Modern methods of visualization of the angle of the anterior chamber of the eye in the diagnosis and treatment of glaucoma
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Abstract:
Purpose. To analyze the literature reflecting the main modern methods of visualizing the angle of the anterior chamber of the eye, which are used in patients with glaucoma. Material and methods. To perform the review, a search was carried out for literature sources on the Pubmed, Scopus and Elibrary reference databases for the period up to 2022 inclusive using the following keywords: anterior camera angle, gonioscopy, electronic gonioscopy, optical coherence tomography, ultrasound biomicroscopy and the same phrases in Russian. Results. The variety of clinical and morphological forms of glaucoma, the wide prevalence, frequency of occurrence and steady growth of this disease require timely diagnostics, as well as dynamic monitoring of the results of conservative and surgical treatment in patients with glaucoma. Despite the importance of such a diagnostic method as gonioscopy, ophtalmologists still do not use it sufficiently, the frequency of its application during the first visit to the doctor for glaucoma varies from 17.96 to 45.9%. There are also additional instrumental methods of examination of patients with glaucoma that allow an objective assessment of the structures of the eye anterior segment: automated gonioscopy, optical coherence tomography of the eye anterior segment and ultrasound biomicroscopy. These methods can be used both for the primary diagnosis of glaucoma and its dynamic observation, as well as for choosing surgical treatment tactics and monitoring its results thanks to high-precision visualisation and image documentation. Each of them has its own characteristics, advantages and disadvantages, depending on the specifics of the disease and the presence of concomitant ocular pathology, which are described in this article. Conclusion. Taking into account the variety of clinical forms of glaucoma and the insufficient equipment of medical institutions, especially primary care, it can be concluded that it is necessary to improve diagnostic algorithms. Methods such as electronic gonioscopy, optical coherence tomography of the eye anterior segment and ultrasound biomicroscopy will make the diagnostic process more accurate and informative, help to correctly diagnose and determine treatment tactics for both primary care physicians and surgeons. The possibility of documenting the results obtained and creating a system for their analysis can contribute to the founding of a generalized database, which will greatly simplify and accelerate the process of providing care to patients with glaucoma. Key words: glaucoma, anterior chamber angle, gonioscopy, electronic gonioscopy, optical coherence tomography, ultrasound biomicroscopyKeywords:
Gonioscopy
Ultrasound biomicroscopy
Glaucoma surgery
Gonioscopy is the widely used technique of grading and evaluating the anterior chamber angle in current glaucoma evaluation practice. The grading of angle and open angle or narrow angle classification with gonioscopy is fairly accurate when done by an experienced ophthalmologist. In recent years, UBM and anterior segment OCT are advanced and in depth imaging tools for the anterior segment evaluation and accurate angle measurements. In our study, we have included 200 eyes for anterior chamber angle grading with gonioscopy and UBM and results are compared. Our study shows that some amount of estimation of angle depth by gonioscopy is overestimated in nearly closed and grade 1 angles. Estimation of grades 2 and 3 is nearly accurate with gonioscopy and comparable to UBM angle grading. Over diagnosis of occludable angles with gonioscopy which can be explained due to iris contour, inter-observer reliability or limitation to examine far periphery of the angle and this can be overcome by UBM examination. UBM provides accurate anterior chamber angle in degrees, peripheral iris configuration details and quantification of measurements is possible. Keywords: Gonioscopy, Ultrasound Biomicroscopy (UBM).
Gonioscopy
Ultrasound biomicroscopy
Anterior chamber angle
Grading (engineering)
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INTRODUCTION:
Glaucoma is the most common cause of irreversible blindness and second leading cause of blindness16. It is characterized by optic neuropathy and visual function loss. Primary angle closure glaucoma is potentially preventable if diagnosis is done before irreversible damage. Hence to an ophthalmologist direct visualisation of the angle of anterior chamber of eyes is of crucial importance. Aqueous outflow occurs through the angles and should be studied as an important structure of eyes.
Ultrasound biomicroscopy and gonioscopy are the two important measures to study angles of anterior chamber of eyes.
Gonioscopy is a subjective method of study of anterior chamber angles of eyes, it is considered as the gold standard technique. It is an integral part of diagnostic evaluation and is done routinely in all patients with glaucoma. It is often associated with misdiagnosis and under detection of angle closure.
