Narrow Angle Group Research Articles

Circadian alignment, cardiometabolic disease, and sex specific differences in adults with overweight/obesity.

Circadian disruption promotes weight gain and poor health. The extent to which sex plays a role in the relationship between the circadian timing of behaviors and health outcomes in individuals with overweight/obesity is unclear. We investigated the sex-specific associations between circadian alignment and cardiometabolic health markers in females and males with overweight/obesity. Thirty volunteers with overweight/obesity (15 female; BMI≥25.1kg/m2) underwent an evening in-laboratory assessment for dim-light melatonin onset (DLMO), body composition via dual energy x-ray absorptiometry, and a fasted blood sample. Circadian alignment was determined as the time difference between DLMO and average sleep onset over 7-days (phase angle), with participants categorized into narrow/wide phase angle groups based on median phase angle split. Due to known differences in metabolic markers between sexes, participants were subdivided based on sex into narrow and wide phase angle groups. Males in the narrow phase angle group had higher android/gynoid body fat distribution, triglycerides, and Metabolic Syndrome risk scores, while females had higher overall body fat percentage, glucose, and resting heart rates (all p<0.04). Furthermore, a narrower phase angle in males was negatively associated with android/gynoid body fat (r=-0.53, p=0.04) and negatively associated with body fat (r=-0.62, p=0.01) and heart rate (r=-0.73, p<0.01) in females. Circadian disruption may not only promote a trajectory of weight gain but could also contribute to negative health consequences in a sex-dependent manner in those already with overweight/obesity. These data may have implications for clinical utility in sex-specific sleep and circadian interventions for adults with overweight/obesity.

Intraocular Pressure Fluctuation Throughout the Day.

Purpose To compare intraocular pressure (IOP) values at different time points, both in the total sample and according to iridocorneal angle aperture, to assess whether IOP fluctuations were constant throughout the day, and to examine correlations with other factors. Methods Over a single day, the IOP of 34 volunteers was measured at three-hour intervals from 9:00 a.m. to 6:00 p.m. To avoid any IOP value being affected by other measurements, anamnesis, slit-lamp evaluation (with iridocorneal angle measurement), and refractive status were performed after the final measurement. The differences between IOP values at different time points and IOP fluctuation at three-hour intervals were compared by ANOVA and Friedman test, respectively, both for the total group and according to iridocorneal angle aperture. For relationships, Pearson's correlation was performed for parametric variables and Spearman's correlation for nonparametric variables. Results Significant differences were observed in IOP between time points for the total sample (p < 0.001), but not for a narrow-angle group (p = 0.058). No significant differences were found in IOP fluctuations at three-hour intervals either in the total sample or according to angle aperture (all p ≥ 0.332). There was a positive correlation of IOP at different time points (all r ≥ 0.646, all p < 0.001)but no relationship with spherical equivalent, age, or sleep duration (all p ≥ 0.057). IOP at 12:00 p.m. was correlated with a 12:00 p.m. to 3:00 p.m. fluctuation (r = 0.428, p = 0.012); and IOP fluctuation between 9:00 a.m. and 12:00 p.m. was correlated with age (r = 0.485, p = 0.004). Conclusion As IOP decreases from morning until at least 6:00 p.m., measuring these two values during clinical evaluation is essential for the effective monitoring and prevention of IOP-related diseases.

Effects of Hemodialysis on Intraocular Pressure and Ocular Biological Parameters in Different Angle Structures.

Purpose This study is aimed at evaluating the effects of hemodialysis on intraocular pressure (IOP) and exploring the possible factors affecting IOP. Methods Fifty-two patients with hemodialysis (HD) that were diagnosed with chronic renal failure by nephrology were divided into four groups: wide angle, narrow angle, extremely narrow angle, and closed angle. IOP, central anterior chamber depth (ACD), lens thickness (LT), angle opening distance (AOD), trabecular-iris angle (TIA), iris thickness (IT), and ciliary body thickness (CBT) were recorded before and after HD. The Pearson coefficient test was used to determine correlations among changes in IOP and AOD, ACD, TIA, IT, CBT, and LT. Results The IOP in the extremely narrow angle group had significant difference compared with that in the wide angle group and narrow angle group (P < 0.05, P < 0.01). In the narrow angle group, change in LT was positively correlated with change in IOP (P < 0.05). In the extremely narrow angle group, change in LT was positively correlated with change in IOP (P<0.01), whereas changes in AOD and TIA were negatively correlated with change in IOP (P < 0.01; P < 0.05). Conclusion The effect of HD on IOP varies with the structure of the anterior chamber. The increasing of IOP in the extremely narrow-angle group is related with the changes of structure of anterior chamber.

