Iris Root Research Articles

Topography of Lymphatic Markers in Human Iris and Ciliary Body.

Reports of lymphatics in the anterior human uvea are contradictory. This might be caused due to a certain topography, which has not been considered yet. Therefore, here we systematically analyze iris and adjacent ciliary body with immunohistochemistry by combining various lymphatic markers. Human iris and ciliary body were obtained from cornea donors and prepared for cryosectioning. Cross sections of tissue blocks at 12/3/6/9 o'clock position and at corresponding intersections (1:30/4:30/7:30/10:30) were processed for immunohistochemistry of LYVE-1, PDPN, PROX1, FOXC2, VEGFR3, and CCL21, and when necessary, these lymphatic markers were combined with CD31, α-smooth muscle-actin, CD68, and 4',6-diamidino-2 phenylindole dihydrochloride (DAPI). Double, triple, and quadruple marker combinations were documented using confocal microscopy. Numerous podoplanin+ cells were mainly located at the anterior border of the iris while LYVE-1+ cells were distributed throughout the nonpigmented part. Both cell populations were PROX1/FOXC2/CCL21/VEGFR3-. Blood vessels, iris smooth muscles, and individual cells were VEGFR3+. While PDPN+ cells were rarely detected posteriorly of the iris root, many LYVE-1+ cells were present within the ciliary body muscle and villi. Within the muscle, occasionally PDPN+ vessel-like structures were detectable, but these were never colocalized with LYVE-1. Similar vessel-like structures were VEGFR3+/PROX1-/CCL21-, but CD31+. Further, ciliary muscle fibers and ciliary epithelium were immunoreactive for VEGFR3/CCL21, but were LYVE-1/PDPN-. A certain topography of structures at the various uvea-positions investigated was not obvious. The majority of LYVE-1+ cells displayed immunoreactivity for CD68. Lymphatic vessels colocalizing for at least two lymphatic markers were not detectable. Therefore, if present, putative lymphatic channels of the anterior uvea might display a different marker panel than generally presumed.

Plateau iris in Japanese patients with primary angle closure and primary angle closure glaucoma.

PurposeTo determine the prevalence of plateau iris in Japanese patients with primary angle closure (PAC) and primary angle closure glaucoma (PACG) and analyze the biometric parameters in patients with plateau iris using ultrasound biomicroscopy (UBM).MethodsIn this cross-sectional observational study, subjects aged >50 years with PAC and PACG who had previously undergone a patent laser peripheral iridotomy underwent UBM in one eye. UBM images were qualitatively analyzed using standardized criteria. Plateau iris in a quadrant was defined by anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact. At least two quadrants had to fulfill these UBM criteria for an eye to be classified as having plateau iris. A-scan biometry was used to measure anterior segment parameters.ResultsNinety-one subjects with PAC (58 subjects) or PACG (33 subjects) and 68 normal controls were recruited. The mean (standard deviation) ages of PAC and PACG patients and normal controls were 73.5 (6.2) and 72.6 (7.3), respectively. Based on UBM criteria, plateau iris was found in 16 eyes (17.6%) of 91 eyes. In these 16 eyes, quadrant-wise analysis showed ten eyes (62.5%) had plateau iris in two quadrants; four eyes (25%) had plateau iris in three quadrants; and two eyes (12.5%) had plateau iris in four quadrants. Anterior chamber depth, lens thickness, axial length, lens position, and relative lens position were not statistically significant between the group having plateau iris and that not having plateau iris, respectively.ConclusionApproximately 20% of Japanese subjects with PAC and PACG with a patent laser peripheral iridotomy were found to have plateau iris on UBM. No morphological difference was noted in the anterior segment of the eye between those with or without plateau iris.

Iris metastasis from systemic cancer in 104 patients: the 2014 Jerry A. Shields Lecture.

