Ultrasound Biomicroscopy Parameters Research Articles

Ahmed's sub-flap mattress suture deep sclerectomy assessment with Ultrasound Biomicroscopy.

To assess the efficacy of adding Ahmed's sub-flap mattress suture to deep sclerectomy (DS). Forty eyes with open angle glaucoma were assigned randomly into two groups: Group A: underwent DS with Ahmed's sub-flap mattress suture. Group B: underwent conventional DS. Patients were followed up closely for 6 months with serial IOP measurements and ultrasound biomicroscopy (UBM) was used to assess the surgical site functionally and anatomically at the first and sixth month. Adding Ahmed's sub-flap mattress suture improved the IOP lowering effect of DS significantly from 43% in group B to 53% in group A at 6-month (p = 0.027). IOP in group A was at 1 week, 1 month and 6-month visits (7.9 ± 1.3, 11.7 ± 2.2 and 13.3 ± 1.9 mmHg respectively) compared to group B (10.1 ± 4.6, 14.1 ± 5.2 and 16.8 ± 4.1 mmHg respectively) (p = 0.025, 0.041 and 0.001 respectively). UBM parameters were significantly larger in group A at 1 and 6 months. Strong statistically significant negative correlations were established between IOP and all the UBM parameters apart from intrascleral lake height at the first and sixth month (p < 0.01 in all of them). Finally, significant correlations were found between IOP at 6 months and whole bleb anteroposterior length and height at 1 month (p = 0.001). Adding Ahmed's sub-flap mattress suture to routine DS is an effective economical addition that will enhance the IOP lowering effect of DS. Also, assessment of the bleb by UBM is useful in predicting the success of deep sclerectomy surgery.

Clinical and diagnostic imaging profile of three anterior segment dysgenesis disorders presenting with infantile corneal opacities.

To describe three anterior segment dysgenesis disorders with infantile corneal opacities, namely, congenital hereditary endothelial dystrophy (CHED), primary congenital glaucoma (PCG), and Peters anomaly (PA) in terms of clinical characteristics, histopathology, genetic association, and diagnostic imaging profiles using imaging modalities such as ultrasound biomicroscopy (UBM) and microscope-integrated intraoperative optical coherence tomography (i-OCT). Seventy-four eyes with 22 eyes of CHED, 28 eyes of PA, and 24 eyes of PCG were clinically evaluated and underwent imaging using UBM and i-OCT. Corneal buttons of 16 operated patients underwent histopathological analysis, while genetic analysis was done in 23 patients using whole-exome sequencing. Corneal diameters (CD) and UBM parameters like anterior chamber depth (ACD), iris thickness (IT), and ciliary body (CB) thickness revealed a statistically significant difference between the three categories. In PA, 9 eyes had a third rare phenotype with only a posterior corneal defect with no iris adhesions. Genetic mutations were seen in all tested patients with CHED, in 83.3% of patients with PCG, and in 80% of patients with the third type of PA. i-OCT helped in the characterization of corneal opacity, identification of posterior corneal defects, iridocorneal adhesions, and contour of Descemet's membrane. Overlapping phenotypes of the above disorders cause a diagnostic dilemma and parameters like CDs, UBM ACD, IT, and CB thickness help differentiate between them. i-OCT can help in classifying the diseases in a high resolution, non-contact manner, and can better delineate corneal characteristics. The rare third type of PA phenotype may have a genetic association.

Long-term effects of mild cataract extraction versus laser peripheral iridotomy on anterior chamber morphology in primary angle-closure suspect eyes

AimTo compare lens extraction (LE) and laser peripheral iridotomy (LPI) on anterior segment morphology in primary angle-closure suspect (PACS) eyes.MethodsThis prospective clinical trial included 144 patients with PACS who underwent...

Predictive Equation for Angle Opening Distance at 750 μm After Laser Peripheral Iridotomy in Primary Angle Closure Suspects.

