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PurposeTo describe examination and imaging characteristics of presumed iris papulosa in a case of ocular syphilis.ObservationsA 60-year-old man who presented with granulomatous anterior uveitis in his left eye was also noted to have an unusual vascularized iris papule associated with posterior synechiae at the nasal pupillary margin. Anterior segment OCT (AS-OCT) of the iris lesion demonstrated a hyperreflective anterior surface with multiple vascular lumen, internal hyperreflectivity, and shadowing. Ultrasound biomicroscopy (UBM) imaging revealed an echodense mass with relative hyperechogenicity in the anterior portion of the lesion. Systemic work-up confirmed a diagnosis of syphilis, and he was treated with topical steroids and parenteral penicillin.Conclusion and importanceWe characterize the rare finding of iris papulosa that may be encountered in syphilitic uveitis and its distinctive features on both UBM and AS-OCT. This report highlights that syphilis should be considered as a possible diagnosis for an undifferentiated vascular iris mass.

Angle-closure glaucoma secondary to ciliary body cysts is a rare condition. Different pharmacological and surgical treatment modalities have been described. Among these, subliminal transscleral cyclophotocoagulation is a promising alternative due to fewer ocular complications and the same intraocular pressure reducing efficacy. The case is presented of a 33-year-old woman with a 6-year history of uncontrolled ocular hypertension, and a one-month history of glaucoma, treated with multiple drugs and surgical interventions, with persistent elevated intraocular pressure. She came to the clinic due to eye pain and photophobia of the right eye of 3 days onset prior to her visit. An ultrasound biomicroscopy was performed, finding cysts in the ciliary body. It was then decided to perform subliminal transscleral cyclophotocoagulation, achieving a reduction in intraocular pressure, which was maintained after three months of follow-up.

Purpose To describe features of uveitis-glaucoma-hyphema (UGH) syndrome, using Anterior Segment-Optical Coherence Tomography (AS-OCT) and Ultrasound Biomicroscopy (UBM) and to evaluate the diagnostic role of AS-OCT as an imaging technique alternative to UBM. Design Retrospective case series. Methods Four eyes of 4 patients with UGH syndrome were analyzed. All patients reported previous uncomplicated cataract surgery with in-the-bag implantation of single-piece-intraocular lens (IOL). They underwent at presentation complete ophthalmological examination and imaging with slit-lamp anterior segment photographs, UBM and AS-OCT. Results Although AS-OCT did not allow to visualize the structures behind the iris, it displayed a contact between IOL (plate and/or haptics) and iris and IOL tilting in 3 out of 4 eyes. AS-OCT directly detected the cause of UGH syndrome in one eye, 2 eyes required some expedients to display the iris chafing, like scans in mydriasis and/or patient's gaze direction change. AS-OCT did not allow to appreciate the IOL-iris contact (showed by UBM technique) only in one eye, probably due to the change of patient position from supine to sitting, and consequent anteriorization of iris diaphragm. Furthermore AS-OCT showed fine details, as capsular bag collapse and indirect signs of haptic malposition in 3 out of 4 eyes. Conclusion AS-OCT is a non-invasive technique that allows to determine IOL position and IOL-uveal contact in selected cases of UGH syndrome. Considering AS-OCT and UBM advantages and limitations, AS-OCT should be used as first imaging modality when clinical diagnosis is uncertain. When UGH diagnosis cannot be verified using AS-OCT, UBM should be performed.

Purpose To evaluate quantitative relationships between biometric measurements and expected intraocular pressure reduction following phacoemulsification. Design A prospective, comparative clinical study. Methods Forty nine candidates for phacoemulsification were included. Intraocular pressure was measured preoperatively and after 7 and 30 days. Ocular biometrics were measured using optical biometry and ultrasound biomicroscopy preoperatively and 1 month postoperatively. Results Patients were sub-grouped into open-angle glaucoma (12 eyes), angle-closure glaucoma (18 eyes), and cataract-only groups (19 eyes). The mean intraocular pressure reduction was −1.67 ± 2.73, −13.11 ± 7.98, and −7.50 ± 3.58 mmHg in the cataract-only, angle-closure glaucoma, and open-angle glaucoma groups ( p = 0.001). The delta-intraocular pressure at day 7 showed positive correlations with lens vault and relative-lens vault ( p = 0.005 and 0.001). It showed negative correlations with lens position, relative-lens position, anterior chamber depth, aqueous depth, and nasal and temporal angles in addition to lens thickness, anterior vault, nasal trabeculo-ciliary angle, and temporal-trabeculo-ciliary angle at the end of the follow-up period. Regression analysis revealed significant associations between preoperative intraocular pressure and both nasal-trabeculo-ciliary angle and anterior vault ( p = 0.038 and 0.019) and delta-intraocular pressure and both nasal-trabeculo-ciliary angle and relative-lens vault ( p = 0.001 and ≤0.001) with an area under the curve of 0.71 for relative-lens vault. For every degree decrease in nasal-trabeculo-ciliary angle, there was an expected 0.33 mmHg intraocular pressure reduction with no expected change if nasal-trabeculo-ciliary angle decreased to Conclusions The relationship between anterior-segment-biometrics could determine intraocular pressure behavior after phacoemulsification. The preoperative nasal-trabeculo-ciliary angle and relative-lens vault could be significant predictors for postoperative intraocular pressure reduction.

Purpose The purpose of this study was to describe 2 cases of biopsy-proven conjunctival myxomas and present their optical signs on high-resolution optical coherence tomography (HR-OCT) with clinical and histopathological correlations. Methods Two middle-aged female patients with a clinical diagnosis of conjunctival cysts were referred for surgical treatment. Clinical assessment, photographs, ultrasound biomicroscopy, and HR-OCT images were obtained. Excisional biopsies were performed, and specimens were sent for histopathological and immunohistochemical analyses. Results Clinically, these patients presented with a well-circumscribed, semitranslucent, yellow-pinkish mass. Ultrasound biomicroscopy showed a dome-shaped epibulbar mass with medium-to-high internal reflectivity. No compromise of the underlying sclera was noted. HR-OCT showed a normal conjunctival epithelium, a subepithelial nonhomogeneous mass with hyperreflective and hyporeflective areas lined by a highly hyperreflective band, and mild posterior shadowing. Histopathological findings and immunoreactivity for CD34 and vimentin confirmed the diagnosis of conjunctival myxoma. Conclusions The HR-OCT optical signs found in our 2 cases strongly correlated with the microscopic findings. Disclosing the optical signs observed on HR-OCT can help clinicians diagnose and differentiate this lesion, guiding its management. However, more studies with a larger number of patients comparing conjunctival myxoma and other ocular surface tumors are needed to enlighten readers about the unique pattern observed by HR-OCT.

Iris melanocytoma (IM) is a rare variant of iris nevus with distinctive clinical and histopathological features. A 66-year-old woman, with a history of right eye pigmented iris nevus, presented to us with a recent onset of visual acuity decrease in that eye. She had a melanocytic iris lesion with iridocorneal angle invasion, peripheral corneal adhesion, pupil corectopia, sectorial cataract and high intraocular pressure. Ultrasound biomicroscopy did not exclude malignant transformation, so excisional biopsy was performed revealing the presence of IM without signs of atypia. Subsequently, the patient underwent cataract surgery combined with iridoplasty and later an ab externo trabeculectomy. Most cases of IM remain stable and require no intervention, but in cases of unusual clinical course, with rapid growth or secondary glaucoma, surgical treatment is indicated as a diagnostic and therapeutic measure. This case report highlights the importance of a timely and multidisciplinary ophthalmological approach for a better visual outcome.

Objective To identify corneal structure differences on quantitative high-frequency ultrasound biomicroscopy (UBM) among subjects with congenital glaucoma compared with controls. Methods This prospective case-control study evaluated 180 UBM images from 44 eyes of 30 subjects (18 control and 12 glaucoma, mean age 5.2±8.0 years, range 0.2-25.8 years) enrolled in the Pediatric Anterior Segment Imaging and Innovation Study (PASIIS). ImageJ was used to quantify a comprehensive set of corneal structures according to 21 quantitative parameters. Statistical analysis compared corneal measurements in glaucoma subtypes and age-matched controls with significance testing and mixed effects models. Results Significant differences between congenital glaucoma cases and controls were identified in 16 of 21 measured parameters including angle-to-angle, central and peripheral corneal thicknesses, scleral integrated pixel density, anterior corneal radius of curvature, and posterior corneal radius of curvature. Eight parameters differed significantly between primary congenital glaucoma and glaucoma following congenital cataract surgery. Conclusion Multiple measurable corneal structural differences exist between congenital glaucoma and control eyes, and between primary and secondary congenital glaucoma, including but not limited to corneal width and thickness. The structural differences can be quantified from UBM image analysis. Further studies are needed to determine whether corneal features associated with glaucoma can be used to diagnose or monitor progression of congenital glaucoma.

