DOCSLIB.ORG

Expert Tips for Assessing the Narrow Angle

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Expert Tips for Assessing the Narrow Angle Clinical Update EXTRA VIDEO & ADDITIONAL CONTENT AVAILABLE GLAUCOMA MD Roundtable: Expert Tips for Assessing the Narrow Angle moderated by sanjay g. asrani, md, with paul j. foster, frcs, paul f. palmberg, md, phd, and robert ritch, md, facs his article is part of an occa- Light vs. Dark sional series of MD Round- tables, in which a group of 1A 1B experts discuss a topic of interest in their field. This Tmonth, Sanjay G. Asrani, MD, of the Duke Eye Center, leads a roundtable on diagnosing the narrow angle. He is joined by Paul J. Foster, FRCS, of Uni- versity College London, Paul F. Palm- berg, MD, PhD, of Bascom Palmer Eye Institute, and Robert Ritch, MD, FACS, of the New York Eye and Ear In- firmary. Following are edited excerpts Angle is open in the light (1A) but closed in the dark (1B), showing the impor- from their conversation. tance of darkness in assessing a narrow angle. Next month, these experts discuss when to consider laser iridotomy for we had a lot of practical information So now, it’s uncommon for me to narrow angles. on how to do gonioscopy. Unfortu- get referrals from ophthalmologist nately, in the subsequent issues, much colleagues where I think that they’ve An Increase in Narrow Angles? of that practical information on criti- missed angle closure. But, certainly, Dr. Asrani: Do you feel that you are cal features somehow dropped out, and there are a lot of cases that come from diagnosing narrow angles with greater it would be nice to get it back in: for optometry where they have been re- frequency than your colleagues over example, no light through the pupil, ferred for high pressure, and no assess- the past five to 10 years? no fixation target, doing it in a dark ments of the angle were performed. Dr. Palmberg: I take it you’re ask- room, using a Zeiss-type lens, and us- Second, Even Third, Opinions. Dr. ing if we’re finding a lot of cases of ing the parallelepiped method. Ritch: About 30 years ago, there was angle closure that were referred to us Status in the U.K. Dr. Asrani: Paul so much angle closure that was undi- for poor IOP [intraocular pressure] Foster, what is your take on this? agnosed and misdiagnosed. Patients control by doctors who thought the Dr. Foster: In the United Kingdom, would be referred with chronic open- patients had open-angle glaucoma. Of- the system is probably slightly differ- angle glaucoma or primary open-angle ten, at cocktail parties, glaucoma spe- ent. We tend to get fewer referrals from glaucoma, but they had 90 percent cialists get together and say, “What’s general ophthalmologists. More of the PAS [peripheral anterior synechiae]. wrong with the general ophthalmolo- time, the referral has come from an And either people recognize that bet- gists? They’re missing a lot of angle optometrist direct to a glaucoma spe- ter now, or I’m not getting that many closure.” And I usually say, “Well, cialist. I think that glaucoma special- referrals. what’s wrong with us that we haven’t ists in the U.K. now are fairly sensitive I still see a few patients who have been teaching gonioscopy and related to the idea that everybody should have been misdiagnosed, but mostly I see techniques well?” gonioscopy. And I think the standards people who have already been diag- When the first Preferred Practice of gonioscopy have improved dramati- nosed—they have been told by one robert ritch, md Pattern for angle closure was written, cally in the last 10 years. doctor that they had narrow angles but eyenet 31 Glaucoma 2A 2B your technique of gonioscopy that Paul Palmberg started to talk about? Darkness Is Essential. Dr. Ritch: Yes. I agree with everything that Paul said. It’s really important, number one, to do gonioscopy in a completely darkened room. I tell this to my fellows and go over it over and over again. And after they’ve done six months of a fel- WHAT LINE IS THIS? (2A) Is this somewhat discontinuous pigmented line (arrow) lowship, I’ll walk in on them and they the pigmented band of the trabecular meshwork? The angle appears to be fairly tell me it’s a grade 2 angle; but when I open, grade 3. (2B) With indentation gonioscopy, the angle opens, and the same turn the lights out and do gonioscopy, line is clearly shown to be a Sampaolesi line, with a splotchy, “salt-and-pepper” the angle closes up. And I say, “Did appearance; below it is the true trabecular meshwork line, a continuous line with you do it in the