Assessment of the anterior chamber parameters after laser iridotomy in primary angle close suspect using Pentacam and gonioscopy

AIM:To evaluate the changes in the anterior segment parameters of the subjects with primary angle closure suspect(PACS) before and after laser iridotomy(LI) using the Pentacam and gonioscopy. METHODS:Forty-eight eyes of 48 PACS were included.Anterior chamber angle(ACA),central anterior chamber depth(ACD),anterior chamber volume(ACV) and central corneal thickness(CCT) were recorded from the Pentacam before and one month after LI.ACA was graded according to Shaffer classification using Goldmann gonioscopy.RESULTS:ACA increased significantly from 25.59±4.41 to 26.46±4.33 degrees(P=0.009) and ACV changed from 85.97±16.07mm3to 99.25±15.83mm3(P=0.000).The changes in ACD,CCT and intraocular pressure were non-significant(P】0.05).Gonioscopy showed significant widening of the Shaffer angle in 4 quadrants(P【0.001).CONCLUSION:Pentacam can serve as the objective instrument in assessing the efficacy of LI.

Gonioscopy and Ultrasound Biomicroscopy in the Detection of Angle Closure in Patients with Shallow Anterior Chamber

Objective To assess the agreement between gonioscopy and ultrasound biomicroscopy(UBM) in detecting angle closure in Chinese patients with shallow anterior chamber. Methods An observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded. Results 85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor(κ<0.4) with Kappa analysis in both dark and light conditions in each quadrant. The accordance of agreement between gonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber(P=0.005) or plateau iris configuration tended to produce different results(P=0.075) in the 2 methods. Conclusion Gonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.

Dual Scheimpflug imaging as a screening method for occludable angles-a comparison with gonioscopy

AIM: To evaluate dual Scheimpflug analyzer(Galilei) as a screening method for the diagnostic of gonioscopically narrow anterior chamber angles(ACA). METHODS: In 40 eyes of 40 patients with different ACA range, the ACA, anterior chamber volume(ACV) and anterior chamber depth(ACD) were analyzed using the dual Scheimpflug analyzer(Galilei G6 system). Correspondence between these parameters and Shaffer's classification based on gonioscopy were studied. Receiving operator characteristic(ROC) curves and partition analysis were used to determine the efficacy of the Galilei system in screening for narrow angles. Agreement(Kappa statistics), sensitivity, and specificity for each eye, according to Galilei measures, were also assessed. RESULTS: Shaffer's grade(from 0 to 4) were significantly associated with each of the measurements(P<0.001). In screening eyes with narrow angles with the Galilei, the area under the ROC curve was largest(0.90) when ACD was used as the reference, and partition analysis demonstrated that those eyes were most adequately partitioned with an ACD of 2.86 mm with 100% sensitivity and 80% specificity. CONCLUSION: The Galilei is a secure, repeatable and noncontact screening method for narrow angles. However it does not provide sufficient information about the ACA anatomy to be considered a substitute for gonioscopy.

Gonioscopy: A Review

Gonioscopy allows us to examine the angle of anterior chamber and forms part of complete ophthalmic examination and it is mandatory for the diagnosis and management of glaucoma. Gonioscopy permits the identification of eyes at risk for closure and detects angle abnormalities that could have diagnostic and therapeutic implications. Principle, types and techniques of gonioscopy, various types of gonioscopic lenses used, indications of performing gonioscopy, gonioscopic anatomy and grading are discussed in this article.

Intraocular pressure and gonioscopic findings in primary angle-closure disease in India—a big data study

