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1.
BMJ Open Ophthalmol ; 7(1): e000931, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35402728

RESUMO

Objective: To evaluate the diagnostic performance of manual grading of anterior segment optical coherence tomography (AS-OCT) in detection of plateau iris configuration (PIC) based on the presence of standardised ultrasound biomicroscopy (UBM) criteria in at least two quadrants; namely, clinical diagnosis of PIC (DxPIC). Methods and analysis: In this cross-sectional study, paired AS-OCT and UBM images were evaluated by three glaucoma specialists. AS-OCT was classified into two mechanisms, PIC versus non-PIC, of primary angle closure disease (PACD) and AS-OCT-PIC diagnostic performance was tested with DxPIC. Results: One hundred and seventy-nine eyes of 142 patients were enrolled for analysis, and DxPIC was found in 85 eyes (47.49%). Intraobserver agreement rates of AS-OCT classification by the graders were 0.77, 0.701 and 0.742 (all p<0.001), and interobserver agreement rates, between a senior glaucoma specialist and the other two glaucoma specialists, were 0.68 and 0.702 (all p<0.001). Plateau iris was classified in AS-OCT images by the three graders, rated 32.96%-39.1% and 24.58%-34.08% in the horizontal and vertical axes, respectively. Diagnostic performance was analysed, yielding sensitivity ranging from 56.47% to 77.78%, and specificity of 48.94% to 64.29%. We applied disease prevalence of 30%, revealing positive predictive values varying from 32.16% to 44.44%, and negative predictive values of 72.4% to 85.71%. Accuracy ranged from 51.2% to 65%. Agreement between the two devices was fair, kappa range 0.31-0.351. Conclusion: Performance of manual grading of AS-OCT in detection of DxPIC was relatively poor; therefore, unadjusted AS-OCT does not appear to be good for manual PIC screening in PACD patients and cannot serve as a substitute for UBM in PIC detection.


Assuntos
Glaucoma , Doenças da Íris , Estudos Transversais , Glaucoma/diagnóstico , Gonioscopia , Humanos , Iris/diagnóstico por imagem , Doenças da Íris/diagnóstico , Tomografia de Coerência Óptica/métodos
2.
Transl Vis Sci Technol ; 11(4): 22, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35452095

RESUMO

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.


Assuntos
Algoritmos , Glaucoma , Estudos Transversais , Glaucoma/diagnóstico , Gonioscopia , Humanos , Processamento de Imagem Assistida por Computador/métodos
3.
BMC Ophthalmol ; 22(1): 113, 2022 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-35277133

RESUMO

BACKGROUND: To study the iridolenticular contact area (ILCA) under different light conditions in acute primary angle closure (APAC). METHODS: This cross-sectional, observational study involved 22 unilateral APAC patients and 59 cataract patients (59 eyes). Images of the APAC eyes, fellow eyes and cataract eyes were collected by anterior segment optical coherence tomography (ASOCT) under different light conditions respectively. The ILCA, anterior chamber width (ACW), anterior chamber area (ACA), lens vault (LV), angle opening distance at 750 µm (AOD750), trabecular iris space area at 750 µm (TISA750) and iris area at 750 µm (IA750) were measured using Image J software. RESULTS: The ILCA of cataract eyes were significantly larger than APAC eyes (4.424 ± 1.208 vs 4.049 ± 2.725mm2, P = 0.034) and fellow eyes (4.424 ± 1.208 vs 3.651 ± 1.629 mm2, P = 0.008) under dark condition. Under dark condition, ILCA of APAC eyes was negatively correlated with AOD750 (r = -0.444, P = 0.038), TISA750 (r = -0.498, P = 0.018). The ILCA of cataract eyes under dark condition was significantly greater than under bright condition (4.424 ± 1.208 vs 2.526 ± 0.992 mm2, P < 0.001). CONCLUSIONS: This study showed that ILCA in both APAC eye and fellow eye were smaller than cataract eye. Future study should focus on both the contact area and force at the interface of lens and iris with larger sample size.


Assuntos
Catarata , Glaucoma de Ângulo Fechado , Segmento Anterior do Olho/diagnóstico por imagem , Estudos Transversais , Glaucoma de Ângulo Fechado/diagnóstico , Gonioscopia , Humanos , Pressão Intraocular , Estudos Prospectivos
4.
BMC Ophthalmol ; 22(1): 144, 2022 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-35351034