The paper describes the details of observation and surgical treatment of a patient with an established diagnosis of melanoma of the iris and ciliary body. The presence of neoplasm growth signs required a surgical treatment, which helped preserve the eye and its visual functions. Ultrasound biomicroscopy is a modern informative method for observing neoplasms of the iridociliary zone. A timely performed block excision provides a good anatomical and functional result.

The ciliary body (CB) is part of the uvea and is a complex, highly specialized structure with multiple functions and significant relationships with nearby structures. Its functions include the aqueous humor (AH) production in the ciliary processes, the regulation of the AH output through the uveoscleral pathway, and accommodation, which depends on the ciliary muscle. Also, the CB is an important determinant of angle width as it forms part of the ciliary sulcus. Until recently, knowledge of the CB was based on histological studies. However, this structure can currently be assessed in vivo using imaging techniques such as ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT). Both techniques have shown good reproducibility of their measurements allowing for quantification of CB dimensions and their localization. In effect, studies have shown a larger CB in myopia and its diminishing size with age. Swept-source OCT devices offer fast, non-invasive high-resolution imaging allowing the identification of multiple structures. UBM requires contact and is uncomfortable for the patient. However, this technique offers deeper imaging and therefore remains the gold standard for assessing the posterior chamber, ciliary processes, or zonula. The clinical utility of CB imaging includes its assessment in different types of glaucoma such as angle-closure, malignant or plateau iris. Diagnostic CB imaging is also invaluable for the assessment of ciliochoroidal detachment when suspected, the position after the implantation of a pre-crystalline or sulcus-sutured lenses, diagnosis or monitoring of cysts or tumors, sclerotomies after retinal surgery, intermediate uveitis, or accommodation.

Most of the ciliary body and ciliary processes of the eye cannot be directly visualized in vivo because of the posterior location of the pars plicata to the posterior chamber and iris. However, ciliary anatomy can be effectively imaged using ultrasound biomicroscopy (UBM) by placing the probe close to the limbus, perpendicular to this structure. Previous studies measuring ciliary body parameters in meridian UBM images found that these parameters were measured with poor reliability and repeatability. This study evaluates the intra-observer reliability and inter-observer agreement of a standardized protocol for measuring six ciliary parameters in transverse or quadrant UBM images that capture an entire row of ciliary processes. All six ciliary parameters have high intra-observer reliability, with ciliary body thickness, ciliary process length and ciliary process density measurements being the most consistent for each observer. The coefficient of variation for each observer ranged from 1.4%-15%. Inter-observer agreement was also high for all six parameters, with an intra-class correlation coefficient >0.8. Utilizing transverse UBM images of the pars plicata allows for consistent quantitative analysis in control subjects.

PURPOSE To characterize the true position of in-the-bag intraocular lenses (IOLs) relative to the limbus using ultrasound biomicroscopy and estimate scleral-sutured IOL positioning. METHODS This prospective single-center study included 70 eyes of 41 patients with in-the-bag posterior chamber IOLs. Four vertical ultrasound biomicroscopy captures were performed in each eye in the superior, inferior, nasal, and temporal quadrants. Postoperative biometric data were collected. The primary outcome was the vertical distance of the in-the-bag IOL from the sclerocorneal limbus. Secondary outcomes included anterior shift and refractive change of a theoretical scleral-sutured IOL using sclerotomies at 2.5 mm and 3 mm posterior to the limbus. RESULTS A total of 265 ultrasound biomicroscopy images were analyzed, including 64 superior, 69 inferior, 66 nasal, and 66 temporal. The true in-the-bag IOL position measured as distance posterior to the sclerocorneal limbus was 4.23 ± 0.56 mm superiorly, 4.22 ± 0.46 mm inferiorly, 3.95 ± 0.48 mm nasally, and 3.86 ± 0.52 mm temporally. The anterior shift of a theoretical scleral-sutured IOL was 0.60 mm for a 3-mm sclerotomy and 0.93 mm for a 2.5-mm sclerotomy, resulting in a theoretical myopic shift of 0.45 diopter (D) and 0.79 D, respectively, assuming a 15-D IOL. Larger biometric measurements correlated with a more posterior in-the-bag position. CONCLUSION True in-the-bag IOL position was found to be more posterior than estimates of scleral-sutured IOLs. Additional corrections in scleral-sutured IOL calculations may improve refractive outcomes.

Background: Chronic dacryocystitis is the most frequent disorder in the lacrimal drainage system. The disease has been considered to be strongly associated with obstruction of the lacrimal duct, which creates a fertile environment for bacterial colonization and promotes lacrimal sac inflammation. Objective: The aim of this work was to evaluate lacrimal sac diameter in different age groups using ultrasound biomicroscopy (UBM). Patients and Methods: Twenty-four eyes of 24 normal individuals. They were divided according to age into 3 groups; group A: age ranging between 30 and 40 years, group B: age ranging between 40 and 50 years and group C: age above 50 years. Lacrimal sac diameter was assessed. Ocular examination and special tests were done for lacrimal drainage system (regurge test and fluorescein dye disappearance test) with imaging of lacrimal passages by ultrasound biomicroscopy. Results: All patients had no symptoms of epiphora, negative both regurge test and dye disappearance test and clear contents of the lacrimal sac. There was no statistically significant difference between groups regarding either longitudinal or horizontal lacrimal sac diameter. Conclusion: UBM can be used for imaging and measuring lacrimal passages and thus can be useful as an adjunctive to clinical examination and surgical planning in cases with lacrimal system diseases.

To date, the factors affecting the course of the reparative process after non-penetrating deep sclerectomy (NPDS) have not been fully determined. There is no systematic information about the regulatory role of the cytokines TGF-β, IL-6, IL-8 and MMP-9, VEGF A 121 and 165 in the formation mechanisms of the newly created pathways consistency of intraocular aqueous humor outflow.Purpose. To determine possible ways of impact of biologically active aqueous humor molecules of the anterior chamber and lacrimal fluid on the hypotensive effect of non-penetrating deep sclerectomy.Methods.A prospective study of 65 patients with open-angle glaucoma before and 12 months after NPDS and 22 patients without eye hydrodynamic disorders with the determination of the initial concentrations of biologically active molecules in the lacrimal fluid and aqueous humor of the anterior chamber. Twelve months after NPDS all patients were divided into three groups, depending on the hypotensive effect of the operation, according to the criteria.Results. Multivariate discriminant analysis showed the greatest inter-group differences, calculated by the square of the Mahalanobis distance, between group 3 with no hypotensive effect of NPDS and the control group (R2 = 8.48, p = 0.001). The most informative features that determine the differences between the 4 groups in the total population, calculated according to the Fischer F-test, were MMP-9 (F = 14.7, p = 0.001) and TGF-β (F = 7.08, p = 0.001) in the aqueous humor of the anterior chamber. In pairwise comparison of groups 1 and 2, the maximum level of significance according to the F-criterion was characteristic of the level of tear IL-6 (F = 21.25, p = 0.001), with approximately equal degree – IL-8 (F = 7.85, p = 0.001) and VEGF (F = 7.12, p = 0.001), to a lesser extent TGF of aqueous humor (F = 4.43, p = 0.001) and MMR-9 (F = 2.23, p = 0.001). Between groups 1–3, the maximum differences according to the Fisher criterion were observed in the IL-8 (F = 20.99, p = 0.001), TGF (F = 8.75, p = 0.001) and to a lesser extent – TGF (F = 5.83, p = 0.001).Conclusion. The analysis of the obtained data showed the decisive role of the imbalance of proinflammatory cytokines, signaling proteins with prolymphoangiogenic activity, and MMP-9 in the aqueous humor of the anterior chamber, as well as in the initial state of the lacrimal fluid in the postoperative healing processes after NPDS.

