Normal Anterior Chamber Depth Research Articles

Anterior Segment Characteristics of Eyes with Anterior Chamber Depth Less than 2.8mm and Axial Length Greater than 25mm.

This study aimed to investigate anterior segment parameters of eyes, with anterior chamber depth (ACD) less than 2.8mm and axial length greater than 25.0mm. This cross-sectional study included 180 myopic eyes of 180 consecutive patients with axial length greater than 25.0mm. Patients were divided into low ACD (ACD < 2.8mm, n = 56) and normal ACD (ACD ≥ 2.8mm, n = 124) groups. Anterior segment parameters were measured using Scheimpflug imaging and ultrasound biomicroscopy. A general linear model was used to compare parameters between the two groups, after adjusting for age and spherical equivalent. Compared with the normal ACD group, the low ACD group had lower values for the following parameters: corneal diameter, trabecular-anterior iris surface angle, angle-opening distance at 500μm, anterior chamber volume, anterior chamber width, anterior vault, iris thickness at 500μm, ciliary sulcus-to-sulcus diameter, distance between cornea and sulcus, trabecular-ciliary process distance, maximum ciliary body thickness, ciliary process length, relative anterior vault, relative distance between cornea and sulcus, and relative lens position (general linear model, p < 0.05). In contrast, central corneal thickness, iris curvature, lens thickness, lens vault, and iris-ciliary angle were greater in the low ACD group (general linear model, p < 0.05). A smaller anterior segment, as well as a thicker and more anteriorly positioned lens, may correlate with shallow ACD in eyes with long axial length.

Effect of axial length and anterior chamber depth on the peripheral refraction profile.

To evaluate the effect of axial length (AL) and anterior chamber depth (ACD) on peripheral refractive profile in myopic patients compared to emmetropic participants. This cross-sectional study was conducted in right eyes of 58 participants of whom 38 were emmetropic and 20 were myopic. Central and peripheral refraction were measured at 10°, 20°, and 30° eccentricities in nasal and temporal fields using an open-field autorefractor. The Lenstar LS900 was used to measure ACD and AL. The participants were divided into three groups of short (<22.5 mm), normal (22.5-24.5 mm), and long eye (>24.5 mm) according to AL and three groups of low ACD (<3.00 mm), normal ACD (3.00-3.60 mm), and high ACD (>3.60 mm) according to ACD. The mean age of the participants was 22.26±3.09y (range 18-30y). The peripheral mean spherical refractive error showed a hypermetropic shift in myopic and emmetropic groups although this shift was more pronounced in the myopic group. The results showed significant changes in the spherical equivalent, J0, and J45 astigmatism in all gazes with an increase in eccentricity (P<0.001). The pattern of refractive error changes was more noticeable in long and short eyes versus normal AL eyes. Moreover, the pattern of peripheral refractive changes was much more prominent in the high ACD group versus the normal ACD group and in the normal ACD group versus the low ACD group. Peripheral refraction changes are greater in participants with AL values outside the normal range and deeper ACD values compared to participants with normal AL and ACD.

Correlation between axial length, anterior chamber depth, and other biometric measurements with iol master 700 in normal eyes, short eyes, long eyes, and extremely long eyes in latin american population

Background: Several studies have shown the correlation between ocular biometry with refractive errors. Since these parameters can be influenced by race, ethnicity, and genetics, their differences between different populations can probably explain the differences in refractive errors. We present the biometric values measured in 431 eyes with normal, short, long, and extremely long axial length (AL) from the Latin American population. Patients and Methods: All eye measurements were performed using optical biometry with IOL Master and stratified according to AL and anterior chamber depth (ACD) and evaluated in relation to each other. Symmetry between right eye (RE) and left eye (LE) was also analyzed. Setting: The study was conducted at Private practice, Guadalajara, Jalisco, Mexico. Results: ACD, white-to-white (WTW), and average keratometries (K) increase as AL increases in normal, short, and long eyes, but this correlation is not maintained in extremely long eyes. Most of the short eyes and eyes with normal AL have a normal ACD, but most of the long and extremely long eyes have an ACD >2.5 mm. In normal and short eyes, the AL and WTW are symmetric in both eyes, but in long and extremely long eyes, there are significant differences between RE and LE. ACD is symmetric in RE and LE regardless of AL. Conclusions: The importance of the ocular biometry in Latin American eyes relies on clarifying the assumptions of biometric measurements commonly used in various areas of ophthalmology including intraocular lens calculation formulas.