RESUMO

BACKGROUND: Laser peripheral iridotomy (LPI) is effective in primary angle-closure suspects (PACS); however, predictors for anterior segment alterations after LPI are limited. We aimed to evaluate the anterior segment biometric parameters before and after LPI in PACS using the recently developed, CASIA 2 device of anterior segment optical coherence tomography (AS-OCT). METHODS: We performed LPI in 52 PACS. Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber width (ACW), anterior chamber volume (ACV), iris curvature (ICURVE), iridotrabecular contact (ITC), lens vault (LV), lens thickness (LT), radius of the lens, angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) at different distances (i.e., 500 µm from the sclera spur), were evaluated before and after LPI using CASIA 2. RESULTS: Eyes of PACS after LPI had a greater ACV, AOD, ARA, TISA, and TIA, and a lower ITC and ICURVE (all p < 0.001) than those before LPI. On a 360° scan, the anterior chamber angle in the superior quadrant increased the most after the LPI. A higher baseline LT was significantly associated with a greater postoperative increase in AOD 500, ARA 500, TISA 500, and TIA 500 (p = 0.001, p = 0.010, p = 0.004, and p < 0.001, respectively). CONCLUSIONS: We found that LPI widens the anterior chamber angle in the PACS, especially, in the superior quadrant around the iridotomy hole. Eyes with a thicker lens are more likely to experience angle opening because of the LPI.


Assuntos
Glaucoma de Ângulo Fechado , Tomografia de Coerência Óptica , Segmento Anterior do Olho/diagnóstico por imagem , Glaucoma de Ângulo Fechado/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Iridectomia/métodos , Lasers , Tomografia de Coerência Óptica/métodos
5.
Indian J Ophthalmol ; 70(4): 1232-1238, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35326023

RESUMO

Purpose: : To analyze the ocular biometric parameters of eyes with acute primary angle closure (APAC) as compared to fellow eyes. Methods: : A cross-sectional study was conducted on 27 patients presenting with recent onset APAC to a tertiary eye institute in India. Anterior and posterior ocular biometric parameters were measured simultaneously by anterior segment optical coherence tomography (AS-OCT), A-scan, ultrasound biomicroscopy (UBM), and B-mode ultrasonogram (USG). The parameters measured were anterior chamber depth (ACD), anterior chamber angle (ACA), angle opening distance (AOD500, AOD750), lens vault (LV), axial length (AL), ciliary body thickness maximum (CBTmax) and at the point of scleral spur (CBT0), anterior placement of the ciliary body (APCB), and retinochoroidal thickness (RCS). Results: Mean age ± SD of patients with APAC was 55.66 ± 7.2 years with female preponderance (21:6 patients). Mean presenting IOP ± SD of the affected eye and fellow eye were 54.74 ± 11.67 mm Hg and 18.7 ± 11.67 mm Hg, respectively. Eyes with APAC had statistically significant narrower anterior ocular biometric parameters, higher LV, decreased ciliary body thickness, more APCB, and longer AL than the fellow eyes. CBTmax is the only variable that had significance (ß = -0.421,95% CI: -0.806 to - 0.035, P = 0.034) in the univariate analysis with RCS thickness in APAC eyes. Further, there was a correlation between CBT0 and APCB with CBTmax both in univariate (ß = 0.894, P < 0.0001 and ß = -0.351, P = 0.039) and multivariable analysis (ß = 0.911, P < 0.0001 and ß = -0.416, P = 0.016). Conclusion: Compared to the fellow eyes, APAC eyes had different ocular biometric parameters. In addition to known biometric parameters associated with pupillary block (narrower anterior biometric parameters-ACA, ACD, and AOD), our study found multiple nonpupillary block factors such as higher lens vault and thinner and more anteriorly placed ciliary body to be associated with APAC.


Assuntos
Glaucoma de Ângulo Fechado , Doença Aguda , Segmento Anterior do Olho/diagnóstico por imagem , Biometria , Corpo Ciliar/diagnóstico por imagem , Estudos Transversais , Feminino , Glaucoma de Ângulo Fechado/diagnóstico , Gonioscopia , Humanos , Pressão Intraocular , Microscopia Acústica , Tomografia de Coerência Óptica/métodos
6.
J Glaucoma ; 31(5): 356-360, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35220386

RESUMO

Gonioscopy is an important part of glaucoma diagnosis and management. Imaging and documentation of the anterior chamber angle has been previously performed using slit-lamp-assisted photography or using smartphones with or without an attached macro lens. Smartphones have transformed ophthalmic imaging by virtue of their availability, easy use, and portability. In this report, the authors aim to demonstrate gonio-imaging using a smartphone attached with an intraocular lens which behaves like a macro lens. With the patient in a sitting position or in the supine position, a goniolens is placed on the patient's cornea. A smartphone with a 10 D intraocular lens attachment over its camera is used to take images or videos of the anterior chamber angle with high magnification. This imaging modality is cost-effective and can be used for screening and photographic documentation of the angle, and can be of immense benefit, especially in primary health care centers.


