Ultrasound Biomicroscopy Research Articles

The Agreement of the Nomogram Tool and Ultrasound Biomicroscopy Images in Calculating Ultrasound Cycloplasty Probe Model in Chinese Patients

Purpose: The aim of the study was to compare and explore the agreement between the nomogram tool and ultrasound biomicroscopy (UBM) images method to calculate the ultrasound cycloplasty (UCP) probe model in Chinese glaucoma patients. Methods: Retrospective analysis of Chinese glaucoma patients who visited Zhongshan Ophthalmic Center in Guangzhou from January to December 2019 and were eligible for UCP surgery. Visual acuity, intraocular pressure (IOP), ocular axial length (AL), and horizontal corneal diameter (white to white [WTW]) were measured. UBM images with clear ciliary body imaging and AL and WTW data were sent to trained personnel for probe model measurements. The data calculated by both methods were analyzed using unweighted and weighted κ statistics. The level of agreement refers to Landis and Koch’s guideline for the strength of agreement indicated with weighted κ values. Results: 1,061 eyes of 642 patients were involved, with a mean age of 61.66 ± 11.66 years. Their best-corrected visual acuity converted to logarithm of minimal-angle-of-resolution (logMAR) scores of −0.18–3.00 with a mean value of 0.69 ± 0.77. IOP was 22.0–60.0 mm Hg with a mean of 27.97 ± 5.66 mm Hg. The mean AL and WTW were 22.88 ± 1.33 (19.15–32.14) mm and 11.52 ± 0.49 (10.00–12.90) mm, respectively. The agreement between the two methods was fair (weighted κ = 0.299), matching in 62.86% of eyes (weighted κ = 0.299, κ = 0.264). The agreement in primary open angle glaucoma, acute primary angle-closure glaucoma, chronic primary angle-closure glaucoma, and secondary glaucoma patients was 60.85% (weighted κ = 0.336, κ = 0.301), 65.06% (weighted κ = 0.146, κ = 0.127), 62.26% (weighted κ = 0.204, κ = 0.184), and 57.97% (weighted κ = 0.332, κ = 0.280) of eyes, respectively. Conclusion: The agreement between UBM images and the nomogram tool to calculate the UCP probe model of Chinese patients is at a fair level. The nomogram tool prefers to use larger probes. Improvements to the nomogram tool, such as including data from more ethnic groups and being able to calculate separately for different types of glaucoma, are needed to improve accuracy. The inclusion of parameters or images from more directions of the eye may help measure probe models more accurately for both the nomogram tool and the UBM image measurement.

Anterior Segment Parameter Changes after Cataract Surgery in Open-Angle and Angle-Closure Eyes: A Prospective Study.

Background: To investigate the anterior segment parameters before and after cataract surgery in open-angle eyes and different subtypes of primary angle-closure glaucoma (PACG) eyes and to further explore the potential relationship between the anterior rotation of the ciliary process and crystalline lens. Methods: An observational, prospective study was performed on 66 patients who had cataract surgery including 22 chronic PACG patients, 22 acute PACG patients, and 22 open-angle cataract patients. Anterior segment parameters including the trabecular-ciliary process distance, ciliary process area, trabecular-ciliary angle (TCA), maximum ciliary body thickness (CBTmax), and so on, were measured using ultrasound biomicroscopy preoperatively and 3 months postoperatively. Results: After the surgery, there were significant increases in TCA (p < 0.001) and CBTmax (p < 0.05) in all three groups, while there was no significant change in the trabecular-ciliary process distance (p > 0.05) in all three groups. No significant difference in the changes of ciliary process area, TCA, and CBTmax (p > 0.05) pre- and postoperatively among the three groups were identified. Conclusions: Extractions of crystalline lenses played similar roles in terms of decreasing the anterior rotation of ciliary processes in open-angle eyes and angle-closure eyes. A natural anatomical abnormality may be a more important factor in the anterior rotation of ciliary processes in PACG patients.