Ultrasound biomicroscopy (UBM) is an important tool in the diagnosis, evaluation and follow up of glaucoma patients. Even if we are dealing with a primary angle closure glaucoma (PACG) or a primary open angle glaucoma (POAG) patient, the mechanism of angle closure can be revealed by performing an UBM. The device can help differentiate between the two types of glaucoma even in patients with opaque corneas when gonioscopy cannot be performed. Knowing the type of glaucoma is vital, especially regarding an individualized treatment, since each patient is unique and needs to be treated accordingly, in order to prevent glaucomatous optic neuropathy and visual field loss. Abbreviations: AC = anterior chamber, ICE = iridocorneal endothelial syndrome, IOP = intraocular pressure, NTG = normal tension glaucoma, PACG = primary angle closure glaucoma, PC = posterior chamber, PEX = pseudoexfoliation syndrome, POAG = primary open angle glaucoma, UBM = ultrasound biomicroscopy.

This review presents data on the use of the method of ultrasonic biomicroscopy (UBM) of the anterior segment of the eye in ophthalmological practice in adults and children. Ultrasound biomicroscopy (UBM) is a contact non-invasive method for visualizing structures of the anterior segment of the eye using high-frequency ultrasound in the range from 35 to 100 MHz. Literature data indicate that UBM can be used to visualize almost all structures of the anterior segment, including the cornea, iridocorneal angle, anterior chamber, iris, ciliary body and lens, as well as the peripheral parts of the retina, vasculature and vitreous. There is data on the use of this method in the study of pathogenetic aspects of glaucoma, pseudoecfoliative syndrome, various types of cataracts, post-traumatic injuries of the anterior segment of the eye, meimobium gland dysfunction and other ophthalmopathologies. The use of UBM in children, due to the peculiarities of its implementation, is not widespread, but due to the specificity of the data obtained using it, it is promising. The limited information about the use of UBM in retinopathy of prematurity and the diagnostic capabilities of the method makes its use especially relevant in this severe retinal disease of premature newborns.

PRCIS The addition of limited deep sclerectomy (LDS) to conventional trabeculectomy increases the success rate, especially in pseudophakic eyes. PURPOSE This study aimed to evaluate the efficacy of LDS in enhancing the intraocular pressure (IOP)-lowering outcomes of trabeculectomy. DESIGN This was a parallel-arm, single-masked, randomized-controlled trial. METHODS A total of 68 patients (68 eyes) with moderate to advanced primary open-angle glaucoma or primary angle-closure glaucoma with pseudophakia were recruited at a tertiary eye care center in Northern India and randomized into 2 groups. Thirty-five eyes in group 1 were subjected to trabeculectomy alone and 33 eyes in group 2 were subjected to trabeculectomy with LDS. All cases were supplemented with low-dose subconjunctival mitomycin-C (0.1 mg/mL for 1 min) in both groups. The primary outcome measure was IOP, and success rates were calculated for IOP ≤18/15/12 and ≥5 mm Hg. The secondary outcome measures included evaluation of bleb morphology, presence of an intrascleral aqueous lake, and supraciliary flow on ultrasound biomicroscopy. RESULTS The mean postoperative IOP at 12 months was 13.4±1.83 mm Hg in group 1 and 12.5±1.67 mm Hg in group 2 (P=0.04). For IOP cutoff ≤15 mm Hg, absolute success was noted in 11 (31.4%) and 22 eyes (66.6%) in groups 1 and 2, respectively (P=0.004). At 12 months, the intrascleral lake was detected in 2 (6%) eyes in group 1 and in 9 (29%) eyes in group 2 (P=0.02). Supraciliary flow was detected in 2 eyes (6.2%) in group 2 and none in group 1 at 12 months (P=0.02). In the Cox proportional hazard model, trabeculectomy with LDS was associated with a lower rate of failure (hazard ratio: 0.32, 95% confidence interval: 0.13-0.75, P=0.009). CONCLUSION The addition of LDS to trabeculectomy led to lower mean IOP and higher success rates at 12 months, compared with trabeculectomy alone.

PURPOSE OF REVIEW: To discuss recent studies of imaging modalities for ocular surface pathologies. RECENT FINDINGS: Novel micro-ocular coherence tomography technology can produce high-resolution images of corneal cellular and nervous structures. Ocular coherence tomography angiography can aid in detecting early stage limbal stem cell deficiency. Several studies used in vivo confocal microscopy to evaluate corneal nerve metrics and morphology. SUMMARY: The applications of anterior segment optical coherence tomography, anterior segment optical coherence tomography angiography, ultrasound biomicroscopy, and in vivo confocal microscopy are useful technologies for imaging the ocular surface. Several studies have used artificial intelligence in combination with imaging technologies to create reliable and effective systems to detect and visualize ocular surface pathologies. AS OCT continues to be a key imaging tool and future development of μOCT technology may further enhance its utility.

The front part of the eye is exposed to the surface of the body, making it susceptible to injury. Blunt eye injuries often destroy the tissue structure in the anterior part of the eye. Often there is detachment of the iris root, separation of the ciliary body, the angle of retraction of the chamber, and complete dislocation or subluxation of the lens. Ordinary ocular ultrasound can penetrate into opaque tissue, but because of its low resolution, it can only show its outline, which is still very small for doctors in assisting diagnosis. Ultrasonic biomicroscopy is a very real-time analysis, will not be affected by the refraction space, and has great application value for ocular trauma. Based on this, this article proposes the ultrasound biomicroscope diagnosis analysis and fine nursing research of traumatic anterior chamber injury based on intelligent virtual reality technology. This article describes literature methods, experimental analysis methods, and other methods, in-depth study of the causes of traumatic anterior injuries, ultrasound biomicroscopy, and other theoretical knowledge, ultrasound biomicroscopy and microcontrol experiments for traumatic anterior injury design, and finally the causes of eye damage. This study compares the pairing results of ultrasound biomicroscopy biological measurements, analyzes the relationship between anterior bleeding level and anterior ocular injury, and analyzes the outcome and extent of service ophthalmology. The angle retreat accounted for 52.17% in grade I, 72.22% in grade II, and 60% in grade III. Anterior bleeding can cause single or complex iris root detachment, iris root detachment, ciliary body detachment, and angular leakage. The more the bleeding, the more serious the eye damage.

Introduction: Ologen™ is traditionally placed subconjunctivally during trabeculectomy, which limits its area of action. Subscleral implantation of Ologen has been described involving fashioning a gutter beneath the scleral flap. This, however, would not prevent fibrosis at the margins of the scleral flap. We describe a modified technique of Ologen® placement that has the potential to prevent scarring at the margins of the flap withoutthe need to fashion a gutter. Materials and methods: The study involved a retrospective review of patients who had undergone trabeculectomy with Ologen implantation by the wick technique between January 2015 and August 2016. Patients judged to be at high risk of trabeculectomy failure were operated with this technique. Results: A total of six patients with median age of 38.5 years were included in the study. The mean preoperative intraocular pressure (IOP) was 30.8 ± 7.3 mmHg, which reduced to 10.6 ± 2.2 mmHg 18 months after surgery. By 18 months postoperative, all patients had IOP in the low teens (two patients required additional topical medication). One patient had two episodes of hypotony that responded to steroids and cycloplegics. Another patient required two needlings to bring IOP under control. No other complications were noted. Ultrasound biomicroscopy done 3 months after surgery showed two pieces of Ologen in one patient. Conclusions: The results of our study show that this technique may be used effectively in patients at high risk of trabeculectomy failure. Further studies in a larger number of patients with diverse high-risk conditions are required before this technique is recommended for general use.