Assuntos
Lentes Intraoculares , Smartphone , Análise Custo-Benefício , Gonioscopia , Humanos , Pressão Intraocular , Fotografação
7.
Invest Ophthalmol Vis Sci ; 63(2): 23, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35147659

RESUMO

Purpose: The purpose of this study was to investigate whether the lamina cribrosa (LC) curve changes in response to intraocular pressure (IOP) reduction following administration of topical ocular hypotensive eye drops in eyes with normal tension glaucoma (NTG). Methods: Ninety-three eyes of 93 patients with treatment naïve NTG at initial examination and with ≥20% reduction from baseline IOP following administration of topical ocular hypotensive eye drops were included. Serial horizontal B-scan images of the optic nerve head (ONH) were obtained from each eye using enhanced depth imaging spectral domain optical coherence tomography (OCT) before and 1 year after IOP-lowering treatment. The LC curvature in each eye was assessed by measuring the LC curvature index (LCCI) in horizontal OCT B-scan images obtained at three (superior, central, and inferior) locations spaced equidistantly across the vertical optic disc diameter before and after IOP-lowering treatment. We evaluated the OCT detectible change in the LC curvature based on the interval change of LCCI to exceed the intersession standard deviation of 1.96 times and factors associated with the magnitude of the LCCI change in the eyes showing significant LC change. Results: IOP decreased from 15.7 ± 2.5 mm Hg at baseline to 11.2 ± 1.7 mm Hg after topical glaucoma medication. Among the 93 subjects, 62 (66.7%) eyes showed the significant reduction of the LCCI (interssetional change over 1.5) after the treatment; greater interssessional change of the LCCI after IOP reduction was associated with younger age (P = 0.020) and larger baseline LCCI (P < 0.001). Conclusions: The OCT detectible changes in LC curvature occurred in response to a modest decrease in the IOP in the naïve NTG eyes. The therapeutic benefit of these changes need to be assessed in longitudinal studies.


Assuntos
Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/fisiopatologia , Hipotensão Ocular/fisiopatologia , Disco Óptico/patologia , Administração Oftálmica , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Feminino , Gonioscopia , Humanos , Glaucoma de Baixa Tensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Disco Óptico/diagnóstico por imagem , Estudos Prospectivos , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Tonometria Ocular , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
8.
BMC Ophthalmol ; 22(1): 59, 2022 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-35135528

RESUMO

BACKGROUND: To report a case of malignant glaucoma that developed after gonioscopy-assisted transluminal trabeculotomy (GATT). CASE PRESENTATION: An 85-year-old male pseudophakic patient affected by pseudoexfoliative glaucoma (PEXG), unresponsive to medical glaucoma treatment, underwent uneventful GATT surgery. On the first day after surgery, the eye showed a shallow central and peripheral anterior chamber (AC) with a raised intraocular pressure (IOP) measured at 55 mmHg. Optical coherence tomography and ultrasound biomicroscopy confirmed the diagnosis of malignant glaucoma. Laser iridotomy, posterior capsulotomy and hyaloidotomy were performed, and the patient was treated with atropine sulphate 1%, maximum topical and systemic ocular hypotensive drugs with no improvement in the IOP. Subsequently, the patient underwent pars plana anterior vitrectomy, resulting in deepening of the AC with opening of the iridocorneal angle and decrease of the IOP. No further postoperative complications were recorded, and the IOP remained controlled 12 months after surgery without antiglaucoma medications. CONCLUSIONS: Despite the minimally invasive profile of GATT, malignant glaucoma may develop after this procedure. Early recognition and prompt treatment are mandatory for preventing permanent visual loss.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Trabeculectomia , Idoso de 80 Anos ou mais , Câmara Anterior , Seguimentos , Glaucoma/etiologia , Glaucoma/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Masculino , Estudos Retrospectivos , Trabeculectomia/efeitos adversos , Resultado do Tratamento
10.
Indian J Ophthalmol ; 70(2): 558-563, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35086237

RESUMO

To compare the quantitative measurements of the anterior chamber angle (ACA) and iris parameters in patients with juvenile open-angle glaucoma (JOAG), pigmentary glaucoma (PG), and healthy controls using anterior segment optical coherence tomography (AS-OCT). METHODS: This was a retrospective, cross-sectional study of 25 eyes with JOAG, 25 eyes with PG, and 25 control eyes. Anterior chamber depth, angle-opening distance 500 and 750, trabecular-iris space 500 and 750, scleral spur angle, iris thickness (IT, measured at the thickest part), and iris bowing were obtained using AS-OCT (Visante" OCT 3.0 Model 1000, Carl Zeiss Meditec, Inc). RESULTS: The quantitative ACA parameters were found to be significantly higher in JOAG and PG patients compared to healthy controls (P < 0.001); there was no significant difference between the eyes with JOAG and PG (P > 0.05). In eyes with JOAG and PG, there was significantly backward bowing of the iris in temporal and nasal angles compared to control subjects (P < 0.001). Median iris bowing was not significantly different between the patients with JOAG and PG (P > 0.05). The temporal and nasal angle iris thickness were significantly thinner in eyes with JOAG than the eyes with PG (P < 0.001) and age-matched control subjects (P < 0.001). The median IT did not differ between the patients with PG and control subjects (P > 0.05). In patients with JOAG, the intraocular pressure (IOP) was inversely correlated with IT (r = -0.43, P < 0.05). CONCLUSION: AS-OCT provided quantitative data on the ACA and iris parameters in JOAG and PG. The evaluation of the ACA and iris structures using AS-OCT revealed higher ACA measurements and posterior bowing of the iris in patients with JOAG and PG. Furthermore, the patients with JOAG were found to have thinner IT than the ones with PG and healthy controls.


