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Bhirud A, Tripathi A, Agarwal M, Mishra A. Universal slit-lamp mounted indentation gonioscopy tool for angle evaluation: An innovative device. Indian J Ophthalmol 2024; 72:928-930. [PMID: 38634755 DOI: 10.4103/ijo.ijo_3035_23] [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: 11/16/2023] [Accepted: 02/16/2024] [Indexed: 04/19/2024] Open
Abstract
In the field of ophthalmology, slit-lamp gonioscopy has long been a cornerstone for examining anterior chamber angles and diagnosing conditions such as angle closure, secondary causes of raised intraocular pressure, neovascularization of angle, angle recession, angle tumors, and foreign bodies. However, the conventional approach for goniophotography is a demanding procedure requiring juggling a gonioscopy lens in one hand and a smartphone in the other. Balancing a gonioscopy lens with one hand makes it difficult to adjust and focus the image in busy clinical settings. This article introduces a groundbreaking solution to this problem - a universal slit-lamp-mounted gonioscope ingeniously repurposed from discarded materials, that is, indirect goniophotography (IndiGo). This novel system simplifies the process of both gonioscopy and goniophotography, allowing ophthalmologists to easily assess anterior chamber angles and capture high-quality images. These images can be swiftly shared with glaucoma specialists worldwide for digital analysis. Not only does this approach enhance examination efficiency, but also it fosters sustainability in ophthalmic diagnostics.
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Affiliation(s)
- Atul Bhirud
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
| | - Anchal Tripathi
- Department of Ophthalmology, Military Hospital, Jammu, J&K, India
| | - Mohini Agarwal
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
| | - Avinash Mishra
- Department of Ophthalmology, Military Hospital, Jalandhar, Punjab, India
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Lee SS, Nagar S, Rajagopalan L, Orilla W, Csaky KG, Almazan A, Yang L, Robinson MR. Using a Novel, Subconjunctival, Sustained-Release Mitomycin C Formulation in a Rabbit Model of Filtration Surgery with Gel Stent Implantation. J Ocul Pharmacol Ther 2024; 40:297-308. [PMID: 38687355 DOI: 10.1089/jop.2023.0100] [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: 05/02/2024] Open
Abstract
Purpose: To investigate gel stent implantation with and without intraoperative sustained-release mitomycin C (MMC SR) in a rabbit model for gel stent implantation, and to examine aqueous humor outflow (AHO) postimplantation. Methods: Four groups of rabbits were included. Group 1 was untreated (control). Groups 2, 3, and 4 received the gel stent without MMC, with MMC solution (subconjunctival injection), and with MMC SR (subconjunctival injection), respectively. Intraocular pressure (IOP) and AHO were assessed via tonometry and indocyanine green-based angiography, respectively. The main efficacy measure was change in IOP from baseline. Results: Following gel stent implantation, Groups 2, 3, and 4 maintained ≥20% IOP reduction (response) for a median duration of 1 week, 6.5 weeks, and 30 weeks, respectively. Angiography showed normal aqueous humor drainage (Group 1) beginning at the perilimbal trabecular plexus and continuing posteriorly to episcleral outflow vessels. Following implantation, drainage occurred preferentially and directly into the subconjunctival bleb. Conclusions: Gel stent implantation with MMC SR was most effective in achieving sustained, long-term IOP reduction in the rabbit model, compared with implantation with or without MMC solution. Bleb presence and the postimplantation aqueous angiography results indicated redirection of the AHO to the subconjunctival vasculature and presumed lymphatics, suggesting efficient glaucoma filtration to lower IOP in this model. This rabbit model and aqueous angiography may help refine understanding of the mechanism of action of minimally invasive glaucoma surgeries and ultimately translate to improved surgical devices and procedures for patients with glaucoma.
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Affiliation(s)
- Susan S Lee
- Allergan, an AbbVie company, Irvine, California, USA
| | - Saumya Nagar
- Allergan, an AbbVie company, Irvine, California, USA
| | | | | | - Karl G Csaky
- Retina Foundation of the Southwest, Dallas, Texas, USA
| | | | - Liuqing Yang
- Allergan, an AbbVie company, Irvine, California, USA
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Elubous KA. Navigating hypotony challenges with XEN gel implantation. Expert Rev Med Devices 2024; 21:277-284. [PMID: 38454782 DOI: 10.1080/17434440.2024.2327529] [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: 12/09/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
INTRODUCTION The XEN Gel, a hydrophilic tube meticulously crafted to adhere to the principles of the Hagen - Poiseuille law, is designed to facilitate efficient aqueous shunting without inducing hypotony. Implantable ab interno or ab externo, with or without conjunctival opening, the device shows no significant outcome differences. Despite numerical hypotony signaling failure, patients may fare well below 6 mmHg. AREAS COVERED This review provides insights into device variability, challenges related to hypotony, associated risk factors, and hypotony management. EXPERT OPINION The progressive evolution of the XEN Gel constitutes a significant advancement in the field of glaucoma management. Comparative studies investigating diverse implantation methodologies, particularly the ab interno and closed conjunctival approaches, highlight the device versatility in addressing individual patient needs. Exploring hypotony from both statistical and clinical perspectives challenges the traditional view of intraocular pressure as a straightforward success or failure indicator. The incidence of hypotony-related issues varies between device models, emphasizes the need for an individualized approach during device selection. Overall, understanding the dynamics of hypotony is crucial for optimizing the outcomes of XEN Gel implantation.
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Affiliation(s)
- Khaled A Elubous
- Department of Ophthalmology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, McGill University, Montreal, QC, Canada
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Leshno A, Shalev D, Landau Prat D. Ophthalmic exam and ophthalmology residents' subspecialty preference. Int J Ophthalmol 2024; 17:359-364. [PMID: 38371249 PMCID: PMC10827627 DOI: 10.18240/ijo.2024.02.20] [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: 06/04/2023] [Accepted: 11/20/2023] [Indexed: 02/20/2024] Open
Abstract
AIM To evaluate residents' perceptions and attitudes toward the various aspects of a comprehensive ophthalmic examination, and to determine if these factors correlate with their choices for fellowship and future career plans. METHODS This is a cross-sectional study. A questionnaire on the perception of the ophthalmic exam was sent via SurveyMonkey to ophthalmology residents throughout Israel. Eighty of them (one-half of all ophthalmology residents in 2019) completed it. The first part related to how they perceived each component of the ophthalmic evaluation. The second part related to their future fellowship plans. The Chi-squared test was used to compare categorical variables and Student's t-test and One-way ANOVA were used to compare continuous variables. Multivariate logistic regression analysis was applied as needed to detect interactions between variables and to exclude confounder effects. RESULTS Slit-lamp examination of the anterior and posterior segments ranked as the most likeable aspects, whereas gonioscopy, ocular motility examination and visual acuity assessment were least likeable. Anterior segment and retina subspecialties were the ones most sought after. Forty-nine respondents (61.3%) noted a direct correlation between their preferred parts of comprehensive ophthalmic evaluations and their choice of subspecialty. Perceptions of selected components of those evaluations were significantly associated with responders' intentions to pursue anterior segment, retina, or oculoplastic fellowships (P<0.05). CONCLUSION Perspectives of residents toward the ophthalmic examination, and most specifically its individual components, play an important role in their choice of subspecialty training.