dark,” and they say a “fine powdered brown sugar” appearance. yes. Then I say, “Real dark? I mean the lights completely out; the computer didn’t need an iridotomy, and the next a second opinion because of poor IOP screen off?” And they say, “Oh, uh, no, one told them they had narrow angles control, and they are being treated just mildly dark.” but needed an iridotomy, and another by other glaucoma specialists when I There should be no light through would tell them they didn’t have nar- diagnose that they actually have inter- the pupil. So the main thing is to use a row angles, not to worry about it. mittent angle closure or narrow angles. small slit beam—a little square slit— And I’ll give them the definitive And they are surprised that the other and look first in the inferior mirror. decision. You know, I had one patient glaucoma specialists did not pick it up. The superior angle is the narrowest come in, and her husband was taking So Paul Palmberg, I agree entirely with 98 percent of the time. If the superior all these notes. I said, “Look, you’ll get your ability to show the patient’s fam- angle is more open than the inferior a copy of the consultation letter. Your ily members the condition. angle, I consider that a potential sign husband doesn’t need to take all these With Teaching Scope. Dr. Asrani: of exfoliation syndrome. notes.” She said, “That’s not my hus- Also, sometimes I use the teaching Dr. Palmberg: And don’t use a band—that’s my lawyer.” scope that I have on all the slit lamps. I fixation target because that alters the encourage the family members to look pupil. Demonstrating Angle Closure through it when I examine patients Be Sure to Wait. Dr. Asrani: I re- With Video. Dr. Palmberg: For patients who are skeptical or doubtful of this ally encourage my fellows to wait 10 like that, I have found it helpful to have diagnosis. I show this to them on an- seconds after the gonio lens has been a video camera on my slit lamp. I show terior segment OCT by turning on the placed on the eye, so as to let the them the angle, and then I make sure lights and then turning off the lights, constriction of the pupil get relaxed, that there is no light going through the and then that convinces them with a to lose the effect of accommodation. pupil. They sit there—the patient and, lot more certainty. Paul Foster, do you When the pupil is in the middilated usually, the husband, not the lawyer— have a technique that you use in the position, that is when you see the angle and watch the angle close over a course U.K. to convince patients, or do they closed, and that has really allowed me of about eight to 10 seconds in the take your word for it? to diagnose a lot more of these narrow dark. And then, because they have seen With OCT. Dr. Foster: I’ve found angles than before. I do exactly the it, they believe it. (See Fig. 1.) that it’s difficult to illustrate the angle same thing as Bob and Paul, putting You can show them how dynamic closure to the medical layman. So I the parallelepiped light into the mir- it is and why it was that one doctor on agree that anterior segment OCT is ex- ror, avoiding the pupil altogether. one occasion and one at another time tremely useful, with scans made in the Dr. Ritch: I’ve concluded that 10 might actually have seen different light and in the dark, often showing an seconds is not enough in some cases. things, depending on the state of hy- open angle in the light and closed in Sometimes I have to wait two minutes. dration and certainly on the technique the dark. And as soon as patients see And after two minutes, they finally get with light through the pupil. So if any those images, they become convinced. narrower and narrower and then close one doctor does see the angle close, up to the trabecular meshwork. that trumps the observations of others. Expert Tips for Gonioscopy Dr. Palmberg: I guess that’s the In that way, patients don’t feel judg- Dr. Asrani: Bob, you pioneered the point of it, Bob, that if you see it stead- mental against the other doctors. concept of doing gonioscopy in the ily narrowing, you wait to see where Dr. Asrani: I certainly agree, and dark and promoted it. Unfortunately, it’s going to finish. that’s why I asked the question. I have very few people have adopted it. Would Getting Started. Dr. Ritch: I started been seeing patients who come in for you be able to share a few more tips on doing indentation gonioscopy when I paul palmberg, md, phd 32 january 2015 Glaucoma was a fellow, and I found that you have do is wrap my little finger around the des.