Assuntos
Glaucoma de Ângulo Fechado , Glaucoma de Ângulo Aberto , Câmara Anterior/diagnóstico por imagem , Segmento Anterior do Olho , Estudos Transversais , Glaucoma de Ângulo Aberto/diagnóstico , Gonioscopia , Humanos , Pressão Intraocular , Iris/diagnóstico por imagem , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
11.
Indian J Ophthalmol ; 70(2): 574-579, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35086240

RESUMO

PURPOSE: To assess anterior chamber configuration changes during phacoemulsification in primary angle-closure suspect (PACS/PAC) and primary open-angle glaucoma (POAG). METHODS: Prospective observational comparative study of anterior segment optical coherence tomography (AS-OCT) findings before and after phacoemulsification on three groups of patients (PACS/PAC, POAG, and controls). Data were collected over a period of 9 months. Main outcome measures included mean change in anterior chamber depth (ACD), angle opening distance (AOD), and trabecular iris space area (TISA). RESULTS: 153 patients (51 PACS/PAC, 51 POAG, and 51 controls) were included in the study. Change in all parameters (ACD, AOD at 500 um, and AOD at 750 um) between the groups demonstrated a greater change in PACS/PAC as compared to POAG and controls. AOD at 750 µm in the temporal quadrant, which has been considered to be having the highest correlation or best representation of the angle, increased in all groups after phacoemulsification (463.59 ± 10.99 vs. 656.27 ± 9.73 mm in PACS; 521.29 ± 16.36 vs. 674.37 ± 8.72 mm in POAG; 549.27 ± 12.40 vs. 702.82 ± 13.04 mm in controls, (P < 0.001). After phacoemulsification, intraocular pressure (IOP) decreased by 2.75 ± 1.17 mm Hg in PACS/PAC (P < 0.001), 2.14 ± 1.33 mm Hg in POAG and 1.90 ± 1.25 mm Hg in controls and it was statistically significant in the PACS group compared to control (P < 0.001). CONCLUSION: Phacoemulsification with intraocular lens implantation is associated with increase in the ACD and angle parameters and a corresponding decrease in IOP. Findings were more pronounced in PACS/PAC suggesting early phacoemulsification may be a treatment option in this group.


Assuntos
Glaucoma de Ângulo Fechado , Glaucoma de Ângulo Aberto , Facoemulsificação , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/diagnóstico , Glaucoma de Ângulo Aberto/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Facoemulsificação/métodos , Estudos Prospectivos , Tomografia de Coerência Óptica/métodos
12.
Indian J Ophthalmol ; 70(2): 708-709, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35086290

RESUMO

BACKGROUND: Though various gonioscopy teaching platforms are available, they predominantly comprise of real time scenarios and videos. For a beginner, we suggest providing animations of the real time scenario for cognitive training; and then putting them in real time scenarios for a better concept application and practice. PURPOSE: This video highlights the basic tips and tricks needed to perform gonioscopy with metaphorical conceptual learning matching the 2D and 3D animations with real time scenarios. SYNOPSIS: Simple and practical scenarios with technical details on how to perform gonioscopy and various challenges are shown. All the animations and videos are created by us, tailored to a neophyte. The following concepts are covered: normal angle (animation versus real-time), dynamicity of the gonioscopic dates of person, methods of gonioscopy - direct and Indirect, precautions and slit lamp adjustment, bubble trouble, patient examination, iris process versus peripheral anterior synechiae (animation versus real-time), patient examination (angle viewing order) for different lens, how to remove gonioscopy lens from the eye, static versus dynamic gonioscopy, situations where gonioscopy is contraindicated, grading of the angle (with animations), clinical scenarios (pseudoexfoliation, pigment dispersion, angle recession and aniridia), and surgical scenarios (patent ostium and blocked ostium). HIGHLIGHTS: Multiple animations and real-time videos with focal points for effective practice are the highlights of this video. VIDEO LINK: https://youtu.be/fFmPmqgdjyM.