Aim: The aim of this study was to investigate the changes in anterior segment parameters as assessed by ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) and to propose a prediction equation for the width of the angle after LPI.Design: This was a prospective study.Participants: The participants included 100 subjects with primary angle closure suspect (PACS).Methods: Anterior segment UBM parameters were measured, whereas AOD750 was chosen to indicate the width of the angle associated with gonioscopic angle closure, as found in a prior study.Main Outcome Measures: Angle parameters, iris parameters, anterior chamber parameters and ciliary body parameters.Results: All angle parameters increased after LPI, including the mean angle opening distance at 750 μm (AOD750), mean angle opening distance at 500 μm from the scleral spur (AOD500), mean angle opening distance at 750 μm from the scleral spur (AOD750), and mean angle recess area at 750 μm from the scleral spur (ARA750). Among iris parameters and ciliary body parameters, the iris thickness at 2,000 μm (IT2000), iris curvature (IC), and trabecular-ciliary process distance (ICPD) were reduced after LPI. The final equation consisted of four parameters: anterior chamber depth (ACD), iris thickness at 750 μm from the scleral spur (IT750), AOD750, and lens vault (LV). This equation explained 42.7% of the variability in the angle opening indicator AOD750 after LPI, whereas in the plateau iris configuration subgroup, the accuracy of the prediction equation reached the highest a maximum of 68.6%.Conclusions: There was an increase in angle opening and iris flattening after LPI. An equation involving four angle parameters was constructed, this equation which could explained 42.7% of the variability in the angle opening indicator AOD750 after LPI whereas in the plateau iris configuration subgroup, the accuracy of the prediction equation reached a maximum of 68.6%.

Ultrasound Biomicroscopy Might Predict the Outcome of Phacoemulsification-Visco Dissection in Medically Controlled Primary Angle-Closure Glaucoma Eye With Extensive Peripheral Anterior Synechia.

Objective: The treatment procedures of primary angle-closure glaucoma (PACG) with extensive peripheral anterior synechia (PAS) is a subject of debate. This study is to investigate the clinical features of phacoemulsification (Phaco)-visco dissection in medically controlled PACG patients with PAS > 180° and evaluate the predictability of Ultrasound Biomicroscopy (UBM) parameters on postoperative intraocular pressure (IOP).Methods: 48 eyes (48 patients) with acute angle-closure glaucoma (AACG) and 30 eyes (30 patients) with chronic angle-closure glaucoma (CACG) were prospectively included. All patients underwent phaco-viscogoniolysis and foldable lens implantation and were followed for 1 year after surgery. We analyzed preoperative and postoperative IOP, the numbers of anti-glaucoma medicine, the visual field value, the extent of PAS, and UBM parameters alterations, and evaluated the correlation between preoperative UBM parameters and one-year postoperative IOP.Results: IOP reduced significantly from 16.24 ± 4.33 to 14.49 ± 3.69 mmHg in AACG group and from 16.16 ± 3.69 mmHg to 14.31 ± 4.12 mmHg in CACG group, and PAS decreased significantly from 270 ± 60.33 to 171 ± 56.44° in AACG group and from 285 ± 70.46 to 168 ± 61.32° in CACG group, and the number of anti-glaucoma drugs decreased significantly in both groups. Several UBM parameters, including anterior chamber depth, trabecular iris angle, and peripheral iris thickness 500 increased while iris convex reduced considerably in the two groups, and angle opening distance 500 and trabecular-meshwork ciliary process angle increased significantly only in AACG group. One-year postoperative IOP correlated with preoperative angle opening distance 500 and trabecular iris angle negatively and iris convex positively.Conclusion: Phaco-visco dissection can effectively reduce IOP, the numbers of glaucomatous medications, and PAS in medically controlled PACG patients with extensive PAS. UBM parameters might be valuable for analyzing postoperative anterior segment structure and predicting postoperative IOP of Phaco-visco dissection in PACG patients with extensive PAS.

The significance of ultrasound biomicroscopy in the objective assessment of post-trabeculectomy bleb success.

