1
|
Li B, Xie T, Nawy S, Shen Y. The development and the genetic diseases of the ciliary body. CELL INSIGHT 2024; 3:100162. [PMID: 38595769 PMCID: PMC11002873 DOI: 10.1016/j.cellin.2024.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
The ciliary body, located at the junction of the choroid and iris, is crucial in the development of the embryonic eye. Notch2 signalling, Wnt signalling, transforming growth factor β (TGF-β) signalling, and Pax6 signalling are critical for coordinating the ciliary body formation. These signalling pathways are coordinated with each other and participate in the ciliary body development, ensuring the precise formation and optimal functioning of the eye structure. Although rare, ciliary body hypoplasia, ciliary tumours, and genetic-related iritis indicate the intricate nature of ciliary body development. Given the ciliary body's important biological significance and potential medical relevance, we aim to provide a comprehensive overview of the developmental molecular mechanisms governing ciliary body formation and function. Here, we focus on the intricate signalling pathways governing ciliary body development and corresponding genetic ciliary diseases.
Collapse
Affiliation(s)
- Baige Li
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
| | - Ting Xie
- Division of Life Science, The Hong Kong University of Science and Technology, Kowloon, Hong Kong Special Administrative Region (SAR), China
| | - Scott Nawy
- University of California Berkeley, Department of Molecular and Cell Biology, Berkeley, CA, USA
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan University, Wuhan, Hubei, China
- Frontier Science Center for Immunology and Metabolism, Medical Research Institute, School of Medicine, Wuhan University, Wuhan, Hubei, China
| |
Collapse
|
2
|
Abdelrahman AM, Ismail YM. Primary Transscleral Diode Laser Cyclophotocoagulation for Management of Glaucoma in Nanophthalmic Eyes. J Glaucoma 2024; 33:e15-e18. [PMID: 37585376 DOI: 10.1097/ijg.0000000000002284] [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: 02/01/2023] [Accepted: 07/23/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE The aim of this study was to assess the efficacy and safety of double-row transscleral cyclophotocoagulation in controlling intraocular pressure in patients with secondary angle closure glaucoma due to nanophthalmos, not being controlled by medical therapy. PATIENTS AND METHODS A prospective case series study that included 13 eyes of 8 patients diagnosed with secondary angle closure glaucoma due to nanophthalmos at the Giza Eye Subspeciality Center, treated by 24 cyclodiode applications in a double-row technique. Success was defined as complete success by control of intraocular pressure <21 mm Hg without medication and qualified success in which control of pressure <21 mm Hg achieved with 1 or 2 medications. RESULTS The average reduction in intraocular pressure at 3 months was 57.3±20.14% and at 6 months 44.5±32%, with an average eye drop intake of 1.3±0.8 drops. There was a significant reduction of intraocular pressure at 6 months compared with the preprocedure pressure ( P =0.01). Complete success achieved in 3 eyes, pressure controlled without any medication, and qualified success in 9 eyes. CONCLUSION Transscleral cyclophotocoagulation is a safe and effective primary therapy for managing glaucoma in nanophthalmic eyes.
Collapse
Affiliation(s)
- Ahmed M Abdelrahman
- Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, Cairo, Egypt
| | | |
Collapse
|
3
|
Issiaka M, Zrikem K, Mchachi A, Benhmidoune L, Rachid R, Belhadji MEL, Salam Youssoufou Souley A, Amza A. Micropulse diode laser therapy in refractory glaucoma. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2023; 3:23-28. [PMID: 37846428 PMCID: PMC10577867 DOI: 10.1016/j.aopr.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/25/2022] [Accepted: 10/05/2022] [Indexed: 10/18/2023]
Abstract
Purpose Description of safety and efficacy of micropulse Transscleral cyclophotocoagulation as a treatment option for refractory glaucoma. Methods This is a prospective study including 39 eyes of 31 patients followed for refractory glaucoma, who benefited from transscleral cyclophotocoagulation using a microplused laser. The main indication for the procedure was increased ocular pressure refractory to quadritherapy in various types of glaucoma. The patients were treated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 nm. The parameters for the procedure were a duration of 90 s per hemisphere with a power of 2000 mW and an energy of 180 J. Both the upper and lower hemispheres were treated in the same procedure, sparing the 3 o'clock and 9 o'clock meridians, and all the patients benefited from a single treatment session. The following parameters were evaluated: ocular pain and overall tolerance; visual acuity; and the evolution of IOP postoperatively up to 9 months. Results The glaucoma subtypes treated are as follows: primary open-angle glaucoma (n = 05), chronic angle-closure glaucoma (n = 13), neovascular glaucoma (n = 07), aphakic glaucoma (n = 06), malignant glaucoma (n = 04), post-traumatic angle recession (n = 02), and inflammatory glaucoma (n = 02). The mean pre-operative intraocular pressure was 42.3 ± 5.2 mmHg and the mean post-operative intraocular pressure at 9 months was 16.9 ± 1.9 mmHg. The reduction in IOP was 49.9%. The average number of intraocular pressure-lowering medications used prior to surgery was four, and the average number of medications used at the 9-month post-operative visit was 2.0 ± 1.2 (70.3% of patients were on dual therapy). The overall success rate was 60.5%. Conclusions Micropulse transscleral cyclophotocoagulation appears to be a safe and efficient treatment for refractory glaucoma. Its indications should therefore be broadened and proposed early in various situations.
