Iris Changes Research Articles

Iris clues in ACG.

Primary angle closure glaucoma is a major cause of visual morbidity in Asia, which hosts 80% of the worldwide cases. In India, primary angle closure glaucoma (PACG) comprises almost 50% of adult glaucomas in hospital setting with its asymptomatic presentation predominating at 80%. Early diagnosis is critical to prevent the blinding trajectory of this disease, which is purported to cause twice as much blindness compared to open angle glaucoma. Traditional screening methods to identify PACG range from van Herick and flashlight test (relatively poor predictors) to gonioscopy (gold standard). Altered iris morphology are intrinsic to PACG, resulting in specific iris patterns. Iris appraisal could emerge as a method to screen underlying PACG. This would not only be specific, objective, but also easily performed at the peripheral level by a trained personnel and used in the era of tele-medicine for mass screening by AI softwares. This article seeks to detail these iris changes.

Iris Manifestations in Inadequately Treated Chronic Recurrent Vogt-Koyanagi-Harada Disease

ABSTRACT Purpose To describe the iris changes in chronic recurrent Vogt-Koyanagi-Harada Disease (VKH) Methods Retrospective case series. Clinical features of 3 VKH patients who developed bilateral depigmentation of the iris are described. Results Patients had delayed diagnosis and inadequately treated chronic recurrent VKH. Patient 1 presented with bilateral multiple contiguous small granulomatous iris stromal lesions, severe diffuse iris swelling more severe near the iris root, producing peripheral iris undulations. Diffuse iris atrophy and peripheral depigmentation subsequently developed. Patient 2 presented with peripheral iris depigmentation, atrophy of the ciliary zone iris stroma and sparing of the sphincter pupillae, giving a ‘sunflower appearance.’ Patient 3 had extensive iris depigmentation, atrophy, and transillumination defects involving the entire iris. Conclusion Uncontrolled bilateral diffuse granulomatous stromal iris inflammation leads to subsequent depigmentation, transillumination defects and atrophy, beginning in the peripheral iris. Sphincter pupillae is initially spared but complete iris atrophy may develop.

IRIS CHANGES AT PATIENTS WITH TEMPORОMANDIBULAR JOINT DISEASES AND URINARY SYSTEM PATHOLOGY

Relevance. In recent years, many have been devoted to the problem of the temporomandibular joint (TMJ) diseases, in which the attention is paid to the widespread pathology of TMJ in young people, which develops against the background of the genetically-determined weakness of connective tissue (CTs), which is also the present occurrence of various concomitant diseases of polygenic-multifactorial nature, including the organs of the urinary system (US).
 The study of the state of the iris is used as a screening technique that allows you to quickly, simply, harmlessly, informatively, painlessly, non-invasively diagnose the genetically determined structural and functional state and quality of the CTs.
 Objective. To investigate the iris changes in patients with TMJ and US diseases, to reveal the dependence of the occurrence of degenerative-dystrophic and destructive-inflammatory changes in the joints and US on the structural and functional state of the CTs, to supplement the known traditional methods of diagnosing genetically determined CTs weakness.
 Materials and methods. The study involved 54 patients (men – 14, women – 40), whose average age was 37.3±7.6 years, who were treated at the Dental Medical Center of the Bogomolets NMU. Control group – 22 patients (men – 10, women – 12) without general somatic pathology, with a physiological bite, without signs of TMJ diseases, whose average age was 25.7±6.8 years. Main group – 22 patients (men – 4, women – 28) with TMJ diseases and US pathology, whose average age was 31.6±7.7 years.
 Iridobiomicroscopy was performed in patients of both groups. Iridogenetic constitutional signs were determined: the color of eyes, constitutional type after E.S. Velkhover, type with the connective tissue weakness after I. Deck, the density of iris stoma.
 The obtained laboratory data were referenced in the International System of Units and processed by variational statistics using MedStat and EZR v.1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan, 2017), which is a graphical interface to RFSC (The R Foundation for Statistical Computing, Vienna, Austria).
 Results. Among the examined patients with TMJ diseases and MVS pathology, 75% showed predominantly light eye color and V degree (46.9%) of iris stroma density, in the control group: dark iris color (54.5%) and II degree (68.2%) of iris density.
 Iridogenetic constitutional signs of the CT weakness in the patients with TMJ diseases have been determined: the light color of eyes, radial-lacunar constitutional type after E.S. Velkhover (75%), lymphatic constitutional type with the connective tissue weakness after I. Deck (57,9%).
 Structural local or chromatic changes of the iris stroma in the projection region of the kidney (75%) and bladder (43.6%) in young patients with TMJ diseases showed a congenital weakness of the CTs of these organs and a tendency to develop pathology of the US.
 Conclusions. Patients with degenerative-dystrophic and destructive-inflammatory diseases of the TMJ and concomitant US pathology are characterized by iridogenetic constitutional signs of the CTs weakness in the patients with TMJ diseases have been determined: the light color of eyes, radial-lacunar constitutional type after E.S. Velkhover, low degree of iris stroma density, lymphatic constitutional type with the connective tissue weakness after I. Deck.
 Structural local or chromatic changes of the iris stroma in the projection region of the kidney and bladder in young patients with TMJ diseases showed a congenital weakness of the CTs of these organs and a tendency to develop pathology of the US.
 It can be assumed that the development of TMJ diseases in young patients is based on dysplastic changes in the CTs system, which is additionally manifested in the examined patients by pathological changes in the US.
 Iridobiomicroscopy, as a screening technique for determining the structural and functional state of CTs, makes it possible to increase the accuracy of diagnostics when examining patients with TMJ diseases who have concomitant pathology of internal organs, including US.

