Anterior Segment In Patients Research Articles

Application of indocyanine green iris angiography in the evaluation of anterior segment blood supply in different strabismus patients

Objective: To evaluate the perfusion features of the anterior segment in patients with different types of strabismus. Methods: A cross-sectional study. Sixteen strabismus patients (16 eyes) who received the examination of iris indocyanine green angiography (ICGA) in Tianjin Eye Hospital from November 2016 to December 2021 were enrolled and divided into two groups according to whether they had a history of extraocular muscle injury/rectus muscle surgery. All patients underwent routine ophthalmic examinations. Angiographic images were obtained by the anterior segment camera, and indicators such as arm to iris circulation time, whole iris filling time, regression onset time, and complete regression time were recorded. The independent sample t test or Mann-Whitney U test was used to compare iris perfusion aspects of the two groups, and the Pearson/Spearman correlation tests was used to analyze the correlation of arm to iris circulation time and whole iris filling time with age and course of strabismus. Results: Among the 16 patients, there were 10 males and 6 females. The mean age was (49.2±13.2) years, and the course of strabismus ranged from 2 to 31 months. There were 7 patients in the group of without extraocualr muscle injury and 9 patients in the extraocular muscle injury/surgery group. There was no significant difference in age and course of strabismus between the two groups (both P>0.05). The arm to iris circulation time [M (Q1, Q3)] of the group without extraocular muscle injury and the group with extraocular muscle injury/surgery were 18 (18, 21) and 22 (20, 24) s, respectively. The average whole iris filling time was (13.86±1.95) and (12.22±3.60) s, respectively. There was no statistical significance between the two groups (both P>0.05). Correlation analysis showed that arm to iris circulation time was not correlated with age and course of strabismus (r=-0.033, -0.079; both P>0.05). And the whole iris filling time was not correlated with age and course of disease (r=0.057, -0.119; both P>0.05). The matrix scatter plots showed that in the group of extraocular muscle injury/surgery, there were three patients who were older than the average (49.2 years) and above the median of arm to iris circulation time (20 s) (two cases with the vertical muscle involved), meanwhile, there were three patients (all with the vertical muscle involved) whose course of strabismus was longer than 6 months and above the median of arm to iris circulation time, which were more than those in the group of without extraocular muscle injury (1 case, respectively). Conclusions: ICGA in patients with strabismus show that a history of injury to the extraocular muscle or surgical treatment beyond 2 months had no effect on iris perfusion. Age and course have no correlation with iris reperfusion. The vertical muscle involvement has more effects on the blood supply to the anterior segment.

Ultrasound biomicroscopy of the anterior segment in patients with primary congenital glaucoma: a review of the literature.

Primary congenital glaucoma (PCG) is a form of childhood glaucoma caused by maldevelopment of the anterior chamber. Disease severity differs greatly amongst patients. Ultrasound biomicroscopy (UBM) is a non-invasive technique that can visualize the anterior segment in infants invivo. The purpose of this narrative review is to make an overview of the UBM data in PCG and study the applicability of UBM in characterizing the disease. An online search was performed on PubMed in December 2020. After a critical appraisal of the included articles, study and patient characteristics were summarized. The UBM measurements of the anterior segment in PCG of the different studies were analysed. Six studies were included in this review. All were cross-sectional prospective studies. A total of 221 PCG eyes were examined. PCG eyes showed a larger trabecular iris angle, decreased iris thickness, narrower or absent Schlemm's canal and an increased zonular length compared to controls. Abnormal tissue membrane covering the trabecular meshwork and abnormal insertion of the iris and ciliary process were frequently found. The success rate of glaucoma surgery depended on the severity of anterior segment malformations found with UBM. Malformations of the anterior segment in PCG can be demonstrated by UBM invivo. This imaging can help to characterize disease severity and might support surgical treatment decisions.

Features of the Anterior Segment of the Eyeball in Children with 5 Cicatricial Retinopathy of Prematurity According to Ultrasound Biomicroscopy and Optical Coherent Tomography

