical relevance in calculation of IOL power was found, and the two devices appeared to be comparably effective in clinical practice.
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Affiliation(s)
- Boonsong Wanichwecharungruang
- Department of Ophthalmology, Rajavithi Hospital and Rangsit Medical College, Bangkok, Thailand
- Department of Ophthalmology, Priest Hospital, Bangkok, Thailand
| | | | - Wisakorn Wongwijitsook
- Department of Ophthalmology, Rajavithi Hospital and Rangsit Medical College, Bangkok, Thailand
| | - Kittipong Kongsomboon
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Somporn Chantra
- Department of Ophthalmology, Rajavithi Hospital and Rangsit Medical College, Bangkok, Thailand
- * E-mail:
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21
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Cho HK, Choae W. Long-Term Outcome of Corneal and Anterior Chamber Angle Parameters after Combined Laser Iridotomy and Iridoplasty Using Dual Scheimpflug Analyzer: 1 Year Results. J Clin Med 2022; 11:jcm11030813. [PMID: 35160264 PMCID: PMC8836430 DOI: 10.3390/jcm11030813] [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: 12/24/2021] [Revised: 01/21/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
Background: To investigate the outcomes of corneal and anterior chamber angle (ACA) parameters after laser iridotomy (LI) combined with peripheral iridoplasty (PI) using dual Scheimpflug analyzer in the long term. Methods: Fifty-eight eyes (58 subjects) with shallow AC were included in this prospective cohort study. Images of the Dual Scheimpflug analyzer were obtained before, 1 week, and 1 year after LI and PI. Pachymetry from three zones (central, middle, and peripheral), corneal aberration, and spherical equivalent (SE) were acquired. AC depth (ACD), AC volume (ACV), ACA from four quadrants, and intraocular pressure (IOP) were also obtained. For comparison of the results, the linear mixed-effects model was employed. Results: ACD significantly increased from 2.09 ± 0.25 mm to 2.10 ± 0.23 mm at 1 year after laser (all p < 0.05). ACV and ACA increased significantly after laser at 1 year (all p < 0.05). IOP significantly decreased from 15.97 ± 4.20 mmHg to 13.73 ± 2.63 mmHg at 1 year (all p < 0.0001). No significant changes were found in the coma, trefoil, total corneal aberration, pachymetry from three zones, corneal volume, central corneal thickness, and SE after LI and PI until 1 year (all p > 0.05). Conclusions: LI plus PI ameliorated parameters of ACA efficiently and significantly reduced IOP in eyes with shallow AC until 1 year of long-term follow-up. However, parameters of the cornea and SE were not influenced by LI with PI until after 1 year.
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Affiliation(s)
- Hyun-kyung Cho
- Department of Ophthalmology, School of Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University, Changwon 51472, Korea
- lnstitute of Health Sciences, School of Medicine, Gyeongsang National University, Jinju 52727, Korea
- Correspondence: or ; Tel.: +82-55-214-2410; Fax: +82-55-214-3257
| | - Wooseok Choae
- Department of Ophthalmology, Barunsungmo Eye Clinic, Busan 49247, Korea;
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22
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Cai JC, Chen YL, Cao YH, Babenko A, Chen X. Numerical study of aqueous humor flow and iris deformation with pupillary block and the efficacy of laser peripheral iridotomy. Clin Biomech (Bristol, Avon) 2022; 92:105579. [PMID: 35085976 DOI: 10.1016/j.clinbiomech.2022.105579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Disclosing the mechanism of primary angle closure glaucoma with pupillary block is important to the diagnosis as well as treatments, such as the laser peripheral iridotomy. Comparing with abundant clinical researches, there have been fewer quantitative studies of the aqueous humor flows with synechia iris configurations, and the efficacy of laser peripheral iridotomy in treating glaucoma. METHODS Based on the mathematical models of aqueous humor flow and iris deformation, the flow fields were simulated by computational fluid dynamics with normal and synechia iris configurations (iris-lens gap of 30, 5 and 2 μm, respectively), and through one-way fluid-structure coupling technique the deformations of the iris under the flow field pressure were calculated by finite element analysis. The efficacy of glaucoma treatment with different orifice sizes was also investigated. FINDINGS Results show that the pressure difference between anterior and posterior chambers and iris deformation increase dramatically with the iris-lens gap distance less than 5 μm, and when further decreasing this gap may lead the iris touch the cornea causing angle closure glaucoma with noticeable iris bombé. Laser peripheral iridotomy simulation results show that iridotomy size of 0.2 mm can effectively decrease the pressure difference across the iris and relieve iris bombé. INTERPRETATION This is a biomechanical numerical study, and the results are reasonable compare to those of published works. It may shed additional light on the diagnosis and treatment of angle closure glaucoma with pupillary block.
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Affiliation(s)
- Jian-Cheng Cai
- College of Engineering, Zhejiang Normal University, Jinhua 321004, China.
| | - Yan-Ling Chen
- Department of Ophthalmology, Jinhua People's Hospital, Jinhua 321000, China
| | - Yue-Hong Cao
- Department of Ophthalmology, Jinhua People's Hospital, Jinhua 321000, China.
| | - Andrii Babenko
- College of Engineering, Zhejiang Normal University, Jinhua 321004, China
| | - Xi Chen
- College of Mathematics, Physics and Information Science and Engineering, Zhejiang Normal University, Jinhua 321004, China
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23
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Kurysheva NI, Sharova GA. [Primary anterior chamber angle closure: progression from suspect to glaucoma. Part 1. Frequency and rate of transition from suspected primary angle closure to true angle closure and primary angle closure glaucoma]. Vestn Oftalmol 2022; 138:101-107. [PMID: 36004598 DOI: 10.17116/oftalma2022138041101] [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] [Indexed: 06/15/2023]
Abstract
To review the literature devoted to the problem of primary anterior chamber angle closure (PAC) and the development of this pathology from glaucoma suspect to primary angle closure glaucoma. The paper includes a trend analysis of the studies concerning primary angle closure suspects (PACS). The concept of this review is conditioned by the conflicting strategies for treating patients with initial PAC without glaucomatous optic neuropathy. Solving the problem of angle closure plays a key role in preventing the development of PAC glaucoma, which is the world's leading cause of irreversible blindness. This part of the review provides information on the frequency and rate of disease progression in PACS. The analyzed literature data is contradictory and indicates the need for further search that would consider a standardized approach to defining the concept of PAC disease, demographic factors and unified examination methods for generalizing and systematizing data in order to draw out unified treatment recommendations.
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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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24
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Primary Angle-Closure Disease Preferred Practice Pattern®. Ophthalmology 2021; 128:P30-P70. [PMID: 34933744 DOI: 10.1016/j.ophtha.2020.10.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 01/10/2023] Open
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25
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Rozon JP, Des Marchais B. Recommendations for intraocular pressure measurement one hour after laser peripheral iridotomy: Review of the literature. J Fr Ophtalmol 2021; 44:1413-1418. [PMID: 34565658 DOI: 10.1016/j.jfo.2021.04.014] [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: 11/16/2020] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the need to measure intraocular pressure one hour after laser peripheral iridotomy in patients with narrow angles, to determine the significance of the immediate IOP spike after LPI, and to assess risk factors associated with these. METHODS A review of the literature on IOP measurements after LPI was conducted using the PubMed databases in January 2020. RESULTS The proportion of treated eyes with an IOP spike one hour after treatment was between 6 and 9.8% depending on the study. Fewer than 1% of the eyes had an immediate post-treatment IOP of 30mmHg or more. Risk factors associated with IOP spikes include hyphema, pigment dispersion, and high pretreatment IOP. Patients of Asian descent, who possess thick irides, or any patient having thick irides, also exhibited increased risk of IOP spikes. CONCLUSIONS The majority of the studies that have evaluated this complication were conducted in an Asian population, which affects the generalisability of these results to a wider population, considering anatomical differences. Although it is not uncommon to observe IOP spikes following LPI, the majority will not experience an increase of 10mmHg from baseline or a post-LPI IOP of 30mmHg or more. Even though it has been recommended to measure the IOP of all patients one hour after an LPI in order to avoid missing a spike, we suggest measuring IOP one hour after an LPI in patients who possess at least one risk factor or if there is any preexisting damage to the optic nerve.
