Multiple bilateral iridociliary cysts: ultrasound biomicroscopy and clinical characteristics

BACKGROUND: To describe the utility of ultrasound biomicroscopy in diagnosing multiple bilateral iridociliary cysts and to determine the clinical significance of this condition. METHODS: A retrospective review of 73 patients referred for ultrasound biomicroscopy who were found to have bilateral iridociliary cysts. RESULTS: Seventy-three patients were identified who demonstrated 2 or more cysts in 1 eye and at least 1 in the other with ultrasound biomicroscopy. A solitary iris elevation was the most common reason for referral (84.9%). There were 44 patients for whom sufficient follow-up data were available, with a mean follow-up of 40.4 months. Clinical sequelae included 1 case of sectoral cataract (2.3%) and 4 cases of cyst-related glaucoma (9.1%). INTERPRETATION: Multiple bilateral iridociliary cysts is a common condition with occasional clinical significance. Ultrasound biomicroscopy is a valuable technique in diagnosing this condition. Patients who have significant angle compromise should be followed and treated as required for glaucoma.     

应用超声生物显微镜检查及诊断青光眼术后睫状体脱离

目的：探讨青光眼术后睫状体脱离造成浅前房的形态学改变及其临床意义。方法：应用眼科传统B超及超声生物显微镜（ultrasound biomicroscopy,UBM)对青光眼术后睫状体脱离的患眼,健眼形态进行观察并对其测量的相关数据进行统计学分析。结果：UBM对B超不能诊断的睫状体脱离和脉络膜浅脱离,能特异性地进行检查诊断,其特征性表现为：巩膜与睫状体间存在无回声区,睫状体位置前移,前旋,睫状体平坦部向眼中轴部位移动,部分患者可见睫状体平坦部呈层间分离,前房变浅的原因是睫状突向前扭转,导致虹膜根部膨隆,晶状体向前移位,所有睫状体脱离眼均为360度全周脱离,而非某一象限的脱离,不伴有脉络膜脱离的单纯睫状体脱离所致的青光眼术后浅前房,一般不致前房完全消失,保守治疗可奏效,结论：应用UBM检查可以对睫状体脱离造成的青光眼术后浅前房进行明确诊断,为临床治疗提供可靠依据。     

基于超声生物显微镜图像分型的先天性白内障摘出术后后发性白内障的手术设计及疗效观察

目的　基于超声生物显微镜（ultrasound biomicroscope,UBM）对先天性白内障摘出术后后发性白内障（posterior capsular opacification,PCO）图像特征的影像学分类,探讨PCO类型与手术方式选择的关系。方法　对在广州市妇女儿童医疗中心行先天性白内障摘出术,术后采用水囊式UBM成像技术进行检查,并确诊为PCO的27例（40眼）患儿的UBM检查结果进行分析。根据UBM图像特征将PCO分为3组,并根据分型实施不同的手术方式:膜性纤维化型组采用Nd:YAG激光晶状体后囊膜切开术,皮质再生型组采用前段玻璃体切割术,混合型组采用前段玻璃体切割联合电子撕囊术。术后定期随访并复查UBM。结果　全部术眼术中视轴区混浊均被清除,晶状体后囊膜中央切口均为直径3.0~4.0 mm的圆形透明区,PCO手术的成功率为100%。术后随访6~30个月,膜性纤维化型组20眼中2眼发生虹膜粘连、瞳孔膜样闭锁,再次手术,采用虹膜后粘连分离联合前段玻璃体切割术治疗,术后未再次复发;皮质再生型组14眼和混合型组6眼术后视轴区均未再次出现混浊。PCO术后总复发率为5.0%。结论　对先天性白内障摘出术后PCO的UBM图像进行分型,有助于最佳手术方式的选择,可达到更好的治疗效果。     

睫状体脱离手术前后超声生物显微镜检查的临床价值

目的探讨睫状体脱离手术前后超声生物显微镜（ultrasone biomicroscope,UBM）检查的临床价值。方法72例睫状体脱离术前术后进行UBM检查,以观察和对比手术前后的改变。结果经UBM检查72例均诊断为睫状体脱离,其中18例为睫状体上腔与前房沟通型,54例为睫状体与巩膜间连续裂隙样断离。结论UBM检查对挫伤性睫状体脱离的诊断、指导手术和判断手术效果具有重要的临床指导价值。     

Massive anterior chamber involvement after Intra-arterial chemotherapy for retinoblastoma: ultrasound biomicroscopy and histopathology

This case report highlights the usefulness of Ultrasound Biomicroscopy (UBM) in a case of retinoblastoma which showed massive anterior chamber involvement after treatment with intra-arterial chemotherapy. UBM was used to document tumour pseudohypopion, cells in the aqueous humor, implanted clusters of cells on the corneal endothelium, iris nodules, lens capsule deposits and ciliary body invasion. The UBM data, compared with the histopathologic analysis, performed on eye tissue, after enucleation of the affected eye, revealed a significant concordance. UBM may represent an important diagnostic tool in retinoblastoma, when the decision about enucleation of the eye must be made in the absence of histopathologic data.     

