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Objective Animal Studied Procedure Conclusion To describe the removal of an adherent, presumed plant‐based, anterior chamber foreign body (ACFB) from the inferior iridocorneal angle in a dog using hydropulsion and ophthalmic viscoelastic device (OVD) capture.A 6‐year‐old female spayed pit bull terrier who was referred for further evaluation of a corneal opacity after being observed running into a thorned succulent plant 1 month earlier. On ophthalmic examination, no corneal foreign body was noted, though mild uveitis was present. Gonioscopy revealed a suspected plant foreign body (thorn tip) in the inferior iridocorneal angle.Under general anesthesia, the ACFB was dislodged from the inferior iridocorneal angle using hydropulsion with balanced salt solution. The superior half of the anterior chamber had been filled with 2% hydroxypropyl methylcellulose OVD to trap the foreign object. One month later, the uveitis had resolved and repeat gonioscopy confirmed the absence of any ACFB in the iridocorneal angle.In the absence of an intraoperative goniolens or endoscopy, hydropulsion and OVD capture of adherent ACFBs may be a feasible option for removal. [ABSTRACT FROM AUTHOR]

Objective: To assess whether gonioscopy performed on Samoyed puppies (6–14 weeks of age) is a reliable predictor of their gonioscopy results as adults (>11 months of age). Procedure: A retrospective medical record search was performed to identify Samoyed dogs that had undergone gonioscopy as a puppy (6–14 weeks of age). A second prospective gonioscopy examination was performed as an adult (>11 months of age) and the results were compared. Gonioscopy was assessed on two characteristics: percent of iridocorneal angle (ICA) unaffected by pectinate ligament abnormalities (PLA) and ICA width, with PLA results categorized into unaffected (≥75% open), moderately affected (50%–74% open), and severely affected (<50% open) and the width categorized into wide, moderate, narrow, and closed groups. A multivariate model was created that considered factors such as PLA, angle width, sex, puppy age, neuter status, and time between examinations. Results: The eyes of 77 Samoyed dogs (154 eyes) met inclusion criteria. When assessing PLA, 90% of dogs had the same categorization as a puppy and as an adult. When assessing ICA width, 53.2% of dogs had the same width classification as a puppy and as an adult. There is strong evidence that variation between puppy and adult results increases with time between examination (p =.03). Conclusion: Puppies unaffected by PLA and with a wide ICA angle, are likely to retain these features as adults. Selection of puppies with desirable gonioscopic traits may help breeders to choose dogs likely to retain these traits as adults for breeding. This may reduce the incidence of glaucoma in the breed. Puppy examinations should be performed in both eyes. Examination of adults prior to breeding remains prudent. [ABSTRACT FROM AUTHOR]

CONTEXT: Glaucoma is the leading cause of blindness and vision loss worldwide and hasa major impact on quality of life. As glaucoma is a multifactorial disease, it is important to identify the association between its ocular and systemic risk factors. AIMS: To assess the demographic profile, type of glaucoma, grade, risk factors and severity of same in first time diagnosed patients of glaucoma. SETTINGS AND DESIGNS: Primary open angel and Primary close angle glaucoma patients were selected according to inclusion criteria and cross-sectional observational study was carried out. METHODS: This analysis includes study of 200 patients diagnosed with glaucoma for the first time at a Western Regional Institute of Ophthalmology in Western India. Patients visual BCVA, age, intraocular pressure, corneal pachymetry, gonioscopy, central disc ratio, visual field findings and optical coherence tomography (OCT) were analysed. STATISTICAL ANALYSIS USED: Data were analysed using independent t test and statistical software Spss 26.0 version and Microsoft excel. P < 0.05 was considered stastically significant. Results: The study revealed that the mean age of patient of POAG was 60 and PACG was 57 years. POAG mean IOP was 20.98 ± 2.78 and PACG mean IOP was 28.37 ± 5.33. We observed 11.5% patients with advanced glaucomatous damage clinically and on perimetry report. POAG patients were more aged than POCG patients and also had advanced glaucomatous damage clinically and on perimetry report. Hypertension and diabetes were most commonly observed risk factors. CONCLUSIONS: this study undermines the utmost importance of raising awareness about glaucoma and the significance of early screening before irreversible glaucomatous damage occurs. [ABSTRACT FROM AUTHOR]

Background: Laser peripheral iridotomy done prophylactically in primary angle closure suspects. Purpose of laser peripheral iridotomy is to preserve visual function and maintain quality of life by preventing acute angle closure crisis/Primary angle closure glaucoma from developing. Objective: To study the Role of laser peripheral iridotomy in primary angle closure suspects. Materials and Method: This prospective interventional non-randomised hospital based study was conducted among the patients with primary angle closure suspects attending the department of ophthalmology at Minto Hospital, in Bangalore during the study period from Nov 2011 to May 2013. Results: We included 50 eyes of 29 patients that satisfied our inclusion criteria. This consisted of 8 male and 21 female patients in the age group of 40 to 70 years. After complete evaluation and confirming the diagnosis of primary angle closure suspects, patients were subjected to Nd-YAG laser iridotomy. Angle width, ACD and AXL parameters using gonioscopy and A-scan ultrasound before and after the procedure were compared. None of the patients had any serious iridotomy related complications. A statistically significant change was noted in the angle width using gonioscopy two weeks following laser iridotomy in primary angle closure suspects. There was an overall increase of 2 units in Shaffer angle grading in all 4 quadrants. Conclusion: Laser iridotomy produces a significant widening of the anterior chamber angle in patients with primary angle closure suspects. [ABSTRACT FROM AUTHOR]

Background: Pseudoexfoliation glaucoma (PXG) is more aggressive than Primary open angle glaucoma; Intraocular pressure (IOP) is higher, IOP fluctuations are excessive, and there is substantial damage to the optic nerve and visual field. Resistance to medical management, aggressive nature, and increased intraoperative complications of PXG make it distinct entity from primary open angle glaucoma. So, this study was conducted to analyze the prevalence of glaucoma in Pseudoexfoliation syndrome (PXS) and its clinical spectrum. Methodology: This was a hospital based, descriptive study done between February 2021 to August 2022, where patients satisfying the inclusion criteria were recruited for the study. Detailed history was taken. Visual acuity, anterior segment examination, IOP, gonioscopy, fundus examination visual field analysis, contrast sensitivity were evaluated. PXG was diagnosed based on pseudoexfoliative material on slit lamp examination, IOP>21 mm Hg, glaucomatous cupping, pigmentation of trabecular meshwork and visual field defects. Results: Prevalence of glaucoma in patients with PXS was 35.2%. Prevalence and laterality of PXS increases with increase in age and more common in males. Iris and lens were the most common sites for Pseudoexfoliation (PXF) material. Nuclear cataract was predominant in PXS. Central corneal thickness (CCT) in patients with PXG was found to be thinner that patients with PXS. Mean IOP in PXG was higher than in PXS. High-pressure glaucoma, Open angle glaucoma and unilateral glaucoma was most common type of glaucoma in PXG, which showed increased severity of optic disc damage and advanced field defects. Interpretation & conclusion: Thus, in view of high prevalence of glaucoma and aggressive nature of glaucoma in PXS leading to blindness, all elderly patients should be screened for PXS and patients with PXS should undergo complete glaucoma evaluation and follow up and treatment to prevent blindness. [ABSTRACT FROM AUTHOR]

