Central Anterior Chamber Depth Research Articles

Intrasession repeatability and agreement of the anterior corneal assessment provided by a multidiagnostic device

ABSTRACT Clinical relevance Multidiagnostic systems have recently appeared on the market. Knowledge of the repeatability and validity of any instrument is mandatory before its introduction in clinical practice. Background The aim of this work is to examine the intrasession repeatability of anterior pole measurements provided by the multidiagnostic device Wave Analyzer Medica 700 (WAM700) and agreement with Pentacam measurements in normal eyes. Methods In the right eyes of 113 participants, three repeat measurements of central keratometry, central corneal thickness, anterior chamber depth and corneal eccentricity were made with the WAM700 and Pentacam in random order. Intrasession repeatability and agreement were determined. Results Employing WAM700, intrasession repeatability for keratometry, central corneal thickness and anterior chamber depth was good (ICCs ≥ 0.992; CV 0.48–0.98%), yet worse than the values obtained for the Pentacam (ICCs ≥ 0.998; CV 0–0.33%). WAM700 showed excellent intrasession repeatability when used to measure the anterior chamber depth (Sw 0.03 mm). However, the repeatability of this device was inferior for central corneal thickness (Sw 4.24 μm) and keratometry measurements (Sw < 0.21 D) and was poor for corneal eccentricity (Sw 0.07; ICC 0.908; CV 14.58%). Agreement between WAM700 and Pentacam showed a high ICC for the keratometry measurements, central corneal thickness and anterior chamber depth (>0.972) but lower for corneal eccentricity (ICC 0.762). Conclusions In healthy eyes, the WAM700 multidiagnostic device showed good intrasession repeatability for keratometry, central corneal thickness and anterior chamber depth measurements. Agreement between WAM700 and Pentacam was good for the anterior chamber depth measurement. However, these instruments cannot be considered interchangeable for keratometry, central corneal thickness and eccentricity readings.

The Effect of Persistent High Intraocular Pressure Treated by Phacoemulsification Combined with Goniosynechialysis in Eyes with Acute Primary Angle- closure Glaucoma

AIM: To investigate the availability and safety of phacoemulsification combined with goniosynechialysis for patients with persistent high intraocular pressure in acute primary angle-closure glaucoma. METHODS: Retrospective study. The clinical data of 31 patients (31 eyes) with persistent high intraocular pressure of primary angle-closure glaucoma treated in our center from January 2018 to April 2022 were collected. Each patient underwent phacoemulsification combined with goniosynechialysis after removing the cloudy corneal epithelium and recording the best corrected visual acuity(BCVA), intraocular pressure, and the appearance of the anterior chamber All data were analyzed statistically. RESULTS: After surgical treatment, the best corrected visual acuity was 0.70 (0.30, 0.90) 1 week, 0.30 (0.20, 0.50), 1 month, 0.30 (0.10,0.40), 3 months after surgery, and 0.30 (0.20,0.40) at the last follow-up, respectively, and it was significantly higher than preoperative 1.40 (1.10,2.00) (P &lt; 0.01). The intraocular pressure was 16.20 (12.30,19.40) mmHg, 11.90 (10.80,14.20) mmHg, 13.80 (12.10,16.20) mmHg, 0.30 (0.10,0.40) mmHg and 11.70 (10.40, 12.40) mmHg at 1 day, 1week, 1 month, 3 months, and the last follow-up, and were significantly lower than preoperative 38.60(33.90,42.80)mmHg (P &lt;0.01 ). The central anterior chamber depth and anterior chamber angle width were significantly different between pre-operation and each visit time after the operation (P &lt; 0.01). CONCLUSION: Phacoemulsification combined with goniosynechialysis is a safe and feasible method to treat patients of acute primary angle-closure glaucoma eyes with persistent high intraocular pressure, which can reopen the anterior chamber angle, control intraocular pressure, and improve the visual acuity.

Ocular Biometric Characteristics in Preoperative Diagnosis of Acute Angle Closure With and Without Zonular Laxity.

