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Purpose: To investigate the role of conjunctival swab in diagnosing COVID-19 and to find out correlation between COVID-19 severity and conjunctival swab positivity. Study Design: Analytic Correlational study. Place and Duration of Study: Primasatya Husada Citra Hospital Surabaya, Indonesia in March 2021. Methods: Forty-seven patients diagnosed with COVID-19 and admitted in the hospital during the month of March 2021 were included. Sociodemographic data, symptoms, ocular manifestations, and result of reverse transcription-polymerase chain reaction (RT-PCR) from nasopharyngeal and conjunctival swabs for SARS-CoV-2 were collected. Conjunctival swab was taken 1 - 4 days after the nasopharyngeal swab. Patients were divided into two groups; group with ocular symptoms and the other group with ocular signs. Patients with ocular signs had chemosis, conjunctival hyperemia, and eye discharge. This group also included patients who were on Ventilator and could not complain about their ocular problems. Data were analyzed using Spearman correlation analysis with p-value less than 0.05 considered as statistically significant. Results: Conjunctival swab PCR was negative in 95.7% patients. Correlation between COVID-19 severity and conjunctival swab was also not significant (P = 0.589). Only 2 subjects (4.3%) who had ocular signs and symptoms revealed positive PCR (p > 0.05). Similarly, severity of the disease was also not correlated with positivity of conjunctival swab (p > 0.05). Conclusions: The limited sensitivity of conjunctival specimens based on the result of this study showed that the diagnostic value of conjunctival specimens for the detection of SARS-CoV-2 is low. [ABSTRACT FROM AUTHOR]

Purpose: To find the diagnostic accuracy of Disc Damage Likelihood Scale (DDLS) and cup-to-disc ratio (CDR) for diagnosis of glaucoma taking central corneal thickness (CCT) adjusted intraocular pressure (IOP) and characteristic visual filed defects with corresponding OCT-ONH changes as standard. Study Design: Comparative, cross-sectional. Place and Duration of Study: Department of Ophthalmology, Mayo Hospital, Lahore, from August 2020 to February 2021. Methods: Three hundred and nine patients were enrolled after taking informed consent. Demographic data was obtained and patients underwent complete ocular exam including DDLS and CDR, Slit-lamp biomicroscopy, gonioscopy and IOP. CCT, visual fields and OCT ONH was done. The patient was said to have glaucoma if his CCT adjusted IOP was greater than 21 mmHg, visual field defects and OCT changes. It was compared with CDR and DDLS, which was taken as suggestive of glaucoma with scores greater than 5. Results: Mean age of patients was 54.82 ± 9.29 years, 108 (34.95%) were males. The sensitivity, specificity and diagnostic accuracy of DDLS for detection of glaucoma was 78.57%, 84.97% and 80.91% and the sensitivity, specificity and diagnostic accuracy of CDR for detection of glaucoma was 82.14%, 49.56% & 70.23% taking CCT adjusted IOP and characteristic visual field defects with corresponding OCT changes as standard. Conclusion: DDLS is useful, cost effective and has higher accuracy to detect glaucomatous damage as compared to CDR for diagnosis of glaucoma taking CCT adjusted IOP and characteristic visual field defects with corresponding OCT changes as standard. [ABSTRACT FROM AUTHOR]

Purpose: To classify subjects with primary angle closure into clusters based on features from anterior segment optical coherence tomography (ASOCT) imaging and to explore how these clusters correspond to disease subtypes, including primary angle closure suspect (PACS), primary angle closure glaucoma(PACG), acute primary angle closure (APAC) and fellow eyes of APAC and reveal the factors that become more predominant in each subtype of angle closure. Method: A cross-sectional study of 248 eyes of 198 subjects(88 PACS eyes, 53 PACG eyes, 54 APAC eyes and 53 fellow eyes of APAC) that underwent complete examination including gonioscopy, A-scan biometry, and ASOCT. An agglomerative hierarchical clustering method was used to classify eyes based on ASOCT parameters. Results: Statistical clustering analysis produced three clusters among which the anterior segment parameters were significantly different. Cluster 1(43 eyes) had the smallest anterior chamber depth(ACD) and area, as well as the greatest lens vault (p<0.001 for all). Cluster 2(113 eyes) had the thickest iris at 2000 microns(p = 0.048), and largest iris area(p<0.001), and the deepest ACD (p<0.001). Cluster 3(92 eyes) was characterized by elements of both clusters 1 and 2 and a higher iris curvature(p<0.001). There was a statistically significant difference in the distribution of clusters among subtypes of angle closure eyes(p<0.001). Although the patterns of clusters were similar in PACS and PACG eyes, with the majority of the eyes classified into cluster 2(55%, and 62%, respectively), the highest proportion of APAC and fellow eyes were assigned to clusters 1(44%) and 3 (51%), respectively. Conclusion: Hierarchical cluster analysis identified three clusters with different features. Predominant anatomical components are different among subtypes of primary angle closure. [ABSTRACT FROM AUTHOR]

