Biometric indicators of eyes with occult lens subluxation inducing secondary acute angle closure

Abstract

Background: To compare the anterior biometrics in eyes with secondary acute angle closure induced by occult lens subluxation (ASAC-LS), misdiagnosed as acute primary angle closure (APAC) at the first visit with APAC, chronic primary angle closure glaucoma (CPACG), and cataract. Methods: This retrospective case study included 17 eyes with angel closure due to occult LS, who were misdiagnosed as APAC on their first visit, 56 APAC eyes, 54 CPACG eyes, and 56 cataract eyes. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AD) and lens thickness (LT) were recorded. Lens position (LP), relative lens position (RLP), corrected lens position (CLP) were calculated. Quantitative data were subject to one-way analysis of variance and correlation analysis. Categorical data were analyzed using the chi-squared test. Receiver operating characteristic (ROC) curves were plotted to obtain a suitable cutoff value of ocular biometrics. Results: The ASAC-LS patients had a longer ocular axial length than APAC and CPACG patients. Central corneal thickness of the ASAC-LS patients was not significantly different from APAC patients, but was significantly different from CPACG and cataract patients. The APAC patients had the smallest ACD, while the ASAC-LS patients had the smallest AD. The ASAC-LS patients had the largest lens thickness. According to ROC curve analysis, RLP, ACD, AD, CLP, LP had high power of discrimination. Conclusions: This study revealed that LS secondary PAC patients had a shallower AD, thicker CCT comparing to those of APAC, CPACG and cataract patients. For patients with acute angle-closure glaucoma, it is necessary to exclude lens zonula relaxation. Trial registration: NCT03752710, retrospectively registered.

Ocular Manifestations of Acute Secondary Angle Closure Associated With Lens Subluxation

“…Based on our analysis, ACD < 1.4 mm and ACD difference > 0.63 mm are highly indicative of abnormal lens zonular dehiscence or relaxation. Unlike our study, Xing suggested that ACD < 1.25 mm reflected lens subluxation in their study (12). The difference in our studies may be due to the analysis of small sample sizes.…”

“…Lens subluxation is a multifactorial condition that involves a common malpositioning of the lens, likely due to the partial zonular dehiscence or zonular laxity/weakness (12). Among the 20 lens subluxation cases examined in this study, 7 were caused by trauma, 2 cases by high myopia, 1 case by RP, 1 case had familial lens subluxation, 1 case had spontaneous lens subluxation, and the remaining cases had unknown causes.…”

Congenital ciliary body cysts causing lens abnormalities and secondary angle closure glaucoma in a child

“… 16 , 19 Multiple studies have described angle closure in the setting of disrupted lens zonule anatomy, leading to abnormal lens configuration or position. 20 , 21 , 22 , 23 Given the examination and imaging findings in this patient, the ciliary body cysts, in combination with the lens abnormalities, were the essential contributor to the angle closure.…”

Zonulopathy Identified During Cataract Extraction in Patients With Primary Angle Closure Disease

“…The high proportion of zonulopathy in PACD has been observed and has been emphasized by glaucoma specialists during surgical care. Previous studies regarding zonulopathy in patients with ACG have included some cases with zonulopathy, secondary to trauma or other etiologies including pseudoexfoliation syndrome, retinitis pigmentosa, etc 13,21–23 . In this study, we investigated intraoperatively diagnosed zonulopathy in patients with PACD having no history of trauma or other known causes of zonulopathy.…”

“…According to the receiver operating characteristic curve analysis, the ACD in the study eyes and the intereye asymmetry ACD contributed to the differential diagnosis of acute PAC and secondary AAC with cutoff values of 1.4 and 0.63 mm, respectively. Xing et al 22 found that the subjects with AAC secondary to lens subluxation had longer AL, smaller ACD, and thicker LT compared with the acute and chronic PACG subjects. According to the receiver operating characteristic curve study, RLP and ACD illustrated a high discrimination for the group with ACG secondary to zonulopathy.…”