Impact of the angle between aortic and mitral annulus on the occurrence of hemolysis during Impella support

Abstract Background Hemolysis of Impella is known as a major comorbidity and adequate device positioning and optimization of volume status are recommended. However, we have sometimes experienced hemolysis refractory to these adjustments and anatomical feature appears to be crucial in such cases. Methods We enrolled 26 patients (median 71 y; BSA 1.6 m2; LVEF 27%) with cardiogenic shock who received Impella insertion from March 2018 to November 2019. The angle of the aortic and mitral annulus which was drawn at the apical 3-chamber view on echocardiography, just before or after Impella insertion was measured (Figure). Hemolytic event was defined as follows; (1) Gross dark red urine and elevation of serum LDH level after initiation of Impella support were seen and subsequently required to lower the support level of Impella under P6. (2) Blood sample data indicating hemolysis (i.e. elevation of LDH level over 1.5 fold of normal range, anemia complicated with decreased haptoglobin, the elevation of total bilirubin level accompanied indirect bilirubin elevation) was found and subsequently required to initiate continuous hemodiafiltration. Results The freedom from hemolytic event was significantly lower in the narrow angle group (&amp;lt;126.5 degrees, Figure A) compared with the wide angle group (≥126.5 degrees, Figure B) (18% vs 83%, p&amp;lt;0.0001). The narrow angle was a significant risk factor of hemolytic event with an unadjusted hazard ratio 13.9 (95% confidence interval 2.88–67.2, p=0.0499) and a hazard ratio 15.5 (95% confidence interval 3.15–76.3, p=0.0008) adjusted for lower pulmonary artery pulsatility index, which was another risk factor significant in the univariate analyses. Furthermore, 30-day survival rate was significantly lower in the narrow angle group compared with the wide angle group (63% vs 100%, p=0.0116). Conclusions The narrow angle (&amp;lt;126.5 degrees) was an independent risk factor of hemolytic event and 30-day survival was lower compared with the wide angle group. Figure 1 Funding Acknowledgement Type of funding source: None

Optimal cannula positioning of HeartMate 3 left ventricular assist device.

Cannula position in HeartMate II and HeartWare left ventricular assist devices (LVADs) is associated with clinical outcome. This study aimed to investigate the clinical implication of the device positioning in HeartMate 3 LVAD cohort. Consecutive patients who underwent HeartMate 3 LVAD implantation were followed for one year from index discharge. At index discharge, chest X-ray parameters were measured: (a) cannula coronal angle, (b) height of pump bottom, (c) cannula sagittal angle, and (d) cannula lumen area. The association of each measurement of cannula position with one-year clinical outcomes was investigated. Sixty-four HeartMate 3 LVAD patients (58 years old, 64% male) were enrolled. In the multivariable Cox regression model, the cannula coronal angle was a significant predictor of death or heart failure readmission (hazard ratio 1.27 [1.01-1.60], P = .045). Patients with a cannula coronal angle ≤28° had lower central venous pressure (P = .030), lower pulmonary capillary wedge pressure (P = .027), and smaller left ventricular size (P = .019) compared to those with the angle >28°. Right ventricular size and parameters of right ventricular function were also better in the narrow angle group, as was one-year cumulative incidence of death or heart failure readmission (10% vs. 50%, P = .008). Narrow cannula coronal angle in patients with HeartMate 3 LVADs was associated with improved cardiac unloading and lower incidence of death or heart failure readmission. Larger studies to confirm the implication of optimal device positioning are warranted.

