[Alteration of anterior chamber and angle structure in eyes with primary angle closure after laser peripheral iridotomy].

OBJECTIVE: To quantitatively evaluate the long-term changes in anterior segment morphology by using ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) in eyes with primary angle closure (PAC). METHODS: This was a clinical case series study. A total of 54 eyes with PAC of 31 consecutive patients were enrolled. Routine ophthalmic and UBM examination were performed at visit one (before LPI), 2 weeks, 6, and 12 months after LPI. The parameters of anterior chamber were measured by UBM and calculated. Results of each follow-up time were analyzed using repeated measures analysis of variance. Parameters of UBM measurement at 750 µm anterior to the sclera spur and at 500 µm counterpart were compared using paired student t-test. RESULTS: Compared to before LPI, anterior chamber depth (ACD) was deepened by approximate 0.10 mm after LPI, however, it was not statistically significant (F = 3.50, P > 0.05). Angle opening distance (AOD), trabecular-iris angle (TIA), angle recess area (ARA) and trabecular-ciliary process distance (TCPD) were significantly increased at 2 weeks, 6 and 12 months after LPI compared with respective baseline [AOD750: (165.0 ± 70.3), (185.8 ± 68.5), (196.1 ± 77.7) µm vs (66.2 ± 51.6) µm, F = 92.60; TIA750: 14.1° ± 6.3°, 15.5° ± 6.2°, 16.4° ± 5.9° vs 6.4° ± 4.9°, F = 92.60; ARA: (0.058 ± 0.024), (0.065 ± 0.023), (0.068 ± 0.026) mm(2) vs (0.025 ± 0.017) mm(2), F = 92.60; TCPD: (647.1 ± 113.0), (701.8 ± 93.4), (670.1 ± 95.4) µm vs (571.0 ± 97.2) µm, F = 34.00; P < 0.05]. The parameters of UMB measurement at 750 µm were significantly increased more than that at 500 µm anterior to the sclera spur (AOD: t = 5.90, TIA750: t = 2.70, P < 0.05; ARA: t = 2.00, P = 0.05). CONCLUSIONS: LPI can significantly widen the peripheral anterior angle in eyes with PAC lasting for at least 1 year after LPI. Parameters detected by UBM at 750 µm anterior to the sclera spur appear to be more sensitive in evaluating the alternation of peripheral angle structure.

[Significance of optic disc topography and retinal nerve fiber layer thickness measurement by spectral-domain OCT in diagnosis of glaucoma].

OBJECTIVE: To study the significance of optic disc tomography and retinal nerve fiber layer (RNFL) thickness measurement by spectral-domain optical coherence tomography (OCT) in the diagnosis of glaucoma. METHODS: It was a noninterventional, observational study. The optic disc topographic parameters and total and regional RNFL thickness were measured by RTVue OCT in 60 normal eyes and 97 glaucomatous eyes. One-way analysis of variance was used to compare the parameters above mentioned between normal and glaucomatous groups. The area under the receiver operating characteristic curve (AUC) and the sensitivity at 80% specificity were used to assess the ability of each testing parameter in the differentiation between normal and glaucoma eyes. RESULTS: There were statistically significant differences in all RTVue OCT measurement parameters (F = 1.024, P = 0.596;F = 36.519, 54.464, 27.659, 36.176, 20.562, 63.833, 30.031, 54.652, 98.146, 78.705, 99.839, 43.728, 75.720, 45.709, 39.380, 33.590, 66.887, 78.335, 45.485;P = 0.000) except disc area. The average RNFL thickness in normal, early, moderate and advanced glaucomatous eyes was 109.950, 93.313, 80.374 and 65.570 µm, respectively. Among the eight regions around the optic disc, the thickest RNFL was located at the inferotemporal (150.066 µm) and superotemporal (146.285 µm) regions in normal eyes, and the superotemporal (108.569, 103.420 and 88.708 µm in early, moderate and advanced glaucomatous eyes, respectively) and inferotemporal (108.201, 102.830 and 86.369 µm in early, moderate and advanced glaucomatous eyes, respectively) regions in glaucomatous eyes. Both in normal and glaucomatous eyes, the thinnest RNFL was located at the nasal and temporal regions, respectively. For optic disc topographic parameters, the highest AUC was vertical cup/disc ratio (AUC = 0.762, 0.946 and 0.988 in early, moderate and advanced glaucomatous eyes, respectively), and the sensitivity at 80% specificity was 62.2%, 76.5% and 99.2% in early, moderate and advanced glaucomatous eyes, respectively. For RNFL thickness, the highest AUC was superotemporal region RNFL thickness (AUC = 0.915) and the sensitivity at 80% specificity was 89.5% in early glaucomatous eyes. The highest AUC was inferior average RNFL thickness (AUC = 0.967) and the sensitivity at 80% specificity was 94.1% in moderate glaucomatous eyes. The highest AUC was average RNFL thickness (AUC = 0.985) and the sensitivity at 80% specificity was 99.2% in advanced glaucomatous eyes. Among the eight regions around the optic disc, RNFL thickness of region ST (AUC = 0.915, 0.926 and 0.966 in early, moderate and advanced glaucomatous eyes, respectively) achieved the highest AUC. RNFL thicknesses of the nasal and temporal regions showed the lowest AUCs. CONCLUSIONS: RTVue OCT shows fair discriminating ability in distinguishing normal from glaucomatous eyes. RTVue OCT is a useful equipment for the diagnosis of glaucoma.

