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Queiruga-Piñeiro J, Barros A, Lozano-Sanroma J, Fernández-Vega Cueto A, Rodríguez-Uña I, Merayo-LLoves J. Assessment by Optical Coherence Tomography of Short-Term Changes in IOP-Related Structures Caused by Wearing Scleral Lenses. J Clin Med 2023; 12:4792. [PMID: 37510907 PMCID: PMC10381863 DOI: 10.3390/jcm12144792] [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: 06/21/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The mechanism that could increase intraocular pressure (IOP) during scleral lens (SL) wear is not fully understood, although it may be related to compression of the landing zone on structures involved in aqueous humor drainage. METHODS Thirty healthy subjects were fitted with two SLs of different sizes (L1 = 15.8 mm, L2 = 16.8 mm) for 2 h in the right eye and left eye as a control. Central corneal thickness (CCT), parameters of iridocorneal angle (ICA), Schlemm's canal (SC), and optic nerve head were measured before and after wearing both SLs. IOP was measured with a Perkins applanation tonometer before and after lens removal and with a transpalpebral tonometer before, during (0 h, 1 h, and 2 h), and after lens wear. RESULTS CCT increased after wearing L1 (8.10 ± 4.21 µm; p < 0.01) and L2 (9.17 ± 4.41 µm; p < 0.01). After L1 removal, the ICA parameters decreased significantly (p < 0.05). With L2 removal, nasal and temporal SC area and length were reduced (p < 0.05). An increased IOP with transpalpebral tonometry was observed at 2 h of wearing L1 (2.55 ± 2.04 mmHg; p < 0.01) and L2 (2.53 ± 2.22 mmHg; p < 0.01), as well as an increased IOP with Perkins applanation tonometry after wearing L1 (0.43 ± 1.07 mmHg; p = 0.02). CONCLUSIONS In the short term, SL resulted in a slight increase in IOP in addition to small changes in ICA and SC parameters, although it did not seem to be clinically relevant in healthy subjects.
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Affiliation(s)
- Juan Queiruga-Piñeiro
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Alberto Barros
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Javier Lozano-Sanroma
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Andrés Fernández-Vega Cueto
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Ignacio Rodríguez-Uña
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
| | - Jesús Merayo-LLoves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, 33012 Oviedo, Spain
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidad de Oviedo, 33006 Oviedo, Spain
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Krzyzanowska I, Töteberg-Harms M. [Angle-closure glaucoma]. DIE OPHTHALMOLOGIE 2022; 119:1167-1179. [PMID: 36303042 DOI: 10.1007/s00347-022-01745-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Angle-closure glaucoma is a rare form of glaucoma characterized by a narrow or an occlusion of the anterior chamber angle and subsequently an obstruction of the outflow of aqueous humor resulting in an increase in intraocular pressure. Symptoms can include severe eye pain and/or headache, blurred vision, a medium-sized and rigid pupil, conjunctival hyperemia, and nausea. Treatment options include pressure-lowering topical and systemic medications as well as surgical interventions, especially cataract surgery and laser iridotomy. Besides parasympathomimetics (pilocarpine), all topical antiglaucoma medications can principally be used (beta-receptor antagonists, carbonic anhydrase inhibitors, alpha‑2 selective adrenergic antagonists, prostaglandins and prostaglandin analogues). Carbonic anhydrase inhibitors and osmotic agents (e.g., mannitol) can be systemically used.
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Affiliation(s)
| | - Marc Töteberg-Harms
- Medical College of Georgia, Department of Ophthalmology, Augusta University, 1120 15th Street, BA-2320, 30912, Augusta, GA, USA.
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Yu Z, Wang F, Dong F, Li N, Wang D, Wang L. Comparison of Ocular Morphological Parameters Related to Lens Position by Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopy. Int J Clin Pract 2022; 2022:7599631. [PMID: 35685518 PMCID: PMC9159221 DOI: 10.1155/2022/7599631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective is to compare parameters related to lens position measured using anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in patients with senile cataract and perform a consistency analysis. METHODS This prospective study included 102 patients (102 eyes) scheduled for simple cataract surgery. Among the total patients, 44 were men, and 58 were women. AS-OCT (sitting) and UBM (lying) were used to measure the anterior chamber depth (ACD) in horizontal and vertical orientations and the iris-lens contact distance (ILCD) and iris-lens angle (ILA) in inferior, superior, nasal, and temporal quadrants. Paired-sample t-test was used to compare ACD, ILCD, and ILA measurements of the two methods, while Pearson's linear correlation and Bland-Altman analyses were used to analyze the correlation and consistency of the two results. RESULTS The horizontal (2.499 ± 0.464 mm) and vertical (2.531 ± 0.463 mm) ACD measured using AS-OCT and the horizontal (2.556 ± 0.467 mm) and vertical (2.563 ± 0.479 mm) ACD measured using UBM were significantly different (P < 0.001); moreover, the results showed good correlation and agreement. A significant difference was observed between the two methods in terms of ILCD measured in inferior, superior, nasal, and temporal quadrants (P < 0.001), and a significant correlation was found between measurements of both methods (P < 0.001). Approximately 3.92% (4/102), 0.98% (1/102), 3.92% (4/102), and 2.94% (3/102) of points were outside the 95% limits of agreement in the four quadrants, respectively, and the agreement of the results was good. ILA measured using both methods differed in inferior, superior, nasal, and temporal quadrants (P=0.003, 0.011, 0.001, 0.001, respectively), and the correlation was good (P < 0.001). The percentage of points outside the 95% limit was higher in inferior, superior, nasal, and temporal quadrants (4.90% (5/102), 5.88% (6/102), 5.88% (6/102), and 6.86% (7/102)) with poor agreement of the results. CONCLUSIONS The correlation between AS-OCT and UBM in terms of measuring lens position-related parameters was good, but the agreement was unstable. The differences in measurement position (sitting and supine) and/or measurement methods (optics and ultrasound) may lead to variability in results.