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Affiliation(s)
- Ari Leshno
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer 5262000, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Daf Shalev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Ophthalmology, Edith Wolfson Medical Center, Holon 5822012, Israel
| | - Daphna Landau Prat
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer 5262000, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Jiang W, Yan Y, Cheng S, Wan S, Huang L, Zheng H, Tian M, Zhu J, Pan Y, Li J, Huang L, Wu L, Gao Y, Mao J, Cong Y, Wang Y, Deng Q, Shi X, Yang Z, Liu S, Zheng B, Yang Y. Deep Learning-Based Model for Automatic Assessment of Anterior Angle Chamber in Ultrasound Biomicroscopy. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2497-2509. [PMID: 37730479 DOI: 10.1016/j.ultrasmedbio.2023.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The goal of the work described here was to develop and assess a deep learning-based model that could automatically segment anterior chamber angle (ACA) tissues; classify iris curvature (I-Curv), iris root insertion (IRI), and angle closure (AC); automatically locate scleral spur; and measure ACA parameters in ultrasound biomicroscopy (UBM) images. METHODS A total of 11,006 UBM images were obtained from 1538 patients with primary angle-closure glaucoma who were admitted to the Eye Center of Renmin Hospital of Wuhan University (Wuhan, China) to develop an imaging database. The UNet++ network was used to segment ACA tissues automatically. In addition, two support vector machine (SVM) algorithms were developed to classify I-Curv and AC, and a logistic regression (LR) algorithm was developed to classify IRI. Meanwhile, an algorithm was developed to automatically locate the scleral spur and measure ACA parameters. An external data set of 1,658 images from Huangshi Aier Eye Hospital was used to evaluate the performance of the model under different conditions. An additional 439 images were collected to compare the performance of the model with experts. RESULTS The model achieved accuracies of 95.2%, 88.9% and 85.6% in classification of AC, I-Curv and IRI, respectively. Compared with ophthalmologists, the model achieved an accuracy of 0.765 in classifying AC, I-Curv and IRI, indicating that its high accuracy was as high as that of the ophthalmologists (p > 0.05). The average relative errors (AREs) of ACA parameters were smaller than 15% in the internal data sets. Intraclass correlation coefficients (ICCs) of all the angle-related parameters were greater than 0.911. ICC values of all iris thickness parameters were greater than 0.884. The accurate measurement of ACA parameters partly depended on accurate localization of the scleral spur (p < 0.001). CONCLUSION The model could effectively and accurately evaluate the ACA automatically based on fully automated analysis of UBM images, and it can potentially be a promising tool to assist ophthalmologists. The present study suggested that the deep learning model can be extensively applied to the evaluation of ACA and AC-related biometric risk factors, and it may broaden the application of UBM imaging in the clinical research of primary angle-closure glaucoma.
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Affiliation(s)
- Weiyan Jiang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yulin Yan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Simin Cheng
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Shanshan Wan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Linying Huang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Hongmei Zheng
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Miao Tian
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jian Zhu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yumiao Pan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jia Li
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Li Huang
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Lianlian Wu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yuelan Gao
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jiewen Mao
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yuyu Cong
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yujin Wang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Qian Deng
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaoshuo Shi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Zixian Yang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Siqi Liu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Biqing Zheng
- School of Resources and Environmental Sciences of Wuhan University, Wuhan, Hubei Province, China
| | - Yanning Yang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China.
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Keller MJ, Gast TJ, King BJ. Advancements in high-resolution imaging of the iridocorneal angle. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1229670. [PMID: 38983074 PMCID: PMC11182319 DOI: 10.3389/fopht.2023.1229670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/31/2023] [Indexed: 07/11/2024]
Abstract
High-resolution imaging methods of the iridocorneal angle (ICA) will lead to enhanced understanding of aqueous humor outflow mechanisms and a characterization of the trabecular meshwork (TM) morphology at the cellular level will help to better understand glaucoma mechanics (e.g., cellular level biomechanics of the particulate glaucomas). This information will translate into immense clinical value, leading to more informed and customized treatment selection, and improved monitoring of procedural interventions that lower intraocular pressure (IOP). Given ICA anatomy, imaging modalities that yield intrinsic optical sectioning or 3D imaging capability will be useful to aid in the visualization of TM layers. This minireview examines advancements in imaging the ICA in high-resolution.
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Affiliation(s)
- Matthew J Keller
- School of Optometry, Indiana University, Bloomington, IN, United States
| | - Thomas J Gast
- School of Optometry, Indiana University, Bloomington, IN, United States
| | - Brett J King
- School of Optometry, Indiana University, Bloomington, IN, United States
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Ocansey S, Ekure E, Osuagwu UL, Ekpenyong BN, Ovenseri-Ogbomo G, Kyeremeh S, Ogbuehi KC, Agho KE, Mashige KP, Ndep AO, Naidoo KS. Profiling and factors associated with glaucoma diagnostic practice in sub-Saharan Africa-a cross sectional study of Nigerian and Ghanaian optometrists. BMC Ophthalmol 2023; 23:351. [PMID: 37553655 PMCID: PMC10410918 DOI: 10.1186/s12886-023-03083-0] [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: 11/03/2022] [Accepted: 07/14/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Ghana and Nigeria are the two countries in Africa that currently run the Doctor of Optometry (OD) program in sub-Saharan Africa (SSA). Optometrists in these countries are licensed to provide glaucoma care. Despite the clinically relevant practice guidelines for glaucoma, there is no data on the practice patterns for glaucoma eye care in SSA, a region with the highest prevalence of glaucoma. This study aimed to profile glaucoma diagnosis adherence to practice guidelines among optometrists in two neighbouring anglophone countries (Nigeria and Ghana). METHODS A web-based cross-sectional survey of practising optometrists was conducted in both countries. Each country data was weighted to reflect the total number of licensed and practising optometrists at the time of this survey. Descriptive analyses were performed against demography and practice factors using survey commands to adjust for sampling weights when estimating confidence intervals (CI) around prevalence estimates. Simple and multiple logistic regression analyses were performed to identify factors associated with glaucoma diagnosis. RESULTS A total of 493 optometrists (238, 48.3% and 255, 51.7%) from Ghana and Nigeria respectively, responded to the survey-the first to document and compare the glaucoma diagnostic criteria between optometrists in Ghana and Nigeria. More Ghanaian than Nigerian optometrists diagnosed glaucoma and over 90% in both countries reported that they frequently performed either tonometry, visual field testing, or fundus examination during glaucoma diagnosis. Ghanaian optometrists were significantly more likely to diagnose glaucoma than Nigerian optometrists (adjusted odd ratio, AOR = 6.15, 95%CI:1.63-23.15, P = .007). Optometrists who have practiced for more than 10 years (AOR = 7.04; 95%CI:1.74-28.47, P = .006) and private practice optometrists (AOR = 3.33; 95%CI:1.13-9.83, P = .03) were more likely to diagnose glaucoma. CONCLUSIONS The study provides information for evaluating glaucoma assessment for optometrists in both countries. Optometrists in both countries are reasonably well-equipped to diagnose glaucoma and are practicing at an adequate level, but with room for improvement.
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Affiliation(s)
- Stephen Ocansey
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Edgar Ekure
- Department of Biomedicine, Salus University, 8360 Old York Road, Elkins Park, PA, 19027, USA
| | - Uchechukwu L Osuagwu
- Bathurst Rural Clinical School (BRCS), School of Medicine, Western Sydney University, PO Box 9008, Bathurst, New South Wales, 2795, Australia.