Purpose: to study the features of the anatomical and topographic relationships of the eye’s anterior segment structures in children with stage 5 ROP in the cicatricial period with the method of ultrasound biomicroscopy and optical coherent tomography of the anterior segment and to evaluate the possibility of using the data to optimize the surgical treatment of ROP.Patients and methods. For the period 2015–2018 in the Kaluga branch of the Fyodorov Eye Microsurgery, 68 children (118 eyes) with 5 cicatricial ROP stages were examined and treated. Gestational age at birth varied from 24 to 31 weeks, body weight at birth — from 630 to 1600 grams. Age at the time of the survey ranged from 5 to 15 months. All children underwent the complex diagnostic examination, which included biometrics, tonometry, ultrasound ophthalmoscanning in B-mode, as well as UBM and OCT of the anterior segment of the eyeball. The extent of fixation of retrolental opacities to the posterior lens capsule, the presence of cystic cavities and retinal folds at the periphery, traction detachment of the ciliary body were determined. OCT of the eye anterior segment was performed in the presence of iridocorneal contact in order to clarify its length. As a result, a comprehensive detailed assessment made it possible to clarify or reject the characteristics identified by UBM, as well as determine the phasing and develop an individual plan of the operation in each case.Conclusion. The use of complex diagnostic examinations, including UBM and OCT of the eye anterior segment in patients with 5 cicatricial PH stages, allows to optimize the tactics of surgical treatment in the advanced stages of the disease.

Evaluation of anterior segment parameters in pars plana vitrectomy and silicone oil injection

Purpose The aim of this study was to compare the changes in anterior segment parameters induced by pars plana vitrectomy (PPV) and silicone oil injection in phakic and pseudophakic eyes.Patients and methods This is a prospective comparative study that included 40 eyes with rhegmatogenous retinal detachment that underwent vitrectomy and silicone oil injection. They were divided equally into two groups. Group 1 included phakic eyes and group 2 included pseudophakic eyes. Anterior segment parameters were documented by using a CSO Camera (Costruzione Strumenti Oftalmici) before and 1 month after surgery. The changes in the following parameters were compared between the two groups: anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), central corneal thickness (CCT), corneal volume (CV), horizontal anterior chamber diameter, and surgically induced astigmatism.Results At 1 month postoperatively, in group 1, there was a significant decrease in the mean of ACA and ACV as compared with the preoperative values (P=0.024 and 0.011, respectively). In group 2, there was a significant decrease in the 1-month postoperative mean of ACD, ACA, and ACV as compared with the preoperative values (P=0.021, <0.0001 and 0.015, respectively) and a significant increase in the mean of CCT and CV values (P<0.0001 and 0.002, respectively). In group 2, there was more reduction in ACD, less reduction in ACA, and higher increase in CCT and CV as compared with group 1 (P=0.021, 0.001, <0.0001, and 0.023, respectively).Conclusion The presence of the crystalline lens acts as a barrier which decreases the changes in the anterior segment parameters and improves the functional outcome following PPV and silicone oil injection as compared with pseudophakia. Therefore, it may be useful to stabilize the anterior segment in patients with PPV and silicone oil injection.

Hydrogen sulfide serves as a biomarker in the anterior segment of patients with diabetic retinopathy.

The present study aims to determine hydrogen sulfide (H2S) concentrations of the aqueous humor from patients with diabetic retinopathy (DR) to compare its levels in the anterior segments, also to investigate its effect on the retinal microvascular endothelial cells under high glucose condition. AH samples were collected from patients with proliferative diabetic retinopathy (n = 11), non-proliferative diabetic retinopathy (n = 12) and diabetic patients without DR as controls (n = 12). There were 5 patients with PDR received intraocular anti-VEGF injection (Lucentis). Cultured RF/6A cells were grouped into control group, mannitol group, high glucose group and NaHS co-administrated high glucose group. Concentrations of H2S were detected by chemical assay. Cell apoptosis was evaluated by flow cytometry. A significantly higher H2S level was observed in AH samples of PDR patients among other groups. The H2S level of DR group was higher than that of control group. Decreased H2S levels in the AH of post-injected PDR patients were observed compared with their AH samples before the anti-VEGF injection. In cell culture, low concentration of NaHS can reverse high-glucose-induced apoptosis of RF/6A cells. Our study revealed increased H2S levels in the anterior segments of different DR patients. The anti-VEGF injection reduced the H2S level in AH from PDR patients. The study suggested that H2S may serve as a biomarker in the progression of PDR. On the other hand, the H2S donor exerted a protective effect on retinal vascular endothelial cells against high-glucose-induced apoptosis.

Dynamic changes of anterior segment in patients with different stages of primary angle-closure in both eyes and normal subjects.

