Changes in Anterior Segment Parameters After Laser Peripheral Iridotomy in Caucasian Eyes With Different Primary Angle Closure Mechanisms.

PRCIS: Subgrouping of angle closure mechanisms based on the swept-source optical coherence tomography images may help to identify the predominant underlying anatomic mechanism, evaluate personal treatment, and improve the better outcomes. PURPOSE: The purpose of this study was to evaluate changes in anterior segment parameters in Caucasian eyes with different angle closure mechanisms before and after laser peripheral iridotomy (LPI). METHODS: Sixty-six subjects underwent swept-source optical coherence tomography (CASIA, Tomey Corporation) angle imaging in the dark before and 7 days after LPI. On the basis of the baseline swept-source optical coherence tomography images, the eyes were categorized into 4 angle closure mechanisms, namely pupillary block (PB), plateau iris configuration (PIC), thick peripheral iris (TPI), and large lens vault (LLV). Sixteen out of 128 cross-sectional images (11.25 degrees apart) per volume scan were selected for analysis. We used a generalized estimating equation to compare quantitative parameters among angle closure mechanisms and between before and after LPI after adjusting the intereye correlation. RESULTS: The mean age of subjects was 67.7±9.2 years, with the majority being female (82.2%). One hundred twenty-nine eyes (67 primary angle closure suspects, 34 primary angle closure, and 28 primary angle closure glaucoma) were categorized into PB (n=71, 55%), PIC (n=40, 31%), TPI (n=14, 10.9%), and LLV (n=4, 3.1%). Anterior chamber depth was the shallowest in the LLV, followed by TPI, PB, and PIC group at baseline. Widening of the angle and reduction of the iris curvature (IC) due to LPI were observed in all groups (all P <0.01). When compared to the PB group, the LPI-induced angle widening in the TPI group was significantly less even though the iris curvature reduction in the TPI group was greater (all P <0.05). CONCLUSIONS: In patients with angle closure, anterior segment morphology and LPI-induced angle widening were different among the various angle closure mechanisms.

Circumferential Assessment of Changes in Anterior Segment Characteristics and Baseline Predictors of Angle Widening After Laser Iridotomy in Caucasian Eyes.

PRCIS: Laser peripheral iridotomy (LPI) widened the iridocorneal angle and flattened the iris circumferentially in Caucasian eyes and baseline refractive error, lens vault, and iris volume play a significant role in the angle widening. PURPOSE: The purpose of this study was to investigate circumferential angle widening and iris changes after LPI using swept-source optical coherence tomography (SS-OCT) in Caucasian eyes with the use of novel anterior segment parameters. MATERIALS AND METHODS: A total of 130 eyes (68 primary angle-closure suspect, 34 primary angle closure, and 28 primary angle-closure glaucoma eyes) of 66 subjects underwent 360-degree SS-OCT (SS-1000 CASIA) angle imaging and gonioscopy in the dark before and 7, 30, 90 days after LPI. For each eye, 16 frames (11.25 degree apart) were selected for analysis from 128 cross-sectional images, and novel 2-dimensional and 3-dimensional anterior segment parameters namely angle opening distance area (AODA) and the trabecular-iris space volume (TISV) 750 µm from the scleral spur, as well as iris parameters such as iris thickness (IT750 and IT2000), iris curvature, and iris curvature area were measured for each image. RESULTS: AODA and TISV were significantly increased and the iris curvature and iris curvature area were significantly decreased at days 7, 30, and 90 after LPI when compared with their baseline (all P<0.001) but there was no significant change in the IT750 and IT2000 (all P>0.05). The multivariable linear regression model showed a significant association of ΔAODA with refractive error (ß=-0.23, P=0.013), lens vault (ß=2.8, P=0.007), and iris volume (ß=-0.11, P=0.027) after adjusting for age and sex. CONCLUSIONS: LPI widened the iridocorneal angle and flattened the iris circumferentially in Caucasian eyes in this study. Baseline refractive error, lens vault, and iris volume play a significant role in the circumferential angle widening by LPI.

Predictive Value of Bleb Vascularity after Mitomycin C Augmented Trabeculectomy.

