Modified Dark Room Provocative Test for Primary Angle Closure

Li, Dejiao; Wang, Ke; Wang, Bingsong; Wang, Tao; Jonas, Jost B.

doi:10.1097/ijg.0b013e31820bd215

Cited by 3 publications

(4 citation statements)

References 26 publications

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“…In patients with primary angle closure glaucoma before LPI, a pupillary block mechanism associated with anterior lens shift has been suggested to be responsible for the rise in IOP. Li et al 19 found that anterior segment OCT was much more sensitive than gonioscopy for detecting angle closure after DRPT, presumably due to lower examination light level; with OCT examination, angle closure could be demonstrated in 91% of patients with positive DRPT. However, they did not correlate angle closure with variations in IOP.…”

Section: Discussionmentioning

confidence: 99%

Gonioscopic Findings Associated With a Positive Dark-room Provocative Test in Narrow Angles After Laser Iridotomy

Desgroseilliers¹,

Harasymowycz²,

Kamdeu-Fansi³

et al. 2014

Journal of Glaucoma

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A positive DRPT was found in patients presenting a more compromised drainage angle after LPI, due to anterior synechiae and/or an anteriorly positioned ciliary body as shown by the presence of a double-hump sign. DRPT may help identify patients at higher risk of intermittent increases in IOP among those presenting persistent narrow angles after LPI, and indentation gonioscopy remains an important step in evaluating these patients.

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Section: Discussionmentioning

confidence: 99%

Gonioscopic Findings Associated With a Positive Dark-room Provocative Test in Narrow Angles After Laser Iridotomy

Desgroseilliers¹,

Harasymowycz²,

Kamdeu-Fansi³

et al. 2014

Journal of Glaucoma

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“…Some studies have suggested the use of provocative tests, like the dark room test or the prone position test, to detect patients prone to PACG . These tests aim to evoke an abnormal increase in IOP within the eye.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Some studies have suggested the use of provocative tests, like the dark room test or the prone position test, to detect patients prone to PACG. 7,8 These tests aim to evoke an abnormal increase in IOP within the eye. Abnormal or exaggerated IOP responses to these stress tests in PACS can suggests an increased likelihood of these asymptomatic eyes developing PAC/PACG because of shallow anterior chambers and narrow angles; however, negative test results do not necessarily preclude later development of PACG.…”

Section: Introductionmentioning

confidence: 99%

Water‐drinking test in primary angle‐closure suspect before and after laser peripheral iridotomy

Waisbourd

Savant

Sun

et al. 2015

Clinical Exper Ophthalmology

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Background: This study aimed to investigate whether performing a laser peripheral iridotomy in primary angle-closure suspects had an effect on the intraocular pressure response during the water-drinking test.Design: Prospective study in a hospital setting.Participants: Primary angle-closure suspects scheduled for a laser peripheral iridotomy.Methods: Primary angle-closure suspects were evaluated before the laser peripheral iridotomy and 2 weeks after. On each visit, subjects underwent the waterdrinking test. Intraocular pressure was measured every 15 min within a 1-h period.Main Outcome Measures: Intraocular pressure fluctuations during the water drinking test.Results: Twenty patients were enrolled. The mean age was 58.1 years (±10.2 SD), predominantly female (n = 14, 70%). Average intraocular pressure range (maximum-minimum) during the waterdrinking test increased significantly from 2.6 ± 1.1 mmHg before the laser peripheral iridotomy to 3.5 ± 1.5 mmHg after (P = 0.04). The mean difference between peak and last intraocular pressure measurements increased after the laser peripheral iridotomy was performed, from 2.5 mmHg (±1.27 SD) to 3.3 mmHg (±1.66 SD), (P = 0.057). There was no change in mean peak intraocular pressure (maximum-baseline) before and after the laser peripheral iridotomy (P = 0.87).Conclusions: Primary angle-closure suspects who underwent the water-drinking test had a slightly more pronounced recovery of intraocular pressure after the laser peripheral iridotomy was performed, which may be attributed to increase in the area of exposed trabecular meshwork following treatment. Differences in intraocular pressure curves before and after laser peripheral iridotomy were minimal, and therefore, the water-drinking test had limited value as a provocative test in this patient population.

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“…The same group subsequently proposed a modified DRPT with an anterior chamber angle assessment by OCT at 3 minutes of dark adaptation, comparing it with a gonioscopic angle assessment after 1.5 hours, and found a higher diagnostic precision in predicting primary angle closure for the first technique (sensitivity 91% vs. 67%, specificity 57% vs. 80%) [139].…”

Section: Effect Of Light-dark Conditionsmentioning

confidence: 99%

Angle Closure Glaucoma: Pathogenesis and Evaluation. A Review

Fea¹,

Bertaina²,

Consol³

et al. 2012

J Clinic Experiment Ophthalmol

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Pupillary block is the most common mechanism responsible for angle closure [9], but the anatomical configuration which causes a plateau iris may be a more common mechanism than was previously thought. Pupillary block mechanismIn pupillary block, the resistance to aqueous flow from the posterior to anterior chamber is at the level of the pupil, creating a pressure gradient that causes forward bowing of the peripheral iris and closure of the angle [10,11].Aqueous humor flow from the posterior chamber into the anterior chamber is regulated by a differential pressure between the anterior and the posterior chamber. This pressure differential may increase greatly when the dimensions of the iris-lens channels are changed. As this pressure increment increases, the iris becomes more convex and can close angle.Extreme anterior iris-bulging, iris bombé would be expected with pressure differentials of 10-15 mm Hg [12]. The variables that influence the flow through the ''pinch region'' (iris-lens channels) and influence the pressure differential and related iris contour have been studied extensively [12][13][14][15][16].Changes in pupillary size, increased channel length and decreased height, movement of the iris insertion posteriorly or of the lens anteriorly, were associated with an expected increase in the pressure differential. Other variables exist and interact to determine the iris contour, including eye size, especially the dimensions of the anterior segment, lens size and position, iris stroma and iris musculature characteristics, ciliary body anatomy, and physiologic parameters including aqueous humor flow rate, facility of outflow, vitreousaqueous fluid flow, and the effects of accommodation and blinking [9]. AbstractPrimary open angle glaucoma (PACG) is a major cause of blindness especially in Asia. The pathogenesis of this condition has been widely investigated. Traditionally gonioscopy is the method of choice for the esamination of patients considered to be at risk for angle closure, but it is a rather invasive procedure and it is reported to be primarily used by glaucoma specialists. Recently newer ultrasound and optical methods for the evaluation of the anterior chamber angle have been introduced in the clinical practice, with distinct advantages and disadvantages both compared to each other and to gonioscopy. This review will address the pathogenesis of PACG, the use of gonioscopy and will evaluate the newer methods of angle examination.

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Modified Dark Room Provocative Test for Primary Angle Closure

Abstract: A modified DRPT with an anterior chamber angle assessment by OCT at 3 minutes of dark adaptation as compared with a gonioscopic angle assessment after 1.5 hours of dark adaptation had a higher diagnostic precision in predicting primary angle closure.

Cited by 3 publications

References 26 publications

Gonioscopic Findings Associated With a Positive Dark-room Provocative Test in Narrow Angles After Laser Iridotomy

Gonioscopic Findings Associated With a Positive Dark-room Provocative Test in Narrow Angles After Laser Iridotomy

Water‐drinking test in primary angle‐closure suspect before and after laser peripheral iridotomy

Angle Closure Glaucoma: Pathogenesis and Evaluation. A Review

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