Background: Glaucoma is a collection of eye diseases that affect the optic nerve, which is essential for proper vision. An unusually high pressure in the eye is often the source of this injury. Glaucoma is the second leading cause of blindness in the world. It is a serious worldwide problem that causes severe ocular morbidity and impairment as a consequence of its progressive nature, which results in permanent vision loss. Material and Methods: This is a prospective and observational study was conducted in the Department of Ophthalmology at Subbaiah Institute of Medical Sciences, Shivamogga from November 2022 to December 2023. Total 74 (Due to COVID pandemic the study subjects was reduced from 100 to 74). Data was collected from patients of primary open angle glaucoma with systemic hypertension presenting to ophthalmology department. Patients with systemic hypertension meeting the criteria mentioned above were included in the study after taking informed consent. A detailed history regarding past medical illness including hypertension, duration of hypertension, family history of glaucoma was taken. Details regarding antihypertensive medications and any other medications that the patient was on were also obtained. Results: Among study participants, about 66 % were males & 34% were females Demonstrating that out of 74 patients, 31 patients i.e., 42% had high IOP & remaining 58% had normal IOP. The mean values of IOP in right & left eyes were 21 mm of Hg & 20.80 mm of Hg respectively; clearly showing that mean IOP is slightly higher in Right eye of patients. Median values were 21 for right eye & 20.50 for left eye. Standard deviation for right eye was 3.664 & left eye was 3.188. Maximum value for right eye was 34 & minimum was 14 and for left eye maximum & minimum values were 30 & 14 respectively. The mean value for Central Corneal Thickness in Right eye as 511.36 with a standard deviation of 15.431 & median lies at 510. Conclusion: Even though, many studies reported that higher systemic blood pressure is having higher risk of developing POAG & few studies reported that hypotension is also a risk factor for developing POAG. But, in the current study there was a statistically significant association found between Systemic hypertension & POAG and also IOP is positively correlated with SBP. Thus, with this study, it can be concluded that systemic hypertension is one of the risk factors for developing POAG. [ABSTRACT FROM AUTHOR]

Glaucoma is one of the leading causes of irreversible blindness globally and is characterized by the gradual loss of retinal ganglion cells. The primary risk factor for the development and progression of glaucoma is increased intraocular pressure (IOP). Numerous surgical interventions exist to lower IOP should conservative therapy fail. One trend in recent years has been minimally invasive glaucoma surgery (MIGS) as an alternative to traditional methods. The ISTENT inject® is an ab interno trabecular micro-bypass implant designed to be implanted through the trabecular meshwork into the Schlemm's canal to lower IOP. The aim of the study was the postoperative visualization and description of the positioning of the ISTENT inject® using automated circumferential goniophotography. Patients with symptomatic cataracts and mild to moderate primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigment-dispersion glaucoma were included who underwent combined cataract surgery with the ISTENT inject® and received postoperative automated gonioscopy with the NIDEK Gonioscope GS-1 to visualize the location of the implant. Twenty-four implants of 14 eyes in 11 patients could be visualized. Out of the implants, 14.3% were in the trabecular meshwork, 46.4% were at the border between the trabecular meshwork and scleral spur, 25% were below the trabecular meshwork, and 14.3% of the implants were not detectable in the gonioscopy. In the overall cohort, a statistically significant IOP reduction was found over the 12-month postoperative observation period. Even in three eyes, in each of which both stents were located below the trabecular meshwork, an IOP reduction over 12 months was observed compared to the baseline IOP. In this study, vertical two-dimensional positioning of the ISTENT inject® was performed for the first time using NIDKE GS-1 automated 360° goniophotography. The method is suitable for postoperative visualization, control, and documentation of positioning after ISTENT inject® implantation. Further studies are needed to analyze the correlation between positioning of the ISTENT inject® in the chamber angle and postoperative IOP reduction. [ABSTRACT FROM AUTHOR]

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: The aim of this study was to evaluate the efficacy of digital visualization for enhancing the visualization of iridocorneal structures during surgical gonioscopy. Methods: This was a prospective, single-center study on a series of 26 cases of trabecular stent implantation performed by the same surgeon. Images were recorded during surgical gonioscopy, and before stent implantation, with standard colors and with the optimization of various settings, principally color saturation and temperature and the use of the cyan color filter. Subjective analyses were performed by two glaucoma surgeons, and objective contrast measurements were made on iridocorneal structure images. Results: The surgeons evaluating the images considered the optimized digital settings to produce enhanced tissue visibility for both trabecular meshwork pigmentation and Schlemm's canal in more than 65% of cases. The mean difference in the standard deviation of the pixel intensity values was 37.87 (±4.61) for the optimized filter images and 32.37 (±3.51) for the standard-color images (p < 0.001). The use of a cyan filter provided a good level of contrast for the visualization of trabecular meshwork pigmentation. Increasing the color temperature highlighted the red appearance of Schlemm's canal. Conclusions: We report here the utility of optimized digital settings including the cyan filter and a warmer color for enhancing the visualization of iridocorneal structures during surgical gonioscopy. These settings could be used in surgical practice to enhance the visualization of the trabecular meshwork and Schlemm's canal during minimally invasive glaucoma surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and invasiveness of manual gonioscopy and automated 360-degree gonioscopy. Method: Manual and automated gonioscopy were performed on 70 patients with glaucoma. Manual gonioscopy was performed by a glaucoma specialist and an ophthalmology resident, and automated gonioscopy (GS-1) was performed by orthoptists. We compared the examination time for acquiring gonioscopic images (GS-1: 16 directions; manual gonioscopy: 8 directions). Furthermore, we compared the pain and discomfort scores during the examination using the Individualized Numeric Rating Scale. Among the images acquired by automated gonioscopy, we also evaluated the percentages of acquired images that could be used to determine the angle opening condition. Results: The examination time was not significantly different between manual (80.2±28.7) and automated gonioscopy (94.7±82.8) (p = 0.105). The pain score of automated gonioscopy (0.22±0.59) was significantly lower than that of manual gonioscopy (0.55±1.11) (p = 0.025). The discomfort score was not significantly different between manual (1.34±1.90) and automated gonioscopy (1.06±1.50) (p = 0.165). Automated gonioscopy successfully acquired clear gonioscopic images in 93.4% of the total images. Conclusion: Automated gonioscopy is comparable in examination time and invasiveness to manual gonioscopy and may be useful for 360-degree iridocorneal angle evaluation. [ABSTRACT FROM AUTHOR]

Introduction: diagnosing and managing highly myopic patients who might have or willdevelop glaucoma stillappears to be challenging and genuine diagnostic dilemma. This is due to the fact that high myopia is associated with elongation of the eye and resulting in tilting and torsion of the optic disc, causing visual filed defects that may resemble glaucomatous damage. This is why we are constantly asking ourselves is it glaucoma or just myopia? Or even both. Allophthalmologists assessing high myopic patients often encounter this dilemma. By 2050, about half the world's population will have myopia and in some parts of the world, these rates are already approaching 90%. Aim: early diagnosis assessment in myopic patients with changes in the visual field that might indicate glaucoma is the main goal of our research. Structural and functional defects in myopic eyes are difficult to distinguish from those caused by glaucoma. Materials and methods: this was prospective-retrospective randomized, clinical research. In order to make a scientifically valuable statistical comparison, a total of 300 eyes has been examined, i.e. 100 eyes in 3 groups of respondents of both gender: I group - patients with glaucoma, II group - patients with myopia and glaucoma, III group - patients only with myopia. Each group was also divided regarding the size of the optic disc diameter into 3 categories: small (<1.30 mm), medium (1.31-2.09 mm) and large (>2.10 mm). The following ophthalmological examinations were performed on all patients: natural visual acuity and best-corrected visualacuity, Goldman applanation tonometry, biomicroscopy examination, autorefractometry, gonioscopy, fundus examination - direct ophthalmoscopy (Volk lens +90D), spectral three-dimensional optical coherence tomography (SOCT 3D), static computerized perimetry. Results: our research results showed that respondents with progressive visual field loss have accordingly a higher numeric value of Disc Damage Likelihood Scale (DDLS). There is a statistically significant difference in the quality of the visual field in relation to the size of the disc in respondents diagnosed with glaucoma with and without the associated diagnosis of myopia. Conclusion: analyzing the comorbidity of glaucoma and myopia, it is possible to create a diagnostic algorithm technique and procedure with emphasis and aim in early detection of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To measure angle of anterior chamber with Gonioscopy and compare with anterior segment OCT. Study Design: Descriptive observational study. Place and Duration of Study: This study was conducted at the Department of Ophthalmology, Pakistan institute of Medical Sciences, Islamabad from 1st March 2021 to 31st August 2021. Methods: A total number of 102 patients participated in the study. Study included participants older than 30 years of age, of either gender, who were either diagnosed as a case of angle closure-Glaucoma or were angle closure-Glaucoma suspect. Sampling was done using convenient sampling technique. The selected patients underwent gonioscopy and the anterior segment OCT and the grades of the angle were determined. Grading was compared between the two techniques. The collected data was analyzed by using SPSS 23 version. Result: The mean age of patients was 59.16 ± 6.03 years. Out of 102 patients, 34 (33.3%) patients were male and 63 (66.7%) patients were female. The mean intraocular pressure was 17.80 ± 4.25 (mmHg). The accuracy of angle closure detection by Gonioscopy was 35.3% and by anterior segment, OCT was 60.8%. The p value was significant in both the groups. The Anterior segment OCT turned out to be better than Gonioscopy. Conclusion: Anterior segment OCT is more efficient in determination of angle of anterior chamber than gonioscopy. Using anterior segment OCT to examine anterior chamber angle and surrounding tissues helps in diagnosing early stages of disease and directing therapy. [ABSTRACT FROM AUTHOR]