Background: Residency training is the basis of good clinical and surgical practice.Purpose: The aim is to know the demographics, training experience, and perception of young ophthalmologists to improve the present residency programs in India.Setting: Young ophthalmologists trained in India.Methods: A survey was conducted by the Academic and Research Committee of the All India Ophthalmology Society, in 2014-2016 of young ophthalmologists (those trained between 2002 and 2012, with 2-10 years' postresidency experience) to gauge teaching of clinical and surgical skills during the postgraduate residency program.Statistical Analysis: Statistical Package for Social Sciences version 16.Results: Of the 1005 respondents, 531 fulfilled inclusion criteria. Average age was 32.6 years (standard deviation [SD] 4). On a scale of 0-10, clinical skills teaching was graded as (mean, SD): Slit lamp examination (7.2, SD 2.8), indirect ophthalmoscopy (6.2, SD 3.3), gonioscopy (5.7, SD 3.4), perimetry (6.2, SD 3.2), optical coherence tomography (4.6, SD 4), and orthoptic evaluation (4.3, SD 3.1). The mean (SD) and median of surgeries performed independently was intracapsular cataract extraction 3.0 (14.9), 0; extracapsular cataract extraction 39.9 (53.2), 18; small incision cataract surgery 75.3 (64.4), 55; phacoemulsification 30 (52.6), 1; pterygium excision 31.5 (43.5), 15; dacryocystectomy 20.3 (38.1), 4; dacryocystorhinostomy 11.7 (26.2), 2; chalazion 46.4 (48.3), 30; trabeculectomies 4 (14.9), 0; strabismus correction 1.4 (4.9), 0; laser-assisted in situ Keratomileusis 1.5 (12.2), 0; retinal detachment 1.5 (12.5), 0; vitrectomy 3.0 (17.0), 0; keratoplasty 5.2 (17.8), 0; eyelid surgery 8.6 (18.9), 2 and ocular emergencies 41.7 (52.4), 20. Observed and assisted surgeries were more common. However, the range of grading was 0-10 in all categories.Conclusion: Residency training in India varies considerably from program to program. Standardization is needed to assure all graduates are competent and render consistent quality of service. [ABSTRACT FROM AUTHOR]

Optical coherence tomography (OCT), a noninvasive imaging modality that uses low-coherence light to obtain a high-resolution cross-section of biological structures, has evolved dramatically over the years. The Swept-source OCT (SS-OCT) makes use of a single detector with a rapidly tunable laser as a light source. The Casia SS-1000 OCT is a Fourier-domain, SS-OCT designed specifically for imaging the anterior segment. This system achieves high resolution imaging of 10μm (Axial) and 30μm (Transverse) and high speed scanning of 30,000 A-scans per second. With a substantial improvement in scan speed, the anterior chamber angles can be imaged 360 degrees in 128 cross sections (each with 512 A-scans) in about 2.4 seconds. We summarize the clinical applications of anterior segment SS-OCT in Glaucoma. Literature search: We searched PubMed and included Medline using the phrases anterior segment optical coherence tomography in ophthalmology, swept-source OCT, use of AS-OCT in glaucoma, use of swept-source AS-OCT in glaucoma, quantitative assessment of angle, filtering bleb in AS- OCT, comparison of AS-OCT with gonioscopy and comparison of AS-OCT with UBM. Search was made for articles dating 1990 to August 2015. [ABSTRACT FROM AUTHOR]