Biometric parameters, including binocular difference of anterior chamber depth (ACD), lens vault (LV) in affected eyes, and binocular difference of the LV, had high efficiency in diagnosing acute angle closure (AAC) with zonular laxity. To investigate the ocular biometric characteristics of eyes with AAC with zonular laxity to further explore the sensitive parameters for preoperative diagnosis. This study included 50 patients with AAC with zonular laxity and 54 patients with AAC without zonular laxity. Demographic data, ocular examination results, and biometric parameters on ultrasound biomicroscopy images were compared between the affected and fellow eyes in 2 groups. Parameters significant in the multiple linear regression model were included in a regression equation and the diagnostic efficiency was evaluated by area under the curve. In patients with AAC with zonular laxity, the binocular difference of central ACD, LV in affected eyes, and binocular difference of the LV were significantly larger than those in patients without zonular laxity respectively and these three parameters were all significant in multiple linear regression analysis (all P <0.001). The area under the curve of binocular difference of ACD, LV in affected eyes, and binocular difference of LV were 0.972, 0.796, and 0.855, respectively, with the cutoff values of 0.23, 1.28, and 0.19mm. The regression equation containing these three parameters was: ln ( P /(1- P ))=-4.322 + 1.222 [LV in affected eyes (mm)] + 3.657 [binocular difference of LV (mm)] + 6.542 [binocular difference of ACD (mm)], with the accuracy of prediction reaching 94.05%. Binocular difference of ACD, LV in affected eyes, and binocular difference of LV had high efficiency in diagnosing AAC with zonular laxity.

Differences in anterior chamber depth in keratoconus patients with binocular very asymmetry ectasia

BackgroundTo evaluate the difference in anterior chamber depth (ACD) between two eyes among keratoconus patients with binocular very asymmetric ectasia (VAE) and to explore the influencing factors.MethodsThe corneal curvature and ACD in both eyes of patients with VAE were measured by Sirius (version 3.2, CSO, Italy) at the following points: corneal vertex, maximum curvature (apex), and the 1.5 mm, 2.5 mm, and 3.5 mm superior-, inferior-, nasal-, temporal-paracentral from center. The mean pupil power (MPP) and corneal morphology parameters were also measured. Correlations between ACD and curvature and morphology parameters were analyzed by linear regression.Results172 eyes of 86 patients (9 to 45 years) were classified into the VAE-N (n = 86) group and the VAE-E group (n = 86) based on the corneal morphology. The central (3.32 ± 0.27 mm versus 3.43 ± 0.29 mm, P < 0.001) and paracentral ACDs increased significantly in the VAE-E group, and the corneal morphology parameters were also significantly higher. The central ACD was significantly correlated with the MPP (r = 0.465), KVf/b (Keratoconus Vertex front/back) (r = 0.306, r = 0.327), and BCVf/b (Baiocchi Calossi Versaci front/back) (r = 0.356, r = 0.416). Linear regression showed good relationships between △ACD and △MPP (R2 = 0.429) and △KVf/b (R2 = 0.504, R2 = 0.536).ConclusionsThe ACD was larger in the VAE-E group. The difference in ACD between the VAE-E and VAE-N groups was significantly correlated with corneal curvature and the extent of corneal elevation, indicating the influences of both the corneal magnification effect and corneal ectasia on ACD.

Central anterior chamber depth correlated with white-to-white distance in normal, long, and short eyes.

To explore the associations between central anterior chamber depth (CACD) and other anterior segment biometric parameters and to determine the possible determinants of CACD in short, normal, and long eyes. The biometric data of pre-operation patients aged 50-80years with coexisting cataract and primary angle-closure disease or senile cataract were reviewed. Axial length (AL), CACD, lens thickness (LT), central corneal thickness (CCT), and white-to-white distance (WTW) were measured by Lenstar optical biometry (Lenstar 900). The data of 100 normal eyes (AL = 22to 26mm), 100 short eyes (AL ≤ 22mm), and 100 long eyes (AL ≥ 26mm) were consecutively collected for subsequent analyses. The mean age of the subjects was 66.60 ± 7.85years, with 25.7% of the sample being men. Both CACD and WTW were found to be smallest in short eyes and were smaller in normal eyes than in long eyes (F = 126.524, P < 0.001; F = 28.458, P < 0.001). The mean LT was significantly thicker in short eyes than in normal and long eyes (4.66mm versus 4.49mm versus 4.40mm; F = 18.099, P < 0.001). No significant differences were observed in CCT between the three AL groups (F = 2.135, P = 0.120). Stepwise regression analysis highlighted AL, LT, and WTW as three independent factors associated with CACD in the normal AL group. In the short AL group and long AL group, LT and WTW were independent factors associated with CACD. CACD increases as AL elongates and reaches a peak when AL exceeds 26mm. Furthermore, CACD showed inverse correlation with LT and positive correlation with WTW. A relatively small WTW results in an anteriorly positioned lens, and thus, a decrease in CACD.