To compare clinical characteristics and ultrasound biomicroscopy (UBM) measurements of cases with functional and non-functional blebs, and to identify potential risk factors capable of affecting UBM parameters. Thirty-one patients aged 40-79 were included. Following trabeculectomy, cases were divided into two groups as those with functional bleb (Group 1, n = 20) and those with non-functional bleb (Group 2, n = 11). UBM was performed. In Group 1 compared to Group 2, lower postoperative intraocular pressure (IOP) (12.1 ± 1.7 vs 27.2 ± 3.2 mmHg, p < 0.001), greater bleb height (1.0 ± 0.2 vs 0.5 ± 0.3 mm, p < 0.001), greater scleral route visibility [16/20 (80%) vs 4/11 (36.4%), p = 0.023] and lower bleb reflectivity (1.8 ± 0.2 vs 2.4 ± 0.4, p = 0.015) were observed. In Group 1, as postoperative IOP decreased, bleb height and scleral route visibility increased (r = -0.387, p = 0.029 for bleb height; r = -0.374, p = 0.033 for scleral route), and bleb reflectivity decreased (r = 0.359, p = 0.042). In Group 1, as duration of preoperative antiglaucoma drug use increased, bleb reflectivity increased (r = 0.348, p = 0.046). Preoperative IOP and number of preoperative antiglaucoma drug use had no effect on UBM parameters in groups (p > 0.05). UBM is useful in assessing bleb success. Lower bleb reflectivity, greater bleb height and greater scleral route visibility indicate that the bleb is functional. To the best of our knowledge, this is the first study investigating effects of preoperative IOP, number and duration of preoperative antiglaucoma drug use on UBM parameters. In cases with functional bleb, duration of preoperative drug use affects only bleb reflectivity, while postoperative IOP affects bleb height, scleral route visibility and bleb reflectivity.

Transscleral cyclophotocoagulation followed by cataract surgery: a novel protocol to treat refractory acute primary angle closure

BackgroundTo introduce a novel protocol to treat refractory acute primary angle closure (APAC): transscleral cyclophotocoagulation (TCP) followed by cataract surgery.MethodsThirteen APAC eyes (13 patients) were enrolled in this prospective case series as study group. All patients underwent emergency TCP (20 pulses of 2000 mW during 2000 ms applied to the inferior quadrant) followed by scheduled cataract surgery. They were compared to 13 age- and gender-matched patients treated with emergency phacotrabeculectomy. We recorded intraocular pressure (IOP), best corrected visual acuity (BCVA), and complications, and several ultrasound biomicroscopy (UBM) parameters before and after TCP.ResultsIn the study group, IOP decreased from 51.5 ± 7.0 mmHg (mean ± standard deviation) before TCP to 16.4 ± 5.4 mmHg 1 day after TCP (P < 0.001). At 6 months, there was no significant difference in IOP between the study group (14.0 ± 3.4 mmHg) and control group (16.7 ± 4.3 mmHg; P = 0.090); IOP lowering medications were used by 0/13 in the study group and 2/13 patients in the control group (P = 0.48). At 6 months, there was no significant difference in BCVA between the study group and the control group (20/25 (20/200 to 20/25) and 20/30 (20/50 to 20/25), respectively; P = 1.0). The UBM parameters anterior chamber depth (P = 0.016), angle-opening distance at 500 μm (P = 0.011), and maximum ciliary body thickness (P < 0.001) increased significantly while the iris-ciliary process distance decreased significantly (P = 0.020) after TCP.ConclusionsTCP effectively lowers IOP and modifies the anterior chamber morphology in APAC; TCP followed by cataract surgery can be considered an alternative to treat refractory APAC but needs further evaluation.Trial registrationThis project was registered in Chinese Clinical Trial Registry (ChiCTR1800017475) at July, 31, 2018 (http://www.chictr.org.cn/edit.aspx?pid=29629&htm=4).

COMPARATIVE EVALUATION OF ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY, ULTRASOUND BIOMICROSCOPY, AND INTRAOCULAR PRESSURE CHANGES AFTER PANRETINAL PHOTOCOAGULATION BY PASCAL AND CONVENTIONAL LASER.