To investigate the extent of iris trabecular contact (ITC) measured by anterior segment OCT (AS-OCT) and its association with primary angle-closure (PAC) and PAC glaucoma (PACG) in eyes with gonioscopic angle-closure and to determine the diagnostic performance of ITC for detection of gonioscopic angle-closure. Multicenter, prospective study. A total of 119 healthy participants with gonioscopic open-angle and 170 patients with gonioscopic angle-closure (94 with PAC suspect and 76 with PAC/PACG) were included. One eye of each subject was randomly selected for AS-OCT imaging. Angle-opening distance (AOD500) and trabecular iris space area (TISA500) were measured every 10° for 360°. Two criteria of ITC500 were examined: (1) AOD500 = 0 mm and (2) TISA500 = 0 mm2. The association between the extent of ITC500 and PAC/PACG in eyes with gonioscopic angle-closure was analyzed with logistic regression analysis. Sensitivity and specificity of ITC500 for detection of gonioscopic angle-closure; odds ratio (OR) of PAC/PACG. The sensitivity of ITC500 ≥ 10° for detection of gonioscopic angle-closure ranged from 82.4% (AOD500 = 0 mm) to 84.7% (TISA500 = 0 mm2), and the specificity was 85.7% (for both AOD500 = 0 mm and TISA500 = 0 mm2). The extent of ITC500 determined by AS-OCT, not cumulative gonioscopy score (i.e., the sum of the modified Shaffer grades over 4 quadrants), was associated with the odds of PAC/PACG in eyes with gonioscopic angle-closure; the odds of PAC/PACG increased by 5% for every 10° increase in ITC500 (OR, 1.051, 95% confidence interval [CI], 1.022–1.080 for AOD500 = 0 mm; OR, 1.049, 95% CI, 1.022–1.078 for TISA500 = 0 mm2). Axial length and anterior chamber depth were not associated with PAC/PACG in eyes with gonioscopic angle-closure (P ≥ 0.574). A greater extent of ITC measured by AS-OCT, not angle-closure determined by gonioscopy, was associated with a greater odds of PAC/PACG in eyes with gonioscopic angle-closure. [ABSTRACT FROM AUTHOR]

Purpose: Indication of laser peripheral iridotomy (LPI) is often conjectural due to dependency on gonioscopy and strict dichotomous classification of occludability. Indentation gonioscopy is the gold standard but is under-utilized for various reasons. The prevalence of primary angle closure disease (PACD) in eastern India is 1.5-1.9%, with a 22% five-year progression rate. Many angle closure patients may go blind without timely diagnosis and iridotomy. General ophthalmologists need alternate, validated methods for diagnoses. Pilocarpine eye drop causes miosis, and flattens the iris, producing angle changes detectable by spectral domain optical coherence tomography (SD-OCT). We hypothesized that the amount of angle change may be a suitable indicator for iridotomy.Methods: Our prospective cross-sectional single-masked observational study evaluated pilocarpine-induced changes in angle parameters detected by SD-OCT. Out of 372 patients enrolled, 273 patients (539 eyes) remained, with a mean age of 48.6 years (SD = 10.36). All eyes were graded by the Van Herick (VH) method, gonioscopy, and anterior segment (AS) SD-OCT and reassessed after pilocarpine drops.Results: The sensitivity and specificity of tomography measurements against gonioscopy grades were 61% and 85%, respectively. The receiver operating characteristic (ROC) curve was 0.85. Pilocarpine-induced angle widening was significant in gonioscopically narrower angles. Low Van Herick grades (217 eyes), narrow gonioscopy grades (238 eyes), and a narrow OCT angle value (165 eyes) were candidates for iridotomy.Conclusion: Our study results showed that pilocarpine-induced angle widening detected by SD-OCT could be a strong objective indicator for LPI. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the gonioscopic changes in patients receiving Descemet's stripping endothelial keratoplasty (DSEK) without pre-existing ocular hypertension (OHT) and to report its correlation with post-surgery OHT, graft survival, and visual outcomes.Methods: Adult patients who underwent DSEK surgery from April 2014 to March 2018 with at least 2 years of follow-up were analyzed in this retrospective study. Demographic details, indication of DSEK, necessary anterior and posterior segment findings, and the post-DSEK OHT details were documented.Results: A total of 58 patients (23 males and 35 females) with a mean age of 61.44 ± 8.8 years were included in the study. The most common etiology for DSEK surgery was pseudophakic bullous keratopathy in 47 eyes (81.03%). A total of 22.41% (13/58) eyes showed elevated intra-ocular pressure (IOP) following DSEK surgery. The most common cause of IOP elevation was steroid-induced OHT in seven eyes (12.06%). Gonioscopy examination revealed areas of peripheral anterior synechiae (PAS) in 17 (29.3%) eyes. OHT was found in 4/17 (23.5%) eyes having PAS. Three of these cases required trabeculectomy + goniosynechiolysis (GSL), and the fourth case required GSL alone to control IOP. These four cases also required repeat DSEK for failed grafts. The mean pre-operative best corrected visual acuity was 1.62 logMAR (range 1.17-1.77), which gradually improved to 0.79 logMAR (range 0.3-1.77) after 2 years (p < 0.00001).Conclusion: PAS was found to be an important factor associated with post-DSEK ocular hypertension in our study. OHT in PAS cases required definitive surgical treatments to control IOP. It adversely affected the graft survival and in turn affected visual outcomes also. [ABSTRACT FROM AUTHOR]

To describe a realistic goat's eye model to aid in surgical training of ophthalmology residents for improvising skills in intraoperative gonioscopy and incisional goniotomy surgery. This study provides a descriptive report explaining the step-by-step methodology for setting up a goat's eye model to train the ophthalmology residents in both intra-operative gonioscopy and incisional goniotomy. The goat's eyeball was prepared and mounted within the socket of a mannequin head. The mannequin head was tilted and microscope angulation was adjusted to allow adequate visualization of angle structures. Following intra-operative visualisation of angle structures through a Swan Jacob lens, incisional goniotomy was performed using a microvitreo-retinal blade on approximately 120° nasal angle. The model was found to produce reproducible results when tested on 22 trained residents. The Goniotomy on Goat's Eye (GOGE) model can provide a realistic and a relatively inexpensive tool for resident surgeons to develop bimanual coordination and enhance their surgical skills to perform effective intraoperative gonioscopy and incisional goniotomy surgery. [ABSTRACT FROM AUTHOR]

Purpose: To quantitatively compare iridocorneal angle assessments using gonioscopy and anterior segment optical coherence tomography (AS-OCT). Patients: US and Chinese patients with open-angle glaucoma (OAG) and/or ocular hypertension (OHT). Methods: Analysis was pooled from 2 multicenter, noninterventional studies conducted in the US and China. Gonioscopy Shaffer grade and an AS-OCT method that approximates the angle width relative to local morphologic variations were compared by measuring the same iridocorneal angles. A third, separate, single-center, noninterventional study was conducted to verify results observed from the pooled analysis. Results: From the pooled studies, a total of 239 eyes were measured using Shaffer grade and AS-OCT. Of these, 6 were Shaffer grade 2, 37 in Shaffer grade 3, and 196 in Shaffer grade 4. There was a trend of increasing Shaffer grade with increasing AS-OCT angle width. Open iridocorneal angles, Shaffer grade ≥ 3, had a ∼ 98% sensitivity and 88% positive predictive value for identifying AS-OCT angle width ≥ 300 μm, using the AS-OCT method. To verify these results, a total of 28 right eyes were imaged for the third study. A trend of increasing Shaffer grade with increasing AS-OCT angle width was observed, and angles with Shaffer grade ≤ 2 had AS-OCT angle width < 300 μm. Conclusion: The AS-OCT method can determine the space in the anterior chamber and can potentially identify angles that are the appropriate size for certain glaucoma devices. Information gathered from AS-OCT can provide additional comprehensive and quantitative assessment to gonioscopy. [ABSTRACT FROM AUTHOR]

