Predictors of angle widening after laser iridotomy in Chinese patients with primary angle-closure suspect using ultrasound biomicroscopy

AIM:To assess the predictive value of baseline parameters of ultrasound biomicroscopy(UBM) for angle widening after prophylactic laser peripheral iridotomy(LPI) in patients with primary angle-closure suspect(PACS).METHODS:Angle-opening distance(AOD),trabecular iris angle(TIA),iris thickness,trabecular-ciliary process angle,and trabecular-ciliary process distance were measured using UBM performed before and two weeks after LPI.Iris convexity(IC),iris insertion,angulation,and ciliary body(CB) size and position were graded.Uni-and multivariate regression analyses were used to determine factors predicting the change in AOD(ΔAOD500,calculated as an angle width change before and after LPI) in all quadrants and in subgroup quadrants based on IC.RESULTS:In 94 eyes of 94 patients with PACS,LPI led to angle widening with increases in AOD500 and TIA(P<0.01).Multivariable regression analysis showed that IC(P<0.001),CB position(P=0.007) and iris insertion(P=0.049) were significantly predictive for ΔAOD500.All quadrants were categorized into extreme IC(27.8%),moderate IC(62.3%),and absent IC(9.9%) subgroups.The AOD500 increased by 220% and no other predictive factor was found in the extreme IC quadrants.The AOD500 increased by 55%,and baseline iris angulation was predictive for smaller changes in ΔAOD500 in the moderate IC quadrants.CONCLUSION:In PACS patients,quadrants with greater iris bowing predict substantial angle widening after LPI.Quadrants with a flatter iris,anteriorly positioned CB,and basal iris insertion are associated with less angle widening after LPI.Quadrants with iris angulation as well as a flatter iris configuration predict a smaller angle change after LPI.     

白内障人工晶状体植入术前后角膜厚度和前房深度及前房角的改变

目的:探讨超声乳化白内障吸除折叠式人工晶状体植入术前后,术眼前房深度和角膜厚度及前房角结构的改变。方法:对20例20眼老年性白内障患者行超声乳化白内障吸除折叠式人工晶状体植入术,分别于术前和术后1wk使用超声生物显微镜量化测量前房深度、角膜厚度和前房角宽度。结果:全部患者术后1wk角膜厚度明显增加,前房深度明显增大;500μm处前房角开放距离(AOD500)及ACA角度均与术前值比较明显增加,且均P<0.01。结论:超声乳化白内障吸除折叠式人工晶状体植入术可以使角膜厚度显著增加;可显著增加老年性白内障患者的前房深度及房角宽度。     

水囊法超声生物显微镜对儿童先天性角膜混浊影像学特点的分析

目的借助水囊法超声生物显微镜检查探讨儿童先天性角膜混浊的影像学特点。方法回顾性分析先天性角膜混浊患儿142例(181眼),观察先天性角膜混浊的眼前节发育情况,根据发育异常的表型分为A、B、C、D四型。结果 181眼中有A型43眼(23.8%),仅前部角膜混浊不伴有其他结构异常。B型11眼(6.1%)为后部或全层角膜混浊,伴角膜后部局部缺损,而虹膜晶状体正常。C型88眼(48.6%)为虹膜或房角发育异常,但晶状体未见异常,其中房角发育异常范围小于4个方位的C1型共35眼(19.3%);房角发育异常范围大于等于4个方位的C2型共53眼(29.3%)。D型39眼(21.5%)为角膜虹膜与晶状体粘连,或存在混浊、膜样、缺如等晶状体异常。双眼混浊患者两眼表现可不对称;同时伴有晶状体和虹膜异常的比例,双眼混浊(32.1%)显著多于单眼(13.6%)(χ2=8.947,P=0.003)。结论采用水囊包裹探头的超声生物显微镜是适合于儿童的眼前节检查方法,可用于分析先天性角膜混浊角膜、虹膜、房角和晶状体的影像学特点并分型,对明确其诊断和预后具有指导意义。     

Evaluation of eyes with relative pupillary block by indentation ultrasound biomicroscopy gonioscopy