Measurement of anterior chamber volume with rotating scheimpflug camera and anterior segment optical coherence tomography.

BACKGROUND: Measurement of anterior segment parameters plays an important role in diagnosis and treatment of glaucoma. The objective of this study was to evaluate the repeatability and reproducibility of anterior chamber volume (ACV) measurements with rotating scheimpflug camera (RSC) and to examine agreement with anterior segment optical coherence tomography (AS-OCT). METHODS: Thirty nine healthy normal subjects were recruited from the Eye Center of Tongren Hospital. ACV was measured using RSC and AS-OCT in a randomly selected eye for each subject. For RSC measurements, both automatic and manual ACV measurements and 2 independent operators' ACV measurements were obtained. All subjects were invited for 3 visits within a week to evaluate repeatability and reproducibility of ACV measurement by RSC. Agreement was evaluated between RSC and AS-OCT. RESULTS: Good repeatability and reproducibility were found for both automatic and manual ACV measurements obtained by RSC. For intrasession repeatability, coefficient of variation (CVw) and intraclass correlation coefficient (ICC) values for automatic were 3.52% and 0.98; the values for manual were 3.44% and 0.97, respectively. For intersession reproducibility, the respective CVw and ICC values were 3.96% and 0.96. Good agreement was also found in 2 operators for both automatic and manual ACV measurements; nevertheless, poor agreement was found between RSC and AS-OCT (95% confidence interval (CI) for agreement of automatic RSC measurement versus AS-OCT were -96.3 to 72.8 microl and 95% CI for agreement of manual RSC measurement versus AS-OCT were between -41.7 to 10.1 microl). CONCLUSIONS: Both RSC automatic and manual ACV measurements showed good repeatability and reproducibility, and showed comparable agreement between 2 independent operators, but poor agreement was found between RSC and AS-OCT.

Accuracy and repeatability of direct ciliary sulcus diameter measurements by full-scale 50-megahertz ultrasound biomicroscopy.

BACKGROUND: Phakic intraocular lens (pIOL) implantation has been a popular means for the treatment of high ametropia. Measurements of ciliary sulcus diameter is important for pIOL size determining. But till now, no perfect system can directly measure it. The present study was to evaluate the accuracy, repeatability and reproducibility of direct sulcus diameter measurements obtained by a full-scale 50-megahertz (MHz) ultrasound biomicroscopy (UBM). METHODS: A fresh cadaver human eye with a scale marker inserted through the posterior chamber plane from 3 o'clock to 9 o'clock meridian and 30 randomly selected eyes from 30 normal subjects were scanned by full-scale 50-MHz UBM in horizontal meridional scan plane. The distance between the scales and the whole length of the marker inside the cadaver eye were measured by the same observer using the "built-in" measurement tools and the indicating error of instrument was calculated. Reproducibility of the measurement was evaluated in 30 eyes by 2 operators using Blander and Altman plot test. Repeatability was evaluated from 10 successive eyes randomly selected from the 30 eyes by one operator. RESULTS: On a scale of 1 mm, the greatest indicating error was 40 microm; the mean largest indicating error of 1 mm scale from the 10 images was (26 +/- 14) microm; on a scale of 11 mm, the greatest indicating error was 70 microm; the error rate was 0.64%. The mean length of the needle inside the eye of the 10 images was 11.05 mm, with the mean indicating error of 47 microm, the average error rate was 0.43%. For ciliary sulcus diameter measurements in vivo, the coefficient of variation was 0.38%; the coefficients of repeatability for intra-observer and inter-observer measurements were 1.99% and 2.55%, respectively. The limits of agreement for intra-observer and inter-observer measurement were -0.41 mm to 0.48 mm and -0.59 mm to 0.58 mm, respectively. CONCLUSION: The full-scale 50-MHz UBM can be a high accuracy and good repeatability means for direct measuring the ciliary sulcus diameter and useful for size determining of posterior chamber pIOL.

Inhibitory effect of activin A on activation of lipopolysaccharide-stimulated mouse macrophage RAW264.7 cells.

Activin A is a member of transforming growth factor beta (TGF-beta) superfamily, which is also named restrictin-P, and can inhibit the secretion of nitric oxide (NO) and interleukin-1beta (IL-1beta) from LPS-activated mouse macrophages. In this study, the regulation effect and possible mechanism of activin A as an anti-inflammatory factor on lipopolysaccharide (LPS)-activated macrophages were investigated in vitro. It was observed that activin A could not only decrease the secretion of IL-1beta and NO, as well as the mRNA expressions of IL-1beta and iNOS, but also suppress the pinocytosis of mouse macrophage cell line RAW264.7 cells induced by LPS. In addition, activin A could obviously reduce the expressions of CD68 and CD14, as well as Toll-like receptor 4 (TLR4) on RAW264.7 cells induced by LPS, but could not influence the proliferation of RAW264.7 cells. These findings suggest that activin A may play an important down-regulation role in inflammatory factor production and phagocytosis of the activated macrophages via suppressing the maturation of LPS-induced macrophages or LPS-TLR4 signal transduction.