Assuntos
Glaucoma de Ângulo Fechado , Glaucoma de Ângulo Aberto , Doenças da Íris , Câmara Anterior , Glaucoma de Ângulo Fechado/diagnóstico , Gonioscopia , Humanos , Pressão Intraocular , Iris , Lâmpada de Fenda
13.
Invest Ophthalmol Vis Sci ; 63(1): 1, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-34978560

RESUMO

Purpose: The purpose of this study was to investigate trabecular meshwork (TM) and Schlemm's canal (SC) morphology in Posner-Schlossman syndrome (PSS). Methods: Forty-five patients with PSS were recruited. TM thickness and length as well as SC area and diameter of both affected and fellow eyes were assessed using swept-source optical coherence tomography. Results: TM thickness (108.24 ± 28.29 µm vs. 89.36 ± 25.82 µm, P = 0.014), SC area (6010.90 ± 1287.54 µm2 vs. 5445.69 ± 1368.89 µm2, P = 0.003), and SC diameter (239.38 ± 60.17 µm vs. 217.76 ± 60.79 µm, P = 0.010) were significantly greater in the affected eyes. Furthermore, TM thickness (113.32 ± 30.03 µm vs. 89.00 ± 26.99 µm, P = 0.046), SC area (6216.32 ± 1267.87 µm2 vs. 5476.40 ± 1390.15 µm2, P = 0.001), and SC diameter (246.82 ± 64.12 vs. 212.53 ± 64.29 µm, P = 0.001) were significantly greater in the affected eyes than in the fellow eyes in the ocular hypertension (OHT) subgroup (affected eye with intraocular pressure [IOP] > 21 mm Hg). However, those differences were not noted in the ocular normal tension (ONT) subgroup (affected eye with IOP ≤ 21 mm Hg, all P > 0.05). Conclusions: TM edema might play a role in the IOP elevation in PSS. The edematous TM could make controlling IOP of the affected eyes difficult. When TM edema is relieved, IOP of the affected eyes can reduce to normal spontaneously or with IOP-lowing medications.


Assuntos
Limbo da Córnea/patologia , Malha Trabecular/patologia , Uveíte Anterior/patologia , Adulto , Estudos Transversais , Feminino , Glaucoma de Ângulo Aberto/patologia , Gonioscopia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/patologia , Tamanho do Órgão , Microscopia com Lâmpada de Fenda , Síndrome , Tomografia de Coerência Óptica , Adulto Jovem
14.
J Glaucoma ; 31(4): 261-267, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35089890

RESUMO

PRCIS: Long-term prognosis of primary angle-closure was assessed after lens extraction (LE) according to different mechanisms of angle closure (AC). Patients with pupillary block (PB) had a higher probability of glaucomatous progression than patients with plateau iris configuration (PIC). PURPOSE: The aim was to investigate and compare the clinical characteristics and long-term prognosis of primary angle-closure disease (PACD) after LE according to different mechanisms of AC. METHODS: In this retrospective observational cohort study, 118 eyes with PACD that underwent LE (mean follow-up; 6.0±3.5 y after surgery) were included. PACD eyes were categorized into three subgroups according to their dominant AC mechanisms, determined by anterior segment optic coherent tomography obtained before LE; PB, PIC, and exaggerated lens vault (ELV). Postoperative glaucomatous progression was determined according to functional (visual field) or structural (optic disc photographs or optic coherent tomography measured retinal nerve fiber layer thickness) criteria. Univariate and multivariate logistic regression analysis was performed to determine the risk factors associated with glaucomatous progression. RESULTS: Fifty-two, 51, and 15 eyes with PB, PIC, and ELV, respectively, were included. All eyes showed significant intraocular pressure reduction, with a greater reduction in the ELV group than in the PB group after LE (27.0% vs. 12.5%, P=0.018). Lower baseline retinal nerve fiber layer thickness [odds ratio (OR): 0.966, P=0.004] and thinner central corneal thickness (OR: 0.985, P=0.021), and the PB group (OR: 2.891, P=0.022, reference to PIC group) were significantly associated with glaucomatous progression after LE. CONCLUSIONS: In eyes with PACD, glaucoma progression was observed following LE despite reduced intraocular pressure. The probability of progression was highest in eyes with pupil block as a mechanism of AC. Close monitoring of glaucoma in these patients is suggested.