Purpose: to assess the efficacy and safety of needling performed by the new scleroconjunctival dissector according to our specific technique.Patients and methods. The study included 60 patients diagnosed with operated subcompensated or decompensated glaucoma. Thirty patients underwent microinvasive reoperation with the help of a sclero-conjunctival dissector. The control group consisted of 30 patients; they underwent repeated sinustrabeculectomy with iridectomy. A standard ophthalmological examination and ultrasound biomicroscopy were performed before the operation and in dynamics (after 1, 3, 6, 9 months).Results: 76.7 % of the experimental group had IOP less than or equal to 15 mm Hg six months after microinvasive reoperation. In the control group, the same mark was 70 %. Hyphema occurred in 23.3 % of the main group, it was stopped by conservative treatment. 10 % of patient developed choroid detachment, it did not require surgical treatment. Hyphema was formed in 36.7 % in the control group and choroid detachment — in 53.3 % of patients. The complications were more manifested and required surgical treatment in the control group. According to the data of ultrasound biomicroscopy, the acoustic density in the control group steadily increased, while the height of the filtration bleb first increased and then decreased. This may indicate significant tissue induration, probably as a result of fibrosis after an operating injury. The intrascleral «lake» height does not differ between the groups when comparing dynamic observations, and the volume of the intrascleral cavity is significantly greater in the main group than in the control group (p < 0.0001) at admission and during dynamic observation. The text of the article describes a clinical case of a patient who underwent microinvasive reoperation.Conclusion. When there are indications for re-surgery, an adequate and thorough diagnosis of the preservation of the surgically created outflow tract, namely gonioscopy and ultrasound biomicroscopy, is important. In patients with intact internal fistula and without pronounced fibrosis of the intrascleral drainage pathways, it is possible to carry out microinvasive reoperation according to our technique using a scleroconjunctival dissector, this allows to reduce the risk of postoperative complications and achieve hypotensive efficacy comparable to repeated filtering surgery.

Background The aim of the present study was to investigate the role of ultrasound biomicroscopy (UBM) in the evaluation of postoperative complications in children with congenital cataracts. Methods A retrospective study was conducted between September 2012 and December 2016 at Guangzhou Women and Children's Medical Center. Red reflex test and high-resolution bag/balloon UBM were performed to evaluate postoperative congenital cataracts. The red reflex test results were recorded, and UBM imaging results were recorded and analyzed. Different postoperative complications were classified based on the UBM imaging features, and a second procedure was performed accordingly. The UBM images were compared with the images captured from the intraoperative videos. Results In total, we looked at 120 eyes in 96 patients (65 males and 31 females) in the present study. The age of the cohort was 3-76 months. A total of 51 eyes with poor red reflex were included. There were complications in 46 eyes after congenital cataract surgery, as detected by UBM, including posterior capsular opacification (n=29 eyes), pupil block (n=8 eyes), synechia (n=5 eyes), hyphema (n=1 eye), and abnormal intraocular lens (IOL) placement (n=3 eyes). UBM images showed specific features of postoperative complications. Conclusions UBM is a valuable tool for the early evaluation of postoperative complications of congenital cataracts, especially for those with media opacities or when pupil dilation is not possible.

Purpose of the study to carry out a comparative analysis of the state of the zonular fibers before and after surgery on UBM between femtolaser assisted and classical ultrasound cataract removal. Material and methods. 19 patients (38 eyes) with age-related cataracts. 22 eyes were with pseudo-exfoliative syndrome. All patients were examined with grade 1 lens subluxation. The first group of 19 eyes underwent cataract femto-phacoemulsification. The second group included 19 eyes without using a femtolaser. The state of the fibers was determined on the UBM on the fifth day after the operation at the end of antibiotic therapy. Results. The data showed the presence of a statistically significant difference between the group with femto-assistance and the group without it. In the first group, UBM analysis showed that the state of the zonular fibers remained in the same state in 16 of 19 eyes. In the second group, 11 of 19 eyes required ring implantation with suturing to the sclera and 3 required IOL implantation with seamless fixation to the sclera and vitrectomy. Conclusions. The appropriate path to surgery depends on the most accurate objective assessment of the condition of the lens ligaments, since the position of the IOL is one of the main factors for a good result expected by the patient after surgery. Reducing the «trauma» of the eye with lens surgery has been a key success factor and femtolaser guidance provides valuable assistance in obtaining it. Key words: lens subluxation, femtosecond laser, UBM.

Objective To describe the clinical use of ultrasound biomicroscopy (UBM) to evaluate equine corneal disease. Methods Images were obtained using a 50-MHz probe ultrasound biomicroscopy system (Quantel Aviso) and Clear Scan® probe cover. Six horses with corneal disease were evaluated via UBM for lesion size, lesion depth, and continuity of Descemet's membrane. Horses were sedated and received auriculopalpebral nerve blocks and application of topical anesthetic prior to UBM. Results Ultrasound biomicroscopy was easily performed in all cases. UBM evaluation of three cases of corneo-limbal squamous cell carcinoma yielded information regarding lesion depth for planning of keratectomies using fixed-depth keratomes and subsequent β-radiation therapy. Corneal depth and continuity of Descemet's membrane were determined in two horses with stromal abscesses and allowed for planning of therapeutic options. In one horse with a corneal foreign body, UBM contributed to accurate assessment of the foreign body's stromal depth, which could not be assessed during ophthalmic examination due to extensive corneal cellular infiltrate. The information regarding corneal depth allowed for more accurate pre-surgical planning in patients with opaque corneal lesions. Conclusions Ultrasound biomicroscopy was easily performed and provided useful information regarding lesion depth and continuity of Descemet's membrane for patients with corneo-limbal squamous cell carcinoma, stromal abscesses, and a corneal foreign body, allowing for increased precision in pre-surgical planning and development of therapeutic protocols.

PURPOSE To evaluate the optic plate and haptics of a specially designed sutureless intrascleral-fixated intraocular lens (IOL) using ultrasound biomicroscopy and anterior segment optical coherence tomography (AS-OCT). SETTING Department of Ophthalmology, San Marino Hospital, Republic of San Marino. DESIGN Retrospective observational case series. METHODS Eyes that underwent intrascleral fixation with IOL implantation (Carlevale) were included. Preoperative and postoperative refractive outcomes were reported. Optic plate tilt and haptics position were assessed with ultrasound biomicroscopy, whereas intrascleral plug depth and conformation were evaluated with AS-OCT. RESULTS The study comprised 10 aphakic eyes. Postoperative visual acuity improved in all patients. At postoperative month 3, 3 eyes (30%) had a vertical tilt of more than 100 μm, whereas no horizontal tilt was observed in any patient. The mean vertical intraocular tilt was 0.19 ± 0.22 mm. Of 20 haptics, 13 (65%) passed through the ciliary sulcus, 4 (20%) posterior to the ciliary body, and 3 (15%) through the ciliary body. AS-OCT scans showed a mean intrascleral plug depth of 247.20 ± 62.82 μm in the nasal sector and 265.50 ± 30.11 μm in the temporal sector, with adequate integration of the T-shaped plugs in the scleral tissue. CONCLUSIONS This secondary IOL showed good intraocular stability and safe haptics fixation, making it suitable for the intrascleral fixation technique. The specific foldable design results in a low predisposition to optic plate tilt and haptic torsion. In long eyes, the sulcus-to-sulcus distance should be carefully evaluated preoperatively because the flexible structure of the IOL could be subjected to excessive stretching.

The study was a prospective observational study comparing semi-automated to manual quantitative ultrasound biomicroscopy image analysis among 82 images from 41 eyes of 32 subjects (21 controls and 11 glaucoma) enrolled in the Pediatric Anterior Segment Imaging Innovation Study. Interclass correlation coefficients and correlation coefficients were greater than 0.8 for all parameters, and comparison of respective analysis speed was 7 times faster for the semi-automated method compared to manual image quantification.

Background/ObjectiveAnterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) are two non-invasive imaging techniques used for the measurement of tumour thickness in corneal and bulbar conjunctival tumours. Histopathology (HP), however, remains the gold standard for the measurement of tumour thickness. The aim of this study was to determine whether AS-OCT and UBM are as accurate as HP for measuring tumour thickness.MethodsForty-two corneal and bulbar conjunctival tumours were imaged using AS-OCT and UBM. Images were assessed and tumour thickness was measured. Eleven patients subsequently underwent surgical excision. All specimens were measured during histopathological analysis. The correlation of the thickness measurement on HP to AS-OCT and UBM was then statistically analysed. In cases where the tumour was not excised, thickness measurement comparisons between AS-OCT and UBM were analysed.ResultsAS-OCT and UBM measurements of tumour thickness were found to be significantly positively correlated (p=ConclusionBoth AS-OCT and UBM are useful techniques to image and measure the thickness of corneal and conjunctival bulbar tumours. While AS-OCT provides better details than UBM, it was more limited in visualising the posterior boundary of the tumour, particularly in malignant tumours. While thickness measurements of both methodologies were correlated, neither should yet be considered as replacements to the gold standard of HP.