Optimal Cannula Positioning of Heart Mate 3 Left Ventricular Assist Device

Cannula position in HeartMate II and HVAD left ventricular assist devices (LVADs) is associated with clinical outcome. We aimed to investigate the clinical implication of the device positioning in HeartMate 3 LVADs. Consecutive patients who underwent HeartMate 3 LVAD implantation were followed for one year from index discharge. At index discharge, chest X-ray parameters were measured: (1) cannula coronal angle, (2) height of pump bottom, (3) cannula sagittal angle, and (4) cannula lumen area. Sixty-four HeartMate 3 LVAD patients (58 years old, 64% male) were enrolled. In the multivariate Cox regression model, cannula coronal angle was a significant predictor of heart failure readmission (hazard ratio 1.27 [1.01-1.60], p = 0.045). Patients with a cannula coronal angle ≤28 degrees had lower central venous pressure (p = 0.030), lower pulmonary capillary wedge pressure (p = 0.027), and smaller left ventricular size (p = 0.019) compared to those with the angle >28 degrees. Right ventricular size and parameters of right ventricular function were also better in the narrow angle group, as was survival free of heart failure readmission (90% vs. 50%, p = 0.008; Figure). Narrow cannula coronal angle in patients with HeartMate 3 LVADs was associated with improved cardiac unloading and higher survival free of heart failure readmission. Further studies to clarify the methodology and implication of optimal device positioning are warranted.

Clinical profile and burden of primary glaucoma in rural camp patients attending a tertiary care center in India

Purpose: To study clinical profile and burden of primary glaucoma in rural camp patients attending a tertiary care center. Materials and Methods: A cross-sectional study was conducted in a tertiary care hospital of a single academic institute after ethical approval. Primary glaucoma patients aged ≥40 years, referred from the outreach camps, were included for a period of 12 months (2016–2017). A detailed history was recorded. Ocular examination included visual acuity, slit-lamp examination, disc evaluation, gonioscopy, intraocular pressure (IOP), and visual fields. Glaucoma was defined according to the International Society Geographical and Epidemiological Ophthalmology. Results: Out of 4204 referred cases from community program, 115 cases had primary glaucoma. Open-angle group had 63 (54.78%) cases whereas narrow-angle group had 52 (45.22%). The hospital-based prevalence for open-angle glaucoma was 1.11% (95% confidence interval [CI]: 0.8, 1.44) and for narrow-angle glaucoma was 1.07% (95% CI: 0.76, 1.38). The mean IOP was higher in narrow-angle group (P

Association of Angle Width With Progression of Normal-Tension Glaucoma

Glaucoma has been dichotomically classified as open or closed angle, and accordingly, distinct therapies have been administered. In this study, the issue of narrow-angle normal-tension glaucoma (NTG), which may be an intermediate-stage or hybrid-stage disease entity, was addressed. To determine whether anterior chamber (AC) angle width plays any role in NTG progression. Retrospective analysis of prospectively collected data at Seoul National University Hospital between January 2004 and December 2009. Fifty-two eyes of narrow-angle NTG and 52 wide-angle NTG eyes matched for age, untreated intraocular pressure, and mean deviation of visual field. Nonindentation gonioscopy was used to grade AC angles: narrow angle was defined as a partially invisible (invisible in ≥90° and <180°) pigmented posterior trabecular meshwork, and wide angle was defined as a fully visible pigmented posterior trabecular meshwork. Data were analyzed in September 2017. Optic disc/retinal nerve fiber layer defect and visual field progression. Of the narrow-angle NTG cohort, the mean (SD) age was 49.5 (9.1) years and 15 individuals (28.8%) were women; of the wide-angle NTG cohort, the mean (SD) age was 48.7 (9.5) years and 19 (36.5%) were women. All participants were Korean. Over the course of the mean (SD) 7.6 (0.4)-year follow-up period, 25 of 52 narrow-angle eyes (48.1%) and 13 of 52 wide-angle eyes (25.0%) showed structural progression (odds ratio [OR], 2.78; 95% CI, 1.21-6.37; P = .02). Meanwhile, 21 of 52 narrow-angle eyes (40.3%) and 9 of 52 wide-angle eyes (17.3%) showed functional progression (OR, 3.24; 95% CI, 1.31-8.00; P = .009). The cumulative probability of both structural and functional progression was significantly greater in the narrow-angle than in the wide-angle group (mean [SD] 5-year survival rates, 0.56 [0.07] vs 0.83 [0.05]; P = .006 and 0.60 [0.07] vs 0.87 [0.05]; P = .007, respectively). The baseline diurnal intraocular pressure's SD was approximately 1.38-times greater in the narrow-angle than in the wide-angle group (1.8 [0.6] vs 1.3 [0.3] mm Hg; mean difference, 0.52; 95% CI, 0.32-0.72; P < .001). For the follow-up intraocular pressure fluctuation, the narrow-angle group showed an approximately 1.75-times greater SD (2.1 [0.5] vs 1.2 [0.3] mm Hg; mean difference, 0.93; 95% CI, 0.77-1.09; P < .001). Narrow-angle NTG showed a greater probability of disease progression than did wide-angle NTG. Further studies determining whether augmented or differentiated treatment strategies would be beneficial for patients with narrow-angle NTG are warranted.