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.     

Validity of a new comprehensive pterygia grading scale for use in clinical research and clinical trial

Purpose

To determine the reliability and agreement of a new comprehensive pterygium grading scale for use in clinical research and clinical trials.

Methods

Thirty eyes with pterygia were enrolled in this study. Primary gaze position and lateral gaze position images were taken of each eye with a modified single-lens reflex camera system. Our grading scale includes five parameters: two hyperemia parameters of pterygia on two different gaze position images and three size parameters, quantifying length, width, and area of the cornea encroachment of pterygium, using ImageJ software. All images were graded on the five parameters by two masked, certified reading center graders. Two graders independently graded all the images to determine inter-grader reliability. One grader regraded the images after 3 days to determine intra-grader reliability. Intraclass correlation coefficient (ICC) and inter-rater agreement statistic (κ) calculations were performed.

Results

The intra-grader reliability for hyperemia grading was high on both primary and lateral gazing positions (κ value is 0.93 and 0.96). The inter-grader reliability for hyperemia grading was also good (κ value is 0.85 and 0.87). The mean value of width, length, and area of the cornea encroachment of pterygium was 4.31 ± 2.04 mm, 2.08 ± 1.43 mm, and 7.84 ± 7.62 mm², respectively. The intra-grader agreement on width, length, and area were excellent, with ICCs of 0.98 (95% CI 0.96–0.99), 0.99 (95% CI 0.98–1.0), and 0.97 (95% CI 0.94–0.99), respectively. The inter-grader agreement on width, length, and area were also excellent, with ICCs of 0.96 (95% CI 0.90–0.98), 0.99 (95% CI 0.98–0.99), and 0.99 (95% CI 0.97–0.99), respectively.

Conclusions

There was excellent intra- and inter-observer reproducibility with the new comprehensive grading scale. This scale could lead to the development of standardized grading assessments and quantification of pterygia that would be valid in clinical research and clinical trials.

     

Surgical removal of subfoveal choroidal neovascularization in pathologic myopia: a 12-year follow-up study

The purpose of this study was to review the 12-year visual outcomes of patients who underwent surgical removal for subfoveal choroidal neovascularization (CNV) attributable to pathologic myopia. This retrospective study included 14 patients, with a mean age of 45.8 years, high myopia (>6 D) and classic subfoveal CNV. They were treated with pars plana vitrectomy and surgical removal of CNV. All patients were followed up every 3 months for 2 years, with visual acuity (VA), fundus examination, and fluorescein angiography and then every year for 5 years. Ten patients underwent a final visit with VA and fundus examination after a minimum 12-year follow-up. The main outcome measurement was VA and the secondary outcome measurement was the lesion size. After 12 years of follow-up, the mean VA did not significantly change over time, with a mean gain of 0.22 logMAR at 1 year, and 0.18, 0.12 and 0.05 at 2, 5 and 12 years, respectively. The anatomical evolution was characterized by a significant enlargement of the lesion size at 5 years. This study showed that final VA after surgical treatment with 12 years of follow-up was poor, due to the significant CNV scar enlargement over time. These results should prompt a prospective randomized study of other medical treatments, particularly anti-vascular endothelial growth factor therapy.     

Changes in anterior chamber depth and angle width after filtration surgery: a quantitative study using ultrasound biomicroscopy

