Scleral-ciliary Process Angle Research Articles

Effect of Phacoemulsification on Anterior Chamber Angle in Eyes with Medically Uncontrolled Filtered Primary Angle-Closure Glaucoma.

Purpose To evaluate the effect of phacoemulsification and intraocular lens (IOLs) implantation in eyes with medically uncontrolled primary angle-closure glaucoma (PACG) previously treated with trabeculectomy and to quantify the anatomical changes in the anterior chamber angle by ultrasound biomicroscopy (UBM). Methods Forty-four eyes of 37 consecutive patients with medically uncontrolled PACG coexisting cataracts with a surgical history of trabeculectomy were included in this study. Each patient underwent phacoemulsification and IOL implantation. Indentation gonioscopy and UBM were performed preoperatively and then again 3 months after surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications and anatomical changes in the anterior chamber angle. Results The mean logarithm of the minimum angle of resolution BCVA significantly improved from 0.52 ± 0.30 preoperatively to 0.26 ± 0.23 postoperatively (p < 0.001). The mean IOP significantly decreased from 24.33 ± 9.65 mmHg preoperatively to 18.04 ± 7.86 mmHg postoperatively (p < 0.05). 001). The median number of antiglaucoma medications decreased from 2 preoperatively to 1 postoperatively (p < 0.001). There was no significant difference in the extent of peripheral anterior synechia after the surgery (p > 0.05). Some parameters, including anterior central chamber depth, angle opening distance at 500 μm, trabecular-iris angle, and scleral ciliary process angle, were significantly higher after than before surgery (p < 0.001). However, the crystalline lens rise was significantly smaller following the surgery (p < 0.001). Conclusions Phacoemulsification and IOL implantation reduced the IOP and improved vision in eyes with medically uncontrolled filtered PACG. The mechanism underlying the outcomes observed following surgery might be related to the anterior chamber deepening, widened drainage angle, and improved aqueous fluid flow to the trabecular meshwork.

Ultrasound Biomicroscopic Evaluation of Anterior Segment Parameters and Surgical Area Following Trabeculectomy Surgery.

Objectives:This study used ultrasound biomicroscopy (UBM) imaging to evaluate the anterior segment structure and surgical area of patients with open angle glaucoma following a trabeculectomy procedure.Methods:Consecutive patients with primary open angle or pseudoexfoliative glaucoma who underwent a trabeculectomy were included. UBM was used to examine the anatomical parameters of anterior chamber depth, anterior chamber angle, angle opening distance at 500 µm (AOD500), trabecular ciliary process distance (TCPD), iris ciliary process distance, scleral ciliary process angle (SCPA), and ciliary process thickness, as well as the internal ostium opening, ostium-iris distance, and scleral flap dimensions. Bleb morphologies were evaluated qualitatively using the Yamamoto classification and quantitatively according to the presence of drainage from the medial, lateral, and posterior borders.Results:Twenty-five eyes of 23 patients (4 female, 19 male) were included in the study. The TCPD and SCPA measurements were significantly greater in the postoperative third month (1.04±0.12 mm vs 1.09±0.16 mm, p<0.05; 58.6±3.9° vs 60.8±3.8°, p<0.05, respectively). Cases with a longer ostium-iris distance had a significantly greater AOD500, TCPD, and SCPA (p<0.05). Bleb drainage and morphological classification were correlated (p=0.001).Conclusion:UBM is a sound and efficient method to investigate anterior segment variations and the surgical bleb following a trabeculectomy. TCPD and SCPA values increased after surgery.

Morphometric assessment of normal human ciliary body using ultrasound biomicroscopy.

To quantitatively assess the biometry of the ciliary body in normal human eyes using ultrasound biomicroscopy. We evaluated 85 eyes of 85 normal subjects (35 men and 50 women), whose age ranged from 11 to 86years (mean±SD, 56.8±20.4years). The eyes were assessed along the 3-, 6-, 9-, and 12-o'clock meridians relative to the center of the cornea. Clinical data were collected, including age, axial length, ciliary body length (CBL), ciliary body thickness (CBT), anterior chamber depth, iris root thickness, trabecular-iris angle, and scleral-ciliary process angle. Axial length was measured using A-scan ultrasonography. CBL and CBT tended to be larger in the superior than in the inferior quadrant, but the differences among the four quadrants were not statistically significant. The average CBL showed a significant positive correlation with the average CBT (r=0.40, P<0.001). Average CBL and CBT were significantly correlated with axial length (r=0.33, P=0.031; r=0.46, P<0.01 respectively). In addition, the average CBL was significantly correlated with anterior chamber depth (r=0.23, P<0.05), trabecular-iris angle (r=0.29, P=0.01), and scleral-ciliary process angle (r=0.40, P<0.001). Ultrasound biomicroscopic imaging demonstrated that the ciliary body is similar in size in all circumferences, and eyes with longer axial length have an elongated and thicker ciliary body. The values obtained in the present study may serve as standard clinical references.

