Zonular instability-associated morphologic features in eyes with primary angle closure disease using the swept-source anterior segment - optical coherence tomography system

BACKGROUND

This study aims to investigate the morphologic features of the crystalline lens in Primary Angle Closure Disease (PACD) patients with zonular instability during cataract surgery using the swept-source CASIA 2 Anterior Segment-Optical Coherence Tomography (AS-OCT) system.

METHODS

A total of 398 eyes (125 PACD eyes with zonular instability, 133 PACD eyes with zonular stability, and 140 cataract patient controls) of 398 patients who underwent cataract surgery combined or not glaucoma surgery between January 2021 and January 2023 were enrolled. The crystalline lens parameters were measured by CASIA2 AS-OCT. Then, logistic regression was performed to evaluate the risk factors associated with zonular instability.

RESULTS

The results revealed that PACD eyes had a more anterior lens equator position, a steeper anterior curvature of lens, shorter Axial Length (AL), shallower Anterior Chamber Distance (ACD), higher Lens Vault (LV) and thicker Lens Thickness (LT), when compared to eyes in the cataract control group. Furthermore, PACD eyes in the zonular instability group had steeper front R, front Rs and Front Rf, flatter back Rf, thicker lens anterior part thickness, higher lens anterior-to-posterior part thickness ratios, shallower ACD, and greater LV, when compared to PACD eyes with zonular stability. The logistic regression analysis, which was adjusted for age and gender, revealed that zonular instability was positively correlated with anterior part thickness, lens anterior-to-posterior part thickness ratio, and LV, but was negatively correlated with lens anterior radius and ACD.

CONCLUSION

Steeper anterior curvature, increased lens anterior part thickness, higher anterior-to-posterior part thickness ratio, shallower ACD, and greater LV are the anatomic features of PACD eyes associated with zonular instability.

Topical 0.1% Nepafenac versus 0.09% Bromfenac Eye Drops for Inflammation after Laser Peripheral Iridotomy: A Randomized Controlled Trial

PURPOSE

To assess the safety and efficacy of 0.1% nepafenac versus 0.09% bromfenac eye drops in controlling inflammation after neodymium yttrium-aluminum-garnet (YAG) laser peripheral iridotomy (LPI).

DESIGN

Single-masked, single-center, randomized controlled trial.

PARTICIPANTS

One hundred and sixty eyes of patients with primary angle-closure suspect (PACS) and primary angle closure (PAC) undergoing bilateral LPI.

METHODS

Patients were randomized in a 1:1 ratio to receive 0.1% nepafenac thrice daily or 0.09% bromfenac eye drops twice daily for 2 weeks after neodymium YAG LPI. Assessment was performed by masked investigators at 2 weeks after LPI. A Glaucoma Symptom Scale (GSS) questionnaire was administered both at baseline and 2 weeks after LPI. Subjective comfort scores to the study medications were assessed on the basis of a Likert scale at 2 weeks after LPI. In patients with bilateral PACS or PAC, the right eye was analyzed, and in asymmetrical disease (i.e., when one eye had PACS and the other eye had PAC), the eye with PAC was analyzed.

MAIN OUTCOME MEASURES

The primary outcome (end point) was uncontrolled inflammation, defined as symptomatic inflammation within 1 week after LPI, the presence of anterior chamber cells at 2 weeks, or rebound inflammation after medication discontinuation. The secondary outcome was patient-reported comfort levels with study medications based on the GSS and Likert scale.

RESULTS

At 2 weeks after LPI, 7 patients (6 with PACS and 1 with PAC) in the nepafenac group and 2 patients with PACS in the bromfenac group achieved the primary end point, without a difference between the medication groups (P = 0.09). Post-LPI burning, smarting, and stinging was more common in the bromfenac group (P = 0.01), which also had a higher comfort score on the Likert scale (P = 0.004). The need for repeat LPI was comparable (10.0% in the nepafenac group vs. 15.4% in the bromfenac group; P = 0.22). A multivariate analysis revealed that a greater number of laser shots was associated with the need for repeat LPI (odds ratio, 1.05; 95% confidence interval, 1.00-1.10; P = 0.04).

CONCLUSIONS

Topical 0.09% bromfenac is noninferior to 0.1% nepafenac in controlling inflammation after LPI in eyes with PACS and PAC. Nepafenac may be associated with higher patient-reported comfort.

Quantitative Measurements of Vessel Density and Blood Flow Areas Primary Angle Closure Diseases: A Study of Optical Coherence Tomography Angiography

(1) Purpose: To measure the change in vessel density (VD) and the flow area (FA) on the retina of eyes with primary angle-closure diseases (PACD), including primary angle-closure suspect (PACS), primary angle-closure (PAC), acute primary angle-closure (APAC) and primary angle-closure glaucoma (PACG). (2) Methods: Patients with PACD were prospectively enrolled in this study. All participants underwent thorough ophthalmic examinations. The mean defect (MD), retinal nerve fiber layer (RNFL), ganglion cell complex (GCC) thickness, VD measurement, and blood FA were measured. (3) Results: A total of 147 eyes from 121 subjects were included in this study. The VD of the nerve head layer was significantly lower in PACG and APAC (all p < 0.001). APAC and PACG had lower FA of all layers, except for the choroid layer (p < 0.05). The macular VD of the whole image and blood FA in the superficial layer was significantly lower in PACG (all p < 0.001). The MD, RNFL, and GCC thickness demonstrated a strong correlation with whole image VD in the superficial layer (p < 0.001), while the inside disc VD did not show a significant correlation with MD, RNFL, and GCC thickness (p > 0.05). (4) Conclusions: There was a significant decrease in the VD and FA on the optic disc as well as the VD and FA of the superficial layer in the macular area in APAC and PACG. The changes in VD and FA are correlated with the severity of the glaucomatous structural damage and functional impairment.