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa.
| | - Bernadine N Ekpenyong
- Epidemiology and Biostatistics Unit, Department of Public Health, University of Calabar, Calabar, Cross River State, Nigeria
| | - Godwin Ovenseri-Ogbomo
- Department of Optometry, Centre for Health Sciences, University of the Highlands and Islands, Inverness, IV2 3JH, UK
| | - Sylvester Kyeremeh
- Department of Optometry and Visual Science, College of Science, KNUST, Kumasi, AK-385-1973, Ghana
| | - Kelechi C Ogbuehi
- Department of Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - Kingsley E Agho
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
- School of Health Science, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Khathutshelo P Mashige
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
| | - Antor O Ndep
- Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Kovin S Naidoo
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
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Zimmermann JA, Storp JJ, Merté RL, Heiduschka P, Eter N, Brücher VC. Position of the ISTENT Inject ® Trabecular Micro-Bypass System Visualized with the NIDEK GS-1 Gonioscope-A Postoperative Analysis. J Clin Med 2023; 12:5171. [PMID: 37629213 PMCID: PMC10455890 DOI: 10.3390/jcm12165171] [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: 07/12/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Glaucoma is one of the leading causes of irreversible blindness globally and is characterized by the gradual loss of retinal ganglion cells. The primary risk factor for the development and progression of glaucoma is increased intraocular pressure (IOP). Numerous surgical interventions exist to lower IOP should conservative therapy fail. One trend in recent years has been minimally invasive glaucoma surgery (MIGS) as an alternative to traditional methods. The ISTENT inject® is an ab interno trabecular micro-bypass implant designed to be implanted through the trabecular meshwork into the Schlemm's canal to lower IOP. The aim of the study was the postoperative visualization and description of the positioning of the ISTENT inject® using automated circumferential goniophotography. Patients with symptomatic cataracts and mild to moderate primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigment-dispersion glaucoma were included who underwent combined cataract surgery with the ISTENT inject® and received postoperative automated gonioscopy with the NIDEK Gonioscope GS-1 to visualize the location of the implant. Twenty-four implants of 14 eyes in 11 patients could be visualized. Out of the implants, 14.3% were in the trabecular meshwork, 46.4% were at the border between the trabecular meshwork and scleral spur, 25% were below the trabecular meshwork, and 14.3% of the implants were not detectable in the gonioscopy. In the overall cohort, a statistically significant IOP reduction was found over the 12-month postoperative observation period. Even in three eyes, in each of which both stents were located below the trabecular meshwork, an IOP reduction over 12 months was observed compared to the baseline IOP. In this study, vertical two-dimensional positioning of the ISTENT inject® was performed for the first time using NIDKE GS-1 automated 360° goniophotography. The method is suitable for postoperative visualization, control, and documentation of positioning after ISTENT inject® implantation. Further studies are needed to analyze the correlation between positioning of the ISTENT inject® in the chamber angle and postoperative IOP reduction.
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Affiliation(s)
- Julian Alexander Zimmermann
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany; (J.J.S.); (R.-L.M.); (P.H.); (V.C.B.)
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Dawood YF, Issa AF, Mohammed Ali SS. Changes in anterior chamber biometry and intraocular pressure after uneventful phacoemulsification in non-glaucomatous eyes. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2023; 12:28-35. [PMID: 37641670 PMCID: PMC10445312 DOI: 10.51329/mehdiophthal1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/01/2023] [Indexed: 08/31/2023]
Abstract
Background In non-glaucomatous eyes, many factors impact intraocular pressure (IOP) reduction following phacoemulsification. This study aimed to determine the relationship between changes in IOP and alterations in anterior chamber biometric measurements using the Pentacam Scheimpflug anterior segment imaging system before and after uneventful phacoemulsification in non-glaucomatous eyes. Methods This prospective interventional study included patients with ages of 20 - 80 years, no known systemic diseases, and visually significant cataracts necessitating phacoemulsification with posterior chamber intraocular lens implantation. The preoperative and two-month postoperative IOPs were measured using a Goldmann applanation tonometer, and the iridocorneal angle (ICA) in four quadrants (superior, inferior, nasal, and temporal), anterior chamber depth (ACD), and anterior chamber volume (ACV) were measured using the Pentacam. Results Forty-two eyes of 42 patients with a mean (standard deviation [SD]) age of 56.8 (10.7) years were included; 22 (52%) were men and 20 (48%) were women. The eyes demonstrated statistically significant changes in postoperative IOP, ACD, ACV, and in widening of the ICA (all P < 0.05), with a mean (SD) IOP reduction of 4.5 (2.7) mmHg, ACD deepening of 0.7 (0.6) mm, ACV increase of 33.2 (21.1) mm3, and ICA widening of 7.5o (6.4o), 12.4o (7.7o), 9.1o (7.1o), and 11.5o (6.1o) in the superior, inferior, temporal, and nasal quadrants, respectively. A significant positive correlation was detected between pre- and postoperative IOP (r = + 0.58; P < 0.001) and between pre- and postoperative ACD (r = + 0.50; P < 0.001). Significant negative correlations were detected between preoperative ACV and changes in ACV (r = - 0.42; P < 0.001) and between preoperative ICA and changes in ICA (r = - 0.02; P = 0.001). However, no significant correlations were observed between the changes in IOP and patient age (r = + 0.001; P = 0.957) and axial length of the eye (r = + 0.13; P = 0.221), or changes in ICA (r = - 0.01; P = 0.945), ACD (r = + 0.01; P = 0.945), and ACV (r = - 0.12; P = 0.599). Conclusions We observed a significant reduction in IOP, widening of the ICA, and increases in ACD and ACV after phacoemulsification; however, there was no significant correlation between changes in IOP and other biometric variables. Further studies are required to determine the exact mechanisms underlying these effects.
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Affiliation(s)
- Yousif Farhan Dawood
- Department of Ophthalmology, College of Medicine, University of Anbar, Anbar, Iraq
- Department of Ophthalmology, Ibn Al Haitham Teaching Eye Hospital, Baghdad, Iraq
| | - Ammar Fouad Issa
- Department of Ophthalmology, Ibn Al Haitham Teaching Eye Hospital, Baghdad, Iraq
- Jenna Ophthalmic Center, Baghdad, Iraq
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Tang C, Sun T, Sun Z, Duan H, Liu Y, Zhao L, Li W, Bian L, Qi H. Evaluation of biometric indicators of anterior segment parameters after ICL implantation by swept-source optical coherence tomography. BMC Ophthalmol 2023; 23:193. [PMID: 37131213 PMCID: PMC10155418 DOI: 10.1186/s12886-023-02942-0] [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: 01/01/2023] [Accepted: 04/25/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND To evaluate anterior segment structural alterations after implantable collamer lens (ICL) implantation in myopic patients using swept-source quantitative optical coherence tomography (SS-OCT). METHODS This prospective study included 47 eyes in 24 patients with preoperative spherical equivalent ≥ -3.00 D. Patients underwent ICL implantation at Department of Ophthalmology, Peking University Third Hospital, from May 2021 to December 2022. SS-OCT was used to measure anterior chamber width (ACW), angle opening distance (AOD), angle recess area (ARA), trabecular-iris area (TISA), trabecular-iris angle (TIA), iridotrabecular contact (ITC) area, and ITC Index before ICL implantation surgery and at 1 month follow-up. The correlations among the ITC index, vault, and angle parameters were analysed. Receiver operating characteristic (ROC) analysis was used to explore the ability of the vault to identify eyes with suspected angle-closure. RESULTS At one month following ICL implantation, the ITC area was 0.396 ± 0.37 mm2, and the ITC index is 8.143 ± 5.439%. All angle parameters, except ACW, showed a statistically significant reduction on SS-OCT (P < 0.05). Mean AOD500, AOD750, ARA500, ARA750, TISA500, TISA750, TIA500, and TIA750 values at one month postoperatively decreased by 60.0%, 60.4%, 58.1%, 59.2%, 57.3%, 58.7%, 48.8%, and 50.7%, respectively. The vault was positively correlated with the ITC index and percent change in anterior chamber angle parameters. A vault of > 0.659 mm was found to be optimal for angle-closure suspect with a sensitivity of 85.2% and a specificity of 53.9%. CONCLUSIONS Anterior chamber angle parameters decreased one month after ICL implantation, and their percentage changes and ITC index correlated with the vault. When the vault is larger than 0.659 mm, it is necessary to be alert to possible closed angle suspicion.