Anterior Segment Morphology in Primary Angle Closure Glaucoma using Ultrasound Biomicroscopy.

AimTo evaluate the configuration of the anterior chamber angle quantitatively and study the morphological changes in the eye with ultrasound biomicroscopy (UBM) in primary angle closure glaucoma (PACG) patients after laser peripheral iridotomy (LPI).Materials and methodsA total of 185 eyes of 185 PACG patients post-LPI and 126 eyes of 126 normal subjects were included in this prospective study. All subjects underwent complete ophthalmic evaluation, A-scan biometry, and UBM. The anterior segment and angle parameters were measured quantitatively and compared in both groups using Student’s t-test.ResultsThe PACG patients had shorter axial length, shallower central anterior chamber depth anterior chamber depth (ACD), and anteriorly located lens when compared with normal subjects. Trabecular iris angle (TIA) was significantly narrow (5.73 ± 7.76°) in patients with PACG when compared with normal subjects (23.75 ± 9.38°). The angle opening distance at 500 pm from scleral spur (AOD 500), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), and iris-zonule distance (IZD) were significantly shorter in patients with PACG than in normal subjects (p < 0.0001). The iris lens angle (ILA), scleral-iris angle (SIA), and scleral-ciliary process angle (SCPA) were significantly narrower in patients with PACG than in normal subjects (p < 0.0001). The iris-lens contact distance (ILCD) was greater in PACG group than in normal (p = 0.001). Plateau iris was seen in 57/185 (30.8%) of the eyes. Anterior positioned ciliary processes were seen in 130/185 eyes (70.3%) of eyes.ConclusionIn PACG patients, persistent apposition angle closure is common even after LPI, which could be due to anterior rotation of ciliary body and plateau iris and overcrowding of anterior segment due to shorter axial length and relative anterior lens position.How to cite this article: Mansoori T, Balakrishna N. Anterior Segment Morphology in Primary Angle Closure Glaucoma using Ultrasound Biomicroscopy. J Curr Glaucoma Pract 2017;11(3):86-91.

Functional evaluation of an iridotomy in primary angle closure eyes.

To evaluate the functional efficacy of an iridotomy in primary angle closure (PAC) eyes by measuring IOP responses to provocative tests before and after iridotomy. Prospective cohort study. 50 consecutive adult patients, 40-60years of age, having primary angle closure. Clinical examination, perimetry, biometry and ultrasound biomicroscopy of the angle were done. A darkroom prone provocative test (DRPPT), a mydriatic test and a Valsalva maneuver were performed before and after the iridotomy. IOP change in response to the provocative tests before and after iridotomy, and correlation with baseline parameters. IOP at baseline and after iridotomy was 14.4 ± 2.7mmHg and 14.3 ± 2.6mmHg, respectively (p = 0.)83. There was no significant change on diurnal phasing before and after an iridotomy (p = 0.)11. The mean IOP rise was 5.9 ± 3.7mmHg on the DRPPT, 4.3 ± 3.5mmHg on the Mydriatic test and 9.1 ± 4.9mmHg on the Valsalva maneuver, and was reduced significantly to 3.2 ± 2.1mmHg, 2.3 ± 1.8 and 6.4 ± 3.5, respectively(p < 0.001 for all tests). The decrease in pupillary block component for all 50 eyes was 46.5% for the mydriatic test, 45.8% for the DRPPT and 29.7% for the Valsalva maneuver. PAC eyes positive on the DRPPT and mydriatic test prior to an iridotomy became negative after laser iridotomy in 75.9 and 84.6% eyes, respectively, but on the Valsalva maneuver, only 23.8% became negative. After iridotomy, eyes that continued to be positive on the mydriatic test had a significantly thicker lens (p = 0.02), decreased TCPD (p = 0.014) and narrower trabecular-iris angle (p = 0.048). On the DRPPT, they had a thicker lens (p = 0.03), shorter iris thickness (p = 0.025) and TCPD (p = 0.032), and on the Valsalva maneuver, they had a narrower scleral-ciliary process angle (SCPA; p = 0.019) and shorter TCPD (p = 0.015). This comprehensive functional evaluation of laser iridotomy in early PAC eyes showed a significant reduction in the pupillary block component of IOP response to provocative testing, possibly decreasing IOP fluctuations over time. An iridotomy does not, however, significantly change mean IOP or diurnal phasing of IOP in PAC eyes. Eyes with a very narrow angle or a thick lens may continue to have angle closure due to other pathomechanisms for angle closure.