Anterior segment parameters as predictors of intraocular pressure reduction after phacoemulsification in eyes with open-angle glaucoma

To evaluate intraocular pressure (IOP) change after cataract surgery in eyes with open-angle glaucoma (OAG) and its relationship to angle and anterior segment parameters measured by anterior segment optical coherence tomography (AS-OCT). University of California, San Francisco, California, USA. Prospective case series. Eyes were placed into a narrow-angle group or open-angle group based on gonioscopy grading. Biometric parameters were measured using AS-OCT (Visante) preoperatively, and IOP 4months after surgery was obtained. The IOP change and its relationship to AS-OCT parameters were evaluated. Eighty-one eyes of 69 patients were enrolled. The mean age of the patients was 76.8years. The preoperative IOP was 15.02mm Hg on 1.89 glaucoma medications. The average mean deviation of preoperative visual field was -4.58dB. The meanIOP reduction was 2.1mm Hg (12.8%) from a preoperative mean of 15.0mm Hg. The IOP reduction was significantly greater in eyes with narrow angles than in eyes with open angles (20.4% versus 8.0%) (P=.002). In multivariate analysis, preoperative IOP (β=-0.53, P<.001, R2=0.40), angle-opening distance at 500mm (β=5.83, P=.02, R2=0.45), angle-opening distance at 750mm (β=5.82, P=.001, R2=0.52), and lens vault (β=-0.002, P=.009, R2=0.47) were associated with IOP reduction postoperatively. In eyes with OAG, IOP reduction after cataract surgery was greater in eyes with narrower angles. Preoperative IOP, angle-opening distance, and lens vault were predictors for IOP reduction.

Association between choroidal thickness and anterior chamber segment in eyes with narrow or open-angle.

To investigate the relationship between choroidal thickness and anterior chamber segment in subjects with eyes with narrow or open-angle. The subfoveal choroidal thickness was measured with enhanced depth-imaging optical coherence tomography and anterior chamber parameters were measured with ultrasound biomicroscopy in one eye of 23 subjects with open-angle eyes and 38 subjects with narrow-angle eyes. The mean age was 59.52±7.04y for narrow-angle subjects and 60.76±7.23y for open-angle subjects (P=0.514). Multivariate linear regression analysis was performed to assess the association between choroidal thickness and narrow-angle parameters. There were no differences in subfoveal choroidal thickness between open- and narrow-angle subjects (P=0.231). Anterior chamber parameters, including central anterior chamber depth, trabecular iris angle, iris thickness 500 µm from the scleral spur (IT500), and ciliary body thickness at 1 mm and 2 mm from the scleral spur (CBT1, CBT2) showed significant differences between the two groups (P<0.05). Subfoveal choroidal thickness showed negative correlation (β=-0.496, P=0.016) only with anterior chamber depth in the open-angle group and with age (β=-0.442, P=0.003) and IT500 (β=-0.399, P=0.008) in the narrow-angle group. However, subfoveal choroidal thickness was not correlated with trabecular iris angle, anterior chamber depth, ciliary body thickness, or central corneal thickness in the narrow-angle group. Choroidal thickness does not differ in the two groups and has not correlated with anterior chamber parameters in narrow-angle subjects, suggesting a lack of relationship between choroidal thickness and primary angle-closure glaucoma.

Predictive factors for intraocular pressure reduction after phacoemulsification in Swiss patients.