Purpose: To compare clinical characteristics and ultrasound biomicroscopy (UBM) measurements of cases with functional and non-functional blebs, and to identify potential risk factors capable of affecting UBM parameters. Methods: Thirty-one patients aged 40–79 were included. Following trabeculectomy, cases were divided into two groups as those with functional bleb (Group 1, n = 20) and those with non-functional bleb (Group 2, n = 11). UBM was performed. Results: In Group 1 compared to Group 2, lower postoperative intraocular pressure (IOP) (12.1 ± 1.7 vs 27.2 ± 3.2 mmHg, p 0.05). Conclusion: UBM is useful in assessing bleb success. Lower bleb reflectivity, greater bleb height and greater scleral route visibility indicate that the bleb is functional. To the best of our knowledge, this is the first study investigating effects of preoperative IOP, number and duration of preoperative antiglaucoma drug use on UBM parameters. In cases with functional bleb, duration of preoperative drug use affects only bleb reflectivity, while postoperative IOP affects bleb height, scleral route visibility and bleb reflectivity.

Gonioscopy is the widely used technique of grading and evaluating the anterior chamber angle in current glaucoma evaluation practice. The grading of angle and open angle or narrow angle classification with gonioscopy is fairly accurate when done by an experienced ophthalmologist. In recent years, UBM and anterior segment OCT are advanced and in depth imaging tools for the anterior segment evaluation and accurate angle measurements. In our study, we have included 200 eyes for anterior chamber angle grading with gonioscopy and UBM and results are compared. Our study shows that some amount of estimation of angle depth by gonioscopy is overestimated in nearly closed and grade 1 angles. Estimation of grades 2 and 3 is nearly accurate with gonioscopy and comparable to UBM angle grading. Over diagnosis of occludable angles with gonioscopy which can be explained due to iris contour, inter-observer reliability or limitation to examine far periphery of the angle and this can be overcome by UBM examination. UBM provides accurate anterior chamber angle in degrees, peripheral iris configuration details and quantification of measurements is possible. Keywords: Gonioscopy, Ultrasound Biomicroscopy (UBM).

Lacrimal canaliculitis (LC) is a rare infection of lacrimal passage, which is usually late diagnosed or misdiagnosed. Traditional lacrimal system tests barely provide a clear and definite understanding of the pathological changes in lacrimal passage. We presented three patients with asymptomatic and atypical symptoms who were misdiagnosed and were eventually diagnosed with chronic LC with assistance of 80-MHz ultrasound biomicroscopy (80-MHz UBM) and lacrimal endoscopy. To our knowledge, the mutual assistance of above two techniques diagnosing LC has never been reported, it can provide better images and observations of the canaliculus from the inside out and can guide the differential diagnosis.

Purpose We evaluate the role of microscope-integrated intraoperative optical coherence tomography (i-OCT) in pediatric keratoplasty. Design: Combined prospective and retrospective, comparative, interventional study conducted at the Dr Rajendra Prasad Center for Ophthalmic Sciences in New Dehli, India. Methods: Seventy-five children ≤16 years of age undergoing planned keratoplasty were divided into 2 groups and compared regarding intraoperative course and postoperative outcome. In group 1 (prospective group, n = 56), preoperative anterior segment visualization was performed clinically, with ultrasound biomicroscopy (UBM) and i-OCT and keratoplasty was commenced under i-OCT microscope. In group 2 (retrospective group, n = 19), a conventional microscope was used during keratoplasty. Results: In group 1, i-OCT, UBM, and clinical examination detected retrocorneal membrane in 10%, 7.5%, and 5% (P = .005), iris adhesions in 62.5%, 57.5%, and 20% (P = .02), iris stump in aniridia 15%, 10%, and 0% (P = .001), shallow central anterior chamber in 22.5%, 22.5%, and 7.5% (P = .003), and shallow peripheral anterior chamber in 65%, 60%, and 17.5% (P = .004) of children, respectively. The use of i-OCT affected intraoperative surgeon decision making in 45% and 33% of cases of anterior and posterior lamellar keratoplasty, respectively. During penetrating keratoplasty, concomitant intraoperative procedures were higher in group 1 than in group 2, namely synechiolysis (19/40 vs 2/15; P = .1), pupilloplasty (4/40 vs 0/15; P = .02), lens extraction (4/40 vs 1/15; P = .5), and anterior vitrectomy (2/40 vs 1/15; P = .4). Postoperative secondary interventions were lower (P = .04) in group 1 (48.21% vs 94.74%). Conclusions: Anterior segment imaging with i-OCT and UBM immediately before surgery improves the surgical planning of children with corneal opacities. In addition, the use of i-OCT refines intraoperative steps, thereby optimizing the postoperative outcome of pediatric keratoplasty.

Background Here, we describe a patient who exhibited pseudophakic angle closure due to vitreous block following ureteroscopic lithotripsy under general anesthesia. Case Presentation A 57-year-old Thai man presented with sudden eye pain and blurring of vision in the left eye following ureteroscopic lithotripsy under general anesthesia. The patient had a history of coconut hit into his left eye which resulted in traumatic anterior lens subluxation, for which he had undergone phacoemulsification and scleral-fixated intraocular lens implantation in the left eye. Prior scleral fixation procedure, anterior vitrectomy was not performed. Clinical examination showed mushroom-shaped vitreous in the anterior chamber with absolute pupillary block, which had resulted in acute angle closure. Thus, topical and oral antiglaucoma medications were administered to achieve normal intraocular pressure in the left eye, followed by laser peripheral iridotomy in that eye. The anterior chamber depth was successfully increased. Limited anterior vitrectomy by a pars plana approach was performed to prevent recurrent angle closure. The patient’s vision improved and his intraocular pressure remained controlled without any antiglaucoma medication. Conclusion Vitreous block can occur in patients with pseudophakia, especially in the presence of a ruptured posterior capsule. Cautious intraoperative anterior vitrectomy and surgical iridectomy are warranted. General anesthesia may contribute to the onset of vitreous block in susceptible patients.

Objective: Filtration in the area subjected to CO2 laser-assisted sclerectomy surgery (CLASS) is described using ultrasound biomicroscopy (UBM) and the clinical grading scale to evaluate the mechanism of intraocular pressure (IOP) reduction. Methods: Twenty-eight patients with open-angle glaucoma underwent CLASS. The Indiana Bleb Appearance Grading Scale evaluation was performed 1 month after surgery to determine bleb height, extent, vascularity, and leakage. UBM was used to describe and measure the surgical area. Bleb morphology, the size of the scleral lake, scleral route, and trabeculodescemetic membrane (TDM) thickness were examined. Results: One month after CLASS, IOP significantly decreased from 20.46 ± 3.92 mmHg to 12.71 ± 2.99 mmHg, and the anterior chamber depth significantly more shallow, from 2.75 ± 0.36 mm to 2.61 ± 0.33 mm( p Conclusion: UBM examination indicated the aqueous humor drainage route. In the early stage after CLASS, subconjunctival and choroidal drainage routes might be the major mechanism underlying IOP reduction. Mild and moderate congestion of bleb blood vessels warrant attention to avoid early bleb scarring.

Purpose To compare the distribution of plateau iris in eyes across varying severity of primary angle closure glaucoma (PACG) using standardized ultrasound biomicroscopy (UBM) criteria. Design Cross-sectional study. Methods UBM was performed on 210 patients with PACG who had previously undergone laser peripheral iridotomy. Plateau iris was defined as the presence of all the following UBM criteria in ≥2 quadrants of the angle: anteriorly directed ciliary body, absent ciliary sulcus, iris angulation, flat iris plane, and iridotrabecular contact. Disease severity was based on the visual field mean deviation (MD) and classified as early-to-moderate (MD ≥ −12 dB), advanced (−12.01 dB to −20 dB), and severe (MD Results Of 210 subjects recruited, 23 were excluded because of poor quality UBM images. The remaining 187 patients were categorized as having early-to-moderate (n = 103), advanced (n = 38), and severe PACG (n = 46). Of these subjects, 48.1% were male, and 90.9% were of Chinese ethnicity. The overall proportion of plateau iris was 36.9%, with 32.0% (33/103) in early-to-moderate, 34.2% (13/38) in advanced, and 50% (23/46) in severe PACG (P = .03, comparing severe PACG with early-to-moderate groups). Among the severe PACG group, those with plateau iris configuration had significantly smaller anterior chamber area (P = .03) and volume (P = .01) compared with those without plateau iris. Conclusion The higher proportion of plateau iris configuration in eyes with severe PACG compared with early-to-moderate PACG suggest that this may be a contributory factor for disease severity.