Purpose To investigate the incidence of gonioscopic angle closure after 4 years in subjects with gonioscopically open angles but varying degrees of angle closure detected on anterior segment optical coherence tomography (AS OCT; Visante; Carl Zeiss Meditec, Dublin, CA) at baseline. Design Prospective, observational study. Participants Three hundred forty-two subjects, mostly Chinese, 50 years of age or older, were recruited, of whom 65 were controls with open angles on gonioscopy and AS OCT at baseline, and 277 were cases with baseline open angles on gonioscopy but closed angles (1–4 quadrants) on AS OCT scans. Methods All subjects underwent gonioscopy and AS OCT at baseline (horizontal and vertical single scans) and after 4 years. The examiner performing gonioscopy was masked to the baseline and AS OCT data. Angle closure in a quadrant was defined as nonvisibility of the posterior trabecular meshwork by gonioscopy and visible iridotrabecular contact beyond the scleral spur in AS OCT scans. Main Outcome Measures Gonioscopic angle closure in 2 or 3 quadrants after 4 years. Results There were no statistically significant differences in age, ethnicity, or gender between cases and controls. None of the control subjects demonstrated gonioscopic angle closure after 4 years. Forty-eight of the 277 subjects (17.3%; 95% confidence interval [CI], 12.8–23; P < 0.0001) with at least 1 quadrant of angle closure on AS OCT at baseline demonstrated gonioscopic angle closure in 2 or more quadrants, whereas 28 subjects (10.1%; 95% CI, 6.7–14.6; P < 0.004) demonstrated gonioscopic angle closure in 3 or more quadrants after 4 years. Individuals with more quadrants of angle closure on baseline AS OCT scans had a greater likelihood of gonioscopic angle closure developing after 4 years ( P < 0.0001, chi-square test for trend for both definitions of angle closure). Conclusions Anterior segment OCT imaging at baseline predicts incident gonioscopic angle closure after 4 years among subjects who have gonioscopically open angles and iridotrabecular contact on AS OCT at baseline. [ABSTRACT FROM AUTHOR]

Aim To evaluate quantitative changes in anterior segment optical coherence tomography (AS-OCT) parameters at 4 years in subjects with open angles on gonioscopy at baseline. Methods 339 gonioscopically open-angle subjects aged >50 years underwent AS-OCT imaging (Visante, Carl Zeiss Meditec, Dublin, California, USA) at baseline and at 4 years. Customised software was used to analyse images. Linear regression was performed to assess baseline predictors of change in mean trabecular iris space area (TISA). Results Of the 339 subjects, 204 (61%) had good images for analysis. The mean age at baseline was 60 (SD 6.42) years; 55.4% were women and 87.7% were Chinese. Overall, there was a decrease in anterior chamber depth (ACD), anterior chamber area (ACA), anterior chamber volume (ACV) and angle opening distance at 500/750 mm, TISA 500/750 mm, iris thickness at 2000 mm and iris area in both nasal and temporal quadrants ( p<0.05) at 4 years. There was an increase in iris curvature (ICURV) and lens vault (LV) ( p<0.05). With univariate analysis, shorter axial length (AxL), shallower ACD, greater LV, smaller ACA/ACV and larger mean ICURV at baseline were associated with less change in TISA750 at follow-up. On multivariate analysis, only baseline mean ICURV and shorter AxL were predictive of less change in TISA750 at 4 years. Conclusions Angle width significantly decreased; ICURV and LV increased in subjects with gonioscopically open angles followed at 4 years. Eyes with shorter AxL and greater ICURV at baseline had lesser decrease in angle width. [ABSTRACT FROM AUTHOR]

A 66-year-old African American man presented with episodic transient visual loss triggered by bending forward. The initial examination did not suggest intraocular pathology and the patient was nearly sent for vascular evaluation given his cardiovascular risk factors. Fundus photographs taken during an episode of visual loss suggested an intraocular process, however. Gonioscopy revealed a microhyphema causing a “snow globe” effect in the anterior chamber, most likely related to recent bleb manipulation in the affected eye. [ABSTRACT FROM AUTHOR]

