Chinese eyes had smaller ACD, smaller ACW and greater iris thickness than Caucasians. ACD was the most influential parameter in determining the angle width in both ethnic groups.
Purpose
To identify iris structural alterations associated with intraoperative floppy iris syndrome (IFIS) in patients using systemic α-1-adrenergic receptor antagonists (α-1ARA).
Design
Cross-sectional study.
Participants and Controls
Twenty-nine patients with current or past treatment with any systemic α-1ARA and 22 untreated controls.
Methods
Consecutive eligible patients underwent slit-lamp-adapted optical coherence tomography (SL-OCT, Heidelberg Engineering, GmbH, Dossenheim, Germany) in a masked fashion under standardized lighting conditions.
Main Outcome Measures
Iris thickness at the dilator muscle region (DMR, measured at half of the distance between the scleral spur and the pupillary margin) and at the sphincter muscle region (SMR, 0.75 mm from the pupillary margin), the ratio between the DMR/SMR (to compensate for possible intersubject variability) and pupillary diameter.
Results
Most treated patients were on tamsulosin (27/29). Mean age was similar in study and control groups (70.6 ± 7.6 vs 67.1 ± 9.1 yrs, p=0.061). Photopic pupil diameter was reduced in the study group (2.06 ± 0.5 vs 2.5 ± 0.6 mm, p=0.001). SMR was similar between groups (p=0.53). Significantly lower values were found in treated subjects for the DMR and the DMR/SMR ratio (p<0.001). These differences remained significant after adjusting for pupil diameter (p<0.001). Multiple regression analysis showed that a longer duration of α-1ARA treatment correlated to a reduced DMR/SMR ratio (p=0.001, r=0.47). Age and eye color were not significant in this model.
Conclusion
Patients using systemic α-1ARA have significantly lower values of DMR thickness and DMR/SMR ratio and smaller pupil diameter when compared to age-matched controls. These differences appear to be related to the duration of drug exposure and provide evidence of structural alterations to the iris dilator muscle from this class of agents in IFIS.
We report a case of bilateral Descemet membrane detachment (DMD) after canaloplasty in a 70-year-old Portuguese man with primary open-angle glaucoma. The patient developed bilateral DMD immediately following consecutive (1 week apart) canaloplasty surgery in both eyes. Slitlamp biomicroscopy, gonioscopy, and Fourier-domain optical coherence tomography (FD-OCT) findings are described. On postoperative day 1, in both cases, slitlamp biomicroscopy revealed an unscrolled inferonasal DMD and a clear cornea with deep and quiet anterior chambers. Gonioscopy showed an intact, lightly pigmented, and distended trabecular meshwork with no evidence of suture extrusion. High-resolution FD-OCT revealed a widely dilated canal of Schlemm, trabecular distention, and a retrocorneal hyperreflective membrane corresponding to a DMD. At 3 months, the DMD resolved spontaneously in both eyes. Although DMD is a known complication of canaloplasty, the occurrence of bilateral symmetrically located DMDs in our case suggests a possible anatomical predisposition in addition to factors induced by the surgical technique.
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