Load more

Recommended publications
  • Post-Miosis Changes in the Anterior Chamber Structures in Primary and Lens-Induced Secondary Chronic Angle- Closure Glaucoma
    Int J Ophthalmol, Vol. 12, No. 4, Apr.18, 2019 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: [email protected] ·Brief Report· Post-miosis changes in the anterior chamber structures in primary and lens-induced secondary chronic angle- closure glaucoma Mu Li1, Xiao-Qin Yan1, Gai-Yun Li1,2, Hong Zhang1 1Department of Ophthalmology, Tongji Hospital, Tongji INTRODUCTION Medical College, Huazhong University of Science and laucoma was a leading cause of irreversible blindness Technology, Wuhan 430030, Hubei Province, China G worldwide[1-2], and could be categorized into two types: 2Retinal Department, Shanxi Eye Hospital, Taiyuan 030002, angle-closure glaucoma (ACG) and open angle glaucoma. In Shanxi Province, China Asian, ACG is more prevalent than open angle glaucoma[3-5]. In Co-first authors: Mu Li and Xiao-Qin Yan terms of ACG, it could be divided into primary and secondary Correspondence to: Gai-Yun Li. No.100, Fudong Street, types. For the pathogenesis of primary ACG, besides the Taiyuan 030002, Shanxi Province, China. [email protected]; non-pupillary block mechanisms[6-11], the major mechanism Hong Zhang. No.1095, Jiefang Road, Wuhan 430030, Hubei was pupillary block[12-13]. As an initial option for primary Province, China. [email protected] ACG treatment, miotics could induce the contraction of the Received: 2018-04-13 Accepted: 2018-12-05 sphincter pupillae, which could then pull the peripheral iris away from the trabecular meshwork and therefore reopen Abstract the angle, and finally decrease intraocular pressure (IOP) and ● To evaluate post-miosis changes in the anterior chamber control the progression of glaucoma.
    [Show full text]
  • Ophthalmology Abbreviations Alphabetical
    COMMON OPHTHALMOLOGY ABBREVIATIONS Listed as one of America’s Illinois Eye and Ear Infi rmary Best Hospitals for Ophthalmology UIC Department of Ophthalmology & Visual Sciences by U.S.News & World Report Commonly Used Ophthalmology Abbreviations Alphabetical A POCKET GUIDE FOR RESIDENTS Compiled by: Bryan Kim, MD COMMON OPHTHALMOLOGY ABBREVIATIONS A/C or AC anterior chamber Anterior chamber Dilators (red top); A1% atropine 1% education The Department of Ophthalmology accepts six residents Drops/Meds to its program each year, making it one of nation’s largest programs. We are anterior cortical changes/ ACC Lens: Diagnoses/findings also one of the most competitive with well over 600 applicants annually, of cataract whom 84 are granted interviews. Our selection standards are among the Glaucoma: Diagnoses/ highest. Our incoming residents graduated from prestigious medical schools ACG angle closure glaucoma including Brown, Northwestern, MIT, Cornell, University of Michigan, and findings University of Southern California. GPA’s are typically 4.0 and board scores anterior chamber intraocular ACIOL Lens are rarely lower than the 95th percentile. Most applicants have research lens experience. In recent years our residents have gone on to prestigious fellowships at UC Davis, University of Chicago, Northwestern, University amount of plus reading of Iowa, Oregon Health Sciences University, Bascom Palmer, Duke, UCSF, Add power (for bifocal/progres- Refraction Emory, Wilmer Eye Institute, and UCLA. Our tradition of excellence in sives) ophthalmologic education is reflected in the leadership positions held by anterior ischemic optic Nerve/Neuro: Diagno- AION our alumni, who serve as chairs of ophthalmology departments, the dean neuropathy ses/findings of a leading medical school, and the director of the National Eye Institute.
    [Show full text]
  • Contractile Cells in the Human Scleral Spur
    Exp. Eye Res. (1992) 54, 531-543 Contractile Cells in the Human Scleral Spur ERNST TAMM”“, CASSANDRA FLUGEL”, FRITZ H.STEFANIb~~~ JOHANNES W. ROHEN” aDepartment of Anatomy, University of Erlangen- Niirnberg and bEye Hospital of the University of Munich, Germany (Received Lund 75 March 7997 and accepted in revised form 73 June 7997) The scieral spur in 37 human (age 17-87 years) and six cynomolgusmonkey eyes (2-4 years) was investigated. Serial meridional and tangential sections were studied with ultrastructural and immunocytochemicalmethods. The bundlesof the ciliary muscledo not enter the scleralspur, but their tendons, which consistof elasticfibres join the elasticfibres in the scleralspur. Within the scleralspur a populationof circularly oriented and spindle-shapedcells is found. In contrast to the ciliary musclecells, the scleralspur cellsform no bundles,but are looselyaggregated. They have long cytoplasmicprocesses and are connectedto each other by adherens-typeand gap junctions. They stain intensely for a-smooth muscleactin. myosin and vimentin. In contrast to the ciliary musclecells, they do not stain for desmin. Ultrastructurally, the scleral spur cells contain abundant thin (actin) filaments, but do not otherwise show the typical ultrastructural features of ciliary musclecells. The scleral spur cells do not expressa completebasal lamina. They form individual tendinousconnections with the elasticfibres in the scleral spur, which are continuous with the elasticfibres of the trabecular meshwork.The scleralspur cellsare in close contact with nerve terminals containing small agranular (30-60 nm) and large granular (65-l 10 nm) vesiclesbut alsowith terminalscontaining small granular (30-60 nm) vesicleswhich are regardedas typical for adrenergic terminals. We conclude that the scleral spur cells are contractile myofibroblasts.Their contraction might influence the rate of the aqueousoutflow.