Terrien marginal degeneration and Fuchs’ superficial marginal keratitis are considered rare and slowly progressive corneal diseases with a bilateral lesion, unknown etiology, and have a number of similar clinical signs. Clinically, Terrien marginal degeneration is characterized by peripheral thinning, which appears at the beginning of the disease usually in the upper half, but can also begin with the lower half of the cornea. In the case of Fuchs’ superficial marginal keratitis, biomicroscopic examination, at the initial stages of the disease’s development, in the lower and lower nasal segments, reveals peripheral corneal thinning. As a rule, in both diseases, the lesions on the two eyes are asymmetric, but peripheral corneal thinning is the main pathological sign. Purpose. To determine the diagnostic criteria for Terrien disease and Fuchs’ marginal keratitis, to identify their similarities and differences. Patients and methods. For the period 2017–2020, 40 patients were examined; they were divided into 3 groups. 30 patients with Terrien marginal degeneration, 7 patients with Fuchs’ superficial marginal keratitis, 3 patients with signs of Terrien marginal degeneration in one eye and typical manifestations of Fuchs’ superficial marginal keratitis in the other eye. The following methods were used for diagnostics: confocal microscopy, optical coherence tomography of the anterior segment, keratotopography. Results. A survey of 40 patients revealed many common clinical signs of two previously considered separate diseases. According to the literature, it is known that the main difference between these two diseases is the localization of corneal lesions. We found that different localization of the lesion in Terrien degeneration and superficial marginal Fuchs keratitis is present in some patients and only in the initial stages of both diseases. Conclusions . Terrien’s degeneration and Fuchs’ superficial marginal keratitis may be different variants of clinical manifestations or different stages of progression of the same disease. Since the etiology of Terrien’s degeneration and Fuchs’ superficial marginal keratitis had not been established, it is recommended to follow the clinical course of the diseases during treatment.

Objective This study describes the imaging of the filtering area in CO2 laser-assisted sclerectomy surgery (CLASS) using ultrasound biomicroscopy (UBM) combined with the Indiana Bleb Appearance Grading Scale (IBAGS) and evaluates the mechanism by which CLASS lowers the intraocular pressure (IOP). Methods Twenty-eight cases (28 eyes) of primary open-angle glaucoma that could not be controlled by drugs underwent CLASS. At 1, 3, 6, 12, 18, and 24 months after surgery, IBAGS was used to evaluate the external morphology of the filtering blebs, and UBM was used to describe and measure their internal structure. Results During the early period after CLASS, most cases showed diffuse filtering blebs with a serious degree of congestion. At the end of follow-up, most cases did not present filtering blebs. All patients showed an intact and thin trabeculodescemetic membrane (TDM) with an average thickness of 0.094 ± 0.017 mm. The scleral reservoir size gradually decreased over time and tended to stabilize after 18 months. At 3 and 6 months after surgery, 53.57% of the patients had abnormalities in the TDM area, and after laser goniopuncture treatment, the scleral reservoir became slightly larger and the IOP decreased. The TDM thickness was not correlated with postoperative IOP, and the scleral reservoir size was negatively correlated with IOP. Conclusion During the early phase after CLASS, the subconjunctival and suprachoroidal pathways may be the main mechanisms lowering IOP; over time, internal drainage pathways such as the intrascleral, trabecular-meshwork, and suprachoroidal pathways play greater roles in lowering IOP.

Purpose Ultrasound biomicroscopy (UBM) has been used to characterize anterior segment dimensions in plateau iris configuration (PIC), but transverse measurements between the recesses of the ciliary sulcus (sulcus-to-sulcus diameter [STSD]) and the ciliary body processes (interplicata diameter [IPD]) have not been reported. We measured STSD and IPD and compared these among eyes with PIC, primary angle closure (PAC), and control eyes with open angles. Design Retrospective, cross-sectional clinical study. Participants Sixty-nine participants, 37 PIC, 13 PAC, and 19 controls. Methods We searched our clinical UBM database for PAC and PIC cases. Controls were assembled by reviewing images obtained for surveillance of ocular surface lesions. Anterior segment measurements were performed using the UBM digital caliper tool. Robust-fit ANOVA identified among-group differences. Pairwise t tests were used to test the significance of between-group differences. Main Outcome Measures Anterior chamber depth (ACD), angle opening distance (AOD), ciliary body area and thickness, iris area, horizontal and vertical STSD, and horizontal and vertical IPD. Results Fifty-five left eyes were analyzed (30 PIC, 10 PAC, and 15 controls). ACD was smaller in PAC than in PIC and control eyes (P Conclusions STSD and IPD are narrower in PIC and PAC than in healthy eyes. Further studies that examine the ratio of white-to-white cornea diameter to the IPD may provide a mechanism for reported cases of in-the-bag uveitis–glaucoma–hyphema syndrome in PIC.

Testis tissue xenografting and testis cell aggregate implantation from various donor species into recipient mice are novel models for the study and manipulation of testis formation and function in target species. Thus far, the analysis of such studies has been limited to surgical or post-mortem retrieval of samples. Here we used ultrasound biomicroscopy (UBM) to monitor the development of neonatal porcine testis grafts and implants in host mice for 24 wk, and to correlate UBM and (immuno)histologic changes. This led to long-term visualization of gradual changes in volume, dimension and structure of grafts and implants; detection of a 4 wk developmental gap between grafts and implants; and revelation of differences in implant development depending on the craniocaudal site of implantation on the back of host mice. Our data support the reliability and precision of UBM for longitudinal study of transplants, which eliminates the need for frequent surgical sampling.

Background Posterior scleritis is a rare inflammatory ocular disease, characterized by severe and painful inflammation of the sclera. It is often misdiagnosed or underdiagnosed, due to its general and varying clinical presentation profile, which primarily involves pain and visual impairment but which can include eyelid edema, choroidal folds, serous retinal detachment, disc edema, hard exudates in fovea and subretinal mass. We report here a case of posterior scleritis, with symptoms of eye pain and red eye, initially misdiagnosed as acute conjunctivitis. Case summary A 56-year-old man presented to a local hospital with complaint of pain and redness in the right eye. The initial diagnosis was acute conjunctivitis and he was given antibiotic eyedrops. Upon week-long continuance of the symptoms despite treatment, he presented to our hospital. Initial examination revealed a shallow anterior chamber in the right eye and vision reduction to 0.6. Further testing by optical coherence tomography, ultrasound biomicroscopy, and fundus photography indicated diagnosis of posterior scleritis. The patient was given methylprednisolone (oral) on a tapered reduction schedule (starting with 70 mg/d). According to the peaks and troughs of symptoms, compound betamethasone injection was administered into the bulb, culminating in discontinuation of the oral corticosteroid. Subsequent optical coherence tomography showed the subretinal fluid near the optic disc to be completely absorbed after treatment. Conclusion Posterior scleritis should be among the differential diagnosis of eye pain and redness, and diagnosis requires further ophthalmic accessory examination, such as by optical coherence tomography.

Purpose: Our purpose is to report a patient with primary unilateral ciliary body marginal zone lymphoma who initially presented with hemorrhagic hypopyon. Methods: Retrospective review of the clinical, imaging, and immunohistopathological features of the case was performed. Results: A 59-year-old man was referred with right anterior uveitis of unknown etiology which was unresponsive to systemic treatment. Slit-lamp biomicroscopy showed normotensive hemorrhagic hypopyon in that eye. Anterior segment ultrasound biomicroscopy revealed an iridociliary mass lesion. Because an anterior chamber paracentesis was noncontributory, a diagnostic cyclectomy was performed. Histopathological evaluation showed that the neoplastic cells were positive for CD20, lambda light chain, and BCL 2. BCL 6, CD10, CD5, SOX11, kappa, and Cyclin D1 stains were negative. The final diagnosis was extranodal marginal zone lymphoma of the ciliary body. Conclusions: Although rare, ciliary lymphoma may be a cause of intractable anterior uveitis. Repeat biopsies could be carried out when there is a high level of clinical suspicion.