Assuntos
Glaucoma de Ângulo Fechado , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos
15.
Curr Eye Res ; 47(2): 256-261, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34569390

RESUMO

PURPOSE: To analyze anatomical factors contributing to angle closure based on anterior segment optical coherence tomography (AS-OCT) imaging. METHODS: A total of 238 patients with angle closure and 1122 normal controls were consecutively recruited for this study. Participants' eyes were imaged using AS-OCT under the same darkened ambient light conditions. The following parameters were analyzed: central anterior chamber depth (ACD); anterior chamber area (ACA); anterior chamber volume (ACV), anterior chamber width (ACW); corneal diameter (CD); posterior cornea curvature (PCC); anterior cornea curvature (ACC); maximum iris thickness (ITM); iris thickness at 750 um (IT750) and 2000 um (IT2000) from the scleral spur; iris curvature (IC); iris area (IA); lens vault (LV); angle opening distance (AOD); trabecular iris space area at 500 um (TISA500) and 750 um (TISA750) from the scleral spur; angle recess area (ARA). Lasso regression models were used to detect the collinearity of parameters. The multivariable logistic regression was performed to determine the independent association between angle closure and those parameters included in Lasso regression model. Also Factor analysis was performed to extract a few underlying factors (components) from these parameters. RESULTS: Lasso regression showed that ACD, ACV, PCC, IT750, IT2000 and LV were screened in the model. The multivariable logistic regression indicated that ACV, PCC, IT750 and LV were significantly associated with angle closure. Factor analyses revealed that 4 factors, each with its closely associated clusters of variables, produced the best results: ACA, ACV and ACD (Factor 1); LV, tIC and nIC, (Factor 2); ACW, CD and PCC (Factor 3); and tITM, tIT2000, tIT750, nIT2000 and nIT750 (Factor 4). CONCLUSIONS: Four separate mechanisms were showed to be involved in the pathogenesis of angle closure, from anterior chamber dimensions, lens, iris and cornea respectively. The parameters ACV, PCC, IT750, and LV are more predominant in determining angle closure.


Assuntos
Glaucoma de Ângulo Fechado , Tomografia de Coerência Óptica , Segmento Anterior do Olho/diagnóstico por imagem , Segmento Anterior do Olho/patologia , Glaucoma de Ângulo Fechado/diagnóstico , Gonioscopia , Humanos , Pressão Intraocular , Iris/patologia , Tomografia de Coerência Óptica/métodos
16.
Ophthalmology ; 129(3): 285-294, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34592243

RESUMO

PURPOSE: We hypothesized that the effect of blood lipid-related metabolites on primary open-angle glaucoma (POAG) would differ according to specific lipoprotein particles and lipid sub-fractions. We investigated the associations of blood levels of lipoprotein particles and lipid sub-fractions with POAG. DESIGN: Cross-sectional study. PARTICIPANTS: Individuals recruited for the baseline visit of the population-based Singapore Epidemiology of Eye Disease study (n = 8503). METHODS: All participants underwent detailed standardized ocular and systemic examinations. A total of 130 blood lipid-related metabolites were quantified using a nuclear magnetic resonance metabolomics platform. The analyses were conducted in 2 stages. First, we investigated whether and which lipid-related metabolites were directly associated with POAG using regression analyses followed by Bayesian network modeling. Second, we investigated if any causal relationship exists between the identified lipid-related metabolites, if any, and POAG using 2-sample Mendelian randomization (MR) analysis. We performed genome-wide association studies (GWAS) on high-density lipoprotein (HDL) 3 cholesterol (after inverse normal transformation) and used the top variants associated with HLD3 cholesterol as instrumental variables (IVs) in the MR analysis. MAIN OUTCOME MEASURE: Primary open-angle glaucoma. RESULTS: Of the participants, 175 (2.1%) had POAG. First, a logistic regression model showed that total HDL3 cholesterol (negatively) and phospholipids in very large HDL (positively) were associated with POAG. Further analyses using a Bayesian network analysis showed that only total HDL3 cholesterol was directly associated with POAG (odds ratio [OR], 0.72 per 1 standard deviation increase in HDL3 cholesterol; 95% confidence interval [CI], 0.61-0.84), independently of age, gender, intraocular pressure (IOP), body mass index (BMI), education level, systolic blood pressure, axial length, and statin medication. Using 5 IVs identified from the GWAS and with the inverse variance weighted MR method, we found that higher levels of HDL3 cholesterol were associated with a decreased odds of POAG (OR, 0.91; 95% CI, 0.84-0.99, P = 0.021). Other MR methods, including weighted median, mode-based estimator, and contamination mixture methods, derived consistent OR estimates. None of the routine lipids (blood total, HDL, or low-density lipoprotein [LDL] cholesterol) were associated with POAG. CONCLUSIONS: Overall, these results suggest that the relationship between HDL3 cholesterol and POAG might be causal and specific, and that dysregulation of cholesterol transport may play a role in the pathogenesis of POAG.