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Affiliation(s)
- Chuhao Tang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Tong Sun
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Zhengze Sun
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Hongyu Duan
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Yilin Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Lu Zhao
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Wenlong Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Linbo Bian
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Hong Qi
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key 9 Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China.
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11
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Yang G, Li K, Yao J, Chang S, He C, Lu F, Wang X, Wang Z. Automatic measurement of anterior chamber angle parameters in AS-OCT images using deep learning. BIOMEDICAL OPTICS EXPRESS 2023; 14:1378-1392. [PMID: 37078037 PMCID: PMC10110310 DOI: 10.1364/boe.481419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 05/03/2023]
Abstract
The early assessment of angle closure is of great significance for the timely diagnosis and treatment of primary angle-closure glaucoma (PACG). Anterior segment optical coherence tomography (AS-OCT) provides a fast and non-contact way to evaluate the angle close using the iris root (IR) and scleral spur (SS) information. The objective of this study was to develop a deep learning method to automatically detect IR and SS in AS-OCT for measuring anterior chamber (AC) angle parameters including angle opening distance (AOD), trabecular iris space area (TISA), trabecular iris angle (TIA), and anterior chamber angle (ACA). 3305 AS-OCT images from 362 eyes and 203 patients were collected and analyzed. Based on the recently proposed transformer-based architecture that learns to capture long-range dependencies by leveraging the self-attention mechanism, a hybrid convolutional neural network (CNN) and transformer model to encode both local and global features was developed to automatically detect IR and SS in AS-OCT images. Experiments demonstrated that our algorithm achieved a significantly better performance than state-of-the-art methods for AS-OCT and medical image analysis with a precision of 0.941, a sensitivity of 0.914, an F1 score of 0.927, and a mean absolute error (MAE) of 37.1±25.3 µm for IR, and a precision of 0.805, a sensitivity of 0.847, an F1 score of 0.826, and an MAE of 41.4±29.4 µm for SS, and a high agreement with expert human analysts for AC angle parameter measurement. We further demonstrated the application of the proposed method to evaluate the effect of cataract surgery with IOL implantation in a PACG patient and to assess the outcome of ICL implantation in a patient with high myopia with a potential risk of developing PACG. The proposed method can accurately detect IR and SS in AS-OCT images and effectively facilitate the AC angle parameter measurement for pre- and post-operative management of PACG.
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Affiliation(s)
- Guangqian Yang
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Kaiwen Li
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Jinhan Yao
- Department of Cataract, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Shuimiao Chang
- Department of Cataract, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Chong He
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Fang Lu
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
| | - Xiaogang Wang
- Department of Cataract, Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi 030001, China
- Co-last authors
| | - Zhao Wang
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, Sichuan 610054, China
- Co-last authors
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12
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Randhawa J, Chiang M, Porporato N, Pardeshi AA, Dredge J, Apolo Aroca G, Tun TA, Quah JH, Tan M, Higashita R, Aung T, Varma R, Xu BY. Generalisability and performance of an OCT-based deep learning classifier for community-based and hospital-based detection of gonioscopic angle closure. Br J Ophthalmol 2023; 107:511-517. [PMID: 34670749 PMCID: PMC9018872 DOI: 10.1136/bjophthalmol-2021-319470] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/02/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the generalisability and performance of a deep learning classifier for automated detection of gonioscopic angle closure in anterior segment optical coherence tomography (AS-OCT) images. METHODS A convolutional neural network (CNN) model developed using data from the Chinese American Eye Study (CHES) was used to detect gonioscopic angle closure in AS-OCT images with reference gonioscopy grades provided by trained ophthalmologists. Independent test data were derived from the population-based CHES, a community-based clinic in Singapore, and a hospital-based clinic at the University of Southern California (USC). Classifier performance was evaluated with receiver operating characteristic curve and area under the receiver operating characteristic curve (AUC) metrics. Interexaminer agreement between the classifier and two human examiners at USC was calculated using Cohen's kappa coefficients. RESULTS The classifier was tested using 640 images (311 open and 329 closed) from 127 Chinese Americans, 10 165 images (9595 open and 570 closed) from 1318 predominantly Chinese Singaporeans and 300 images (234 open and 66 closed) from 40 multiethnic USC patients. The classifier achieved similar performance in the CHES (AUC=0.917), Singapore (AUC=0.894) and USC (AUC=0.922) cohorts. Standardising the distribution of gonioscopy grades across cohorts produced similar AUC metrics (range 0.890-0.932). The agreement between the CNN classifier and two human examiners (Ҡ=0.700 and 0.704) approximated interexaminer agreement (Ҡ=0.693) in the USC cohort. CONCLUSION An OCT-based deep learning classifier demonstrated consistent performance detecting gonioscopic angle closure across three independent patient populations. This automated method could aid ophthalmologists in the assessment of angle status in diverse patient populations.
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Affiliation(s)
- Jasmeen Randhawa
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Michael Chiang
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Natalia Porporato
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Anmol A Pardeshi
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Justin Dredge
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Galo Apolo Aroca
- Roski Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Tin A Tun
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | | | - Marcus Tan
- Ophthalmology, National University of Singapore, Singapore
| | | | - Tin Aung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
- Ophthalmology, National University of Singapore, Singapore
| | - Rohit Varma
- Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California, USA
| | - Benjamin Y Xu
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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13
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Feasibility of Automated Gonioscopy Imaging in Clinical Practice. J Glaucoma 2023; 32:159-164. [PMID: 36877821 DOI: 10.1097/ijg.0000000000002162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/14/2022] [Indexed: 03/08/2023]
Abstract
PRCIS Automated gonioscopy provided good-quality images of the anterior chamber angle. There was a short learning curve for operators, and the examination was well tolerated by patients. Patients expressed a preference for automated gonioscopy compared with traditional gonioscopy. PURPOSE The purpose of this study was to assess the feasibility of using a desktop automated gonioscopy camera in glaucoma clinics by examining patient tolerability, ease of use, and image quality and comparing patient preference compared with traditional gonioscopy. PATIENTS AND METHODS A prospective study was conducted in a university hospital clinic. Traditional gonioscopy was performed followed by imaging of the iridocorneal angle (ICA) using the Nidek GS-1 camera by 2 glaucoma specialists. Participants were asked to rate the comfort of automated gonioscopy and which method they preferred. The clinicians graded the ease of acquisition for each patient, and the image quality was reviewed by a grader. RESULTS Forty-three eyes of 25 participants were included. Sixty-eight percent of participants viewed automated gonioscopy as "extremely comfortable," and the remainder reported it "comfortable". Forty percent preferred automated gonioscopy compared with traditional gonioscopy, while 52% were equivocal. Clinicians scored 32% of participants as "somewhat difficult" to the image. In 46% of eyes, good-quality photographs were obtained for 360 degrees of the ICA. Only 1 eye had no parts of the ICA clearly visible. Seventy-four percent of eyes had at least half of the ICA clearly visible in all 4 quadrants. CONCLUSION Automated gonioscopy provided good-quality images of the ICA for most patients. It was often not possible to image the entire 360 degrees at the first attempt, but the examination was comfortable for patients, and only 8% preferred traditional gonioscopy to the automated photographic examination.
