Differences in outflow channels between two eyes of unilateral primary congenital glaucoma

Gupta, Viney; Singh, Abhishek; Pandya, Ishan; Sofi, Rayees Ahmad; Sen, Suvajit; Somarajan, Bindu I; Gupta, Shikha; Nag, Tapas Chandra

doi:10.1111/aos.14540

Cited by 11 publications

(7 citation statements)

References 34 publications

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“…In a previous study, we have also shown that SC can open backward into the intracameral space both on in vivo imaging as well as on histopathology in fellow eyes of congenital glaucoma. 10 Similar opening of SC intracamerally was seen in 2 eyes post ACP (Fig 2c Post), suggesting another route of clearing for corneal edema.…”

Section: (Which Was Not Certified By Peer Review)supporting

confidence: 60%

Corneal cisterns as drainage aqueducts

Gupta

JOSHI

Mahalingam

et al. 2022

Preprint

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Importance: Anterior chamber paracentesis (ACP) is a known method of rapid reduction of IOP. The mechanism of how corneal fluid clears after ACP is not well described. Objective: To determine the mechanism of instantaneous corneal clearing of edema after ACP. Design, setting, and participants: This case series includes consecutive patients with high IOP and associated corneal edema, who presented to the Glaucoma Services of our tertiary care center. Pre and post intervention ASOCTs were analyzed. Main outcome measures: Resolution of corneal edema, clinical picture and imaging of peripheral cornea and iridocorneal angle area. Results: Ten consecutive patients who underwent an ACP were included in this study. The mean IOP pre-intervention was 48.4 8.2 mmHg. ASOCT showed ill-defined conventional pathways of aqueous outflow, which were blocked by peripheral anterior synechiae in 4 eyes. Immediately post ACP, the IOP was 16.3 5.6 mmHg (p 0.001) and corneal edema resolved immediately. We found on ASOCT, that the intrastromal hypolucency of the peripheral corneal cistern which was limited in extent and U shaped, showed a posterior extension into the corneolimbal junction to form well defined anastomoses with the conventional aqueous drainage channels demonstrating a direct conduit for intracorneal fluid to egress. In 2 of 10 eyes, Schlemms canal opened intracamerally as well, suggesting direct reflux of intra-corneal fluid into the anterior chamber. Conclusion and Relevance: After an ACP, in eyes with corneal edema to relieve IOP, we observed that the intracorneal cisterns undergo peripheral extension to drain corneal fluid through the conventional distal outflow channels.

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Section: (Which Was Not Certified By Peer Review)supporting

confidence: 60%

Corneal cisterns as drainage aqueducts

Gupta

JOSHI

Mahalingam

et al. 2022

Preprint

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“…[ 33 34 ] We have shown that SD-OCT scans can successfully capture the anterior angle at high resolution and may help in identifying angle dysgenesis in cases where angle anomalies are subtle enough to go unnoticed. Although identifying gross dysgenesis of the angle, as in PCG may be easier,[ 35 ] subtle angle anomalies as in JOAG or POAG are more challenging to identify. The biological changes in the extracellular matrix (ECM) comprising the trabecular drainage pathways that lead to IOP elevation have been identified in histopathological studies[ 36 37 ] in POAG.…”

Section: Discussionmentioning

confidence: 99%

In vivo identification of angle dysgenesis and its relation to genetic markers associated with glaucoma using artificial intelligence

Gupta,

Birla,

Varshney

et al. 2023

Indian Journal of Ophthalmology

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Purpose: To predict the presence of angle dysgenesis on anterior-segment optical coherence tomography (ADoA) by using deep learning (DL) and to correlate ADoA with mutations in known glaucoma genes. Participants: In total, 800 high-definition anterior-segment optical coherence tomography (AS-OCT) images were included, of which 340 images were used to build the machine learning (ML) model. Images used to build the ML model included 170 scans of primary congenital glaucoma (16 patients), juvenile-onset open-angle glaucoma (62 patients), and adult-onset primary open-angle glaucoma eyes (37 patients); the rest were controls (n = 85). The genetic validation dataset consisted of another 393 images of patients with known mutations that were compared with 320 images of healthy controls. Methods: ADoA was defined as the absence of Schlemm’s canal, the presence of hyperreflectivity over the region of the trabecular meshwork, or a hyperreflective membrane. DL was used to classify a given AS-OCT image as either having angle dysgenesis or not. ADoA was then specifically looked for on AS-OCT images of patients with mutations in the known genes for glaucoma. Results: The final prediction, which was a consensus-based outcome from the three optimized DL models, had an accuracy of >95%, a specificity of >97%, and a sensitivity of >96% in detecting ADoA in the internal test dataset. Among the patients with known gene mutations, (MYOC, CYP1B1, FOXC1, and LTBP2) ADoA was observed among all the patients in the majority of the images, compared to only 5% of the healthy controls. Conclusion: ADoA can be objectively identified using models built with DL.

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“…4 Our previous study also demonstrated that the SC can open directly into the anterior chamber, both on in vivo imaging and histopathology. 5 While this is a small series, our observations offer an alternative mechanistic explanation for the instantaneous clearing of corneal oedema post-ACP, which requires further support from experimental studies.…”

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confidence: 81%

Peripheral corneal channels as drainage aqueducts

Gupta,

Singh,

Panigrahi

et al. 2023

Clinical Exper Ophthalmology

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High intraocular pressure (IOP) often leads to corneal oedema and anterior chamber paracenteses (ACP), results in a rapid reduction in IOP and immediate corneal clearing. We used high-definition anterior segment optical coherence tomography (ASO-CT) to analyse the corneal changes following ACP. Ten consecutive patients presenting with high IOP and associated corneal oedema were enrolled after obtaining ethical approval from the Ethics Committee of our Institute and written informed consent from the patients. The study was conducted in accordance with the Declaration of Helsinki guidelines.The patients, underwent ophthalmic examination, and anterior segment photos were taken before and after ACP using the Eye Cap system (Haag Streit) (Figure 1A; preand post-intervention). We also imaged their cornea and angle on high-resolution spectral domain AS-OCT (Spectralis, Heidelberg Engineering) before and after ACP. The median age of the patients was 46 years (range 12-67). The mean pre-intervention IOP was 48.4 ± 8.2 mmHg, and post-intervention it significantly reduced to 16.3 ± 5.6 mmHg (p < 0.001; paired t-test).We examined the ASOCT images of the peripheral cornea (Figure 1A; pre-and post-intervention). The AS-OCT

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Differences in outflow channels between two eyes of unilateral primary congenital glaucoma

Cited by 11 publications

References 34 publications

Corneal cisterns as drainage aqueducts

Corneal cisterns as drainage aqueducts

In vivo identification of angle dysgenesis and its relation to genetic markers associated with glaucoma using artificial intelligence

Peripheral corneal channels as drainage aqueducts

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