To describe the clinical features, treatment, and outcome of patients with iris metastasis. Retrospective case series of 160 tumors in 107 eyes of 104 patients with iris metastasis from systemic cancer. The median age at presentation with iris metastasis was 60 years. Iris metastasis was more common in whites (n = 93, 89%) and women (n = 65, 62%). The primary tumor was located in the breast (n = 34, 33%), lung (n = 28, 27%), skin (melanoma) (n = 13, 12%), kidney (n = 7, 7%), esophagus (n = 3, 3%), and others (n = 19, 19%). The main symptoms were pain (n = 33, 32%) or blurred vision (n = 31, 30%). The main findings were corectopia (n = 38, 37%) and secondary glaucoma (n = 38, 37%). The metastasis was unifocal (n = 84, 78%) or multifocal (n = 23, 21%) for a total of 160 tumors. The main tumor was centered at the iris root (n = 72, 69%), midzone (n = 22, 21%), or pupillary margin (n = 10, 10%), with median tumor diameter of 5 mm. Coexistent conjunctival or ciliary body/choroidal metastases were found in 39 patients. Management of iris metastasis included systemic chemotherapy (n = 18, 22%), external beam radiotherapy (n = 34, 41%), plaque radiotherapy (n = 20, 24%), surgical excision (n = 4, 5%), enucleation (n = 3, 4%), or observation (n = 4, 5%). Following treatment, tumor control without recurrence was achieved in 95% cases. In 98 cases with adequate follow-up information, death occurred in 85 (87%) at median 10 months (range, <1-239 months) from the date of iris metastasis. Metastatic tumors to the iris generally originate from primary malignancies in the breast, lung, or skin (melanoma). Despite successful ocular treatment, life prognosis is poor.

Ultrasound biomicroscopy as a diagnostic tool in infants with primary congenital glaucoma.

PurposeStudying the role of ultrasound biomicroscopy (UBM) in detection of anterior segment changes in infants with primary congenital glaucoma (PCG).MethodsCross-sectional study that included 25 eyes of 15 patients suffering from PCG and a control group of 15 eyes of ten age- and sex-matched participants. Diagnosis of PCG was based on clinical data (intraocular pressure, corneal diameter, fundus examination and amplitude-modulation scan measurement of axial length). UBM examination was done for all participants for measurement of central corneal thickness, anterior chamber depth, lens thickness, iris thickness (measured 2 mm from the iris root and again at the thickest point near the pupil), zonular length, posterior chamber depth, and angle of anterior chamber. Qualitative evaluation was done for abnormal angle membranes, iris insertion level, and ciliary processes position and configuration.ResultsMean age ± standard deviation was 10.32±3.59 months in the study group and 14.54±5.9 months in the control group. The central corneal thickness, anterior chamber depth, zonular length, and angle of anterior chamber were significantly larger in the study group than in the control group, with mean values 700±190 μm, 3.55±0.32 mm, 1.02±0.15 mm, and 58.47°±5.57°, respectively. The posterior chamber depth had a mean of 0.33±0.06 mm, which was significantly smaller than that of the control group. In the study group, the mean iris thickness 2 mm from the iris root was 0.32±0.04 mm, the mean iris thickness at the thickest point near the pupil was 0.38±0.08 mm, and the mean lens thickness was 3.32±0.18 mm. These three parameters were smaller than the control group but the difference was insignificant. Loss of normal iris configuration was detected in all eyes of the study group. Anterior iris insertion was detected in 56% of the eyes in the study group, and abnormal angle membrane was found in 12%.ConclusionUBM is a useful tool for detection of anterior segment changes in PCG, which is helpful especially in cases with opaque cornea or cases with borderline clinical findings.

Disorder of the blood aqueous barrier after endoscope-guided intraocular lens transscleral fixation surgery