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14
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Kita Y, Hollό G, Mochizuki T, Emoto Y, Kita R, Hirakata A. Effect of Topical Pilocarpine Instilled Before Laser Peripheral Iridotomy on Regional Iris Thickness in Primary Angle Closure Disease: A Swept-Source Anterior Segment Optical Coherence Tomography Pilot Study. Semin Ophthalmol 2023:1-5. [PMID: 36715463 DOI: 10.1080/08820538.2023.2169580] [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: 01/31/2023]
Abstract
PURPOSE To determine whether the temporal-superior or the nasal-superior iris area becomes thinner (more optimal) for laser peripheral iridotomy (LPI) after pilocarpine instillation in primary angle closure disease (PACD); and to identify an angle for optimal penetration of the laser beam. PATIENTS AND METHODS Iris thickness at 2 mm from the iris root in the preset scanning axes was measured using swept-source anterior segment optical coherence tomography before and 60 minutes after the instillation of pilocarpine 2% in one eye of 30 consecutive Japanese PACD patients with thick, dark brown iris. Iris thickness at 1:30 and 10:30 clock hour positions were evaluated in sagittal and oblique directions, resulting sagittal iris thickness (SIT) and minimum iris thickness (MIT) parameters, respectively. RESULTS Compared to the baseline values, iris thickness decreased significantly (P < .001) in both locations after pilocarpine instillation. Both before and after pilocarpine instillation the temporal-superior iris thickness was significantly smaller than the nasal-superior thickness (P ≤ .001). After pilocarpine instillation, the temporal-superior iris was significantly thinner in an approximately 13° angle direction temporal to the sagittal direction than in the sagittal direction (MIT: 0.322 mm; SIT: 0.346 mm, P < .001). CONCLUSIONS After pilocarpine instillation, the temporal-superior iris and an approximately 13° angle temporal to the sagittal direction may provide an optimal location and laser beam angle for LPI in PACD eyes.
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Affiliation(s)
- Yoshiyuki Kita
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Gábor Hollό
- Tutkimusz Ltd, Solymár, Hungary.,Eye Center, Prima Medica Health Centers, Budapest, Hungary
| | - Tsukasa Mochizuki
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Yoshinobu Emoto
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Ritsuko Kita
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
| | - Akito Hirakata
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan
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15
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Changes in Anterior Chamber Angle and Choroidal Thickness in Patients with Primary Angle-Closure Glaucoma after Phaco-Goniosynechialysis. J Clin Med 2023; 12:jcm12020406. [PMID: 36675335 PMCID: PMC9867213 DOI: 10.3390/jcm12020406] [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: 10/16/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) complicated by cataracts. This prospective cohort study included 60 patients with PACG complicated by cataracts from the Department of Ophthalmology of Shaoxing People’s Hospital, China. Patients underwent PEI combined with GSL (PEI-GSL group) or laser peripheral iridotomy (LPI) followed by PEI (PEI group). Intraocular pressure (IOP) and endothelial counts were significantly decreased in both groups after surgery, while best-corrected visual acuity and central anterior chamber depth were significantly increased. However, there were no significant differences between the two groups. The opening degrees of room corners at 12, 3, 6, and 9 o’clock were recorded as AA12, AA3, AA6, and AA9, respectively. Anterior chamber depth was significantly increased postoperatively compared to preoperatively in both groups, with no significant between-group differences (all ps > 0.05). At 1, 3, and 6 months postoperatively, the width at AA12, AA3, and AA9 points was higher in the PEI-GSL group than in the PEI group (all ps < 0.05). Significant between-group differences at AA6 were observed preoperatively (p = 0.023) and at 1 (p = 0.027) and 3 (p = 0.033) months postoperatively but not at 6 months postoperatively (p = 0.055). CT was smaller postoperatively than preoperatively (all ps < 0.001). The present study suggests that patients with PACG who underwent PEI with or without GSL had reduced IOP and CT after surgery.
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16
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Mukhopadhyay D, Patel K, Huda S. Increase in anterior chamber angle depth after topical pilocarpine measured by spectral domain optical coherence tomography: A possible additional indicator for laser peripheral iridotomy in primary angle-closure suspects in an opportunistic set-up. Indian J Ophthalmol 2022; 70:4174-4179. [PMID: 36453309 PMCID: PMC9940567 DOI: 10.4103/ijo.ijo_764_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Indication of laser peripheral iridotomy (LPI) is often conjectural due to dependency on gonioscopy and strict dichotomous classification of occludability. Indentation gonioscopy is the gold standard but is under-utilized for various reasons. The prevalence of primary angle closure disease (PACD) in eastern India is 1.5-1.9%, with a 22% five-year progression rate. Many angle closure patients may go blind without timely diagnosis and iridotomy. General ophthalmologists need alternate, validated methods for diagnoses. Pilocarpine eye drop causes miosis, and flattens the iris, producing angle changes detectable by spectral domain optical coherence tomography (SD-OCT). We hypothesized that the amount of angle change may be a suitable indicator for iridotomy. Methods Our prospective cross-sectional single-masked observational study evaluated pilocarpine-induced changes in angle parameters detected by SD-OCT. Out of 372 patients enrolled, 273 patients (539 eyes) remained, with a mean age of 48.6 years (SD = 10.36). All eyes were graded by the Van Herick (VH) method, gonioscopy, and anterior segment (AS) SD-OCT and reassessed after pilocarpine drops. Results The sensitivity and specificity of tomography measurements against gonioscopy grades were 61% and 85%, respectively. The receiver operating characteristic (ROC) curve was 0.85. Pilocarpine-induced angle widening was significant in gonioscopically narrower angles. Low Van Herick grades (217 eyes), narrow gonioscopy grades (238 eyes), and a narrow OCT angle value (165 eyes) were candidates for iridotomy. Conclusion Our study results showed that pilocarpine-induced angle widening detected by SD-OCT could be a strong objective indicator for LPI.
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Affiliation(s)
- Debdas Mukhopadhyay
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India,Correspondence to: Prof. Debdas Mukhopadhyay, BKG Eye Institute, Gour Road, Mokdompur, Malda - 732 103, West Bengal, India. E-mail:
| | - Khevna Patel
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India
| | - Sadaf Huda
- Department of Ophthalmology, MGM Medical College, Kishanganj, Bihar, India,Department of Ophthalmology, BKG Malda Eye Institute, Malda, West Bengal, India
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Evaluation of the Anterior Chamber Angle Structures in Perinatal Infants Using a Wide-Field Digital Fundus Camera. Curr Med Sci 2022; 42:1305-1309. [PMID: 36544034 DOI: 10.1007/s11596-022-2646-9] [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: 08/09/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed to evaluate the ability of a digital fundus camera to observe the development of the anterior chamber angle (ACA) in premature infants. METHODS Forty-eight eyes of preterm infants (n=48) were examined by a digital fundus camera to observe the development of the ACA. ACA grading was performed based on the visualization of the anterior chamber structures according to the Scheie Angle Depth Evaluating System. RESULTS ACA images from all 48 infants were successfully acquired using RetCam3. The corrected gestational age ranged from 30 weeks to 49 weeks, which covered the period from 2 months preterm to >2 months post-term. As the corrected gestational age increased, the corrected gestational age grading was significantly decreased. The mean corrected gestational ages of the infants corresponding to the ACA classification from grade IV to grade 0 were 32.75±1.89, 37.20±1.30, 39.75±2.38, 40.56±2.24, and 44.23±2.14 weeks, respectively, which were all significantly different (P<0.05). The regression analysis showed a linear correlation between the grading of the ACA and the corrected gestational age (R2=0.724, P=0.0001). CONCLUSION The ACA of a full-term newborn can be fully detected and evaluated by a digital fundus camera. For premature infants, part of the ACA is not visible physiologically; however, it should not be misdiagnosed as angle closure or a narrow angle.