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Affiliation(s)
- J-P Rozon
- Medical school, Université Laval, 1050, avenue de la Médecine, G1V 0A6, Quebec, Canada
| | - B Des Marchais
- Department of Ophthalmology, Centre universitaire d'ophtalmologie, Hôpital du Saint-Sacrement, CHU de Québec, Université Laval, 1050, chemin Sainte-Foy, G1S 4L8, Québec, Canada.
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26
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Wang W, Wang L, Wang X, Zhou S, Lin S, Yang J. A Deep Learning System for Automatic Assessment of Anterior Chamber Angle in Ultrasound Biomicroscopy Images. Transl Vis Sci Technol 2021; 10:21. [PMID: 34570190 PMCID: PMC8479575 DOI: 10.1167/tvst.10.11.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose To develop and assess a deep learning system that automatically detects angle closure and quantitatively measures angle parameters from ultrasound biomicroscopy (UBM) images using a deep learning algorithm. Methods A total of 3788 UBM images (2146 open angle and 1642 angle closure) from 1483 patients were collected. We developed a convolutional neural network (CNN) based on the InceptionV3 network for automatic classification of angle closure and open angle. For nonclosed images, we developed a CNN based on the EfficienttNetB3 network for the automatic localization of the scleral spur and the angle recess; then, the Unet network was used to segment the anterior chamber angle (ACA) tissue automatically. Based on the results of the latter two processes, we developed an algorithm to automatically measure the trabecular-iris angle (TIA500 and TIA750), angle-opening distance (AOD500 and AOD750), and angle recess area (ARA500 and ARA750) for quantitative evaluation of angle width. Results Using manual labeling as the reference standard, the ACA classification network's accuracy reached 98.18%, and the sensitivity and specificity for angle closure reached 98.74% and 97.44%, respectively. The deep learning system realized the automatic measurement of the angle parameters, and the mean of differences was generally small between automatic measurement and manual measurement. The coefficients of variation of TIA500, TIA750, AOD500, AOD750, ARA500, and ARA750 measured by the deep learning system were 5.77%, 4.67%, 10.76%, 7.71%, 16.77%, and 12.70%, respectively. The within-subject standard deviations of TIA500, TIA750, AOD500, AOD750, ARA500, and ARA750 were 5.77 degrees, 4.56 degrees, 155.92 µm, 147.51 µm, 0.10 mm2, and 0.12 mm2, respectively. The intraclass correlation coefficients of all the angle parameters were greater than 0.935. Conclusions The deep learning system can effectively and accurately evaluate the ACA automatically based on fully automated analysis of a UBM image. Translational Relevance The present work suggests that the deep learning system described here could automatically detect angle closure and quantitatively measure angle parameters from UBM images and enhancing the intelligent diagnosis and management of primary angle-closure glaucoma.
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Affiliation(s)
- Wensai Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Lingxiao Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaochun Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Sheng Zhou
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Song Lin
- Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jun Yang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
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27
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Gao X, Zhou Y, Zuo C, Chen L, Ren J, Lin H, Liao Y, Gong H, Hu H, Lin M. Predictive Equation for Angle Opening Distance at 750 μm After Laser Peripheral Iridotomy in Primary Angle Closure Suspects. Front Med (Lausanne) 2021; 8:715747. [PMID: 34458290 PMCID: PMC8387715 DOI: 10.3389/fmed.2021.715747] [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: 05/27/2021] [Accepted: 07/21/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of this study was to investigate the changes in anterior segment parameters as assessed by ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) and to propose a prediction equation for the width of the angle after LPI. Design: This was a prospective study. Participants: The participants included 100 subjects with primary angle closure suspect (PACS). Methods: Anterior segment UBM parameters were measured, whereas AOD750 was chosen to indicate the width of the angle associated with gonioscopic angle closure, as found in a prior study. Main Outcome Measures: Angle parameters, iris parameters, anterior chamber parameters and ciliary body parameters. Results: All angle parameters increased after LPI, including the mean angle opening distance at 750 μm (AOD750), mean angle opening distance at 500 μm from the scleral spur (AOD500), mean angle opening distance at 750 μm from the scleral spur (AOD750), and mean angle recess area at 750 μm from the scleral spur (ARA750). Among iris parameters and ciliary body parameters, the iris thickness at 2,000 μm (IT2000), iris curvature (IC), and trabecular-ciliary process distance (ICPD) were reduced after LPI. The final equation consisted of four parameters: anterior chamber depth (ACD), iris thickness at 750 μm from the scleral spur (IT750), AOD750, and lens vault (LV). This equation explained 42.7% of the variability in the angle opening indicator AOD750 after LPI, whereas in the plateau iris configuration subgroup, the accuracy of the prediction equation reached the highest a maximum of 68.6%. Conclusions: There was an increase in angle opening and iris flattening after LPI. An equation involving four angle parameters was constructed, this equation which could explained 42.7% of the variability in the angle opening indicator AOD750 after LPI whereas in the plateau iris configuration subgroup, the accuracy of the prediction equation reached a maximum of 68.6%.
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Affiliation(s)
- Xinbo Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yuying Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Liming Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Jiawei Ren
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huishan Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunru Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haijun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huanling Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingkai Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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28
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Mou DP, Liang YB, Fan SJ, Peng Y, Wang NL, Thomas R. Progression rate to primary angle closure following laser peripheral iridotomy in primary angle-closure suspects: a randomised study. Int J Ophthalmol 2021; 14:1179-1184. [PMID: 34414081 DOI: 10.18240/ijo.2021.08.07] [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: 01/02/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To report the progression rate (PR) to primary angle closure (PAC) following laser peripheral iridotomy (LPI) in PAC suspects (PACS). METHODS Prospective, randomized controlled interventional clinical trial conducted at the Handan Eye Hospital, China. Totally 134 bilateral PACS, defined as non-visibility of the posterior trabecular meshwork for ≥180 degrees on gonioscopy were randomly assigned to undergo LPI in one eye. Gonioscopy and Goldmann applanation tonometry were performed prior to, on day 7 and 12mo post LPI. RESULTS Eighty of 134 patients (59.7%) could be followed up at one year. The mean intraocular pressure (IOP) in treated eyes was 15.9±2.6 mm Hg at baseline, 15.4±3.0 mm Hg on day 7; 16.5±2.9 mm Hg at one month, and 15.5±2.9 mm Hg at 12mo; the IOP in untreated eyes was similar (P=0.834). One or more quadrants of the angle opened in 93.7% of the LPI treated eyes, but 67.0% (53/79) remained closed in two or more quadrants. The PR to PAC in untreated eyes was 3.75% and one developed acute angle-closure glaucoma (AACG); the PR to PAC in treated eyes was 2.5% and none had developed peripheral anterior synechia (PAS) or AACG. CONCLUSION LPI can open some of the occludable angle in the majority of eyes with PACS, but 67% continue to have non-visibility of the trabecular meshwork for over 180 degrees.
