Subgrouping of Primary Angle-Closure Suspects Based on Anterior Segment Optical Coherence Tomography Parameters

Nongpiur, Monisha E.; Gong, Tianxia; Lee, Hwee Kuan; Perera, Shamira A.; Cheng, Li; Foo, Li Lian; He, Mingguang; Friedman, David S.; Aung, Tin

doi:10.1016/j.ophtha.2013.05.028

Cited by 53 publications

(54 citation statements)

References 22 publications

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“…Consistent with our study, using agglomerative hierarchical clustering method, Nongpiur et al 27 categorized PACS eyes into three subgroups. One subgroup was characterized by a large LV and a shallow ACD; a second subgroup was characterized by a large iris area; and the third subgroup was characterized by elements of both the first and the second subgroups.…”

Section: Discussionsupporting

confidence: 87%

Role of lens vault in subtypes of angle closure in Iranian subjects

Moghimi

Vahedian

Zandvakil

et al. 2014

Eye

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Purpose The purpose of this study is to quantify anterior chamber (AC) parameters and to determine the proportion of eyes with exaggerated lens vault (LV) in different subtypes of angle closure disease using anterior segment optical coherence tomography (AS-OCT). Patients and methods In this prospective study, 115 eyes of 115 Iranian patients with angle closure disease were included and categorized into three groups: (1) fellow eyes of acute angle closure (AAC; 40 eyes); (2) primary angle closure glaucoma (PACG; 39 eyes); and (3) primary angle closure suspect (PACS; 36 eyes). Complete ophthalmic examination including gonioscopy, A-scan biometry, and AS-OCT were performed. Angle parameters, LV, and iris thickness (IT) were measured using AS-OCT. An exaggerated LV was defined as LV more than one-third the distance between the corneal endothelium and a line drawn to connect the nasal and temporal scleral spurs. Results Fellow eyes of AAC had the shallower AC (P ¼ 0.01), greater iris curvature (I-curve; P ¼ 0.01), and higher LV (P ¼ 0.02) as compared with PACS and PACG eyes. There was no statistically significant difference in the mean IT at 750 mm from scleral spur among the three groups (P ¼ 0.45). Exaggerated LV was found in 67.5, 35.9, and 40% of fellow eyes of AAC, PACG, and PACS, respectively, (P ¼ 0.008) with an odds ratio of 1.92 (P ¼ 0.005) for fellow vs PACG and 1.68 (P ¼ 0.01) for fellow vs PACS. Conclusions Exaggerated LV is highly prevalent in fellow eyes of AAC. These eyes have shallower AC depth, greater I-curve, and higher LV when compared with PACG and PACS.

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Section: Discussionsupporting

confidence: 87%

Role of lens vault in subtypes of angle closure in Iranian subjects

Moghimi

Vahedian

Zandvakil

et al. 2014

Eye

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“…In the general angle-closure population, several studies identified distinct subgroups of PAC subjects with different mechanisms. 24,25 Thus, in angle-closure patients with longer AL, there might also exist various types of angle closure, including pupillary block and nonpupillary block. A previous case series reported that nonpupillary block mechanism was more common in angle closure with high myopia than in the general angle-closure population.…”

Section: Discussionmentioning

confidence: 99%

What Are the Characteristics of Primary Angle Closure With Longer Axial Length?