To compare intraocular pressure, anterior segment optical coherence tomography, and ultrasound biomicroscopy parameters over 3 months after panretinal photocoagulation (PRP) for proliferative diabetic retinopathy after 1 of 2 sittings by conventional laser (half PRP) and a single sitting of Pattern Scan Laser (PASCAL) PRP. This was a prospective, randomized, interventional study. All tests were performed at baseline, and at 1, 6, and 24 hours, and 1, 4, 8, and 12 weeks after PRP. The intraocular pressure at 1 hour and 6 hours after PRP was significantly raised in both groups. Mean intraocular pressure was 21.17 ± 4.01 mmHg after PASCAL and 17.48 ± 3 mmHg after conventional laser at 1 hour, P < 0.001. On anterior segment optical coherence tomography, conventional laser PRP caused a more significant narrowing of angle-opening distance (AOD750) and trabecular-iris space area (TISA 500), P = 0.03 and 0.04, respectively, on Day 1. Ultrasound biomicroscopy showed a significantly narrow angle in both groups on Day 1. A significant increase in ciliary body thickness was observed in both groups, with 57.1% of PASCAL and 100% of conventionally treated eyes showing ciliary effusion on Day 1 that decreased but persisted for the next 3 months. Performing PRP in sittings, prescribing previous glaucoma medications in patients at risk, and recording intraocular pressure an hour after the PRP could decrease complications.

Functional evaluation of the filtering bleb by ultrasound biomicroscopy after trabeculectomy with mitomycin C.

To study the role of ultrasound biomicroscopy (UBM) in the assessment of the bleb function after trabeculectomy with mitomycin C (MMC). This was a cross-sectional study including all cases had undergone trabeculectomy with MMC 0.2 mg/mL for 3min. Participants were recruited from the follow-up cases at Department of Ophthalmology, Tanta University in the period from August 2015 to August 2016. Full history taking and ophthalmological examination were performed. Intraocular pressure (IOP) was measured using Goldmann applanation tonometry and the history of prescribed postoperative antiglaucoma medications was recorded. Accordingly, the trabeculectomy blebs were divided clinically into successful blebs when the IOP post-operative was ≤18 mm Hg without medications. Scanning examination of the filtering bleb using UBM examination was performed at the period from 2 to 36mo after trabeculectomy (13.6±9.7mo). This study included 33 trabeculectomy filtering blebs of 25 patients (9 males and 16 females). The mean age of patients was 53.2±14.2y (range 25-71y). We had 20 eyes with complete success, 9 eyes with qualified success, and 4 eyes with failure after trabeculectomy with MMC. The blebs were classified into successful blebs (IOP ≤18 mm Hg without antiglaucoma medications), others were classified into qualified successful and failed blebs. There was a significant correlation between certain UBM findings (intra-bleb reflectivity, draining sub-scleral tract, bleb height, and intrableb fluid cysts) and cases with different grades of clinical functional success (P<0.01). UBM is an objective tool in the functional assessment of the post-trabeculectomy filtering bleb through a significant correlation between certain UBM parameters and the different grades of clinical functional success.

Prediction of accommodative optical response in prepresbyopic subjects using ultrasound biomicroscopy

To determine whether relatively low-resolution ultrasound biomicroscopy (UBM) can be used to predict the accommodative optical response in prepresbyopic eyes as well as in a previous study of young phakic subjects, despite lower accommodative amplitudes. College of Optometry, University of Houston, Houston, USA. Observational cross-sectional study. Static accommodative optical response was measured with infrared photorefraction and an autorefractor (WR-5100K) in subjects aged 36 to 46 years. A 35 MHz UBM device (Vumax, Sonomed Escalon) was used to image the left eye, while the right eye viewed accommodative stimuli. Custom-developed Matlab image-analysis software was used to perform automated analysis of UBM images to measure the ocular biometry parameters. The accommodative optical response was predicted from biometry parameters using linear regression, 95% confidence intervals (CIs), and 95% prediction intervals. The study evaluated 25 subjects. Per-diopter (D) accommodative changes in anterior chamber depth (ACD), lens thickness, anterior and posterior lens radii of curvature, and anterior segment length were similar to previous values from young subjects. The standard deviations (SDs) of accommodative optical response predicted from linear regressions for UBM-measured biometry parameters were ACD, 0.15 D; lens thickness, 0.25 D; anterior lens radii of curvature, 0.09 D; posterior lens radii of curvature, 0.37 D; and anterior segment length, 0.42 D. Ultrasound biomicroscopy parameters can, on average, predict accommodative optical responses with SDs of less than 0.55 D using linear regressions and 95% CIs. Ultrasound biomicroscopy can be used to visualize and quantify accommodative biometric changes and predict accommodative optical response in prepresbyopic eyes.