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Affiliation(s)
- Da-Peng Mou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology&Visual Science Key Lab, Beijing 100730, China
| | - Yuan-Bo Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology&Visual Science Key Lab, Beijing 100730, China.,Handan Eye Hospital, Handan 056001, Hebei Province, China
| | - Su-Jie Fan
- Handan Eye Hospital, Handan 056001, Hebei Province, China
| | - Yi Peng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology&Visual Science Key Lab, Beijing 100730, China
| | - Ning-Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology&Visual Science Key Lab, Beijing 100730, China
| | - Ravi Thomas
- Queensland Eye Institute, Brisbane 4343, Australia.,University of Queensland, Brisbane 4343, Australia
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29
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Wang W, Wang L, Wang T, Wang X, Zhou S, Yang J, Lin S. Automatic Localization of the Scleral Spur Using Deep Learning and Ultrasound Biomicroscopy. Transl Vis Sci Technol 2021; 10:28. [PMID: 34427626 PMCID: PMC8399238 DOI: 10.1167/tvst.10.9.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to develop a convolutional neural network (CNN) for automated localization of the scleral spur in ultrasound biomicroscopy (UBM) images of open-angle eyes. Methods UBM images were acquired, and one glaucoma specialist provided reference coordinates of scleral spur locations in all images. A CNN model based on the EfficientNetB3 architecture was developed to detect the scleral spur in each image. The prediction errors and Euclidean distance were used to evaluate localization performance of the CNN model. Trabecular-iris angle 500 (TIA500) and angle-opening distance 500 (AOD500) were measured and analyzed using the scleral spur locations provided by the specialist and predicted by the CNN model. Results The CNN was developed using a training dataset of 2328 images and tested using an independent dataset of 258 images. The mean absolute prediction errors of CNN model were 48.06 ± 45.40 µm for X-coordinates and 30.84 ± 27.03 µm for Y-coordinates. The mean absolute intraobserver variability was 47.80 ± 44.45 µm for X-coordinates and 29.50 ± 25.77 µm for Y-coordinates. The mean Euclidean distance of the CNN was 60.41 ± 49.02 µm and the intraobserver mean Euclidean distance was 59.78 ± 47.12 µm. The mean absolute error in TIA500 was 1.26 ± 1.38 degrees for all test images and in AOD500 was 0.039 ± 0.051 mm. Conclusions A CNN can detect the scleral spur on UBM images of open-angle eyes with performance similar to that of a glaucoma specialist. Translational Relevance Deep learning algorithms for automating scleral spur localization would facilitate the quantitative assessment of the opening of the angle and the risk in angle closure.
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Affiliation(s)
- Wensai Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Lingxiao Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Tao Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Xiaochun Wang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Sheng Zhou
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Jun Yang
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Song Lin
- Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Wanichwecharungruang B, Phumratprapin C, Kongsomboon K, Seresirikachorn K. Real-world Surgical Outcomes of Primary Angle-closure Glaucoma. Clin Ophthalmol 2021; 15:2823-2833. [PMID: 34234405 PMCID: PMC8254540 DOI: 10.2147/opth.s315747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/27/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate surgical outcomes of the four common procedures utilized for primary angle-closure glaucoma (PACG). Methods A retrospective study of survival rate in surgical management of PACG was conducted in a referral eye center. One hundred and ninety-nine eyes from 173 PACG patients were collected for chart review. The procedures used were phacoemulsification (PE), combined PE with goniosynechialysis (PE-GSL), combined PE with trabeculectomy (PE-Trab), and trabeculectomy alone. Failure was defined as postoperative IOP >21 mmHg in patients who needed second surgical intervention or those who had IOP <5 mmHg with loss of light perception. Cumulative survival rates, risk of surgical failure, and complications were analyzed. Results PE, PE-GSL, PE-Trab, and trabeculectomy were performed in 84 eyes (42.2%), 76 eyes (38.2%), 21 eyes (10.6%), and 18 eyes (9%), respectively. Cumulative survival rates at 60 months were 13%, 55%, 42% and 43%, respectively. Cox regression analysis indicated that each mmHg IOP increased, the risk of surgical failure decreased by 13% (adjusted hazard ratio (HR) 0.87; 95%CI: 0.84-0.93, p<0.001). Conclusion Real-world surgical outcomes of PACG showed that PE alone had a low survival rate of 13% in 60-month follow-up whereas PE-GSL achieved the highest rate of 55%. PE-GSL should be initially considered for management of PACG, since it can restore and sustain the physiologic aqueous pathway and preserve the conjunctiva for future filtering surgery if needed.
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Affiliation(s)
- Boonsong Wanichwecharungruang
- Glaucoma Services, Department of Ophthalmology, Rajavithi Hospital and Rangsit Medical College, Bangkok, Thailand.,Department of Ophthalmology, Priest Hospital, Bangkok, Thailand
| | - Chompunoot Phumratprapin
- Glaucoma Services, Department of Ophthalmology, Rajavithi Hospital and Rangsit Medical College, Bangkok, Thailand.,Department of Ophthalmology, Hua Chiew Hospital, Bangkok, Thailand
| | - Kittipong Kongsomboon
- Department of Preventive and Social Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Kasem Seresirikachorn
- Glaucoma Services, Department of Ophthalmology, Rajavithi Hospital and Rangsit Medical College, Bangkok, Thailand
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Li W, Chen Q, Jiang C, Shi G, Deng G, Sun X. Automatic Anterior Chamber Angle Classification Using Deep Learning System and Anterior Segment Optical Coherence Tomography Images. Transl Vis Sci Technol 2021; 10:19. [PMID: 34111263 PMCID: PMC8142723 DOI: 10.1167/tvst.10.6.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose The purpose of this study was to develop a software package for the automatic classification of anterior chamber angle using anterior segment optical coherence tomography (AS-OCT). Methods AS-OCT images were collected from subjects with open, narrow, and closure anterior chamber angles, which were graded based on ultrasound biomicroscopy (UBM) results. The Inception version 3 network and the transfer learning technique were applied in the design of an algorithm for anterior chamber angle classification. The classification performance was evaluated by fivefold cross-validation and on an independent test dataset. Results The proposed algorithm reached a sensitivity of 0.999 and specificity of 1.000 in the judgment of closed and nonclosed angles. The overall classification of the proposed method in open angle, narrow angle, and angle-closure classifications reached a sensitivity of 0.989 and specificity of 0.995. Additionally, the sensitivity and specificity reached 1.000 and 1.000 for angle-closure, 0.983 and 0.993 for narrow angle, and 0.985 and 0.991 for open angle. Conclusions The experimental results showed that the proposed method can achieve a high accuracy of anterior chamber angle classification using AS-OCT images, and could be of value in future practice. Translational Relevance The proposed deep learning-based method that automate the classification of anterior chamber angle can facilitate clinical assessment of glaucoma.