AIM:To describe the gonioscopic profile and intraocular pressure(IOP)in primary angle-closure(PAC)disease in patients presenting to a tertiary eye care network in India.METHODS:A cross-sectional hospital-based study that included 31484 new patients presenting between 2011 and 2021.Patients with a clinical diagnosis of PAC/suspect/glaucoma were included.The data was collected from an electronic medical record system.RESULTS:PAC glaucoma(PACG)(47.55%)was the most common diagnosis followed by PAC(39.49%)and PAC suspect(PACS;12.96%).Female preponderance(54.6%)was noted with higher mean age at presentation among males(P<0.0001).PACS and PAC showed the highest prevalence in 6th decade but PACG was higher at 7th decade.The probability of angle opening was 95.93%,90.32%and 63.36%in PACS,PAC and PACG eyes respectively post peripheral iridotomy(PI).Plateau iris syndrome(PIS)was noted in 252 eyes and all showed post dilated rise of IOP.A post dilated IOP rise was also noted with 8.86%,33.95%and 57.19%eyes with PACS,PAC and PACG respectively with IOP rise between 6-8 mm Hg across the disease spectrum.CONCLUSION:The superior quadrant is the narrowest angle and difficult to open with indentation and post PI.The probability of angle opening is less in PIS especially the complete variety along with post dilated IOP rise.The post dilated IOP rise in angle closure eyes warrants a careful dilatation,especially with PIS.

Efficacy of Combined Phacoemulsification and Goniosynechialysis in the Treatment of Patients with Primary Angle Closure Disease and Concomitant Cataract at Preah Ang Duong Hospital in Cambodia

Background: Goniosynechialysis is a surgical procedure that has been shown to slow the progression of glaucoma in oriental eyes with chronic angle closure glaucoma. This procedure was successful in 80% of cases, and the peripheral anterior syenchiae did not exist until one year later. Nonetheless, there is little evidence of its efficacy in our context. Our study aims to investigate the efficacy of goniosynechialysis during phacoemulsification in patients with primary angle closure disease and concomitant cataract. Methods: This was an observational, prospective study. The intra-ocular pressure, need for anti-glaucoma drugs, visual acuity, the extent of synechiae, anterior chamber depth, surgical success rate, and other indicators were monitored for at least three months following surgery. Results: This study included 114 patients (118 eyes), 61 with chronic angle closure glaucoma (51.69%), 33 with primary angle closure (27.97%), and 24 with acute attack angle closure (20.34%), who were surgically treated with phacoemulsification and goniosynechialysis (Phaco-GSL). The mean intra-ocular pressure had significantly decreased three months after surgery (pre- vs post-op: 22.04 ± 10.86 vs 15.41 ± 6.06 mmHg, p-value p-value p-value p-value p-value Conclusion: Regardless of the type of glaucoma, combined phacoemulsification-goniosynechialysis is effective in lowering pressure, restoring vision, reducing the need for anti-glaucoma drugs, and preventing the synechial recurrence. Success was higher in eyes with less extensive synechiae. Phaco-GSL is safe and effective in the treatment of primary angle closure diseases with co-existing cataract.

The Acute Angle Closure Crisis in Senegalese Melanodermas: Epidemiological and Clinical Aspects of 24 Cases

Introduction Acute angle closure crisis (AACC) is a major ophthalmic emergency. It is a sight-threatening pathology that is very common in women but rarely described in melanodermas. The aim of this work is to investigate the epidemiological and clinical aspects of acute angle closure crisis. Results We collected 24 patient records, totaling 25 eyes. The average age of our patients was 52.04 years, with a male-to-female ratio of 0.6. A family history of glaucoma occurred in 34% of patients. Patients consulted for a painful red eye associated or not with decreased visual acuity (DVA). The condition was bilateral in one patient. The average visual acuity wax 0.34/10e. The cornea was cloudy and the pupil in areflexic mydriasis in all sick eyes. Hypothalamia was present in 72% of eyes and cataracts in 54.16% of cases. The average intraocular press was 44.38 mmHg and the average cup/disc (C/D) was 0.46. Gonioscopy was performed in 7 patients. The fellow eye did not present any abnormalities in 92% of cases. Conclusion The acute angle closure crisis is a rare condition in melanodermas and common in woman. His diagnostic is essentially clinical and completed by gonioscopy which plays a fundamental role. .