    [Show full text]
  • Navigating the Angle: Gonioscopy
    4/13/17 Navigating the Angle: Gonioscopy Justin Schweitzer, OD, FAAO Cataract, Cornea, Refractive and Glaucoma Surgery Specialist Vance Thompson Vision Sioux Falls, South DaKota To Participate in Live Polling: • Download “Poll Everywhere” App from your mobile app store • Log on & choose “I’m Participating” • Join PollEv.com/ Or to participate via mobile device without the app, text Cornea to 22333 to join Allergan GlauKos Bausch and Lomb Bio-Tissue Alcon BioTissue Reichert 1 4/13/17 2 4/13/17 How do we view the angle? Direct Lens – use a contact lens with specific anterior curvature that will overcome critical angle Indirect – use a mirror to overcome the critical angle Direct Gonioscopy Koeppe Lens Indirect Gonioscopy Goldmann Three Mirror Zeiss four-mirror lens 3 4/13/17 Gonioscopy The gold standard for assessing the drainage apparatus of the eye CPT code 92020 Gonioscopy Important in distinguishing between different types of glaucoma Open vs Closed angle glaucoma Types of Goniolenses 4 4/13/17 6 mirror lens?!?! 5 4/13/17 SlitS -Lamp Setup 6 4/13/17 Set-up Tips Position mirror at 12:00 Keep gonio lens oriented straight, not tilted Put light on mirror before you go to the oculars Consider resting hand on the patient’s head and using elbow rest if needed Start with Low Mag and Observe Iris Conformation Optical Corneal Wedge 7 4/13/17 How Do We Do It? Angle Anatomy Angle Anatomy Posterior Iris Insertion Ciliary Body (Band) Scleral Spur Trabecular MeshworK Anterior Schwalbe’s Line 8 4/13/17 Ciliary Body (Band) Visibility - Wide Pigmentation Scleral Spur Tr ab ec u l ar Mesh w o r K 9 4/13/17 Schwalbe’s Line Review – Identifying Angle Structures – Two Basic Techniques Posterior Anterior Anterior (Optical Wedge) to Posterior Angle Presentations 10 4/13/17 What Are You Seeing? 11 4/13/17 What Are You Seeing? What Are You Seeing? 12 4/13/17 Recording Your Findings St.
    [Show full text]
  • The Narrow Range of Intraocular Pressure (TOP) (12-20Mmhg)
    J. Smooth Muscle Res. 32: 229•`247, 1996. Review Ocular Outflow Facility with Emphasis on Neuronal Regulation of Intraocular Smooth Muscles Ryo SUZUKI, MD Department of Ophthalmology, Yamaguchi University School of Medicine, Ube City, 755, Japan The narrow range of intraocular pressure (TOP) (12-20mmHg) in normal individuals has stimulated a search for possible regulatory mechanisms7,18,65) of aqueous production and outflow6,46). Compared with aqueous production, the aqueous outflow mechanisms of the neuronal, humoral, and mechanical processes have been studied much less. Because the eye constitutes a small portion of total body mass, it is very difficult to determine the neuronal and mechanical regulations of intraocular muscle and outflow facility. Locally acting mechanisms, should be an ideal means for integrating its physiology58,76). The peripheral nervous system is designed to effect such local control. Because most available antiglaucoma agents interact with the autonomic mechanisms and mechanical activities of the smooth muscles in the eye53,59,68),combined studies of the intraocular muscles with eye perfusion7,66) and cell shape changes of cultured cells from the outflow route22,66) would suggest the role of the nervous system in regulating IOP. From an historical view point, much speculation and minimal experimentation have been focused on the influence of the iris sphincter, the iris dilator, and the ciliary muscles on aqueous humor outflow. Accommodation, cholinergic agonists, and stimulation of the oculomotor nerve, all increase outflow facility19), whereas ganglionic blocking agents and anticholinergic drugs decrease the ocular outflow facility5,66). Furthermore, the outflow facility increase with intravenous pilocarpine administration is instantaneous, suggesting that the effect is mediated by an arterially perfused tissue31,32,46).