Analysis of Primary Iris and Ciliary Body Cysts in Chinese Patients With Primary Angle Closure Disease

Aim: To investigate the incidence and clinical features of primary iris and ciliary body cysts in Chinese primary angle closure disease (PACD). Patients were evaluated by measuring and analyzing the cysts with an ultrasound biomicroscope (UBM). Methods: The data of patients diagnosed with PACD were reviewed. Demographic data were collected, and the cyst number, size, location, and trabecular-iris angle (TIA) were measured, with the size including the longest diameter (LD) and its corresponding vertical diameter (CVD). Results: A total of 1,334 cases (2,317 eyes) were reviewed, and 409 cysts were found in 131 cases (168 eyes), with an average of 2.43 ± 3.14 cysts per eye. The ages of the patients with cysts ranged from 25 to 80 years, with an average age of 55.24 ± 12.22 years. The detection rate was 7.3%, and the majority of cysts were located in the iridociliary sulcus. Among the 131 patients, 94 had monocular cysts, while binocular cysts occurred in 37 patients. The locations of the cysts in both eyes were mainly in the inferior and temporal quadrants (42.5 and 34.0%, respectively). The cysts were mainly of medium size (49.9%), followed by small cysts (33.3%), large cysts (14.7%) and giant cysts (2.2%). The average LD was 0.68 ± 0.33 mm, and the average CVD was 0.45 ± 0.23 mm. There were no statistically significant differences in the TIA between the cyst area and unaffected area. Conclusions: The incidence of cysts is 7.3% in the PACD population. The cysts are mainly monocular, medium in size, and located in the iridociliary sulcus. Additionally, the cysts were located mainly in the inferior and temporal quadrants. These cysts have little effect on the anterior chamber angle.

Temporary changes of visual outcomes and anterior chamber parameters after phacoemulsification and low-add-power segmented intraocular lens implantation for primary angle closure disease

PURPOSE

To evaluate the temporary changes in visual outcomes and anterior segment parameters after cataract surgery plus low-add bifocal intraocular lens (IOL) implantation for primary angle closure disease (PACD).

METHODS

This retrospective comparative case-control study included two groups: low-add-power segmented IOL and monofocal IOL. Postoperative examination involved evaluation of uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), uncorrected intermediate visual acuity (UIVA), and spherical equivalent (SE). Anterior segment examination was performed using anterior segment optical coherence tomography.

RESULTS

This study included 19 eyes of 11 consecutive patients who underwent cataract surgery. The low-add group had better UDVA than the monofocal group at 3 months postoperatively, better UIVA at 1 month postoperatively, better UNVA at 1 week postoperatively. In the low-add group, SE increased at 1 and 3 months postoperatively compared with 1 week postoperatively. In the monofocal group, objective SE decreased at 1 and 3 months postoperatively compared with 1 week postoperatively. In the low-add group, the anterior chamber depth (ACD) became significantly deep gradually at 1 and 3 months compared with at 1 week postoperatively. In the monofocal group, the ACD became significantly shallow gradually at 1 and 3 months than at 1 week postoperatively.

CONCLUSION

The low-add-power segmented IOL achieved better far and intermediate distance visual acuity after cataract surgery in PACD patients than did the monofocal IOL. The ACD became deeper and SE showed a hyperopic shift with the low-add-power segmented IOL at 1 and 3 months after cataract surgery compared with at 1 week after cataract surgery.

Confirmation and refinement of the heterozygous deletion of the small leucine-rich proteoglycans associated with posterior amorphous corneal dystrophy

PURPOSE

To present the clinical and cytogenetic features of a previously unreported family with posterior amorphous corneal dystrophy (PACD) associated with a heterozygous deletion of the small leucine-rich proteoglycan (SRLP) genes on chromosome 12.

METHODS

Clinical characterization was performed using slit lamp biomicroscopic and optical coherence tomography (OCT) imaging. Genomic DNA was collected from affected and unaffected family members, and a cytogenomic array was used to identify copy number variations (CNV) present in the PACD locus.

RESULTS

Three members of a Guatemalan family presented with clinical characteristics consistent with PACD: bilateral posterior stromal lamellar opacification, decreased corneal curvature, and iridocorneal adhesions. OCT imaging demonstrated decreased corneal thickness and hyperreflectivity of the posterior third of the corneal stroma. CNV analysis confirmed the presumed clinical diagnosis of PACD by revealing a 0.304 Mb heterozygous deletion in the PACD locus on chromosome 12 that included the four SLRP genes (KERA, LUM, DCN, and EPYC) deleted in each of the PACD families in which CNV analysis has been reported.

CONCLUSIONS

This is the first report of the OCT appearance of PACD and the second confirmation of a heterozygous deletion of chromosome 12q21.33 as the cause of PACD, highlighting the utility of array-based cytogenomics to confirm the suspected clinical diagnosis of PACD. As the smallest previously reported pathogenic deletion was 0.701 Mb, the 0.304-Mb deletion we report is the smallest identified to date and reduces the size of the PACD locus to 0.275 Mb.