Moving beyond the Slit-Lamp Gonioscopy: Challenges and Future Opportunities

Cutolo, Carlo Alberto; Bonzano, Chiara; Scotto, Riccardo; Iester, Michele; Bagnis, Alessandro; Pizzorno, Chiara; Catti, Carlo; Traverso, Carlo Enrico

doi:10.3390/diagnostics11122279

Cited by 9 publications

(17 citation statements)

References 41 publications

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“…A likely sentinel episcleral vessel was visible. A gonioscopy examination, considered the clinical reference standard in assessing the anterior chamber angle [ 12 ], was performed using a three-mirror gonioscopy lens ( Figure 3 ) (Ocular Instruments, Bellevue, Washington State, United States of America). The tumoral mass was present at the inferonasal iris and anterior chamber angle level.…”

Section: Resultsmentioning

confidence: 99%

Underlying Ciliary Body Uveal Melanoma in a Patient with Chronic Lymphocytic Leukemia Presenting for Hyphema

et al. 2022

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(1) Background: Ciliary body uveal melanoma is a rare subtype of uveal melanoma which comprises 3–5% of melanomas, an immunogenic cancer, and can present multifaceted initial clinical manifestations, masquerading as various ocular pathologies. Chronic lymphocytic leukemia (CLL) presents immunodeficiency and risk for the development of a secondary malignancy, with Bruton’s tyrosine kinase inhibitor treatment having a mutagenic effect and a secondary anti-platelet aggregation effect. We present the case of a 65-year-old patient undergoing treatment for CLL with ibrutinib who presented with recurrent hyphema that masked an underlying, inferiorly situated, ciliary body uveal melanoma; (2) Methods: Retrospective case review; (3) Results: An ophthalmological examination together with imaging via mode B ultrasound and contrast-enhanced magnetic resonance imaging resulted in the clinical and imagistic diagnosis of a ciliary body uveal melanoma. A pathological examination of the enucleated eye confirmed the diagnosis. Postoperative tumoral reoccurrence was not detected for 1½ years, however, CLL immunosuppression worsened with admission for severe COVID-19 disease. (4) Conclusions: CLL patient screening for melanoma should also include detailed ophthalmological examinations, which could also include ultrasound ophthalmological imaging. The avoidance of uveal melanoma metastatic disease is paramount for patient survival. CLL manifests additional profound immunosuppression.

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Section: Resultsmentioning

confidence: 99%

Underlying Ciliary Body Uveal Melanoma in a Patient with Chronic Lymphocytic Leukemia Presenting for Hyphema

et al. 2022

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“…Photographs also allow comparison over time, useful for longitudinal follow-up and are useful for postoperative documentation of microinvasive glaucoma surgical devices. 3 Automated gonioscopic photography also offers the potential for reducing variation in the quality of ICA assessment. Inter-observer and intra-observer variability in the interpretation of gonioscopic images remains, at best, fair.…”

Section: Discussionmentioning

confidence: 99%

“…Gonioscopy is essential for patients with raised IOP or suspected or confirmed glaucoma to assess the status of the ICA and determine the most appropriate treatment option. 2,3 Examination of the ICA is also important for the diagnosis of secondary glaucomas such as neovascular glaucoma.…”

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confidence: 99%

“…Elevated intraocular pressure (IOP) is the key modifiable risk factor, and to ascertain the mechanism of raised IOP, it is important to visualize the anatomy of the iridocorneal angle (ICA), the location of the trabecular meshwork and primary site of aqueous outflow. Gonioscopy is essential for patients with raised IOP or suspected or confirmed glaucoma to assess the status of the ICA and determine the most appropriate treatment option 2,3. Examination of the ICA is also important for the diagnosis of secondary glaucomas such as neovascular glaucoma.…”

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confidence: 99%

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Feasibility of Automated Gonioscopy Imaging in Clinical Practice

Barbour-Hastie

Deol

Peroni

et al. 2022

Journal of Glaucoma

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Précis: Automated gonioscopy provided good-quality images of the anterior chamber angle. There was a short learning curve for operators, and the examination was well tolerated by patients. Patients expressed a preference for automated gonioscopy compared with traditional gonioscopy. Purpose: The purpose of this study was to assess the feasibility of using a desktop automated gonioscopy camera in glaucoma clinics by examining patient tolerability, ease of use, and image quality and comparing patient preference compared with traditional gonioscopy. Patients and Methods: A prospective study was conducted in a university hospital clinic. Traditional gonioscopy was performed followed by imaging of the iridocorneal angle (ICA) using the Nidek GS-1 camera by 2 glaucoma specialists. Participants were asked to rate the comfort of automated gonioscopy and which method they preferred. The clinicians graded the ease of acquisition for each patient, and the image quality was reviewed by a grader. Results: Forty-three eyes of 25 participants were included. Sixty-eight percent of participants viewed automated gonioscopy as “extremely comfortable,” and the remainder reported it “comfortable”. Forty percent preferred automated gonioscopy compared with traditional gonioscopy, while 52% were equivocal. Clinicians scored 32% of participants as “somewhat difficult” to the image. In 46% of eyes, good-quality photographs were obtained for 360 degrees of the ICA. Only 1 eye had no parts of the ICA clearly visible. Seventy-four percent of eyes had at least half of the ICA clearly visible in all 4 quadrants. Conclusion: Automated gonioscopy provided good-quality images of the ICA for most patients. It was often not possible to image the entire 360 degrees at the first attempt, but the examination was comfortable for patients, and only 8% preferred traditional gonioscopy to the automated photographic examination.

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“…The technique is most often used to determine whether a patient has open or closed anterior chamber iridocorneal angles (ICAs) while also allowing one to carefully study the ICA to observe its anatomy [ 4 ]. A new area of particular interest is the examination of microinvasive glaucoma surgery (MIGS) device positioning in patients who have had glaucoma surgery [ 5 , 6 ]. This is essential for assessing the angle appearance, pre-operative angle surgery preparation, and assessing post-operative placement of MIGS device and surgical outcome.…”

Section: Introductionmentioning

confidence: 99%

Mispositioned Hydrus Microstents: A Case Series Imaged with NIDEK GS-1 Gonioscope

Laroche

Martin

Brown

et al. 2022

Journal of Ophthalmology

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Introduction. The Hydrus microstent has become a common procedure in glaucoma surgery intended to improve outcomes of cataract surgery to lower intraocular pressure. Despite proper placement, this device can subsequently be noted to not be in the proper position. In this case series, we report mispositioned Hydrus microstents in five different patients and use NIDEK GS-1 gonioscopy. Case Report. We report five different patients who had cataract surgery and who were subsequently noted to have mispositioned Hydrus stents. No stents needed to be removed. All patients had improved vision and stable visual fields, and none required secondary surgery. Management and Outcome. In each case of mispositioned stents, vision was significantly improved and there was no inflammation or other complications noted. Discussion. Hydrus stents can be noted to be mispositioned during the post-operative period after successful insertion. This can often be well tolerated requiring no further intervention.

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Moving beyond the Slit-Lamp Gonioscopy: Challenges and Future Opportunities

Cited by 9 publications

References 41 publications

Underlying Ciliary Body Uveal Melanoma in a Patient with Chronic Lymphocytic Leukemia Presenting for Hyphema

Underlying Ciliary Body Uveal Melanoma in a Patient with Chronic Lymphocytic Leukemia Presenting for Hyphema

Feasibility of Automated Gonioscopy Imaging in Clinical Practice

Mispositioned Hydrus Microstents: A Case Series Imaged with NIDEK GS-1 Gonioscope

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