PurposeTo compare changes in anterior segment parameters under light and dark (light-to-dark) conditions among eyes with chronic primary angle-closure glaucoma (CPACG), fellow eyes with confirmed or suspect primary angle-closure (PAC or PACS), and age-matched healthy eyes.MethodsConsecutive patients with CPACG in one eye and PAC/PACS in the fellow eye, as well as age-matched healthy subjects were recruited. Anterior segment optical coherence tomography measurements were conducted under light and dark conditions, and anterior chamber, lens, and iris parameters compared. Demographic and biometric factors associated with light-to-dark change in iris area were analyzed by linear regression.ResultsFifty-seven patients (mean age 59.6±8.9 years) and 30 normal subjects matched for age (60.6±9.3 years) and sex ratio were recruited. In regards to differences under light–to-dark conditions, angle opening distance at 500 μm (AOD500μm) and iris area during light-to-dark transition were smaller in CPACG eyes than fellow PACS/PAC eyes and normal eyes (P<0.017). Pupil diameter change was largest in normal eyes, and larger in PACS/PAC eyes than CPACG eyes (P<0.017). There was an average reduction of 0.145 mm2 in iris area for each millimeter of pupil diameter increase in CPACG eyes, 0.161 mm2 in fellow PAC/PACS eyes, and 0.165 mm2 in normal eyes. Larger iris curvature in the dark and diagnosis of PACG were significantly associated with less light-to-dark iris area changes.ConclusionsDynamic changes in iris parameters with light-to-dark transition differed significantly among CPACG eyes, fellow PAC/PACS eyes, and normal eyes. Greater iris curvature under dark conditions was correlated with reduced light-to-dark change in iris area and pupil diameter, which may contribute to disease progression.

Changes of anterior segment in patients with primary angle-closure glaucoma treated with phacoemulsification and intraocular lens implantation detected by Pentacam

Changes of anterior segment in patients with primary angle-closure glaucoma treated with phacoemulsification and intraocular lens implantation detected by Pentacam

Recurrence of iris melanoma after proton beam therapy

Background/AimsA retrospective service evaluation to report on recurrence of iris melanoma after proton beam therapy (PBT).MethodsThe cohort comprised 150 consecutive eyes with iris melanoma treated with proton beam radiotherapy. Treatment...

Evaluation of biological measurement of ocular anterior segment in patients with primary angle closure glaucoma with cataract

目的 采用眼前节光学相干断层扫描(SL-OCT)、超声生物显微镜(UBM)及传统的A型超声3种不同的检测方法观察原发性闭角型青光眼(PACG)合并白内障患者的眼前节解剖结构,评价3种检测方法的临床应用价值.方法 研究设计为诊断试验.对PACG合并白内障的患者30例42眼行白内障超声乳化联合人工晶状体(IOL)植入术,于术前、术后1个月分别用SL-OCT、UBM及A型超声对眼前节进行测量,分析手术前后SL-OCT、UBM及A型超声测量的眼前节参数的变化,并比较3种不同的检查方法对眼前节测量参数间的差异,同时监测手术前后视力及眼压的情况.结果 SL-OCT、UBM、A型超声检测显示所有患者术后1个月中央前房深度(ACD)明显增加,与术前比较差异均有统计学意义(t=-15.695、t=-15.367、t=-6.981,P 0.05).术前和术后1个月SL-OCT、UBM和A型超声3种检测方法测得的ACD差异均有统计学意义(F=21.060,P 0.05).术前及术后3d、7d、1个月眼压逐渐下降,视力逐渐改善,差异均有统计学意义(F=35.792,P=0.000;F=124.891,P=0.000).结论 SL-OCT、UBM和A型超声可以客观、准确地提供PACG合并白内障患者眼前节的解剖参数,为选择白内障超声乳化联合IOL植入术的手术时机提供参考依据。

Morphologic Changes in the Anterior Segment in Patients with Initial-onset or Recurrent Vogt-Koyanagi-Harada Disease

Purposes: To investigate morphologic changes in anterior segments based on inflammatory phases of Vogt-Koyanagi-Harada (VKH).Methods: The author recruited 76 consecutive eyes of 38 patients with initial-onset VKH and 52 eyes of 26 patients with recurrent VKH. Morphologic changes in anterior segments were measured by ultrasound biomicroscopy (UBM). UBM parameters and intraocular pressure (IOP) were compared between two groups.Results: Ciliary thickness and area significantly increased in the recurrent group compared with the initial-onset group. Twelve patients (31%) in the initial-onset group showed supraciliary effusions, but no patients in the recurrent group had supraciliary effusions. Angle opening and anterior chamber depth were significantly decreased in the initial-onset group compared with the recurrent group. High IOP > 30 mmHg was found in 7 patients with initial-onset disease, while low IOP < 10 mmHg was detected in 6 patients with recurrent disease.Conclusions: The results indicate that morphologic changes associated with IOP alterations depend on inflammatory phases of VKH disease.