BACKGROUND: To evaluate the relationship between bleb vascularity and surgical outcome one year after mitomycin C (MMC) augmented trabeculectomy. METHODS: This was a prospective study of 51 eyes of 44 patients after MMC-augmented primary trabeculectomy with follow-up of 12 months. The total vessel area of a bleb was measured with ImageJ software on color photographs of the bleb on day 1 and 14, then months 1, 3, 6 and 12 after trabeculectomy. Blebs were classified clinically as successful (intraocular pressure (IOP) ≤ 18 mmHg and a >30% reduction in IOP without antiglaucoma medications or additional surgical interventions) or failed. Linear regression analysis was performed to determine the correlation of bleb vascularity with IOP and outcome. RESULTS: At 1 year, 40 eyes (78.4%) were classified as successful and 11 eyes (21.6%) as failed. The mean bleb vascularity at 1, 3 and 12 months after surgery was significantly higher in failed blebs (16.31% vs. 13.01%, p = 0.005, 14.93% vs. 10.15%, p = 0.001, 8.99% vs. 6.37%, p = 0.011, respectively). There were no significant differences in mean bleb vascularity at 1 and 14 days postoperatively in successful and failed blebs. The results revealed a significant association between vessel area at 1 and 3 months after trabeculectomy with IOP at 6 months postoperatively (p = 0.005 and p = 0.009, respectively). CONCLUSIONS: In this prospective study, we demonstrated a strong relationship between bleb vascularity and the surgical outcomes of trabeculectomy. Vascularity of the filtering bleb during early postoperative period was not correlated with IOP or success of trabeculectomy at one year. Increased bleb vascularity 1, 3 and 12 months after trabeculectomy appears to predict surgical failure at 1 year after trabeculectomy.

Phacotrabeculectomy using collagen matrix implant (Ologen® ) versus mitomycin C: a prospective randomized controlled trial.

PURPOSE: To compare the efficacy and safety of collagen matrix implant (Ologen® ; OLO) with mitomycin C (MMC) in phacotrabeculectomy. METHODS: Prospective, single-centre, nonblinded, randomized controlled trial. A total of 53 eyes of 45 patients were enrolled in the study protocol with 27 eyes randomly assigned to OLO and 26 to MMC. The follow-up was 12 months. The primary outcome measure was mean change from baseline intraocular pressure (IOP) in both groups after 12 months. The secondary outcome measures were cumulative success rates at 12 months with Kaplan-Meier analysis, change in number of medications, change in best corrected visual acuity (BCVA), and bleb morphology assessed using Moorfields Bleb Grading System and anterior segment swept-source optical coherence tomography. RESULTS: The mean IOP decreased from 26.4 ± 6.1 mmHg to 13.7 ± 3.8 in the OLO group and from 23.4 ± 3.6 mmHg to 13.3 ± 2.8 in the MMC group at 1 year without significant intergroup differences. At 1 year, the overall success rates were 92.6% and 92.3% in the OLO and MMC groups, respectively. There were no significant differences in the overall success rates, BCVA, number of medications, morphology of the filtering blebs and rate of complications at the end of the follow-up. CONCLUSION: Ologen (OLO) provides similar surgical outcomes in phacotrabeculectomy compared with adjunctive MMC. It may be a new, safe and effective alternative to MMC for combined phacoemulsification and trabeculectomy surgery.

[Acute posterior multifocal placoid pigment epitheliopathy (APMPPE)--a report of three cases]. / Ostra tylna wieloogniskowa plackowata epiteliopatia barwnikowa (APMPPE)--opis trzech przypadków.

PURPOSE: The aim of this study is to present and discuss three cases of acute posterior multifocal placoid pigment epitheliopathy (APMPPE). MATERIAL AND METHODS: Three young patients (one woman and two men), developed rapid loss of vision in one or both eyes. Basic ophthalmic examination and additional diagnostic methods including: fluorescein angiography (FA), indocyanine green angiography (ICG), optical coherence tomography (OCT) and human leucocyte antigen (HLA) class I test were performed. RESULTS: Based on the results of performed investigations the diagnosis of acute posterior multifocal placoid pigment epitheliopathy (APMPPE) was established. Fundus examination revealed characteristic multifocal, placoid, creamy or grey/white subretinal lesions. Fluorescein angiography in acute stage of the disease demonstrated early hypofluorescence followed by later hyperfluorescence of the lesions. Indocyanine green angiography demonstrated hypofluorescence in all stages of the angiogram. In one case, class I HLA-B7 antigen was found. In all presented cases visual acuity markedly improved with general glicocorticosteroids. CONCLUSIONS: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is characterized by rapid, but transient loss of visual acuity. Diagnosis is established in fluorescein angiography and prognosis for recovery is good, however in cases with poor visual acuity glicocorticosteroids might be beneficial.