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Affiliation(s)
- Zhiying Yu
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fenglei Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fang Dong
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Na Li
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dabo Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ling Wang
- Department of Ophthalmology, The Affiliated Hospital of Qingdao University, Qingdao, China
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Drechsler J, Lee A, Maripudi S, Kueny L, Levin MR, Saeedi OJ, Bazemore M, Karwoski B, Birdsong R, Martinez C, Jaafar MS, Yousaf S, Ahmed ZM, Madigan WP, Alexander JL. Corneal Structural Changes in Congenital Glaucoma. Eye Contact Lens 2022; 48:27-32. [PMID: 34608027 PMCID: PMC8688203 DOI: 10.1097/icl.0000000000000844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify corneal structure differences on quantitative high-frequency ultrasound biomicroscopy (UBM) among subjects with congenital glaucoma compared with controls. METHODS This prospective case-control study evaluated 180 UBM images from 44 eyes of 30 subjects (18 control and 12 glaucoma, mean age 5.2±8.0 years, range 0.2-25.8 years) enrolled in the Pediatric Anterior Segment Imaging and Innovation Study (PASIIS). ImageJ was used to quantify a comprehensive set of corneal structures according to 21 quantitative parameters. Statistical analysis compared corneal measurements in glaucoma subtypes and age-matched controls with significance testing and mixed effects models. RESULTS Significant differences between congenital glaucoma cases and controls were identified in 16 of 21 measured parameters including angle-to-angle, central and peripheral corneal thicknesses, scleral integrated pixel density, anterior corneal radius of curvature, and posterior corneal radius of curvature. Eight parameters differed significantly between primary congenital glaucoma and glaucoma following congenital cataract surgery. CONCLUSION Multiple measurable corneal structural differences exist between congenital glaucoma and control eyes, and between primary and secondary congenital glaucoma, including but not limited to corneal width and thickness. The structural differences can be quantified from UBM image analysis. Further studies are needed to determine whether corneal features associated with glaucoma can be used to diagnose or monitor progression of congenital glaucoma.
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Affiliation(s)
- Jennifer Drechsler
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Adrianna Lee
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Snehaa Maripudi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Laura Kueny
- Department of Ophthalmology, Children’s National Hospital, 111 Michigan Avenue, Washington, DC 20010
| | - Moran R Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Marlet Bazemore
- Department of Ophthalmology, Children’s National Hospital, 111 Michigan Avenue, Washington, DC 20010
| | - Bethany Karwoski
- Department of Ophthalmology, Children’s National Hospital, 111 Michigan Avenue, Washington, DC 20010
| | - Richard Birdsong
- Department of Ophthalmology, Children’s National Hospital, 111 Michigan Avenue, Washington, DC 20010
| | - Camilo Martinez
- Department of Ophthalmology, Children’s National Hospital, 111 Michigan Avenue, Washington, DC 20010
| | - Mohamad S Jaafar
- Department of Ophthalmology, Children’s National Hospital, 111 Michigan Avenue, Washington, DC 20010
| | - Sairah Yousaf
- Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland School of Medicine, 670 West Redwood Street, Room 7181, Baltimore, MD 21201
| | - Zubair M Ahmed
- Department of Otorhinolaryngology Head and Neck Surgery, University of Maryland School of Medicine, 670 West Redwood Street, Room 7181, Baltimore, MD 21201
| | - William P Madigan
- Department of Ophthalmology, Children’s National Hospital, 111 Michigan Avenue, Washington, DC 20010
| | - Janet Leath Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
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Abstract
Objectives: To report the clinical and demographic characteristics, imaging findings, treatment results, and follow-up data of patients with iris cysts. Materials and Methods: The medical records of 37 patients with iris cysts were retrospectively analyzed. Ultrasound biomicroscopy (UBM), swept-source optical coherence tomography (SS-OCT), and SS-OCT angiography (SS-OCTA) were performed to examine the iris cysts. Results: The mean age of the patients was 34.4 years, ranging from 5 to 85 years. Twenty-four patients (65%) were female and 13 (35%) were male. Mean follow-up period was 21.3 months, ranging from 4 months to 8 years. Thirty-five (94.5%) of the cysts were classified as primary and 2 (4.5%) were classified as secondary. Thirty-one (83.7%) of the primary cysts were pigment epithelial and 4 were stromal. Primary iris pigment epithelial cysts