Quantitative analysis of dynamic iris changes in primary angle-closure disease with long axial lengths: the Handan Eye Study.

To investigate dynamic iris changes in patients with primary angle-closure disease (PACD) with long axial length (AL) compared to those with short and medium AL. This observational cross-sectional study enrolled participants aged 35 years or older from the Handan Eye Study follow-up examination who were diagnosed with PACD and underwent Visante anterior segment optical coherence tomography (ASOCT) imaging under light and dark conditions. The right eye of each participant was included in the analysis. AL was categorized as short (<22.0 mm), medium (≥22.0 to ≤23.5 mm), or long (>23.5 mm). Anterior segment parameters, including iris dynamic changes, were compared among the three groups with different ALs. Data from 448 patients with PACD were analyzed. We found that 10.9% of included eyes had a long AL with a flatter cornea; larger central anterior chamber depth, angle opening distance, anterior chamber width, anterior chamber area, and volume; and smaller lens thickness and lens vault (LV) (P < 0.05) than those with short AL. No significant difference existed between the three groups in iris thickness, iris cross-sectional area (IA), iris curvature, or pupil diameter (PD) change between light and dark (P > 0.05). The significant associated factors for IA changes were area recess area (ARA) in the dark, LV in the dark, and PD change from light to dark (P < 0.05). Dynamic and static iris parameters were consistent across patients with PACD with short, medium, or long AL and may contribute to the pathogenesis of angle closure in atypical PACD.

Impact of improved minimally invasive anterior vitrectomy on the prognosis of patients with malignant glaucoma

BackgroundThe importance of communicating the anterior chamber and vitreous cavity for managing malignant glaucoma (MG) is widely recognized. This study investigated the impact of improved minimally invasive anterior vitrectomy (IAV) on the prognosis of MG.MethodsThis retrospective interventional study included patients with MG who underwent conventional surgery or improved minimally IAV in Nanchang Aier Eye Hospital between January 2011 and April 2021. For the improved step, a small amount of triamcinolone acetonide was injected into the vicinity of the iris. Then, the residual vitreous body adhering to triamcinolone acetonide was excised. Comparisons were made using repeated measures ANOVA, t-test, and chi-squared test.ResultsThirty-one eyes from 26 patients were included: 15 eyes from 13 patients in the conventional group and 16 eyes from 13 patients in the IAV group. The 1-week, 1-month, and 3-month intraocular pressure (IOP) and the 3-month mean central anterior chamber depth were comparable between the two groups (all P > 0.05). The conventional group showed one eye with intraoperative vitreous hemorrhage and two eyes with postoperative re-shallowing of the anterior chamber; such events did not occur in the IAV group, and none developed corneal endothelial decompensation, IOL deviation, suprachoroidal hemorrhage, or retinal detachment during treatment and follow-up.ConclusionPatients with MG who undergo improved minimally IAV might have similar postoperative IOP and central anterior chamber depth compared with conventional surgery but with reduced complications such as intraoperative vitreous hemorrhage and postoperative re-shallowing of the anterior chamber. Improved minimally IAV might be an alternative surgery for MG.

Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect

Identifying primary angle closure suspect (PACS) eyes at risk of angle closure is crucial for its management. However, the risk of progression and its prediction are still understudied in long-term longitudinal studies about PACS. To explore baseline predictors and develop prediction models for the 14-year risk of progression from PACS to primary angle closure (PAC). This cohort study involved participants from the Zhongshan Angle Closure Prevention trial who had untreated eyes with PACS. Baseline examinations included tonometry, ultrasound A-scan biometry, and anterior segment optical coherence tomography (AS-OCT) under both light and dark conditions. Primary angle closure was defined as peripheral anterior synechiae in 1 or more clock hours, intraocular pressure (IOP) greater than 24 mm Hg, or acute angle closure. Based on baseline covariates, logistic regression models were built to predict the risk of progression from PACS to PAC during 14 years of follow-up. The analysis included 377 eyes from 377 patients (mean [SD] patient age at baseline, 58.28 [4.71] years; 317 females [84%]). By the 14-year follow-up visit, 93 eyes (25%) had progressed from PACS to PAC. In multivariable models, higher IOP (odds ratio [OR], 1.14 [95% CI, 1.04-1.25] per 1-mm Hg increase), shallower central anterior chamber depth (ACD; OR, 0.81 [95% CI, 0.67-0.97] per 0.1-mm increase), and shallower limbal ACD (OR, 0.96 [95% CI, 0.93-0.99] per 0.01 increase in peripheral corneal thickness) at baseline were associated with an increased 14-year risk of progression from PACS to PAC. As for AS-OCT measurements, smaller light-room trabecular-iris space area (TISA) at 500 μm from the scleral spur (OR, 0.86 [95% CI, 0.77-0.96] per 0.01-mm2 increase), smaller light-room angle recess area (ARA) at 750 μm from the scleral spur (OR, 0.93 [95% CI, 0.88-0.98] per 0.01-mm2 increase), and smaller dark-room TISA at 500 μm (OR, 0.89 [95% CI, 0.80-0.98] per 0.01-mm2 increase) at baseline were identified as predictors for the 14-year risk of progression. The prediction models based on IOP and central and limbal ACDs showed moderate performance (area under the receiver operating characteristic curve, 0.69; 95% CI, 0.63-0.75) in predicting progression from PACS to PAC, and inclusion of AS-OCT metrics did not improve the model's performance. This cohort study suggests that higher IOP, shallower central and limbal ACDs, and smaller TISA at 500 μm and light-room ARA at 750 μm may serve as baseline predictors for progression to PAC in PACS eyes. Evaluating these factors can aid in customizing PACS management.