Imaging techniques for ocular neoplasia

Background: Novel ocular imaging modalities have greatly impacted the diagnosis and management of different types of ocular neoplasia. In this narrative review, we summarize the practical features of popular and novel imaging modalities for ocular tumors.&#x0D; Methods: Four databases, including PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar, were searched from January 1, 2000 to August 31, 2022. Articles reporting different imaging modalities for diagnosing or monitoring treatment responses of ocular tumors were extracted using various combinations of the following keywords: ocular neoplasia, positron emission tomography or PET, single-photon emission computed tomography or SPECT, optical coherence tomography or OCT, OCT angiography or OCTA, computed tomography or CT, ultrasonography or US, ultrasound biomicroscopy or UBM, and magnetic resonance imaging or MRI.&#x0D; Results: Various ocular imaging modalities had different accuracies as adjunctive tools for detecting or managing ocular tumors. Anterior ultra-high-resolution optical coherence tomography (OCT) could be used to evaluate images with &lt; 5-µm resolution. OCT angiography provided deeper insight into retinal vascular changes associated with the malignant transformation of choroidal melanoma. OCT in children altered the diagnosis of suspicious retinoblastoma in 3% of the cases and treatment plan in 11% of the cases. While positron-emission tomography (PET)/computed tomography (CT) allowed the detection of metastatic lesions of choroidal melanoma by full-body scanning, single-photon emission CT was more sensitive compared to PET in detecting choroidal melanoma. Ultrasound biomicroscopy, with an accuracy exceeding 92.5%, could detect retinal calcification in lesions measuring 2–3 mm. Magnetic resonance imaging (MRI) had better contrast compared to ultrasound biomicroscopy and higher sensitivity compared to CT in detecting post-laminar optic nerve invasion. However, MRI had a lower spatial resolution compared to OCT. Further development of imaging modalities and their application in drug development would improve the treatment of ocular tumors.&#x0D; Conclusions: Although diagnosing ocular tumors depend on clinical characteristics, innovations in ocular imaging have enabled early diagnosis and timely, appropriate management of ocular neoplasia, which are conducive to favorable visual outcomes and increased life expectancy. Further systematic reviews and meta-analyses of primary studies focusing on a specific imaging modality in ocular neoplasia could precisely determine the diagnostic accuracy of each imaging modality to better guide eye practitioners with efficient diagnostic or therapeutic approaches for these sight- or life-threatening entities. Imaging modalities may play a major role in drug development in the future.

Innovative Technologies in the Monitoring of the Age-Related Cataract

Literature review is devoted to modern high-technology instrumental methods of the lens evaluation, which have been developed to improve efficiency of the diagnostics and management of cataract in ophthalmological clinical practice. The slit-lamp examination of lens and retroillumination images are used for subjective assessment of cataract according to LOCS III grading system. Currently objective methods of lens evaluation have practical value and provide information about early age-related changes of crystalline lens with the quantitative assessment of the severity of opacities including the optical and ultrasound examinations. Optical methods include densitometry using Scheimpflug images obtained from applications to quantify the localization of lens opacities and their progression rate. Another method is the intensity distribution analysis of the wave front of the optical aberrations according to grading cataract severity with the objective scatter index (OSI) obtained by double-pass technology. Moreover the optical quantitative assessment of lens opacities is carried out by the Shack—Hartmann wave front sensor to identify the grade of nuclear opalescence (N-type) with the Lens Opacities Classification System III. This method is very helpful in nuclear cataract. Swept source optical coherent tomography (SS-OCT) with variable length of wave and high frequency detector is used for the density measurements of nuclear and cortical opacities of lens imaging in micro- and macro dimensional scale. Ultrasound biomicroscopy is the most informative ultrasonic diagnostic method for the evaluation of acoustic density and early age-related changes of lens. Current high-informative methods of quantitative assessment of the optical density of lens are helpful in determination of indications for surgery, the optimization of phacoemulsification settings and prevention of intraoperative complications. The use of high-technologic methods demonstrated the effectiveness of eye drops 0,005 % pirenoxine in early lens opacities management.

Evaluation of Multimodal Biometric Parameters for Diagnosing Acute Angle Closure Secondary to Lens Subluxation.