were classified as peripheral in 26 patients (72.2%), midzonal in 4 (11.1%), and dislodged in 1 (2.7%). Stromal cysts were classified as acquired in 3 patients (8.1%) and congenital in 1 patient (2.7%). Secondary iris cysts were caused by perforating eye injury. UBM could visualize both the anterior and posterior surfaces of the cysts (26 patients). Anterior segment SSOCT could visualize the anterior but not the posterior surface of the cysts (4 patients). Iris cysts did not display intrinsic vascularity on SS-OCTA (4 patients). All pigment epithelial cysts were managed by observation. Of the 4 primary stromal cysts, 3 were managed by surgical excision and 1 by observation. Two secondary cysts required surgical removal. Conclusion: Pigment epithelial cysts generally remain stable without need for treatment. However, iris stromal cysts frequently require surgical intervention. UBM and SS-OCT were valuable in the diagnosis of iris cysts. On UBM, iris cysts appear with a thin, hyperechoic wall with hypoechoic internal content. Iris cysts did not have intrinsic vascularity on anterior segment SS-OCTA.
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Affiliation(s)
- Helin Ceren Köse
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Kaan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Melek Banu Hoşal
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Li J, Drechsler J, Lin A, Widlus M, Qureshi A, Stoleru G, Saeedi O, Levin MR, Kaleem M, Jaafar M, Madigan WP, Alexander JL. Repeatability and Reliability of Quantified Ultrasound Biomicroscopy Image Analysis of the Ciliary Body at the Pars Plicata. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1949-1956. [PMID: 33858721 PMCID: PMC8169634 DOI: 10.1016/j.ultrasmedbio.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
Most of the ciliary body and ciliary processes of the eye cannot be directly visualized in vivo because of the posterior location of the pars plicata to the posterior chamber and iris. However, ciliary anatomy can be effectively imaged using ultrasound biomicroscopy (UBM) by placing the probe close to the limbus, perpendicular to this structure. Previous studies measuring ciliary body parameters in meridian UBM images found that these parameters were measured with poor reliability and repeatability. This study evaluates the intra-observer reliability and inter-observer agreement of a standardized protocol for measuring six ciliary parameters in transverse or quadrant UBM images that capture an entire row of ciliary processes. All six ciliary parameters have high intra-observer reliability, with ciliary body thickness, ciliary process length and ciliary process density measurements being the most consistent for each observer. The coefficient of variation for each observer ranged from 1.4%-15%. Inter-observer agreement was also high for all six parameters, with an intra-class correlation coefficient >0.8. Utilizing transverse UBM images of the pars plicata allows for consistent quantitative analysis in control subjects.
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Affiliation(s)
- Joy Li
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Drechsler
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anna Lin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matthew Widlus
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Azam Qureshi
- Department of Dermatology, George Washington School of Medicine & Health Sciences, Washington, DC, USA
| | - Gianna Stoleru
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - M Roni Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mona Kaleem
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Mohamad Jaafar
- Department of Ophthalmology, Children's National Hospital, Washington, DC, USA
| | - William P Madigan
- Department of Ophthalmology, Children's National Hospital, Washington, DC, USA
| | - Janet Leath Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA.
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Alexander JL, Maripudi S, Kannan K, Drechsler J, Levin MR, Saeedi OJ, Kaleem M, Bazemore M, Karwoski B, Martinez C, Jaafar M, Madigan WP. Semiautomated Assessment of Anterior Segment Structures in Pediatric Glaucoma Using Quantitative Ultrasound Biomicroscopy. J Glaucoma 2021; 30:e222-e226. [PMID: 33596011 PMCID: PMC8261835 DOI: 10.1097/ijg.0000000000001809] [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: 11/26/2020] [Accepted: 01/14/2021] [Indexed: 11/26/2022]
Abstract
The study was a prospective observational study comparing semiautomated to manual quantitative ultrasound biomicroscopy image analysis among 82 images from 41 eyes of 32 subjects (21 controls and 11 glaucoma) enrolled in the Pediatric Anterior Segment Imaging Innovation Study. Intraclass correlation coefficients and correlation coefficients were >0.8 for all parameters, and comparison of respective analysis speed was 7 times faster for the semiautomated method compared with manual image quantification.