Changes in Anterior Segment Biometry by Laser Iridotomy in Eye With Shallow Anterior Chamber

Purpose: To identify the impact of the presence of peripheral anterior synechia (PAS) on the depth of the anterior segment in patients with a shallow anterior chamber after laser iridotomy (LI) by analyzing changes in the anterior segment biometry using ultrasound biomicroscopy (UBM). Methods: Twenty eyes of 20 patients with PAS and shallow anterior chamber, and another 20 eyes of 20 patients with shallow anterior chamber without PAS were studied. The changes in the anterior segment biometry for each group of patients were examined using gonioscopy and UBM before and after the LI. Results: The central corneal thicknesses and scleral thicknesses of the two groups did not show significant differences (p > 0.05). The anterior chamber depths, anterior chamber angles, trabecular meshwork-iris distances, and angle-opening distances 500 increased significantly after the peripheral LI (p

This issue of Acta

The cover illustration shows ultrasound biomicroscopy of the anterior segment as seen in the article by Peizeng et al. in this issue of Acta. In the editorial, Stefan Seregard discusses the controversial issue of tumour growth rates and risks as discussed in the article by Kujala et al. in this issue. Kumar from Saudi Arabia reviews vernal keratoconjunctivitis and its treatment. He discusses the immunology and pathophysiology of this chronic bilateral seasonal allergic inflammation of the conjunctiva. Cruess et al. in Canada and USA review the experience with photodynamic therapy with verteporfin. While this treatment is being replaced by VEGF antibodies, it was certainly a groundbreaking change in the treatment of exudative AMD and may still play a role in combined treatment regiments in the future. Kujala et al. in Helsinki observe that a primary conjunctival melanoma is less deadly than a primary uveal melanoma but perhaps only because they are diagnosed earlier and smaller. This is issue is further discussed in the editorial by Stefan Seregard. Garweg and Köerner in Switzerland show that the visual recovery is excellent in patients with vitreous haemorrhage caused by Terson syndrome and treated by vitrectomy. Frimpong-Boateng et al. in Kiel examined the combination of photodynamic therapy and intravitreal triamcinolone and found this to be synergistic. However a comparison with VEGF antibody remains to be performed. Corydon et al. in Århus examined the long term fate of cryopreserved corneas and found that these can function for a long time, even if the regular hexagonal pattern does not exist. Sundelin et al. found that levofloxaein penetrates into the anterior chambers when given an eye drops before and after cataract surgery. Claesson et al. in Sweden and UK examined pseudophakic bullous keratopathy in the Swedish cornea transplant register. They found phacoemulsification to be a risk factor for persistent macular edema after cataract surgery. Immediate corneal transplants had a better survival rate than keratoplasty for late onset pseudophakic bullous keratopathy. Zhivov et al. in Germany found that mitomycin C delays corneal epithelialization and prolongs postoperative edema and punctuate keratitis when used after pterygium surgery. Wollensak and Iomdina in Germany and Russia used riboflavin and UV light to increase scleral strength through a collagen cross-linking. They suggest that this might be useful in progressive myopia. Lin et al. in Taiwan stress that early diagnosis and treatment is essential in Fusarium and Acanthamoeba keratitis. Horwath-Winter et al. in Austria found that uric acid is in comparable amounts in tear fluid and aqueous humor and these levels are two to three times lower than that in serum. While uric acid is an important antioxidant its biologic contribution in the eye is uncertain. Linke et al. in Hamburg describe a case of Salzmann′s nodular degeneration of the cornea. Lin et al. in Taiwan point out that optic neuritis is an uncommon complication of systemic lupus erythematosus and early diagnosis and prompt treatment are important for restoring visual function. Kesler et al. in Israel suggest that non-arteritic anterior ischemic optic neuropathy may involve a heightened microinflammatory response and that this may provide inside into the pathophysiology. You et al. in China and Germany report that optic nerve drusen is found in about 0.2% of adult Chinese. Wiemer et al. in the Netherlands used aberrometry and Scheimpflug imaging to examine the ocular refraction of diabetic patients in hyperglycaemia. They suggest that blurred vision during hyperglycaemia is not necessarily caused by changes in refractive properties of the diabetic eye. Peizeng et al. in China and the Netherlands use ultrasound biomicroscopy to image inflammatory changes in the anterior segment of patients with anterior uveitis, as is shown on the cover illustration. Diolaiuti et al. in Switzerland embolized orbital venous malformations. I hope that the readers of Acta enjoy the current issue.