Phacoemulsification is known to induce postoperative intraocular pressure (IOP) reduction, the degree of which varies according to glaucoma subtype and race. The authors set out to investigate the effect of cataract surgery on IOP, in a Swiss Caucasian population, and identify ocular predictive factors. 234 consecutive cases of 188 patients undergoing phacoemulsification between January 2011 and December 2012 were retrospectively reviewed and data collected. Exclusion criteria included acute angle closure, malignant glaucoma and pre-existing or subsequent glaucoma surgery. Pre- and post-operative visual acuity, IOP, gonioscopic findings, glaucoma medications, and laser treatments were recorded for eligible eyes. All eyes received the same postoperative regimen. Using multivariate analysis the predictive power of preoperative IOP, iridocorneal angle width, axial length on IOP reduction following phacoemulsification at months 3, 6 and 12 postoperatively were assessed. Eyes with narrow angles were compared against those with open angles. 172 eyes of 121 patients met the inclusion criteria; mean age was 70.3 years (SD±10.7 years), with 77 males. Preoperatively median IOP was 16 mmHg (range 9-32 mmHg), mean number of glaucoma medications was 1.2 (SD±1.1), median visual acuity was 0.28 LogMAR (range 0-2.3LogMar). At 3 months post-operatively mean IOP decreased to 14 mmHg (p<0.01) and remained statistically significantly reduced until 12 months, mean number of glaucoma medications was reduced to 1.0 and mean Snellen visual acuity increased to 0.8. Multivariate analysis revealed that pre-operative IOP and iridocorneal angle width (at 3 months) were significant predictive indicators of IOP reduction. At 12 months, IOP reduction was similar between open and narrow angle groups and total IOP reduction was no longer statistically significant. No intraoperative complications were recorded. Intraocular pressure reduction following phacoemulsification was greatest during the very early post-operative period, particularly in narrow angle patients. By one year, angle size was no longer predictive of IOP lowering, however pre-operative IOP and number of anti-glaucoma medications remained correlated with total IOP reduction.

Dynamic Changes in Anterior Segment Morphology during the Valsalva Maneuver Assessed with Ultrasound Biomicroscopy

We evaluated dynamic changes in anterior segment morphology during the Valsalva maneuver with ultrasound biomicroscopy (UBM). For this prospective observational study, a group of patients with narrow angles and a group of normal subjects were recruited. The anterior segment of subjects was imaged and analyzed quantitatively using UBM before and during the Valsalva maneuver. Changes in anterior segment parameters from baseline and during the Valsalva maneuver, and the differences in parameters between the narrow angle and control groups were analyzed. Of 151 subjects recruited for the study, 68 (45.0%) were men and 83 (54.9%) had narrow angles. For the overall group, during Valsalva maneuver, the subjects' central anterior chamber depth (ACD) became shallower (from 2.286-2.262 mm, P < 0.001), and the anterior chamber angle became narrower (from 14.673-13.370 degrees, P = 0.004), the angle opening distance became smaller (from 0.158-0.140 mm, P = 0.014), and the peripheral iris thickness became thicker (from 0.494-0.508 mm, P = 0.041), while the central iris thickness did not change. Compared to normal controls, narrow angle subjects had shallower ACD and thicker iris at baseline, but there was no significant difference between the 2 groups in dynamic changes in the anterior segment after the Valsalva maneuver. The Valsalva maneuver, performed frequently in daily activities, can lead to significant narrowing of the angles in subjects with open and narrow angles. This factor may be important in eyes at risk for angle closure glaucoma.

Association of Lens Vault with Narrow Angles among Different Ethnic Groups

Purpose: To compare lens vault between open-angle and narrow-angle eyes in African-, Caucasian-, Hispanic-, Chinese- and Filipino-Americans.Methods: In this prospective study, 436 patients with open angle and narrow angle based on the Shaffer gonioscopic grading classification underwent anterior-segment optical coherence tomography. The Zhongshan Angle Assessment Program was used to calculate lens vault. The narrow-angle group included 32 Chinese-Americans, 22 Filipino-Americans, 26 African-Americans, 24 Hispanic-Americans and 73 Caucasian-Americans. The open-angle group included 56 Chinese-Americans, 29 Filipino-Americans, 45 African-Americans, 27 Hispanic-Americans and 102 Caucasian-Americans. Linear mixed effect regression models, accounting for the use of both eyes and adjusting for age, sex, pupil diameter and spherical equivalent, were used to test for the ethnicity and angle coefficients. Tukey’s multiple comparison test was used for pairwise comparisons among the open-angle racial groups.Results: Significant difference in lens vault was found among the open-angle racial groups (P = 0.022). For the open-angle patients, mean values for the lens vault measurements were 265 ± 288 µm for Chinese-Americans, 431 ± 248 µm for Caucasian-Americans, 302 ± 213 µm for Filipino-Americans, 304 ± 263 µm for Hispanic-Americans and 200 ± 237 µm for African-Americans. Using Tukey’s multiple comparison for pairwise comparisons among the open-angle racial groups, a significant difference was found between African-American and Caucasian-Americans groups (P < 0.001). P values for the rest of the pairwise comparisons were not statistically significant. No significant difference was found among the narrow-angle racial groups (P = 0.14). Comparison between the open angle and narrow angle within each racial group revealed significant difference for all racial groups (P < 0.05).Conclusion: Among all the ethnicities included in this study, narrow-angle eyes have greater lens vault compared to open-angle eyes. With the exception of the comparison between African-Americans and Caucasian-Americans, differences in lens vault measurements among the racial groups with open angle were statistically insignificant. Our data suggest that other factors may play a greater role in predisposing Asian races to angle closure.