Background: Hypermetropic eyes are generally smaller in globe volume, resulting in crowding of anterior chamber when the lens size is normal. The aim of this study is to document the prevalence of occludable angles in hypermetropes visiting tertiary eye care centre of western region of India and to highlight the importance of screening for angle closure suspects in high risk groups. Material And Methods: This cross sectional study is based on clinical study of patients attended by M & J Western Regional Institute of Ophthalmology. The study group was divided into two subgroups: patients who are hyperopic on refraction and patients who are either emmetropic or myopic. Relative risk and Odd's ratio was calculated for relation between refractive error and occludable angle. Result: Risk of Occludable angle in hypermetropes = 0.23.Risk of Occludable angle in myopes and emmetropes = 0.06. Relative risk in hypermetropes = 4.15 i.e. hypermetropes have nearly 4 times risk of developing occludable angle than myopes and emmetropes. Relative risk in myopes and emmetropes = 0.24 i.e. myopes and emmetropes have 0.24 times risk of developing occludable angle than hypermetropes. Odd's ratio in the first group = 5.1 i.e. the possibility for a patient with occludable angle being a hypermetrope. Odd's ratio in the second group = 0.2 i.e. the possibility for a patient with occludable angle being a myope or an emmetrope. Conclusion: When occludable angle is detected on gonioscopy in > 270 degrees, a peripheral iridectomy can be performed as a prophylactic measure and patients can be given a liberal follow up. A society like India where people have less awareness regarding glaucoma being a silent thief and not understanding the importance follow up examination in glaucoma, gonioscopy should be made a part of routine examination and peripheral iridotomy done as necessary. [ABSTRACT FROM AUTHOR]

Objective: To evaluate efficacy of gonioscopy-assisted transluminal trabeculotomy and relate to severity of glaucoma. Methods: A retrospective analysis of medical records of patients submitted to gonioscopy-assisted transluminal trabeculotomy, at a private hospital, from 2019 to 2021. Results: A total of 20 were submitted to gonioscopy-assisted transluminal trabeculotomy (2 eyes) or facectomy and gonioscopy-assisted transluminal trabeculotomy (18 eyes). Patients with advanced-stage disease achieved a decrease by 5 mmHg (26.5%) in IOP, with a reduction of 2.3 drugs, and eyes with mild or moderate glaucoma showed a drop by 8 mmHg (40%) in mean IOP and of 2.1 drugs. Half of the operated eyes had hyphema in the first days as the main surgical complication. Conclusion: Gonioscopy-assisted transluminal trabeculotomy is an effective procedure to reduce IOP and the number of drugs being used, with greater IOP decrease in eyes with mild/moderate glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether gonioscopic examination using a four-mirror goniolens affects intraocular pressure (IOP). Materials and Methods: This cross-sectional study included one randomly selected eye of 30 patients with primary open-angle glaucoma (POAG) under medical treatment and 27 healthy controls. IOP was measured using a noncontact tonometer (NT), then with a Tono-pen, followed by gonioscopic examination using a four-mirror goniolens (without gel), and finally a second IOP measurement by Tono-pen. We compared NT and Tono-pen measurements obtained before gonioscopic examination, and Tono-pen measurements obtained before and after gonioscopic examination. We evaluated the relationship between the difference in Tono-pen measurements before and after gonioscopy and central corneal thickness (CCT) and palpebral fissure height (PFH). Results: Mean IOPs in the POAG and control groups were 15.7±3.2 and 16±2.7 mmHg with NT before gonioscopy, 15.3±2.6 and 14.8Ü2.27 mmHg with Tono-pen before gonioscopy, and 14.9±3.1 and 14.37±2.13 mmHg with Tono-pen after gonioscopy, respectively. In pre-gonioscopic measurements, NT and Tono-pen measurements did not differ significantly in the POAG group (p>0.05), whereas NT measurements were higher than Tono-pen measurements in controls (p<0.05). The mean change in IOP after gonioscopy was -0.32±1.60 and -0.44±1.69 mmHg in the POAG and control groups, respectively (p>0.05). There was no difference in CCT between groups (p>0.05), whereas PFH was smaller in controls (9.67±0.73 vs. 10.Ü0.55 mm; p<0.05). Change in IOP was not correlated with CCT or PFH in either group (p>0.05). Conclusions: Our results indicate that gonioscopic examination using a four-mirror goniolens has no significant effect on IOP in open-angle eyes. [ABSTRACT FROM AUTHOR]

To develop and evaluate the performance of a 3-dimensional (3D) deep-learning–based automated digital gonioscopy system (DGS) in detecting 2 major characteristics in eyes with suspected primary angle-closure glaucoma (PACG): (1) narrow iridocorneal angles (static gonioscopy, Task I) and (2) peripheral anterior synechiae (PAS) (dynamic gonioscopy, Task II) on OCT scans. International, cross-sectional, multicenter study. A total of 1.112 million images of 8694 volume scans (2294 patients) from 3 centers were included in this study (Task I, training/internal validation/external testing: 4515, 1101, and 2222 volume scans, respectively; Task II, training/internal validation/external testing: 378, 376, and 102 volume scans, respectively). For Task I, a narrow angle was defined as an eye in which the posterior pigmented trabecular meshwork was not visible in more than 180° without indentation in the primary position captured in the dark room from the scans. For Task II, PAS was defined as the adhesion of the iris to the trabecular meshwork. The diagnostic performance of the 3D DGS was evaluated in both tasks with gonioscopic records as reference. The area under the curve (AUC), sensitivity, and specificity of the 3D DGS were calculated. In Task I, 29.4% of patients had a narrow angle. The AUC, sensitivity, and specificity of 3D DGS on the external testing datasets were 0.943 (0.933–0.953), 0.867 (0.838–0.895), and 0.878 (0.859–0.896), respectively. For Task II, 13.8% of patients had PAS. The AUC, sensitivity, and specificity of 3D DGS were 0.902 (0.818–0.985), 0.900 (0.714–1.000), and 0.890 (0.841–0.938), respectively, on the external testing set at quadrant level following normal clinical practice; and 0.885 (0.836–0.933), 0.912 (0.816–1.000), and 0.700 (0.660–0.741), respectively, on the external testing set at clock-hour level. The 3D DGS is effective in detecting eyes with suspected PACG. It has the potential to be used widely in the primary eye care community for screening of subjects at high risk of developing PACG. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to review the literature that compares the accuracy of Anterior Segment-Optical Coherence Tomography (AS-OCT) against gonioscopy in detecting eyes with angle closure. It is currently unclear how AS-OCT fits into clinical practice for detecting angle closure. This is a systematic review and meta-analysis. Methods: A literature search was performed on Medline, Embase, Scopus and the Cochrane Central Register of Controlled Trials to identify studies that investigated the diagnostic accuracy of AS-OCT in detecting eyes with angle closure as diagnosed by gonioscopy. Eligible studies included in the analysis met stringent inclusion criteria determining the sensitivity and specificity of AS-OCT. Results: The initial search identified 727 studies, of which 23 were included in the final analysis. We found substantial variation in the parameters being studied and methodologies. The sensitivity of AS-OCT ranged from 46 to 100% (median 87%). Twenty-one studies identified parameters that showed sensitivity above 80%. The specificity ranged from 55.3 to 100% (median 84%). Conclusion: AS-OCT demonstrates good sensitivity for detecting angle closure. It may provide an avenue to address high rates of undiagnosed angle closure, such as found in developing Asian countries. However, AS-OCT is not yet able to replace gonioscopy. Clinicians should consider whether the diagnostic accuracy of AS-OCT is acceptable for their specific clinical use before adopting it. More studies are needed to determine the utility of AS-OCT, including longitudinal studies to determine the significance of eyes classified to have closed angles by AS-OCT but open on gonioscopy. [ABSTRACT FROM AUTHOR]