Pressure Changes in Patients with Chronic Renal Failure Undergoing Hemodialysis

Purpose: To determine the effects of hemodialysis on intraocular pressure (IOP) and to evaluate the correlation of IOP changes with anterior chamber angle anatomy. Patients and Methods: The study included 80 eyes of 40 patients with chronic renal failure (CRF) undergoing hemodialysis at the High Technology Medical Center between October 2018 and October 2021. Hemodialysis (HD) was performed 3 times a week and the duration of the procedure was 3 - 5 hours. The enrolled patients were grouped according to the width of the anterior chamber angle. IOP was evaluated at three different times during HD. Intraocular pressure was measured in both eyes in an upright sitting position with iCare tonometer. Results: According to the study results, there was no statistically significant difference in the axial length between the three measurements (p = 0.232). In patients with normal anterior chamber depth, IOP decreased significantly (68.75%) or did not show any changes in their IOP during or after the session. In patients with moderate narrow-angle (22.5%), IOP revealed no statistically significant differences. In patients with narrow-angle (8.75%), there was a marked increase in IOP. Changes in intraocular pressure were correlated with the anatomy of the anterior chamber angle. Loss in body weight as a result of hemodialysis was statistically important (p Conclusion: A significant increase in mean was revealed during and after hemodialysis in patients with extremely narrow-angle in comparison to eyes with wide or moderately anterior chamber angle. Eyes with shallow anterior chambers are at risk of having impaired aqueous humor outflow facilities and, as a result, significantly increase IOP during HD. Because of the high prevalence of narrow angles in the Caucasian population, it is of clinical importance to investigate the IOP changes in patients on HD. The results of our study support the idea that iridocorneal angle anatomy is affecting IOP fluctuation occurring in patients with ESRD undergoing HD.

Nd: Yag laser iridotomy in Shaffer-Etienne grade 1 and 2: angle widening in our case studies

·AIM: To obtain widening of a potentially occludable angle, in according to Kanski’s indications, through preventive Nd:Yag laser iridotomy. The observational study was performed by using gonioscopy for the selection and follow-up of 1165 treated eyes and exploiting Shaffer-Etienne gonioscopic classification as a quality/quantity test of the angle recession.·METHODS: Between September 2000 and July 2012,586 patients were selected at the Outpatients’ Ophthalmological Clinic of the Policlinico Umberto I of Rome in order to undergo Nd: Yag laser iridotomy. A Goldmann type contact lens, Q-switched mode, 2-3defocus, and 7-9 m J intensity with 2-3 impulse discharges were used for surgery.·RESULTS: From as early as the first week, a whole360° angle widening were evident in the patients, thus showing the success of Nd:Yag laser iridotomy in solving relative pupil block. The angle remained narrow by 270° in 14 eyes only, despite repetitions of further treatment with laser iridotomy in a different part of the iris, twice in 10 eyes and three times in 4 eyes.·CONCLUSION: Nd:Yag laser iridotomy revealed itself as being a safe and effective treatment in widening those critical Shaffer-Etienne grade 1 and 2 potentially occludable angles.

Evaluation of Nasal and Temporal Anterior Chamber Angle with Four Different Techniques

Background: Anterior chamber angle (ACA) can be measured by many different techniques. In order for a technique to be a part of the routine eye examination, it has to be quick and easy in good agreement with gonioscopy both nasally and temporally. Aim: To investigate variation in ACA measurement between gonioscopy, van Herick technique, anterior segment optical coherence tomography (AS-OCT) and Sirius Scheimpflug-Camera both nasally and temporally. Method: The ACA of 50 eyes of 25 healthy subjects was measured with gonioscopy, van Herick technique, AS-OCT and Sirius Scheimpflug-Camera. The angle was measured both nasally and temporally. Results: No statistically significant difference could be found between gonioscopy, van Herick technique and AS-OCT either nasally or temporally. The Sirius Scheimpflug-Camera on the other hand showed statistically significant difference to gonioscopy (p < 0.0001) both nasally (p = 0.03, p = 0.001, p < 0.0001) and temporally (p = 0.0002, p = 0.001, p Conclusion: This study showed good agreement between three of the four techniques. ACA measurements obtained by the Sirius Scheimpflug-Camera should therefore not be considered interchangeable with those obtained by the remaining three methods.