Objective To observe the function of the blood-aqueous barrier(BAB) after transscleral sulcus suture intraocular lens (IOL) fixation under endoscope guidance.Methods 39 eyes of 38 cases were enrolled in this study.Endoscope-assissted transscleral IOL fixation was performed in 33 eyes,of which 21 eyes were eyeball contusion or foreign body injury,3 eyes were endogenous endophthalmitis,and 9 eyes were proliferative diabetic retinopathy.A foldable IOL was fixed in ciliary sulcus.3 eyes underwent phacoemulsification combined with IOL implantation and 3 eyes with regular IOL fixation without endoscope guidance were taken as control.The observed items included post-surgery vision and slit-lamp microscopy.The BAB function was examined using the laser flare cell meter (Kowa FC-2000) preoperatively and on postoperative day 1,7,30 by an independent examiner.The wilcoxon test was used for data analysis.Results Postoperatively,the best corrected visual acuities of all cases ranged from 0.2 ～ 1.0 (0.6 ± 0.21),were better than pre-operative hand movement/30 cm ～0.2.The UBM indicated the IOL of 1 eye dislocated slightly in regular IOL fixation group 1 week after surgery.The aqueous flare mean photon counts showed significant difference (F =216.2,214.1,P ＜ 0.05) in endoscope-assissted and regular lens fixation groups between phacoemulsification before surgery and after surgery especially on postoperative day 1,and highly significant difference between the regular lens fixation and the endoscope assissted on day 1 (F =220.3,P ＜ 0.05),but no statistically significant difference (F =205.0,P ＞ 0.05) on postoperative day 30.Conclusion Endoscope-assissted transscleral IOL fixation has little effect on BAB function.The different anatomical characteristics of ciliary sulcus,pars plana and iris root may be crucial reasons for different BAB damage. Key words: Endoscope-guided; Aphakia; Fixation, lens, intraocular; Barrier, blood-aqueous

Comparison of three kinds of operation for glaucoma and cataract clinical curative effect

Objective To compare three kinds of operation method in the treatment of glaucoma with cata-ract indications and clinical efficacy .Methods 90 patients with glaucoma combined with cataract were randomly divided into A,B,C three groups,patients in group A underwent phacoemulsification and IOL implantation therapy , patients in group B underwent phacoemulsification and IOL implantation combined with peripheral iridectomy treat -ment,patients in group C underwent phacoemulsification and IOL implantation and trabecular bite resection ,compared three groups of patients with clinical curative effect The .Results of three groups of patients before treatment and operation visual acuity compared to no significant difference （P>0.05）,the treatment after operation,all patients vis-ual acuity was improved ,no significant difference in visual contrast and three group of patients after operation （ P>0.05）.Three groups of patients before operation ,1 week after operation,6 months after the IOP had no statistically significant difference （ P>0.05）;the same group of patients before and after operation in different time points .The intraocular pressure had significant differences （P〈0.05）.Three groups of patients with postoperative iris root is rela-tively flat,wide angle increases,and the remaining peripheral iris mucosal area has been narrowed ,visible range be-come larger;no serious complication occurred .Conclusion Glaucoma patients with cataract treated with three kinds of operation mode ,can significantly improve the visual acuity of patients ,so it has high value in clinical application . Key words: Glaucoma; Cataract; Operation mode

Anterior chamber keratinous horn

A 14-year-old boy presented with a 6-month history of small white masses in his right eye. Examination revealed a white floating fluffy lesion and 2 vegetative hornlike white lesions originating at the periphery of the iris. On ultrasound biomicroscopy, a normal echogenic mass was detected on the inferior iris root and angle, with no posterior chamber or cilliary body involvement. Histopathology following an excisional biopsy revealed keratinous material. There was no recurrence during 10 months of follow-up.

A Ciliary Body Tumor Preventing Angle Closure

We present a case report of a 60-year-old white woman, found to have advanced angle closure glaucoma in the right eye and appositional closure for about half of the left eye and no glaucoma. The remaining angle of the left eye was open with localized heavy pigmentation of the ciliary body band and trabecular meshwork. Ultrasound biomicroscopy showed a ciliary body tumor displacing the iris root centripetally preventing angle closure.

Light–dark changes in iris thickness and anterior chamber angle width in eyes with occludable angles

