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American Journal of Ophthalmology Aug 2021The purpose of this study was to determine classification criteria for sympathetic ophthalmia.
PURPOSE
The purpose of this study was to determine classification criteria for sympathetic ophthalmia.
DESIGN
Machine learning of cases with sympathetic ophthalmia and 5 other panuveitides.
METHODS
Cases of panuveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used in the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the panuveitides. The resulting criteria were evaluated in the validation set.
RESULTS
A total of 1,012 cases of panuveitides, including 110 cases of sympathetic ophthalmia, were evaluated by machine learning. The overall accuracy for panuveitides was 96.3% in the training set and 94.0% in the validation set (95% confidence interval: 89.0-96.8). Key criteria for sympathetic ophthalmia included bilateral uveitis with 1) a history of unilateral ocular trauma or surgery and 2) an anterior chamber and vitreous inflammation or a panuveitis with choroidal involvement. The misclassification rates for sympathetic ophthalmia were 4.2% in the training set and 6.7% in the validation set.
CONCLUSIONS
The criteria for sympathetic ophthalmia had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
Topics: Adult; Anterior Chamber; Female; Humans; Male; Middle Aged; Ophthalmia, Sympathetic; Tomography, Optical Coherence
PubMed: 33845005
DOI: 10.1016/j.ajo.2021.03.048 -
Indian Journal of Ophthalmology Jun 2023Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative...
BACKGROUND
Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow-ups and management of the blebs play a critical role in the long-term success. This video is aimed at showing the real-world management of blebs postoperatively.
PURPOSE
This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation.
SYNOPSIS
This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed.
HIGHLIGHTS
We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture-related complications and their management have been shown along with practical examples.
VIDEO LINK
https://youtu.be/2WFQJAPyOvY.
Topics: Humans; Anterior Chamber; Filtering Surgery; Intraocular Pressure; Postoperative Complications; Suture Techniques; Sutures; Trabeculectomy
PubMed: 37322725
DOI: 10.4103/IJO.IJO_336_23 -
PloS One 2020To predict the anterior chamber volume (ACV) after implantable collamer lens (ICL) implantation based on ICL size and parameters of anterior segment optical coherence...
PURPOSE
To predict the anterior chamber volume (ACV) after implantable collamer lens (ICL) implantation based on ICL size and parameters of anterior segment optical coherence tomography (AS-OCT).
DESIGN
Retrospective study.
METHODS
This study included 222 eyes of 222 patients who underwent ICL implantation at Nagoya Eye Clinic. The patients were divided into two groups: prediction group, for creating the prediction equation (148 eyes, mean age: 32.11 ± 8.04 years), and verification group, for verifying the equation (74 eyes, mean age: 33.03 ± 6.74 years). The angle opening distance (AOD), anterior chamber width (ACW), ACV, anterior chamber depth, lens vault, angle-to-angle distance, angle recess area, and trabecular iris space area were calculated using AS-OCT. A stepwise multiple regression analysis was performed. After the creation of the prediction equation, its accuracy was verified in the verification group.
RESULTS
The ACV, AOD750, ACW, and ICL size were selected as explanatory variables to predict postoperative ACV. Mean predicted (114.2 ± 21.83 mm3) and actual postoperative ACVs (116.1 ± 25.41 mm3) were not significantly different (P = 0.269); absolute error was 10.59 ± 9.13 mm3. In addition, there was high correlation between actual and predictive ACV (adjusted R2 = 0.6996, p < 0.0001). Bland-Altman plot revealed that there was no addition or proportional error between predicted and actual postoperative ACV.
CONCLUSION
Postoperative ACV was accurately predicted using AS-OCT parameters and ICL size. This prediction equation may be useful for making decisions regarding ICL size.
Topics: Adult; Anterior Chamber; Anterior Eye Segment; Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Iris; Lens Implantation, Intraocular; Lens, Crystalline; Male; Middle Aged; Myopia; Phakic Intraocular Lenses; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Young Adult
PubMed: 33196664
DOI: 10.1371/journal.pone.0242434 -
Nature Communications Oct 2021Primary congenital glaucoma (PCG) is a severe disease characterized by developmental defects in the trabecular meshwork (TM) and Schlemm's canal (SC), comprising the...