PURPOSE: To investigate changes in anterior chamber angle configuration with indentation ultrasound biomicroscopy gonioscopy of relative pupillary block (RPB). DESIGN: Cross-sectional study. METHODS: This study included 26 eyes of 26 patients with RPB. We determined angle opening distance 500 and angle recess area using indentation ultrasound biomicroscopy gonioscopy and compared a small-sized standard eye cup with a new eye cup with an area for inducing pressure. RESULTS: Indentation ultrasound biomicroscopy images documented concavity of the iris in eyes with RPB. Both the new and the small standard eye cups widened the anterior chamber angle significantly (P <.0001) without causing corneal damage. Angle changes were significantly greater for the new eye cup design. CONCLUSIONS: Indentation ultrasound biomicroscopy gonioscopy is a useful technique for observation and diagnosis of RPB. Using a small standard or the newly designed eye cup, the procedure can be performed easily and without causing corneal damage.     

Clinicopathological correlation of congenital corneal opacification using ultrasound biomicroscopy.

AIM: To investigate the correlation between clinical, high frequency ultrasound biomicroscopy (UBM) and, where possible, histological findings in cases of congenital corneal opacification presenting to the departments of ophthalmology, Great Ormond Street Hospital for Children, London, and the Hospital for Sick Children, Toronto, Canada. METHOD: 22 eyes of 13 children (age range 3-225 days) with congenitally opaque corneas were examined. UBM was performed using the ultrasound biomicroscope (Allergan-Humphrey). All eyes underwent penetrating keratoplasties (PKP) except five. The host corneas were all sent for histological examination. RESULTS: The final diagnosis in our series was Peters' anomaly in nine cases (70%), corneal dystrophy in two cases (15%), and sclerocornea in two cases (15%). The UBM findings changed the clinical diagnosis in five cases (38%). In these five cases histology was available in four and confirmed the UBM diagnosis in each case. In no case of the 13 where histology was available did it contradict the UBM findings. In two cases a hypoechoic region in the anterior stroma was seen on UBM which correlated histologically with absent Bowman's layer and oedema. In two cases UBM revealed aniridia and in one, congenital aphakia, which was not apparent clinically. CONCLUSION: UBM examination is not only very useful in evaluating the clinical diagnosis in congenital corneal opacification, it also acts as a preoperative guide in cases undergoing PKP by detecting keratolenticular and iridocorneal adhesions and other ocular abnormalities such as aniridia and congenital aphakia. In all cases where PKP was performed the UBM diagnosis was confirmed histologically. The clinical diagnosis was incorrect in five cases. This has important implications in studies of phenotype/genotype correlation of congenital corneal opacification.     

超声生物显微镜指导青光眼激光手术

目的 了解利用超声生物显微镜(UBM)为早期闭角型青光眼选择激光手术的术式和评价疗效的意义.方法 62例98眼早期原发性闭角型青光眼,按照UBM的检查结果分为两组:A组虹膜膨隆型,32例53眼,行Q开关Nd:YAG激光周边虹膜切除术;B组虹膜高褶型,30例45眼,行倍频Nd:YAG激光虹膜成形术.结果 激光术后3个月,62例98眼的平均眼压从术前的(22.20±3.40)mmHg降到(17.50±1.80)mmHg(1 mmHg=0.133 kPa);平均用药指数从术前的(2.50±1.50)分降到(1.10±0.80)分;A组和B组小梁虹膜夹角较术前分别增加了7°和9°;房角开放距离(AOD500),分别增加130 μm和155μm;晶状体虹膜角分别减少了9°和6°,虹膜悬韧带距离分别减少了24μm和13μm.差异均有统计学意义(P<0.01).结论 利用UBM为早期闭角型青光眼选择激光手术的术式和评价其疗效是准确可靠的.     