    [Show full text]
  • Gonioscopy—A Primer
    Review Glaucoma Gonioscopy—A Primer Syed Shoeb Ahmad Queen Elizabeth Hospital, Kota Kinabalu, Malaysia DOI: https://doi.org/10.17925/USOR.2017.10.01.42 ssessment of the anterior chamber angle (ACA) is an indispensible investigation for evaluation of glaucoma. The most commonly performed method for the determination of the ACA is gonioscopy. This technique, while being simple, is often hampered by the A subjective nature of the procedure, especially in inexperienced hands. This review is intended to improve the knowledge, attitude, and practice among the practitioners regarding the procedure of gonioscopy. Keywords Gonioscopy is a requisite investigation for all patients with glaucoma. It is a procedure for evaluation Gonioscopy, anterior chamber, glaucoma of the anterior chamber angle (ACA), utilizing special instruments known as gonio-lenses or -prisms. angle-closure, glaucoma open-angle Alexios Trantas (1867–1961) was the first to use the term “gonioscopy” in 1907 (Figure 1). The term was derived from the Greek word “gonia” meaning angle and “skopein” to observe. Trantas used a direct Disclosure: Syed Shoeb Ahmad has nothing to disclose in relation to this article. This study involves a review of ophthalmoscope and digital pressure at the limbus to observe the ACA in a patient with keratoglobus. the literature and did not involve any studies with human Later, Maxmilian Salzmann (1862–1954) used indirect gonioscopy with a contact lens for examination or animal subjects performed by any of the authors. No funding was received for the publication of this article. of the angle (Figure 1).1 Therefore, both Trantas and Salzmann are called the “Fathers of gonioscopy”.1,2 Acknowledgements: Syed Shoeb Ahmad wishes to thank the Secretariat of the Greek Glaucoma Society, Dr Gonioscopy helps to categorize the type of glaucoma, that is, open- or closed-angle.
    [Show full text]
  • Diagnostic Performance of Anterior Chamber Angle Measurements for Detecting Eyes with Narrow Angles an Anterior Segment OCT Study
    EPIDEMIOLOGY SECTION EDITOR: LESLIE HYMAN, PhD Diagnostic Performance of Anterior Chamber Angle Measurements for Detecting Eyes With Narrow Angles An Anterior Segment OCT Study Arun Narayanaswamy, DNB; Lisandro M. Sakata, MD, PhD; Ming-Guang He, MD, PhD; David S. Friedman, MD, PhD; Yiong-Huak Chan, PhD; Raghavan Lavanya, MD; Mani Baskaran, DNB; Paul J. Foster, PhD, FRCS(Ed); Tin Aung, PhD, FRCS(Ed) Objective: To assess the diagnostic performance of angle and ARA to assess the performance of these measure- measurements from anterior segment optical coherence ments in detecting eyes with narrow angles. tomography (AS-OCT) images for identifying eyes with narrow angles. Results: Of 2047 individuals examined, 582 were excluded mostly because of poor image quality or inability to locate Methods: We conducted a community-based cross- the scleral spur. Of the remaining 1465 participants, 315 sectional study of individuals 50 years or older who had (21.5%) had narrow angles on gonioscopy. Mean (SD) age phakic eyes and who underwent AS-OCT imaging in the was 62.7 (7.7) years, 54.1% were women, and 90.0% were dark by a single operator and gonioscopy by an ophthal- Chinese. The AUCs were highest for AOD750 in the nasal mologist masked to AS-OCT findings. An eye was con- (0.90 [95% confidence interval, 0.89-0.92]) and temporal sidered to have narrow angles if the posterior pig- (0.91 [0.90-0.93]) quadrants. mented trabecular meshwork was not visible for at least 180° on gonioscopy. Horizontal AS-OCT images were ana- Conclusions: The AOD750 is the most useful angle mea- lyzed for the following measurements using customized surement for identifying individuals with gonioscopic nar- software: angle opening distance (AOD) at 250, 500, and row angles in gradable AS-OCT images.
