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Beside the examination of optic nerve head and retinal nerve fibre bundles, gonioscopy is the most important examinations we have to perform when performing structure analysis. The differentiation of angle closure, angle closure suspect and open angle is essential not only for the correct diagnosis, but as well to draw the best therapeutic consequences out of these findings. In addition to grading systems that help us to classify the types of glaucoma, we can find pathological changes like abnormal vessels, inflammatory induced changes, pigmentations, clefts etc. that help us to make the right diagnosis and therapy. Nowadays As‐OCT is a big help and makes it a lot easier, but there are still essential deficits, that do not allow to replace gonioscopy by this new examination. In the presentation we will show, what we can see in normal and pathological eyes and which findings can be seen in AS‐OCT and which ones cannot been seen. [ABSTRACT FROM AUTHOR]

Gonioscopy is an indispensable part of work up in the context of glaucoma. Its value lies not only in differentiation between open angle and angle closure glaucoma. It is also providing essential clues for other specific glaucoma diagnoses, like pseudoexfoliation, pigment dispersion, neovascularization, goniodysgenesis and post‐traumatic changes. Examples will be shown. [ABSTRACT FROM AUTHOR]

Although new techniques for the assessment of the anterior chamber angle have become available recently, gonioscopy remains the gold standard. Different lenses that can be used for gonioscopy and their application will be discussed. Further, suggestions for a systematic assessment of the anterior chamber angle will be presented. Normal findings in healthy eyes will be summarized. [ABSTRACT FROM AUTHOR]

Purpose To assess the surgical and functional outcome of internal direct cyclopexy as therapy of complicated traumatic cyclodialysis. Methods The single-centre interventional case-series study included eyes with traumatic cyclodialysis who had consecutively been treated. Internal cyclopexy was performed using double-armed sutures introduced into the eye through the pars plana opposite to the cyclodialysis cleft and which were laid parallel to limbus. Additional procedures included cataract surgery, and pars plana vitrectomy. The cyclodialysis was documented upon ultrasound biomicroscopy and gonioscopy. Results The study included 44 patients (44 eyes). The cyclodialysis extended over 4.8 ± 3.2 clock hours of scleral spur circumference (range 1-12 hr, median 4 hr), involving >180° of the scleral spur circumference in 16 eyes (37%) and 360° in 3 eyes (7%). Besides cyclodialysis, additional trauma-related complications included hyphema, iridodialysis, lens dislocation, cataract, vitreous haemorrhage, retinal detachment, suprachoroidal haemorrhage and endophthalmitis. The surgery performed on average at 64 days after the trauma included a mean number of 4.6 ± 1.9 sutures (range: 2-9), with 1.2 sutures per 30° width of cyclodialysis. Mean follow-up was 32 ± 8 weeks (range: 6-51 weeks). Closure of the cyclodialysis was achieved in all 44 eyes, and intraocular pressure (IOP) increased from 8.0 ± 3.4 mmHg (range: 3 21 mmHg) to 14.4 ± 4.0 mmHg (range: 11-21 mmHg). Mean visual acuity (VA) improved from 2.3 ± 1.1 log MAR (range: 0.22-4.0) to 1.2 ± 0.8 log MAR (range 0.3-4.0 log MAR). Conclusion In conclusion, internal direct cyclopexy is a novel and relatively little invasive surgery technique for the repair of traumatic cyclodialysis. [ABSTRACT FROM AUTHOR]

Although new techniques for the assessment of the anterior chamber angle have become available recently, gonioscopy remains the gold standard. Different lenses that can be used for gonioscopy and their application will be discussed. Further, suggestions for a systematic assessment of the anterior chamber angle will be presented. Normal findings in healthy eyes will be summarized. [ABSTRACT FROM AUTHOR]

Gonioscopy is a not very attractive and well‐accepted examination, neither by the ophthalmologist, nor by the patient. Therefore, it is logical, that there is an extensive research and development on the field of other options. These options, like Anterior Segment ‐OCT, Scheimpflug Camera, UBM and the "Gonioscope", will be shown with their theoretical and practical advantages and disadvantages as well as their clinical use will be discussed and shown with pictures and movies. [ABSTRACT FROM AUTHOR]