Assuntos
HDL-Colesterol/sangue , Glaucoma de Ângulo Aberto/sangue , Análise da Randomização Mendeliana , Metabolômica , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Estudo de Associação Genômica Ampla , Glaucoma de Ângulo Aberto/diagnóstico , Gonioscopia , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Razão de Chances , Polimorfismo de Nucleotídeo Único , Microscopia com Lâmpada de Fenda , Tonometria Ocular
17.
Am J Ophthalmol ; 236: 79-88, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34695398

RESUMO

PURPOSE: To identify risk factors for surgical failure after gonioscopy-assisted transluminal trabeculotomy (GATT) in juvenile open-angle glaucoma (JOAG). DESIGN: Prospective, interventional case series. METHODS: GATT was the initial surgery in 70 eyes of 70 patients with JOAG. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤21 mm Hg with at least a 20% reduction from preoperative IOP, with or without the use of antiglaucoma medication (qualified and complete success, respectively) at each postoperative visit. IOP spike was defined as IOP >30 mm Hg and an increase of at least 10 mm Hg from IOP before the spike, and then reduced to ≤21 mm Hg. RESULTS: The median age at the time of surgery was 19.3 years (range, 4.9-37.5 years) with a visual field mean deviation of -17.4 ± 10.6 dB. Mean IOP decreased from 31.3 ± 9.5 mm Hg preoperatively to 15.8 ± 2.7 at 12 months postoperatively. The complete and qualified success rates were 74.3% and 91.4%, respectively. An IOP spike occurred in 52 eyes (74%), with a median spike duration of 3.5 days (range, 1-21 days). Longer duration of IOP spike (P = .009) and older age at the time of surgery (P = .025) were both associated with worse surgical outcomes. Advanced disease was associated with prolonged IOP spike (P = .007). CONCLUSIONS: GATT provided excellent outcomes in patients with severe JOAG. Older age and longer duration of postoperative IOP spike are risk factors for failure. Severe cases are more likely to have longer durations of IOP spike. Frequent IOP monitoring during the early postoperative period is needed to detect IOP spikes in these patients.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Trabeculectomia , Seguimentos , Glaucoma/cirurgia , Glaucoma de Ângulo Aberto/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
18.
J Glaucoma ; 31(1): 54-59, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34628429

RESUMO

PURPOSE: Glaucoma is a well-known sequelae of corneal transplant surgery and is a leading cause of visual loss in this patient group. We evaluated the performance and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in this population. DESIGN: Noncomparative retrospective case series. PARTICIPANTS: Consecutive eyes of patients receiving the GATT procedure for uncontrolled intraocular pressure (IOP) following corneal transplant surgery from 2016 to 2019. METHODS: Retrospective analysis of eyes with a history of prior corneal transplant undergoing GATT at Glaucoma Associates of Texas between 2016 and 2019 was performed. Data included IOP, patient demographics, preoperative and postoperative medications, preoperative and postoperative corneal procedures, complications, and need for reoperation for IOP control. MAIN OUTCOME MEASURES: IOP reduction and medication use following the procedure. RESULTS: Thirty-nine eyes of 32 patients with prior corneal transplant surgery underwent a GATT procedure. Prior corneal surgery included penetrating keratoplasty (59.0%), Descemet's stripping endothelial keratoplasty (35.9%), Descemet's membrane endothelial keratoplasty (2.6%), and deep anterior lamellar keratoplasty (2.6%). Patient age ranged from 24 to 94 years (mean 68.0 y) with 44% female and 81% Caucasian. The majority of patients had secondary open angle glaucoma (64.1%). There was a significant reduction in IOP and number of medications at all postoperative time points after censoring patients requiring reoperation to control IOP (P<0.001). At 24 months the pressure decreased from baseline of 30.9±11.5 to 13.9±4.7 mm Hg. Medications decreased from 4.2±1.0 medications at baseline to 0.6±1.0 at 24 months. Visual acuities decreased significantly over the first postsurgical month (all P<0.05), but these recovered at subsequent follow-up visits with 2-Snellen line improvements exceeding losses from month 3 to 36. Seven eyes required reoperation for uncontrolled glaucoma at a median of 8.5 months (range: 1.6 to 16.2 mo) after GATT. The cumulative proportion of eyes undergoing repeat cornea surgery was 2.6%, 2.6%, and 14.3% at 12, 24, and 36 months post-GATT, respectively. CONCLUSIONS: This case series describes a group of glaucoma patients, with a history of prior corneal surgery, that were safely and successfully treated with GATT. While classically traditional glaucoma surgeries are considered the standard of care for eyes following corneal transplant surgery, GATT should be considered as a reasonable, safe and effective alternative for surgically lowering IOP.