Ultrasound biomicroscopy findings in the area of previous surgical intervention in refractory glaucoma patients under topical ocular hypotensive therapy

to evaluate the effectiveness of different classes of topical hypotensive medications in refractory primary open-angle glaucoma (POAG), judging from structural changes in artificial pathways for intraocular fluid (IOF) visualized with ultrasound biomicroscopy (UBM). UBM analysis was performed in 104 eyes of 102 patients, mean age 68.4 ± 0.8 years, including 41 POAG patients with well controlled intraocular pressure (IOP) (group 1) and 41 refractory POAG patients with poorly controlled IOP (group 2), all under topical hypotensive therapy (prostaglandin analogues, beta blockers, carbonic anhydrase inhibitors, or combination drugs). The control group consisted of 20 patients, who maintained normal IOP after a single glaucoma surgery and did not require medical management. The following UBM parameters were evaluated: intrascleral cavity and filtering bleb heights and conjunctival and scleral flap thicknesses. Findings differed depending on the condition of IOF outflow pathways. Unlike the poorly controlled patients, UBM parameters in group 1 were comparable to those in the controls. The optimal control of postoperative IOP was achieved on combination therapy (a beta blocker plus a carbonic anhydrase inhibitor). In contrast to well controlled POAG patients, target values of IOP were not achieved in refractory POAG patients with either of the topical therapeutic measures. Moreover, intrascleral cavity and filtering bleb heights in these patients were reliably low (p ≤ 0.01), as confirmed by UBM analysis of the area of surgical intervention.

Factors Related to Future Peripheral Anterior Synechiae Formation on Ultrasound Biomicroscopy

To study factors associated with future peripheral anterior synechiae (PAS) formation on ultrasound biomicroscopy (UBM) in eyes with a shallow peripheral anterior chamber. Fifteen subjects with a shallow peripheral anterior chamber but no PAS in both eyes, in 2001, that had no medical or surgical intervention until 2008 were included in this study. The same examiners performed gonioscopy and UBM at the 3, 6, 9, and 12 o'clock limbal positions under dark and light conditions in 2001 and 2008. A masked examiner performed a quantitative evaluation of the angle configurations in the UBM images. The presence or absence of PAS was determined by compression gonioscopy. The UBM parameters and the number of appositional closures per eye were compared between PAS-positive eyes and PAS-negative eyes. One eye from 15 subjects were randomly selected and included in the analyses. The gonioscopic gradings and UBM parameters did not change significantly (P>0.1) between 2001 and 2008. Seven (47%; 95% confidence interval, 25-70) of 15 eyes developed PAS. In 2001, under dark conditions, the appositional angle closure in 3 to 4 quadrants was found more often (P=0.026) in 7 eyes where PAS developed during the following 7 years than in other 8 eyes. In eyes with a shallow peripheral anterior chamber but no PAS, PAS developed in 47% of eyes followed without intervention for 7 years. PAS was significantly more likely to develop in eyes with the appositional angle closure found in 3 to 4 quadrants under dark conditions.

Peripheral Anterior Synechia Reduce Extent of Angle Widening After Laser Peripheral Iridotomy in Eyes With Primary Angle Closure