Ultrasound Biomicroscopy in Narrow Peripheral Anterior Chamber Eyes With or Without Peripheral Anterior Synechiae

To compare the configurations of the anterior ocular segment including the anterior chamber (AC) angle and ciliary body between eyes with a narrow AC angle (ACA) with and without peripheral anterior synechiae (PAS). One hundred and one eyes of 101 consecutive patients with a temporal peripheral AC depth one-quarter of the corneal thickness or less were included. Gonioscopy and ultrasound biomicroscopy were performed under light and dark conditions. The existence of PAS was further confirmed with compression gonioscopy with indentation. Eyes with findings suggestive of plateau iris configuration or those with glaucomatous optic neuropathy were carefully excluded. The biometric parameters including the ACA, the angle opening distance at 500 mum, the trabecular-ciliary process distance, the iris-zonule distance, and the scleral-ciliary process angle were determined. PAS were found in 43 (43%) of the 101 eyes. There were no differences in age, refractive error, or intraocular pressure between PAS-positive and PAS-negative eyes (P>0.1). ACA, iris-zonule distance, scleral-ciliary process angle under light and/or dark conditions were significantly smaller in the PAS-positive eyes than in the PAS-negative eyes (P<0.05). Shallow peripheral AC depth and relatively anteriorly located ciliary body was significantly associated with the presence of PAS in eyes with a narrow ACA.

Comparison of Ultrasound Biomicroscopic Changes After Glaucoma Triple Procedure and Trabeculectomy in Eyes With Primary Angle Closure Glaucoma

To evaluate ultrasound biomicroscopy changes in the anterior chamber angle (ACA) configuration after glaucoma triple procedure (GTP), compared with those seen after trabeculectomy, in eyes with primary angle closure glaucoma (PACG). Twenty-nine PACG eyes that underwent GTP were compared with 27 eyes that underwent trabeculectomy only, using ultrasound biomicroscopy. Anterior segment parameters such as anterior chamber depth, angle opening distance (AOD500), trabecular ciliary process distance, trabecular iris angle, iris ciliary process distance, iris thickness along the trabecular ciliary process distance line (ID1), scleral ciliary process angle, scleral iris angle, and angle recess area were measured preoperatively and at 3 months postoperatively; these parameters were then compared between the procedures. Among the anterior segment parameters, postoperative increases in the anterior chamber depth, AOD500, and angle recess area were statistically significant in the eyes that underwent trabeculectomy. For the eyes that underwent GTP, all parameters except the iris ciliary process distance and ID1 were significantly increased after the operation. For the eyes that underwent GTP, the ciliary body process was posteriorly positioned and the ACA was significantly increased after the operation, as compared with the eyes that underwent trabeculectomy. The posterior shift of the ciliary process only after GTP was indirect evidence that the lens plays an important role in ACA configuration in eyes with PACG.

Anterior segment changes during accommodation in eyes with a monofocal intraocular lens: High-frequency ultrasound study

To analyze anterior segment structure changes during accommodative stimuli after monofocal intraocular lens (IOL) implantation using 2 ultrasound biomicroscopy (UBM) systems. Department of Ophthalmology, University of Verona, Verona, Italy. Twenty-six eyes (23 patients) with 1 of 4 monofocal IOL types were studied. Five to 9 months postoperatively, the patients were examined by high-frequency UBM using the HiScan system (Optikon 2000 SpA) and UBM 840 system (Carl Zeiss Meditec). Anterior chamber depth (ACD), iris-zonule distance, anterior chamber angle (ACA), scleral-ciliary process angle, and iris-ciliary process angle were measured using both systems. The iris-ciliary process distance and scleral spur perpendicular-sulcus distance were measured with the UBM 840 system and the sulcus-sulcus distance and capsular bag-IOL position with respect to ciliary process apex, with the HiScan system. Two experienced examiners performed all measurements. All parameters except the horizontal iris-ciliary process distance and vertical ACA measured by the UBM 840 system and horizontal ACA by the HiScan system showed significant variation during accommodation. An anterior shift of the IOL-capsular bag ciliary processes--sulcus-zonular iris complex was observed. A simultaneous centripetal shift of ciliary bodies and processes, shown by a reduction in sulcus and capsular bag diameter, was also observed. Anterior segment structures demonstrated accommodative movement on UBM after implantation of standard monofocal IOLs.