Evaluation of anterior chamber morphology following scleral buckling with Pentacam

PurposeTo evaluate anterior segment parameter changes following scleral buckling (SB) surgery for rhegmatogenous retinal detachment (RRD) using the Pentacam Scheimpflug system. MethodsTwenty-eight phakic eyes of 28 patients who underwent SB surgery for RDD were included. The anterior chamber volume (ACV), central anterior chamber depth (CACD), mean anterior chamber angle (ACA) and ACA in a specific position (buckle quadrant), and central corneal thickness (CCT) were evaluated preoperatively and at 1 day, 1 week, and 1 and 3 months postoperatively by an anterior Pentacam Scheimpflug method. ResultsThe ACV parameters were significantly decreased compared with preoperative levels at 1 day after SB surgery (P = 0.0004), but had no significant differences at 1 week, and 1 and 3 months (P > 0.05). The mean intraocular pressure (IOP) at 1 day was significantly higher than the preoperative level, but no subsequent significant difference was noted between the preoperative IOP and that at 1 week and 1 and 3 months postoperatively (P > 0.05). The CCT at 1 day after surgery increased significantly (P = 0.0122) and subsequently returned to the normal level postoperatively at 1 week and remained stable until 3 months (P > 0.05). The degree of postoperative ACA displayed different changes in the different quadrants and there was a significant increase in the ACA of the buckle quadrants at 1 day (P < 0.0001), 1 week (P = 0.02), and 1 month (P = 0.0266) after surgery, returning to the normal level at 3 months. ConclusionsThe changes of anterior chamber parameters after SB can be demonstrated by Pentacam both objectively and quantitatively. The ACV and CCT changes were mild and resumed their preoperative parameters after 1 week, while the increase of the ACA at the buckle quadrant returned to normal after 3 months. SB surgeries without encircling or conducted with radial buckling might decrease anterior chamber change.

Association of body mass index and PXDNL gene variants with acute primary angle closure in southern Chinese population

This study aimed to evaluate the association of body mass index (BMI) and the weight-related gene, peroxidasin-like (PXDNL), with acute primary angle closure (APAC) and primary angle-closure glaucoma (PACG) in southern Chinese population. Total 4700 study subjects (1024 APAC, 781 PACG, and 2895 control subjects) with complete ophthalmic examinations were enrolled into this study. The association of BMI with APAC, PACG and ocular biometric parameters was evaluated. Three PXDNL missense variants were genotyped by TaqMan assay, and their association with APAC and PACG was also investigated. Multivariable logistic regression analysis showed that BMI and body weight were significantly associated with both APAC and PACG (P < 0.01). Multiple linear regression analysis demonstrated that each 1 kg/m2 increased in BMI was associated with 0.038 mm increase in axial length, 0.018 mm increase in central anterior chamber depth, 0.002 mm increase in lens position, 0.012 mm increase in corneal diameter and 0.014 mm decrease in lens thickness among the APAC subjects (P < 0.001), but not with PACG. Genetic association analysis identified that PXDNL rs11985241–rs16916207 CT haplotype conferred a higher risk to APAC (OR = 1.25, P = 0.004) than the TG haplotype, but not with PACG. The APAC subjects carrying the rs11985241 C or rs16916207 T alleles showed significantly lower weight than those carrying the corresponding protective alleles. In summary, this study revealed that lower BMI could be associated with higher risk of APAC. PXDNL could be a new associated gene for APAC.