To quantify the effect of laser peripheral iridotomy (LPI) on angle widening in primary angle closure with and without peripheral anterior synechia (PAS). Prospective hospital-based study of 44 consecutive patients (69 eyes) with primary angle closure. Comprehensive ophthalmic examination and ultrasound biomicroscopy were performed at enrollment and 2 weeks following LPI. The following angle parameters: angle opening distance, trabecular-iris angle, and angle recess area were obtained. On the basis of the presence of PAS, angle quadrants were divided into 3 groups: group A comprised quadrants in PAS-negative eyes; group B, the unaffected quadrants in PAS-positive eyes; and group C, the quadrants with PAS in PAS-positive eyes. Correlation between PAS and angle width was determined and changes in angle parameters following LPI were compared between groups. Sixty-six eyes of 42 patients (31 eyes with PAS) were available for analysis. Groups A, B, and C provided 140, 66, and 58 quadrants, respectively, for analysis. There was a moderate negative correlation between angle width changes (angle opening distance, trabecular-iris angle, angle recess area) after LPI and PAS extent at baseline (r=-0.46 to -0.39; P<0.01). The change in angle width was significantly different between groups A and B compared to group C (P<0.01); there was no difference between groups A and B. Changes in anterior chamber angle following LPI were inversely correlated with presence of PAS. Quadrants unaffected by PAS can be expected to widen as much as in eyes with only appositional closure. In quadrants with PAS the ultrasound biomicroscopy parameters did not change following LPI.

EARLY ESTIMATION OF VENTRICULAR SYSTOLIC PRESSURE AND SUCCESSFUL AORTIC CONSTRICTION IN A MOUSE MODEL OF CARDIAC PRESSURE OVERLOAD BY ULTRASOUND BIOMICROSCOPY

ObjectivesElevation of left ventricular end-systolic pressure (LVESP) and hypertrophic response in mice varies after transverse aorta constriction (TAC). Micromanometric catheterization, conventionally used to select the mice with successful TAC, is...

Nanophthalmos: quantitative analysis of anterior chamber angle configuration before and after cataract surgery

Background/aimsTo analyse quantitatively the anterior segment configuration in eyes with nanophthalmos before and after cataract surgery.MethodsThis was a retrospective, non-comparative, interventional case series. Eleven eyes in eight patients with nanophthalmos...

Early Estimation of Left Ventricular Systolic Pressure and Prediction of Successful Aortic Constriction in a Mouse Model of Pressure Overload by Ultrasound Biomicroscopy

Elevation of left ventricular end-systolic pressure (LVESP) and hypertrophic response in mice varies after transverse aorta constriction (TAC). Micromanometric catheterization, conventionally used to select mice with successful TAC, is invasive and nonreusable. We aimed to establish noninvasive imaging protocols for early estimation of successful TAC by ultrasound biomicroscopy (UBM). Out of 55 C57BL/6J mice, we randomly selected 45 as TAC group and 10 as controls. UMB was performed before TAC and, at day 3 and day 14, after TAC. In all mice, LVESP was measured with a Millar conductance catheter at day 14. With LVESP ≥ 150 mm Hg set as indicator of successful TAC (TAC+) and LVESP < 150 mm Hg as unsuccessful (TAC−), receiver operating characteristic curve analysis demonstrated that postoperative inner diameter at aortic banding site (IDb), peak flow velocity at aortic banding site (PVb) and peak flow velocity of right/left common carotid artery (PVr/l) at day 3 served as most effective predictors for LVESP at day 14 (area under curve = 0.9016, 0.9143, 0.8254, respectively. p < 0.01 for all). Among all UBM parameters at day 3, IDb, PVb, right common carotid artery peak flow velocity (PVr) and PVr/l correlated best with LVESP at day 14 (R2 = 0.5740, 0.6549, 0.5208, 0.2274, respectively. p < 0.01 for all). Furthermore, IDb, PVb, and PVr/l at day 3 most effectively predict long-term cardiac hypertrophy, using the cut-off values of 0.45 mm, 2698.00 mm/s, 3.08, respectively. UBM can be a noninvasive and effective option for early prediction of successful TAC.

Anterior Segment Optical Coherence Tomography Characteristics in an Asian Population

To quantify the angle characteristics in an Indian population, and determine the prevalence of eyes at risk of angle closure. This population-based cohort study was carried out to evaluate individuals, 40 to 59 years of age, clinically. The individuals underwent anterior segment optical coherence tomography of their right eyes in the horizontal meridian, using the enhanced protocol. The mean scleral spur angle for the population was 24.2±10.2 degrees, and a manually measured angle recess was 23.2±10.2 degrees, with a κ value of agreement of 0.78, 85.7%. An angle of <20 degrees was seen in 154 eyes, 38.7%, 20 to 30 degrees in 154 eyes, 38.7%, and >30 degrees in 90 eyes, 22.6%. An anterior chamber angle of <20 degrees was significantly associated with age, sex, and a steep iris configuration.The scleral spur angle and the manually recorded anterior chamber angle recess correlated very well with all angle ultrasound biomicroscopy parameters, but showed the highest receiver operating characteristic curve with trabecular iris space area 500, r=0.989 and angle opening distance 750, r=0.943. On multivariate analysis, there was a significant correlation with trabecular iris space area, angle opening distance, and height. Of individuals, 38.7%, 40 to 60 years of age, were found to have an anterior chamber angle of <20 degrees, reflecting the high prevalence of primary angle closure and primary angle closure glaucoma in India.