To evaluate the clinical characteristics and multimodal biometric parameters from ultrasound biomicroscopy (UBM) and IOL Master biometry of patients with acute secondary angle-closure due to lens subluxation (ASAC-LS), acute primary angle-closure (APAC), and cataract. This retrospective study included 22 eyes with ASAC-LS, 27 eyes with APAC, and 39 eyes with cataract. Gender, age, affected eye, best corrected visual acuity, axial length, central corneal thickness, and anterior chamber depth (ACD) assessed by UBM and IOL Master were measured and compared between the three groups. In addition, we compared the ratio of ACD (ACD ratio) and the difference of ACD (ACD difference) measured by the two instruments. Logistic regression analysis was conducted to evaluate the predictive factors for lens subluxation. Receiver operating characteristic (ROC) curves were plotted to obtain a suitable cutoff value of biometric parameters to separate ASAC-LS cases from APAC and cataract cases. In the ASAC-LS group, the median (interquartile range [IQR]) ACD measured by IOL Master was 2.47 (IQR 1.85-2.92) mm while the median ACD measured by UBM was 3.11 (IQR 2.60-3.76) mm. The difference of ACD measured by the two instruments was statistically significant in the ASAC-LS group (P < 0.001) whereas the differences were not statistically significant in the APAC group (P = 0.521) and cataract group (P = 0.204). Subsequent pairwise comparison revealed that only the ACD difference (0.40 [IQR 0.22-1.08] mm) and ACD ratio (1.18 [IQR 1.07-1.40]) in the ASAC-LS group were significantly different from those in the APAC group (ACD difference 0.02 [IQR 0.01-0.07] mm; ACD ratio 1.01 [IQR 1.00-1.04]) and cataract group (ACD difference 0.09 [IQR 0.01-0.14] mm; ACD ratio 1.03 [IQR 1.00-1.04]) (all P < 0.001). The ACD difference and ACD ratio were significantly associated with lens subluxation in the multivariate logistic regression analysis (P < 0.001 and P = 0.001, respectively). Additionally, the ROC curve analysis showed that the ACD difference at 0.235mm and the ACD ratio at 1.080 were the respective cut-off values for lens subluxation, with a sensitivity of 77.3% and specificity of 100.0%. Our findings provide a new option for identifying lens subluxation. Specifically, combining the ACD from UBM and IOL Master may be helpful for differential diagnosis of ASAC-LS.

Novel Discoveries of the Relationship Between the Vitreous Zonule and the Anterior Segment Characteristics in Eyes With Primary Angle-Closure Disease.

To investigate the presence of the vitreous zonule (VZ) in different subtypes of primary angle-closure disease (PACD) and to explore the relationship between VZ and anterior chamber angle characteristics. Patients with clinical diagnoses of acute primary angle-closure (PAC)/PAC glaucoma (APAC[G]) or chronic PAC/PAC glaucoma (CPAC[G]) and healthy subjects were enrolled. A total of 300 eyes of 180 subjects were included. Anterior segment parameters and the presence of the VZ were assessed by ultrasound biomicroscopy. The presence of VZ was compared among different subtypes of PACD. Anterior segment parameters were compared between eyes in vitreous zonule group (VZG) and no vitreous zonule group (NVZG). Logistic regression analysis was conducted to identify factors associated with the presence of VZ. APAC(G) eyes had lower VZ presence compared to the fellow eyes of APAC(G) (P < 0.001). VZ was more likely to be seen in the eyes of healthy subjects and PAC suspect than in the eyes of PAC and PAC glaucoma (PACG) (P < 0.05). NVZG had shorter angle opening distance 500/750 (P < 0.001), smaller trabecular iris angle 500/750 (P < 0.001), smaller trabecular-iris space area 500/750 (P < 0.001), smaller trabecular-ciliary angle (P = 0.009), smaller iris area (P = 0.010), and greater lens vault (P = 0.004) compared to VZG. Greater lens vault (LV) was independently associated with absence of VZ (odds ratio = 0.253; 95% confidence interval, 0.109-0.586; P = 0.001). VZ was less likely to be observed in PAC/PACG eyes. PACD eyes with less VZ had narrower angle, more anteriorly rotated ciliary body, and greater LV.