Retinitis pigmentosa with bilateral irido-fundal coloboma

A 40-year-old male, presented with gradual painless progressive loss of vision in both the eyes more in right since 1 year. Born out of consanguineous marriage, he gave a history of night blindness since childhood. The best-corrected visual acuity was 20/200 and 20/40 in right and left eye, respectively. Refraction showed an axial myopia of -9.00 DS/-1.50 DC at 100 degree in the right eye. The left eye showed refraction of +1.00 DC at 170 degree. Intraocular pressure with noncontact tonometer was 15 and 16 mm of Hg. Axial length was found to be 24.93 mm and 23.60 mm in right and left eye, respectively. Vertical and horizontal corneal diameters were 11 mm in both eyes. Keratometry values in the right eye were K vertical 43.55D, K horizontal 44.06D and in the left eye were K vertical 43.05D, K horizontal 43.49D. Slit-lamp examination revealed a clear cornea and normal anterior chamber depth. Inferonasal iris coloboma was noted in both eyes [Fig. 1]. The lens showed nuclear sclerosis grade 2 with posterior subcapsular opacification in right and nuclear sclerosis grade 2 in the left eye according to the Lens Opacities Classification System II (LOCS II) The posterior segment showed a normal-looking disc with minimal arteriolar attenuation, boney spicules distributed from the mid periphery throughout the retina in both eyes. Chorio-retinal coloboma was type 3 (separated from the optic disc by a clear area of the retina) in the right eye [Fig. 2] and type 7 (extreme peripheral coloboma) in the left eye [Fig. 3] according to Ida Manns classification. B scan ultrasonography showed an excavated lesion in the inferior aspect suggestive of fundus coloboma in the right eye. In the left eye the coloboma was not well demarcated on B scan ultrasonography.Figure 1: Anterior segment photographs with diffuse illumination (a) Right eye showing inferonasal iris coloboma with cataractous lens. (b) Left eye showing inferonasal iris colobomaFigure 2: (a) Fundus photograph of right eye showing coloboma in the inferior quadrant sparing disc and macula with bony spicules in the mid periphery. (b) Fundus photograph right eye, superonasal quadrant showing bony spicules in the mid peripheryFigure 3: (a) Fundus photograph of left eye depicting bony spicules in mid periphery and extreme peripheral coloboma inferiorly. (b) Peripheral coloboma with bony spicules in inferior quadrantPhacoemulsification with intraocular lens implantation under topical anesthesia was done in the right eye. Postoperatively at the end of 1 month best-corrected visual acuity was 20/30 in the right eye with a refraction of -0.75 DC at 80 degrees and near vision of N6 with + 3.00 DS. Discussion Retinitis pigmentosa is most commonly associated with posterior subcapsular cataract 53%[1] glaucoma 2.3%[2] myopia, keratoconus, vitreous detachment, and optic disc drusen. Association of macular colobomas with retinitis pigmentosa, especially autosomal dominant RP and Ushers syndrome has been extensively reported in the literature. In 2004, phenotypically different RP with macular coloboma was reported by Parmeggiani in 3 adult siblings[3], which was stated as an autosomal dominant feature. The association of iris and fundal coloboma with RP has been rarely reported in the literature. Kelly et al.[4] described the incidence, ocular findings, and systemic associations of coloboma in a population-based cohort study in the United States, reported one case with unilateral coloboma in association with RP. Population-based studies in India are scanty. Pallavi Agrawal et al.[5] reported a similar case of unilateral coloboma from a case in Mumbai, India in 2013. Bilateral Irido-fundal coloboma and RP can be separate entities occurring together in this case, or it could be a rare association. Similar cases/case series need to be reported to come to a conclusive result. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Update on Microinvasive Glaucoma Surgery.

Update on Microinvasive Glaucoma Surgery.

Autologous ipsilateral lamellar corneal-flap transposition for treatment of peripheral corneal perforation