Comparison of Optic Nerve Head Topography and Retinal Nerve Fiber Layer in Eyes with Narrow Angles Versus Eyes from a Normal Open Angle Cohort – A Pilot Study

Purpose: To compare the optic nerve head (ONH) and retinal nerve fiber layer (RNFL) in eyes with narrow angles and normal intraocular pressure (IOP) to normal control eyes.Materials and methods: A total of 70 eyes of 52 subjects with narrow angles and 40 eyes of 34 normal subjects were enrolled. Narrow angle eyes were defined as the following: (i) the pigmented trabecular meshwork was not visible for ≥ 180° on gonioscopy, (ii) untreated IOP ≤ 21 mmHg, (iii) no peripheral anterior synechiae (PAS) was observed, and (iv) optic discs were without glaucomatous changes, defined as neuroretinal rim thinning, focal notching, disc hemorrhages, or focal RNFL defects. ONH and peripapillary RNFL imaging were obtained with Heidelberg Retina Tomograph (HRT II) and Fourier-domain optical coherence tomography (RTVue OCT).Results: No significant difference was found in mean age between the two groups (p = 0.06), but the narrow angle group had significantly more women (p = 0.04). The narrow angle group had significantly higher IOP and smaller mean angle width (both p < 0.001). Vertical cup-to-disc ratio (VCDR) was significantly larger in the narrow angle group (p = 0.02). In visual field (VF) results, the mean deviation (MD) was significantly lower and pattern standard deviation (PSD) was significantly higher in the narrow angle group (both p < 0.001). After adjusting for disc area, the RNFL thickness of the inferior-temporal region was significantly thinner in the narrow angle group (135 ± 21.7 µm) compared with normal group (149 ± 22.1 µm, p < 0.01). This finding remained significant after Bonferroni correction for multiple comparisons. Smaller angle width was a significant predictor of RNFL thinning in the inferior-temporal region (p < 0.001).Conclusion: These data suggest that eyes with narrow angles may develop glaucomatous optic nerve damage in the absence of IOP elevation during office hours.

Anterior Chamber Depth, Iridocorneal Angle Width, and Intraocular Pressure Changes After Phacoemulsification

To determine the association of changes in anterior chamber angle and anterior chamber depth (ACD) with intraocular pressure (IOP) reduction after uncomplicated phacoemulsification. In this prospective study, subjects underwent phacoemulsification with foldable lens implantation. Anterior chamber angle grading of 2 or less (Shaffer grading) in 3 or all quadrants was considered narrow angle (NA). Anterior segment optical coherence tomography and tonometry were performed preoperatively and 10 days and 1, 3, and 6 months after surgery. The ACD and angle opening distance at 500 μm anterior to the scleral spur (AOD500) were assessed from anterior segment optical coherence tomography. Data were collected from 63 eyes that underwent cataract surgery. Twenty-six eyes were classified as having NA. Before surgery, the mean (SD) AOD500 and ACD in the NA group were 0.179 (0.014) mm and 2.23 (0.07) mm, respectively. Six months after surgery, the mean (SD) AOD500 and ACD in the NA group were 0.389 (0.025) mm and 3.75 (0.05) mm, respectively. The postoperative IOP was reduced significantly in both groups. We found that each 0.1-mm increase in AOD500 corresponded to a mean (SD) 0.42 (0.18)-mm Hg decrease in IOP (P < .001) in the NA group and 0.32 (0.16) mm Hg (P = .046) in the OA group. Postoperative reduction in IOP was proportional to the increase in angle in both groups, but the IOP reduction per 0.1-mm increase in AOD500 in NA eyes was greater than that in OA eyes.