Quantitative Cluster Headache Analysis for Neurological Diagnosis Support Using Statistical Classification

Cluster headache (CH) belongs to the group III of The International Classification of Headaches. It is characterized by attacks of severe pain in the ocular/periocular area accompanied by cranial autonomic signs, including parasympathetic activation and sympathetic hypofunction on the symptomatic side. Iris pigmentation occurs in the neonatal period and depends on the sympathetic tone in each eye. We hypothesized that the presence of visible or subtle color iris changes in both eyes could be used as a quantitative biomarker for screening and early detection of CH. This work scrutinizes the scope of an automatic diagnosis-support system for early detection of CH, by using as indicator the error rate provided by a statistical classifier designed to identify the eye (left vs. right) from iris pixels in color images. Systematic tests were performed on a database with images of 11 subjects (four with CH, four with other ophthalmic diseases affecting the iris pigmentation, and three control subjects). Several aspects were addressed to design the classifier, including: (a) the most convenient color space for the statistical classifier; (b) whether the use of features associated to several color spaces is convenient; (c) the robustness of the classifier to iris spatial subregions; (d) the contribution of the pixels neighborhood. Our results showed that a reduced value for the error rate (lower than 0.25) can be used as CH marker, whereas structural regions of the iris image need to be taken into account. The iris color feature analysis using statistical classification is a potentially useful technique to investigate disorders affecting the autonomous nervous system in CH.

Evaluation of the iris thickness changes for the Chinese families with GPR143 gene mutations

PurposePathogenic variants of the G-protein coupled receptor 143 (GPR143) gene may result in Ocular albinism type I (OA1). In this study, we describe the clinical features and investigate the GPR143 gene mutations in six Chinese families with OA1 and evaluate the thickness changes of iris for the affected males and female carriers. MethodsFamilies were ascertained, and patients underwent complete ophthalmologic examinations, including the best corrected visual acuity (BCVA), anterior segment of the eyes, vitreous and fundus changes. Spectral domain optical coherence tomography (SD-OCT) was used to measure the full iris thickness, the stroma/anterior border (SAB) layer, and the posterior epithelial layer (PEL) at the pupillary and ciliary regions. DNA was extracted from the peripheral blood vessels after confirmed consent information. GPR143 gene was directly sequenced by the Sanger method. ResultsThe affected males had variable reduced visual acuity, nystagmus and macular hypoplasia. Four novel frameshift mutations and two previously reported missense/nonsense mutations in the GPR143 gene were detected in these families. The thickness of the iris was significantly reduced at the ciliary region in the affected males, compared with that in the normal controls and the female carriers. ConclusionsPathogenic variants in the GPR143 gene may disturb the normal melanogenesis in the pigmented tissues of the eye, result in macular hypoplasia, and alter the thickness of the iris.

The effect of normobaric hypoxia on the secretion of insulin and growth hormone

Effect of normobaric hypoxia on insulin (IRI) and somatotropic hormone (STH) secretion was studied in 24 normal subjects aged 35-55 years. Control group consisted of 18 subjects administered placebo. Adaptation to normobaric hypoxia was attended by changes in IRI and STH but not in the glycemia level. Hypoxic exposure was associated with an increase of the plasma STH concentration and a tendency to normalization of IRI in all examinees. These parameters correlated with body weight index.

