Outcome Following Laser Peripheral Iridotomy and Predictors of Future Lens Extraction

Choroidal Effusion with Exudative Retinal Detachment following Non Perforating YAG-Laser Peripheral Iridotomy: A Case Report

AIM

To report a case of choroidal effusion and exudative retinal detachment following a non perforating Yttrium-Aluminium-Garnett (YAG)-laser iridotomy.

DESIGN

Case report.

METHODS

A 53-year-old woman complains of sudden onset of blurred vision in her left eye 15 days after the attempt of YAG-laser peripheral iridotomy. Clinical examination revealed 3+ flare and 1+ cells in the anterior chamber, 2+ vitreous cells, swollen optic nerve, ciliochoroidal effusion, and exudative retinal detachment involving macular area in the left eye. After starting treatment with prednisone 25 mg once daily, choroidal effusion and retinal detachment were managed successfully without any surgical approach.

CONCLUSION

Serous choroidal and exudative retinal detachments are rare complications following YAG-laser procedure. In our case, this clinical presentation occurs after a non perforating iridotomy. In medical practice, exudative retinal detachment should be always considered after YAG-laser iridotomy.

Machine learning-couched treatment algorithms tailored to individualized profile of patients with primary anterior chamber angle closure predisposed to the glaucomatous optic neuropathy

Background

Primary angle closure glaucoma (PACG) is still one of the leading causes of irreversible blindness, with a trend towards an increase in the number of patients to 32.04 million by 2040, an increase of 58.4% compared with 2013. Health risk assessment based on multi-level diagnostics and machine learning-couched treatment algorithms tailored to individualized profile of patients with primary anterior chamber angle closure are considered essential tools to reverse the trend and protect vulnerable subpopulations against health-to-disease progression.

Aim

To develop a methodology for personalized choice of an effective method of primary angle closure (PAC) treatment based on comparing the prognosis of intraocular pressure (IOP) changes due to laser peripheral iridotomy (LPI) or lens extraction (LE).

Methods

The multi-parametric data analysis was used to develop models predicting individual outcomes of the primary angle closure (PAC) treatment with LPI and LE. For doing this, we suggested a positive dynamics in the intraocular pressure (IOP) after treatment, as the objective measure of a successful treatment. Thirty-seven anatomical parameters have been considered by applying artificial intelligence to the prospective study on 30 (LE) + 30 (LPI) patients with PAC.

Results and data interpretation in the framework of 3P medicine

Based on the anatomical and topographic features of the patients with PAC, mathematical models have been developed that provide a personalized choice of LE or LPI in the treatment. Multi-level diagnostics is the key tool in the overall advanced approach. To this end, for the future application of AI in the area, it is strongly recommended to consider the following:Clinically relevant phenotyping applicable to advanced population screeningSystemic effects causing suboptimal health conditions considered in order to cost-effectively protect affected individuals against health-to-disease transitionClinically relevant health risk assessment utilizing health/disease-specific molecular patterns detectable in body fluids with high predictive power such as a comprehensive tear fluid analysis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-023-00337-1.

Prediction of postoperative effective lens position using iris root depth in primary angle-closure diseases

PURPOSE

To evaluate the role of a new parameter, iris root depth (IRD), in intraocular lens power calculation using ultrasound biomicroscopy (UBM) in primary angle-closure diseases (PACDs), and to compare the accuracy of 6 formulas in PACDs: Barrett Universal II (BUII), Haigis, Hill-Radial Basis Function (RBF) v. 3.0, Hoffer Q, Kane and Sanders Retzlaff Kraff/Theoretical (SRK)/T.

SETTING

Zhongshan Ophthalmic Center, Guangzhou, China.

DESIGN

Retrospective consecutive case series.

METHODS

Patients diagnosed with PACDs who had undergone cataract surgery were reviewed to first evaluate the performance of 6 formulas. Then preoperative UBM examinations of 58 eyes were used to measure IRD and predict effective lens position (ELP) to generate the Haigis IRD formula. The accuracy of Haigis IRD was compared with BUII, Haigis and Kane formulas. The SD of predicted error was the main indicator evaluating formula performance, according to heteroscedastic analysis.

RESULTS

103 eyes (103 patients) were included. The SDs of Kane (0.59, P = .01), RBF 3.0 (0.61, P = .02) and SRK/T formula (0.62, P = .04) were significantly lower than Hoffer Q. Modified with IRD, Haigis IRD generated the lowest SD (0.41), which was significantly lower than Haigis formula (0.54, P = .03) and was equal to Kane formula (0.45, P = .37).