Primary congenital glaucoma (PCG) is a severe disease characterized by developmental defects in the trabecular meshwork (TM) and Schlemm's canal (SC), comprising the conventional aqueous humor outflow pathway of the eye. Recently, heterozygous loss of function variants in TEK and ANGPT1 or compound variants in TEK/SVEP1 were identified in children with PCG. Moreover, common variants in ANGPT1and SVEP1 have been identified as risk alleles for primary open angle glaucoma (POAG) in GWAS studies. Here, we show tissue-specific deletion of Angpt1 or Svep1 from the TM causes PCG in mice with severe defects in the adjacent SC. Single-cell transcriptomic analysis of normal and glaucomatous Angpt1 deficient eyes allowed us to identify distinct TM and SC cell populations and discover additional TM-SC signaling pathways. Furthermore, confirming the importance of angiopoietin signaling in SC, delivery of a recombinant ANGPT1-mimetic promotes developmental SC expansion in healthy and Angpt1 deficient eyes, blunts intraocular pressure (IOP) elevation and RGC loss in a mouse model of PCG and lowers IOP in healthy adult mice. Our data highlight the central role of ANGPT1-TEK signaling and TM-SC crosstalk in IOP homeostasis and provide new candidates for SC-targeted glaucoma therapy.
Topics: Angiopoietin-1; Animals; Anterior Chamber; Aqueous Humor; Calcium-Binding Proteins; Cell Adhesion Molecules; Cell Communication; Disease Models, Animal; Endothelial Cells; Gene Expression Profiling; Glaucoma, Open-Angle; Intraocular Pressure; Mice; Mice, Knockout; Neural Crest; Proteins; Recombinant Proteins; Signal Transduction; Single-Cell Analysis; Trabecular Meshwork
PubMed: 34663817
DOI: 10.1038/s41467-021-26346-0 -
Turkish Journal of Ophthalmology Apr 2020We present patient characteristics and follow-up results of cases with anterior chamber dexamethasone implant migration. The common feature of all six presented cases...
We present patient characteristics and follow-up results of cases with anterior chamber dexamethasone implant migration. The common feature of all six presented cases was vitrectomized eyes. Four of the patients had sutured intraocular lens (IOL) implantation due to complicated cataract surgery, one had combined retinal detachment surgery with sutured IOL implantation, and one had vitrectomy for diabetic intravitreal hemorrhage cleaning and uncomplicated cataract surgery. Anterior chamber implant migration caused corneal edema in all cases and elevated intraocular pressure in three cases. In two cases, the dexamethasone implant was directed into the vitreous cavity after maximum pupillary dilation and corneal manipulation with cotton tip applicator with the patient in reverse Trendelenburg position. There was no other complication until dexamethasone implant degradation, with clear cornea at final examination. In two cases, the implant was removed from the anterior chamber by aspiration, but keratoplasty surgery was planned due to endothelial cell loss and persistent corneal edema during follow-up. In the last two cases, the dexamethasone implant was redirected into the vitreous chamber with a 23-gauge catheter and anterior chamber maintainer but they migrated into the anterior chamber again. In one of these patients, the implant was aspirated by catheter and corneal transplantation was performed due to corneal edema, while the other patient's implant was redirected into the vitreous chamber with no further anterior migration. The risk of dexamethasone implants migrating into the anterior chamber of vitrectomized eyes and those with sutured IOL implantation should be kept in mind and the patient should be informed and advised to see an ophthalmologist immediately before permanent corneal endothelial damage occurs.
Topics: Anterior Chamber; Dexamethasone; Drug Implants; Foreign-Body Migration; Humans; Macular Edema; Male; Middle Aged; Tomography, Optical Coherence
PubMed: 32367704
DOI: 10.4274/tjo.galenos.2019.43778 -
Indian Journal of Ophthalmology Nov 2022Manual small-incision cataract surgery (MSICS) has existed as an alternative to conventional phacoemulsification since its inception. The size of the incision has been...