A 1-year-old Maine Coon female spayed cat was presented for a 7-week history of bilateral pinkish masses located over the dorsotemporal conjunctival quadrants. Ophthalmic examination revealed the presence of bilateral temporal, slightly hyperemic, subconjunctival masses, fluctuant, and nonpainful. The remainder of the ocular examination was unremarkable. Ultrasound biomicroscopy and B-scan ultrasonography confirmed the presence of a bilateral cavitated and tubular structure, extending within the temporal orbit, with anechoic fluid-like content. Surgical removal was performed. Histopathology described the lesions as lacrimal gland tissue, markedly infiltrated by inflammatory cells, associated with cavitated structures filled with proteinaceous debris, and lined by flattened bilayered cuboidal epithelial cells. Bilateral adenitis of unknown origin and dacryops of the temporal lacrimal glands were diagnosed. Both surgical sites healed uneventfully, and no recurrence was reported on either eye during a 12-month follow-up period.

To evaluate the outcome and viability of a modified self-sealing scleral pocket technique for scleral fixation of an intraocular lens (IOL).Retrospective interventional case series.A retrospective, interventional case series in which 81 eyes underwent this modified technique, performed in the previous 4 years. Cases included a dislocated IOL and an absent posterior capsule or subluxated cataract. Two diagonally opposed paralimbal, curved self-sealing scleral pockets were made 3 mm away from the limbus along with a vitrectomy. A multipiece IOL was used, and the haptics were fixed under the scleral pockets inside a linear scleral tunnel underneath the superficial scleral flap. The conjunctiva was opposed by using cautery. Postoperatively, anterior segment optical coherence tomography (AS-OCT) was performed in order to detect intrascleral hyper-reflective cross-section of the haptics and optic tilt. The optic position was re-evaluated using ultrasound biomicroscopy (UBM). Main outcomes were mean pre- and postoperative best corrected visual acuity (BCVA), postoperative astigmatism. Postoperative AS-OCT was performed to detect the position of the haptics and optics. UBM was done to recheck any optic tilt.Mean pre- and postoperative BCVA were LogMAR 1.2 ± 0.59 and LogMAR 0.47 ± 0.3 (P0.001). Mean postoperative astigmatism was 1.27 ± 1.02 Dcyl. In AS-OCT, an intrascleral hyper-reflective shadow signified stable haptics without any optic tilt. UBM also showed a stable position of the IOL optic without any tilt.This modified, simple way of scleral fixation of an IOL decreases the duration of surgery with minimal complication.

Purpose: To investigate the characteristics of silicone oil (SO) emulsification after vitrectomy for rhegmatogenous retinal detachment (RRD) and possible correlations with clinical factors.Methods: Patients who underwent primary pars plana vitrectomy with SO injection for RRD followed by SO removal at the Eye and ENT Hospital of Fudan University between January 2016 and January 2020 were included. Ultrasound biomicroscopy (UBM) images of the anterior segment were taken before SO removal. Eight signs of SO emulsification in the UBM images were graded as 1 (present) or 0 (not present) and the grades for all signs in each eye were summed. Correlations between SO emulsification grade and clinical factors were determined.Results: A total of 118 patients (118 eyes) were enrolled in this study. Emulsified SO particles were found in all 118 eyes (100%). The eight signs were more frequently detected in the superior part of the eye. The mean total SO emulsification grade was 19.99 ± 12.98 (range: 1–36). Younger age and male (both P < 0.05) were associated with higher total SO emulsification grade. Patients with intraocular pressure (IOP) > 21 mmHg or the use of antiglaucoma medications at the time of SO removal had a higher total SO emulsification grade, were younger, and were more frequently male (all P < 0.05) than patients without ocular hypertension.Conclusions: UBM could play an important role in the diagnosis and grading of SO emulsification. Younger patients and males are more prone to SO emulsification, which may lead to elevated IOP.

There is a clinical case of the occurrence of angle-closure glaucoma due to closure of the angle of front camera with the cyst of a ciliary body. Patient A., 42 years old, complained about a feeling of transient blurring of the right eye vision, visual impairment in the evening. At the initial ophthalmological examination, the maximum corrected visual acuity in both eyes was 1.0, intraocular pressure according to pneumotonometry: OD — 21 mm Hg, OS — 14.8 mm Hg. There were no changes in the anterior segment of the eyeball according to biomicroscopic data. Taking into account the asymmetry of IOP data, the patient underwent the following studies: static perimetry, optical coherence tomography (OCT), flowmetry with the calculation of tolerant intraocular pressure (TIOP). According to OCT and static perimetry, pathological deviations were not detected. When performing flowmetry on the left eye, the indicators were within normal values, however, a significant decrease in the volume of eye ocular blood flow and an increase in the IOP were determined in the right eye. In the left eye, the TIOP corresponded to the IOP, and in the right eye, the IOP indicators exceeded the TIOP value. The lack of correlation between morphofunctional indicators and flowmetry data, an unburdened hereditary history of glaucoma, and a discrepancy between flowmetry and age could indicate the development of the angle-closed glaucoma, so the patient was referred to ultrasound biomicroscopy. The echographic picture of the anterior part of the right eye was characterized by a decrease in the depth of the anterior chamber, a partial displacement of the peripheral part of the iris anteriorly, a slight narrowing of the angle of the anterior chamber, and an uneven posterior chamber. In the region of the process part of the ciliary body along the meridian of 3 hours, a thinwalled volumetric formation, anechogenic, with clear contours and dimensions was revealed: height 4.3 mm, length 4.8 mm. The root of the iris was determined by the average attachment to the ciliary body. In accordance with this, the diagnosis was made: OD — cyst of the ciliary body, the patient was referred for consultation about a possible laser surgical intervention.

Ultrasound biomicroscopy (UBM) is the only available option for noninvasive, high-resolution imaging of the intricate iridociliary complex, and for anterior segment imaging with corneal haze or opacity. While these unique features render UBM essential for specific types of trauma, congenital anomalies, and anterior segment tumors, UBM imaging has found clinical utility in a broad spectrum of diseases for structural assessments not limited to the anterior intraocular anatomy, but also for eyelid and orbit anatomy. This imaging tool has a very specific niche in the pediatric population where anterior segment disease can be accompanied by corneal opacity or clouding, and anomalies posterior to the iris may be present. Pediatric patients present additional diagnostic challenges. They are often unable to offer detailed histories or fully cooperate with examination, thus amplifying the need for high-resolution imaging. This purpose of this systematic review is to identify and synthesize the body of literature involving use of UBM to describe, evaluate, diagnose, or optimize treatment of pediatric ocular disease. The collated peer-reviewed research details the utility of this imaging modality, clarifies the structures and diseases most relevant for this tool, and describes quantitative and qualitative features of UBM imaging among pediatric subjects. This summary will include information about the specific applications available to enhance clinical care for pediatric eye disease.摘要: 对于复杂的虹膜睫状体结构以及合并角膜混浊或不透明的眼前节进行非侵入性、高分辨率成像, 超声生物显微镜(UBM)是唯一选择。虽然这些特征使UBM对于特定类型的创伤、先天性畸形和眼前节肿瘤的诊断是必要的, 但人们已经在广泛的疾病谱中, 发现了UBM成像在结构评估中的临床用途。其不仅可用于眼内前节解剖, 也可用于眼睑和眼眶解剖的评估。在儿童群体中, 无论伴有角膜混浊或是云翳的眼前节疾病, 该成像工具都有非常特殊的地位。对于儿科患者的诊断, 医生会面临额外的挑战。儿童通常无法提供详细病史也无法全力配合相关检查, 因此对高分辨率成像的需求更大。本综述的目的是针对涉及应用UBM对儿童眼病进行描述、评估、诊断或优化治疗的文献进行筛选与整合。所筛选出的研究详细说明了这种成像方式的用途, 阐明了最适用于该工具的结构和疾病, 并描述了儿童受试者UBM成像的定量和定性特征。同时, 本文得出的结论将包括可用于加强儿童眼病临床护理的具体应用。.