The ophthalmic lenses that come in contact with the eyes pose a high risk for the transmission of bacterial and viral infections in eye clinics. Disinfecting these lenses does not happen stringently in a busy practice. We describe a novel method of disinfecting ophthalmic contact lenses using a semiautomated lens disinfector equipment, semiautomated lens disinfector. The equipment has motors to pump in and pump out water and disinfecting solution into a reservoir bath. The used ophthalmic lenses will be placed in a tray that partially dips into the bath for disinfection. Microbiology tests that were done to check the quality of the disinfection cycle showed good outcomes. Disinfection of ophthalmic contact lenses with the new equipment appeared to effectively eliminate contaminant microorganisms. This equipment can be used in busy ophthalmic clinics to alleviate the chances of cross-infection. [ABSTRACT FROM AUTHOR]

To assess anatomic changes after laser peripheral iridotomy (LPI) and predictors of angle widening based on anterior segment (AS) OCT and angle opening based on gonioscopy. Prospective observational study. Primary angle-closure suspects (PACSs) 50 to 70 years of age. Participants of the Zhongshan Angle Closure Prevention (ZAP) Trial underwent gonioscopy and AS-OCT imaging at baseline and 2 weeks after LPI. Primary angle-closure suspect was defined as the inability to visualize pigmented trabecular meshwork in 2 or more quadrants on static gonioscopy. Laser peripheral iridotomy was performed on 1 eye per patient in superior (between 11 and 1 o'clock) or temporal or nasal locations (at or below 10:30 or 1:30 o'clock). Biometric parameters in horizontal and vertical AS-OCT scans were measured and averaged. Linear and logistic regression modeling were performed to determine predictors of angle widening, defined as change in mean angle opening distance measured at 750 μm from the scleral spur (AOD 750); poor angle widening, defined as the lowest quintile of change in mean AOD 750 ; and poor angle opening, defined as residual PACS after LPI based on gonioscopy. Anatomic changes and predictors of angle widening and opening after LPI. Four hundred fifty-four patients were included in the analysis. Two hundred nineteen underwent superior LPI and 235 underwent temporal or nasal LPI. Significant changes were found among most biometric parameters (P < 0.006) after LPI, including greater AOD 750 (P < 0.001). One hundred twenty eyes (26.4%) showed residual PACS after LPI. In multivariate regression analysis, superior LPI location (P = 0.004), smaller AOD 750 (P < 0.001), and greater iris curvature (P < 0.001), were predictive of greater angle widening. Temporal or nasal LPI locations (odds ratio [OR], 2.60, P < 0.001) was predictive of poor angle widening. Smaller mean gonioscopy grade (OR, 0.34, 1-grade increment) was predictive of poor angle opening. Superior LPI location results in significantly greater angle widening compared with temporal or nasal locations in a Chinese population with PACS. This supports consideration of superior LPI locations to optimize anatomic changes after LPI. [ABSTRACT FROM AUTHOR]

To evaluate corneal endothelium damage with silicone oil (SO) presence in the anterior chamber after pars plana vitrectomy. We investigated the medical records of consecutive 54 eyes of 53 patients undergoing SO removal after pars plana vitrectomy with SO tamponade at Saitama Medical Center, Jichi Medical University, Japan. We recorded SO tamponade retention period, anterior chamber SO with gonioscope, area of SO attachment to the corneal endothelium before SO removal surgery, and the lens status. We then retrospectively investigated the correlation between SO presence in the anterior chamber and the decrease rate of corneal endothelial cell (CEC) density during SO tamponade. The average decrease rate of CEC density was 7.6 (0–38.1) %. The correlation between SO tamponade retention period and decrease rate of CEC density was high (p = 0.0001). However, there was no correlation between anterior chamber SO under gonioscope, SO attaching area, and lens status with the decrease rate of CEC density (p = 0.11, p = 0.93, p = 0.16). No correlation was observed between CEC loss and the existence of anterior chamber SO, although CEC decrease rate was relatively high after a long SO tamponade period. These findings suggest that SO presence in the anterior chamber may not directly injure CEC. [ABSTRACT FROM AUTHOR]

To investigate the association of peripheral anterior synechiae (PAS) with intraocular pressure (IOP) and anterior-segment parameters in subjects with primary angle-closure glaucoma (PACG). A total of 267 subjects with PACG were recruited and underwent gonioscopy and anterior-segment optical coherence tomography (ASOCT). Customized software was used to measure ASOCT parameters, including angle opening distance (AOD750) and trabecular-iris-space-area (TISA750) at 750 µm from the scleral spur, anterior chamber depth, width, area and volume (ACD, ACW, ACA, ACV), iris thickness (IT750), iris area (IAREA), and lens vault (LV). Presenting IOP was defined as the first IOP reading before the initiation of IOP-lowering treatment. The mean age of the 267 subjects was 67.0 ± 8.9 years, 140 (52.4%) were male, and 246 (92.1%) were of Chinese ethnicity. PAS was present in 122 (45.7%) subjects, and was most frequently found in the superior quadrant (79.5%). Subjects with PAS had greater presenting IOP (28.7 ± 12.9 vs 22.4 ± 9.7 mmHg, p < 0.001), narrower AOD750 (p < 0.001), smaller TISA750 (p < 0.001), ACD (p = 0.04), ACA (p = 0.02), ACV (p = 0.01) and larger LV (p = 0.01) compared to PACG eyes without PAS. No significant differences were noted for iris parameters. A multivariate logistic regression analysis showed that higher presenting IOP (β = 0.20, p < 0.001), worse visual field mean deviation (β = − 0.20, p = 0.01) and narrower AOD750 (β = − 0.25, p = 0.03) were the only parameters that significantly correlated with the extent of PAS in clock hours. Almost one-half of the subjects with PACG demonstrated PAS; these eyes were associated with higher presenting IOP, smaller anterior segment dimensions and more severe disease. [ABSTRACT FROM AUTHOR]

Objective: To assess whether preoperative gonioscopy status is associated with the development of postoperative glaucoma after phacoemulsification. Procedure: Eligible dogs and eyes were selected from medical records (2007‐2017), and each eye was classified as having normal or abnormal gonioscopy status. Records were examined for postoperative glaucoma, and data were collected for baseline variables including patient signalment, surgical factors, and pre, intra, and postoperative medications. Results: Of 305 dogs (505 eyes) selected for review in this study, 111 dogs (163 eyes) had abnormal gonioscopy findings, and 194 dogs (342 eyes) had normal gonioscopy findings. Postoperative glaucoma occurred in 24% (39/163) of eyes with abnormal gonioscopy and in 14% (49/342) eyes with normal gonioscopy. Eyes with abnormal gonioscopy status were at higher risk of postoperative glaucoma compared to normal eyes (P =.025). There was no important confounding due to the numerous baseline variables summarised above. Regardless of gonioscopy status, the risk of glaucoma was highest during the first 2 months after surgery. Conclusions: Eyes with abnormal gonioscopy findings are at increased risk of postoperative glaucoma compared with eyes with normal gonioscopy findings. Gonioscopy is recommended as a part of presurgical assessment in all dogs prior to phacoemulsification. Further study is needed to assess whether the incidence of postoperative glaucoma can be reduced by increased monitoring or altered treatment protocols in cases that are known to have abnormal gonioscopy findings prior to cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between gonioscopic iridocorneal angle (ICA) morphology and the incidence of postoperative ocular hypertension (POH) and postoperative glaucoma in dogs undergoing cataract surgery. Animals studied: Retrospective analysis of 138 eyes of 78 canine patients who underwent phacoemulsification at North Carolina State University from December 1, 2015 through April 30, 2017. Methods: Medical records of all phacoemulsification patients with preoperative RetCam gonioscopic images were reviewed for preoperative, intraoperative, and postoperative variables. Gonioscopic angle indices were calculated using a novel (ZibWest) angle grading system, and these indices were analyzed for outcome‐related significance. Results: Increased surgeon experience was associated with increased probability of POH and vision loss. Higher average ZibWest Angle indices (ie, more open angles with less pectinate ligament dysplasia/ abnormality) were associated with a significantly decreased probability of medically unresponsive glaucoma. Increased patient age was significantly associated with an increased probability of both postoperative glaucoma and vision loss. Female dogs were significantly more likely to experience postoperative glaucoma compared to male dogs. Increased surgery time was significantly associated with increased probability of vision loss. Conclusions: The ZibWest angle index may predict increased risk for developing medically unresponsive glaucoma with cataract surgery. Female sex, and increased patient age, surgical time, and surgeon experience were associated with increased postoperative morbidity. [ABSTRACT FROM AUTHOR]