The purpose of this study was to investigate and measure light-dark changes in iris thickness (IT) and anterior chamber angle width in eyes with occludable angles and open angles by using anterior segment optical coherence tomography (AS-OCT). We examined 153 eyes of 153 Japanese patients with primary angle closure suspect, primary angle closure, primary angle closure glaucoma, or primary open angle glaucoma. AS-OCT was used to determine pupil diameter, IT, angle opening distance at 500 μm (AOD₅₀₀), and trabecular-iris space area at 500 μm (TISA₅₀₀) in each quadrant of the anterior chamber angle (superior, inferior, temporal, and nasal) under light and dark conditions. In the angle closure cases, IT, AOD₅₀₀ and TISA₅₀₀ in the dark varied significantly among the four quadrants (P < 0.05, analysis of variance). In contrast, in the open angle cases, IT, AOD₅₀₀ and TISA₅₀₀ in the dark did not differ significantly among the four quadrants. In the angle closure cases and the open angle cases, significant negative associations were found between IT difference [IT(light)-IT(dark)] and AOD₅₀₀ difference [AOD₅₀₀(light)-AOD₅₀₀(dark)] (R = -0.411, P < 0.001 and R = -0.501, P = 0.001, respectively) and between IT difference and TISA₅₀₀ difference [TISA₅₀₀(light)-TISA₅₀₀(dark)] (R = -0.475, P < 0.001 and R = -0.462, P = 0.002, respectively). Our results suggest that thickening of the iris root under dark conditions is related to the mechanism of primary angle closure. It is important to analyze both the angle structure and peripheral IT in each quadrant.

Ocular histiocytic sarcoma in a cat

A 13-year-old male neutered British blue cat presented with uveitis, hyphema, and dyscoria in the right eye. Light microscopic examination revealed that the ciliary body, iris root, drainage angle, and adjacent choroid were infiltrated by sheets of large neoplastic mononuclear and multinucleate round to polygonal cells. Neoplastic cells stained immunopositive for CD18 and HLA-DR (MHC class II) and were immunonegative for CD3, CD79a, MUM-1, CD117 (c-Kit), and S100. These findings were consistent with a histiocytic sarcoma. The cat later developed multiple cutaneous masses composed of a similar neoplastic cell population to that seen in the eye. Eight months following enucleation, the cat developed respiratory distress and was euthanized. Postmortem examination revealed multiple pulmonary tumors associated with a pleural effusion.

Congenital iris ectropion uveae presenting with glaucoma in infancy

A healthy 5-month-old boy presented with a sporadic unilateral right-sided sectorial ectropion uveae, anterior insertion of the iris root, increased IOP, and glaucomatous disk changes. The absence of other additional ocular anomalies and the appearance of the angle led to a diagnosis of congenital iris ectropion syndrome. IOPs became refractory to maximal topical therapy, and trabeculotomy surgery was performed. The patient has since been stabilized on topical agents.

ASSOCIATION OF OCT ANGLE RECESS WIDTH WITH IOP RESPONSE AFTER INTRAVITREAL TRIAMCINOLONE INJECTION

A circumferential pretrabecular anatomical structure, the angle recess (AR), can be imaged with anterior segment ocular coherence tomography. AR's utility to predict ocular hypertension after intravitreal triamcinolone injection was assessed. All intravitreal triamcinolone injection recipients from 2002 to 2005 with high-resolution anterior segment ocular coherence tomography images had AR width (between the anteriormost prominence of the iris root and posterior cornea) measured by masked physicians using the caliper function of Stratus ocular coherence tomography. Intraocular pressures (IOPs) from 1 month before to 6 months after the injection were compiled for IOP rise (Δ) and maximal IOP (max), categorized as "minimal" (IOPmax < 21 mmHg and/or IOPΔ ≤ 5 mmHg), "moderate" (IOPmax 21-29 mmHg and/or IOPΔ 6-14 mmHg), or "severe" (IOPmax ≥ 30 mmHg and/or IOPΔ ≥ 15 mmHg). Linear regression and analyses of variance were applied. Twenty-six eyes satisfied the entry criteria, with 11 (42%) eyes demonstrating minimal, 11 (42%) moderate, and 4 (15%) severe IOP responses. The corresponding (mean ± SEM) AR widths were: 326 ± 31.5 μm, 281 ± 22.0 μm, and 138 ± 20.3 μm, respectively. Highly significant AR width differences existed between moderate and severe responders and between minimal and severe responders (both P < 0.004); 5 of 6 patients with IOP ≥ 29 mmHg had AR < 200 μm. These findings indicate that a potentially clinically useful relationship exists between AR width and IOP elevation accompanying intravitreal triamcinolone injection. Anterior segment screening could become a beneficial extension of ocular coherence tomography for retinal practices.