To study the clinical outcome of autologous ipsilateral lamellar corneal-flap transposition for treatment of peripheral corneal perforation. Medical records of 13 patients who underwent autologous ipsilateral lamellar corneal-flap transposition for peripheral corneal perforation from January 2008 to February 2015 were retrospectively reviewed. The diameter of the corneal ulcers was all ≤ 3.0 mm, and the diameter of perforations was all ≤ 2.0 mm. All patients were followed up for 3-12 months with an average of 8 months. The healing of ulcer, clarity of the grafts, pre-and postoperative visual acuity, and astigmatism were documented and analyzed. At 1 day after surgery, all patients had normal anterior chamber depth without aqueous leak. No double chamber or iris synechia was found. The corneal grafts showed mild to moderate edema. On postoperative days 7-14, the corneal edema receded, the grafts became transparent gradually, and the ulcer margin was blurred. Three months after surgery, all the grafts remained transparent. There was no recurrence of ulcer during the follow-up period. The best corrected visual acuity before and after surgery was 0.44 ± 0.19 and 0.47 ± 0.20, respectively, which indicated no statistically significant difference(t=0.706, P=0.461). The corneal astigmatism before and after surgery was 0.44±0.19 and 0.47±0.20, respectively, which showed statistically significant difference(t=2.391, P<0.05). Autologous ipsilateral lamellar corneal-flap transposition is a safe and effective surgical procedure for treating peripheral corneal perforation. It can be considered as an alternative method for penetrating or lamellar keratoplaty when the availability of corneal tissue is limited, or for cases with a high risk of developing immunologic allograft rejection, although the surgical indications are limited. (Chin J Ophthalmol, 2016, 52: 663-668).

Transplanted vascular endothelial cells to replace corneal endothelial cells by improved anterior chamber injection

To observe form and function changes of vascular endothelial cells (VEC) which were transplanted to the posterior surface of rhesus monkey cornea without Descemet's Membrane by anterior chamber injection, explore the feasibility of transplanting VEC to treat corneal endothelial injury, and find new method of corneal endothelial cell transplantation. Cultured VEC to proliferate in vitro.Rhesus monkeys were randomly divided into two groups: Experimental group (6) and control group (6) according to a random number table. The experimental group:transplant the culured VEC to the posterior surface of rhesus monkey cornea without Descemet's membrane by anterior chamber injection. The control group:Tear out the Descemet's membrane by capsulotomy needle without VEC transplantation. A ultrasound apparatus was adopted to measure the postoperative thicknes of the cornea and Goldman intraocular pressure meter measuring intraocular pressure in the postoperative 7 days, 14 days, 30 days, 60 days, 90 days, organize the data and entered into the computer , applicated the software of SPSS 11.5 for data independent samples t-test and analysis of variance. The eyes were removed respectively in postoperative 30, 60, 90 days to do pathological HE dyeing and scanning electron microscopy (SEM) observation of VEC in the posterior surface of cornea graft. Corneal transpareney:In the experimental observation period (3 months), the experimental group had better transparency than the control group with normal anterior chamber depth and without bullous keratopathy. And the corneal neovascularization was exist in the cornea graft in experimental group in the third month. After 3 months, the corneal thickness of experimental group (500 ± 14) µm was significantly lower than the control group (618 ± 11) µm, Corneal thickness values between experimental and control groups were statistically significant differences in changes (all P < 0.05, t-values were -3.256, -4.419, -12.896 postoperative 1, 2, 3 months). Changes of intraocular pressure difference between the experimental group and the control was not statistically significant (all P > 0.05, t-values were -1.179, -2.166, -2.536 postoperative 1, 2, 3 months). The pathological:the cell layer was visible in the posterior surface of cornea graft. The control group:can't find the cell sample structure.SEM:Experimental group showed that VEC with irregular shape uniformly distributed on the inner surface of cornea and growing well, a small amount of white blood cells can be seen between VEC, and part of cellular debris exist in the trabecular meshwork. Control group showed a fiber material without VEC. Ultrasonic emulsification can established a repeatability and simple model of corneal endothelial injury in Rhesus monkeys.VEC can be transplanted to the corneal surface by Anterior chamber injection and the cells can grow on the surface and play a barrier role in maintaining the state of dehydration and transparency of the cornea to a certain extent. After transplantation, organizational structure and morphology of the anterior chamber angle does not produce pathological effects in the short term. Prompt that transplant the culured VEC to the posterior surface of rhesus monkey cornea without Descemet's Membrane by anterior chamber injection to substitute the function of the corneal endothelial cells may be a new idea for treatment of corneal endothelial damage.