Comparative analysis between early and late onset primary angle closure glaucoma

AbstractObjective: This prospective observational pilot study aimed at comparing the aetiology and clinical profile of early onset primary angle closure glaucoma (EPACG) with late onset primary angle closure glaucoma (LPACG).Methods: The early (18–40 year) and late (≥50 year) onset PACG patients without any surgical intervention or any other pathology (leading to secondary angle closure) were enrolled. One eye of each patient was considered for analysis. Clinico‐demographic details of the patients were noted. Anterior segment optical tomography (CASIA2, Tomey Corporation, Japan), Ultrasound biomicroscopy (Vumax, Sonomed, NY) were performed to identify the etiopathogenesis among two groups.Results: Mean age of participants was 32.8 ± 7.8 years EPACG (n = 45) and 55.83 ± 6.7 years in the LPACG group (n = 31). Relative pupillary block (90.32%, n = 28) was the commonest mechanism of angle closure in LPACG while non pupillary block [66.67%, n = 31, pseudoplateau iris‐ 44.44% (n = 20), plateau iris‐24.44% (n = 11)] was the commonest mechanism in EPACG group. The EPACG had significantly shorter axial length (22.1 ± 1.1 vs 22.93 ± 1; p = 0.003), thinner lens (4.35 ± 0.3 vs. 4.6 ± 0.2; p = 0.01), more anterior relative lens position (0.19 ± 0.01 vs. 0.2 ± 0.01; p = 0.007), lesser anterior chamber depth (2.1 ± 0.3 vs. 2.3 ± 0.32; p = 0.01) and lesser anterior chamber area (15 ± 3.3 vs. 16.7 ± 3.4; p = 0.04) compared to LPACG. EPACG had greater lens vault (0.79 ± 0.4 vs. 0.61 ± 0.2; p = 0.01) compared to LPACG. Among the EPACG, 15.55%, (n = 7, vs. none in LPACG) had nanophthalmos. The BCVA was worse in EPACG (0.2 (range 0–2) vs. 0.6 (0–2) logMAR in LPACG) despite refractive error being more emmetropic vs LPACG.Conclusions: Non pupillary block mechanisms are more common in EPACG as compared to LPACG. Despite thinner lens, early onset group has greater lens vault and shorter axial length contributing to greater angle crowding and present with greater visual morbidity.

Microspherophakia and megalocornea with or without secondary glaucoma: A case series

AbstractPurpose: To report a case series of 6 eyes of 3 children diagnosed with microspherophakia and megalocornea with or without secondary glaucoma (MSPKA) and to discuss its clinical features and management.Methods: We reviewed 3 cases of a boy (case 1) and 2 sisters (cases 2,3) diagnosed with MSPKA from two consanguineous families. Ultrasound biomicroscopy was performed in 2 eyes and anterior‐segment swept‐source optical coherence tomography in 6 eyes.Results: Mean corneal diameter was 13 mm. Lens equatorial diameters were, in case 1, 6.2 mm in the right eye (RE) and 6.1 mm in the left eye (LE); in case 2, 7.4 mm (RE) and 7.7 mm (LE). Systemic work‐up was unremarkable.Case 1: A 6‐year‐old boy presented with bilateral lens subluxation and advanced secondary angle‐closure glaucoma (SACG). Best‐corrected visual acuity (BCVA) was 20/200 (RE) and was limited to counting fingers (LE). We performed phacoemulsification, anterior vitrectomy and retro‐pupillary iris‐claw intraocular lens implantation (RPIC‐IOL) in both eyes. At 5 months follow‐up, BCVA was 20/50 (RE) and 20/100 (LE). Intraocular pressure (IOP) decreased to 14 mmHg in both eyes.Case 2: Ophthalmologic examination in a 5‐year‐old girl showed in both eyes: a BCVA of 20/50, megalocornea, normal IOP and iridophacodonesis. Surgery with scleral fixation of the capsular bag will be considered.Case 3: An 8‐year‐old girl was referred after a bilateral lensectomy following spontaneous luxation of the lens into the anterior chamber in her RE. Examination showed bilateral megalocornea, aphakia and normal IOP. Secondary RPIC‐IOL implantation and amblyopia management were planned.Genetic testing for the Latent Transforming Growth Factor Beta Binding Protein 2 (LTBP2) gene mutation was performed in both sisters.Conclusions: MSPKA is a rare condition that can be associated with extraocular manifestations. Patients are at a high risk of lens dislocation and SACG. Surgical management remains challenging and should not be delayed.

Acute bilateral glaucoma related to uveal effusion syndrome associated with topiramate