    [Show full text]
  • Iridolenticular Contact Decreases Following Laser Iridotomy for Pigment Dispersion Syndrome
    CLINICAL SCIENCES Iridolenticular Contact Decreases Following Laser Iridotomy for Pigment Dispersion Syndrome Peter J. Breingan, MD; Kohji Esaki, MD; Hiroshi Ishikawa, MD; Jeffrey M. Liebmann, MD; David S. Greenfield, MD; Robert Ritch, MD Objective: Toevaluatechangesinanteriorsegmentanatomy mean±SD refractive error was −5.0 ± 3.9 diopters. Angle after laser iridotomy for pigment dispersion syndrome. recess area (mean±SD, 0.78 ± 0.28 vs 0.35 ± 0.11 mm2; P=.001, paired t test) and iris-lens contact distance (2.05 Methods: Ultrasound biomicroscopy was performed on ± 0.28 vs 0.79 ± 0.13 mm; P,.001) decreased following 7 eyes of 7 untreated patients with reverse pupillary block iridotomy. Central anterior chamber depth did not change. and pigment dispersion syndrome. A radially oriented im- age with the probe perpendicular to the eye in the supe- Conclusion: Flattening of the iris following laser iri- rior meridian was obtained before and at least 1 week af- dotomy for pigment dispersion syndrome causes a de- ter laser iridotomy in each eye. We assessed changes in crease in iris-lens contact and angle width while lens po- angle recess area and iris-lens contact distance. sition remains constant. Results: Mean ± SD patient age was 31.3 ± 5.7 years and Arch Ophthalmol. 1999;117:325-328 PERIPHERAL iris concavity RESULTS facilitates iridozonular contact and pigment lib- Seven eyes of 7 patients (5 men, 2 wom- eration in pigment disper- en) were enrolled (Table 1). Mean pa- sion syndrome and pig- tient age was 31.3 ± 5.7 years (range, 23-37 Amentary glaucoma. In reverse pupillary years).
    [Show full text]
  • Forward and Inward Movement of the Ciliary Muscle Apex with Accommodation in Adults
    Forward and Inward Movement of the Ciliary Muscle Apex with Accommodation in Adults THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Trang Pham Prosak Graduate Program in Vision Science The Ohio State University 2014 Master's Examination Committee: Melissa D. Bailey, OD, PhD, Advisor Donald O. Mutti, OD, PhD Marjean Kulp, OD, PhD Copyright by Trang Pham Prosak 2014 Abstract Purpose: to study the inward and forward movement of the ciliary muscle during accommodation and to investigate the effects of one hour of reading on the ciliary muscle behavior in young adults. Methods: Subjects included 23 young adults with a mean age of 23.7 ± 1.9 years. Images of the temporal ciliary muscle of the right eye were obtained using the Visante™ Anterior Segment Ocular Coherence Tomography while accommodative response was monitored simultaneously by the Power-Refractor. Four images were taken at each accommodative response level (0, 4.0 and 6.0 D) before and after one hour of reading. Ciliary muscle thickness was measured at every 0.25 mm posterior to the scleral spur. SSMAX, which is the distance between scleral spur and the thickest point of the muscle (CMTMAX), was also measured. The change in the ciliary muscle thickness and SSMAX with accommodation from 0 to 4.0 D and 0 to 6.0 D was calculated. Paired t-tests were used to determine if the ciliary muscle thickness and SSMAX for the 4.0 and 6.0 diopters of accommodative response were different after one hour of reading.