Glaucoma anterior chamber morphometry based on optical Scheimpflug images

To compare the performance of gonioscopy and noncontact morphometry with anterior chamber tomography (High Resolution Pentacam - HR) using optical Scheimpflug images in the evaluation of the anterior chamber angle (ACA). Transversal study. 112 eyes from 74 subjects evaluated at the Glaucoma Department, Fluminense Federal University, underwent gonioscopy and Pentacam HR. Using gonioscopy, the ACA was graded using the Shaffer Classification (SC) by a single experienced examiner masked to the Pentacam HR findings. Narrow angle was determined in eyes in which the posterior trabecular meshwork could not be seen in two or more quadrants on non-indentation gonioscopy (SC Grade 2 or less). Pentacam HR images of the nasal and temporal quadrants were evaluated by custom software to automatically obtain anterior chamber measurements, such as: anterior chamber angle (ACA), anterior chamber volume (ACV) and anterior chamber depth (ACD). Based on gonioscopy results, 74 (60.07%) eyes of patients classified as open-angle (SC 3 and 4) and 38 (33.93%) eyes of patients classified as narrow-angle (SC 1 and 2). Noncontact morphometry with Scheimpflug images revealed a mean ACA of 39.20 ± 5.31 degrees for open-angle and 21.18 ± 7.98 degrees for narrow-angle. The open-angle group showed significant greater ACV and ACD values when compared to narrow-angle group (ACV of 193 ± 36 mm³ vs. 90 ± 25 mm³, respectively, p<0.001; and ACD of 3,09 ± 0,42 mm vs. 1,55 ± 0,64 mm, respectively, p<0.0001.). In screening eyes with open-angle and narrow-angle with the Pentacam ACA of 20º (SC Grade 2) using the ROC curves, the analysis showed 52.6% of sensitivity and 100% of specificity. The Pentacam showed ability in detecting eyes at risk for angle closure analyzing ACV and ACD.

Comparisons of anterior segment biometry between Chinese and Caucasians using anterior segment optical coherence tomography

PurposeTo compare anterior segment parameters between eyes of Chinese and Caucasians using anterior segment optical coherence tomography and to evaluate the association between these parameters and anterior chamber angle width...

Assessment of Scleral Spur Visibility With Anterior Segment Optical Coherence Tomography

To develop a grading system to evaluate the scleral spur visibility and to investigate the association between this and the angle width. Sixty healthy normal subjects (33 with open angles and 27 with narrow angles on dark room gonioscopy) underwent anterior segment imaging with the Visante OCT (Carl Zeiss Meditec, Dublin, CA). The anterior chamber angles at 12-o' clock hour positions were imaged and analyzed. The scleral spur at each clock hour position was independently graded by 2 observers. A scleral spur visibility score (SSVS) of 2 denotes clear visibility of the scleral spur. SSVS of 0 and 1 represent undetectable and moderately by visibile scleral spur, respectively. The interobserver agreement of the SSVS was evaluated with kappa statistics. The associations between age, sex, axial length, refraction, angle width [mean anterior chamber angle detection with edge measurement and identification algorithm (ACADEMIA) angle], and the mean SSVS were examined with univariate and multivariate analyses. The mean gonioscopy grades were 3.6 and 0.8 for the open and narrow angle groups, respectively. The interobserver agreement in grading the scleral spur visibility was 0.71. The inferior angle (6:00) had the worst visibility of the scleral spur (SSVS=1.05+/-0.49) whereas the scleral spur of the nasal angle (3:00) showed the best visibility (SSVS=1.66+/-0.46). There were significant differences between SSVS at 6:00 and the other clock hours except for 5:00 and 7:00. The mean SSVS correlated positively with gonioscopy grade, anterior chamber depth, and ACADEMIA angle, and negatively with age. The only significant factor associated with scleral spur visibility was the ACADEMIA angle (P=0.013) after adjustment for other covariates. The visibility of the scleral spur is an important determinant of the dimension of anterior chamber angle.