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Affiliation(s)
- Wanyue Li
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Qian Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Chunhui Jiang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Guohua Shi
- Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China
| | - Guohua Deng
- Department of Ophthalmology, the Third People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Xinghuai Sun
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University); Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, 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: 6] [Impact Index Per Article: 2.0] [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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Tang W, Zhang Z, Zhang Y, Yin X, Zhang Y, Li Q. Outcomes of effective goniosynechialysis under an endoscopic view combined with phacoemulsification in residual angle-closure glaucoma with lens opacity: 6-month results. Int Ophthalmol 2020; 40:3529-3538. [PMID: 32737725 DOI: 10.1007/s10792-020-01541-y] [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: 05/14/2020] [Accepted: 07/25/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE We aimed to evaluate the efficacy and safety of effective goniosynechialysis (GSL) under an endoscopic view combined with phacoemulsification in residual angle-closure glaucoma with lens opacity. METHODS This was a retrospective study. Patients with residual angle-closure glaucoma, lens opacity, and uncontrolled intraocular pressure (IOP) who were receiving anti-glaucoma medications were selected to undergo effective GSL under an endoscopic view combined with phacoemulsification. Follow-up examinations were conducted until 6 months postoperatively. RESULTS Twenty-five eyes of 24 patients diagnosed with residual angle-closure glaucoma and lens opacity and peripheral anterior synechiae (PAS) at least ≥ 270° were included. Their mean age was 61.32 ± 6.11 years. Preoperatively, the mean (standard error) IOP was 29.69 (11.22) mmHg, and the median number of IOP-lowering medications used was 3.0. The decreases in the rates of IOP of the patients were 44.29%, 52.17%, 46.95%, 48.37%, and 47.29% at 1 day, 1 week, 1 month, 2.5 months, and 6 months after the surgery, respectively. At 6 months, the median number of IOP-lowering medications used decreased from 3 to 0 and the range of PAS compared to the baseline decreased from 312° to 107° (P < 0.001). We also found that 21/25 eyes achieved improved or stable visual acuity after surgery. Postoperative complications included transiently elevated IOP (12.0%), exudation (8.0%), and hyphema (4.0%). CONCLUSIONS Phacoemulsification combined with effective GSL under an endoscopic view may reopen residual angle-closure glaucoma and reduce the number of IOP-lowering medications for up to 6 months. It is an effective and safe method for patients with residual angle-closure glaucoma and lens opacity.
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Affiliation(s)
- Wei Tang
- Department of Ophthalmology, Wuxi NO.2 People's Hospital Affiliated to Nanjing Medical University, Zhongshan Road 68, Wuxi, 214002, Jiangsu, People's Republic of China
| | - Zhengwei Zhang
- Department of Ophthalmology, Wuxi NO.2 People's Hospital Affiliated to Nanjing Medical University, Zhongshan Road 68, Wuxi, 214002, Jiangsu, People's Republic of China
| | - Yujie Zhang
- Physiology of Nanjing Medical University, Tian yuan East Road 818, Nanjing, 211166, Jiangsu, People's Republic of China
| | - Xiaolei Yin
- Department of Ophthalmology, Wuxi NO.2 People's Hospital Affiliated to Nanjing Medical University, Zhongshan Road 68, Wuxi, 214002, Jiangsu, People's Republic of China
| | - Yinong Zhang
- Department of Ophthalmology, Wuxi NO.2 People's Hospital Affiliated to Nanjing Medical University, Zhongshan Road 68, Wuxi, 214002, Jiangsu, People's Republic of China.
| | - Qianqian Li
- Department of Intensive Care Unit, Wuxi NO.2 People's Hospital Affiliated to Nanjing Medical University, Zhongshan Road 68, Wuxi, 214002, Jiangsu, People's Republic of China.
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Jiang Y, Wang W, Wang L, He M. Association of anterior segment parameters and 5-year incident narrow angles: findings from an older Chinese population. Br J Ophthalmol 2020; 105:970-976. [PMID: 32699050 DOI: 10.1136/bjophthalmol-2020-315852] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE To assess the association of anterior segment optical coherence tomography (AS-OCT) parameters and 5-year incident narrow angle in China. METHODS This was a prospective cohort study of people aged 50 and older residing in Liwan District, Guangzhou, China. Random clustering sampling was used to identify adults aged 50 years and older in Liwan District, Guangzhou. In 2008 and 2013, this study was repeated and added AS-OCT imaging under dark and light conditions. Customised software (ZAAP) was used to analyse horizontal AS-OCT scans. Angle opening distance (AOD), trabecular iris space area (TISA), anterior chamber volume (ACV) and maximal iris thickness (ITM) were measured. Multiple logistic regression analysis models were used to investigate the associations of the final angle status with baseline AS-OCT parameters. ORs and 95% CIs were calculated. RESULTS Of the 220 subjects with eligible AS-OCT images and gonioscopic results in 2008, the response rate was 77.3%. A total of 27 (15.9%) subjects developed narrow angles and 143 (84.1%) had open angles on gonioscopy in 2013. Subjects developed narrow angles had greater spherical equivalent and shallower anterior chamber depth, smaller angle parameters, thicker IT750 and ITM, smaller anterior chamber parameters, greater lens vault, and smaller dynamic parameters (ΔITM, ΔACA, ΔACV) at baseline. After adjusting confounders, the predictors of incident narrow angles included smaller AOD750, TISA750, ΔACA and greater ITM, ΔIarea. CONCLUSIONS Incident narrow angles were associated with smaller anterior ocular dimensions, thicker iris and smaller light-to-dark changes at baseline. These findings can help in early diagnosis in this population.
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Affiliation(s)
- Yu Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou 510060, China
| | - Wei Wang
- Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Lanhua Wang
- Department of Preventive Ophthalmology, Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
| | - Mingguang He
- Sun Yat-Sen University Zhongshan Ophthalmic Center, Guangzhou, China
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Xu BY, Chiang M, Pardeshi AA, Moghimi S, Varma R. Deep Neural Network for Scleral Spur Detection in Anterior Segment OCT Images: The Chinese American Eye Study. Transl Vis Sci Technol 2020; 9:18. [PMID: 32818079 PMCID: PMC7395674 DOI: 10.1167/tvst.9.2.18] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/11/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To develop a deep neural network that detects the scleral spur in anterior segment optical coherence tomography (AS-OCT) images. Methods Participants in the Chinese American Eye Study, a population-based study in Los Angeles, California, underwent complete ocular examinations, including AS-OCT imaging with the Tomey CASIA SS-1000. One human expert grader provided reference labels of scleral spur locations in all images. A convolutional neural network (CNN)-based on the ResNet-18 architecture was developed to detect the scleral spur in each image. Performance of the CNN model was assessed by calculating prediction errors, defined as the difference between the Cartesian coordinates of reference and CNN-predicted scleral spur locations. Prediction errors were compared with intragrader variability in detecting scleral spur locations by the reference grader. Results The CNN was developed using a training dataset of 17,704 images and tested using an independent dataset of 921 images. The mean absolute prediction errors of the CNN model were 49.27 ± 42.07 µm for X-coordinates and 47.73 ± 39.70 µm for Y-coordinates. The mean absolute intragrader variability was 52.31 ± 47.75 µm for X-coordinates and 45.88 ± 45.06 µm for Y-coordinates. Distributions of prediction errors for the CNN and intragrader variability for the reference grader were similar for X-coordinates (P = 0.609) and Y-coordinates (P = 0.378). The mean absolute prediction error of the CNN was 73.08 ± 52.06 µm and the mean absolute intragrader variability was 73.92 ± 60.72 µm. Conclusions A deep neural network can detect the scleral spur on AS-OCT images with performance similar to that of a human expert grader. Translational Relevance Deep learning methods that automate scleral spur detection can facilitate qualitative and quantitative assessments of AS-OCT images.
