Effect of combined water drinking test and dark room provocative testing in Caucasian eyes with narrow angles.

PURPOSE: To assess the usefulness of water drinking test and dark room provocative testing (WDT + DRPT) in current clinical practice by evaluating input parameters from Swept-source Optical Coherence Tomography (SS-OCT) images, and to determine if clinical factors like axial length, central endothelial cell count (CECC) and retinal nerve fibre layer thickness (RNFL) thickness are associated with a positive WDT + DRPT. METHODS: SS-OCT examination was performed in consecutive subjects presenting as new patients in the outpatient clinic aged > 40 years. If at least one eye met the inclusion criteria (anterior chamber angles <20° and anterior chamber depth < 2.5 mm on SS-OCT), subjects were included in this study and WDT + DRPT was carried out. The eye with the smallest angle was analysed. The difference in parameters between eyes with a positive (≥8 mmHg) and negative (<8 mmHg) increase in intraocular pressure (IOP) after WDT + DRPT were statistically analysed. Second, the correlation between IOP increase after WDT + DRPT and anterior chamber angle parameters (RNFL thickness, CECC and axial length) was studied. RESULTS: A total of 95 subjects with a mean age of 64 years were included. There was an association between IOP increase after WDT + DRPT and anterior chamber angle characteristics, however this was not of clinical significance. No positive results after WDT + DRPT were found in patients with anterior chamber angles ≥ 20°. CONCLUSIONS: The present findings indicate that this combined provocative test has no definite correlative or predictive value in angle closure disease. Further, the test is not useful in predicting early diagnosis or possible CECC or RNFL loss.

Early Phacoemulsification After Acute Angle Closure in Patients With Coexisting Cataract.

PURPOSE: The purpose of this study is to evaluate the effect of early phacoemulsification on the management of acute angle closure glaucoma in patients with coexisting cataract after initial treatment with medical therapy and laser peripheral iridotomy. PATIENTS AND METHODS: This study involved a retrospective analysis of patients presenting to the Maastricht University Medical Center+ with acute angle closure and coexisting cataract between 2005 and 2015. Patients were included after initial treatment with a standard protocol comprising topical and systemic medical therapy and laser peripheral iridotomy. Patients underwent small-incision phacoemulsification with intraocular lens implantation into the capsular bag by experienced surgeons within 3 months of the acute angle closure episode. The effect on intraocular pressure, number of glaucoma medications, visual acuity, and complications was assessed. RESULTS: A total 35 patients were included in the study (mean age, 71±10 y; 20% male; mean refractive error, +1.6±1.8 diopters). The mean duration between acute angle closure episode and phacoemulsification was 37±22 days. There were no complications. Intraocular pressure decreased in all patients from 17.0±8.2 mm Hg to 13.2±3.9 mm Hg after 3 months (P=0.008), whereas the mean number of glaucoma medications decreased from 2.9±1.1 to 0.7±0.9 (P<0.001), with 56% of patients discontinuing all medications. Visual acuity improved from 0.9±0.9 logMAR to 0.2±0.3 logMAR (P<0.001). CONCLUSIONS: Early phacoemulsification with intraocular lens implantation results in a reduced intraocular pressure and number of glaucoma medications after an acute angle closure glaucoma crisis in patients with coexisting cataract. Although surgery may be challenging, the results are promising, with significant improvement in visual acuity in most patients.

Reproducibility of anterior chamber angle analyses with the swept-source optical coherence tomography in young, healthy Caucasians.

PURPOSE: To assess the reproducibility of iridocorneal angle (ICA) analysis in young, healthy Caucasian subjects using swept-source optical coherence tomography (SS-OCT) by determining variability and interobserver agreement between expert and nonexpert observers. METHODS: Thirty-one healthy volunteers (nonexperts) acquired three consecutive SS-OCT images of the right eyes of their peer nonexperts. Images were analyzed by 31 nonexperts and additionally by three experts, whereby the angle opening distance (AOD) and the trabecular iris space area (TISA) at 500 and 750 µm were calculated. A random intercept model was used to determine the amount of variation between observers. In addition, the intra-observer variability between nonexperts and experts was calculated by determining the coefficient of variation (CV). RESULTS: A significant difference was found in the expert analysis for the nasal and temporal angle in the AOD500 (P = 0.002), AOD750 (P < 0.01), and TISA750 (P < 0.01), and the values AOD500 (P = 0.025), AOD750 (P = 0.012), and TISA500 (P = 0.010) were significantly larger if nonexperts analyzed SS-OCT images. The CV was only significant larger for nonexperts for AOD500 (11.1% vs. 8.7%, P < 0.01). CONCLUSIONS: This study demonstrated high reproducibility of angle analysis in young, healthy Caucasian subjects using SS-OCT. Nevertheless, nonexperts obtained significant larger values compared with experts, implying that training is a necessary requirement before analyzing SS-OCT images in ophthalmic practice.