Collapse
Affiliation(s)
- Moctar Issiaka
- Adult Ophthalmology Department, 20 August 1953 Hospital, Ibn Rochd University Hospital of Casablanca, Casablanca, Morocco
| | - Khalil Zrikem
- Adult Ophthalmology Department, 20 August 1953 Hospital, Ibn Rochd University Hospital of Casablanca, Casablanca, Morocco
| | - Adil Mchachi
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
- Adult Ophthalmology Department, 20 August 1953 Hospital, Ibn Rochd University Hospital of Casablanca, Casablanca, Morocco
| | - Leila Benhmidoune
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
- Adult Ophthalmology Department, 20 August 1953 Hospital, Ibn Rochd University Hospital of Casablanca, Casablanca, Morocco
| | - Rayad Rachid
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
- Adult Ophthalmology Department, 20 August 1953 Hospital, Ibn Rochd University Hospital of Casablanca, Casablanca, Morocco
| | - Mohamed EL. Belhadji
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
- Adult Ophthalmology Department, 20 August 1953 Hospital, Ibn Rochd University Hospital of Casablanca, Casablanca, Morocco
| | | | - Abdou Amza
- Ophthalmology Department of the Amirou Boubacar Diallo National Hospital, Niamey, Niger
| |
Collapse
|
4
|
Minhaz AT, Sevgi DD, Kwak S, Kim A, Wu H, Helms RW, Bayat M, Wilson DL, Orge FH. Deep Learning Segmentation, Visualization, and Automated 3D Assessment of Ciliary Body in 3D Ultrasound Biomicroscopy Images. Transl Vis Sci Technol 2022; 11:3. [PMID: 36180029 PMCID: PMC9547360 DOI: 10.1167/tvst.11.10.3] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to develop a fully automated deep learning ciliary body segmentation and assessment approach in three-dimensional ultrasound biomicroscopy (3D-UBM) images. Methods Each 3D-UBM eye volume was aligned to the optic axis via multiplanar reformatting. Ciliary muscle and processes were manually annotated, and Deeplab-v3+ models with different loss functions were trained to segment the ciliary body (ciliary muscle and processes) in both en face and radial images. Results We trained and tested the models on 4320 radial and 3864 en face images from 12 cadaver eye volumes. Deep learning models trained on radial images with Dice loss achieved the highest mean F1-score (0.89) for ciliary body segmentation. For three-class segmentation (ciliary muscle, processes, and background), radial images with Dice loss achieved the highest mean F1-score (0.75 for the ciliary process and 0.82 for the ciliary muscle). Part of the ciliary muscle (10.9%) was misclassified as the ciliary process and vice versa, which occurred owing to the difficulty in differentiating the ciliary muscle–processes border, even by experts. Deep learning segmentation made further editing by experts at least seven times faster than a fully manual approach. In eight cadaver eyes, the average ciliary muscle, process, and body volumes were 56 ± 9, 43 ± 13, and 99 ± 18 mm3, respectively. The average surface area of the ciliary muscle, process, and body were 346 ± 45, 363 ± 83, and 709 ± 80 mm2, respectively. We performed transscleral cyclophotocoagulation in cadaver eyes to shrink the ciliary processes. Both manual and automated measurements from deep learning segmentation show a decrease in volume, surface area, and 360° cross-sectional area measurements. Conclusions The proposed deep learning segmentation of the ciliary body and 3D measurements showed transscleral cyclophotocoagulation-related changes in the ciliary body. Translational Relevance Automated ciliary body assessment using 3D-UBM has the translational potential for ophthalmic treatment planning and monitoring.