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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, CA, USA
| | - Michael Chiang
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Anmol A. Pardeshi
- Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Sasan Moghimi
- Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
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Deep Learning Classifiers for Automated Detection of Gonioscopic Angle Closure Based on Anterior Segment OCT Images. Am J Ophthalmol 2019; 208:273-280. [PMID: 31445003 DOI: 10.1016/j.ajo.2019.08.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To develop and test deep learning classifiers that detect gonioscopic angle closure and primary angle closure disease (PACD) based on fully automated analysis of anterior segment OCT (AS-OCT) images. METHODS Subjects were recruited as part of the Chinese-American Eye Study (CHES), a population-based study of Chinese Americans in Los Angeles, California, USA. Each subject underwent a complete ocular examination including gonioscopy and AS-OCT imaging in each quadrant of the anterior chamber angle (ACA). Deep learning methods were used to develop 3 competing multi-class convolutional neural network (CNN) classifiers for modified Shaffer grades 0, 1, 2, 3, and 4. Binary probabilities for closed (grades 0 and 1) and open (grades 2, 3, and 4) angles were calculated by summing over the corresponding grades. Classifier performance was evaluated by 5-fold cross-validation and on an independent test dataset. Outcome measures included area under the receiver operating characteristic curve (AUC) for detecting gonioscopic angle closure and PACD, defined as either 2 or 3 quadrants of gonioscopic angle closure per eye. RESULTS A total of 4036 AS-OCT images with corresponding gonioscopy grades (1943 open, 2093 closed) were obtained from 791 CHES subjects. Three competing CNN classifiers were developed with a cross-validation dataset of 3396 images (1632 open, 1764 closed) from 664 subjects. The remaining 640 images (311 open, 329 closed) from 127 subjects were segregated into a test dataset. The best-performing classifier was developed by applying transfer learning to the ResNet-18 architecture. For detecting gonioscopic angle closure, this classifier achieved an AUC of 0.933 (95% confidence interval, 0.925-0.941) on the cross-validation dataset and 0.928 on the test dataset. For detecting PACD based on 2- and 3-quadrant definitions, the ResNet-18 classifier achieved AUCs of 0.964 and 0.952, respectively, on the test dataset. CONCLUSION Deep learning classifiers effectively detect gonioscopic angle closure and PACD based on automated analysis of AS-OCT images. These methods could be used to automate clinical evaluations of the ACA and improve access to eye care in high-risk populations.
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Wang X, Chen J, Kong X, Sun X. Immediate Changes in Peripapillary Retinal Vasculature after Intraocular Pressure Elevation -an Optical Coherence Tomography Angiography Study. Curr Eye Res 2019; 45:749-756. [PMID: 31751156 DOI: 10.1080/02713683.2019.1695843] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To investigate changes in peripapillary retinal vessel density after acute intraocular pressure (IOP) elevation caused by laser peripheral iridotomy (LPI) in primary angle-closure suspects (PACS) by optical coherence tomography angiography (OCTA).Materials and Methods: Ninety-seven participants with PACS were included in this cross-sectional observational study. OCTA and IOP measurement were performed at baseline and 1 h after LPI. PACS eyes were further divided into three groups according to IOP increase 1 h after LPI (group 1 = IOP elevation <5 mmHg, 42eyes; group 2 = IOP elevation ≥5 mmHg and <10 mmHg, 34 eyes; group 3 = IOP elevation ≥10 mmHg, 21eyes). The changes of vessel density in radial peripapillary capillary (RPC) and entire retina were compared among groups.Results: When all eyes were included, the vessel density of RPC and entire retina 1 h after LPI were significantly decreased compared to the baseline (RPC: 64.5 ± 7.9 vs.67.8 ± 6.8, P < .001; retina: 86.3 ± 4.6 vs.88.3 ± 3.8, P < .001). There were significant differences among the three groups in the RPC and retinal vessel density at 1 h after LPI (RPC: 67.4 ± 7.3 vs. 63.2 ± 7.6 vs. 60.9 ± 7.5, P = .003; retinal: 87.7 ± 4.0 vs. 85.8 ± 4.5 vs. 84.3 ± 5.2, P = .015). In group 2 with an increased IOP from 5 mmHg to 10 mmHg, the reduction of vessel density in the RPC was more significant than that of the entire retina (RPC vs. retina: 7.1 ± 10.0% vs. 3.0 ± 4.4%, P = .006).Conclusions: LPI-induced IOP spikes resulted in a decrease in retina vessel density with PACS eyes by OCTA. The reduction of RPC vessel density was more significant than that of the entire retina in the subgroup of IOP increase from 5 to 10 mmHg. This suggests that vessel density in RPC was more sensitive to IOP increase than that of the entire retina in the peripapillary area.
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Affiliation(s)
- Xiaolei Wang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Ministry of Health (Fudan University), and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Junyi Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Ministry of Health (Fudan University), and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Xiangmei Kong
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Ministry of Health (Fudan University), and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia, Ministry of Health (Fudan University), and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
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Tanner L, Gazzard G, Nolan WP, Foster PJ. Has the EAGLE landed for the use of clear lens extraction in angle-closure glaucoma? And how should primary angle-closure suspects be treated? Eye (Lond) 2019; 34:40-50. [PMID: 31649349 DOI: 10.1038/s41433-019-0634-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 12/25/2022] Open
Abstract
Angle-closure glaucoma is an aggressive condition that causes millions to become blind worldwide. This review explores the use of prophylactic laser peripheral iridotomy (PI) in patients classified as primary angle-closure suspects (PACS), and additionally, the use of clear lens exchange as a primary treatment option in established angle-closure disease with or without glaucoma. As PI has a strong prophylactic effect in fellow eyes of patients who have had an acute attack, its use has been widely adopted in those patients classified as PACS, but with limited evidence to support this. A large randomised trial conducted in China has demonstrated that although PI reduces the risk of incident angle-closure disease, the incidence of disease that would threaten vision was much lower than anticipated. This suggests that the benefit of prophylactic PI is very limited. Health services data shows an association between rising cataract surgical rates and of decreasing rates of acute angle-closure. Age-related growth of the lens is a major component of angle-closure disease. Several studies have shown that clear lens extraction (CLE) effectively lowers IOP in angle-closure. The use of CLE as a primary treatment option has been tested against LPI in the EAGLE study, a large RCT that enroled people with angle-closure and an IOP > 30 mmHg, and those with angle-closure glaucoma. The trial showed CLE to be superior to PI both for IOP control and patient reported quality of life. On these grounds, CLE should be considered for first-line treatment of more advanced angle-closure disease.
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Affiliation(s)
- Luke Tanner
- University of Exeter Medical School, College of Medicine & Health, St. Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.,UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK
| | - Winifred P Nolan
- Glaucoma Service, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - Paul J Foster
- Glaucoma Service, Moorfields Eye Hospital, City Road, London, EC1V 2PD, UK. .,UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK. .,NIHR Biomedical Research Centre at Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, EC1V 2PD, UK.