Aim: To evaluate changes of nasal and temporal anterior chamber angle (ACA) in subjects with angle closure glaucoma using Spectralis AS-OCT (SAS-OCT) under dark and light conditions. Methods: Based on dark-room gonioscopy, 24 subjects with open angles and 86 with narrow angles participated in this study. The nasal and temporal angle opening distance at 500 µm anterior to the scleral spur (AOD500), nasal and temporal ACA were measured using SAS-OCT in light and dark conditions. Result: In 2 groups, ACA and AOD500 in nasal and temporal quadrants were significantly greater in light compared to dark (all with p = 0.000). The AOD500 and ACA were significantly higher in nasal than temporal in measured conditions for 2 groups except the ACA and AOD500 of normal group measured in light. The difference between nasal and temporal in dark (29.07 ± 65.71 µm for AOD500 and 5.7 ± 4.07° for ACA) was greater than light (24.86 ± 79.85 µm for AOD500 and 2.09 ± 7.21° for ACA) condition. But the difference was only significant for ACA (p = 0.000). The correlation analysis showed a negative correlation between AOD500 and pupil diameter in temporal and nasal quadrants (both with p = 0.000). While temporal AOD500 difference correlated with spherical equivalent, temporal and asal gonioscopy, nasal AOD correlated with IOP, temporal and nasal gonioscopy. Conclusions: Clinically important changes in ACA structure could be detected with SAS-OCT in nasal and temporal quadrants under different illumination intensity. The results could help in improvement of examination condition for better and more accurate assessment of individuals with angle closure glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To assess variations in the iridocorneal angle width and iris volume in Chinese subjects using swept-source optical coherence tomography (SS-OCT). Methods: Consecutive subjects, aged 40-80 years, with no previous ophthalmic problems were recruited from a population-based study of Chinese Singaporeans. All subjects underwent 360° SS-OCT (SS-1000 CASIA, Tomey Corporation, Nagoya, Japan) angle imaging and gonioscopy in one randomly selected eye in the dark. For each eye, 16 frames (11.25° apart) were selected for analysis from 128 cross-sectional images, and measurements of the trabecular iris space area 750 μm from the scleral spur (TISA750) and iris volume were made for each image. The measurements from four consecutive frames were further averaged as a sector of 45°. Sector-wise angle width and quadrant-wise iris volume were analyzed. Results: Two hundred and twelve subjects (90 with closed-angles) were examined. The majority of the subjects were female (70.7 %) with mean age 61 (±8.9) years. The TISA750 (mm) of superior [0.101 (0.09)], inferior [0.105 (0.09)], superior-nasal [0.111 (0.09)] and superior-temporal [0.117 (0.09)] sectors were smaller compared with other sectors ( P < 0.05). The nasal iris volume (mm) was the smallest compared with other quadrants for the entire cohort [nasal 8.18 (1.2) < inferior 9.13 (1.3) < temporal 9.16 (1.2) < superior 9.33 (1.3), P < 0.001], as well as for open- and closed-angle groups. Conclusions: The irido-corneal angle was narrower in the superior, inferior, superior-nasal and superior-temporal sectors compared with other sectors. Iris volume in the nasal quadrant was the smallest compared with the other quadrants. [ABSTRACT FROM AUTHOR]

Purpose: To identify subgroups of primary angle-closure suspects (PACS) based on anterior segment optical coherence tomography (AS-OCT) and biometric parameters. Design: Cross-sectional study. Participants: We evaluated 243 PACS subjects in the primary group and 165 subjects in the validation group. Methods: Participants underwent gonioscopy and AS-OCT (Carl Zeiss Meditec, Dublin, CA). Customized software (Zhongshan Angle Assessment Program, Guangzhou, China) was used to measure AS-OCT parameters. An agglomerative hierarchical clustering method was first used to determine the optimum number of parameters to be included in the determination of subgroups. The best number of subgroups was then determined using Akaike Information Criterion (AIC) and Gaussian Mixture Model (GMM) methods. Main Outcome Measures: Subgroups of PACS. Results: The mean age of the subjects was 64.8 years, and 65.02% were female. After hierarchical clustering, 1 or 2 parameters from each cluster were chosen to ensure representativeness of the parameters and yet keep a minimum of redundancy. The parameters included were iris area, anterior chamber depth (ACD), anterior chamber width (ACW), and lens vault (LV). With the use of GMM, the optimal number of subgroups as given by AIC was 3. Subgroup 1 was characterized by a large iris area, subgroup 2 was characterized by a large LV and a shallow ACD, and subgroup 3 was characterized by elements of both subgroups 1 and 2. The results were replicated in a second independent group of 165 PACS subjects. Conclusions: Clustering analysis identified 3 distinct subgroups of PACS subjects based on AS-OCT and biometric parameters. These findings may be relevant for understanding angle-closure pathogenesis and management. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