Purpose To describe a modified keratoleptynsis procedure, as a method of preserving central corneal function, and evaluate the outcome in vision, reduction of corneal thickness and treatment of epithelial corneal ulcers in cases with endothelial cell dysfunction. Methods Forty-four dogs (72 eyes) were affected by progressive corneal edema, with or without ulcerative keratitis. All patients were treated with a dorsal and ventral superficial keratectomy followed by conjunctival flaps, maintaining a clear central cornea. Corneal thickness measurements were obtained via ultrasound biomicroscopy. Results All eyes showed resolution of ocular discomfort postoperatively, with a median time to resolution of 35 days. Two years post-surgery, vision had been lost in 2 of 29 eyes (7%). From the initial population, 23 dogs (39 eyes) had follow-up evaluations of corneal thickness. The mean central corneal thickness was 1359 ± 251 μm prior to surgery. Thickening of the central cornea was observed one week after surgery to 1559 ± 263 μm. Decreased corneal thickness was reported, at 1 month, 4 months, 10 months and 2 years postoperatively (1285 ± 267 μm, 1102 ± 150 μm, 1121 ± 288 μm, 1193 ± 283 μm, respectively). All eyes showed a similar trend of increasing and then decreasing corneal thickness. Conclusions This surgical technique provided statistically significant reduction in central corneal thickness and sustained relief of ocular pain. Reduction in corneal thickness appeared to be maintained 2 years post-surgery, and all patients remained comfortable. Superficial corneal pigmentation and fibrosis resulted in vision loss in two eyes.

Introduction: The natural course of adenomas of the ciliary-body epithelium (ACE) is uncertain, due to their low incidence and their frequent initial surgical management. Their differential diagnosis with amelanotic melanoma or metastasis is challenging and diagnostic biopsies require sufficient tissue and highly specialized pathologists. Ultrasound biomicroscopy offers high resolution images and clear sonographic signs suggestive of ACE allowing a more precise differential diagnosis and therefore, a more conservative initial attitude. Methods: Descriptive, retrospective, non-comparative study of consecutive cases of ACE observed between October 2003 and December 2019 in a reference unit in ocular oncology of a tertiary hospital. Patients were studied on a quarterly basis the first year and, subsequently, every 6 months with a complete ophthalmological exam and ultrasound biomicroscopy with the platform Aviso linear scanning 50 MHz probe (Quantel Medical, Clermont-Ferrand, France). Results: Three ACE were analysed for a median of 3 years (interquartile range: 2.5–5.5 years). Clinical features include a whitish-to-brown spherical mass, with engorged superficial vessels. Ultrasound biomicroscopy shows an oval-spherical shape, medium-to-high echogenicity, low acoustic attenuation, regular internal structure, and respect for the neighboring structures. By their clinical-ultrasonographic characteristics, one was considered an adenoma of the pigmented ciliary-body epithelium (browner and hyperechogenic) and two were classified as adenomas of the non-pigmented ciliary epithelium (whitish appearance and medium-echogenicity). Conclusion: Ultrasound biomicroscopy allows a reasonable clinicalsonographic suspicion of ACE. An initial conservative management is proposed as a safer option for stable, mildly symptomatic patients, avoiding aggressive sight threatening treatments.

Introduction: Evaluating the anterior chamber angle (ACA) is important for the early diagnosis and treatment of primary angle-closure glaucoma. The assessment of ultrasound biomicroscopy (UBM) images usually requires well-trained ophthalmologists and screening for patients with narrow ACA is usually time- and labor-intensive. Therefore, the automatic assessment of UBM could be cost-effective and valuable in daily practice. Objective: The objective of this study is to develop an automatic method for localizing and classifying ACA based on UBM images. Methods: UBM images were collected and a coarse-to-fine method was used to localize the apex of the angle recess. By analyzing the grayscale features around the angle recess, closed angles were identified, and the rest were then classified as open or narrow angles, based on the degree of ACA. Using manual classification as the reference standard, the overall accuracy (OAcc), sensitivity (Sen), specificity (Spe), and balanced accuracy of the automatic classification method were evaluated. Results: A total of 540 UBM images from 290 participants were analyzed. Using these UBM images and the proposed method, the ACA was classified as open, narrow, or closed. During processing, the method localized the angle recess with 95% accuracy. The OAcc of the ACA classification was 77.8%, and the Spe and Sen of our method were 85.8 and 81.7% for angle closure; 88.9 and 75.6% for open angles; 91.9 and 76.1% for narrow angles, respectively. Conclusions: Our method of automatic angle localization and classification based on UBM images is feasible and reliable. The automatic classification of ACA provides a basis and reference for future studies.

Anterior Chamber Angle (ACA) assessment plays an important role for the diagnosis of glaucoma. Most of the existing techniques relied on Anterior Segment Optical Coherence Tomography (AS-OCT) or Swept Source Optical Coherence Tomography (SS-OCT). We proposed a system for 360° overview of iridocorneal angle of anterior chamber (ICAAC) via Ultrasound Biomicroscopy (UBM). UBM approach acquires the visualization of anterior segment components as well as diseased structures (glaucoma). Our system consists of a new pairing scheme of feature descriptors, i.e. (FREAK, BRISK), (SURF, BRISK) and Broad Learning System (BLS) for 3D reconstruction and segmentation of ICAAC. The 360° overview of 2D ICAAC gives global conception for ACA assessment. 3D images provide a detailed assessment with the amount of opposition’s and synechiae in angle-closure suspects, angle-closure and angle-closure glaucoma in bright light conditions. Extensive evaluations are performed on dataset consists of 650 ICAAC images in five directions of 65 subjects with 10 samples per subject (5 left eye and 5 right eye) from Shanghai Sixth People’s Hospital. Experiments showed that our approach achieves an overall accuracy of 98.72% with training and testing time 29.26(s), 1.232(s) respectively.

Purpose To report a case of a grown Soemmering ring that manifested as an iris tumour 24 years after cataract surgery. Methods A case report. Results A 27-year-old white man was presented with a suspected iris tumour in his left eye. He had undergone lensectomy in both eyes without intraocular lens implantation 24 years ago. Last year, he was treated by topical anti-glaucoma medication for left eye intraocular pressure (IOP) rising. Six months later, his ophthalmologist found two separate iris bumps. The patient was referred to an ocular oncologist and was to be treated with plaque brachytherapy as iris melanoma, but he denied. Ultrasound biomicroscopy (UBM) of the left eye showed significant angle narrowing due to separate ovoid hyper echoic masses behind the iris, which was clearly separated from the ciliary body. Retained and growth lens material caused a Soemmering ring to enlarge, which was the reason for glaucoma and iris bumping. The patient has been followed for more than one year without any changes being observed. Conclusion An enlarged and grown Soemmering ring should be considered in the differential diagnosis of any iris and ciliary body tumour, especially in patients who have had cataract surgery.

Purpose To assess the efficacy of swept-source optical coherence tomography (SS-OCT) and ultrasound biomicroscopy (UBM) in detecting posterior capsule (PC) defect in patients with traumatic cataract. Design Observational case-series. Methods Sixty-seven eyes from 67 patients, with traumatic cataract severe enough to prevent slit lamp evaluation of the PC, were included in a simple sequence without randomization. Patients underwent both 50-MHz UBM and SS-OCT evaluation of the PC by different operators. Cataract surgery was then performed using a single technique. Results Sixty-seven eyes from 67 patients including 60 men and 7 women were studied. The mean age was 34 ± 14 years and the mean logarithm of minimal angle of resolution of visual acuity was 1.89 ± 0.71. The calculated sensitivity, specificity, and accuracy values for SS-OCT were 96.8% (95% confidence interval [CI] 83.81-99.43), 66.7% (95% CI 48.78-80.77), and 82% (95% CI 70.53-89.62), respectively. For UBM, sensitivity, specificity, and accuracy values were 82.6% (95% CI 62.86-93.02), 57.9% (95% CI 36.28-76.86), and 71.4% (95% CI 56.43-82.83), respectively. Positive predictive and negative predictive values for SS-OCT were 75% (95% CI 59.81-85.81) and 95.2% (95% CI 77.33-99.15) and for UBM were 70.4% (95% CI 51.52-84.15) and 73.3% (95% CI 48.05-89.1), respectively. Conclusion Although both imaging techniques are effective, SS-OCT appears to be at least comparable, or superior in special circumstances, to UBM in detecting preoperative posttraumatic PC rupture. We recommend preoperative assessment of all traumatic cataracts with SS-OCT as a part of surgical planning.