应用超声生物显微镜与房角镜检查眼前房角结果的比较

目的 比较应用超声生物显微镜（ｕｌｔｒａｓｏｕｎｄｂｉｏｍｉｃｒｏｓｃｏｐｙ,ＵＢＭ）与房角镜检查眼前房角的结果,为房角镜检查提供新的技术和资料。方法 采用双盲法分别对１０例（２０只眼）的眼前房角进行超声生物显微镜和裂隙灯显微镜房角镜检查。并将两种检查结果进行比较,采用等级相关法对获取的资料和结果进行统计学分析,（取α＝０．０５）。结果,两种检查法在宽房角状态下对房角的检查结果有较好的一致性, 在     

Comparison of central corneal thickness measurements by specular microscopy,ultrasound pachymetry,and ultrasound biomicroscopy

PURPOSE: To compare the reproducibility and mean values of central corneal thickness (CCT) obtained by specular microscopy, ultrasound pachymetry, and ultrasound biomicroscopy (UBM). SETTING: Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada. METHODS: Thirty-one healthy volunteers were recruited for a sample size of 62 eyes. All subjects had pachymetric measurements by specular microscopy, ultrasound pachymetry, and UBM. Three separate measurements meeting criteria for centrality and perpendicularity were recorded for each eye. RESULTS: The mean CCT by specular microscopy was 572 microm (95% confidence interval (CI), 566-578 microm), which was significantly greater than 550 microm (95% CI, 545-556 microm) (P<.001) and 555 microm (95% CI, 550-560 microm) (P<.001) by ultrasound pachymetry and UBM, respectively. The mean standard deviation (SD) of repeated measurements by specular microscopy was 7.82 microm, which was significantly greater than the mean SDs of 4.14 microm (P<.001) and 3.90 microm (P<.001) by ultrasound pachymetry and UBM, respectively. There was no statistically significant difference between the mean SDs by ultrasound pachymetry and UBM (P=.156). CONCLUSIONS: Although the CCT measurements by specular microscopy were significantly less reproducible than those by ultrasound pachymetry and UBM, the error levels were clinically acceptable. Both ultrasound pachymetry and UBM produced similar CCT measurements, which were significantly less than those generated by specular microscopy. One should be aware of the advantages and limitations of each machine and of possible differences in the CCT measurements by optical and ultrasound pachymetry.     

超声生物显微镜观察房角四度狭窄病例

目的研究房角镜检查Scheie分级为N4患者的前房角,在超声生物显微镜(UBM)检查下的形态表现。方法青光眼患者45例(50眼),其中新生血管性青光眼5眼,急性闭角型青光眼22眼,慢性闭角型青光眼23眼。所有患者均进行房角镜和UBM检查,房角镜检查Scheie分级为N4。结果UBM检查发现房角镜下为N4的前房角存在4种不同形态类型:(1)虹膜紧密前粘连,房角完全关闭。(2)虹膜自房角隐窝向前膨隆,房角完全关闭,睫状体前旋。(3)房角入口处虹膜前粘连,房角隐窝处呈开放状态。(4)房角入口处虹膜向前膨隆,房角入口处呈裂隙状狭窄。结论UBM检查为青光眼的诊断、治疗提供一种新型的检查方法和依据,同时通过UBM检查可进一步探讨青光眼的发病机制及形态变化。     

Evaluation of the anterior chamber angle in Asian Indian eyes by ultrasound biomicroscopy and gonioscopy

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.     

基于深度学习算法的前房角超声生物显微镜图像自动评估系统

目的:探讨一种基于深度学习算法的前房角(ACA)超声生物显微镜(UBM)图像分析系统的临床应用价值。方法:收集2021-01/2022-06于武汉大学人民医院眼科中心进行UBM检查的受试者675名1 130眼的UBM图像4 196张构建图像数据集。采用Unet++网络对ACA组织自动分割,并开发一种支持向量机(SVM)算法对房角开闭状态进行自动分类,同时开发一种自动定位巩膜突、测量ACA参数的算法。另选取黄石爱尔眼科医院的受试者127名221眼的UBM图像631张和武汉大学中南医院的受试者188名257眼的UBM图像594张评估该系统在不同环境下的性能。结果:本研究构建的分析系统对房角开闭状态识别的准确度为95.71%;ACA角度参数测量值的组内相关系数(ICC)均大于0.960,ACA厚度参数测量值的ICC均大于等于0.884,且该系统对ACA参数的准确测量部分依赖于巩膜突的准确定位。结论:本研究构建的智能分析系统能够准确有效地自动评估ACA图像,是一种有潜力的快速识别ACA结构的筛查工具。     