Purpose: To evaluate the intraocular pressure (IOP)-lowering efficacy of goniosynechialysis (GSL) for advanced chronic angle-closure glaucoma (CACG) using a simplified slit-lamp technique. Patients and methods: Patients with CACG with one severely affected eye with best-corrected visual acuity below 20/200 and a mildly or functionally unaffected fellow eye were enrolled in this study. All patients underwent ophthalmologic examinations including measurement of visual acuity, best-corrected visual acuity, and IOP; biomicroscopy; specular microscopy; fundus examination; and gonioscopy followed by anterior chamber paracentesis and GSL for nasal peripheral anterior synechiae in the eye with severe CACG. Results: Thirty patients (18 men, 12 women) were identified as having CACG with an initial mean IOP of 47.1 ± 6.7 mmHg (range 39-61 mmHg) in the severely affected eye. One week after GSL, the mean IOP of the treated eyes decreased to 19.3 ± 2.8 mmHg (range 14-26 mmHg) without antiglaucoma medication (average decrease 27.7 ± 6.5 mmHg; range 16-41 mmHg), which was significant (P < 0.00001) compared with baseline. After an average follow-up period of 36.6 ± 1.0 months (range 35-38 months), the mean IOP stabilized at 17.4 ± 2.2 mmHg (range 12-21 mmHg). The nasal angle recess did not close again in any one of the patients during the follow-up period. The average significant (P < 0.00001) decrease in corneal endothelial cell density in the treated eyes was 260 ± 183 cells/mm2 (range 191-328 cells/mm2). Conclusions: Anterior chamber paracentesis and GSL lowers IOP in advanced CACG, though it may lead to mild corneal endothelial cell loss. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the risk of primary acute angle closure (AAC), changes in intraocular pressure (IOP), and associated risk factors after pupil dilation in Asian subjects with narrow angles (primary angle-closure suspects [PACS]). Design: Prospective clinical study. Participants: A total of 471 subjects aged more than 50 years with narrow angles in Singapore. Methods: This study was part of a prospective trial of PACS. Subjects underwent a detailed ophthalmic evaluation including gonioscopy, biometry, pachymetry, and ultrasound biomicroscopy. All subjects underwent pupil dilation with 1% tropicamide eye drops at the baseline visit, before any laser or medical intervention. Intraocular pressure was measured using Goldmann applanation tonometry by the same observer before and 1 hour after pupil dilation. A dose of oral acetazolamide was given before the patient left the clinic. Main Outcome Measures: Intraocular pressure before and after dilation, and an AAC event. Results: The mean age of the 471 subjects was 63.0±6.9 years (mean ± standard deviation); 75.4% were women, and 92.8% were Chinese. Of the 471 participants, 3 (0.64%; 95% confidence interval [CI], 0.13–1.85) developed AAC within 6 hours of dilation despite pretreatment with oral acetazolamide. Twenty-two subjects (4.67%; 95% CI, 2.95–6.99) showed a postdilation increase in IOP of ≥5 mmHg in either eye, 6 subjects (1.27%; 95% CI, 0.47–2.75) had an IOP increase of ≥8 mmHg in either eye, and 4 subjects (0.85%; 95% CI, 0.23–2.16) had a postdilation IOP of >25 mmHg in either eye. Narrower gonioscopic angle width, that is, having a lower mean gonioscopic modified Shaffer grading (coefficient β −0.51; standard error 0.19; P=0.01), and predilation IOP level (coefficient β −0.17; standard error 0.04; P < 0.001) were significant risk factors for IOP increase after dilation in multivariate linear regression analysis. Conclusions: The risk of AAC among Asian subjects with narrow angles was low after pupillary dilation with tropicamide and oral acetazolamide prophylaxis. The presence of narrower angle width by gonioscopy was the only clinical parameter identified for a significant IOP increase after pupil dilation. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