Manual small-incision cataract surgery (MSICS) has existed as an alternative to conventional phacoemulsification since its inception. The size of the incision has been becoming smaller in MSICS to reduce the surgically induced astigmatism. Smaller incisions go hand in hand with nucleus debulking and fragmenting techniques which have been practiced over almost four decades. Such techniques have a learning curve and require meticulous execution. The authors describe a technique to achieve nucleus bisection or trisection or debulking in a closed anterior chamber. This technique has been in use for a long time; it has shown excellent results and has a shorter learning curve. Since it is done in a closed chamber, the risk to the corneal endothelium is minimized as the anterior chamber remains deep throughout the procedure. Sudden escape of the viscoelastic and shallowing of the chamber are prevented, and the corneal endothelium is well protected. It uses iris as support and reference. The specially designed chopper is an inexpensive addition to the instruments. Fragmentation is achieved in the proximal half of the chamber where control over instruments is maximum. Pristine clear cornea on day 1 is the rule rather than the exception with this technique. This is a safe and repeatable technique for phacofragmentation in cataract extraction.
Topics: Humans; Cataract Extraction; Phacoemulsification; Astigmatism; Endothelium, Corneal; Cataract
PubMed: 36308157
DOI: 10.4103/ijo.IJO_1566_22 -
Current Eye Research Dec 2021: To evaluate the inter- and intra-observer reliability of anterior chamber (AC) angle measurements obtained by swept-source optical coherence tomography (SS-OCT)....
: To evaluate the inter- and intra-observer reliability of anterior chamber (AC) angle measurements obtained by swept-source optical coherence tomography (SS-OCT). Forty-eight consecutive patients diagnosed with primary angle closure suspect (PACS) were included. Three masked observers at different training levels (one glaucoma specialist, one ophthalmology resident, and one pre-medical college student) measured 192 SS-OCT images of the PACS patients. One observer (the glaucoma specialist) repeated measurements 1 week later. SS-OCT parameters included: Anterior segment volume, including corneal, AC, and iris volume; anterior segment dimensions, including AC depth and width (ACD, ACW), and lens vault (LV); and angle parameters, including angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and the trabecular iris angle (TIA). Intraclass correlation coefficients (ICCs) were used to measure reliability. For inter-observer reproducibility, ICCs of corneal, AC, and iris volumes were 0.952 to 0.998. ICCs of ACD at all axes were above 0.989. ICCs of ACW and LV were smallest in the 90°-270° axis (0.751 and 0.768) but not significantly different from other axes. ARA, TISA, and TIA at all angles had significantly smallest ICCs 250 µm from the scleral spur compared with 500 µm and 750 µm. The ICCs comparing observers with different training levels had similar ranges and followed similar trends. For intra-observer repeatability, the smallest ICC was 0.843. Decreasing AC depth correlated with increased inter-observer reproducibility. We found excellent intra-observer repeatability for all SS-OCT parameters. Angle measurements have more variation among the observers when taken 250 µm from the scleral spur. Shallow AC might lead to more variability for angle parameters. Non-expert observers may be recruited for high-quality image grading with standard training.
Topics: Anterior Chamber; Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Middle Aged; Reproducibility of Results; Tomography, Optical Coherence
PubMed: 34253093
DOI: 10.1080/02713683.2021.1942069 -
BMC Ophthalmology Sep 2020We aim to determine the association of iris surface features including crypts, color and contraction furrows with anterior chamber depth (ACD) in a school-based sample...
BACKGROUND
We aim to determine the association of iris surface features including crypts, color and contraction furrows with anterior chamber depth (ACD) in a school-based sample of Chinese teenagers.
METHODS
Totally, 2346 students aged 13 to 14 years in Mojiang located in the Southwestern part of China contributed to this analysis. Iris surface features were graded based on standardized slit-lamp photographs. Ocular biometric parameters including ACD were measured using an IOL Master. Generalized estimating equation was incorporated in the linear regression models to assess the relationship between iris surface features and ACD.
RESULTS
A significant trend of increasing ACDs with more contraction furrows were observed. On average, the mean ACD was 3.03 mm in participants with contraction furrows of grade 1 while it was 3.10 mm in those with grade 3 (mean difference, 0.07 mm, P = 0.01). Adjusting for other potential confounders such as gender, height and weight did not significantly changed the associations. Compared with individuals with contraction furrows of grade 1, those with grade 3 had a greater ACD of 0.06 mm (95% confidence interval: 0.01, 0.11) in multivariate-adjusted model. There were no significant relationships between ACD and iris crypts or color. (P > 0.10).