Essential iris atrophy with secondary angle closure glaucoma: A rare spectrum of Irido-corneal endothelial syndrome

Iridocorneal Endothelial syndrome (ICE) is a rare unilateral progressive disease of unknown Etiology, predominantly occurring in middle aged females. It consists of three overlapping disorders namely progressive iris atrophy, Cogan Reese syndrome and Chandler’s syndrome. Cogan-Reese syndrome is characterised by diffuse iris naevus or pedunculated iris nodules. Chandler’s syndrome is associated with corneal changes portraying “hammered silver” appearance. Iris changes are prominent in progressive iris atrophy. The management is targeted to control corneal edema and secondary glaucoma. The following report is a case of essential iris atrophy, a rare condition under the spectrum of ICE syndrome. The proliferative Endotheliopathy results in characteristic iris changes, Irido-trabecular Synechiae, Corectopia and secondary angle-closure glaucoma. Gonioscopy revealed the characteristic “high peripheral anterior synechiae”. The fundus examination showed unilateral glaucomatous cupping and intraocular pressure was managed with anti-glaucoma medications. Regular monitoring is required for early diagnosis of vision threatening complications in ICE syndrome.

1215-P: Adipose Tissue Insulin Resistance Predicts Ketosis via an SGLT2 Inhibitor

Diabetic ketoacidosis characterized by lipolysis due to insulin deficiency is a side effect reported for SGLT2 inhibitors (SGLT2is). However, little is known about predictors of ketosis via SGLT2i. The antilipolytic effect of insulin in adipose tissue can be evaluated as adipose tissue insulin resistance (Adipo-IR). This study investigated predictors of ketosis via the SGLT2i, tofogliflozin (TOFO), in patients with type 2 diabetes (T2D) focusing on Adipo-IR. Analyzed were 304 T2D patients who received TOFO as initial monotherapy in two TOFO phase 2 and 3 studies. Adipo-IR was calculated by the product of fasting insulin (IRI) and fasting free fatty acids (FFA). Baseline characteristics were: males (67%), age (mean: 58 y), HbA1c (8%), BMI (26kg/m2), β-hydroxybutyrate (BHB) (75µmol/L), eGFR (84mL/min/1.73m2) and Adipo-IR (33pmol/L mmol/L). Participants were grouped by tertiles of baseline Adipo-IR levels (T1-T3). Differences across tertiles were analyzed by ANOVA, Kruskal Wallis and ANCOVA. Multivariate analysis explored the predictors of ketosis. In the order of T3-T1, younger age, higher baseline HOMA-IR levels and higher baseline HOMA-β levels were observed, while baseline HbA1c and BHB levels were identical across tertiles. At 24 weeks after TOFO administration, reduced HbA1c and body weight and increased urinary glucose excretion were identical among tertiles. Percent changes in FFA were T1, mean +50.9%* (* p<0.001 vs. baseline); T2, +25.8*; and T3, +6.6 (p<0.001 across tertiles); and those for BHB were T1, median +117.9%*; T2, +126.9*; and T3, +62.0* (p<0.05). Conversely, percent changes in IRI were T1, mean -11.3%*; T2, -24.2* and T3, -28.3* and in Adipo-IR were T1, +31.1%*; T2, -2.9 and T3, -24.1* (p<0.001 across tertiles). Multivariate analysis indicated an independent association of T3 with a weaker increase in BHB than T1 and T2. In conclusion, high baseline Adipo-IR may attenuate ketosis via SGLT2i through improved Adipo-IR and the antilipolytic effect of insulin despite reduced IRI in T2D. Disclosure Y. Matsubayashi: None. A. Yoshida: Employee; Self; Kowa Pharmaceutical Co. Ltd. T. Nojima: Employee; Self; Kowa Co., Ltd. H. Suganami: Employee; Self; Kowa Co., Ltd. K. Fujihara: None. K. Kaku: Advisory Panel; Self; Astellas Pharma Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.

Surgery-induced iris abnormalities after Descemet membrane endothelial keratoplasty and their impact on postoperative clinical outcomes.