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

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

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

Purpose: This study aimed to identify acute angle closure (AAC) risk following pharmacologic mydriasis and the factors affecting post-mydriatic intraocular pressure (IOP) in a population with a high prevalence of angle closure disease. Methods: In total, 460 individuals aged ≥ 72 years were enrolled in this cross-sectional community-based screening program. IOP was measured at baseline and 1 hour after mydriasis. Individuals with post-mydriatic IOP spike > 6 mmHg received indentation gonioscopy and IOP-lowering medication. Linear regression analysis was used to identify ocular parameters associated with post-mydriatic IOP elevation. Results: The mean age of participants was 77.8 ± 4.1 years, and 65.4% of them were men. In total, 21 eyes of 16 participants (3.48%) had post-mydriatic IOP spikes (range: 6–13.7 mmHg); among them, 15 eyes had an IOP of > 21 mmHg. None of the participants developed AAC. All eyes with IOP spikes were phakic, except for one with pseudophakic angle closure. Analysis of 381 participants with at least one phakic eye revealed that higher post-mydriatic IOP and IOP changes were associated with narrower angle grading, more extensive peripheral anterior synechiae, shallower central anterior chamber, and thicker lens. According to multiple linear regression analysis, post-mydriatic IOP was independently associated with baseline IOP and factors suggestive of crowded anterior chamber based on gonioscopic findings and central or peripheral anterior chamber depth evaluation in conjunction with lens thickness. Conclusion: Post-mydriatic IOP should be measured in phakic eyes with a crowded anterior chamber. Post-mydriatic IOP spikes can be effectively blunted with intervention to prevent AAC. [ABSTRACT FROM AUTHOR]

The crystalline lens plays an important role in the pathophysiology of primary angle closure and primary angle-closure glaucoma. The aging process is associated with a progressive enlargement of the lens, resulting in greater iridolenticular and iridotrabecular contact, which exacerbates both pupillary block and appositional angle closure, irrespective of the cataract status of the lens. Cataract surgery has been shown to widen the angle and reduce intraocular pressure in eyes with primary angle closure or primary angle-closure glaucoma. Recently, clear lens phacoemulsification has been suggested as a treatment modality in such eyes. We review the literature on clear lens extraction in eyes with angle closure and discuss its efficacy, safety, and indications. Although it is evident that clear lens extraction is beneficial in eyes with primary angle closure and primary angle-closure glaucoma, it is technically challenging and should be performed by experienced surgeons who not only master the procedure but are also able to deal with potential complications. Since the follow-up of the reviewed studies is relatively short, long-term follow-up (>10 years) of patients who undergo this procedure is needed to evaluate the safety and confirm the early benefits reported. [ABSTRACT FROM AUTHOR]

Objectives: To describe the signalment, ophthalmic examination findings, and follow‐up of dogs affected with a previously unreported retrocorneal pigmentary lesion. Materials and Methods: Retrospective record evaluation spanning 2009‐2019. Results: Retrocorneal pigmentary lesions were described in 34 patients (46 eyes). German Shepherds (n = 7), Jack Russel terriers (n = 5), and terrier crosses (n = 4) made up 16/34 (47.1%) of the cases. The mean age was 13.5 years (range 1.4‐14.2 years), and 16/30 (53.3%) dogs were female. Most dogs were affected unilaterally (22/34 (64.7%)), the others bilaterally, and 5/34 (14.7%) were referred for it while the others were incidentally diagnosed. The lesions affected the ventral, peripheral, inner cornea and had a round/undulated leading edge. The number of corneal clock hours affected was known for 41/46 (89.1%) eyes and involved 1‐3 clock hours in 32/41 (78.1%) eyes, 4‐6 in 6/41 (14.6%), 7‐9 in 2/41 (4.9%), and 10 in 1/41 (2.4%). The central cornea was affected in 9/46 (19.6%) eyes, and in 5/9 (55.6%), the median corneal clarity score was G2 (scale: G0‐G4). The commonest additional findings included free‐floating uveal cysts (11/34 dogs, 32.4%), cataracts (6/34 dogs, 17.6%), and primary glaucoma (5/34 dogs, 14.7%). Gonioscopy was available in 16/34 (47.1%) dogs and was normal except in primary glaucoma cases. Follow‐up was documented in 13/34 (38.2%) dogs with a mean follow‐up of 17 months (range: 5‐26 months). Lesion progression was documented in 6/13 (46.2%) dogs. Conclusions: Retrocorneal pigmentation occurs as a slowly progressive lesion of older dogs that could impact vision. Histological studies of affected eyes are warranted. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of the study was to report a small case series of patients with iridoschisis seen at our hospital over a period of 5 years. METHODS: Retrospective review of all those files over the past 5 years whereby the diagnosis of iridoschisis/iris atrophy/iris fibrils in anterior chamber (AC) was made. RESULTS: In our case series, the average age at presentation was 49 years (range: 23–85 years). The pathology was bilateral in 57% of patients in our series. Our most common presentations were angle closure glaucoma and cataract. Younger individuals can also manifest iridoschisis. CONCLUSION: The iridoschisis can be an incidental finding, and gonioscopy should be performed in all the cases, as occludable or synechiael angle closure may be present in these cases. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the results of filtration surgery in cases of Glaucoma Capsulare. Study Design: Interventional case series. Place and Duration: Al-Ibrahim Eye Hospital, Karachi, from January 2018 to December 2018. Methods: Forty eyes of forty patients, between 50 to 80 years of age, with Glaucoma Capsulare, not controlled with topical medication were included in the study. Patients not willing for filtration surgery and those who had any other ocular disease were excluded. Pre-operative examination, including visual acuity, retinoscopy, intra ocular pressure and fundus examination was done. Complete blood count, blood sugar and urine complete were also carried out to rule out any other illness. All collected data was analyzed through software SPSS version 20. Results: There were 26 (65.0%) males and 14 (35.0%) females. Mean age was 62.1 ± 12.44 years. Mean preoperative IOP was 34.0 ± 2.43 mm Hg. At first follow-up visit mean IOP (mm Hg) was 11.44 ± 3.2 and at 12 weeks follow-up, the IOP was 10.14 ± 4.1. Angle 0 - I (closed angle) was seen in 6 (15.0%), Angle grade II - III (Open angle) was seen in 10 (25.0%) and grade III - IV (open angle) was seen in 24 (60.0%) patients. Base line visual acuity was 6/9 in 4 (10.0%), 6/12 - 6/18 in 10 (25.0%), 6/18 - 6/24 in 12 (30.0%) and 6/36 - 6/60 in 14 (35.0%) patients. Early complications were flat anterior chamber in 4 (10%) and corneal edema in 4 (10%) patients. However late complications were hyphema and cataract in 2 (5%) and 25 (62.5%) patients respectively. Conclusion: Trabeculectomy significantly lowers the intraocular pressure in patients with Glaucoma Capsulare. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical outcomes of combined prolene gonioscopy assisted transluminal trabeculotomy (GATT) with phacoemulsification in patients with open-angle glaucoma. Methods: Retrospective study of patients with cataract and open-angle glaucoma treated with GATT and phacoemulsification with intraocular lens (IOL) implantation. Patients with neovascular glaucoma, corneal decompensation, unstable IOL, and with bleeding disorders were excluded. The cumulative probability of failure was the primary outcome. Secondary outcomes were the complete success rate, the mean change on intraocular pressure (IOP), best-corrected visual acuity (BCVA) and number of glaucoma medications at the last follow-up. The frequency of complications was also recorded. Results: Thirty two eyes (25 patients) were included. Nineteen (59.3%) were females, with a mean age of 73.4± 12.4 (23– 87 years) and a mean baseline BCVA of 1.1± 0.75 (0.3– 3) LogMAR units. The cumulative probability of failure was 3.2% at 1 month and 6.3% at 6 and 12 months. Sixty-eight and 65.5% of eyes achieved complete success at 3 and 6 months, respectively. The reduction of IOP and number of glaucoma medications at 6 months were statistically significant (p< 0.0001 and p=0.0002, respectively). There was a statistically significant improvement of BCVA (from 1.1± 0.7 to 0.4± 0.7) at 6 months (p< 0.0001). IOP spikes (18.7%) and transient hyphema (9.3%) were the most common complications. Conclusion: Combined GATT with cataract surgery reduced the IOP and was associated with low failure rates and few ocular complications. This procedure offers the advantage to avoid the need for a bleb, scleral, or conjunctival incision, allowing the possibility for future glaucoma procedures. [ABSTRACT FROM AUTHOR]