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Affiliation(s)
- Janet Leath Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Snehaa Maripudi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Karun Kannan
- Johns Hopkins University, Department of Computer Science and Engineering, 3400 N. Charles St., Baltimore, MD 21218, USA
| | - Jennifer Drechsler
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Moran R. Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Osamah J. Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 West Redwood Street, Suite 479, Baltimore, MD 21201
| | - Mona Kaleem
- Wilmer Eye Institute, Johns Hopkins University, 3400 N. Charles St., Baltimore, MD 21218, USA
| | - Marlet Bazemore
- Department of Ophthalmology, Children’s National Health System, 111 Michigan Avenue, Washington, DC 20010, USA
| | - Bethany Karwoski
- Department of Ophthalmology, Children’s National Health System, 111 Michigan Avenue, Washington, DC 20010, USA
| | - Camilo Martinez
- Department of Ophthalmology, Children’s National Health System, 111 Michigan Avenue, Washington, DC 20010, USA
| | - Mohamad Jaafar
- Department of Ophthalmology, Children’s National Health System, 111 Michigan Avenue, Washington, DC 20010, USA
| | - William Patrick Madigan
- Department of Ophthalmology, Children’s National Health System, 111 Michigan Avenue, Washington, DC 20010, USA
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Exploring the Occurrence Mechanisms of Acute Primary Angle Closure by Comparative Analysis of Ultrasound Biomicroscopic Data of the Attack and Fellow Eyes. BIOMED RESEARCH INTERNATIONAL 2021; 2020:8487907. [PMID: 32382576 PMCID: PMC7197009 DOI: 10.1155/2020/8487907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/31/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
Abstract
Purpose To explore the anatomical characteristics and occurrence mechanisms of acute primary angle closure (APAC) by comparing the quantitative data of UBM images of the APAC and fellow eyes. Methods 131 patients (262 eyes) were studied over five years by retrospective analysis. The quantitative data from UBM images including angle opening distance at 500 μm (AOD500), trabecular-iris angle (TIA), iris convexity (IC), iris span (IS), iris-lens angle (ILA), iris-lens contact distance (ILCD), iris-ciliary process angle (ICPA), and limbus-ciliary body angle (LCBA) were retrospectively recorded; comparative analysis of the APAC and fellow eyes was performed. Results The superior, inferior, nasal, temporal, and mean AOD500, TIA, IC, and LCBA (P < 0.001) were significantly smaller in APAC than in fellow eyes. Values of the lens thickness (LT), lens/axial length factor (LAF), lens position (LP), and relative lens position (RLP) were lower in APAC than in fellow eyes (P = 0.021; P = 0.025; P < 0.001; and P < 0.001). In APAC eyes, AOD500 was significantly positively correlated with IC, ILCD, and LCBA; TIA was significantly positively significantly correlated with IC, ILCD, and LCBA. In fellow eyes, AOD500 was significantly negatively correlated with ILA and significantly positively correlated with ILCD, ICPA, LCBA, axial length (AL), central anterior chamber depth (CACD), and LP; TIA was significantly negatively correlated with ILA and significantly positively correlated with IS, ILCD, ICPA, LCBA, AL, CACD, LP, and RLP. Conclusions Multiple nonpupillary block factors (plateau iris, anterior attachment and insertion of the iris root, anterior shift of the lens, and anterior rotation of the ciliary body) promote the occurrence of APAC, and abnormal positional relationships of the iris, ciliary body, and lens may contribute to APAC.
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10
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Yu ZY, Huang T, Lu L, Qu B. Comparison of measurements of anterior chamber angle via anterior segment optical coherence tomography and ultrasound biomicroscopy. World J Clin Cases 2020; 8:3249-3258. [PMID: 32874979 PMCID: PMC7441261 DOI: 10.12998/wjcc.v8.i15.3249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Glaucoma is an irreversible optic neuropathy with the loss of visual field and decrease of vision. The variable clinical manifestations may result in differential diagnostic difficulties. The early screening and diagnosis of glaucoma are currently experiencing a demand for anterior segment analysis tools that can gather more information with one short measurement. Therefore, we analyzed the agreement, difference, and correlation of chamber angle parameters such as angel opening distance at 500 μm (AOD500) and trabeculo-iris space area at 500 μm2 (TISA500) measured by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM).
AIM To compare the differences, correlation, and agreement in measuring AOD500 and TISA500 by AS-OCT and UBM.
METHODS Both AS-OCT and UBM were performed to measure AOD500 and TISA500 in 45 subjects (72 eyes). All subjects without glaucoma were collected from October 2015 to August 2016 at the Ophthalmology Department of the Fourth Affiliated Hospital of China Medical University. Data of the two groups (AOD500 and TISA500) were compared by nonparametric tests. Pearson correlative analysis and Bland–Altman analysis were used to compare the correlation and agreement.
RESULTS There were no significant differences between AS-OCT and UBM in measuring AOD500 (P1 = 0.110, P2 = 0.633, P3 = 0.078, and P4 = 0.474) and TISA500 (P1 = 0.584, P2 = 0.889, P3 = 0.297, and P4 = 0.550) of the four quadrants of the anterior chamber angle. There was a high correlation in measuring AOD500 (r1 = 0.562, r2 = 0.671, r3 = 0.635, and r4 = 0.720; P < 0.001) and TISA500 (r1 = 0.584, r2 = 0.889, r3 = 0.297, and r4 = 0.550; P < 0.001). There was a good agreement in measuring AOD500 and TISA500 by the two modalities.