Purpose: This study aimed to elucidate the frequency of surgery-induced iris abnormalities after Descemet membrane endothelial keratoplasty (DMEK) and their impact on postoperative clinical outcomes.Methods: In this retrospective study, medical records of 32 eyes from 28 consecutive patients (mean age, 65.7±13.4 years; 14 men, 18 women) who underwent DMEK (or triple DMEK) were reviewed. In all patients, inferior peripheral iridectomy was created leaving full intracameral air tamponade at the end of surgery. Sulfur hexafluoride gas was not used in any cases. Surgery-induced iris abnormalities such as pupillary shape changes and iris depigmentation were evaluated by 3 masked observers. Pre-existing abnormalities were excluded. Eyes were divided into two groups based on the presence of surgery-induced iris changes: Group A (with iris abnormalities) and Group B (without). Impacts on postoperative clinical outcomes such as vision and endothelial cell density were analyzed.Results: Surgery-induced iris abnormalities were seen in 15 eyes (Group A, 9 with pupillary shape change and 6 with iris depigmentation; 46.9%), and 17 eyes showed no abnormalities (Group B, 53.1%). No significant differences were detected between groups in age, sex, indication, simultaneous cataract surgery, pre- and 6-month postoperative vision, donor age, donor endothelial cell density, and 6- and 12-month postoperative endothelial cell density.Conclusions: Surgery-induced iris abnormalities were noted in almost half of the eyes after DMEK (46.9%) in this study. However, there was no association between visual outcomes or postoperative endothelial cell density and the iris changes.

Performance analysis of iris-based identification system based on exudates

In the current scenario responsibility of the system administrator is to have a secured system is a challenging task. Iris recognition is proven to provide unique biometric data, very difficult in duplication. Exudate is one of the disorders that occur in the retinal part of eye. Exudate is an earliest and most prevalent symptom of diseases leading to blindness such as diabetic retinopathy and wet macular degeneration. Proposed work is to examine the effect of exudate present on iris and leads to improve the level of security or used to match the unmatched person due to the structural and textural changes of iris. Hough Transform (HT) is employed to identify the unique features in iris. STARE database is used for performance analysis of iris recognition system. Proposed system shows that structural changes and quality degradations are observed in exudate image, may lead to iris recognition system fail, re-enrolment is essential.

Mild aniridia phenotype: an under-recognized diagnosis of a severe inherited ocular disease.

Aniridia is a rare panocular disorder caused by mutations in the PAX6 gene and characterized mainly by iris hypoplasia. Here, we present six families with a history of low vision/blindness with a previously undiagnosed mild aniridia phenotype with minimal iris changes. Retrospective case series of patients diagnosed with a subtle aniridia phenotype characterized by minimal iris abnormalities, foveal hypoplasia, and an identified mutation in PAX6. Data collection from patient's charts included ocular examination findings, visual acuity, refraction, and clinical pictures when available. Genetic analysis was performed by isolation of genomic DNA from peripheral blood. The main outcome was the identification of patients with mild aniridia harboring a PAX6 mutation. In all six families, the phenotype included minimal corectopia and foveal hypoplasia; nystagmus was present in 10 out of 11 patients. A PAX6 mutation was identified in all six families; three of these mutations were identified previously, and three are novel mutations. All the mutations are located within the conventional 128-residue paired domain of PAX6. A mild form of aniridia should be considered in the differential diagnosis of patients with low vision associated with mild iris abnormalities, nystagmus, and foveal hypoplasia. To ensure an accurate diagnosis of aniridia, minimal pupillary changes and/or incipient keratopathy should be examined. The broad phenotypic heterogeneity among aniridia leads to the fact that eye care clinicians must have a high index of suspicion for the disease when seeing undiagnosed low vision patients, because proper diagnosis can improve management as well as facilitate genetic testing and counselling.

Evaluation of Structural Changes in Iris Due to Glaucoma

Evaluation of Structural Changes in Iris Due to Glaucoma

Vehicle energy consumption and an environmental impact calculation model for the transportation infrastructure systems

The interaction of vehicles and tires with various surface and structural features of roadways impact rolling resistance, hence fuel consumption of vehicles. Efficient interaction of vehicles with the roadway provides new opportunities to reduce transportation systems environmental impacts. A roughness–speed impact (RSI) model was developed to quantify the energy and environmental impacts due to vehicle–pavement interaction. The RSI model accounts for the additional rolling resistance of vehicles resulting from pavement surface properties measured in terms of smoothness as well as vehicle efficiency improvements over time. The model uses vehicle-specific power as a basis to develop the analytical equations for representing vehicle–pavement interaction. The proposed analytical model offers advantages for easy integration to LCA software to evaluate GHG reduction policies. According to the model, one unit change of IRI (63.36 in/mile) results in an average increase in fuel consumption of 3% and 2%, respectively, at high and low speeds (65 and 35 mph) for passenger cars. Heavier trucks are less sensitive to IRI change; and one unit change in IRI on average results in 2% and 1% increase, respectively, in fuel consumption of heavy truck at high and low speeds. This paper presents case studies to explore effectiveness of a short-term policy goal concerning with the management of roadway surface features. According to the LCA results with different scenarios of pavement management policies, while vehicle efficiency accounts for about 27% of the potential total energy savings, potential savings from pavement roughness can be up to 7%.