Collapse
Affiliation(s)
- Ahmed Tahseen Minhaz
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | | | - Sunwoo Kwak
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA USA
| | - Alvin Kim
- Department of Mechanical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Hao Wu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Richard W Helms
- UH CMC Division of Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Mahdi Bayat
- Department of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH, USA
| | - David L Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.,Department of Radiology, Case Western Reserve University, Cleveland, OH, USA
| | - Faruk H Orge
- UH CMC Division of Pediatric Ophthalmology and Adult Strabismus, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| |
Collapse
|
5
|
Warjri GB, Senthil S. Imaging of the Ciliary Body: A Major Review. Semin Ophthalmol 2022; 37:711-723. [PMID: 35695216 DOI: 10.1080/08820538.2022.2085515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE We conducted a systematic search of literature to understand the various methods of imaging of the ciliary body. METHODS PubMed, Science Direct, Cochrane Library and Google Scholar were searched comprehensively and systematically to find studies related to the various modalities of ciliary body imaging. RESULTS The various ciliary body parameters that have been described are Ciliary body thickness, Ciliary body length, ciliary muscle thickness, ciliary process length, ciliary muscle length, ciliary muscle anterior length, trabecular ciliary process distance and Iris ciliary process distance. The various angles which have been measured, which mostly have a significance in Primary angle closure glaucoma (PACG) are Iris ciliary angle, Trabecular ciliary angle, scleral ciliary process angle. Various authors have defined them in various ways with subtle differences. Plateau iris and PACG mechanisms, not forgetting malignant glaucoma are better understood with imaging of the ciliary body using the ultrasound biomicroscopy (UBM). The anterior segment optical coherence tomography (ASOCT) imaging of the ciliary body has been described albeit with its own disadvantages. A few other fields dependant on the importance of ciliary body imaging are intravitreal injections, pars plana vitrectomy, measurements for implantable collamer lens (ICL) and of utmost importance, the differentiating features of ciliary body masses. CONCLUSION The UBM is still preferred over the ASOCT for imaging of the ciliary body. A lot of lacunae of knowledge still exists and consensus has to be reached on defining all the parameters universally. Future studies will be able to shed more light on the role of the ciliary body in the many ocular disorders mentioned in this review.
Collapse
Affiliation(s)
| | - Sirisha Senthil
- VST Centre for Glaucoma Services, L V Prasad Eye Institute, Hyderabad, India
| |
Collapse
|
6
|
Fernández-Vigo JI, Kudsieh B, Shi H, De-Pablo-Gómez-de-Liaño L, Fernández-Vigo JÁ, García-Feijóo J. Diagnostic imaging of the ciliary body: Technologies, outcomes, and future perspectives. Eur J Ophthalmol 2021; 32:75-88. [PMID: 34233517 DOI: 10.1177/11206721211031409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The ciliary body (CB) is part of the uvea and is a complex, highly specialized structure with multiple functions and significant relationships with nearby structures. Its functions include the aqueous humor (AH) production in the ciliary processes, the regulation of the AH output through the uveoscleral pathway, and accommodation, which depends on the ciliary muscle. Also, the CB is an important determinant of angle width as it forms part of the ciliary sulcus. Until recently, knowledge of the CB was based on histological studies. However, this structure can currently be assessed in vivo using imaging techniques such as ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT). Both techniques have shown good reproducibility of their measurements allowing for quantification of CB dimensions and their localization. In effect, studies have shown a larger CB in myopia and its diminishing size with age. Swept-source OCT devices offer fast, non-invasive high-resolution imaging allowing the identification of multiple structures. UBM requires contact and is uncomfortable for the patient. However, this technique offers deeper imaging and therefore remains the gold standard for assessing the posterior chamber, ciliary processes, or zonula. The clinical utility of CB imaging includes its assessment in different types of glaucoma such as angle-closure, malignant or plateau iris. Diagnostic CB imaging is also invaluable for the assessment of ciliochoroidal detachment when suspected, the position after the implantation of a pre-crystalline or sulcus-sutured lenses, diagnosis or monitoring of cysts or tumors, sclerotomies after retinal surgery, intermediate uveitis, or accommodation.
Collapse
Affiliation(s)
- José Ignacio Fernández-Vigo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Bachar Kudsieh
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Department of Ophthalmology, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Hang Shi
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Madrid, Spain
| | - Lucía De-Pablo-Gómez-de-Liaño
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Department of Ophthalmology, Hospital 12 de Octubre, Madrid, Spain
| | - José Ángel Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, Spain.,Centro Internacional de Oftalmología Avanzada, Badajoz, Spain.,Department of Ophthalmology, Universidad de Extremadura, Badajoz, Spain
| | - Julián García-Feijóo
- Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|