Is preoperative ciliary body and iris anatomical configuration a predictor of malignant glaucoma development?

To investigate anatomical configuration of ciliary body and iris using ultrasound biomicroscopy as a predictor of malignant glaucoma development. Retrospective study in a tertiary care hospital. Cohort of 31 consecutive patients diagnosed with post-surgical malignant glaucoma. Anterior chamber angle, iris and ciliary body configuration of involved eyes that had ultrasound biomicroscopy evaluation prior to the malignant glaucoma onset were evaluated. In cases with no presurgical ultrasound biomicroscopy exam of the involved eye, images from the fellow eye (imaged within 6 months) were analysed. Qualitative parameters. Thirty-one eyes (31 patients) had confirmed malignant glaucoma between 1996 and 2008. Most patients were women (65%) and had an anatomical narrow angle or angle-closure glaucoma (77%). Mean intraocular pressure at diagnosis was 30.4 ± 13.5 mmHg. The most common operation was trabeculectomy with mitomycin C (55%, 17/31 eyes), combined (3/17) or not (14/17) with cataract extraction and intraocular lens implantation. Among these 31 cases, we were able to evaluate the ultrasound biomicroscopy images of 13 patients (13 eyes) including involved eyes imaged prior to the malignant glaucoma onset or eligible fellow eyes. A narrow angle with or without iridotrabecular contact was found in all eyes. A large and/or anteriorly positioned ciliary body associated with an iris root angulating forward and centrally, revealing a plateau iris configuration, was noticed in 85% (11/13) of these eyes. Identification of plateau iris configuration by ultrasound biomicroscopy should be considered as a possible predictor of post-operative malignant glaucoma development.

Local Recurrence After Uveal Melanoma Proton Beam Therapy: Recurrence Types and Prognostic Consequences

To study the prognosis of the different types of uveal melanoma recurrences treated by proton beam therapy (PBT). This retrospective study analyzed 61 cases of uveal melanoma local recurrences on a total of 1102 patients treated by PBT between June 1991 and December 2010. Survival rates have been determined by using Kaplan-Meier curves. Prognostic factors have been evaluated by using log-rank test or Cox model. Our local recurrence rate was 6.1% at 5 years. These recurrences were divided into 25 patients with marginal recurrences, 18 global recurrences, 12 distant recurrences, and 6 extrascleral extensions. Five factors have been identified as statistically significant risk factors of local recurrence in the univariate analysis: large tumoral diameter, small tumoral volume, low ratio of tumoral volume over eyeball volume, iris root involvement, and safety margin inferior to 1 mm. In the local recurrence-free population, the overall survival rate was 68.7% at 10 years and the specific survival rate was 83.6% at 10 years. In the local recurrence population, the overall survival rate was 43.1% at 10 years and the specific survival rate was 55% at 10 years. The multivariate analysis of death risk factors has shown a better prognosis for marginal recurrences. Survival rate of marginal recurrences is superior to that of the other recurrences. The type of recurrence is a clinical prognostic value to take into account. The influence of local recurrence retreatment by proton beam therapy should be evaluated by novel studies.

Severe and Recurrent Interface Hemorrhage after Endothelial Keratoplasty

To report the occurrence and management of recurrent hemorrhage after Descemet stripping endothelial keratoplasty (DSEK) in a patient with pseudophakic bullous keratopathy. An 84-year-old Chinese woman on two oral antiplatelet drugs underwent DSEK in her left eye. Preoperative best-corrected visual acuity was 20/30 OD and 14/200 OS. Intraoperative bleeding was noted from the iris root. Surgery was completed uneventfully, and interface was thoroughly irrigated in the end. Slit lamp examination on the first postoperative day showed a dense interface hemorrhage and an intraocular pressure of 24 mm Hg. Repeat interface irrigation was carried out on postoperative day 4, but the hemorrhage appeared again on the following day. Donor lenticule was well apposed to the corneal stroma, and visual acuity was hand motions in the operated eye. No further surgical interventions were performed. Corticosteroid eye drops were continued four times a day in the operated eye, and the patient was advised weekly follow-up. Over the next 4 weeks, the interface blood gradually started to clear from the central cornea. At the end of 4 months postoperatively, the interface hemorrhage disappeared completely. A final best-corrected visual acuity of 20/80 was achieved. Specular microscopy revealed an endothelial cell density of 1375 cells/mm2. Interface hemorrhage is a known complication after DSEK surgery. Recurrent hemorrhage may be expected in patients on oral antiplatelet treatment. In cases without associated graft dislocation, conservative management can still result in good visual outcome.