Ultrasound biomicroscopy has revolutionised the evaluation of eye i.e. the anterior segment to understand the path of angle closure glaucoma, pigmentary glaucoma. It also helps in quantitative analysis to yield mechanism of oppositional angle closure and dynamic function of the iris. Hence early detection and treatment of angle closure significantly improves visual prognosis.
Ultrasound biomicroscopy is more established technique which allows a more objective assessment of anterior segment status. Recently used in objective measurement of anterior chamber angles. Also used to study anatomic configuration of the angle structures of the normal eyes and the glaucomatous eyes.
Advantage of ultrasound biomicroscopy is high image resolution. It also allows accurate identification of structural landmarks. It is used to measure angle parameters and also to quantify the data acquired.
AIMS AND OBJECTIVES:
1. To compare ultrasound biomicroscopy measurement of anterior chamber angle of eyes with gonioscopy in patients attending Ophthalmology outpatient department of GOVERNMENT RAJAJI HOSPITAL, MADURAI.
2. To evaluate ability of ultrasound biomicroscopy as a predictor to diagnose early stages of glaucoma.
3. To analyse whether ultrasound biomicroscopy or gonioscopy which is to be more precise method in direct documentation of all structures involved in angle structures configuration.
MATERIALS AND METHODS
SOURCE OF DATA :
It is a hospital based comparative study. It consist of patient attending the ophthalmology out patient department in GOVT. RAJAJI HOSPITAL, MADURAI. It included patients of age group of 20 – 70 years.
METHOD OF COLLECTION OF THE DATA
STUDY DESIGN: One year comparative study of patients.
SAMPLE SIZE : 100 eyes
SAMPLE : Patient attending the outpatient department.
Between the age group of 20–70 years.
PLACE : GOVT. RAJAJI HOSPITAL, MADURAI
DURATION : ONE YEAR.
INCLUSION CRITERIA
Patient attending ophthalmology OPD aged between 20 -70 years
Patient with normal cup disc ratio on funduscopy.
Patient with clinically suspected narrow angles
EXCLUSION CRITERIA
Patient with conjunctivitis, keratitis, uveitis.
Patient with perforating injury.
Patient with corneal haziness.
Patients with previous history of glaucoma surgery, laser surgery.
CONCLUSION : Gonioscopy is a subjective method. It is an useful method of grading and evaluating the angles of anterior chamber of eyes. It helps in segregating into occludable and non occludable fairly accurately when done by an experienced observer.
SUMMARY :
The present study was a comparative study conducted in department of ophthalmology in outpatient department of Govt. Rajaji Hospital, Madurai.
The objective of this test was to compare gonioscopy with ultrasound biomicroscopy for measuring the anterior chamber angle accurately. The study was done for a period of 1 year on 100 eyes of patients attending our OPD. An informed consent was obtained after explaining the risk and advantages associated with study in their own language. After meeting the inclusion and exclusion criteria patient’s eyes was subjected to anterior segment evaluation with slit lamp examination, intraocular pressure, gonioscopy, ultrasound biomicroscopy for the angle assessment of the anterior chamber.
Results of the two measurements were compared. Both methods compared with the ability of each method to define occludable and non occludable. The comparison in our study proved that anterior chamber estimation of angle categorisation into occludable and non occludable was significant. Though
gonioscopy caused over estimation of angle width it will remain the standard for evaluations of angle of anterior chamber. However ultrasound biomicroscopy though costly, it is required for objective quantification of the angles. Widespread and mandatory use of gonioscopy in evaluation of eyes will help in reducing the morbidity from angle closure glaucoma by early detection and intervention. Gonioscopy and Ultrasound biomicroscopy are equally effective.