AbstractPurpose: Drugs mostly sulfa‐related compounds, have produced uveal effusions, forward rotation of the iris‐lens diaphragm, transient myopia, and secondary angle closure. It has been recently encountered one case in which uveal effusions have occurred after administration of topiramate, a new anticonvulsant medication.Methods: A 54‐year‐old woman was seen in our emergency department with severe headaches, progressively blurry vision and photophobia in both eyes starting that morning. On examination, her visual acuity was hand movement in both eyes. Central corneal edema was observed, narrow chamber and anterior lens‐iris complex displacement with an unreactive middle pupil in both eyes. The funduscopic examination was difficult to assess due to the media opacity. Intraocular pressure measured with an applanation tonometer was 45 mm of mercury (mmHg) in the right eye and 50 mmHg in the left eye. Her medications included topiramate which she had started 2 weeks prior to initial examination due to headaches followed by neurology.Results: Topiramate‐induced angle closure has even been described as an idiosyncratic reaction in patients with normal depth of anterior chamber. The drug causes a prostaglandins increasement that trigger ciliary body edema at the local level but without acting at the systemic level. Ultrasound biomicroscopy shows the presence of a ciliochoroidal effusion syndrome, edema and the ciliary body anterolateral rotation, with zonular relaxation, changes that lead to iris‐lens diaphragm anterior displacement and, as a consequence, narrowing of the responsible anterior chamber with an acute glaucoma crisis.Conclusions: Topiramate is a sulfamate monosaccharide and belongs to a new generation of antiepileptic drugs, widely prescribed throughout the world as treatment of generalized tonic–clonic seizures and partial seizures. Prophylaxis of migraine, bipolar disorder, depression and neuropathic pain are other recent indications of its use. Bilateral acute glaucoma due to uveal effusion syndrome should be considered as an infrequent complication of topiramate use.References.1. Prithvi S. Sankar, MD; Louis R. Pasquale et al. Uveal Effusion and Secondary Angle‐Closure Glaucoma Associated With Topiramate Use. Arch Ophthalmol. 2001;119(8):1210–1211.

Clinical presentation and treatment outcomes of an algorithmic approach to uveal effusion syndrome.

To describe the clinical features and treatment outcomes in spontaneous uveal effusion syndrome (UES). A 10-year retrospective chart review of UES patients from a tertiary eye center was carried out. Optical coherence tomography (OCT), fundus fluorescein angiography, and ultrasound biomicroscopy (UBM) scans were performed. UES was managed based on presenting best-corrected visual acuity (BCVA), symptoms, and fundus findings. Patients with secondary causes of uveal effusion were excluded. Twenty-five eyes of 16 patients were included. Of the 16 patients, 14 (88%) were male and 9 (56%) had bilateral disease. Fifteen of 25 affected eyes had nanophthalmos (axial length (AL) <20.5 mm) and 6 had hyperopia with AL >20.5 mm. The presenting mean distance BCVA was 0.74 ± 0.64 logMAR (mean Snellen: 20/100). Eleven eyes had exudative retinal detachment, and 4 also had exudative choroidal detachment (CD). Choroidal thickness (CT) was increased in 11 eyes on B-scan ultrasonography, and the mean CT was 1.74 ± 0.38 mm. Sub-retinal fluid (SRF) and retinal folds were the most common OCT findings. UBM findings included shallow angles, peripheral CD, and supra-ciliary effusion. A combination of local and systemic corticosteroids was used to successfully treat 12 eyes, 6 needed surgery, and 7 were observed. Partial sclerectomy with anterior chamber maintainer-assisted SRF drainage was the favored surgery. The median period of follow-up was 6.5 months (0.1-76 months), and the mean distance BCVA at the last follow-up was 0.58 ± 0.42 logMAR (mean Snellen: 20/80). UES can be suitably managed both medically and surgically based on clinical presentation.

Use of ultrasound biomicroscopy to predict the outcome of anterior segment reconstruction in congenital fibrovascular pupillary membrane with secondary glaucoma

AimsTo evaluate the efficacy and safety of anterior segment reconstruction (ASR) in congenital fibrovascular pupillary membrane-induced secondary glaucoma (CFPMSG) basing ultrasound biomicroscopy (UBM) classification.MethodsThis ambispective cohort study enrolled patients with...

Intravitreal Carboplatin as Salvage Treatment for Progressive Vitreous Disease in Retinoblastoma: A Phase I Clinical Trial

To determine the safety and toxicity profile of intravitreal carboplatin as salvage treatment for retinoblastoma with vitreous disease. Single-institution, interventional prospective clinical trial. Patients with progressive or recurrent vitreous seeds after completion of primary treatment for intraocular retinoblastoma. Eligible eyes received an intravitreal injection of carboplatin every 14 to 21 days with simultaneous focal therapy (laser, thermotherapy, and brachytherapy) provided at the discretion of the ocular oncologist. The evaluation with examination under anesthesia, ultrasound biomicroscopy, and electroretinography (ERG) were performed before each injection to assess for tumor response and drug-related toxicity. A serious adverse event resulted in dose recalculation and ultimately early closure of the study. Regression pattern of vitreous disease and incidence of dose-limiting toxicities. Four patients were enrolled at an initial dose of 0.3 mg. Complete regression of vitreous seeds was noted in all patients after 5, 2, 2, and 1 injections (respectively). Two patients developed recurrent vitreous disease at 3 and 25 months after complete regression and ultimately required enucleation. A serious adverse event occurred in 1 patient who developed acute vision loss with extinguished ERG response 72 hours after the second injection; ultimately, this eye developed a cataract and required enucleation. After temporary suspension and dose modification, 3 patients were enrolled at an injection dose of 3 μg and treated with a total of 5, 2, and 1 injections, respectively. Complete regression of vitreous disease was not achieved in any patient though ERG amplitudes remained stable. After removal from protocol, all 3 patients had a complete response to intravitreal melphalan. Concern for dose escalation and further toxicity in the setting of an effective and safe alternative (melphalan) led to the termination of the study. Intravitreal carboplatin may be effective in treating progressive vitreous seeding at higher doses, but permanent retinal toxicity was observed. Other alternative agents should be considered. Proprietary or commercial disclosure may be found after the references.