Intraocular silicone implant to treat chronic ocular hypotony: an in vivo trial.

The management of chronic ocular hypotony and complicated proliferative vitreoretinopathy-related retinal detachment represents a challenge. Being non-absorbable and non-biodegradable, a silicone oil implant is expected to restore the volume and the intraocular pressure of the globe, as well as to approximate the detached retina. Further advantages could be a long-term tamponade potential, absence of toxicity, and prevention of silicone oil emulsification or anterior chamber oil-prolapse. The aim of this study was to assess the histological tolerance of the silicone oil implant in a pig model. A seamless silicone balloon implant with optional surface modifications was developed. Mini pigs were used as experimental animals, and three variants of silicone implants with different surfaces were tested: uncoated, NCO-sP(EO-stat-PO) coated, and heparin-NCO-sP(EO-stat-PO) coated silicone implants. An extracapsular lens extraction was achieved via a standard phacoemulsification followed by a standard three-port vitrectomy. The implant was then placed in the posterior segment and filled with 5000 centistoke silicone oil. One month later, the pigs were euthanized, the eyes were enucleated, and histological specimens were prepared for microscopy. The analysis of the histology revealed that adverse histological changes in conjunctiva, cornea, iris, and ciliary body could be excluded in all eyes operated on regardless of which variant of implant had been employed. The retina as the implant-contacting ocular tissue showed overall good tolerance, although some inflammatory reaction and fibrous proliferation was evident in some cases. The silicone oil implant is a promising candidate and has the potential to fulfill clinical requirements to act as a long-term intraocular tamponade agent. The heparin-NCO-sP(EO-stat-PO) coating approach could lead to a novel bioactive surface for intraocular devices with excellent properties to hinder cell adhesion and protein adsorption, although further studies will be necessary to evaluate long-term biocompatibility and long-term resistance to biological attacks.

Efferente Pupillenstörungen : Anisokorie und gestörte Lichtreaktion

Efferent pupillary defects are caused by problems of sympathetic or parasympathetic innervation or structural iris changes presenting as anisocoria or impaired pupillary light reaction. This overview describes the diagnostic steps for evaluating efferent pupillary disorders and outlines further steps of work-up.

Efferent pupillary defects : Anisocoria and impaired light reaction

Efferent pupillary defects are caused by problems of sympathetic or parasympathetic innervation or structural iris changes presenting as anisocoria or impaired pupillary light reaction. This overview describes the diagnostic steps for evaluating efferent pupillary disorders and outlines further steps of work-up.

Unclassified Axenfeld-Rieger Syndrome: A CASE SERIES and Review of Literature

ABSTRACTPurpose: To report anterior segment features in unclassified anterior segment dysgenesis with overlapping features of Axenfeld-Rieger syndrome and other developmental anomalies. Methods: This retrospective study included those with atypical or overlapping features in one or both eyes, which were identified as unclassified ASD. Typical ARS was defined as the presence of posterior embryotoxon with or without iris changes like stromal hypoplasia, corectopia, polycoria, or ectropion uvea with or without systemic features. Cases of ARS with overlapping features with other ASD, like aniridia (complete or incomplete absence of iris), iridocorneal endothelial (ICE) syndrome (beaten metal appearance of corneal endothelium), Peters anomaly, isolated trabeculodysgenesis (evidenced by Haab’s striae, buphthalmos, and epiphora) in one or both eyes with other typical ARS features in the same or other eye were included and screened. Results: Of 56 cases of ARS seen over 10 years, a total of 17 eyes of 11 cases (M:F=9:2, unilateral n=3) with unclassified ASD were identified with a median age of patients of 28.45±17.75 years (range 6–30 years). All cases of unclassified ASD had the presence of focal atypical strands of non-progressive anterior synechiae extending from the iris mid-periphery to the cornea with no attachments to the Schwalbe’s line in any case. Adjacent keratic precipitates or pigment were present in three eyes with focal beaten metal appearance in one eye. Three patients developed repeated episodes of anterior uveitis in one eye with stromal involvement seen in all cases, which responded to antiviral therapy. Conclusions: Atypical features like focal strands with differential corneal involvement and onset of viral uveitis in unclassified ARS suggest a possible viral etiology during different periods of eye development.