CONCLUSION There is a high correlation and agreement between AOD500 and TISA500 measurements by AS-OCT and UBM. They are interchangeable under some circumstances. AS-OCT proves to be a better early screening tool for glaucoma.
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Affiliation(s)
- Zi-Yan Yu
- Department of Ophthalmology, Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Key Laboratory of Lens Research of Liaoning Province, Shenyang 110005, Liaoning Province, China
| | - Ting Huang
- Department of Cataract, Aier Mega Ophthalmic Hospital of Chongqing, Chongqing 400060, China
| | - Lu Lu
- Department of Ophthalmology, Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Key Laboratory of Lens Research of Liaoning Province, Shenyang 110005, Liaoning Province, China
| | - Bo Qu
- Department of Ophthalmology, Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University, Key Laboratory of Lens Research of Liaoning Province, Shenyang 110005, Liaoning Province, China
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Qian Y, Liu L, Shi Y, Wang M, Li M, Zou J. Assessment of Anterior Chamber by Ultrasound Biomicroscopy and Anterior Segment Optical Coherence Tomography in Patients with Inflammatory Glaucoma. J Int Med Res 2019; 47:5950-5956. [PMID: 31594445 PMCID: PMC7045678 DOI: 10.1177/0300060519867808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective To investigate the clinical indications of ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) in eyes with inflammatory glaucoma. Methods Sixteen patients (16 eyes) with inflammatory glaucoma were analysed retrospectively. All of the subjects underwent UBM and AS-OCT scans, measuring the following parameters: central corneal thickness (CCT), central anterior chamber depth (ACD), angle-opening distance (AOD500), and trabecular-iris angle (TIA500) in four quadrants. Results Both the UBM and AS-OCT generated detailed, high-resolution images of the anterior segments of the eyes with inflammatory glaucoma. Moreover, the UBM and AS-OCT exhibited statistically similar measurement results for all of the indices. A Bland–Altman analysis showed a high level of agreement between the two imaging techniques. Additionally, the UBM was able to visualize the ciliary body and pars plana, while the cells and the flare in the anterior chamber appeared more pronounced in the UBM images. Conclusions Both the UBM and AS-OCT are useful tools for anterior segment imaging and taking measurements needed for evaluating inflammatory glaucoma. The AS-OCT has the advantages of being noninvasive and fast, whereas the UBM is presently unparalleled in the visualization of the ciliary body and pars plana.
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Affiliation(s)
- Yiyong Qian
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Lin Liu
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Yuehui Shi
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Minli Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Min Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, P. R. China
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Kudsieh B, Fernández-Vigo JI, Vila-Arteaga J, Urcola JA, Martínez-de-la-Casa JM, García-Feijóo J, Ruiz-Moreno JM, Fernández-Vigo JÁ. Update on the usefulness of optical coherence tomography in assessing the iridocorneal angle. ACTA ACUST UNITED AC 2019; 94:478-490. [PMID: 31371112 DOI: 10.1016/j.oftal.2019.06.007] [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: 02/17/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
The iridocorneal angle, due to its implications in the physiopathology of aqueous humour drainage, is a fundamental structure of the anterior chamber. Anterior segment optical coherence tomography is a rapid and non-invasive technique that obtains images in vivo. The high resolution allows it to analyse the normal anatomy of the angle, any alterations, and the changes that occur after different therapeutic interventions. Anterior segment optical coherence tomography technology has evolved to provide images that allow the identification and quantification of the angular structures in healthy subjects and in glaucoma patients, and especially the trabecular meshwork and the Schlemm's canal. It also enables the angle width to be quantified, with some objective parameters that have been standardised in recent years, such as the trabecular-iris angle, the angle opening distance, and the trabecular-iris area. This technique has multiple uses in the study of the different mechanisms of angle closure, the evaluation of changes after a laser peripheral iridotomy or iridoplasty after cataract surgery, as well as after the implantation of phakic lenses.
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Affiliation(s)
- B Kudsieh
- Departamento de Oftalmología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España; Centro Internacional de Oftalmología Avanzada, Madrid, España.