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39
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Vitreous Zonule and its Relation to Anterior Chamber Angle Characteristics in Primary Angle Closure. J Glaucoma 2019; 28:1048-1053. [PMID: 31633619 DOI: 10.1097/ijg.0000000000001387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRECIS Primary angle-closure (PAC) eyes with no vitreous zonule (VZ) appear to have a narrower angle despite similar lens vault and iris configuration than eyes with visible VZ. PURPOSE To assess the clinical significance of the VZ in PAC. METHODS Medical records of 91 eyes of 91 participants with PAC or PAC glaucoma were retrospectively reviewed. Anterior segment parameters were measured using anterior segment optical coherence tomography; presence of the VZ was assessed with ultrasound biomicroscopy. Parameters were compared between eyes with vitreous zonule group (VZG) and no vitreous zonule group (NVZG). Factors associated with VZ presence were determined using logistic regression analysis. RESULTS The NVZG was more likely to have PAC glaucoma than PAC (51.4% vs. 25.0%; P=0.010) and use more glaucoma medications (0.77 vs. 0.36; P=0.004) than the VZG. The NVZG had a smaller anterior chamber area than the VZG (13.6 mm vs. 15.1 mm; P=0.020) but there were no significant between-group differences in anterior chamber depth (1.97 vs. 2.08 mm; P=0.119) and lens vault (1.21 vs. 1.13 mm; P=0.337). NVZG had a smaller scleral spur angle (11.5 vs. 17.4 degrees; P<0.001), angle opening distance at 500 μm (AOD500, 105 vs. 168 μm; P<0.001), and trabecular-ciliary process angle (75.7 vs. 81.9 degrees; P=0.029) than VZG. Older age [odds ratio (confidence interval), 1.087 (1.014-1.164); P=0.018], less AOD500 (0.984 (0.975-0.993); P<0.001), and less trabecular-ciliary process angle (0.938 (0.901-0.977); P=0.002) were independently associated with an absence of VZ. CONCLUSIONS PAC eyes with no VZ had a narrower angle and required more glaucoma medications than eyes with a VZ.
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Bourdon H, Aragno V, Baudouin C, Labbé A. Iridoplasty for plateau iris syndrome: a systematic review. BMJ Open Ophthalmol 2019; 4:e000340. [PMID: 31592025 PMCID: PMC6757510 DOI: 10.1136/bmjophth-2019-000340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/17/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022] Open
Abstract
Plateau iris syndrome (PIS) is a frequent cause of angle closure. Argon laser peripheral iridoplasty (ALPI) has been proposed in PIS to widen the iridocorneal angle. The objective of the present study was to perform a systematic review of the available studies evaluating the efficacy of ALPI on intraocular pressure (IOP), iridocorneal angle opening and the number of medications in patients with chronic angle-closure associated with PIS. One prospective and seven retrospective studies with a minimum 1 month of follow-up were included. Although ALPI seemed to lower IOP, to decrease the number of topical antiglaucoma medications and widen the iridocorneal angle shortly after the procedure, there is no current evidence of long-term efficacy. To date, there is no robust scientific evidence to advocate ALPI as a treatment for chronic angle-closure caused by PIS.
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Affiliation(s)
- Hugo Bourdon
- III, CHNO, Paris, France.,Ophthalmology, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Vittoria Aragno
- III, CHNO, Paris, France.,Ophthalmology, Hopital Ambroise-Pare, Boulogne-Billancourt, France
| | - Christophe Baudouin
- III, CHNO, Paris, France.,INSERM-DGOS Clinical Investigation Center (CIC) 1423, CHNO, Paris, France
| | - Antoine Labbé
- III, CHNO, Paris, France.,INSERM-DGOS Clinical Investigation Center (CIC) 1423, CHNO, Paris, France
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41
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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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42
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Effect of Visibility of the Ciliary Body Processes on Ocular Biometric Parameters in Patients with Primary Angle Closure. Jpn J Ophthalmol 2019; 63:467-473. [PMID: 31522329 DOI: 10.1007/s10384-019-00686-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the differences in ocular biometric parameters between eyes with primary angle closure (PAC) with and without visible ciliary body processes (CBP) (PAC+CBP and PAC-CBP) and normal open-angle controls. STUDY DESIGN Cross-sectional study. METHODS Eyes with PAC and normal open-angle controls underwent detailed ocular examinations and gonioscopy to determine the visibility of the CBP. The following ocular biometric parameters were determined using A-scan ultrasound biometry: axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and vitreous length (VL). The lens-axial length factor (LAF) and relative lens position (RLP) were also calculated. Continuous variables were assessed by analysis of variance with Bonferroni correction. Multiple linear regression analysis was performed to adjust for confounding factors. Area under the receiver operating characteristic curves were calculated to determine the diagnostic capability of biometric parameters. RESULTS 84 PAC+CBP eyes, 57 PAC-CBP eyes, and 32 normal open angle control eyes were evaluated. The means of the ocular biometric values were significantly different among the three groups. AL, ACD, LT, VL, LAF, and RLP were also significantly different among the three groups in the multivariate regression analysis. AL, ACD, and VL were lower in the PAC+CBP group and LT, RLP, and LAF were greater in the PAC+CBP group than in the PAC-CBP and control groups. LAF ≥ 2.4 is the cutting point with the highest sensitivity and specificity to differentiate PAC+CBP from PAC-CBP. CONCLUSIONS The ocular biometric parameters in the PAC+CBP group were more strongly associated with a crowded anterior segment than in the other groups. Visibility of CBP in PAC-affected eyes may serve as a surrogate for an anterior segment crowding mechanism and help to select the most appropriate treatment in individual cases.
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Argon Laser Peripheral Iridoplasty and Argon Laser Pupilloplasty: Alternative Management for Medically Unresponsive Acute Primary Angle Closure. J Ophthalmol 2019; 2019:1876912. [PMID: 31511787 PMCID: PMC6710813 DOI: 10.1155/2019/1876912] [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: 12/18/2018] [Revised: 04/21/2019] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Abstract
Objective To introduce the combined laser technique, argon laser peripheral iridoplasty (ALPI) and argon laser pupilloplasty (ALPP), in the management of medically unresponsive acute primary angle closure (APAC). Design Retrospective study. Methods We retrospectively reviewed the records of 23 patients (27 eyes) with APAC, who were applied ALPI and ALPP when traditional treatment failed. The visual acuity and intraocular pressure (IOP) were monitored before surgery and at 1, 2, 12, 24, and 48 h after surgery. Additionally, the angle-opening status was monitored before surgery and 48 h after the treatment by using an ultrasonic biological microscope (UBM), and the presurgical and postsurgical cornea edema statuses were observed by using a slit lamp. We also documented the complications of laser treatment. Results For the ALPI + ALPP laser-effective group, the presurgical IOP was 52.1 ± 9.3 mmHg and the postsurgical IOP was 37.6 ± 10.9 mmHg (1 h), 28.4 ± 12.4 mmHg (2 h), 19.9 ± 9.0 mmHg (6 h), 16.8 ± 7.3 mmHg (12 h), 15.9 ± 5.9 mmHg (24 h), and 14.9 ± 5.0 mmHg (48 h), with statistically significant differences (p < 0.05) in each time point. It was observed in all the patients that the corneal edema alleviated, the angles opened, and visual acuity recovered with varying degrees at 48 h after applying combined laser treatment. For the ALPI + ALPP laser-ineffective group, further interventions were taken. Definite treatment was given in both groups to maintain the long-term IOP control. Conclusions Although the combination of ALPI and ALPP is a temporizing therapeutic strategy for APAC, it is effective in relieving pupillary block which is unresponsive to miotic agents, opening the closed angle to a certain extent, restoring the transparency of cornea, and reducing IOP to a safe level for further definitive treatment.