Chen

Jiang

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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What are the characteristics of primary angle closure with longer axial length? Invest Ophthalmol Vis Sci. 2018;59:1354-1359. https://doi.org/10.1167 PURPOSE. To compare biometric parameters between primary angle closure with longer axial length (AL) and those with medium or shorter AL. METHODS.We prospectively recruited 138 primary angle-closure patients. Low-coherence interferometry and ultrasound biomicroscopy examinations were performed before laser peripheral iridotomy and pilocarpine treatment. AL was categorized as shorter (<22.5 mm), medium ( ‡22.5 to <23.5 mm), or longer ( ‡23.5 mm). Anterior chamber depth and width (ACD and ACW), lens vault (LV), anterior vault (AV), relative AV (AV/AL), relative lens position (RLP, [ACD þ 1/2 lens thickness]/AL), trabecular-ciliary angle (TCA), keratometry, and other biometric parameters were compared among different AL groups.RESULTS. Among 138 angle-closure patients, 15 (10.9%) patients had longer ALs, of which 11 (73.3%) were male. These angle-closure eyes with longer AL had flatter cornea (P ¼ 0.006 and 0.022 for flat and steep keratometry) and larger ACW (P ¼ 0.006), but smaller RLP (P ¼ 0.019) than those with medium AL; similarly, they had flatter cornea (P < 0.001 for both flat and steep keratometry), and larger ACW (P < 0.001), AV (P ¼ 0.004), and TCA (P ¼ 0.024), but smaller relative AV (P ¼ 0.040) and RLP (P ¼ 0.005) than those with shorter AL. No significant differences were found in the other parameters.CONCLUSIONS. Primary angle closure with longer AL was uncommon. Causes of angle closure in these atypical patients were manifold. These patients were predominantly male; they had smaller relative dimension of the anterior segment, flatter cornea, and more anterior RLP and less anteriorly rotated ciliary body compared with those angle-closure patients with relatively shorter AL.Keywords: myopia, primary angle closure, axial length, biometric parameters P rimary angle closure (PAC) with myopia has received increasing attention in recent years. This is not only because myopia, usually regarded as a protective effect against PAC, can still be observed in some angle-closure patients, 1-4 but also because this kind of PAC may significantly rise with the incremental rate of myopia in East Asia in the future.5 Recent researchers have highlighted that there is a considerable proportion of myopia in the PAC population. A Singaporean study showed that almost one-quarter of PAC was myopic, 5 whereas a Malaysian investigation found that the distribution of myopia was approximately 37% in PAC patients.6 Jin et al. 7 concluded that the increasing prevalence of myopia has minimal influence on the angle-closure prevalence. It seems that we are going to have more myopic PAC with the rise of myopia in the world, especially in East Asia. However, myopia by the definition of the refractive status in angle-closure patients is often misleading. It is well known that PAC usually occurs in the population older than 40 years, 8 so the myopia formation in these patients might be...

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“…Imaging modalities such as anterior segment optical coherence tomography have yielded valuable information on the lens thickness and lens vault [29][30][31] and their mechanical features in angle closure. 32,33 Subjects with angle closure had thicker lens and greater lens vault than normal controls. 29 However, the relative lens vault may be more closely related to angle closure than the absolute value of lens vault.…”

Section: Visually Significant and Visually Nonsignificant Cataract Exmentioning

confidence: 97%

Management of Primary Angle-Closure Glaucoma

Lai,

Choy,

Shum

2016

Asia-Pacific Journal of Ophthalmology

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Primary angle-closure glaucoma (PACG) is a progressive optic nerve degeneration and is defined as a glaucomatous optic neuropathy with associated characteristic enlargement of optic disc cupping and visual field loss that is secondary to ocular hypertension caused by closure of the drainage angle. Angle closure is caused by appositional approximation or adhesion between the iris and the trabecular meshwork. The main treatment strategy for PACG lies in the reduction of intraocular pressure, reopening of the closed angle, and possible prevention of further angle closure. There is no universally agreed best surgical treatment for PACG. Trabeculectomy, goniosynechialysis (GSL), glaucoma implant, and cyclodestructive procedures are effective surgical options. Each of them plays an important role in the management of PACG with its own pros and cons. Accumulating evidence is available to show the effectiveness of visually significant and visually nonsignificant cataract extraction in the treatment of PACG. Trabeculectomy and GSL are often combined with cataract extraction, which may offer additional pressure control benefits to patients with PACG. This review article will discuss laser peripheral iridotomy, argon laser peripheral iridoplasty, and surgeries such as GSL, phacoemulsification, and phaco plus glaucoma surgeries that lower intraocular pressure and also alter the anterior segment and/or drainage angle anatomy. Currently, glaucoma implants and cyclodestruction are mainly reserved for PACG patients who have failed previous filtering operations. Their role as initial surgical treatment for PACG will not be discussed.

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Subgrouping of Primary Angle-Closure Suspects Based on Anterior Segment Optical Coherence Tomography Parameters

Cited by 53 publications

References 22 publications

Role of lens vault in subtypes of angle closure in Iranian subjects

Role of lens vault in subtypes of angle closure in Iranian subjects

What Are the Characteristics of Primary Angle Closure With Longer Axial Length?

Management of Primary Angle-Closure Glaucoma

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