. Purpose: To compare the diagnostic performance of EyeCam (Clarity Medical Systems, Pleasanton, CA, USA) and anterior segment optical coherence tomography (ASOCT, Visante; Carl Zeiss Meditec, Dublin, CA, USA) in detecting angle closure, using gonioscopy as the reference standard. Methods: Ninety-eight phakic patients, recruited from a glaucoma clinic, underwent gonioscopy by a single examiner, and EyeCam and ASOCT imaging by another examiner. Another observer, masked to gonioscopy findings, graded EyeCam and ASOCT images. For both gonioscopy and EyeCam, a closed angle in a particular quadrant was defined if the posterior trabecular meshwork was not visible. For ASOCT, angle closure was defined by any contact between the iris and angle anterior to the scleral spur. An eye was diagnosed as having angle closure if ≥2 quadrants were closed. Agreement and area under the receiver operating characteristic curves (AUC) were evaluated. Results: The majority of subjects were Chinese (69/98, 70.4%) with a mean age of 60.6 years. Angle closure was diagnosed in 39/98 (39.8%) eyes with gonioscopy, 40/98 (40.8%) with EyeCam and 56/97 (57.7%) with ASOCT. The agreement (kappa statistic) for angle closure diagnosis for gonioscopy versus EyeCam was 0.89; gonioscopy versus ASOCT and EyeCam versus ASOCT were both 0.56. The AUC for detecting eyes with gonioscopic angle closure with EyeCam was 0.978 (95% CI: 0.93-1.0) and 0.847 (95% CI: 0.76-0.92, p < 0.01) for ASOCT. Conclusion: The diagnostic performance of EyeCam was better than ASOCT in detecting angle closure when gonioscopic grading was used as the reference standard. The agreement between the two imaging modalities was moderate. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 20-year-old man who was taken to a clinic because of uncontrolled intraocular pressure (IOP). He had an increased IOP that had been detected seven years ago with the use of slit-lamp assisted biomicroscopy wherein it revealed a deep anterior chamber and a widely open anterior chamber angle at gonioscopy in both eyes. The patient's development of glaucomatous optic nerve damage may have his abnormally thick cornea or other cornea related factors.

Purpose: A case series of monitoring Blood reflux during Gonioscopy after 3‐6 months of the implantation of the trabecular micro‐bypass device "iStent inject® or iStent Inject W®" with cataract surgery to evaluate the effectiveness of the implantation and adjust the therapy. Methods: A gonioscopy with Goldmann 3 mirror classic contact lens 903 was performed on 22 eyes after implanting iStent inject® or iStent inject w® combined with cataract surgery. Patients are diagnosed with early primary open‐angle Glaucoma (POAG) or with ocular hypertension (OHT), and they were treated with at least one hypotensive eye drops (ED) before the surgery. The patients were controlled regularly after the surgery, and the therapy was reduced in most cases and adjusted to reach the target pressure according to the guidelines of European glaucoma society with consideration of the IOP before the surgery. The Gonioscopy was performed between 3 and 6 months after the surgery to evaluate the blood reflux through the iStent. Results: The mean IOP in the patients after the surgery was 18 mmHg with a mean of 1.25 eye drops with no complications, and no patient needed a second surgery. The mean reduction of eye drops (ED) was 1 ED after the surgery. Three of the patients who had IOP less than 15 mmHg had blood reflux through one of the two iStents during Gonioscopy. Conclusions: Gonioscopy may offer a reasonable and effective method to evaluate the function of iStent after implanting iStent with no extra costs, and it could help in adjusting the therapy after the surgery. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 75-year-old male patient with a history of normal tension for 6 years. Upon examination, progressive, large superior arcuate scotomas were observed in the humphrey visual field. Gonioscopy showed wide open angle with trabeculum and scleral spur. The patient was subjected to left eye trabeculectomy and was given bevacizumab drops on the 15th day after the surgery. He noted continuous improvement with reduced irritation and redness within 7 days.

. Purpose: To determine the effect of pupillary dilation on intraocular pressure (IOP) in normotensive patients with exfoliation syndrome (XFS). Methods: Patients with XFS were enrolled in this prospective trial. All eyes were untreated, had no previous laser or operative surgery and were normotensive with full visual fields and open angles. IOP was measured before dilation and hourly for four consecutive hours after dilation with tropicamide 1% and phenylephrine 2.5% eyedrops. Results: Twenty-five eyes of 19 White patients (nine male, 10 female) with XFS were enrolled. Twelve eyes (48%) had a rise in IOP of ≥ 4 mmHg above the pre-dilation baseline IOP and four (16%) had a rise of ≥ 9 mmHg (9-28 mmHg). Post-dilation gonioscopy confirmed the presence of an open anterior chamber angle in all eyes. The maximum IOP was reached 3 hr post-dilation in three eyes and after 2 hr in the remaining eyes. The four eyes with marked IOP rise exhibited an elevation of between 1 and 7 mmHg at 1 hr. Extensive pigment release was noticed in all eyes that had a rise in IOP. Conclusion: Patients with XFS are at risk of developing delayed post-dilation IOP rises. Awareness of this phenomenon is particularly important in patients with advanced cupping and/or severe visual field loss who may not be able to tolerate a marked elevation of IOP. An early, mild rise in IOP at 1 hr may serve as a warning sign for a more severe, delayed response. Eyes with XFS should be monitored carefully after dilation, especially those with marked pigment release. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to estimate the prevalence of pseudoexfoliation syndrome (PXS) and analyse its association with particular ocular diseases in patients attending the Department of Ophthalmology at Jordan University Hospital. Methods: A total of 1195 consecutive patients, aged 40–90 years, who attended the Department of Ophthalmology at Jordan University Hospital between December 2005 and March 2007 were included in the study. Each patient underwent complete ophthalmic evaluation, including: relevant history; visual acuity testing; slit-lamp examination, applanation tonometry, gonioscopy and dilated fundus examination. Patients with typical pseudoexfoliative material on the anterior lens surface and/or the pupillary margin in either or both eyes were labelled as having PXS. Results: Of the 1195 patients, 9.1% had pseudoexfoliation (PXF). Their mean age was 68.3 years (standard deviation [SD] 9.57). The prevalence of PXS had a tendency to increase with age but had no sex predilection. Pseudoexfoliation was bilateral in 65.7% of cases. It was significantly associated with cataract, glaucoma and phacodenesis. Of the eyes with PXF, 92.1% had cataract, 33.1% had glaucoma and 7.9% had phacodenesis. Conclusions: Although this study was not population-based, its findings increase our knowledge of PXS in a Middle Eastern country. Few data on PXS are available from this part of the world. [ABSTRACT FROM AUTHOR]