Comparison Between Ocular Biometric Parameters and Intraocular Pressure With and Without Contact Lenses.

To compare the values of central corneal thickness, anterior chamber depth (ACD), lens thickness (LT), vitreous length (VL), axial length (AL), and corneal-compensated intraocular pressure performed with and without contact lenses (CL). Forty volunteer participants (16 men and 24 women, 24.2±2.9 years) were recruited. In a single visit, participants underwent autorefraction, keratometry, biometry, topography, pachymetry, and tonometry with the naked eye (without CL). Then, biometry, pachymetry, and tonometry were repeated twice wearing two CL (somofilcon A and nesofilcon A) fitted in a random order. Many of the ocular biometric values were affected by the use of CL during measurements (paired t test; all P ≤0.003), except for LT and VL (Wilcoxon test; both P ≥0.272). Corneal-compensated intraocular pressure was also affected by contact lens wear during measurements, obtaining lower values when wearing them (Wilcoxon test; all P ≤0.001). Central corneal thickness, ACD, AL, and corneal-compensated intraocular pressure measurements cannot be performed while wearing CL. However, LT and VL measurements were not affected by any contact lens use. In addition, it was observed that ACD results from both devices are not interchangeable either when measured with the naked eye or using any contact lens.

Effect of Cycloplegia on Anterior Segment Structures and Scleral Thickness in Emmetropic Eyes.

Purpose: To evaluate the effects of topical cyclopentolate hydrochloride-induced cycloplegia on anterior segment biomechanics in emmetropic eyes using anterior segment-optical coherence tomography (AS-OCT). Methods: Twenty-five emmetropic eyes of 25 volunteers were included. All underwent central corneal thickness (CCT) and anterior chamber depth (ACD) measurements. Anterior scleral thickness (AST) was measured at the level of the scleral spur (SS)(AST-0), 1,000 μm posterior of the SS (AST-1), and 2,000 μm posterior of the SS (AST-2) in the nasal and temporal quadrants using AS-OCT. All measurements were repeated after cycloplegia. Results: The mean age was 30.6 ± 12.4 (8-45) years. The mean CCT did not significantly change after cycloplegia (P = 0.7). The mean ACD was significantly increased [3.3 ± 0.2 (2.7-3.9) to 3.7 ± 0.3 (3-4.2) μm; P = 0.001]. In the nasal quadrant, the mean AST-1 and AST-2 were 512.3 ± 34.4 (433-570) and 529.6 ± 34.2 (449-599); decreased to 478 ± 26.8 (423-530) and 486.2 ± 28.3 (422-544) μm, respectively, after cycloplegia (P = 0.00; P = 0.00). In the temporal quadrant, the mean AST-1 and AST-2 were 522.5 ± 24.7 (473-578) and 527.2 ± 39.9 (450-604); decreased to 481.1 ± 33.7 (421-550) and 484.6 ± 26.6 (433-528) μm, respectively (P = 0.00; P = 0.00). There was no significant difference in AST-0 after cycloplegia in both quadrants [from 697.5 ± 46 (605-785) to 709.5 ± 64.7 (565-785) for nasal and from 718.4 ± 40.1 (632-796) to 722.9 ± 60.6 (596-838) for temporal; P = 0.2; P = 0.3, respectively]. Conclusion: After cycloplegia, there was a significant thinning of ASTs posterior to SS and a slight increase in AST in the SS level. ACD deepened after cycloplegia, and there was no significant change in CCT. Cycloplegic agents temporarily inhibit ciliary muscle contraction and may affect anterior segment parameters and sclera. Inhibition of forward-inward movement of the ciliary body by cycloplegia affects ASTs and ACD by causing a change in the mechanical force of the ciliary muscle on the sclera.

Correlation Between Corneal Keratometry, Central Corneal Thickness and Anterior Chamber Depth as Measured by Wavelight OB 820 Biometer and Wavelight Oculyzer II in Preoperative Cataract Surgery Patients.