Comparison study for the proportion of underdiagnosed zonulopathy in angle closure glaucoma

Objective: To analyze the proportion and clinical characteristics of underdiagnosed zonulopathy in angle closure glaucoma (ACG) patients and to explore the related risk factors. Methods: Case-control study. Continuous cases of ACG patients who underwent phacoemulsification combined with intraocular lens implantation and goniosynechialysis surgery [ACG group, including acute angle closure glaucoma (AACG) and chronic angle closure glaucoma (CACG)] from November 1, 2020 to October 31, 2021 and age-related cataract patients who underwent phacoemulsification combined with intraocular lens implantation surgery in the same period (control group) were included. The diagnosis of zonulopathy was determined according to the intraoperative signs such as wrinkles of the anterior capsule during continuous circular capsulorhexis. The proportion of zonulopathy, preoperative diagnosis rate of zonulopathy, demographic characteristics, anterior chamber depth (ACD), axis length, difference of ACD in both eyes (ACD of the contralateral eye minus ACD of the operated eye) were compared between the two groups. The related risk factors were explored. The paired t-test (comparison between two groups of normally distributed data), non-parametric test (comparison between two groups of non-normally distributed data), Chi-square test (categorical variables), univariate and multivariate logistic regression analysis were used. Results: There were 104 ACG patients (104 eyes), including 63 AACG patients (63 eyes) and 41 CACG patients (41 eyes), and 117 controls (117 eyes). There was no significant difference in age (P=0.29) and gender (P=0.07) between the two groups. The ACG group had shallower anterior chamber (P<0.001), shorter axial length (P<0.001) and more ACD difference in both eyes (P<0.001). In the ACG group, the proportion of zonulopathy was 46.2% (48/104), which was significantly higher than that (6.0%, 7/117) in the control group (P<0.001). In the control group, only zonular laxity was found, while in the ACG group, besides the predominant zonular laxity (68.8%, 33/48), there was zonular dehiscence (31.3%, 15/48). The eyes with AACG (57.1%, 36/63) had a higher proportion of zonulopathy than those with CACG (29.3%, 12/41) (P=0.006). In the ACG group, only 14 cases (29.8%) were diagnosed preoperatively according to slit lamp examination and/or ultrasound biomicroscopy. The proportion of underdiagnosed zonulopathy was 70.8% in the ACG group (34/48). A smaller ACD was found to be related to the zonulopathy in the ACG group. All AACG cases with an ACD ≤2.0 mm and CACG cases with an ACD ≤1.9 mm had zonulopathy. Multivariate logistic regression showed that the ACD difference in both eyes (P=0.025) and the diagnosis of ACG (AACG vs. cataract, P<0.001; CACG vs. cataract, P=0.023) were independent risk factors associated with zonulopathy. Conclusions: The proportion of underdiagnosed zonulopathy among ACG patients is high. Better preoperative diagnostic methods for zonulopathy are needed. Zonulopathy is common in ACG patients, especially in AACG patients, suggesting that zonulopathy may be related to the pathogenesis of ACG. The shallower the ACD, the riskier the zonulopathy. ACD differences between two eyes and ACG types (including AACG and CACG) were related risk factors of zonulopathy.(This article was published ahead of print on the Online-First Publishing Platform for Excellent Scientific Researches of Chinese Medical Association Publishing House on March 11, 2022).

Reactivation of spontaneously resolved primary congenital glaucoma

A 15-year-old female was evaluated for elevated intraocular pressure (IOP). Ophthalmic examination showed bilateral enlarged corneal diameter, vertical Haab striae, concave iris, deep anterior chamber, and clear lens. IOPs in both eyes were 17 mm Hg with bilateral latanoprost, timolol/dorzolamide fixed-dose combination, and brimonidine eye drops. Immersion ultrasonography axial lengths were 26.1 and 25.6 mm in the right and left eyes, respectively. Ultrasound biomicroscopy of the right eye (Fig.