Purpose Plateau iris configuration (PIC) is a rare condition involving an angle closure unrelated to pupillary block. It may be defined by a narrow angle and a double-hump configuration on gonioscopy. Plateau iris syndrome (PIS) may lead to acute angle-closure glaucoma due to an anterior displacement and rotation of the ciliary body. It has been proposed that ultrasound biomicroscopy (UBM) is helpful in PIC/ PIS diagnosis. Our work aims to describe UBM quantitative and qualitative findings in patients whose gonioscopy suggested a PIC/ PIS Methods Cross-sectional study involving patients with a double hump gonioscopic finding. UBM was then performed by a blinded observer and evaluated for the presence of following ultrasonographic (US) criteria: (1) a thick and flat iris, (2) a sharp, square root angulation on its insertion, (3) an anterior rotation of the ciliary body, (4) irido-ciliary sulcus narrowing, (5) iris-trabecular apposition and (6) a relatively normal anterior chamber (AC) depth. Only high-quality images were accepted Results From September 14 to May 15, 35 patients (59 eyes) were recruited. Only 3 eyes presented the six US criteria, 23 eyes filled five of the criteria, 13 satisfied four criteria, 16 presented three criteria and 4 two criteria. The most commonly verified criteria (over 95% of them) were a thick and flat iris and a square root insertion. There was no association between any of these criteria and sex nor age (p > 0.10). Furthermore, the presence/absence of these criteria did not correlate with either anterior chamber depth, lens vault and lens length (p > 0.10) Conclusions The majority of patients presenting with clinical iris plateau syndrome do not fulfill the entire US criteria for this condition. However, the US-based iris morphological parameters seem to be present in nearly all iris plateau patients. [ABSTRACT FROM AUTHOR]

The article offers information on the common side-effects of latanoprost therapy. Some of the common side-effects include increased pigmentation of pericular skin, conjunctival hyperaemia and iris hyperchromia. Other rare side effect of the therapy is secondary iris epithelial cyst that occurs after intraocular surgery, inflammation or trauma.

Gonioscopy is an essential examination in Glaucoma care. There is no other technique available that can replace it. Differential diagnosis of the different types of glaucoma is not possible without it. This course will highlight the different lenses, examination technique, findings and classifications. It will be shown with Videos, Computer animation as well as clinical cases. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses a new technique for direct gonioscopy to examine the eye's inferior angle at the slit lamp.

Purpose A narrow iridocorneal angle (ICA) is a risk factor for glaucoma progression. However, many patients treated for primary open angle glaucoma (POAG) have never been assessed with dynamic gonioscopy. In this study, we performed dynamic gonioscopy in patients referred for progressing POAG and suspicion of glaucoma (GS) to evaluate the rate of misdiagnosed narrow ICA. Methods We retrospectively analysed the clinical data of consecutive glaucoma or GS patients referred for evaluation from November 2009 to October 2010. All patients had been previously diagnosed with open ICA. Patients were examined by a single ophthalmologist. The evaluation included detailed medical history, comprehensive ophthalmologic examination, diurnal hourly monitoring of the intraocular pressure, static automated perimetry, retinal nerve fiber layer thickness analysis, central pachymetry and dynamic gonioscopy (Possner® lens). Results 135 patients were included. The mean age was 53.6 years (+/‐ 6.2 years). Prior to our evaluation, glaucoma and GS patients had been followed 5.2 years (+/‐ 3.4 years) with an average of 4.2 visits and 2.2 visual fields. 58 patients (43%) had never undergone gonioscopy. A narrow angle was diagnosed in 18 patients (13.3%), including 5 patients with plateau‐iris configuration confirmed by ultrasonic biomicroscopy (27.7% of narrow angles). Conclusion A narrow ICA is not a rare finding among patients diagnosed with POAG or GS patients. Dynamic gonioscopy should be performed systematically for all glaucoma and glaucoma suspect patients, especially in cases of glaucoma progression despite an efficient and well conducted treatment. Lens size evolution with time requires repeated evaluations. [ABSTRACT FROM AUTHOR]