Comparison of Ultrasound Biomicroscopic Configurations Among Primary Angle Closure, Its Suspects, and Nonoccludable Angles: The Kumejima Study

To quantitatively characterize the ultrasound biomicroscopy (UBM) configurations of the peripheral anterior chamber (AC) in primary angle closure (PAC) and its suspects and to evaluate the diagnostic performance of the UBM parameters to differentiate PAC/PAC suspects in a population-based setting. Cross-sectional study. A random 461 of 4632 residents 40 years or older on a southwest island in Japan underwent UBM under light and dark conditions. Of the 374 eligible randomly sampled residents (after excluding 87 with a history of intraocular surgeries, ocular trauma, or iritis; a physical or mental disability making the UBM measurement difficult; or refusal to undergo UBM measurements), reliable UBM images were obtained in 301 right eyes (80.4%). In 45 eyes with PAC/PAC suspects compared to 256 with nonoccludable angles, the angle-opening distance (AOD), trabecular-iris angle (TIA), and trabecular-ciliary process distance (TCPD) under light and dark conditions were smaller (P < .001), while the iris thickness was smaller only under dark conditions (P = .040). Dark-light changes in the AOD and TIA were significantly smaller in the PAC/PAC suspects than in the nonoccludable angles (P < .03); the iris thicknesses did not differ significantly between them. Areas under the receiver operating characteristic curves of the AOD at 500 μm from the scleral spur (AOD500) and TIA in light were 0.94, suggesting these parameters were good for differentiating PAC/PAC suspects. The ideal cutoff values for the AOD500 and TIA under light conditions were 0.17 mm (sensitivity, 0.82; specificity, 0.96) and 15.2 degrees (sensitivity, 0.83, specificity, 0.93), respectively. Eyes with PAC/PAC suspects had shallow ACs, anteriorly located ciliary bodies, and smaller dark-light changes in the peripheral AC depth, while the iris thickness was similar to that in eyes with nonoccludable angles. The peripheral AC depth under light conditions could most clearly differentiate PAC/PAC suspects from nonoccludable angles.

Morphologic Changes in the Anterior Segment in Patients with Initial-onset or Recurrent Vogt-Koyanagi-Harada Disease

Purposes: To investigate morphologic changes in anterior segments based on inflammatory phases of Vogt-Koyanagi-Harada (VKH).Methods: The author recruited 76 consecutive eyes of 38 patients with initial-onset VKH and 52 eyes of 26 patients with recurrent VKH. Morphologic changes in anterior segments were measured by ultrasound biomicroscopy (UBM). UBM parameters and intraocular pressure (IOP) were compared between two groups.Results: Ciliary thickness and area significantly increased in the recurrent group compared with the initial-onset group. Twelve patients (31%) in the initial-onset group showed supraciliary effusions, but no patients in the recurrent group had supraciliary effusions. Angle opening and anterior chamber depth were significantly decreased in the initial-onset group compared with the recurrent group. High IOP > 30 mmHg was found in 7 patients with initial-onset disease, while low IOP < 10 mmHg was detected in 6 patients with recurrent disease.Conclusions: The results indicate that morphologic changes associated with IOP alterations depend on inflammatory phases of VKH disease.

Ultrasound biomicroscopy and iris pigment dispersion: a case―control study

Background/aimsThe study involved eyes affected by pigment dispersion syndrome (PDS) or pigmentary glaucoma (PG) investigated by ultrasound biomicroscopy (UBM). Different irido-corneal parameters were assessed and compared with those from healthy...