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18
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Mispositioned Hydrus Microstents: A Case Series Imaged with NIDEK GS-1 Gonioscope. J Ophthalmol 2022; 2022:1605195. [PMID: 36119138 PMCID: PMC9477617 DOI: 10.1155/2022/1605195] [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: 05/30/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction. The Hydrus microstent has become a common procedure in glaucoma surgery intended to improve outcomes of cataract surgery to lower intraocular pressure. Despite proper placement, this device can subsequently be noted to not be in the proper position. In this case series, we report mispositioned Hydrus microstents in five different patients and use NIDEK GS-1 gonioscopy. Case Report. We report five different patients who had cataract surgery and who were subsequently noted to have mispositioned Hydrus stents. No stents needed to be removed. All patients had improved vision and stable visual fields, and none required secondary surgery. Management and Outcome. In each case of mispositioned stents, vision was significantly improved and there was no inflammation or other complications noted. Discussion. Hydrus stents can be noted to be mispositioned during the post-operative period after successful insertion. This can often be well tolerated requiring no further intervention.
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Zhou Q, Guo J, Chen Z, Chen W, Deng C, Yu T, Li F, Yan X, Hu T, Wang L, Rong Y, Ding M, Wang J, Zhang X. Deep learning-based classification of the anterior chamber angle in glaucoma gonioscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:4668-4683. [PMID: 36187252 PMCID: PMC9484423 DOI: 10.1364/boe.465286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 06/16/2023]
Abstract
In the proposed network, the features were first extracted from the gonioscopically obtained anterior segment photographs using the densely-connected high-resolution network. Then the useful information is further strengthened using the hybrid attention module to improve the classification accuracy. Between October 30, 2020, and January 30, 2021, a total of 146 participants underwent glaucoma screening. One thousand seven hundred eighty original images of the ACA were obtained with the gonioscope and slit lamp microscope. After data augmentation, 4457 images are used for the training and validation of the HahrNet, and 497 images are used to evaluate our algorithm. Experimental results demonstrate that the proposed HahrNet exhibits a good performance of 96.2% accuracy, 99.0% specificity, 96.4% sensitivity, and 0.996 area under the curve (AUC) in classifying the ACA test dataset. Compared with several deep learning-based classification methods and nine human readers of different levels, the HahrNet achieves better or more competitive performance in terms of accuracy, specificity, and sensitivity. Indeed, the proposed ACA classification method will provide an automatic and accurate technology for the grading of glaucoma.
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Affiliation(s)
- Quan Zhou
- Department of Biomedical Engineering, College of Life Science and Technology, Ministry of Education Key Laboratory of Molecular Biophysics, Huazhong University of Science and Technology, Wuhan 430074, China
- These authors contribute equally to this work
| | - Jingmin Guo
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- These authors contribute equally to this work
| | - Zhiqi Chen
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Chen
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chaohua Deng
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tian Yu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fei Li
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoqin Yan
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tian Hu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Linhao Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Rong
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Mingyue Ding
- Department of Biomedical Engineering, College of Life Science and Technology, Ministry of Education Key Laboratory of Molecular Biophysics, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Junming Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xuming Zhang
- Department of Biomedical Engineering, College of Life Science and Technology, Ministry of Education Key Laboratory of Molecular Biophysics, Huazhong University of Science and Technology, Wuhan 430074, China
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20
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Al-Aswad LA, Ramachandran R, Schuman JS, Medeiros F, Eydelman MB. Artificial Intelligence for Glaucoma: Creating and Implementing Artificial Intelligence for Disease Detection and Progression. Ophthalmol Glaucoma 2022; 5:e16-e25. [PMID: 35218987 PMCID: PMC9399304 DOI: 10.1016/j.ogla.2022.02.010] [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] [Received: 01/14/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
On September 3, 2020, the Collaborative Community on Ophthalmic Imaging conducted its first 2-day virtual workshop on the role of artificial intelligence (AI) and related machine learning techniques in the diagnosis and treatment of various ophthalmic conditions. In a session entitled "Artificial Intelligence for Glaucoma," a panel of glaucoma specialists, researchers, industry experts, and patients convened to share current research on the application of AI to commonly used diagnostic modalities, including fundus photography, OCT imaging, standard automated perimetry, and gonioscopy. The conference participants focused on the use of AI as a tool for disease prediction, highlighted its ability to address inequalities, and presented the limitations of and challenges to its clinical application. The panelists' discussion addressed AI and health equities from clinical, societal, and regulatory perspectives.
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Affiliation(s)
- Lama A Al-Aswad
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York; Department of Population Health, NYU Langone Health, NYU Grossman School of Medicine, New York, New York.
| | - Rithambara Ramachandran
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York
| | - Joel S Schuman
- Department of Ophthalmology, NYU Langone Health, NYU Grossman School of Medicine, New York, New York; Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, New York; Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, Brooklyn, New York; Center for Neural Science, NYU, New York, New York; Neuroscience Institute, NYU Langone Health, New York, New York
| | - Felipe Medeiros
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina; Department of Electrical and Computer Engineering, Pratt School of Engineering, Duke University, Durham, North Carolina
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Karabulut M, Karabulut S, Simsek HC, Karalezli A. The iridocorneal angle and related anterior segment structures in pediatric anisohyperopic amblyopic eyes. SAGE Open Med 2022; 10:20503121221107474. [PMID: 35795866 PMCID: PMC9252018 DOI: 10.1177/20503121221107474] [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: 07/28/2021] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives: We aimed at investigating the iridocorneal angle, anterior segment structural differences, and their relationship in pediatric anisohyperopic amblyopic eyes. Methods: This study was designed as an observational case-control study. We prospectively evaluated the pediatric patients who were newly diagnosed with hyperopic anisometropic amblyopia. Iridocorrneal angle in four sectors, axial length, and anterior segment structures were compared to emmetropic fellow and control eyes using Pentacam and IOLMaster 700 devices. The anisohyperopia and iridocorneal angle related factors were determined in hyperopic anisometropic amblyopic eyes. Results: Forty-three hyperopic anisometropic amblyopic eyes, 43 fellow eyes, and 44 control eyes were included. The mean axial length, anterior chamber volume, and anterior chamber depth were significantly reduced in the study eyes compared to the fellow (p < 0.001, p = 0.021, and p = 0.045, respectively) and control eyes (p < 0.001, p = 0.001, and p = 0.009, respectively). The average iridocorneal angle was significantly lower in the study eyes than in the fellow and control eyes (p < 0.001 and p = 0.018, respectively). The iridocorneal angle correlated with anterior chamber depth (r = 0.49, p = 0.013), anterior chamber volume (r = 0.42, p = 0.038), the anterior radius of curvature (r =−0.54, p = 0.005), the posterior radius of curvature (r =−0.58, p = 0.002), and lens thickness (Rho =−0.41, p = 0.033) in the study eyes. Anisohyperopia was related to the interocular difference in axial length (Rho = 0.53, p = 0.005), anterior chamber depth (Rho = 0.53, p = 0.005), and anterior chamber volume (Rho = 0.42, p = 0.031). Conclusion: Pentacam and IOLMaster 700 are suitable for non-contact imaging of iridocorneal angle and anterior segment structures in the pediatric age. These biometric differences and their relationship should be kept in mind whenever anterior or posterior segment surgery is planned for pediatric anisohyperopic amblyopic eyes.