Fluid and structure coupling analysis of the interaction between aqueous humor and iris.

BackgroundGlaucoma is the primary cause of irreversible blindness worldwide associated with high intraocular pressure (IOP). Elevated intraocular pressure will affect the normal aqueous humor outflow, resulting in deformation of iris. However, the deformation ability of iris is closely related to its material properties. Meanwhile, the passive deformation of the iris aggravates the pupillary block and angle closure. The nature of the interaction mechanism of iris deformation and aqueous humor fluid flow has not been fully understood and has been somewhat a controversial issue. The purpose here was to study the effect of IOP, localization, and temperature on the flow of the aqueous humor and the deformation of iris interacted by aqueous humor fluid flow.MethodsBased on mechanisms of aqueous physiology and fluid dynamics, 3D model of anterior chamber (AC) was constructed with the human anatomical parameters as a reference. A 3D idealized standard geometry of anterior segment of human eye was performed. Enlarge the size of the idealization geometry model 5 times to create a simulation device by using 3D printing technology. In this paper, particle image velocimetry technology is applied to measure the characteristic of fluid outflow in different inlet velocity based on the device. Numerically calculations were made by using ANSYS 14.0 Finite Element Analysis. Compare of the velocity distributions to confirm the validity of the model. The fluid structure interaction (FSI) analysis was carried out in the valid geometry model to study the aqueous flow and iris change.ResultsIn this paper, the validity of the model is verified through computation and comparison. The results indicated that changes of gravity direction of model significantly affected the fluid dynamics parameters and the temperature distribution in anterior chamber. Increased pressure and the vertical position increase the velocity of the aqueous humor fluid flow, with the value increased of 0.015 and 0.035 mm/s. The results act on the iris showed that, gravity direction from horizontal to vertical decrease the equivalent stress in the normal IOP model, while almost invariably in the high IOP model. With the increased of the iris elasticity modulus, the equivalent strain and the total deformation of iris is decreased. The maximal value of equivalent strain of iris in high IOP model is higher than that of in normal IOP model. The maximum deformation of iris is lower in the high IOP model than in the normal IOP model.ConclusionThe valid model of idealization geometry of human eye could be helpful to study the relationship between localization, iris deformation and IOP. So far the FSI analysis was carried out in that idealization geometry model of anterior segment to study aqueous flow and iris change.

Iris alterations after DSAEK

Abstract Objective To evaluate a series of case that developed iris changes after performing Descemet's stripping automated endothelial keratoplasty (DSAEK). Methods Retrospective study of eyes that developed iris abnormalities, such as pupil ovalisation, iris atrophy, iridocorneal synechiae, mydriatic pupil, and pigmentary changes after performing DSAEK in a tertiary hospital. Results In a series of the first 32 DSAEK procedures performed, new single or mixed iris alterations were observed in 12 eyes (37.5%). Iris-corneal synechiae were observed in 7 eyes, corectopias in 9 eyes, iris atrophy in 3 cases, and one case developed an areflexic mydriatic pupil. Long-term pigment dispersion at the edge of the lenticule was observed in 12 eyes. The alterations occurred after three months from the surgery. In the evaluation of the associated factors, malignant glaucoma had occurred in 1 case, 2 eyes had required a second surgery, one case by re-DSAEK, and the other one by removing the intraocular lens due to lens opacification. Two cases had a shallow anterior chamber. No relationship was found between the thickness of the peripheral lenticule and the presence of synechiae. Conclusion Iris changes regarding DSAEK are possible. A discussion is presented on the relationship between increased intraocular pressure due to air in anterior chamber and its relationship with ischemia and secondary alterations in the iris.

The role of choroidal thickness change in acute attack of primary angle closure glaucoma

The mechanism of acute attack of primary angle closure glaucoma is unclear. Several studies showed that choroidal thickness was thicker in acute attack eyes than in follow eyes and normal eyes. However, these results are not enough to support the point that choroidal thickness increase is the cause for acute attack of primary angle closure glaucoma. Narrow anterior chamber angle, shallow anterior chamber are risk factors for primary angle closure glaucoma. Dynamic changes of iris, cilliary body crystalline lens and choroid all have effect on the angle width. They could contribute to the acute attack of angle closure. Thus, the acute attack of primary angle closure glaucoma should be the results of interaction effect of multiple risk factors. (Chin J Ophthalmol, 2016, 52: 404-406).