Actual lens positions of three intraocular lenses in highly myopic eyes: an ultrasound biomicroscopy-based study

AimTo evaluate the actual lens positions (ALPs) of three intraocular lenses (IOLs) in highly myopic eyes and to identify relevant factors using ultrasound biomicroscopy (UBM).MethodsNinety-three highly myopic eyes (93 patients)...

The Double-Deck Viscoelastic Technique: a Novel Surgical Technique to Protect the Corneal Endothelium in Penetrating Keratoplasty of Aphakic Silicone Oil-Dependent Eyes after Severe Ocular Injury.

The purpose of this study is to summarize the benefits of the double-deck viscoelastic technique (DDVT), a novel and cost-effective surgical technique that creates a barrier to hinder silicone oil (SO) from connecting and damaging the corneal endothelium in aphakic and SO-dependent eyes. Five SO-dependent and aphakic eyes underwent double-deck viscoelastic embedment and penetrating keratoplasty (PKP) in this retrospective case series. At 1, 6, 12, 18, and 24months after surgery, clinical outcomes including best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and double-deck viscoelastic layer imaging were evaluated. A Heidelberg Retina Tomograph confocal microscope was used to measure ECD. Ultrasound biomicroscopy (UBM) was used to image the double-deck viscoelastic layer. Postoperatively, the BCVA of the patients ranged from hand motion detection to 20/200, and their IOP was between 7 and 10mmHg. The two-deck viscoelastic layer remained mostly static. Patients showed varying degrees of ECD reduction, with ECD loss rates in the first 6months ranging from 6.7 to 75.8cells/mm2/month and then declining to 2.2-14.3cells/mm2/month. In SO-dependent aphakic eyes, double-deck viscoelastic embedment could effectively inhibit SO-corneal endothelium interaction. This technique could lower the pace of ECD loss and lengthen the time of corneal transparency, giving aphakic and silicone oil-dependent patients the opportunity to accept PKP surgery and get better vision quality.

Clinical Application of Foldable Capsular Vitreous Bodies in the Treatment of Severe Ocular Trauma and Silicone Oil Dependent Eyes.

This study aimed to assess the application of a foldable capsular vitreous body (FCVB) in the treatment of severe ocular trauma and silicone oil (SO) dependent eyes. A retrospective analysis was performed on the clinical application of FCVB in the treatment of severe ocular trauma and SO dependent eyes. The results of best-corrected visual acuity and intraocular pressure (IOP) evaluation, B-scan ultrasonography or color Doppler ultrasonography, ultrasound biomicroscopy, and anterior segment photography were recorded during follow-up. A paired t-test was used to compare the difference in IOP before and after FCVB implantation. Seven eyes of seven patients were included in the 6-month follow-up. In all cases, B-scan ultrasonography and ultrasound biomicroscopy showed that FCVB adapted closely to the globe wall and ciliary body, thus supporting the retina. Visual acuity did not improve, except in one case from LP to HM. The mean ± SD IOP was 8.5 ± 1.90 mm·Hg prior to FCVB implantation and 10.43 ± 0.98 mm·Hg after implantation, with no significant difference between these measurements (P=0.095). Five of the seven patients developed differing degrees of corneal opacity and keratopathy. FCVB implantation may be a safe and effective method for the treatment of severe ocular trauma and SO dependent eyes. However, FCVB cannot prevent the phthisis of the traumatic eyes. In addition, corneal opacity and keratopathy are potentially serious complications after surgery. Appropriate case selection and proper surgical timing are required for further investigation.

Suprachoroidal injection of polyzwitterion hydrogel for treating glaucoma

Glaucoma is the primary cause of irreversible blindness worldwide. The current treatments are primarily based on drug usage or surgical operation to reduce intraocular pressure (IOP). However, it is expensive and requires patients to insist on taking the medicine for a long time. The suprachoroidal space (SCS) is the space between the choroid and the sclera, which forms part of the uveovortex pathway in the circulation of aqueous humor. So far, it is still challenging to realize the injection of hydrogels into the SCS with long-term duration. In this work, an in situ-forming polyzwitterionic polycarboxybetaine hydrogel is designed and injected to expand SCS to increase the drainage of aqueous humor from the eye via the uveovortex pathway, thus reducing IOP for at least 6 weeks, while commercial hyaluronic acid hydrogel can only last for about 4 weeks. The clinical ophthalmological safety assessment examination shows that the treatment of polyzwitterion hydrogel is well-tolerated that leads to minimal inflammatory reaction, and histopathology assessment demonstrates that the SCS is expanded after injection of the hydrogel. Further analysis of ultrasound biomicroscopy reveals that there is a strong correlation between IOP reduction and SCS expansion. In short, the polyzwitterion hydrogel developed in this work can prolong the period of IOP reduction by expanding SCS, thus treating ocular hypertension and glaucoma without resorting to drugs or regular surgery.