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Shi G, Jiang Z, Deng G, Liu G, Zong Y, Jiang C, Chen Q, Lu Y, Sun X. Automatic Classification of Anterior Chamber Angle Using Ultrasound Biomicroscopy and Deep Learning. Transl Vis Sci Technol 2019; 8:25. [PMID: 31448182 PMCID: PMC6703191 DOI: 10.1167/tvst.8.4.25] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/22/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose To develop a software package for automated classification of anterior chamber angle of the eye by using ultrasound biomicroscopy. Methods Ultrasound biomicroscopy images were collected, and the trabecular-iris angle was manually measured and classified into three categories: open angle, narrow angle, and angle closure. Inception v3 was used as the classifying convolutional neural network and the algorithm was trained. Results With a recall rate of 97% in the test set, the neural network's classification accuracy can reach 97.2% and the overall area under the curve was 0.988. The sensitivity and specificity were 98.04% and 99.09% for the open angle, 96.30% and 98.13% for the narrow angle, and 98.21% and 99.05% for the angle closure categories, respectively. Conclusions Preliminary results show that an automated classification of the anterior chamber angle achieved satisfying sensitivity and specificity and could be helpful in clinical practice. Translational Relevance The present work suggests that the algorithm described here could be useful in the categorizing of anterior chamber angle and screening for subjects who are at high risk of angle closure.
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Affiliation(s)
- Guohua Shi
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Zhenying Jiang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Guohua Deng
- Department of Ophthalmology, the Third People's Hospital of Changzhou, Changzhou, Jiangsu Province, China
| | - Guangxing Liu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu Province, China
| | - Yuan Zong
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Chunhui Jiang
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Qian Chen
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yi Lu
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xinhuai Sun
- Department of Ophthalmology and Visual Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College of Fudan University, Shanghai, China.,Key NHC Key Laboratory of Myopia (Fudan University), Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
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Yan C, Han Y, Yu Y, Wang W, Lyu D, Tang Y, Yao K. Effects of lens extraction versus laser peripheral iridotomy on anterior segment morphology in primary angle closure suspect. Graefes Arch Clin Exp Ophthalmol 2019; 257:1473-1480. [PMID: 31079203 DOI: 10.1007/s00417-019-04353-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/27/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To compare the anatomical effects on anterior segment by lens extraction (LE, phacoemulsification with posterior chamber intraocular lens implantation) and laser peripheral iridotomy (LPI) in primary angle closure suspect (PACS) eyes. METHODS This prospective comparative cohort trial included a total of 122 consecutive patients identified as PACS aged 52 to 80 years. LE or LPI was performed based on each patient's choice. The anterior segment optical coherence tomography (ASOCT) and gonioscopy were conducted at baseline and 4 weeks post-operation. Outcome measures include percentage of residual angle closure, mean angle width (modified Shaffer grade), angle opening distance (AOD), trabecular iris angle (TIA), trabecular iris space area (TISA), anterior chamber depth (ACD), iris curvature (I-Curve), lens vault (LV), intraocular pressure (IOP), and best-corrected visual acuity (BCVA). RESULTS All anterior angle parameters (AOD, TIA, and TISA) were significantly greater after LE than LPI (P < 0.001 for all). ACD (P < 0.001) increased, LV (P < 0.001) decreased, IOP (P < 0.001) decreased, and BCVA (P < 0.001) increased after LE. However, no significant changes were found in ACD (P = 0.782), LV (P = 0.616), IOP (P = 0.112), and BCVA (P = 0.131) after LPI. In both groups, I-Curve decreased after the operation, but the iris was flatter after LE than LPI (P < 0.001). Gonioscopically, the LE group achieved a larger post-operative angle width (modified Shaffer grade) than LPI (P < 0.001) and all anterior chamber angles were open (defined as posterior pigmented trabecular meshwork (PTM) visible with static gonioscopy) after operation. Nevertheless, after LPI, 12 eyes (20.0%) still had two or more quadrants and 32 eyes (53.3%) still had at least one quadrant in which the posterior PTM could not be observed. CONCLUSIONS Compared with LPI, LE resulted in a wider anterior chamber angle, a deeper anterior chamber, and a lower IOP in PACS eyes. Moreover, no residual angle closure was observed after LE, which could morphologically prevent the progress of angle closure. TRIAL REGISTRATION ChiCTR1800016511.
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Affiliation(s)
- Chenxi Yan
- Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Number 88 Jiefang Road, Hangzhou, China
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Yibo Yu
- Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Number 88 Jiefang Road, Hangzhou, China
| | - Wei Wang
- Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Number 88 Jiefang Road, Hangzhou, China
| | - Danni Lyu
- Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Number 88 Jiefang Road, Hangzhou, China
| | - Yizhen Tang
- Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Number 88 Jiefang Road, Hangzhou, China
| | - Ke Yao
- Eye Center of the 2nd Affiliated Hospital, Medical College of Zhejiang University, Number 88 Jiefang Road, Hangzhou, China.
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46
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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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Koh V, Keshtkaran MR, Hernstadt D, Aquino MCD, Chew PT, Sng C. Predicting the outcome of laser peripheral iridotomy for primary angle closure suspect eyes using anterior segment optical coherence tomography. Acta Ophthalmol 2019; 97:e57-e63. [PMID: 30284403 DOI: 10.1111/aos.13822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/13/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Develop an algorithm to predict the success of laser peripheral iridotomy (LPI) in primary angle closure suspect (PACS), using pretreatment anterior segment optical coherence tomography (ASOCT) scans. METHODS A total of 69 eyes with PACS underwent LPI and time-domain ASOCT scans (temporal and nasal cuts) were performed before and after LPI. After LPI, success is defined as one or more angles changed from closed to open. All the pretreatment ASOCT scans were analysed using the Anterior Segment Analysis Program to derive anterior chamber angle (ACA) measurements. The measurements for each angle were ordered along with angle-independent measurements totalling to 42 measurements which serve as features for the prediction algorithm. Two masked glaucoma fellowship-trained ophthalmologists graded the pre-LPI ASOCT scans to determine whether LPI was likely to successful. RESULTS There were 42 (60.9%) eyes that fulfilled the criteria for success after LPI. Iris concavity, angle recess area (750 μm) and iris concavity ratio showed the highest predictive score and were selected using correlation-based subset selection method. These features were classified into two ('successful' and 'unsuccessful') categories using a Bayes classifier. The algorithm predicted the success of LPI with 79.28% cross validation accuracy, which was superior to the predictive accuracy of the ophthalmologists (kappa 0.497 and 0.636 respectively). CONCLUSION Using pretreatment ASOCT scans, our algorithm was superior to ophthalmologists in predicting the success of LPI for PACS eyes. This novel algorithm could aid decision making in offering LPI as a prophylaxis for PACS.