Gender Variation in Ocular Biometry and Ultrasound Biomicroscopy of Primary Angle Closure Suspects and Normal Eyes

To compare A-scan biometry and ultrasound biomicroscopy of primary angle closure suspects (PACS) with age-matched normal Indian eyes. Subjects with primary angle closure suspects (n=57 eyes) and normal eyes (n=57 eyes) underwent A-scan biometry and ultrasound biomicroscopy. Anterior chamber depth (ACD), anterior chamber angle (ACA), axial length (AXL), lens thickness, relative lens position (RLP), central corneal thickness (CCT), angle opening distance 500, trabecular-ciliary process distance (TCPD), iris-ciliary process distance, iris thickness, and scleral-ciliary process angle were measured. The subjects were divided into males, females, and combined groups for analysis. The parameters were compared using independent sample t test with Bonferroni correction for multiple comparisons. In the combined group, the PACS subjects presented a significantly low ACD, AXL, CCT, AOD500, TCPD, ACA (P<0.001), and RLP (P=0.04). In males, RLP was anterior (P=0.002) and in females, the lens thickness (P<0.001) was significantly thicker among the PACS group. ACD, AXL, CCT, TCPD, ACA, and angle opening distance 500 of the PACS group were significantly lower than in normals. In females, the lens in PACS was thicker than in normals. Lens in males was more anterior-placed in PACS group than in normals.

Ultrasound biomicroscopic changes during accommodation in eyes with accommodating intraocular lenses

To document ciliary body constriction and movement with the Crystalens AT-45 intraocular lens (IOL) (eyeonics) using ultrasound biomicroscopy. Eye Clinic, Department of Neurological and Visual Sciences, University of Verona, Verona, Italy. Patients with no preexisting ocular conditions other than cataract who agreed to return for follow-up were considered. Twenty eyes of 14 patients with a best corrected visual acuity of 5/10 or worse and a refractive error (spherical equivalent) of +/-1.0 diopter (D) had implantation of a Crystalens AT-45 accommodating IOL. Six patients had bilateral implantation. Ultrasound biomicroscopy was performed postoperatively at 1 and 6 months. Before and during accommodation, the anterior chamber depth (ACD) was measured to assess the endothelium-IOL distance and measure the scleral-ciliary process angle to determine whether there was anterior rotation of the ciliary body. The uncorrected distance acuity, best corrected distance acuity, uncorrected near acuity, distance corrected near acuity, best corrected near acuity, and accommodative amplitude were determined. Analysis was done to determine whether there was a correlation between the accommodative amplitude and the percentage variation in the ACD and scleral-ciliary process angle. All surgical procedures were uneventful. The mean uncorrected distance acuity at 1 month was 0.8 +/- 0.14 (SD) and remained stable at 6 months. Three of 20 eyes (15%) and 8 of 20 eyes (40%) had a Jaeger acuity of J1 and J3, respectively, without additional power correction. During accommodation, the mean reduction in ACD was 0.32 +/- 0.16 mm at 1 month and 0.33 +/- 0.25 mm at 6 months. The mean narrowing of the scleral-ciliary process angle was 4.32 +/- 1.87 degrees at 1 month and 4.43 +/- 1.85 degrees at 6 months. There was a correlation between accommodative amplitude and a decrease in the ACD (r=0.404) and a decrease in scleral-ciliary process angle (r=0.773). Anterior displacement of the Crystalens IOL and corresponding anterior rotation of the ciliary body occurred during near vision. The IOL displacement and rotation were proportional to the accommodation capacity.