Anterior chamber depth in normal subjects by rotating scheimpflug imaging

Purpose Anterior chamber depth (ACD) is an important preoperative parameter in anterior segment surgery. Several factors are known to influence ACD, including race and geography. Our purpose was to sample data from various countries to characterize differences in ACD worldwide and, if any, assess their level of clinical significance. Setting International, multicenter. Methods Cross-sectional study. Using the Pentacam Eye Scanner (OCULUS GmbH, Wetzlar, Germany), we analyzed ACD measurements from 1077 eyes of 568 normal adults from nine countries spanning six continents. Differences between countries were assessed by comparison of 95% confidence intervals and by ANOVA. Normative thresholds were constructed at three standard deviations (SD) above and below the mean. Results Mean ACD was 3.11 mm overall, ranging from 2.91 mm (New Zealand) to 3.24 mm (United States). The ACD among New Zealanders was significantly shallower ( P < .0001) than that among Chinese, Egyptians, Germans, Indians, and Americans. The maximum difference in the mean ACDs was 0.33 mm, between New Zealand and the United States. The shallowest 0.15% of normal ACD values occurred below 2.04 mm overall, ranging from 1.69 mm (New Zealand) to 2.42 mm (United States). The deepest 0.15% of normal ACD values occurred above 4.18 mm overall, ranging from 4.03 mm (Saudi Arabia) to 4.35 mm (Brazil). Conclusions ACD did not vary significantly in the countries studied, with the notable exception of New Zealand. Surgeons should anticipate a greater likelihood of a shallow ACD when evaluating patients from New Zealand. Clinical examination and direct measurement of ACD are recommended. Finally, deep ACD has limited clinical utility in screening for keratoconus.

Management of bilateral idiopathic healed sclerokeratouveitis with ciliary and intercalary staphyloma with complicated cataract and secondary glaucoma

Dear Editor, We read the article by Parihar et al.[1] and agree with their conclusions and would like to share the course of a uveitic glaucoma with intercalary staphyloma which was managed well with phacoaspiration, posterior chamber intraocular lens (PCIOL), and Ahmed glaucoma valve (AGV) implantation. Uveitic glaucoma is challenging due to the early onset and the numerous mechanisms of pathogenesis including steroid-induced intraocular pressure (IOP) elevation.[2] Medical and surgical interventions though initially successful eventually fail due to fibrosis.[34] A 32-year-old lady with recurrent episodes of pain and redness in both eyes (BE) for 3 years was referred to our center with uncontrolled high IOP in left eye. She was on topical timolol maleate 0.5%, brimonidine tartrate 0.15%, and dorzolamide 2% twice daily in BE since 6 months and complained of progressive diminution of vision, dark coloration of the sclera, and white opacities on the cornea for 1 year. There was not any history of ocular injury, fever, joint pain, skin lesions, or any other systemic illness. On examination, vision in the right and left eye was 1/60 and 20/200, respectively. Both eyes had vascularized maculoleucomatous corneal opacities, normal anterior chamber depth, annular posterior synechiae, patent peripheral iridectomies, and cataract. She also had bilateral ciliary and intercalary staphyloma more in the right than the left eye. Tonopen reading in the right and left eye was 20 mmHg and 40 mmHg, respectively. Fundus and gonioscopy examination was not possible due to media opacities [Fig. 1].Figure 1: Both eyes showing healed sclerokeratouveitis with complicated cataractB-scan of BE was anechoic. Complete blood counts, ESR, rheumatoid factor, cANCA (antinuclear cytoplasmic antibody), PANCA, antinuclear antibody, HLAB27, chest X-ray, and X-ray of sacroiliac joints were also normal. We diagnosed this patient as bilateral idiopathic healed sclerokeratouveitis with ciliary and intercalary staphyloma with complicated cataract and secondary glaucoma. We planned phacoaspiration with PCIOL and AGV implantation as a single-stage procedure in the left eye under cover of oral prednisolone (1 mg/kg) tapered in 4 weeks. The plate of AGV was placed in the superotemporal quadrant and the tube was covered with the cadaveric scleral graft. Fixing the AGV tube and plate was an extremely uphill task due to thinness of sclera. Using iris retraction hooks, temporal phacoaspiration was performed and a multipiece acrylic foldable PCIOL was implanted in the bag. On the first postoperative day, left eye IOP was 17 mmHg and vision was 20/200. However, on the second day, there were a severe anterior chamber reaction, an exudative membrane over the IOL and iridectomy with an IOP of 22 mmHg and vision of finger counting at 1 m. We performed YAG membranectomy and pigment sweeping of the IOL on the fifth postoperative day. By the seventh day the IOP was 14 mmHg and vision improved to 20/63 and has remained in the lower teens in 2-year follow-up [Figs. 2 and 3].Figure 2: Postoperative appearance at 3 monthsFigure 3: Cadaveric scleral graft covering the tube of the Ahmed glaucoma valveWe would like to conclude that glaucoma drainage device implantation is an appropriate primary surgical procedure in patients with refractory glaucoma with intercalary staphyloma and can be safely combined with phacoaspiration with PCIOL implantation.