To compare and correlate corneal keratometry (K), central corneal thickness (CCT), and anterior chamber depth (ACD) using a partial coherence interferometry device and a Scheimpflug camera system device in patients planned for cataract surgery. Comparative cross-sectional study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology, from December 2021 to June 2022. Patients planned for cataract surgery underwent measurement of central corneal thickness (CCT), anterior chamber depth (ACD), and keratometric values (K) by Wavelight OB 820 biometer and Allergo Oculyzer II, preoperatively. Correlation and inter-device agreement were assessed between two devices. There were 115 patients with a mean age of 64.23 ± 9.26 years. All anterior segment parameters showed excellent agreement and high degree of correlation between the two optical devices. Correlation coefficient (r) for central corneal thickness was r = 0.958 (p<0.001) while correlation coefficient for anterior chamber depth was r = 0.965 (p<0.001), r = 0.966 (p<0.001) for flat K, and r = .0969 (p<0.001) for steep keratometry, respectively. Ophthalmic parameters assessed by both devices were comparable and are recommended to be used in the clinical practice of keratorefractive and cataract surgeries interchangeably. ACD, CCT, Keratometry, Cataract, OB 820 biometer, Oculyzer II.

Swab Pressing vs Stromal Hydration to Prevent Incision Leakage and Transient Collapse of Anterior Chamber in Phacoemulsification

During phacoemulsification, incision leakage and the subsequent anterior chamber collapse often occur after the withdrawal of the handpiece, which cannot be prevented by current sealing techniques. A new technique called swab pressing is proposed here to apply pressure with a cotton swab to seal the incision immediately, but efficacy remains unknown. To determine if swab pressing is noninferior to stromal hydration, the current practice, in sealing incisions in phacoemulsification for age-related cataract. This noninferiority randomized controlled clinical trial was conducted between February 2022 and September 2022 at the Zhongshan Ophthalmic Center, Guangzhou, China. Patients aged 60 to 90 years with age-related cataract were enrolled. Participants were randomly assigned (1:1) to receive swab pressing or stromal hydration. All surgeries were performed by a single experienced surgeon who was unmasked to the assignment. The proportion of closed clear corneal incisions evaluated using intraoperative optical coherence tomography. A total of 126 eyes of 126 participants were randomized into the swab pressing group (63 [50%]) and stromal hydration group (63 [50%]). The mean (SD) age of participants was 69.2 (6.14) years and 70.1 (7.67) years in the pressing and stromal hydration groups, respectively. A total of 39 participants (61.9%) in the pressing group and 35 (55.6%) in the modified group were female. The proportion of closed incisions was 96.8% (61 of 63) in the swab pressing group and 93.7% (59 of 63) in the stromal hydration group. Noninferiority was met, as the lower 95% CI of -5.83 percentage points was greater than the prescribed noninferiority margin of -6.60 percentage points (difference, 3.17 percentage points; 95% CI, -5.83 to 12.18 percentage points). The rate of anterior chamber collapse (pressing: 0 of 63 vs stromal hydration: 35 of 63 [55.6%]; P < .001) was lower in the swab pressing group. There were no differences between the 2 groups in the proportion of closed incisions and central anterior chamber depth at postoperative hour 1 and day 1. In this study, swab pressing was noninferior to stromal hydration in sealing clear corneal incisions in phacoemulsification for age-related cataract. While this trial involved only 1 surgeon who was not masked to the interventions, the results suggest that swab pressing is feasible and further investigations would be warranted to determine if it prevents the intraoperative transient collapse of anterior chamber or affects visual acuity outcomes. ClinicalTrials.gov Identifier: NCT05242653.

Relatively anterior lens position in primary angle-closure glaucoma eyes with long axial length.

To evaluate the refractive status and ocular biometric parameters in primary angle-closure glaucoma (PACG) eyes with different axial lengths (ALs). In total, 742 Chinese PACG subjects with complete ophthalmic examinations were enrolled. The refractive status was categorized as myopia (spherical equivalent [SE] ≤-0.5 D), emmetropia (-0.5 D < SE < +0.5 D), and hyperopia (SE ≥+0.5 D), whereas the AL was divided into short (AL <22.5 mm), regular (22.5 ≤ AL <23.5 mm), and long (AL ≥23.5 mm). The refractive status and ocular biometric parameters were compared among different AL groups. The mean AL of the PACG eyes was 22.53 ± 0.84 mm (range: 19.68-25.57 mm). The refractive status was significantly different among different AL groups (P < 0.001). Also, 92.6% of hyperopic PACG eyes showed AL <23.5 mm, and 19.0% of myopic PACG eyes showed AL ≥23.5 mm. The SE showed significant differences among different AL groups only in the hyperopic subjects (P = 0.012). The AL was significantly longer in myopic eyes (P < 0.001). The PACG eyes with longer AL exhibited lower keratometry, longer central anterior chamber depth and corneal diameter, and lens position and relative lens position closer to the anterior (P < 0.001). Axial hyperopia was common in PACG eyes, and axial myopia was not uncommon. Relatively anterior lens position could explain the occurrence of PACG in the eyes with long AL.