Longitudinal study of anterior segment inflammation by ultrasound biomicroscopy in patients with acute anterior uveitis

This study aimed to investigate dynamic changes in the anterior segment in patients with acute anterior uveitis (AAU) using ultrasound biomicroscopy (UBM). Acute anterior uveitis was diagnosed in 18 patients according to history and ocular examinations. Ultrasound biomicroscopy was performed and the results at three time-points (within 2 weeks of the uveitis attack, and at 2-4 weeks and 6 weeks after it) were analysed. The relationships between clinical manifestations and UBM findings were also evaluated. All investigated AAU patients showed severe ciliary injection, numerous dust keratic precipitates (KPs), aqueous flare and inflammatory cells, and were treated predominantly with corticosteroid and cycloplegic eyedrops. Ultrasound biomicroscopy showed a large number of cells in the anterior and posterior chamber, marked oedema and exudates in and around the iris and ciliary body within 2 weeks of AAU onset. These abnormalities were dramatically improved at 2-4 weeks and almost resolved at 6 weeks and thereafter. Ultrasound biomicroscopy reveals severe inflammatory changes in and around the ciliary body in patients with AAU. These signs rapidly resolve upon treatment.

Kinetics of indocyanine green dye after intraocular surgeries using indocyanine green staining.

To determine the elimination kinetics of indocyanine green (ICG) after intraocular operations using ICG staining. Intraocular fluorescence of ICG was determined using the ICG angiographic mode of a scanning laser ophthalmoscope (in vivo) and fluorescence microscopy (in vitro) after circular curvilinear capsulorhexis with ICG staining during cataract surgery and internal limiting membrane (ILM) peeling with ICG staining during macular hole surgery. We studied 9 eyes of 7 patients with white cataracts and 14 eyes of 14 patients with idiopathic macular holes. Scanning laser ophthalmoscopy revealed fluorescence in the anterior segment of patients with cataracts on the first postoperative day, and fluorescence remained for a mean +/- SD of 6.0 +/- 2.2 days postoperatively. Scanning laser ophthalmoscopy also revealed fluorescence in the posterior pole of patients with macular holes, and it remained for a mean +/- SD of 2.7 +/- 1.4 months postoperatively. Fluorescence microscopy showed fluorescence of the entire tissues, suggesting that ICG had stained not only the surface of the membranes but had also entered them. In both operations, visual outcomes were not significantly different from the results obtained without ICG. Because entire tissues were stained, the differences in ICG kinetics might also be caused by factors other than differences in stainability, such as the environment surrounding the tissues or molecular structural differences between the lens capsule and the ILM. Although we found complete disappearance of fluorescence and good functional recovery, the longer resident time of the dye after macular hole surgery may suggest a potential risk to intraocular tissues.

Ultrasound biomicroscopy diagnosis of congenital glaucoma

In children with congenital glaucoma the assessment of the anterior chamber and the chamber angle might be difficult since scarring and opacities of the cornea are often seen. The purpose of our study was to reveal in vivo--morphology of the anterior segment in patients with congenital glaucoma and opaque cornea. In 46 eyes of 23 children with different degrees of corneal opacities we performed ultrasoundbiomicroscopy (UBM) of the anterior chamber after having performed a complete ophthalmological examination in general anesthesia. Massive abnormalities of the anterior segment morphology were detected in 5 eyes with completely cloudy cornea. In eyes with partial opacity of the cornea, UBM gave additional information concerning the anterior chamber angle topography, as iris remnants in aniridia, or anterior synechia. Especially in cases with extensive corneal opacities the UBM allows us to get morphological and topographic information about the anterior segment and helps to establish an individual strategy for surgical management.

High-Resolution Ultrasound Biomicroscopy of the Anterior Segment in Patients With Dense Corneal Scars

Preoperative evaluation and surgical planning for penetrating keratoplasty in patients with dense corneal scars is often difficult because of poor visualization of the anterior segment. We performed ultrasound biomicroscopy (50-megahertz frequency, 50-micron resolution) on five eyes of five patients with dense corneal opacities of different etiologies to evaluate the anatomic relationships of the iris, lens, angle, and ciliary body. Corneal thickness, the presence or absence of iridocorneal adhesions, peripheral anterior synechiae, and cyclitic membranes, intraocular lens position, and relationships among intraocular structures could be evaluated in vivo. Ultrasound biomicroscopy is the optimal method of obtaining reliable, high-resolution images delineating anatomic relationships and pathology in the anterior segment. This information aids in surgical planning for penetrating keratoplasty and anterior segment reconstruction.