AimsPrimary angle-closure glaucoma is expected to account for nearly 50% of bilateral glaucoma blindness by 2020. This study was conducted to assess the performance of the scanning peripheral anterior chamber depth analyzer (SPAC) and limbal anterior chamber depth (LACD) as screening methods for angle closure.MethodsThis study assessed two clinical populations to compare SPAC, LACD, and gonioscopy: the Zhongshan Angle-closure Prevention Trial, from which 370 patients were eligible as closed-angle participants and the Liwan Eye Study, from which 72 patients were selected as open-angle controls. Eligible participants were assessed by SPAC, LACD, and gonioscopy.ResultsAngle status was defined by gonioscopy. Area under the receiver operating characteristic curve (AUROC) for SPAC was 0.92 (0.89-0.95) whereas AUROC for LACD was 0.94 (0.92-0.97). Using conventional cutoff points, sensitivity/specificity was 93.0%/70.8% for SPAC and 94.1%/87.5% for LACD. Sequential testing using both SPAC and LACD increased the specificity to 94.4% and decreased the sensitivity to 87.0%.ConclusionSPAC has significantly lower specificity than LACD measurement using conventional cutoffs but interpretation of the findings can be performed by modestly trained personnel. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the intraocular pressure (IOP)-lowering effect of latanoprost and bimatoprost as primary therapy in patients with chronic angle-closure glaucoma (CACG) after peripheral iridotomy. Methods: Eighty-two (82) consecutive CACG patients with an IOP greater than 19 mmHg after a peripheral iridotomy were recruited. CACG was defined as chronic elevated IOP, glaucomatous optic neuropathy, and a corresponding visual field defect in eyes with occludable angle and peripheral anterior synechiae on gonioscopy. Patients were randomly assigned to two groups based on daily treatment with either latanoprost 0.005% or bimatoprost 0.03% in the evening for 12 weeks. The IOP was measured at 9 AM and 4 PM on the same day at baseline and also at 4, 8, and 12 weeks. Between-group differences in mean diurnal IOP and IOP reduction were analyzed. Results: After 12 weeks of treatment, mean IOP for both the latanoprost and bimatoprost groups was significantly reduced when compared to the baseline value (21.6 ± 1.9 to 16.4 ± 2.5 mmHg and 22.1 ± 2.0 to 16.9 ± 2.4 mmHg, respectively; P < 0.001 for both). There was no significant difference in IOP reduction between the two treatment groups ( P = 0.40). At 4 and 8 weeks, the IOP changes from baseline were statistically significant at both times for both drugs (all P < 0.001). Conclusions: Both latanoprost and bimatoprost significantly reduced IOP in CACG patients who were inadequately treated by laser peripheral iridotomy. [ABSTRACT FROM AUTHOR]

Purpose: To report the risk factors associated with primary open-angle glaucoma (POAG) in the Burmese population. Methods: The Meiktila Eye study, a population-based cross-sectional study, included inhabitants 40 years of age and over from villages in the Meiktila District. Of 2481 eligible participants identified, 2076 participated in the study and sufficient examination data to diagnose glaucoma in at least one eye was obtained in 1997 participants. The ophthalmic examination included slit-lamp examination, tonometry, gonioscopy and dilated stereoscopic fundus examination. Definitions adhered to the International Society for Geographic and Epidemiological Ophthalmology's recommendations. Univariate and multivariate analyses of potential risk factors were performed. Results: The overall prevalence of POAG was 2.0% (95% CI 0.9–3.1). In the univariate analysis, increasing age ( P = 0.024), spherical equivalent ( P = 0.01), axial length ( P = 0.023) and intraocular pressure (IOP; P < 0.001) were significantly associated with POAG. And in the multivariate analysis, myopia <0.5 D ( P = 0.049), increasing age and IOP ( P < 0.001) were significant risk factors for POAG. Conclusion: POAG in this Burmese population was associated with increasing age, axial myopia and IOP. [ABSTRACT FROM AUTHOR]

The article provides information on glaucoma. It notes that primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness and is the most common chronic optic neuropathy while primary angle closure glaucoma (PACG) is prevalent among East Asians. Gonioscopy is used when evaluating patients for glaucoma to determine if there is a structural or mechanical abnormality that may affect outflow of the aqueous humor. Medications for glaucoma as well as their side effects are cited.

Purpose: To compare the ultrasound biomicroscopic measurement of the anterior chamber angle in Asian Indian eyes, with the angle width estimated by gonioscopy.Materials and Methods: Participants: Patients with open and closed angles attending a glaucoma clinic were recruited for the study.Observation Procedures: Temporal quadrants of the angles of patients were categorized by gonioscopy as Grade 0 to Grade 4, using Shaffer's classification. These angles were quantified by ultrasound biomicroscopy (UBM) using the following biometric characteristics: Angle opening distance at 250 micro (AOD 250) and 500 micro (AOD 500) from the scleral spur and trabecular meshwork-ciliary process distance (TCPD). The angles were further segregated as "narrow angles" (Schaffer's Grade 2 or less) and "open angles" (Schaffer's Grade 3 and 4).Main Outcome Measures: The UBM measurements were computed in each case and analyzed in relation to the gonioscopic angle evaluation.Results: One hundred and sixty three eyes of 163 patients were analyzed. One hundred and six eyes had "narrow angles" and 57 eyes had "open angles" on gonioscopy. There was a significant difference among the mean UBM measurements of each angle grade estimated by gonioscopy (P < 0.001). The Pearson correlation coefficient between all UBM parameters and gonioscopy grades was significant at the 0.01 level. The mean AOD 250, AOD 500 and TCPD in narrow angles were 58+/-49 micro, 102+/-84 micro and 653+/-124 respectively, while it was 176+/-47 micro, 291+/-62 micro and 883+/-94 micro in eyes with open angles (P < 0.001) respectively.Conclusions: The angle width estimated by gonioscopy correlated significantly with the angle dimensions measured by UBM. Gonioscopy, though a subjective test, is a reliable method for estimation of the angle width. [ABSTRACT FROM AUTHOR]

