Enhancing the Early Differential Diagnosis of Plateau Iris and Pupillary Block Using A-Scan Ultrasonography

Chen, Yu‐Yen; Chu, Dachen; Chou, Pesus

doi:10.1371/journal.pone.0118811

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…As the lens thickens with age, the anterior chamber may become more shallow, thereby leading to a more complex clinical presentation [ 17 , 19 ]. Overall, our findings corroborate prior studies in demonstrating a greater degree of ACD variability in PL compared to other mechanisms [ 19 , 22 – 25 ].…”

Section: Discussionsupporting

confidence: 91%

Qualitative and quantitative evaluation of acute angle-closure mechanisms

et al. 2017

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BackgroundTo evaluate ocular biometric parameters in different subtypes of acute angle closure and compared to fellow eyes of AAC and PACS eyes.MethodsThis is a retrospective chart review study. A total of 167 eyes (96 patients) consisting of 71 AAC eyes, 71 fellow eyes of AAC, and 25 PACS eyes were recruited. All patients underwent ocular examination and biometry. The mechanism of AAC was confirmed by ultrasound biomicroscopy. We then subdivided AAC eyes into four subgroups: crowded-angle (CR), lens subluxation (LS) pupillary block (PB), and plateau iris syndrome (PL). Outcome variables included anterior chamber depth (ACD), lens thickness (LT), vitreal length (VL), axial length (AL), lens position and relative lens position (LP and RLP, respectively), and lens axial length factor (LAF).ResultsAmong the three groups, ACD was shallower in AAC eyes than fellow eyes of AAC and PACS eyes (p < 0.01 for both) and AAC eyes demonstrated a lesser LP and RLP. The LT, VL, AL, and LAF were not significantly different among the three groups. Among the four subgroups, LS displayed the most shallow ACD (p = 0.01). The lens position in PL was greater than in CR and LS (p < 0.05 and <0.01, respectively).ConclusionsAAC eyes had a more anterior lens position than fellow eyes and PACS eyes, though lens thickness did not differ among the groups. As such, an anterior lens position may offer more sensitive prognostication regarding future development of AAC compared to lens thickness.

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Section: Discussionsupporting

confidence: 91%

Qualitative and quantitative evaluation of acute angle-closure mechanisms

et al. 2017

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“…This result agrees with many UBM and anterior segment optical coherence tomography studies. 7 , 17 , 24 Moghimi et al 22 does not support our result as they found a non-significant CACD difference between PI and pupillary block mechanisms of PACG ( P = 0.12).…”

Section: Discussioncontrasting

confidence: 65%

“…The crystalline lens was significantly thicker in the non-PI group ( P = 0.001). Chen et al 24 used A-scan ultrasonography to compare the ocular characteristics among PI, pupillary block, and normal eyes and found a significant lens thickness difference between PI and pupillary block ( P < 0.001). Contrary to these results, Mizoguchi et al 21 found that there was a non-significant difference in the mean value of ALT between PI and non-PI groups ( P = 0.15), which may be due to different ethnic patients, Japanese subjects, involved in their study.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Plateau Iris in Primary Angle Closure Glaucoma: An Egyptian Hospital Based Ultrasound Biomicroscopy Study

Hamad

Elmaria²,

Hussein³

et al. 2022

OPTH

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Purpose To determine the distribution and the anatomical characteristics of plateau iris (PI) in primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). Methods Fifty UBM images of PACG cases were studied over one year by retrospective analysis. The data from UBM images including angle opening distance at 500 and 750 μm (AOD500 and AOD750), trabecular-iris angle (TIA), angle recess area at 750 μm (ARA750), maximum ciliary body thickness (CBTmax), anterior placement of ciliary processes (APCP), central anterior chamber depth (CACD), axial lens thickness (ALT), and ciliary sulcus status were analyzed and compared between the PI and non-PI cases. Results Eighteen cases had PI (36%). The mean AOD500, AOD750, and TIA were significantly smaller in PI than in non-PI eyes ( P = 0.01; P = 0.046; and P = 0.026). Values of the ARA750 and CBTmax were not significantly different between the two groups ( P = 0.208 and P = 0.368). CACD was deeper in the PI group ( P = 0.011). ALT was higher in the non-PI group ( P = 0.001). The mean APCP of the PI group was more than those of the non-PI group ( P < 0.001). The number of cases with obliterated ciliary sulcus in more than two quadrants was significantly more in the PI group ( P < 0.001). Conclusion Around one-third of PACG eyes were found to have PI on UBM imaging. The number of obliterated ciliary sulcus and APCP were important UBM parameters that help in PI diagnosis.