PURPOSE: To evaluate the anterior chamber configuration by means of ultrasound biomicroscopy in patients with glaucoma and control subjects, and to determine quantitative changes in this configuration after glaucoma filtration surgery (trabeculectomy) and combined cataract and filtration surgery. METHODS: The study included 33 eyes of 33 patients with glaucoma (diagnosed with primary open-angle or exfoliative glaucoma) in which filtration surgery (n = 17) or combined cataract and filtration surgery (n = 16) was performed, and 25 eyes of 25 age-matched control subjects. Ultrasound biomicroscopy was used to measure anterior chamber depth and the angle width at 500 microm from the scleral spur in all eyes. The patients with glaucoma were examined 2 days before surgery and 3 and 6 months after surgery. RESULTS: There were no significant differences in anterior chamber depth and angle width between patients with glaucoma before surgery and control subjects. Postoperative values for anterior chamber depth were significantly greater in patients with glaucoma who underwent combined surgery, but no significant changes were observed in those who underwent filtration surgery alone. In contrast, angle width was significantly greater after surgery both in patients who underwent combined surgery and in those who underwent filtration surgery alone. CONCLUSION: On ultrasound biomicroscopic evaluation, there were no differences in anterior chamber depth and angle width between patients with glaucoma and control subjects. Trabeculectomy alone widens the angle but does not affect the anterior chamber depth; however, combined surgery both deepens the anterior chamber depth and widens the angle.     

Demonstration of retroiridal extension of an epithelial membrane by ultrasound biomicroscopy: a clinicopathologic correlation

PURPOSE: To report the utilization of ultrasound biomicroscopy (UBM) in identifying the extension into the posterior segment of an epithelial membrane, as correlated by the histopathologic findings. METHOD: Case report. UBM findings before enucleation with histopathologic correlation. RESULTS: UBM demonstrated a membrane tracking from the posterior iris surface over the ciliary body and towards the retina. Light microscopic examination disclosed the epithelial nature of this membrane. CONCLUSION: UBM can identify extension of an epithelial membrane into the posterior segment and thereby guide the approach to surgical management.     

Examination compliance and screening for diabetic retinopathy: a 2-year follow-up study

Early detection and timely treatment of diabetic retinopathy can preserve vision, yet many people with diabetes do not have their eyes examined regularly. The purpose of this study was to examine eye care practices of people with diabetes who had not previously accessed eye care services on a regular basis. Screening with non-mydriatic retinal photography for diabetic retinopathy was initiated in 1996, and targeted people with diabetes who did not access eye care services on a regular basis. Each test area was revisited 2 years after the initial screening. Patients that did not attend the biennial screening were followed up by mail survey. Although none of the participants in this study had been previously accessing eye care services on a regular basis, 87% did so after attending the screening. These results indicate that mobile screening with non-mydriatic photography, as an adjunct to current eye care services, has the potential to increase examination compliance for diabetic retinopathy and to achieve sustained behaviour change.     

Visual recovery after corneal crosslinking for keratoconus: a 1-year follow-up study

Purpose

To evaluate visual recovery and intraocular straylight in keratoconus patients 3 months and 1 year after corneal crosslinking (CXL)

Patients and Methods

Thirty-three eyes of 28 consecutive patients with mild to moderate keratoconus were included. The following were assessed at baseline, 3 months and 1 year after CXL: corrected distance visual acuity (CDVA), intraocular straylight, spherical equivalent (SE), keratometry (Kmax and K min (Diopters D and axis), the regularity index and pachymetry. Changes from baseline were calculated using mixed linear regression models.

Results

The CDVA remained unchanged 3 months after CXL (-0.003 (95 % CI: -0.038 to 0.044); p?=?0.880) and improved after 1 year (-0.042 (95 % CI: -0.078 to -0.007; p?=?0.021)). The mean straylight value increased significantly by 0.27 (95 % CI: 0.18 to 0.35; p?<?0.001) 3 months after CX and normalized to preoperative values after 1 year (0.06 (95 % CI: -0.03 to 0.14; p?=?0.215)). SE improved from the mean preoperative value of -2.61 D (95 % CI: -3.83 to -1.39) by 1.95 (95 % CI: 1.03 to 2.86; p?<?0.001) at 3 months and remained stable at the 1-year follow-up visit (2.17 (95 % CI: 1.21 to 3.12; p?<?0.001)). Parameters of of keratometry changed only minimally. The regularity index remained almost unchanged at 3 months (2.45 (95 % CI: -4.97 to 9.88; p?=?0.503)) and decreased by 6.97 (95 % CI: -14.08 to 0.14; p?=?0.054). Pachymetry decreased by 44.0 μm (95 % CI: 56.1 to 31.9; p?<?0.001) at 3 months and almost returned to preoperative values at 12 months (-11.3 μm (95 % CI: -27.9 to 5.3; p?=?0.175)).

Conclusions

In accordance with the decrease in CDVA and patients’ complaints of disability due to glare, intraocular straylight increased 3 months after surgery. One year after CXL, there was an increase in CDVA due to an improved SE and regularity index, and intraocular straylight had normalized.     

Trabeculectomy: a review and 4-year follow-up.