Purpose: A prospective observational case series to assess the prevalence of appositional angle closure in darkness among iridotomized Chinese eyes after acute primary angle closure (APAC) with the use of both clinical methods and ultrasound biomicroscopy. Methods: Sixteen Chinese patients who had history of APAC and subsequent successful treatment with laser peripheral iridotomy were examined. Fourteen additional control subjects were studied. Gonioscopy and ultrasound biomicroscopic examination were performed in the dark. Gonioscopic appearance of the angle was assessed, and quantitative measurements of the angle from the ultrasound biomicroscopic images were taken. Results: Of the APAC eyes 55.6% had appositionally closed angle clinically and in 38.9% only Schwalbe's line was visi-ble on gonioscopy. Ultrasound biomicroscopy confirmed structurally different anterior segments between eyes with APAC and the control eyes. In particular, the trabecular-ciliary-process distances were markedly different between the two groups. Conclusion: This study documented a high prevalence of appositional closure in iridotomized eyes after APAC in Chinese patients. The anteriorly positioned ciliary body, as documented in these cases by ultrasound biomicroscopy, is the likely mechanism of the angle crowding in this patient population. [ABSTRACT FROM AUTHOR]

Purpose: Acute angle-closure glaucoma is a common ophthalmic emergency and individuals with shallow anterior chambers and suspected narrow angles are increasingly referred to the hospital eye service for assessment. There appears to be variation in subsequent management, with no national consensus or college guidelines. This study ascertains the current use of prophylactic YAG iridotomy in patients with no known history of an acute angle-closure glaucoma attack, and also the methods used in patient selection. Materials and Methods: Questionnaire-based survey mailed to 650 UK consultant ophthalmologists with a covering letter in 2003. Results: A total of 546 questionnaires were returned. In all, 408 respondents (74.7%) confirmed they perform prophylactic YAG iridotomy and of these 347 (85.0%) use patient symptoms and 268 (65.6%) presenting IOP in patient selection, 394 (96.6%) perform gonioscopy and 97 (23.8%) use some form of provocative test first. A total of 135 (25.3%) stated they do not perform this procedure. Conclusion: This study reveals current national practice among UK ophthalmologists, with variations in the assessment of patients with narrow angles but a high uptake of prophylactic YAG iridotomy. [ABSTRACT FROM AUTHOR]

PURPOSE:To estimate the prevalence of posterior embryotoxon (PE) in the general ophthalmic clinic and to identify any features of PE that suggest that it is pathological rather than physiological. METHODS:Over 700 consecutive patients of all ages were examined with the slit lamp during their routine eye clinic appointment. Patients with posterior embryotoxon were invited to return for full ocular examination including keratometry, corneal topography, and gonioscopy. RESULTS:In all, 49 out of 723 patients were found to have PE. This gives a prevalence of 6.8%with an age range of 18 months to 95 years. There was a higher prevalence in the younger age group of 22.5%(age range 18 months to 20 years) compared to 5.9%in the older age range (21-95 years).A total of 29 patients with PE returned for further examination. Six patients had glaucoma (two with Axenfeld's syndrome and one with aniridia), and one had ocular hypertension. In all, 20 patients had bilateral PE on slit-lamp examination, which increased to 24 with gonioscopy. The majority of the PE was seen temporally (97.9%) and limited to a few clock hours. Gonioscopy showed that eight patients with PE had associated inferior pigmentation of schwalbes line. CONCLUSION:This large series found the prevalence of PE the general ophthalmic clinic to be 6.8%. Its presence should prompt careful anterior segment examination, including gonioscopy, to identify any associated abnormalities that may carry a risk of glaucoma. Children should also be assessed for any associated systemic or genetic abnormality.Eye (2005) 19, 396-399. doi:10.1038/sj.eye.6701508 Published online 13 August 2004 [ABSTRACT FROM AUTHOR]

The diagnosis of subacute angle closure glaucoma is suspected in patients with narrow angles of the anterior chamber of the eye, presenting with periodic ocular, or periocular pain. However, some patients may present with headaches in the absence of significant ocular discomfort, which often leads to misdiagnosis and delay in specific therapy. The clinical features of 9 such patients are described. Subacute angle closure glaucoma should always be considered in the differential diagnosis of adult-onset headaches. [ABSTRACT FROM AUTHOR]