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Affiliation(s)
- Müjdat Karabulut
- Department of Ophthalmology, Mugla Sıtkı Koçman University Medical School, Mugla, Turkey
| | - Sinem Karabulut
- Department of Ophthalmology, Mugla Sıtkı Koçman University Medical School, Mugla, Turkey
| | - Hüseyin Cem Simsek
- Department of Ophthalmology, Mugla Sıtkı Koçman University Medical School, Mugla, Turkey
| | - Aylin Karalezli
- Department of Ophthalmology, Mugla Sıtkı Koçman University Medical School, Mugla, Turkey
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Detailed 3D micro-modeling of rat aqueous drainage channels based on two-photon imaging: simulating aqueous humor through trabecular meshwork and Schlemm’s canal by two-way fluid structure interaction approach. Med Biol Eng Comput 2022; 60:1915-1927. [DOI: 10.1007/s11517-022-02580-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
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Characteristics of Anterior Segment in Congenital Ectopia Lentis: An SS-OCT Study. J Ophthalmol 2022; 2022:6128832. [PMID: 35706501 PMCID: PMC9192328 DOI: 10.1155/2022/6128832] [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: 02/27/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the characteristics of anterior chamber angle parameters in congenital ectopia lentis (CEL) patients and to evaluate the sensitivity and specificity of anterior segment parameters in distinguishing CEL from healthy controls. Setting. Zhongshan Ophthalmic Center, Guangzhou, China. Design Cross-sectional study. Methods 35 CEL patients and 35 age- and sex-matched healthy controls were recruited. Axial length (AL) and anterior segment parameters including anterior chamber width (ACW), angle open distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA), and trabecular-iris angle (TIA) were measured. All the above parameters and the ratio index of angle parameters, which was defined as the angle parameter value of the narrower side to that of the contralateral side, were compared between CEL and controls. Receiver operating characteristic (ROC) curves were also plotted to evaluate the diagnostic performance of anterior chamber angle parameters in CEL patients. Results All angle parameters of the contralateral side to the dislocated lens side were significantly smaller than those of the dislocated lens side in CEL (all P < 0.05). For the diagnostic performance of anterior chamber angle parameters, the ratio index of TIAr500 combined with TIAr750 had the best diagnostic performance for CEL screening (AUC = 0.798), and TIAr500 of 0.887 and TIAr750 of 0.917 were detected to be the optimal cut-off points, representing a sensitivity of 89.8% and specificity of 68.7%. Conclusion The contralateral side to the dislocated lens side in the CEL had a narrower anterior chamber angle. TIAr500 combined with TIAr750 is the optimal combination strategy for ectopia lentis screening.
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Matsuo M, Kozuki N, Inomata Y, Kumagai Y, Shiba R, Hamaguchi K, Tanito M. Automated Focal Plane Merging From a Stack of Gonioscopic Photographs Using a Focus-Stacking Algorithm. Transl Vis Sci Technol 2022; 11:22. [PMID: 35452095 PMCID: PMC9055566 DOI: 10.1167/tvst.11.4.22] [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 The purpose of this study was to investigate the utility of automated focal plane merging with the collection of gonio-photographs with different depths of field (DOF) using an established focus-stacking algorithm. Methods A cross-sectional study was conducted at Shimane University Hospital, Izumo, Japan. Sixteen eyes from 16 subjects from the glaucoma clinic were included in this study. Image processing was performed for the images of 16 eyes from 16 angle sector following the successful gonio-photography. The 256 sets of focus-stacked and best-focused images were prepared in random order and were compared for the DOF and informativeness to diagnose angle pathology by masked observers in each set as the subjective assessments. Moreover, the energy of the Laplacian (average |ΔI|), which is an indicator of image sharpness between the photographs with and without the focus-stacking processing was also analyzed with the Laplacian filter as the objective assessment. Results The automated image processing was successfully performed in all stacks of images. The significant deepening of DOF and improvement of informativeness achieved in 255 (99.6%) and 216 (84.4%) images (P < 0.0001 for both, sign test) and the energy of the Laplacian also significantly increased in 243 (94.9%) images (P < 0.0001, sign test). Conclusions Focal plane merging by the automated algorithm can make the gonio-images deeper focus compared with the paired best-focused images subjectively and objectively, which would be useful for angle pathological assessment in clinical practice. Translational Relevance Focal plane merging algorithm for the automated gonio-photography can facilitate the angle assessment by providing informative deep-focus image, which would be useful for glaucoma care.
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Affiliation(s)
- Masato Matsuo
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Nana Kozuki
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Yuina Inomata
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Yoshiki Kumagai
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Ryosuke Shiba
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Koji Hamaguchi
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine (Matsuo, Kozuki, Inomata, Tanito), Izumo, Japan; NIDEK CO., LTD., Gamagori, Japan (Kumagai, Shiba, Hamaguchi)
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Murthy GJ, Ariga M, Singh M, George R, Sarma P, Dubey S, Choudhry RM, Parikh R, Panday M. A deep dive into the latest European Glaucoma Society and Asia-Pacific Glaucoma Society guidelines and their relevance to India. Indian J Ophthalmol 2022; 70:24-35. [PMID: 34937204 PMCID: PMC8917547 DOI: 10.4103/ijo.ijo_1762_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Glaucoma is the second leading cause of blindness in India. Despite advances in diagnosing and managing glaucoma, there is a lack of India-specific clinical guidelines on glaucoma. Ophthalmologists often refer to the European Glaucoma Society (EGS) and Asia-Pacific Glaucoma Society (APGS) guidelines. A group of glaucoma experts was convened to review the recently released EGS guideline (fifth edition) and the APGS guideline and explore their relevance to the Indian context. This review provides the salient features of EGS and APGS guidelines and their utility in Indian scenario. Glaucoma diagnosis should be based on visual acuity and refractive errors, slit-lamp examination, gonioscopy, tonometry, visual field (VF) testing, and clinical assessment of optic nerve head, retinal nerve fiber layer (RNFL), and macula. The intraocular pressure target must be individualized to the eye and revised at every visit. Prostaglandin analogues are the most effective medications and are recommended as the first choice in open-angle glaucoma (OAG). In patients with cataract and primary angle-closure glaucoma (PACG), phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Trabeculectomy augmented with antifibrotic agents is recommended as the initial surgical treatment for OAG. Laser peripheral iridotomy and surgery in combination with medical treatment should be considered in high-risk individuals aged <50 years. In patients with phakic and PACG, phacoemulsification alone or combined phacoemulsification and glaucoma surgery are recommended. Visual acuity, VF testing, clinical assessment of the optic disc and RNFL, and tonometry are strongly recommended for monitoring glaucoma progression.