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Affiliation(s)
- Victor Koh
- Department of Ophthalmology; National University Hospital; Singapore Singapore
| | | | - David Hernstadt
- Department of Ophthalmology; National University Hospital; Singapore Singapore
| | | | - Paul T. Chew
- Department of Ophthalmology; National University Hospital; Singapore Singapore
| | - Chelvin Sng
- Department of Ophthalmology; National University Hospital; Singapore Singapore
- Singapore Eye Research Institute; Singapore Singapore
- Department of Glaucoma; Moorfields Eye Hospital; London UK
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48
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Longitudinal Change in Peripheral Anterior Chamber Depth of Eyes with Angle Closure after Laser Iridotomy. J Ophthalmol 2019; 2018:9106247. [PMID: 30671261 PMCID: PMC6323459 DOI: 10.1155/2018/9106247] [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: 09/04/2018] [Accepted: 12/11/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose To investigate longitudinal changes in peripheral anterior chamber depth (pACD) of eyes with angle closure after laser iridotomy (LI) and factors related to prognosis. Design Retrospective cohort study. Methods Eyes with primary angle closure (PAC), acute PAC, or chronic angle closure glaucoma (CACG) that underwent LI (LI group) and eyes that underwent phacoemulsification and intraocular lens insertion (PEA + IOL group) were employed. Longitudinal changes in pACD were evaluated with a scanning peripheral anterior chamber depth analyzer (SPAC) in addition to routine ophthalmic examination. Results Forty-eight eyes of LI groups (69.8 ± 8.5 years) and 21 eyes of PEA + IOL group (65.6 ± 12.7 years) were enrolled. Mean follow-up times of LI group and PEA + IOL group were 43.4 ± 12.7 months and 36.5 ± 2.5 months, respectively. LI significantly increased pACD as indicated by the SPAC grade change from 3.8 ± 1.1 to 4.6 ± 1.2 (p < 0.001). However, SPAC grade was gradually reduced and reached the pre-LI level by the third year of follow up. PEA + IOL also significantly increased SPAC grade from 6.7 ± 1.6 to 8.7 ± 2.0 (p < 0.001), but no time-related change was observed. Twenty-three cases of LI group presented with deterioration of glaucoma control. The type of angle closure, plateau iris configuration, peripheral anterior synechia, and glaucomatous visual field defects were significantly associated with prognosis of glaucoma after LI. Conclusions Peripheral ACD is temporarily deepened by LI, but returns to the pre-LI level in approximately three years. The type of angle closure and some factors may be related to glaucoma prognosis after LI.
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49
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Na KI, Ha A, Baek SU, Lee WJ, Kim DW, Jeoung JW, Park KH, Kim YK. Predicting the Therapeutic Efficacy of Laser Peripheral Iridotomy for Individuals With Asymptomatic Narrow Angle: The Triple Hump Sign. J Glaucoma 2018; 28:125-130. [PMID: 30531193 DOI: 10.1097/ijg.0000000000001157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the clinical efficacy of a novel screening sign [ie, the triple hump (TH) sign] for prediction of laser peripheral iridotomy (LPI)'s intraocular pressure (IOP)-lowering effectiveness in subjects with asymptomatic narrow angles. METHODS This cross-sectional study was conducted from 2010 to 2015 in a hospital setting. Eighty-four eyes of 84 primary angle-closure suspect (PACS) patients were imaged before LPI using anterior segment optical coherence tomography. The "positive-TH sign" was defined, on anterior segment optical coherence tomography-generated cross-sectional scans, as the characteristic configuration formed by the angulations between the crystalline lens's central anterior surface and both sides of the iris pigment epithelium. After LPI, the extent of IOP reduction was compared between the positive- and negative-TH groups. RESULTS The positive-TH eyes did not significantly differ from the negative-TH ones in pre-LPI IOP (P=0.200). In the positive-TH group, IOP decreased significantly after LPI (by 6.42%±17.96%, from 14.07±3.11 to 12.88±2.65 mm Hg, P=0.002). In the negative-TH group, IOP did not change significantly after LPI (by 4.66%±25.97%, from 13.23±2.42 to 13.52±3.01 mm Hg, P=0.624). CONCLUSION PACS eyes indicating the positive-TH sign showed, at post-LPI 1 month, a greater IOP decrease. On this basis, the TH sign may be a useful screening tool for predicting the effect of LPI and determining the treatment plan in PACS patients.
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Affiliation(s)
- Kyeong Ik Na
- Department of Ophthalmology, Hallym University College of Medicine.,Department of Ophthalmology, Kangdong Sacred Heart Hospital
| | - Ahnul Ha
- Department of Ophthalmology, Seoul National University College of Medicine.,Department of Ophthalmology, Seoul National University Hospital
| | - Sung Uk Baek
- Department of Ophthalmology, Seoul National University College of Medicine.,Department of Ophthalmology, Seoul National University Hospital
| | - Won June Lee
- Department of Ophthalmology, Hanyang University College of Medicine.,Department of Ophthalmology, Hanyang University Hospital, Seoul
| | - Dai Woo Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine.,Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University College of Medicine.,Department of Ophthalmology, Seoul National University Hospital
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine.,Department of Ophthalmology, Seoul National University Hospital
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University College of Medicine.,Department of Ophthalmology, Seoul National University Hospital
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50
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Xu BY, Burkemper B, Lewinger JP, Jiang X, Pardeshi AA, Richter G, Torres M, McKean-Cowdin R, Varma R. Correlation between Intraocular Pressure and Angle Configuration Measured by OCT: The Chinese American Eye Study. Ophthalmol Glaucoma 2018; 1:158-166. [PMID: 31025032 PMCID: PMC6475915 DOI: 10.1016/j.ogla.2018.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To characterize the relationship between angle configuration measured by anterior segment optical coherence tomography (AS-OCT) and intraocular pressure (IOP). DESIGN Cross-sectional study. PARTICIPANTS Subjects aged 50 years or older were identified from the Chinese American Eye Study (CHES), a population-based epidemiological study in Los Angeles, CA. METHODS Each subject underwent a complete ocular exam including Goldmann applanation tonometry, gonioscopy, and AS-OCT imaging. Four AS-OCT images were analyzed per eye and parameters describing angle configuration were measured, including angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), and scleral spur angle (SSA). The relationship between AS-OCT measurements and IOP was assessed using locally-weighted scatterplot smoothing (LOWESS) regression and change-point analyses. MAIN OUTCOME MEASURES Correlation between AS-OCT measurements and IOP. RESULTS 702 eyes (382 closed angle and 320 open angle) from 555 subjects were analyzed. Mean IOP for angle closure eyes was 16.3 ± 3.9 mmHg and open angle eyes was 15.3 ± 2.7 mmHg. Mean IOP increased as AS-OCT measurements decreased for all parameters except TIA750. Once measurement values dropped below parameter-specific threshold values, AS-OCT measurements and IOP were significantly correlated (p < 0.05) for AOD500 (r = -0.416), AOD750 (r = -0.213), ARA500 (r = -0.669), ARA750 (r = -0.680), TISA500 (r = -0.655), TISA750 (r = -0.641), SSA500 (r = -0.538), and SSA750 (r = -0.208). There was no correlation between AS-OCT measurements and IOP in open angle eyes (p > 0.40). CONCLUSIONS There is an anatomic threshold for angle configuration below which IOP is strongly related to the degree of angle closure. This finding suggests reconsideration of current definitions of angle closure and may be relevant for developing new OCT-based methods to identify patients at higher risk for elevated IOP and glaucoma.
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Affiliation(s)
- Benjamin Y Xu
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Bruce Burkemper
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Juan Pablo Lewinger
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Xuejuan Jiang
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Anmol A Pardeshi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Grace Richter
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Mina Torres
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Roberta McKean-Cowdin
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Rohit Varma
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine at the University of Southern California, Los Angeles, California
- Department of Preventive Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
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