    [Show full text]
  • Trabecular Meshwork Height in Primary Open-Angle Glaucoma Versus Primary Angle-Closure Glaucoma
    Trabecular Meshwork Height in Primary Open-Angle Glaucoma Versus Primary Angle-Closure Glaucoma MARISSE MASIS, REBECCA CHEN, TRAVIS PORCO, AND SHAN C. LIN PURPOSE: To determine if trabecular meshwork (TM) depth, and narrower angle width that predispose to obstruc- height differs between primary open-angle glaucoma tion of the trabecular meshwork.2 Moreover, additional (POAG) and primary angle-closure glaucoma (PACG) anatomic differences at the trabecular meshwork level eyes. may help investigators and clinicians in understanding DESIGN: Prospective, cross-sectional clinical study. novel mechanisms related to the pathophysiology of METHODS: Adult patients were consecutively recruited primary angle-closure glaucoma (PACG). from glaucoma clinics at the University of California, San Anterior segment imaging techniques such as ultrasound Francisco, from January 2012 to July 2015. Images were biomicroscopy (UBM) and anterior segment optical coher- obtained from spectral-domain optical coherence tomog- ence tomography (AS-OCT) provide objective evalua- raphy (Cirrus OCT; Carl Zeiss Meditec, Inc, Dublin, Cal- tions of the angle.3,4 Optical coherence tomography ifornia, USA). Univariate and multivariate linear mixed (OCT) technology has evolved from time-domain to models comparing TM height and glaucoma type were Fourier-domain imaging systems, which have enhanced performed to assess the relationship between TM height signal-to-noise ratio, image resolution, and speed.5 and glaucoma subtype. Mixed-effects regression was Gold and associates6 evaluated the normal aging effects used to adjust for the use of both eyes in some subjects. on the TM using Fourier-domain AS-OCT, and concluded RESULTS: The study included 260 eyes from 161 sub- that TM measurements are not related to age.
    [Show full text]
  • Anatomy of the Globe 09 Hermann D. Schubert Basic and Clinical
    Anatomy of the Globe 09 Hermann D. Schubert Basic and Clinical Science Course, AAO 2008-2009, Section 2, Chapter 2, pp 43-92. The globe is the home of the retina (part of the embryonic forebrain, i.e.neural ectoderm and neural crest) which it protects, nourishes, moves or holds in proper position. The retinal ganglion cells (second neurons of the visual pathway) have axons which form the optic nerve (a brain tract) and which connect to the lateral geniculate body of the brain (third neurons of the visual pathway with axons to cerebral cortex). The transparent media of the eye are: tear film, cornea, aqueous, lens, vitreous, internal limiting membrane and inner retina. Intraocular pressure is the pressure of the aqueous and vitreous compartment. The aqueous compartment is comprised of anterior(200ul) and posterior chamber(60ul). Aqueous and vitreous compartments communicate across the anterior cortical gel of the vitreous which seen from up front looks like a donut and is called the “annular diffusional gap.” The globe consists of two superimposed spheres, the corneal radius measuring 8mm and the scleral radius 12mm. The superimposition creates an external scleral sulcus, the outflow channels anterior to the scleral spur fill the internal scleral sulcus. Three layers or ocular coats are distinguished: the corneal scleral coat, the uvea and neural retina consisting of retina and pigmentedepithelium. The coats and components of the inner eye are held in place by intraocular pressure, scleral rigidity and mechanical attachments between the layers. The corneoscleral coat consists of cornea, sclera, lamina cribrosa and optic nerve sheath.
    [Show full text]
  • Effects of Miosis on Anterior Chamber Structure in Glaucoma Implant Surgery
    Journal of Clinical Medicine Article Effects of Miosis on Anterior Chamber Structure in Glaucoma Implant Surgery Kee Sup Park 1,2, Kyoung Nam Kim 1,2,* , Jaeyoung Kim 1,2 , Yeon Hee Lee 1,2, Sung Bok Lee 1,2 and Chang-sik Kim 1,2 1 Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon 35015, Korea; [email protected] (K.S.P.); [email protected] (J.K.); [email protected] (Y.H.L.); [email protected] (S.B.L.); [email protected] (C.-s.K.) 2 Department of Ophthalmology, Chungnam National University Hospital, Daejeon 35015, Korea * Correspondence: [email protected]; Tel.: +82-42-280-7604; Fax: +82-42-255-3745 Abstract: We investigated changes in anterior chamber (AC) structure after miosis in phakic eyes and pseudophakic eyes with glaucoma. In this prospective study, patients scheduled for glaucoma implant surgery were examined using anterior segment optical coherence tomography before and after miosis. Four AC parameters (AC angle, peripheral anterior chamber (PAC) depth, central ante- rior chamber (CAC) depth, and AC area) were analyzed before and after miosis, and then compared between phakic and pseudophakic eyes. Twenty-nine phakic eyes and 36 pseudophakic eyes were enrolled. The AC angle widened after miosis in both the phakia and pseudophakia groups (p = 0.019 and p < 0.001, respectively). In the phakia group, CAC depth (p < 0.001) and AC area (p = 0.02) were significantly reduced after miosis, and the reductions in PAC depth, CAC depth, and AC area were significantly greater than in the pseudophakia group (all p < 0.05).
    [Show full text]