Purpose: Studies examining the anterior chamber angle and angle closure disease often compare quantitative angle information obtained using anterior segment optical coherence tomography (ASOCT) with one of several ordinal scales derived using gonioscopy. We test the assumption that the ordinal gonioscopic angle grades have equal step sizes and can be analysed using metric statistics. Methods: The medical records of 214 consecutive patients who were referred for assessment of the anterior chamber angle were prospectively examined using gonioscopy and ASOCT (Spectralis Optical Coherence Tomography, OCT, www.heidelbergengineering.com). Anterior chamber angle parameters (angle opening distance, AOD, and trabecular‐iris space area, TISA at 500 and 750 microns) were extracted from ASOCT images using a semi‐automated segmentation algorithm written on MATLAB (www.mathworks.com). We first matched the quantitative values for each gonioscopic grade (0–4, from no structures visible to ciliary body visible) and described the frequency distributions to determine separability. We then applied a grade‐agnostic clustering algorithm to determine the concordance between algorithm‐clustered groups (using solely quantitative data) and those obtained using gonioscopy. Results: The frequency distributions of the quantitative ASOCT parameters for each angle grade were mostly non‐parametric and displayed unique distribution characteristics, with a floor effect seen for grade 0 and the lack of a ceiling effect seen for grades 3 and 4. Although we found significant differences in quantitative values across the five angle grades using the frequency distributions, some pairwise comparisons were indistinguishable (such as grades 0 and 1, and grades 3 and 4) due to the overlaps in distributions. On average, differences in quantitative values were consistent between gonioscopic grade steps, but there remained substantial variability that confounds prediction of change between ordinal steps. The clustering algorithm showed approximately 10% of cases with the same group assignment as that of the gonioscopic grade, improving slightly to 30% when the top 5% of quantitative data were excluded from analysis. Conclusions: Our results do not necessarily support the assumption that the ordinal scales used in gonioscopy can be interpreted using an interval scale. We highlight the need for better methods of describing the course and risk of angle closure spectrum disease to identify disease progression and conversion, where gonioscopy remains the gold standard. [ABSTRACT FROM AUTHOR]

Background: Migraine symptoms are frequently referred by glaucoma patients. Although most studies analyze headache in the acute setting of angle closure, many patients with chronic occludable angles also complain of headaches. The aim of this study was to determine the impact of laser peripheral iridotomy (LPI) on the magnitude and frequency of headache symptoms in patients with occludable angles. Methods: Prospective cohort study. Patients with indication for prophylactic LPI due to occludable iridocorneal angle were included. Headache symptoms were assessed before and at least 4 weeks after LPI using the Headache Impact Test-6 (HIT-6) questionnaire. A HIT-6 score of ≥ 50 points was labeled as a clinically significant headache. Results: Thirty-one subjects were included. Prophylactic LPI was performed in 60 eyes, as 2 patients were pseudophakic in the fellow eye. Baseline HIT-6 score was 59.9 ± 11.8, with over three quarters of these patients scoring higher than 50 points (n = 24). A statistically significant reduction in HIT-6 score was found after LPI treatment (45.4 ± 7.7, p < 0.01). Sub-analysis within the clinically symptomatic subjects disclosed a significant improvement after treatment in this group (baseline, 65.3 ± 6.2 vs post-LPI 46.2 ± 8.3, p < 0.01), with a high baseline HIT-6 score being predictive of a symptomatic improvement after LPI (χ2(8) = 15.3, p = 0.001). This is mimicked from the patient's perspective, as the two subjective questions after LPI, concerning pain intensity and frequency, report that 79.2% had a statistically significant improvement of the headaches. Conclusions: Within our sample, the majority of patients with occludable angles had clinically relevant headaches. LPI provided symptomatic relief in the majority of those patients with high HIT-6 scores. Further studies are needed to explore the relationships between headache and angle anatomy. [ABSTRACT FROM AUTHOR]

A 50-year-old woman presented with conjunctival melanosis, scleral pigmentation, and Lisch nodules in her left eye. Intraocular pressure was 24 mmHg in the right eye and 14 mmHg in the left eye. She had open angles on gonioscopy. Fundus examination showed a cup-to-disc ratio of 0.7 in the right eye, with an inferior notch and a splinter hemorrhage, and 0.6 in the left eye, with a deep cup with sloping rims. Humphrey visual fields showed an evolving superior arcuate scotoma in her right eye; the left eye was normal. Systemic examination showed axillary freckling. The patient had a family history of neurofibromatosis type 1 (NF-1), her father having been diagnosed with the condition. She had hyperpigmentation of the skin over the forehead and periocular skin on the left side. These unique ocular and systemic features were suggestive of two phakomatoses, NF-1 and nevus of Ota, in one eye, and primary open-angle glaucoma (POAG) in the other eye. that is, three pathologies present together in the same individual, which is an extremely rare occurrence. [ABSTRACT FROM AUTHOR]

Objective: To describe selected ophthalmic tests and anatomical features of eyes of crab-eating foxes (Cerdocyon thous) and maned wolves (Chrysocyon brachyurus). Animals studied: Six crab-eating foxes (12 eyes), eight maned wolves (16 eyes). Procedures: Intramuscular and/or inhalatory anesthesia, ophthalmic evaluation with portable slit-lamp biomicroscope, Schirmer tear test (STT), intraocular pressure measurement with rebound and applanation (crab-eating fox only) tonometers, measurement of palpebral fissure length (PFL), gonioscopy, and fundoscopy. Data were analyzed with ANOVA and Tukey's tests. Results: Both species presented upper and lower eyelids, both with eyelashes and Meibomian glands openings. A third eyelid was also present. In partial miosis, pigmented projections were observed along the edge of the pupil. The draining angle was open, with thin pectinate ligaments. The retina was holangiotic. For crab-eating foxes, mean ± standard deviation values were as follows: STT: 4.33 ± 2.96 mm/min; PFL: 17.45 ± 1.55 mm; rebound tonometry: 10.70 ± 3.43 mm Hg (TonoVet® calibration D),5.66 ± 3.44 mm Hg (TonoVet®calibration P), 17.00 ± 4.64 mm Hg (TonoVet® Plus calibration dog); and applanation tonometry: 11.70 ± 5.70 mm Hg(TonoPen® XL). For maned wolves, the mean ± standard deviation values were as follows: STT: 9.31 ± 7.40 mm/min; PFL: 22.79 ± 1.63 mm; rebound tonometry: 11.00 ± 2.77 mm Hg (TonoVet® calibration D), 6.78 ± 2.58 mm Hg (TonoVet® calibration P), and 18.29 ± 3.47 mm Hg(TonoVet® Plus calibration dog). Conclusions: This study contributes with knowledge that can help the clinical assessment regarding eyes of crab-eating foxes and maned wolves. The data herein presented for rebound tonometry are new for both species. [ABSTRACT FROM AUTHOR]

Background: Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease.Methods: The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted.Results: Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non-angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001).Conclusions: The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities. [ABSTRACT FROM AUTHOR]

Purpose: To assess the quality and accuracy of glaucoma referrals from ophthalmologist.Methods: Retrospective review of patients chart with referral letter to a tertiary glaucoma center between January and December 2017. Patients aged <16 years, lens-induced glaucoma, uveitic glaucoma, and glaucoma following retinal and corneal surgery were excluded.Results: A total of 184 patients referred by 55 ophthalmologists were included. Mean patient age (SD) was 57.8 ± 14 years. Intraocular pressure was not documented in the referral letter in 113 (61%) patients, gonioscopy in 174 (95%) patients, disc findings in 149 (81%) patients, and visual fields in 175 (95%) patients. Thirteen (37%) of the 35 patients referred as open angle glaucoma were found to have angle closure glaucoma. Pseudoexfoliation glaucoma was diagnosed in 29 (16%) patients, of which 18 were missed by the referring ophthalmologist.Conclusion: In our study >90% of referral letter did not have the essential parameters. A standard template for glaucoma referral is suggested, which will help the patient to get better transfer of care. [ABSTRACT FROM AUTHOR]