Efficacy and safety of laser peripheral iridoplasty with different energy levels and locations in the treatment of primary angle closure disease assessed by swept-source anterior segment optical coherence tomography

BackgroundTo explore the efficacy and safety of laser peripheral iridoplasty (LPIp) with different energy levels and locations in the treatment of primary angle closure disease (PACD) assessed by swept-source anterior segment optical coherence tomography (AS-OCT).MethodsWe enrolled patients with PACD following best-corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber gonioscopy, ultrasound biomicroscopy(UBM), optic disc OCT, and visual field examinations. After Pentacam and AS-OCT measurements, the patients were randomly divided into four treatment groups for LPIp with two different energy levels (high vs. low energy) and two locations (far from the periphery vs. near the periphery) and combined with laser peripheral iridotomy. BCVA, IOP, pupil diameter, central anterior chamber depth, anterior chamber volume, anterior opening distance (AOD)500, AOD750, trabecular iris angle (TIA)500, and TIA750 in four quadrants before and after laser treatment were compared.ResultsWe followed up 32 patients (64 eyes; average age, 61.80 ± 9.79 years; 8 patients/16 eyes per group) for up to 2 years. The IOP of all enrolled patients was decreased after surgery compared to that before (t = 3.297, P = 0.002), the volume of the anterior chamber was increased (t=-2.047, P = 0.047), and AOD500, AOD750, TIA500, and TIA750 were increased (all P < 0.05). Within-group comparisons showed that BCVA in the low-energy/far-periphery group was improved after surgery (P < 0.05). After surgery, the IOP was decreased in the two high-energy groups, whereas the volume of the anterior chamber, AOD500, AOD750, TIA500, and TIA750 were increased in all groups (all P < 0.05). However, when comparing every two groups, the high-energy/far-periphery group showed a stronger effect on pupil dilation than the low-energy/near-periphery group (P = 0.045). The anterior chamber volume in the high-energy/near-periphery group was larger than that in the high-energy/far-periphery group (P = 0.038). The change in TIA500 was for 6 points smaller in the low-energy/near-periphery group than in the low-energy/far-periphery group (P = 0.038). Other parameters showed no significant group differences.ConclusionLPIp combined with iridotomy can effectively reduce IOP, increase anterior chamber volume, increase chamber angle opening distance, and widen the trabecular iris angle. Intraoperatively, high-energy laser spots positioned one spot diameter from the scleral spur can obtain the best effect and safety. Swept-source AS-OCT can safely and effectively quantify the anterior chamber angle.

Fourteen-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle-Closure Prevention Study: Extended Follow-up of a Randomized Controlled Trial

This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for patients with primary angle-closure suspect (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC). Extended follow-up of the Zhongshan Angle-Closure Prevention Study. Eight hundred eighty-nine Chinese patients 50 to 70 years of age with bilateral PACS. Each patient received LPI in 1 randomly selected eye, with the fellow untreated eye serving as a control. Because the risk of glaucoma was low and acute angle closure (AAC) occurred only rarely, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit. Incidence of PAC, a composite end point including peripheral anterior synechiae, intraocular pressure (IOP) of > 24 mmHg, or AAC. During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary end points (P < 0.01). Within them, 1 LPI-treated eye and 5 control eyes progressed to AAC. Primary angle-closure glaucoma was found in 2 LPI-treated eyes and 4 control eyes. The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21-0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes showed more severe nuclear cataract, higher IOP, and larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and greater central anterior chamber depth (CACD) were associated with an increased risk of end points developing in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after the darkroom prone provocative test (DRPPT) were more likely to demonstrate PAC after LPI. Despite a two-third decrease in PAC occurrence after LPI, the cumulative risk of progression was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and to guide clinical practice. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Changes in corneal endothelial cell density after trabeculectomy.