Assuntos
Transplante de Córnea , Glaucoma de Ângulo Aberto , Trabeculectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Córnea , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/cirurgia , Gonioscopia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Ophthalmology ; 129(3): 267-275, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34634364

RESUMO

PURPOSE: To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC). DESIGN: Prospective, observational study. PARTICIPANTS: Six hundred forty-three mainland Chinese with untreated PACS. METHODS: Participants underwent baseline clinical examinations, including gonioscopy, anterior segment OCT (AS-OCT) imaging, and A-scan ultrasound biometry as part of the Zhongshan Angle Closure Prevention (ZAP) Trial. Primary angle closure suspect was defined as an inability to visualize pigmented trabecular meshwork in 2 or more quadrants based on static gonioscopy. Primary angle closure was defined as development of intraocular pressure above 24 mmHg or peripheral anterior synechiae. Progression was defined as development of PAC or an AAC attack. Multivariable logistic regression models were developed to assess biometric risk factors for progression. MAIN OUTCOME MEASURES: Six-year progression from PACS to PAC or AAC. RESULTS: Six hundred forty-three untreated eyes (609 nonprogressors, 34 progressors) of 643 participants were analyzed. In a multivariable model with continuous parameters, narrower horizontal angle opening distance of 500 µm from the scleral spur (AOD500; odds ratio [OR], 1.10 per 0.01-mm decrease; P = 0.03), flatter horizontal iris curvature (IC; OR, 1.96 per 0.1-mm decrease; P = 0.01), and older age (OR, 1.11 per 1-year increase; P = 0.01) at baseline were associated significantly with progression (area under the receiver operating characteristic curve [AUC], 0.73). Smaller cumulative gonioscopy score was not associated with progression (OR, 1.03 per 1-modified Shaffer grade decrease; P = 0.85) when replacing horizontal AOD500 in the multivariable model. In a separate multivariable model with categorical parameters, participants in the lowest quartile of horizontal AOD500 (OR, 3.10; P = 0.002) and IC (OR, 2.48; P = 0.014) measurements and 59 years of age or older (OR, 2.68; P = 0.01) at baseline showed higher odds of progression (AUC, 0.72). CONCLUSIONS: Ocular biometric measurements can help to risk-stratify patients with early angle closure for more severe disease. Anterior segment OCT measurements of biometric parameters describing the angle and iris are predictive of progression from PACS to PAC or AAC, whereas gonioscopy grades are not.


Assuntos
Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/epidemiologia , Idoso , Segmento Anterior do Olho/diagnóstico por imagem , Biometria , China/epidemiologia , Progressão da Doença , Feminino , Glaucoma de Ângulo Fechado/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Tomografia de Coerência Óptica , Tonometria Ocular , Ultrassonografia
20.
Ophthalmology ; 129(1): 45-53, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34619247

RESUMO

PURPOSE: To develop and evaluate the performance of a 3-dimensional (3D) deep-learning-based automated digital gonioscopy system (DGS) in detecting 2 major characteristics in eyes with suspected primary angle-closure glaucoma (PACG): (1) narrow iridocorneal angles (static gonioscopy, Task I) and (2) peripheral anterior synechiae (PAS) (dynamic gonioscopy, Task II) on OCT scans. DESIGN: International, cross-sectional, multicenter study. PARTICIPANTS: A total of 1.112 million images of 8694 volume scans (2294 patients) from 3 centers were included in this study (Task I, training/internal validation/external testing: 4515, 1101, and 2222 volume scans, respectively; Task II, training/internal validation/external testing: 378, 376, and 102 volume scans, respectively). METHODS: For Task I, a narrow angle was defined as an eye in which the posterior pigmented trabecular meshwork was not visible in more than 180° without indentation in the primary position captured in the dark room from the scans. For Task II, PAS was defined as the adhesion of the iris to the trabecular meshwork. The diagnostic performance of the 3D DGS was evaluated in both tasks with gonioscopic records as reference. MAIN OUTCOME MEASURES: The area under the curve (AUC), sensitivity, and specificity of the 3D DGS were calculated. RESULTS: In Task I, 29.4% of patients had a narrow angle. The AUC, sensitivity, and specificity of 3D DGS on the external testing datasets were 0.943 (0.933-0.953), 0.867 (0.838-0.895), and 0.878 (0.859-0.896), respectively. For Task II, 13.8% of patients had PAS. The AUC, sensitivity, and specificity of 3D DGS were 0.902 (0.818-0.985), 0.900 (0.714-1.000), and 0.890 (0.841-0.938), respectively, on the external testing set at quadrant level following normal clinical practice; and 0.885 (0.836-0.933), 0.912 (0.816-1.000), and 0.700 (0.660-0.741), respectively, on the external testing set at clock-hour level. CONCLUSIONS: The 3D DGS is effective in detecting eyes with suspected PACG. It has the potential to be used widely in the primary eye care community for screening of subjects at high risk of developing PACG.


Assuntos
Córnea/patologia , Glaucoma de Ângulo Fechado/diagnóstico , Gonioscopia/métodos , Imageamento Tridimensional/métodos , Iris/patologia , Tomografia de Coerência Óptica/métodos , Malha Trabecular/patologia , Adulto , Idoso , Área Sob a Curva , Córnea/diagnóstico por imagem , Estudos Transversais , Diagnóstico por Computador , Feminino , Humanos , Pressão Intraocular , Iris/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade
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