Optical Coherence Tomography Quantitative Analysis of Iris Volume Changes after Pharmacologic Mydriasis

To describe a method using anterior segment optical coherence tomography (AS OCT) for estimating iris volume. To quantify changes in iris volume induced by pharmacologic mydriasis in narrow-angle eyes predisposed to angle-closure compared with normal open-angle eyes. Cross-sectional study. Thirty fellow eyes of 30 patients who had an episode of primary acute angle-closure and 30 eyes of 30 normal age- and gender-matched subjects with open angles. All fellow eyes had a patent laser peripheral iridotomy. Iris volume and all biometric measurements were performed before and after instillation of 1% tropicamide and at least 1 week later 10% phenylephrine. Iris volume was estimated using AS OCT radial sections of the iris and a customized image-processing software. Iris volume, pupil diameter, angle configuration including angle opening distance at 500 mum (AOD 500) and trabecular-iris space at 500 mum (TISA 500), AS OCT anterior chamber depth, and A-scan ultrasonography axial length before and after pupil dilation. Iris volumes measured before dilation of the pupil were 44.94+/-2.1 mm(3) and 44.29+/-3.9 mm(3) in the fellow eyes and open-angle eyes, respectively, which was not significantly different (P>0.1). Thirty minutes after instillation of 1% tropicamide, mean iris volume increased significantly in the fellow eyes (from 44.94+/-2.1 mm(3) to 49.92+/-2.9 mm(3); P<0.01), whereas it decreased significantly in the open-angle eyes (from 44.29+/-3.9 mm(3) to 37.88+/-2.2 mm(3); P<0.01). Similar changes were observed after instillation of 10% phenylephrine. Based on multivariate analysis, significant predictors of increase in iris volume after pupil dilation were eyes predisposed to angle-closure compared with open-angle eyes (P = 0.008), larger pupil diameter (P = 0.02), and brown eyes (P = 0.01). Relative iris volume increase was correlated significantly with AOD 500 and TISA 500 relative decrease in the narrow-angle group (P<0.05). The iris volume may be estimated with AS OCT. The iris volume increases after pupil dilation in narrow-angle eyes predisposed to acute angle closure. In those patients, this biometric change is associated with a narrowing of the angle despite a patent laser peripheral iridotomy. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Dynamic Analysis of Dark–Light Changes of the Anterior Chamber Angle with Anterior Segment OCT

To describe the use of anterior segment optical coherence tomography (OCT) in studying the dynamic dark-light changes of the anterior chamber angle. Thirty-seven normal subjects with open angles on dark-room gonioscopy and 18 subjects with narrow angles were analyzed. The dynamic dark-light changes of the anterior-chamber angle were captured with real-time video recording. The angle opening distance (AOD500) and trabecular iris space area (TISA500) of the nasal angle and the pupil diameter in each of the representative serial images were measured. Linear regression analysis was performed to investigate the association between AOD500/TISA500 and pupil diameter. Demographic and biometry measurements associated with the AOD difference (AOD500((light)) - AOD500((dark))) and TISA difference (TISA500((light)) - TISA500((dark))) were analyzed with univariate and multivariate regression models. The AOD500/TISA500 measured in the light in the open-angle and the narrow-angle groups were 694 +/- 330 microm/0.24 +/- 0.10 mm(2) and 265 +/- 78 microm/0.10 +/- 0.03 mm(2), respectively. These values were significantly greater than the AOD500/TISA500 measured in the dark (492 +/- 265 microm/0.16 +/- 0.08 mm(2) and 119 +/- 82 microm/0.05 +/- 0.04 mm(2), respectively, all with P < 0.001). The ranges of the AOD/TISA difference were 13 to 817 microm/0.011 to 0.154 mm(2), with an average of 180 microm/0.073 mm(2). Multivariate regression analysis identified a positive correlation between anterior chamber depth and the AOD/TISA difference. Fifty eyes showed significant correlations between AOD/TISA and pupil diameter, whereas one eye showed no association. Four eyes in the narrow angle group developed appositional angle closure in the dark. The dynamic dark-light changes of the anterior chamber angle can be imaged and analyzed with anterior segment OCT. Although the angle width generally decreased linearly with increasing pupil diameter, the differences of the angle width measured in the dark and in the light varied substantially among individuals.