Combination of Trabeculectomy and Primary Pars Plana Vitrectomy in the Successful Treatment of Angle-Closure Glaucoma with BEST1 Mutations: Self-Controlled Case Series.

This study aimed to illustrate the efficacy of the combination of lens extraction, trabeculectomy, and anterior vitrectomy in patients with secondary angle-closure glaucoma (ACG) with autosomal recessive bestrophinopathy or Best vitelliform macular dystrophy. This is a retrospective self-controlled case series study. Five patients undergoing a single trabeculectomy in one eye and triple surgery in the other eye were enrolled. All patients underwent a complete ophthalmic examination that included best-corrected visual acuity (BCVA), intraocular pressure (IOP), ultrasound biomicroscopy, and static gonioscopy. Multimodal fundus imaging was performed, including color fundus photography, fundus autofluorescence, and optical coherence tomography. Genetic testing was also analyzed. Among the 10 eyes, the mean IOP was 31.4 ± 4.7mmHg before surgery. The mean axial length (AL) was 21.53mm and the anterior chamber depth (ACD) was 2.31mm. There were no statistically significant differences in preoperative IOP, BCVA, ACD, and AL between the two groups (all P > 0.05). The mean follow-up time was 64.0months. All five eyes with a single trabeculectomy developed malignant glaucoma (MG). No complications were found in the other five eyes with triple surgery, and the anterior chamber was deepened and stable after surgery until the last visit. The mean IOP at the last visit was normalized to 16mmHg without using any medications. Triple surgery is superior to single trabeculectomy for patients with ACG and BEST1 mutation, effectively bypassing MG complications. The vitreous may play a vital role in the mechanism of ACG in those patients and the high incidence of MG after filtering surgery.

Advantages of Micropulse Technology as a Method of Choice for the Treatment of Secondary Glaucoma in Patients with Corneal Diseases

Postkeratoplasty glaucoma develops after cornea transplantation in 10–53 % cases. For ophthalmotonus stabilization in patients, it was proposed to use micropulse laser surgery.Purpose. To evaluate the effectiveness of micropulse laser surgery in patients with secondary refractory glaucoma after keratoplasty.Patients and methods. The study included 27 eyes after different types of keratoplasty. The average level of intraocular pressure was 33.2 ± 3.7 mmHg, the average number of hypotensive drops was 2.9 ± 0.7. Visual acuity varied from incorrect light perception to 0.3 with correction. Micropulse laser treatment was performed with the standard settings and a power of 2800 mW.Results. On the first day after laser surgery, 24 patients had a decrease in IOP by an average of 24 % to 25.6 ± 3.3 mmHg. Three patients had a reactive increase in IOP by an average of 5 % to 33–36 mmHg. After 12 months of follow-up, the average IOP level was 24.9 ± 1.8 on the hypotensive drops, a decrease of IOP was 24.5 %, the number of hypotensive drops was reduced to 2.1 ± 0.7. In 6 cases, an increase in visual acuity by 1–2 lines was diagnosed due to a decrease in corneal edema. In 3 cases, 1–2 months after laser surgery, patients underwent second transplantation of the Descemet membrane. However, in 2 patients, an IOP increased again to 27–30 mmHg, and it was decided to conduct a repeated micropulse surgery with a power of 2800 mW. When observed for up to 3 months, IOP respond to the target level and averaged 18-20 mmHg. Using ultrasound biomicroscopy, the dynamics of changes in the thickness of the ciliary body was followed in all patients, the average thickness before surgery was 0.56 ± 0.11 mm. After 12 months, there was no statistical difference with the preoperative thickness, the average values were 0.55 ± 0.10 mm, the safety of its main structures was noted.Conclusion. Micropulse cyclophotocoagulation is an effective and safe method of treating secondary refractory glaucoma in the eyes both before keratoplasty and after repeated cornea transplantation, which opens up new prospects in the treatment of glaucoma combined with corneal diseases.