Purpose: Glaucoma is the leading cause of irreversible blindness in the world. The current study aims to estimate prevalence, features, and associations of open angle glaucoma (OAG) in a rural and urban East Indian population.Methods: This is a population based cross sectional study with two arms, rural (28 contiguous villages from 13 Gram Panchayats in Balagarh Police Station, Hooghly district) and urban (Kolkata). Individuals residing in the study area aged 40 years and above were included using multistage random cluster sampling. All subjects underwent a detailed ophthalmic examination at our base hospitals including applanation tonometry, ultrasound pachymetry, gonioscopy, and frequency doubling technology perimetry. The primary outcome was the prevalence of POAG (95% CI). Age and gender specific prevalence estimates were calculated. Multiple logistic regressions were used to analyze the risk factors.Results: Data from 7128 and 6964 subjects aged 40 years or older from Kolkata city and Hooghly district, respectively were analyzed. In the urban population, 2.10% (95% CI: 1.99-2.21%) had POAG and 0.15% (95% CI: 0.13-0.17%) had secondary OAG. In the rural population, 1.45% (95% CI: 0.59-2.31%) had POAG and 0.10 ± 0.03% (95% CI: 0.07-0.13%) had secondary OAG.Conclusion: The study concludes that higher age, higher vertical cup disc ratio (VCDR), and lower central corneal thickness (CCT) are important independent predictors of OAG and emphasizes that increased intraocular pressure (IOP) is not POAG. Gonioscopy, disc evaluation, and screening perimetry need to be incorporated in the detection protocol for glaucoma if we intend to lighten the burden of blindness due to glaucoma. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the morphology of iridocorneal angle and anterior segment in eyes of children with cataract. Methods: In this prospective cross-sectional study, we included eyes of children with bilateral cataract as well as unilateral cataract and fellow eyes. The iridocorneal angle was evaluated using gonioscopy. We compared the preoperative structures of iridocorneal angle and anterior segment between cataractous eyes and fellow eyes. The grading of iridocorneal angle and anatomical changes were analyzed. Results: We finally recruited 55 eyes of 55 children with bilateral cataract and 41 cataractous eyes and 33 fellow eyes of 41 children with unilateral cataract. The fellow eyes were used as a control group. The iridocorneal angle was open in eyes with pediatric cataract when compared to control eyes. The eyes with cataract exhibited more pigments on the trabecular meshwork than control eyes did (unilateral cataract vs. control, p = 0.013; bilateral cataract vs. control, p = 0.002). The eyes with cataract exhibited a smaller cornea than control eyes (unilateral cataract vs. control, p = 0.031; bilateral cataract vs. control, p < 0.001). Conclusions: The iridocorneal angle is open in the eyes of children with cataract. Eyes with increased pigments on the trabecular meshwork need to be carefully monitored and surgeons should to be on the alert for postoperative glaucoma. [ABSTRACT FROM AUTHOR]

OBJECTIVE To evaluate effects of topical ophthalmic administration of diclofenac on intraocular pressure (IOP) when applied at 4 frequencies to eyes of Beagles. ANIMALS 8 ophthalmologlcally normal Beagles. PROCEDURES The study involved four 5-day experimental periods each separated by a 16-day washout period. During each period, I drop of 0.1% diclofenac sodium ophthalmic solution was administered to the right eye at 4 treatment frequencies (I, 2, 3, or 4 times/d); I drop of eyewash was administered to the left eye as a control treatment. A complete ophthalmic examination was performed on days 0 (day before first treatment) and 5 of each experimental period. Gonioscopy was performed on day 0 of the first period. The lOPs were measured at 7 am and 7 pm on days I through 5. RESULTS No abnormalities were detected during neuro-ophthalmic and ophthalmic examinations on day 0 of each experimental period. No adverse reactions to administration of diclofenac or eyewash were observed at any time point. No abnormalities were detected during ophthalmic examinations performed on day 5, and lOPs remained < 25 mm Hg in all 4 periods. No significant differences were identified between the treated and control eyes or among the 4 treatment frequencies. CONCLUSIONS AND CLINICAL RELEVANCE Topical ophthalmic administration of diclofenac up to 4 times/d in dogs with no ophthalmic abnormalities did not significantly increase the IOP. Additional research is needed to evaluate the effect of topical ophthalmic administration of diclofenac on IOP In dogs with anterior uveitis. [ABSTRACT FROM AUTHOR]

Objective: Iridocorneal angle (ICA) narrowing is a known risk factor for primary glaucoma in multiple species, but has not been described in companion rabbits. This study aimed to develop an ICA grading scheme for companion rabbits to enable early glaucoma predisposition diagnosis. Animals studied: Twenty healthy rabbits of varying breeds and ages. Procedures: Rabbits received complete ophthalmic examinations, including gonioscopy, and imaging of the ICA using spectral‐domain optical coherence tomography (SD‐OCT), Scheimpflug imaging (Pentacam® HR), and high‐resolution ultrasound (HRUS). Angle opening distance (AOD) and angle recess area (ARA) of the ICA were measured and assessed for agreement using a Bland‐Altman analysis. A five‐stage gonioscopy grading scheme was created, and Spearman‐rank test assessed for correlation between gonioscopy grades and ICA measurements. Differences among age and sex were analyzed with a nonparametric ANOVA and Wilcoxon rank‐sum test, respectively. Results: Analysis revealed AOD medians of 0.28mm for SD‐OCT [95% CI: 0.24‐0.31], 0.20mm for Pentacam® HR [95% CI: 0.18‐0.21], and 0.25mm for HRUS [95% CI: 0.22‐0.28]. The median ARA was 0.14mm2 for SD‐OCT [95% CI: 0.117‐0.163], 0.09mm2 for Pentacam® HR [95% CI: 0.082‐0.100], and 0.06mm2 for HRUS [95% CI: 0.046‐0.054]. The association between gonioscopy grade and SD‐OCT ARA was significant (P < 0.05), and there was a significant difference (P < 0.001) between imaging modalities for both ARA and AOD. Conclusions: Gonioscopy grade correlated well with SD‐OCT ARA. Therefore, SD‐OCT is recommended as a noncontact method for evaluating companion rabbit ICA. Each imaging device should not be used interchangeably for ICA evaluation. [ABSTRACT FROM AUTHOR]

Purpose: We performed a retrospective, comparative study to determine if patients with aniridia and glaucoma had open angles on high-resolution anterior segment optical coherence tomography (OCT) and clinical gonioscopy. Patients and methods: Forty-three patients (86 eyes) with aniridia had recorded anterior segment OCTs, gonioscopy, or both. Of these patients, 27 (54 eyes) were diagnosed with glaucoma and 16 (32 eyes) had no evidence of glaucoma. All patients had either anterior segment OCT, gonioscopy, or both. Results: The 43 patients with aniridia had average age of 32±17 years, and 27 (62%) were female. Anterior segment OCT and gonioscopy were recorded in 25 (58%) of the patients and 18 (42%) of the patients had gonioscopy alone. Of the 54 eyes with aniridia and glaucoma, 4 (7%) eyes in 3 patients (11%) had partial or completely closed angles. Of the 32 eyes without glaucoma, all (100%) had open angles. The proportion of open angles in the aniridia with glaucoma eyes was not significantly different compared with the aniridia without glaucoma eyes (P=0.32). Of the 4 eyes with closed angles, all had a history of prior surgery for cataract, glaucoma, and/or keratopathy. The proportion of eyes with prior surgery was significantly higher in eyes with open-angle glaucoma and angle-closure glaucoma compared with eyes without glaucoma (P<0.001 and P=0.002, respectively). Conclusion: The majority of eyes with aniridia and glaucoma have open anterior chamber angles, similar to patients with aniridia without glaucoma. All eyes with aniridia and glaucoma that had closed angles had a prior history of ocular surgery. [ABSTRACT FROM AUTHOR]