Ultrasound biomicroscopy
Gonioscopy
Anterior chamber angle
IRIS (biosensor)
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Ultrasound biomicroscopy
Gonioscopy
Anterior chamber angle
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Ultrasound biomicroscopy
Gonioscopy
IRIS (biosensor)
Angle-closure glaucoma
Mydriasis
Iridectomy
Secondary glaucoma
Closure (psychology)
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Objective To compare iridocorneal angle grading systems on the basis of gonioscopy and ultrasound biomicroscopy (UBM). Design Original cross-sectional observational study. Animals 22 dogs. Procedure Gonioscopy, goniophotography, and UBM were performed on 38 eyes from dogs without clinical evidence of glaucoma in the eyes examined. Results Predominant gonioscopic grades derived from goniophotographs were considered normal (n = 26) and mild (12). Ultrasound biomicroscopy angle measurements ranged from 16 to 38° (mean ± SD, 26.2 ± 4.5°). Ciliary clefts depicted on UBM images were graded as open (n = 4), compact/narrow (23), and closed (11). Significant differences were not found between UBM-derived ciliary cleft grades and goniophotography-derived dysgenesis grades, nor between UBM-derived ciliary cleft grades and subjective gonioscopic grades. Clinical Implications Because gonioscopy allows evaluation of the anterior face of the ciliary cleft, whereas UBM provides cross-sectional information of the iridocorneal filtration angle, UBM may yield more information regarding pathogenesis and prognosis of, and preferred management approaches to, glaucoma. Ultrasound biomicroscopy may also be useful as a predictor of glaucoma or to diagnose early stages of glaucoma. ( J Am Vet Med Assoc 1998;213:635-638)
Ultrasound biomicroscopy
Gonioscopy
Ciliary processes
Dysgenesis
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Comparison of gonioscopy and ultrasound biomicroscopy for evaluating the iridocorneal angle in dogs.
To compare iridocorneal angle grading systems on the basis of gonioscopy and ultrasound biomicroscopy (UBM).Original cross-sectional observational study.22 dogs.Gonioscopy, goniophotography, and UBM were performed on 38 eyes from dogs without clinical evidence of glaucoma in the eyes examined.Predominant gonioscopic grades derived from goniophotographs were considered normal (n = 26) and mild (12). Ultrasound biomicroscopy angle measurements ranged from 16 to 38 degrees (mean +/- SD, 26.2 +/- 4.5 degrees). Ciliary clefts depicted on UBM images were graded as open (n = 4), compact/narrow (23), and closed (11). Significant differences were not found between UBM-derived ciliary cleft grades and goniophotography-derived dysgenesis grades, nor between UBM-derived ciliary cleft grades and subjective gonioscopic grades.Because gonioscopy allows evaluation of the anterior face of the ciliary cleft, whereas UBM provides cross-sectional information of the iridocorneal filtration angle, UBM may yield more information regarding pathogenesis and prognosis of, and preferred management approaches to, glaucoma. Ultrasound biomicroscopy may also be useful as a predictor of glaucoma or to diagnose early stages of glaucoma.
Ultrasound biomicroscopy
Gonioscopy
Ciliary processes
Dysgenesis
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Citations (36)
Gonioscopy
Ultrasound biomicroscopy
Anterior chamber angle
IRIS (biosensor)
Angle-closure glaucoma
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Ultrasound biomicroscopy
Gonioscopy
Anterior chamber angle
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Ultrasound biomicroscopy
Gonioscopy
Indentation
IRIS (biosensor)
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Objective To report the occurrence of angle-closure glaucoma in 2 teenagers. Design Observational case reports, review of literature. Methods Review of case histories, examinations, biometries, visual fields, and ultrasound biomicroscopy findings in 2 teenagers with angle-closure glaucoma. Main outcome measures Intraocular pressure, gonioscopy, Humphrey 24–2 visual field (SITA Standard), and ultrasound biomicroscopy. Results The first case involved a 15-year-old white male who presented with an intraocular pressure of 60 mm Hg in the right eye and 24 mm Hg in the left eye and 360-degree appositional closure in both eyes. Ultrasound biomicroscopy revealed prominent bilateral ciliary pigment epithelial cysts pushing the iris anteriorly towards the angle. The second case involved a 14-year-old white male with a strong family history of primary angle-closure glaucoma. The patient had pupillary block and an intraocular pressure of 24 mm Hg in the right eye and 40 mm Hg in the left eye on routine eye examination. Gonioscopy and ultrasound biomicroscopy revealed appositional closure of the angle in all 4 quadrants bilaterally. Conclusion Primary angle-closure glaucoma is uncommon in younger individuals. Therefore, the finding of angle-closure glaucoma in a young individual should alert the physician to the possibility of a secondary cause of angle closure, such as iris pigment epithelial cysts. In addition, special attention to family history is important as the configuration of an occludable anterior chamber angle may, in some instances, be inherited.
Ultrasound biomicroscopy
Gonioscopy
IRIS (biosensor)
Iridectomy
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Citations (22)