Since the first attempt at glaucoma surgery in 1830 many surgical procedures have been devised and adopted depending on the understanding of the aetiology and pathogenesis of the disease. Trabeculectomy, the most recent drainage procedure for glaucoma, has become a widely used, effective, and safe method, particularly for chronic simple glaucoma. Up to 4 years' follow-up of 66 eyes (55 patients) is reported. The findings at 6 months, 1 year, 2 years, 3 years, and 4 years were in agreement with previous reports by other authors. The main postoperative complication was transient hyphaema. Of the total number of eyes, 7 needed miotic drops and 5 required further surgical procedures to control the intraocular pressure.     

Relationship between formation of a filtering bleb and an intrascleral aqueous drainage route after trabeculectomy: evaluation using ultrasound biomicroscopy

We evaluated the relationship between the development of filtering bleb and the thickness of the aqueous drainage route beneath the scleral flap in patients who had undergone trabeculectomy. The relationship between the postoperative intraocular pressure and the size of the filtering bleb was also studied. We studied 29 eyes of 21 patients who had been followed for at least 1 (mean 9.9) month after the trabeculectomy. Ultrasound biomicroscopy was used to examine the filtering bleb and aqueous drainage route beneath the scleral flap. The thickness of the aqueous drainage route beneath the center of the scleral flap was found to be correlated with the development of a filtering bleb (r = 0.391, p < 0.05). The size of the bleb was correlated with the intraocular pressure (r = -0.560, p < 0.05) which had not been treated with antiglaucoma medication during follow-up. Thus, preservation of the aqueous drainage route beneath the scleral flap probably influenced the development of a filtering bleb following trabeculectomy.     

photodynamic therapy for Taiwanese patients with pathologic myopia: a 2-year follow-up

PURPOSE: To examine the efficacy of photodynamic therapy with verteporfin (VPDT) for treatment of subfoveal choroidal neovascularization (CNV) in patients with pathologic myopia. METHODS: In a prospective study, adult patients (18 years of age or older) with new onset subfoveal CNV were treated in two tertiary centers with the standard protocol of VPDT. Snellen best-corrected visual acuity was measured at baseline and at 1 month, 3 months, 6 months, 12 months, 15 months, 18 months, and 24 months after VPDT. Stratified analyses for single and multiple treatments and different age groups were performed by paired t-tests, and the results were compared with baseline findings. RESULTS: Thirty-three patients with single VPDT and 13 patients with multiple treatments were enrolled for analysis. Significant improvement in measurement of visual acuity was found after 24 months of follow-up for the group with single therapy. For patients receiving multiple treatments, an improving trend was not as clear. In prognosis analysis by age groups in the single-treatment group, the younger group had better mean visual acuity at the end of the 24-month study period than the older group. Improvement was much more evident in the younger group, although it was not statistically significant at every follow-up time point. CONCLUSION: In patients with response to single VPDT, visual acuity significantly improved over a 2-year period. In patients receiving multiple treatments, improvement was not as distinctive, suggesting alternative treatment options might be relevant for this subgroup.     

Wound healing of scleral self-sealing incision: a comparison of ultrasound biomicroscopy and histology findings

· Purpose: The goal of this study was to compare the morphologic findings of wound healing in scleral self-sealing incisions using ultrasound biomicroscopy and histology. · Methods: Using a slit-knife, we made a scleral self-sealing incision in the rabbit eye. At various time points postoperatively, ultrasound biomicroscopy was performed to evaluate wound healing; the eyes then were enucleated and studied histologically. We also performed ultrasound biomicroscopy at various time points postoperatively in patients who received a scleral self-sealing incision during cataract surgery. · Results: In rabbit eyes, on days 1 and 2 postoperatively, we detected the scleral wound; thereafter, detection became increasingly difficult. On day 7 postoperatively, the wound was undetectable. By light-microscopic observation, the scleral wound was open at 1 day postoperatively. On day 2 postoperatively, fibrovascular tissue barely extended into the wound; on day 5 postoperatively, connective tissue extended through the full thickness of the wound. On day 7 postoperatively, the connective tissue became dense and aligned with the lamella. In human eyes, using ultrasound biomicroscopy, the scleral incision was detectable until 5 days postoperatively, but undetectable at 7 days postoperatively. · Conclusions: Ultrasound biomicroscopy demonstrates the stages of wound healing of scleral self-sealing incisions. We believe that careful observation is necessary for approximately 7 days following self-sealing incision cataract surgery. Received: 16 July 1997 Revised version received: 13 October 1997 Accepted: 9 February 1998