地区性窄房角患者的房角关闭机制类型分析

目的 了解邯郸地区房角关闭病人的房角形态.方法 利用超声生物显微镜(URM)图像,对邯郸市眼科医院582例(582只眼)窄房角患者的房角及其相关结构进行定性及半定量观察分析,了解各种构型所占的比率.结果 单纯瞳孔阻滞型273例(46.9%),单纯非瞳孔阻滞型33例(5.7%),多种机制共存型276例(47.4%).单纯非瞳孔阻滞型中,单纯睫状体前位19例(3.3%),单纯虹膜周边肥厚14例(2.4%).而多种机制共存型中,瞳孔阻滞+虹膜周边肥厚型121例(20.8%),瞳孔阻滞+睫状体前位型66例(11.3%),瞳孔阻滞+虹膜周边肥厚型+睫状体前位型57例(9.8%),睫状体前位+虹膜周边肥厚型32例(5.5%).结论 多种机制共存是引起邯郸地区闭角型青光眼房角关闭的主要机制,邯郸地区房角关闭患者周边虹膜肥厚、睫状体和虹膜附着位置靠前型所占比率高于南方广州地区,房角关闭发生机制存在一定的地区差异.     

Optical coherence tomography in the imaging of the iridocorneal angle

Anterior segment optical coherence tomography (AS OCT), enables visualization and measurements of the anterior segment of the eye. In particular, it is a valuable tool in the imaging of the iridocorneal angle. In this paper, we reviewed parameters used for analysis of the iridocorneal angle in AS OCT and compared changes of these parameters after cataract surgery, laser iridotomy and illumination. Special attention was paid to changes of such quantitative parameters as TISA (trabecular-iris space area), AOD (angle opening distance), and ARA (angle recess area).     

傅立叶域光学相干断层扫描、A型超声测厚仪和超声生物显微镜测量角膜厚度的相关性分析

目的 探讨傅立叶域光学相干断层扫描(FD-OCT)、A型超声测厚仪和超声生物显微镜(ultrasound biomicroscopy,UBM)测量角膜厚度的差异和可重复性.方法 应用RTVue傅立叶域OCT(RTVue FD-OCT)、A型超声测厚仪和UBM对39例志愿者随机选取一眼进行角膜厚度测量,对三种不同测量仪器测得的角膜厚度值进行比较,采用Pearson相关分析评价三种仪器测量值之间的相关性,对三种测量方法重复测量值的方差进行方差分析,比较三种测量方法的可重复性.结果 RTVue FD-OCT、UBM和A型超声测厚仪测量的角膜厚度值分别为(543.34±34.09) μm、(538.02±33.17)μm、(536.24±31.16) μm,RT-Vue FD-OCT与UBM、A型超声测厚仪的测量值之间差异均有统计学意义(均为P＜0.05),UBM与A型超声测厚仪的测量值差异无统计学意义(P＞0.05).三种测量仪器的测量值均呈正相关(r=0.983、0.966、0.938,均为P＜0.01);RTVueFD-OCT、A型超声测厚仪和UBM角膜厚度重复测量值的方差值分别为3.53±2.87、5.43±3.13、6.64±3.26,RTVueFD-OCT测量可重复性好于A型超声测厚仪和UBM.结论 RTVueFD-OCT、A型超声测厚仪和UBM测量角膜厚度有很好的相关性,RTVueFD-OCT测量可重复性好,且安全、无创,可用于角膜厚度的精确测量.     

Nanophthalmos: ultrasound biomicroscopy and Pentacam assessment of angle structures before and after cataract surgery

We report a case of nanophthalmos with intractable secondary glaucoma. Bilateral cataract extraction with intraocular lens implantation was used as definitive treatment for the chronic angle-closure glaucoma. The changes in angle and ciliary body anatomy were well documented with preoperative and postoperative Pentacam assessment (Oculus Optikger?te GmbH) and ultrasound biomicroscopy (Paradigm Medical Industries) images. We believe these are the first diagnostic and prognostic images of this kind in a nanophthalmic eye.