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“…For PAS that must be mechanically separated, we can adopt a separation method far from the peripheral iris, such as using capsulorhexis forceps to pull the middle and peripheral iris to separate PAS, which may reduce peripheral iris damage and re-PAS recurrence. In addition, according to literature21–24 and our observation, non-pupillary block anatomic factors such as plateau iris, peripheral iris hypertrophy, anterior rotation of the ciliary body, and short AL are all high-risk factors for recurrent PAS after surgery. For peripheral iris hypertrophy and plateau iris, argon laser peripheral iridoplasty can be adopted one month after surgery to contract the peripheral iris stroma and create a space between the anterior iris surface and the trabecular meshwork, which may reduce the possibility of re-PAS.…”

Section: Discussionmentioning

confidence: 63%

Efficacy of Combined Phacoemulsification and Goniosynechialysis in Primary Angle Closure Disease With Different Degrees of Peripheral Anterior Synechiae

Wei

Фу

Nie

et al. 2022

Journal of Glaucoma

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Précis: Phacoemulsification and goniosynechialysis (Phaco-GSL) was equally effective in the treatment of primary angle-closure disease (PACD) with preoperative peripheral anterior synechiae (PAS) <180 degrees and larger than 180 degrees. Patients with a larger preoperative PAS range required more range of mechanical separation intraoperatively and displayed more recurrence of PAS (re-PAS) range postoperatively. Purpose: To evaluate the long-term efficacy of combined phaco-GSL in PACD with different extent of PAS. Patients and Methods: A retrospective study was conducted on 67 patients (79 eyes) who received phaco-GSL. The patients were divided into 2 groups according to the extent of PAS (group A: PAS ≤180 degrees; group B: PAS >180 degrees). Changes in intraocular pressure (IOP), the number of anti-glaucoma drugs, intraoperative mechanical separation of PAS and range of re-PAS during the last follow-up ≥12 months were analyzed. Results: At baseline, eyes in group B presented with higher IOP and more anti-glaucoma drugs usage (P=0.008 and 0.004). The PAS range, IOP, number of anti-glaucoma medication were reduced both in 2 groups at the final visit. The range of mechanical separation intraoperatively and re-PAS postoperatively were both larger in group B (P=0.002 and <0.001). The postoperative re-PAS range was positively correlated with the range of mechanical separation (R 2=0.17). The complete success rates at 12, 24, 36, and 48 months were 86.8%, 71.1%, 71.1%, and 71.1% in group A; and 80.5%, 74.6%, 69.9%, and 69.9% in group B. The qualified success rates were 100%, 96.6%, 92.0%, and 92.0% in group A; and 100%, 89.5%, 85.1%, and 85.1% in group B. Conclusion: Phaco-GSL for the treatment of PACD showed equally effective IOP control regardless of the extent of preoperative PAS.

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Enhancing the Early Differential Diagnosis of Plateau Iris and Pupillary Block Using A-Scan Ultrasonography

Cited by 5 publications

References 23 publications

Qualitative and quantitative evaluation of acute angle-closure mechanisms

Qualitative and quantitative evaluation of acute angle-closure mechanisms

Prevalence of Plateau Iris in Primary Angle Closure Glaucoma: An Egyptian Hospital Based Ultrasound Biomicroscopy Study

Efficacy of Combined Phacoemulsification and Goniosynechialysis in Primary Angle Closure Disease With Different Degrees of Peripheral Anterior Synechiae

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