Urrets-Zavalia syndrome following penetrating keratoplasty for keratoconus

Urrets-Zavalia syndrome (UZS) consists of a fixed dilated pupil associated with iris atrophy. It is a poorly understood complication following penetrating keratoplasty (PKP) for keratoconus (KC). In this work, we aim to establish the incidence, visual outcomes, and an understanding of UZS. This was a retrospective single-center study in a tertiary eye service in the United Kingdom of consecutive patients with UZS following PKP for KC in a 10-year period. Post-operative complications, including raised intraocular pressure (IOP), were recorded. UZS patients and age-matched control patients who had undergone PKP for KC without developing UZS attended a comprehensive clinical assessment. Anterior segment indocyanine green (ICG) angiography assessed iris perfusion. The incidence of UZS was 16.2 %. There was no difference in LogMAR VA or Pelli-Robson contrast sensitivity between groups. There was higher first-day post-operative IOP in UZS (p = 0.02). UZS patients had increased pupil size (p = 0.09) with reduced response to pilocarpine 2 % (p < 0.001). ICG angiography revealed delayed/reduced iris vasculature filling in UZS compared with normal filling patterns of controls. Elevated post-operative IOP within 24 h was a significant factor in the development of UZS. Visual function in UZS patients was unaffected. UZS patients developed longstanding mydriasis with reduced reactivity to topical pilocarpine 2 %. ICG angiography confirmed iris vessel ischemia; supporting the theory that iris ischemia resulting from occlusion of iris root vessels due to elevated IOP causes UZS. We advocate rigorous intraoperative management of ocular viscoelastic devices and aggressive postoperative IOP control in patients undergoing PKP for KC.

Analysis of anatomy features for patients with narrow anterior chamber angle and primary iridociliary body cysts

To investigate the prevalence and anatomy features of iridociliary body cysts in patients with narrow anterior chamber angle. Retrospective case series study. The prevalence and anatomy features of iridociliary body cysts in 223 patients (402 eyes) were analyzed retrospectively with ultrasound biomicroscopy (UBM). All of the patients were examined for susceptive narrow anterior chamber angle without complaint. The age of the patients, the site, diameter and number of cysts, the anterior chamber angle and the central anterior chamber depth were measured. Iridociliary body cysts were found in 19 patients (23 eyes) out of 223 patients (402 eyes), the prevalence is 5.7%. Fifteen patients were unilateral and four patients bilateral. Two cases originated from the ciliary process, eighteen cases from the iris root, and three from both the root and posterior surface of the iris. Twenty one cases were single cysts while two cases were multiple cysts. The diameter of the cysts ranged from 0.5 to 3.1 mm, averaged (0.71 ± 0.53) mm. The average age and the central anterior chamber depth of the eyes with iridociliary body cysts were (55.32 ± 10.74) years and (2.25 ± 0.39) mm, with no significant difference (t = 0.534, 0.783; P > 0.05) as compared to that of patients without cysts, which were (57.46 ± 10.52) years and (2.14 ± 0.34) mm. The anterior chamber angle in iridociliary body cysts group was 8.2° (21.0°, 0.0°), with no significant difference (Z = -0.062, P > 0.05) as compared to that of patients without cysts, which was 8.9° (21.4°, 0.0°). The prevalence rate of iridociliary body cysts in this study is 5.7%, central anterior chamber depth and anterior chamber angle in patients with cysts do not differ form patients without cysts.