| | - J I Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J Vila-Arteaga
- Hospital La Fe, Valencia, España; Clínica Vila-Innova Ocular, Valencia, España
| | - J Aritz Urcola
- Departamento de Oftalmología, Hospital Universitario de Álava, Vitoria, España; Begitek Clínica Oftalmológica, Innova Ocular, Donostia-San Sebastián, España
| | - J M Martínez-de-la-Casa
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J García-Feijóo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, España
| | - J M Ruiz-Moreno
- Departamento de Oftalmología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - J Á Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Universidad de Extremadura, Badajoz, España
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Porporato N, Baskaran M, Tun TA, Sultana R, Tan MCL, Quah JHM, Allen J, Friedman DS, Cheng CY, Aung T. Assessment of Circumferential Angle Closure with Swept-Source Optical Coherence Tomography: a Community Based Study. Am J Ophthalmol 2019; 199:133-139. [PMID: 30502338 DOI: 10.1016/j.ajo.2018.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of swept-source optical coherence tomography (SS-OCT, CASIA SS-1000; Tomey Corporation, Nagoya, Japan) for angle closure detection, in comparison with gonioscopy, in a community setting. DESIGN Reliability analysis. METHODS A total of 2027 phakic subjects aged ≥50 years, with no previous history of glaucoma, laser (including peripheral iridotomy), intraocular surgery, or ocular trauma, were consecutively recruited from a community polyclinic in Singapore. Gonioscopy was performed by a single trained ophthalmologist. SS-OCT angle scans, which obtain radial scans for the entire circumference of the angle, were analyzed by a single examiner, masked to the subject's clinical details. On SS-OCT images, angle closure was defined as contact between the iris and any part of the angle wall anterior to the scleral spur. Different cutoff values of the degree of circumferential angle closure (≥35%, ≥50%, and ≥75%) were taken for analysis to assess SS-OCT performance in detecting angle closure. RESULTS A total of 1857 subjects (91.6%) were included in the final analysis after excluding poor-quality SS-OCT scans. Almost 90% of the subjects were Chinese, with a mean age of 61.8 ± 6.7 years, and more than half were women (63.5%). The overall AUC of SS-OCT manual grading against gonioscopy was 0.84 (95% confidence interval, 0.81-0.88). The prevalence of angle closure on SS-OCT was 26.1% for the ≥35% definition, with an area under the curve of 0.80 (0.77-0.84), sensitivity of 82.5% (75.3%-88.4%), and specificity of 78.5% (76.5%-80.4%). The first-order agreement coefficient statistics for the 2-quadrant gonioscopic definition of angle-closure with corresponding ≥35%, ≥50%, and ≥75% angle closure definitions for SS-OCT were good at 0.89 (0.83-0.93), 0.88 (0.842-0.93), and 0.88 (0.831-0.99), respectively. CONCLUSIONS In this large community-based study, SS-OCT exhibited moderate performance for angle closure detection compared to gonioscopy as the reference standard.
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Affiliation(s)
- Natalia Porporato
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Tin A Tun
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | - Marcus C L Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joanne H M Quah
- SingHealth Polyclinics, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinic Program, Singapore
| | | | - David S Friedman
- Wilmer Eye Institute, Dana Center for Preventive Ophthalmology and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; DUKE-NUS Medical School, Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore.
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14
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Porporato N, Baskaran M, Aung T. Role of anterior segment optical coherence tomography in angle-closure disease: a review. Clin Exp Ophthalmol 2017; 46:147-157. [DOI: 10.1111/ceo.13120] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Natalia Porporato
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
| | - Mani Baskaran
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
| | - Tin Aung
- Singapore Eye Research Institute; Singapore National Eye Centre; Singapore Singapore
- Duke-NUS Graduate Medical School; Singapore Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
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Ma XY, Zhu D, Zou J, Zhang WJ, Cao YL. Comparison of ultrasound biomicroscopy and spectral-domain anterior segment optical coherence tomography in evaluation of anterior segment after laser peripheral iridotomy. Int J Ophthalmol 2016; 9:417-23. [PMID: 27158613 DOI: 10.18240/ijo.2016.03.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To quantitatively assess narrow anterior chamber angle using spectral-domain anterior segment optical coherence tomography (SD-AS-OCT) and ultrasound biomicroscopy (UBM), and to evaluate the correlations and consistency between SD-AS-OCT and UBM. METHODS Fifty-five eyes from 40 patients were examined. Patients were diagnosed with primary angle-closure glaucoma (PACG) remission (11 eyes from 8 patients), primary angle closure (PAC, 20 eyes from 20 patients) and PAC suspect (24 eyes from 12 patients). Each eye was examined by SD-AS-OCT and UBM after laser peripheral iridotomy (LPI). The measurements of SD-AS-OCT were angle open distance (AOD), anterior chamber angle (ACA), trabecular iris angle (TIA), and trabecular iris space area (TISA). UBM measurements were AOD and TIA. Correlations of AOD500 and TIA500 between UBM and AS-OCT were assessed. All parameters were analysed by SPSS 16.0 and MedCalc. RESULTS ACA, TIA and AOD measured by SD-AS-OCT reached a maximum at the temporal quadrant and minimum at the nasal quadrant. TISA reached the maximum at the inferior and minimum at the superior quadrant. Group parameters of AOD500 and AOD750 showed a linear positive correlation, and AOD750 had less variability. UBM outcomes of AOD500 and TIA500 were significantly smaller than those of SD-AS-OCT. The results of the two techniques were correlated at the superior, nasal and inferior quadrants. CONCLUSION Both UBM and SD-AS-OCT are efficient tools for follow-up during the course of PACG. We recommended using parameters at 750 µm anterior to the sclera spur for the screening and follow-up of PACG and PAC. The two methods might be alternatives to each other.