CONCLUSIONS: Patients with history of trauma often present at the time or soon after their injury (eg hyphaema, orbital fractures). Thus, an opportunity exists to screen patients for known sequelae of trauma such as retinal dialysis and angle recession. It was disappointing to learn that this opportunity was not always being utilized, with some patients consequently developing macula-off retinal detachments and potential for reduced visual outcome.Eye (2004) 18, 709-713. doi:10.1038/sj.eye.6701310 Published online 20 February 2004 [ABSTRACT FROM AUTHOR]

To study the appearance of the trabeculo-Descemet's membrane (TDM) after deep sclerectomy with collagen implant (DSCI). All patients who underwent a successful DSCI for open-angle glaucoma were included in a non-randomized clinical study. Gonioscopy was performed between 6 and 12 months postoperatively in all patients. Gonioscopy was performed in 42 eyes of 38 patients after a mean follow-up time of 8.3 ± 2.5 months after DSCI. The diagnosis was chronic open-angle glaucoma in 16 eyes and exfoliative glaucoma in 24 eyes. One patient had pigmentary glaucoma and one had normal tension glaucoma. None of the patients were on glaucoma medication postoperatively. Synechias to the TDM were seen in five eyes. Pigment accumulation to the TDM was seen in nine eyes, four of which had capsular glaucoma, three had primary open-angle glaucoma, one had pigmentary glaucoma and one had normal tension glaucoma. Puncture holes at the TDM were seen in all eight eyes in which Nd:YAG laser goniopuncture had been performed. Postoperative changes, which may go unnoticed without routine gonioscopy, occur at the TDM after deep sclerectomy with collagen implant. Pigment accumulates relatively shortly after surgery. Whether or not these changes are progressive remains unknown. Careful follow-up after deep sclerectomy is necessary and should include routine gonioscopy. [ABSTRACT FROM AUTHOR]

: PurposeTo prospectively quantify changes in anterior segment morphology after laser iridotomy using gonioscopy and ultrasound biomicroscopy (UBM).: DesignProspective comparative observational case series.: ParticipantsFifty-five fellow eyes of patients presenting with acute primary angle closure (APAC).: MethodsThe fellow eyes of patients presenting with APAC were examined with UBM, A-scan ultrasonography, and optical pachymetry at presentation and 2 weeks after sequential argon/neodymium yttrium–aluminum–garnet laser peripheral iridotomy (LPI). UBM images were analyzed using UBM Pro 2000 software. Baseline measurements were made both under standard lighting conditions and in darkness to look for changes in anterior segment findings.: Main outcome measuresThe degree of angle opening was measured using the angle-opening distance (AOD) at 250 and 500 μm from the scleral spur (AOD250 and AOD500, respectively) and angle recess area (ARA).: ResultsFifty-five Asian patients were examined; AOD250, AOD500, and ARA all significantly increased after sequential laser iridotomy (P < 0.002). Gonioscopic grading of the angle opening significantly increased in all 4 quadrants (P < 0.001). The Van Herick grade of limbal anterior chamber depth increased (P < 0.001), whereas the number of eyes classified as occludable decreased (73%–33%, P < 0.001). Anterior chamber depth did not change significantly (2.41 mm ± 0.28 mm vs. 2.42 mm ± 0.30 mm, P = 0.43) as measured with optical pachymetry. Increased illumination increased the angle-opening measures, but induced a different alteration in peripheral iris morphology. Illumination-induced changes were greater after iridotomy than before laser treatment.: ConclusionsIn Asian eyes at high risk of developing APAC, sequential LPI produced a significant widening of the anterior chamber angle without deepening the anterior chamber centrally. LPI produces changes in iris morphology that are different from those caused by an increase in illumination, indicating that different mechanisms account for angle opening under these 2 conditions. [Copyright &y& Elsevier]

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]

The article discusses research being done on glaucoma. It references the study "Gonioscopic Findings Associated with a Positive Dark-Room Provocative Test in Narrow Angles After Laser Iridotomy," by A. Desgroseilliers, P. J. Harasymowycz, A. Kamdeu-Fansi et al, published in the July 16, 2013 issue of the "Journal of Glaucoma." It cites that the study highlights the significance of gonioscopy, after laser peripheral iridotomy (LPI), to look for appositional angle closure and a double-hump sign.