CONCLUSIONS

Kane, RBF 3.0 and SRK/T were more accurate in PACD eyes. Optimized with IRD, Haigis IRD formula achieved the lowest SD and had comparable accuracy with Kane formula. IRD could be a promising parameter to improve accuracy of IOL power calculation for PACDs.

Comparison of Lens Extraction Versus Laser Iridotomy on Anterior Segment, Choroid, and Intraocular Pressure in Primary Angle Closure Using Machine Learning

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.

Extensive serous ciliochoroidal detachments and macular subretinal and intraretinal fluid following laser peripheral iridotomy

Purpose

We present multimodal imaging of an interesting case of a 78-year-old man who developed large ciliochoroidal detachments and macular subretinal and intraretinal fluid in the right eye following bilateral neodymium-doped yttrium aluminium garnet (Nd:YAG) laser peripheral iridotomies (LPIs).

Observations

The ciliochoroidal detachments developed in the absence of documented post-procedure hypotony or intraocular pressure fluctuation. Ultrasound biomicroscopy (UBM) confirmed serous ciliochoroidal detachment. There are a small number of cases of ciliochoroidal detachments developing after peripheral iridotomy, but these have involved either argon laser, significant decrease in intraocular pressure, or underlying ocular conditions or structural abnormalities, such as Vogt-Koyanagi-Harada (VKH) or nanophthalmos.

Conclusions

Serous ciliochoroidal detachments following the relatively non-invasive procedure of LPI are rare occurrences. We present our case in hopes of increasing awareness of this potential acute complication. We also discuss the diagnostic challenges of this unique case, the extensive work up, and current status of the patient.

Accuracy of intraocular lens power calculation in primary angle-closure disease: comparison of 7 formulas

PURPOSE

To assess the accuracy of intraocular lens power calculation formulas Barrett Universal II (BUII), Hill-Radial Basis Function (RBF) 3.0, Kane, Ladas Super Formula (LSF), Haigis, Hoffer Q, and SRK/T in primary angle-closure disease (PACD).

METHODS

A total of 129 PACD eyes were enrolled. Prediction refraction was calculated for each formula and compared with actual refraction. Accuracy was determined by formula performance index (FPI), median absolute error (MedAE) and percentage of eyes with a prediction error (PE) within ± 0.50D. Subgroup analysis was performed according to axial length (AL).

RESULTS

Overall, FPI was ranked as follows: Kane (0.067), RBF 3.0 (0.064), Haigis (0.062), SRK/T (0.060), BUII (0.058), Hoffer Q (0.055), and LSF (0.049). Kane got the highest (71.3%) percentage of eyes with PE within ± 0.50 D. In medium AL eyes (22 mm < AL ≤ 25 mm), FPI ranked the same as in total group. MedAEs were equal across all formulas (P = 0.121). In short eyes (AL ≤ 22 mm), FPI was Kane (0.055), RBF 3.0 (0.050), SRK/T (0.050), Haigis (0.049), BUII (0.047), Hoffer Q (0.045), and LSF (0.033). MedAEs were significantly different across all formulas (P = 0.033). Haigis showed the lowest MedAE (0.35 D), Haigis and Kane got the highest percentage (63.6%) of eyes with PE within ± 0.50 D.

CONCLUSION

Kane outperformed in total PACD eyes; RBF 3.0, Haigis, and SRK/T achieved satisfying performance. When dealing with PACD eyes shorter than 22 mm, Kane achieved the best accuracy. RBF 3.0, SRK/T, Haigis, and BUII achieved comparable outcomes. No formula showed superiority over others for medium AL PACD eyes.

Lasers in Glaucoma: an Overview

Lasers have been in use as a treatment modality of glaucoma for more than last four decades. Each passing year has added newer dimensions to the existing laser technologies enhancing their safety and efficacy profile. This has become possible due to continuous research and innovations with proper understanding of the mechanism of action of different variety of lasers as treatment options. Each category of glaucoma has different underlying pathologies. Adequate knowledge and understanding of indications, limitations and hazards of these laser procedures are must before their application for improvising outcome. Recent years have witnessed a revolution this field. A thorough literature search was conducted in PubMed, Medline, the Cochrane Library Database, EMBASE, and Scopus and Google Scholar until May 2020 using the keywords, and all the articles pertaining to the relevant topics were included in this review. Purpose of this review is to summarize the important laser procedures currently in use for managing glaucoma along with updating the readers with recent advances in laser technologies, their extended applications and also analyzing possible future implications.