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Affiliation(s)
- Xiao-Yun Ma
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, Shanghai 200011, China; Department of Ophthalmology, Shanghai Guanghua Integrative Medicine Hospital, Shanghai 200052, China
| | - Dan Zhu
- Department of Ophthalmology, Shanghai Guanghua Integrative Medicine Hospital, Shanghai 200052, China
| | - Jun Zou
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China
| | - Wen-Jie Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, Shanghai 200011, China
| | - Yi-Lin Cao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Tissue Engineering, National Tissue Engineering Center of China, Shanghai 200011, China
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Sharma R, Sharma A, Arora T, Sharma S, Sobti A, Jha B, Chaturvedi N, Dada T. Application of anterior segment optical coherence tomography in glaucoma. Surv Ophthalmol 2013; 59:311-27. [PMID: 24138894 DOI: 10.1016/j.survophthal.2013.06.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 06/24/2013] [Accepted: 06/25/2013] [Indexed: 02/02/2023]
Abstract
Optical coherence tomography (OCT) is a cross-sectional, three-dimensional, high-resolution imaging modality that uses low coherence interferometry to achieve axial resolution in the range of 3-20 μm. Two OCT platforms have been developed: time domain (TD-OCT) and spectral (or Fourier) domain (SD/FD-OCT). Visante anterior segment OCT (Carl Zeiss Meditec) is a TD-OCT widely used for anterior segment imaging. The SD-OCT systems with both posterior and anterior segment imaging capabilities include the RTVue, iVue (Optovue), the Cirrus (Carl Zeiss Meditec), and the Spectralis (Heidelberg Engineering, Inc.). Each of the SD-OCTs has a wavelength in the range of 820-879 nm. Anterior segment OCT is a non-contact method providing high resolution tomographic cross-sectional imaging of anterior segment structures. Anterior segment OCT provides qualitative and quantitative assessment of the anterior segment structures important to the pathogenesis and the anatomical variations of glaucoma, and the approach to and success of treatment. We summarize the clinical applications of anterior segment OCT in glaucoma.
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Affiliation(s)
- Reetika Sharma
- Glaucoma Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Sharma
- Glaucoma Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tarun Arora
- Glaucoma Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sourabh Sharma
- Glaucoma Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Sobti
- Glaucoma Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Jha
- Glaucoma Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Chaturvedi
- Glaucoma Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Glaucoma Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Smith SD, Singh K, Lin SC, Chen PP, Chen TC, Francis BA, Jampel HD. Evaluation of the Anterior Chamber Angle in Glaucoma. Ophthalmology 2013; 120:1985-97. [DOI: 10.1016/j.ophtha.2013.05.034] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 01/19/2023] Open
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Dusak A, Baykara M, Ozkaya G, Erdogan C, Ozcetin H, Tuncel E. Ultrasound biomicroscopic evaluation of anterior segment cysts as a risk factor for ocular hypertension and closure angle glaucoma. Int J Ophthalmol 2013; 6:515-20. [PMID: 23991389 DOI: 10.3980/j.issn.2222-3959.2013.04.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/06/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To investigate the relationship between the ultrasound biomicroscopic (UBM) features of anterior-segment cysts (ASCs) and increased intraocular pressure (IOP) as a risk factor for closed-angle glaucoma (CAG). METHODS Totally 24 eyes with recently diagnosed ASCs were divided into two groups. First group with ASC and ocular normotension (n=13), second group with ASC and ocular hypertension (n=11). An ophthalmologic examination, including tonometry, slit-lamp biomicroscopy (SLBM), gonioscopy, fundoscopy, pentacam, and UBM, was performed. The features of the ASCs were compared with the IOP. RESULTS ASCs were accurately diagnosed and delineated in 24 eyes using UBM. IOP was elevated in those ASCs with a secondary aetiology (P=0.027), iridociliary location (P=0.006), deformed shape (P=0.013), increased size (P=0.001) and elongated pupillary aperture (P=0.009). However, the count (P=0.343) of ASCs, anterior chamber depth (ACD; P=0.22) and axial lenght (AL; P=0.31) were not associated with ocular hypertension. Correlations were found between the IOP and ASC size (r=-0.712; P=0.003), anterior chamber angle (ACA; r=-0.985; P<0.001), angle opening area (AOA; r=0.885; P<0.001), angulation of iris (r=-0.776, P<0.001), and affected iris quadrant (r =-0.655, P=0.002). CONCLUSION Ocular hypertension in some eyes with ASC might be associated with various mechanisms, including secondary aetiology, iridociliary location, deformed shape, increased size and elongated pupill, which can be determined by UBM.