Ultrasound biomicroscopic findings in aniridia

Purpose To describe the ultrasound biomicroscopic features of eyes with aniridia. Design Observational case series. Methods Nineteen eyes of 10 patients with aniridia (six males and four females) ranging in age from 3 months to 53 years (21.0 ± 16.4, mean ± SD), and 50 normal subjects (30 men and 20 women) ranging from 16 to 56 years (31.1 ± 13.2) were evaluated. Ultrasound biomicroscopic findings were recorded in the 3-, 6-, 9-, and 12-o'clock directions. Adult patients (aged 16 years or older) with aniridia were compared with the age-matched controls. Results Ultrasound biomicroscopy (UBM) detected extremely tiny irises in all eyes with aniridia. The eyes with aniridia showed significantly smaller values than the controls in ciliary body length (4.49 ± 0.63 versus 5.79 ± 0.44 mm, P < .001, unpaired Student t test), ciliary body thickness (0.75 ± 0.17 versus 1.24 ± 0.22 mm, P < .001), iris root thickness (0.47 ± 0.14 versus 0.61 ± 0.07 mm, P < .001), scleral-ciliary process angle (31.7 ± 3.26 versus 43.1 ± 4.48 degree, P < .001), and anterior chamber depth (1.99 ± 0.43 versus 2.94 ± 0.34 mm, P < .001). In the aniridia eyes, there was a significantly positive correlation between iris thickness and ciliary body thickness (Pearson r = 0.829, P = .001). Conclusion Ultrasound biomicroscopic imaging demonstrated that not only iris hypoplasia but also ciliary body hypoplasia exist in aniridia. Anterior inclination of the ciliary process was also found, which was thought to be at least partly responsible for the shallow anterior chamber.

Ultrasound biomicroscopic and conventional ultrasonographic study of ocular dimensions in primary angle-closure glaucoma

Objective To determine the biometric findings of ocular structures in primary angle-closure glaucoma (PACG). Design An observational case series with comparisons among three groups (patients with acute/intermittent PACG [A/I-PACG], patients with chronic PACG [C-PACG], and normal subjects [N]). Participants A total of 54 white patients with PACG (13 male, 41 female) were studied: 10 with acute, 22 with intermittent, and 22 with chronic types of PACG. Forty-two normal white subjects (11 male, 31 female) were studied as control subjects. Only one eye was considered in each patient or subject. Testing Ultrasound biomicroscopy (UBM) and standardized A-scan ultrasonography (immersion technique) were performed in each patient during the same session or within 1 to 3 days. Main outcome measures The following A-scan parameters were measured: anterior chamber depth (ACD), lens thickness (LT), axial length (AL), lens/axial length factor (LAF), and relative lens position (RLP). Ten UBM parameters were measured, the most important of which were anterior chamber angle, trabecular-ciliary process distance (TCPD), angle opening distance at 500 μm from the scleral spur (AOD 500), and scleral-ciliary process angle (SCPA). Results Compared to normal subjects, the patients with PACG presented a shorter AL (A/I-PACG = 22.31 ± 0.83 mm, C-PACG = 22.27 ± 0.94 mm, N = 23.38 ± 1.23 mm), a shallower ACD (A/I-PACG = 2.41 ± 0.25 mm, C-PACG = 2.77 ± 0.31 mm, N = 3.33 ± 0.31 mm), a thicker lens (A/I-PACG = 5.10 ± 0.33 mm, C-PACG = 4.92 ± 0.27 mm, N = 4.60 ± 0.53 mm), and a more anteriorly located lens (RLP values, A/I-PACG = 2.22 ± 0.12, C-PACG = 2.34 ± 0.16, N = 2.41 ± 0.15). The LAF values in A/I-PACG, C-PACG, and N were 2.28 ± 012, 2.20 ± 0.11, and 1.97 ± 0.12, respectively. Anterior chamber angle (A/I-PACG = 11.72 ± 8.84, C-PACG = 19.87 ± 9.83, N = 31.29 ± 9.18°) and SCPA (A/I-PACG = 28.71 ± 4.02, C-PACG = 30.87 ± 6.04, N = 53.13 ± 9.58°) were narrower, TCPD (A/I-PACG = 0.61 ± 0.12 mm, C-PACG = 0.71 ± 0.14 mm, N = 1.08 ± 0.22 mm) and AOD 500 shorter (A/I-PACG = 0.13 ± 0.09 mm, C-PACG = 0.21 ± 0.10 mm, N = 0.36 ± 0.11 mm) in patients with PACG. All the biometric differences proved statistically significant using the one-way analysis-of-variance test. Conclusions In patients with PACG, the anterior segment is more crowded because of the presence of a thicker, more anteriorly located lens. The UBM confirms this crowding of the anterior segment, showing the forward rotation of the ciliary processes. A gradual progressive shift in anatomic characteristics is discernible on passing from normal to chronic PACG and then to acute/intermittent PACG eyes.