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Affiliation(s)
- Gowri J Murthy
- Glaucoma Service, Prabha Eye Clinic and Research Centre, Bangalore, India
| | - Murali Ariga
- HOD- Ophthalmology, Sundaram Medical Foundation, Chennai, India
| | - Maneesh Singh
- Executive Director, Netralayam, the Superspeciality Eye Care Centre, Kolkata, India
| | - Ronnie George
- Glaucoma Services, Sankara Nethralaya, Medical and Vision Research Foundations, Chennai, India,
Correspondence to: Dr. Ronnie George, Glaucoma Services, Sankara Nethralaya, Medical and Vision Research Foundations, 18, College Road, Chennai, Tamil Nadu, India. E-mail:
| | - Prafulla Sarma
- Consultant, Glaucoma Clinic, Prime Eye Care Center, Guwahati, Assam, India
| | | | - Reena M Choudhry
- HOD, Glaucoma Services, ICARE Eye Hospital and Post Graduate Institute, Noida, India
| | - Rajul Parikh
- Consultant, Shreeji Eye Clinic and Palak’s Glaucoma Care Center, Mumbai, India
| | - Manish Panday
- Director, Glaucoma, Ratan Jyoti Netralaya Ophthalmic Institute and Research Centre, Gwalior, India
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Moving beyond the Slit-Lamp Gonioscopy: Challenges and Future Opportunities. Diagnostics (Basel) 2021; 11:diagnostics11122279. [PMID: 34943516 PMCID: PMC8700682 DOI: 10.3390/diagnostics11122279] [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: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/01/2022] Open
Abstract
After almost a century from its introduction in clinical practice, slit-lamp gonioscopy is still considered the reference standard for evaluating the anterior chamber angle (ACA). Gonioscopy is essential for diagnosing angle closure disease, and ACA features are included in glaucoma’s diagnostics and treatments algorithms. However, shortcomings of slit-lamp gonioscopy include a steep learning curve, lack of agreement between examiners and poor documentation. Thanks to advances in miniaturization and computing, new instruments for digital gonioscopy have been developed and marketed. This narrative review focuses on the Gonioscope GS-1, which permits semi-automated circumferential documentation of the ACA in real-colour photographs. Advantages and disadvantages of GS-1 compared with slit-lamp gonioscopy and other ACA imaging technologies such as optical coherence tomography are discussed. Finally, potential opportunities offered by this device for telemedicine, virtual clinics, and automatic classification with deep learning are presented.
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Zheng Q, Hu M, Li ZL, Chang PJ, Zhao YE. Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT. Int J Ophthalmol 2021; 14:1527-1532. [PMID: 34667728 DOI: 10.18240/ijo.2021.10.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). CONCLUSION Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.
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Affiliation(s)
- Qian Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Man Hu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Zhang-Liang Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Ping-Jun Chang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
| | - Yun-E Zhao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,National Clinical Research Center for Ocular Diseases, Wenzhou 325027, Zhejiang Province, China
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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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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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Shon K, Sung KR, Yoon JY. Implications of the Relationship Between Refractive Error and Biometry in the Pathogenesis of Primary Angle Closure. Invest Ophthalmol Vis Sci 2021; 62:38. [PMID: 34463718 PMCID: PMC8411854 DOI: 10.1167/iovs.62.10.38] [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 The purpose of this study was to investigate the relationship between refractive error and ocular biometry and its implication in the pathogenesis of primary angle closure (PAC). Methods We have retrospectively recruited 119 PAC eyes and 388 non-PAC eyes with an axial length (AL) of ≤25.0 mm and a spherical equivalent (SE) of ≥−6.0 diopters (D). Stepwise multiple regression was performed for keratometry value (K), AL, anterior chamber depth (ACD), and SE. Results PAC eyes were more likely to be in women and have a higher IOP and shorter AL than non-PAC eyes. In a multiple regression analysis, SE was not associated with PAC. The associations between AL and SE or AL and ACD were not different in PAC eyes compared with non-PAC eyes. However, the cornea was flatter in PAC eyes (β = −0.448, P < 0.001), and a flatter cornea was associated with more hyperopic refraction (β = −0.454, P < 0.001) and shallower ACD (β = 0.073, P < 0.001) in PAC eyes. ACD was not associated with SE in non-PAC eyes, but shallower ACD was associated with greater myopic refraction in PAC eyes (β = 1.117, P = 0.006). Conclusions PAC eyes seem to have flatter cornea compared with non-PAC eyes. A shallower ACD seems to be associated with greater myopic refraction in PAC eyes, but not in non-PAC eyes.
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Affiliation(s)
- Kilhwan Shon
- Department of Ophthalmology, Gangneung Asan Hospital, Gangneung, Korea
| | - Kyung Rim Sung
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Joo Young Yoon
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
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Soebijantoro I, Gondhowiardjo TD, Soesatyo M. Association Between Anterior Chamber Angle and Corneal Endothelial Cell Density in Chronic Angle Closure. Clin Ophthalmol 2021; 15:1957-1964. [PMID: 34007148 PMCID: PMC8121679 DOI: 10.2147/opth.s309005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the association between corneal endothelial cell density (ECD) and degree of anterior chamber angle (ACA) opening in eyes with chronic angle closure glaucoma. Methods The study was conducted at JEC Eye Hospitals in Indonesia. Treatment-naïve patients aged ≥40 years with IOP >21 mmHg and peripheral anterior chamber depth (ACD) grade 2 or less by Van Herick's technique were recruited. Trabecular iris angle (TIA; degree) was measured using anterior segment optical coherence tomography (AS-OCT) and classified as: grade 1 ≤10°, grade 2 11-20°, and grade 3 >20°. Noncontact specular microscopy was performed, and the following corneal parameters were obtained:ECD (cells/mm2), coefficient of variation (CV; μm2/cell), percentage of hexagonal cells, and central corneal thickness (CCT; μm). Results A total of 52 eyes from 52 subjects were recruited (16 grade 1 TIA, 24 grade 2 TIA, and 12 grade 3 TIA). Presenting IOP was not significantly different between groups. The median central corneal ECD was 2684.5 (1433-2934), 2587.0 (1902-3103), and 2441.0 (1659-3005) cells/mm2 in grade 1, 2, and 3 TIA, respectively, with no significant differences across the groups (P = 0.67). The CV was lowest in grade 3 TIA (36.4 ± 7.2 μm2/cell), and highest in grade 1 TIA (38.3 ± 9.6 μm2/cell), but the differences were not significant (P = 0.74). Likewise, the percentage of hexagonality and CCT was not significantly different. TIA was not correlated with IOP but was modestly correlated with age. Conclusion The corneal ECD and morphological characteristics such as CV and hexagonality were not significantly different across various TIA grading in chronic angle closure. This may reflect the lack of chronic and gradual IOP insult on corneal endothelial parameters as TIA did not show direct effect towards IOP.
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Armstrong GW, Kalra G, De Arrigunaga S, Friedman DS, Lorch AC. Anterior Segment Imaging Devices in Ophthalmic Telemedicine. Semin Ophthalmol 2021; 36:149-156. [PMID: 33656960 DOI: 10.1080/08820538.2021.1887899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Obtaining a clear assessment of the anterior segment is critical for disease diagnosis and management in ophthalmic telemedicine. The anterior segment can be imaged with slit lamp cameras, robotic remote controlled slit lamps, cell phones, cell phone adapters, digital cameras, and webcams, all of which can enable remote care. The ability of these devices to identify various ophthalmic diseases has been studied, including cataracts, as well as abnormalities of the ocular adnexa, cornea, and anterior chamber. This article reviews the current state of anterior segment imaging for the purpose of ophthalmic telemedical care.
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Affiliation(s)
- Grayson W Armstrong
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Gagan Kalra
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Sofia De Arrigunaga
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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