Anterior optical coherence tomography: a non-contact technique for anterior chamber evaluation

To assess a new non-contact anterior optical coherence tomography (OCT) system for anterior chamber evaluation. A new commercial 131-nm infrared light anterior OCT system was used for anterior chamber evaluation. Forty-four eyes of 35 subjects (18 normal subjects, 17 subjects with anterior chamber abnormalities) were enrolled in the study. Eyes were divided into those with narrowed, broadened and normal anterior chamber depth. Anterior chamber angle dynamics were assessed in three patients with angle-closure glaucoma and cataract extraction. Anterior OCT was also used for visualization of the anterior chamber (OCT goniometry) in a subject with multiple local anaesthetic allergies with phobia regarding conventional contact gonioscopy. Anterior OCT is a new, easy-to-handle, non-contact technique that allows exact evaluation of anterior chamber parameters such as anterior chamber depth, chamber angle dynamics, corneal curvature and corneal thickness.

Anterior chamber depth in plateau iris syndrome and pupillary block as measured by ultrasound biomicroscopy

Purpose To quantitatively analyze the anterior chamber depth (ACD) in patients with pupillary block and plateau iris syndrome. Design Retrospective, consecutive, observational case series Methods We measured the ACD in 318 eyes of 318 patients who had been diagnosed by ultrasound biomicroscopy as having either pupillary block or plateau iris syndrome. Pupillary block patients were all preiridotomy and plateau iris patients were all postiridotomy. Anterior chamber depth was measured axially from the internal corneal surface to the lens surface using the ultrasound instrument's internal measuring capability. Results The mean ACD in patients with plateau iris syndrome (n = 181) was significantly smaller than the hypothesized normal ACD (2.04 ± 0.30 mm vs 3.0 mm, P = .0001). The mean ACD in patients with pupillary block (n = 137) was also significantly smaller than the hypothesized normal ACD (2.17 ± 0.30 mm vs 3.0 mm, P = .0001). The mean ACD in patients with plateau iris syndrome was significantly smaller than the ACD in patients with pupillary block (2.04 ± 0.30 mm vs 2.17 ± 0.30 mm, P = .001). Conclusions Review of the literature suggests that patients with plateau iris have a normal or deeper axial ACD compared with pupillary block. This study found that the ACD associated with plateau iris syndrome is shallower than normal and also shallower than in pupillary block.

A case of angle closure glaucoma caused by plateau iris and adie’s pupil

PurposeTo describe a case of plateau iris associated with bilateral Adie’s pupil. DesignInterventional case report. MethodsA 54-year-old woman presented with pain in her right eye and headache. Intraocular pressure was 34 mm Hg in the right eye. Light reflex was defective bilaterally. ResultsUltrasound biomicroscopic imaging revealed normal anterior chamber depth and narrow angle. The ciliary processes were situated anteriorly. The eyes showed supersensitivity to 0.125% pilocarpine. The patient was diagnosed as having bilateral angle-closure glaucoma induced by Adie’s pupil and plateau iris. ConclusionMild pupillary dilation caused by Adie’s pupil may have played a role in the development of angle closure in the plateau iris configuration of our patient.

Hypotony and Choroidal Detachment as Late Complications of Trabeculectomy

Seven eyes of six patients with glaucoma developed a flat anterior chamber, hypotony, and choroidal detachment two to 26 months after technically uncomplicated trabeculectomy. No signs warranting immediate surgical intervention, such as wound or bleb leakage, contact between cornea and lens, or massive choroidal detachments touching in the midvitreous cavity were found on initial examination. After treatment with topical corticosteroids and cycloplegic eyedrops, five of seven eyes showed marked clinical improvement within one month. The two remaining eyes eventually returned to normal anterior chamber depth, but required repeat filtration surgery for intraocular pressure control.

Anterior Chamber Depth After Intrascleral Filtering Surgery

SUMMARY Intrascleral filtering surgery was performed i ? 58 eyes and the anterior chamber (AC) depth was estimated postoperatively by recording the equivalent number of corneal thicknesses (CT) of central AC depth (lens-cornea distance). Lens-cornea touch occurred in 3 of 28 eyes with chronic simple glaucoma and was highly correlated with cataract formation. Lens-cornea touch did not develop in any of 11 eyes with other types of phakic glaucoma. Lens-cornea touch did not occur in any eye if the postoperative AC depth was ever 2 CT or greater and all three instances of lens-cornea touch occurred on or by the fifth postoperative day. Nineteen aphakic eyes were operated and all had normal AC depth from the first postoperative day. The data do not support the common belief that filtering procedures done beneath a scleral flap result in faster AC depth reformation than filtering procedures not done beneath a scleral flap.