Increased iris–lens contact following spontaneous blinking: Mathematical modeling

The purpose of this work was to study in silico how iris root rotation due to spontaneous blinking alters the iris contour. An axisymmetric finite-element model of the anterior segment was developed that included changes in the iris contour and the aqueous humor flow. The model geometry was based on average values of ocular dimensions. Blinking was modeled by rotating the iris root posteriorly and returning it back to the anterior. Simulations with maximum rotations of 2°, 4°, 6°, and 8° were performed. The iris–lens contact distance and the pressure difference between the posterior and anterior chambers were calculated. When the peak iris root rotation was 2°, the maximum iris–lens contact increased gradually from 0.28 to 0.34mm within eight blinks. When the iris root was rotated by 6° and 8°, the pressure difference between the posterior and anterior chambers dropped from a positive value (1.23Pa) to negative values (−0.86 and −1.93Pa) indicating the presence of reverse pupillary block. Apparent iris-lens contact increased with steady blinking, and the increase became more pronounced as posterior rotation increased. We conclude that repeated iris root rotation caused by blinking could maintain the iris in a posterior position under normal circumstances, which would then lead to the clinically observed anterior drift of the iris when blinking is prevented.

Novel grading system for pupillary ruff changes and associated features

To evaluate the reproducibility of a new system for grading pupil ruff changes and associated findings. Observational comparative study. Forty-seven photograph sets including iris, pupil edge and ruff, and inferior anterior chamber drainage angle. A novel system for recording pupillary ruff changes was developed, along with reference iris, pupil and gonioscopy images. A prospective masked agreement study was undertaken using two observers who graded the photograph sets using this new system. Parameters included pupillary ruff absence and abnormality, pupil edge pigment, trabecular meshwork pigment, Sampaolesi line pigment, iris root pigment, and pigment 'lumps' and 'piles'. Intraobserver and interobserver agreement for the parameters of the grading system, assessed with the intraclass correlation coefficient and Bland-Altman plots. Photographs of 47 eyes of 47 glaucoma suspects and glaucoma patients were evaluated. Agreement percentages of ≥95% (average 96%) and ≥60% (average 70%) were obtained for intraobserver and interobserver agreement, respectively. The average interobserver single-measure intraclass correlation coefficient and repeat-measures intraclass correlation coefficient were 0.75 (range 0.54-0.88) and 0.85 (range 0.70-0.94), respectively. There was a non-significant trend towards interobserver systematic bias on one of the nine parameters (iris stroma pigment at the pupil edge). This grading system provides a reliable and reproducible system for encoding of clinical signs of pupil ruff atrophy for clinical research.

Prevalence of plateau iris configuration in primary angle closure glaucoma using ultrasound biomicroscopy in the Indian population

Purpose:To report the prevalence of plateau iris in patients with primary angle closure glaucoma (PACG), in North India.Materials and Methods:The patients with PACG, attending the glaucoma services at a tertiary care center in North India were included in the study. All patients had undergone Nd-YAG laser peripheral iridotomy at least four weeks prior to inclusion in the study. Four weeks prior to inclusion in the study, none of the patients had used pilocarpine. Ultrasound Biomicroscopy (UBM) images were qualitatively evaluated and plateau iris configuration was defined in an eye if the following criteria were fulfilled in two or more quadrants: anteriorly directed ciliary process supporting the peripheral iris, steep rise of iris root from its point of insertion followed by a downward angulation from the corneoscleral wall, absent ciliary sulcus, and iridotrabecular contact in the same quadrant.Results:One hundred and one eyes were included in the study. There were 63 (62.4%) females and 38 (37.6%) males. The mean age of the patients was 57.8 ± 9.5 years (range: 42 to 78 years). The mean axial length in the study population was 22.2 ± 1.1 mm. The mean spherical equivalent refraction was 0.06 ± 1.12 D. The mean intraocular pressure was 18.5 ± 4.7 mmHg (range: 12 – 24 mmHg). Twenty-nine (28.7%) subjects were diagnosed with plateau iris on the basis of above-defined criteria. Of the 29 eyes, 18 (62.1%) subjects had plateau iris in two quadrants, nine (31.03%) in three quadrants, and two (6.8%) had this configuration in all the four quadrants.Conclusions:Approximately 30% of the eyes with PACG had plateau iris on UBM. Plateau iris was very often the cause for residual angle closure following laser peripheral iridotomy in Indian eyes with PACG.