CONCLUSIONS
More iris contraction furrows are associated with greater ACDs while the association with iris color and crypts were not significant.
Topics: Adolescent; Anterior Chamber; China; Cross-Sectional Studies; Humans; Iris; Tomography, Optical Coherence
PubMed: 32967649
DOI: 10.1186/s12886-020-01652-1 -
BMC Ophthalmology Aug 2020To investigate the distribution of peripheral anterior chamber depth (ACD) and the relationship between peripheral ACD and gonioscopy compared to other ocular parameters...
BACKGROUND
To investigate the distribution of peripheral anterior chamber depth (ACD) and the relationship between peripheral ACD and gonioscopy compared to other ocular parameters for primary angle closure disease (PACD) screening. We performed a population-based survey in Pudong New District of Shanghai, China, in 2011.
METHODS
Cross-sectional study. Adults 50 and older were enrolled from a population-based study using cluster random sampling in Pudong New District, Shanghai. Remote ocular screening was performed with digital anterior eye structure photography. Van Herrick measurements were used to evaluate the peripheral ACD, the depth of the peripheral anterior chamber, and corneal thickness (CT), and the ACD to CT ratio was calculated. Subjects with peripheral ACD less than 0.5 CT were made follow-up appointments for clinical examination with gonioscopy. Receiver operating characteristic curves (ROC) were generated to show the performance of different tests in screening for primary angle closure disease (PACD).
RESULTS
Two thousand five hundred twenty-eight adults participated in the study with 91 patients diagnosed with PACD. Two thousand four hundred sixty-three subjects had valid data in the right eye available for analysis. The mean peripheral ACD values for men and women were significantly different: 1.04 ± 0.46 (range 0.11-2.93) CT and 0.87 ± 0.41 (range 0.12-2.96) CT respectively (t = - 4.18; P<0.0001). Multivariate logistic regression analysis reveals that peripheral ACD declined by 0.31 CT (P < 0.0001) per diopter of SE and was 0.19 CT (P < 0.0001) shallower in women than in men (r2 = 0.1304, P < 0.0001). Peripheral ACD performed best in screening for PACD.
CONCLUSIONS
Peripheral ACD measurement is recommended for PACD screening in community elderly Chinese.
Topics: Adult; Aged; Anterior Chamber; China; Cross-Sectional Studies; Female; Glaucoma, Angle-Closure; Gonioscopy; Humans; Intraocular Pressure; Male
PubMed: 32859174
DOI: 10.1186/s12886-020-01618-3 -
Asia-Pacific Journal of Ophthalmology... 2016Digital imaging technologies for glaucoma diagnostics have evolved rapidly over the recent years. From time-domain optical coherence tomography (OCT) to spectral-domain... (Review)
Review
Digital imaging technologies for glaucoma diagnostics have evolved rapidly over the recent years. From time-domain optical coherence tomography (OCT) to spectral-domain and swept-source OCTs, the application of OCT for analysis of the anterior chamber angle and the optic nerve head (ONH) is expanding. The second-generation anterior segment swept-source OCT is able to image the configuration of the anterior chamber angle in 3 dimensions in less than 1 second and perform 360-degree analysis of the anterior chamber angle width for detection of angle closure. The morphology, density, and dimensions of the crystalline lens in relation to the anterior chamber can now be examined from the anterior corneal surface to the posterior lens surface, facilitating the investigation of the involvement of the crystalline lens in primary angle closure. Spectral-domain and swept-source OCTs have improved the measurement reliability of the lamina cribrosa and the neuroretinal rim configurations. Studying the deformation of the lamina cribrosa and ONH surfaces is relevant to decipher the mechanisms of ONH damage in the development and progression of glaucoma. Software and algorithms for automatic analysis of the anterior chamber angle dimensions and deformation of the ONH and lamina cribrosa surfaces are required to process large volumetric data sets, and they are under active development. It is expected that new imaging technologies will improve the detection and risk assessment of angle-closure and open-angle glaucomas.
Topics: Anterior Chamber; Glaucoma; Humans; Nerve Fibers; Optic Disk; Optic Nerve Diseases; Reproducibility of Results; Tomography, Optical Coherence
PubMed: 26886114
DOI: 10.1097/APO.0000000000000179