Diagnostic performance of anterior segment optical coherence tomography in detecting plateau iris

Abstract

ObjectiveTo evaluate the diagnostic performance of manual grading of anterior segment optical coherence tomography (AS-OCT) in detection of plateau iris configuration (PIC) based on the presence of standardised ultrasound biomicroscopy (UBM) criteria in at least two quadrants; namely, clinical diagnosis of PIC (DxPIC).Methods and analysisIn this cross-sectional study, paired AS-OCT and UBM images were evaluated by three glaucoma specialists. AS-OCT was classified into two mechanisms, PIC versus non-PIC, of primary angle closure disease (PACD) and AS-OCT-PIC diagnostic performance was tested with DxPIC.ResultsOne hundred and seventy-nine eyes of 142 patients were enrolled for analysis, and DxPIC was found in 85 eyes (47.49%). Intraobserver agreement rates of AS-OCT classification by the graders were 0.77, 0.701 and 0.742 (all p<0.001), and interobserver agreement rates, between a senior glaucoma specialist and the other two glaucoma specialists, were 0.68 and 0.702 (all p<0.001). Plateau iris was classified in AS-OCT images by the three graders, rated 32.96%–39.1% and 24.58%–34.08% in the horizontal and vertical axes, respectively. Diagnostic performance was analysed, yielding sensitivity ranging from 56.47% to 77.78%, and specificity of 48.94% to 64.29%. We applied disease prevalence of 30%, revealing positive predictive values varying from 32.16% to 44.44%, and negative predictive values of 72.4% to 85.71%. Accuracy ranged from 51.2% to 65%. Agreement between the two devices was fair, kappa range 0.31–0.351.ConclusionPerformance of manual grading of AS-OCT in detection of DxPIC was relatively poor; therefore, unadjusted AS-OCT does not appear to be good for manual PIC screening in PACD patients and cannot serve as a substitute for UBM in PIC detection.

Acute Angle Closure in an 18-Year-Old Due to Plateau Iris

“…Peripheral laser iridotomy is the typically first-line surgical intervention [ 8 ]. Similar to the current practice of peripheral iridotomy in primary angle closure patients, peripheral laser iridotomy of the other eye to prevent angle closure could be considered.…”

Long-Term Risk and Prediction of Progression in Primary Angle Closure Suspect

“…More cohorts are needed to validate our findings in populations with different ethnic backgrounds and those living in areas with insufficient access to medical services. Finally, the Visante AS-OCT has become outdated and been replaced by swept source AS-OCT. 33 Three-dimensional and high-resolution measurement of the anterior chamber is expected to improve our models' predictive performance.…”

Plateau iris: A review

“…In one study, manual grading of AS-OCT showed poor performance in the diagnosis of PIC, and the authors suggest that it should not be used as a substitution for UBM in PIC detection among primary angle closure patients. 42 Moghimi et al . found no significant difference between anterior chamber parameters in a pupillary block and PIC patients, with plateau iris patients having a thicker peripheral iris at base.…”