Glaucoma is a leading cause of blindness worldwide for which trabeculectomy is the most effective surgical intervention for advanced disease. However, trabeculectomy has been associated with alterations to corneal endothelium, including a decrease in corneal endothelial cell density (CECD). The purpose of this study was to investigate changes in CECD after trabeculectomy, and identify factors contributing to cell loss, such as pre-operative biometry and lens status. This retrospective study included 72 eyes of 60 patients who underwent trabeculectomy between January 2018 and June 2021 at two private hospitals. Demographic and clinical data were obtained at baseline. Corneal specular microscopy was performed pre-operatively and at 6 months after surgery. CECD was evaluated and compared between groups to quantify changes to corneal endothelium and identify significant factors affecting decreases in cell density. Mean CECD was 2284.66 ± 375.59 pre-operatively and 2129.52 ± 401.96 after 6 months (p < 0.001). A greater decrease in CECD (p = 0.005) was observed in phakic eyes (235.45 ± 118.32) compared to pseudophakic eyes (137.82 ± 107.30). The amount of cell loss was negatively correlated with pre-operative central corneal thickness (p = 0.009) and anterior chamber (AC) depth (p = 0.033). There were no significant correlations between changes to CECD and patient age, gender, number of pre-operative glaucoma medications and number of post-operative antifibrotic agents. Significant decreases in CECD occurred after trabeculectomy. Less corneal endothelial cell loss occurred in pseudophakic eyes. Hence, if patients need trabeculectomy and cataract surgery, it may be better to perform cataract surgery first. Longer term studies should derive more information.

Analysis of risk and protective factors associated with retinal nerve fiber layer defect in a Chinese adult population.

To investigate the risk and protective factors associated with the retinal nerve fiber layer defect (RNFLD) in a Chinese adult population. This study was a cross-sectional population-based investigation including employees and retirees of a coal mining company in Kailuan City, Hebei Province. All the study participants underwent a comprehensive systemic and ophthalmic examination. RNFLD was diagnosed on fundus photographs. Binary logistic regression was used to investigate the risk and protective factors associated with the RNFLD. The community-based study included 14 440 participants. There were 10 473 participants in our study, including 7120 males (68.0%) and 3353 females (32.0%). The age range was 45-108y, averaging 59.56±8.66y. Totally 568 participants had RNFLD and the prevalence rate was 5.42%. A higher prevalence of RNFLD was associated with older age [P<0.001, odds ratio (OR): 1.032; 95% confidence interval (CI): 1.018-1.046], longer axial length (P=0.010, OR: 1.190; 95%CI: 1.042-1.359), hypertension (P=0.007, OR: 0.639; 95%CI: 0.460-0.887), and diabetes mellitus (P=0.019, OR: 0.684; 95%CI: 0.499-0.939). The protective factors of RNFLD were visual acuity (P=0.038, OR: 0.617; 95%CI: 0.391-0.975), and central anterior chamber depth (P=0.046, OR: 0.595; 95%CI: 0.358-0.990). In our cross-sectional community-based study, with an age range of 45-108y, RNFLD is associated with older age, longer axial length, hypertension, and diabetes mellitus. The protective factors of RNFLD are visual acuity and central anterior chamber depth. These can help to predict and evaluate RNFLD related diseases and identify high-risk populations early.

Changes in Anterior Chamber Angle and Choroidal Thickness in Patients with Primary Angle-Closure Glaucoma after Phaco-Goniosynechialysis.

We aimed to observe changes in angle width and choroidal thickness (CT) before and after phacoemulsification intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) in patients with primary angle-closure glaucoma (PACG) complicated by cataracts. This prospective cohort study included 60 patients with PACG complicated by cataracts from the Department of Ophthalmology of Shaoxing People’s Hospital, China. Patients underwent PEI combined with GSL (PEI-GSL group) or laser peripheral iridotomy (LPI) followed by PEI (PEI group). Intraocular pressure (IOP) and endothelial counts were significantly decreased in both groups after surgery, while best-corrected visual acuity and central anterior chamber depth were significantly increased. However, there were no significant differences between the two groups. The opening degrees of room corners at 12, 3, 6, and 9 o’clock were recorded as AA12, AA3, AA6, and AA9, respectively. Anterior chamber depth was significantly increased postoperatively compared to preoperatively in both groups, with no significant between-group differences (all ps > 0.05). At 1, 3, and 6 months postoperatively, the width at AA12, AA3, and AA9 points was higher in the PEI-GSL group than in the PEI group (all ps < 0.05). Significant between-group differences at AA6 were observed preoperatively (p = 0.023) and at 1 (p = 0.027) and 3 (p = 0.033) months postoperatively but not at 6 months postoperatively (p = 0.055). CT was smaller postoperatively than preoperatively (all ps < 0.001). The present study suggests that patients with PACG who underwent PEI with or without GSL had reduced IOP and CT after surgery.