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Affiliation(s)
- Abdurrahim Dusak
- Department of Radiology, School of Medicine, Uludag University, Bursa 16059, Turkey
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Fibrin membrane pupillary-block glaucoma after uneventful cataract surgery treated with intracameral tissue plasminogen activator: a case report. BMC Ophthalmol 2012; 12:3. [PMID: 22433746 PMCID: PMC3326710 DOI: 10.1186/1471-2415-12-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 03/20/2012] [Indexed: 11/10/2022] Open
Abstract
Background Fibrin pupillary-block glaucoma is a rare complication after cataract surgery. The treatment for this condition is still controversial, since Nd:YAG laser fibrin membranotomy tends to reocclude and laser peripheral iridotomy entails the risk of damaging the corneal endothelium in the presence of corneal edema associated with elevated intraocular pressure. Case presentation A 62-year-old man with diabetes mellitus developed acute elevation of intraocular pressure with a shallow anterior chamber five days after uneventful cataract surgery. Initially, slit lamp examination provided only limited information due to severe corneal edema. After resolution of corneal edema with systemic glaucoma therapy, a complete fibrin membrane was observed across the pupil by slit lamp examination. Anterior segment optic coherence tomography clearly revealed a thin fibrin membrane covering the entire pupillary space, a shallow anterior chamber, and a deep posterior chamber. The intraocular lens was not observed by anterior segment optic coherence tomography. In contrast, ultrasound biomicroscopy, which has superior penetration depth, was able to visualize the intraocular lens deep in the posterior chamber. Injection of tissue plasminogen activator into the anterior chamber resulted in complete fibrinolysis and released the pupillary block. Conclusion This case suggests that ocular anterior segment imaging modalities, especially ultrasound biomicroscopy, serve as powerful diagnostic tools to identify mechanisms of acute angle closure glaucoma, which is often accompanied by poor intraocular visibility. This is the first reported case of fibrin pupillary-block glaucoma after cataract surgery successfully treated with intracameral tissue plasminogen activator.
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Bianciotto C, Shields CL, Guzman JM, Romanelli-Gobbi M, Mazzuca D, Green WR, Shields JA. Assessment of anterior segment tumors with ultrasound biomicroscopy versus anterior segment optical coherence tomography in 200 cases. Ophthalmology 2011; 118:1297-302. [PMID: 21377736 DOI: 10.1016/j.ophtha.2010.11.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 10/29/2010] [Accepted: 11/09/2010] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare ultrasound biomicroscopy (UBM) versus anterior segment optical coherence tomography (AS-OCT) for imaging of tumors of the anterior segment of the eye. DESIGN Retrospective, noninterventional case series. PARTICIPANTS We included 200 patients. METHODS Review of medical records of patients who underwent both UBM and AS-OCT for evaluation of anterior segment tumors. MAIN OUTCOME MEASURES Comparison of tumor surface and internal visualization. RESULTS There were 200 eyes with anterior segment tumors involving the iris stroma in 96 (48%), ciliary body in 14 (7%), combined iris and ciliary body in 32 (16%), iris pigment epithelium (IPE) in 44 (22%), conjunctiva in 6 (3%), sclera in 4 (2%), and others in 6 (1% each). The diagnoses included nevus in 75 eyes (38%), melanoma in 47 (24%), cyst in 48 (24%), epithelioma (adenoma) in 5 (3%), metastasis, melanocytosis and melanocytoma in 4 eyes each (2%), and others (1% each). Image analysis (UBM vs AS-OCT) revealed adequate visualization of all tumor margins (189 [95%] vs 80 [40%]), posterior tumor shadowing (9 [5%] vs 144 [72%]), and high overall image quality (159 [80%] vs 136 [68%]). Comparison for better image resolution (UBM vs AS-OCT) disclosed UBM provided better overall tumor visualization (138 [69%] vs 62 [31%]) and better resolution of the posterior margin (147 [74%] vs 53 [27%]), whereas AS-OCT provided better resolution of the anterior margin (40 [20%] vs 160 [80%]) as well as better overall resolution of anterior segment anatomy (41 [21%] vs 159 [80%]). Better resolution was found with UBM for pigmented tumors (n = 162; 107 [66%] vs 55 [34%]) as well as for nonpigmented tumors (n = 38; 23 [61%] vs 15 [39%]). Regarding location, iris tumor resolution was similar with each technique (49 [52%] vs 45 [48%]). CONCLUSIONS For anterior segment tumors, UBM offers better visualization of the posterior margin and provides overall better images for entire tumor configuration compared with AS-OCT.
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Affiliation(s)
- Carlos Bianciotto
- Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Current World Literature. Curr Opin Ophthalmol 2011; 22:141-6. [DOI: 10.1097/icu.0b013e32834483fc] [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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Anterior segment optical coherence tomography of acute primary angle closure. Graefes Arch Clin Exp Ophthalmol 2010; 248:825-31. [DOI: 10.1007/s00417-009-1291-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 12/22/2009] [Accepted: 12/24/2009] [Indexed: 11/25/2022] Open
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