Objective: To assess the agreement between findings obtained at dark-room gonioscopy and ultrasound biomicroscopy (UBM) in the diagnosis of iridotrabecular apposition in light and dark conditions. Methods: We enrolled patients with appositional angle closure at dark-room gonioscopy performed using a 1-mm slitlamp beam that did not cross the pupil. Ultrasound biomicroscopic images were acquired in normal room light and subsequently with all room lights off. Images were evaluated for the presence or absence of iris-cornea contact. The angle opening distance at 500 μm was calculated. Results: Iridotrabecular apposition in at least 1 angle quadrant was demonstrated in all 18 eyes at dark-room gonioscopy, 17 eyes (94%) at dark-room UBM, and only 10 eyes (56%) at UBM in room light. Of 18 superior angles that were appositionally closed at dark-room gonioscopy, apposition was demonstrated on UBM images in 16 (89%) in a dark room but only 6 (33%) in room light. Angle opening distance was less during dark-room gonioscopy in all but the nasal quadrant. Conclusion: We found high agreement between gonioscopy and UBM when both are performed in a completely dark room. Our findings support the recommendation that, in routine clinical practice, gonioscopy be performed in a dark room to avoid misdiagnosis of treatable iridotrabecular apposition.

Agreement between gonioscopy and ultrasound biomicroscopy in detecting iridotrabecular apposition. Commentary

Purpose:  To compare the diagnostic performance of EyeCam (Clarity Medical Systems, Pleasanton, CA, USA) and anterior segment optical coherence tomography (ASOCT, Visante; Carl Zeiss Meditec, Dublin, CA, USA) in detecting angle closure, using gonioscopy as the reference standard.

Comparison of Eyecam and Anterior Segment Optical Coherence Tomography in Detecting Angle Closure

Imaging of Hydroxychloroquine Toxicity with Fluorescence Lifetime Imaging Ophthalmoscopy.

Purpose To quantify interquadrant differences in anterior chamber angle (ACA) configuration assessed on gonioscopy, EyeCam, and anterior segment optical coherence tomography (AS-OCT) in a cohort of Chinese Americans. Methods Subjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES), a population-based epidemiologic study in Los Angeles, CA. Each subject underwent a complete ocular exam, including gonioscopy, EyeCam, and AS-OCT, under dark ambient lighting. Gonioscopy and AS-OCT imaging and EyeCam image grading were performed by trained ophthalmologists. Results Seven hundred nine eyes from 709 subjects were analyzed. Less anatomic variation among the quadrants was detected on gonioscopy and EyeCam compared with AS-OCT (P < 0.05). The mean gonioscopy grade, EyeCam grade, and AS-OCT measurement for each quadrant varied by up to 10.3%, 6.4%, and 46.2% of the superior quadrant value, respectively. There were significant interquadrant differences (P < 0.05) among mean AOD750 measurements when grouping by quadrant and gonioscopy or EyeCam grade. Mean AOD750 measurements were smallest for the superior quadrant by between 14.3% and 38.1% and 17.4% and 37.9% on gonioscopy and EyeCam, respectively, compared with other quadrants. Conclusions Gonioscopy and EyeCam significantly underrepresent anatomic variations of the ACA compared with AS-OCT. Gonioscopy or EyeCam grades from different quadrants do not appear to be comparable or interchangeable, which supports reconsideration of current definitions and methods used to diagnose and manage primary angle closure disease. Translational Relevance AS-OCT imaging raises concerns about current clinical definitions and methods that rely gonioscopy or EyeCam to assess the ACA.

Differences in Anterior Chamber Angle Assessments Between Gonioscopy, EyeCam, and Anterior Segment OCT: The Chinese American Eye Study

Retinal ganglion cells (RGCs) are a population of neurons of the central nervous system (CNS) extending with their soma to the inner retina and with their axons to the optic nerve. Glaucoma represents a group of neurodegenerative diseases where the slow progressive death of RGCs results in a permanent loss of vision. To date, although Intra Ocular Pressure (IOP) is considered the main therapeutic target, the precise mechanisms by which RGCs die in glaucoma have not yet been clarified. In fact, Primary Open Angle Glaucoma (POAG), which is the most common glaucoma form, also occurs without elevated IOP. This present review provides a summary of some pathological conditions, i.e., axonal transport blockade, glutamate excitotoxicity and changes in pro-inflammatory cytokines along the RGC projection, all involved in the glaucoma cascade. Moreover, neuro-protective therapeutic approaches, which aim to improve RGC degeneration, have also been taken into consideration.

https://www.mdpi.com/1422-0067/22/15/7994/pdf

Risk Factors for Retinal Ganglion Cell Distress in Glaucoma and Neuroprotective Potential Intervention

Assessment of the anterior chamber angle (ACA) is an essential part of the ophthalmological examination. It is intrinsically related to the diagnosis and treatment of glaucoma and has a role in its prevention. Although slit-lamp gonioscopy is considered the gold-standard technique for ACA evaluation, its poor reproducibility and the long learning curve are well-known shortcomings. Several new imaging techniques for angle evaluation have been developed in the recent years. However, whether these instruments may replace or not gonioscopy in everyday clinical practice remains unclear. This review summarizes the last findings in ACA evaluation, focusing on new instruments and their application to the clinical practice. Special attention will be given to the comparison between these new techniques and traditional slit-lamp gonioscopy. Whereas ultrasound biomicroscopy and anterior segment optical coherence tomography provide quantitative measurements of the anterior segment's structures, new gonio-photographic systems allow for a qualitative assessment of angle findings, similarly to gonioscopy. Recently developed deep learning algorithms provide an automated classification of angle images, aiding physicians in taking faster and more efficient decisions. Despite new imaging techniques made analysis of the ACA more objective and practical, the ideal method for ACA evaluation has still to be determined.

/pdf/anterior-chamber-angle-assessment-techniques-a-review-1dlvud88zf.pdf

Anterior Chamber Angle Assessment Techniques: A Review.

Glaucoma and neuroinflammation: An overview

To evaluate the efficacy and safety of PreserFlo® MicroShunt in primary open angle glaucoma (POAG) eyes after a single failed trabeculectomy. Retrospective review of POAG eyes with a failed trabeculectomy that underwent PreserFlo® MicroShunt implantation from March 2019 to November 2019, in two Italian glaucoma centers. Pre- and postoperative data were collected and compared. A total of 31 surgeries in 31 patients were reviewed. Mean preoperative IOP and mean preoperative number of medications were 24.12 ± 3.14 mmHg and 3.29 ± 0.64, respectively, and decreased to 12.56 ± 2.64 mmHg and 0.46 ± 0.77 at the 12-month postoperative follow-up visit (p < 0.01). The most frequent adverse events were transient hypotony (6 eyes, 19.3%) and choroidal effusion (3 eyes, 9.6%). In all cases spontaneous resolution was observed, with no intervention. In POAG eyes with a single failed trabeculectomy, the PreserFlo® MicroShunt was safe and effective in reducing the IOP after a 12-month follow-up. The PreserFlo® MicroShunt may represent a viable choice as a second surgery.

/pdf/efficacy-and-safety-of-preserflo-microshunt-after-a-failed-30ag17987m.pdf

Efficacy and Safety of PreserFlo® MicroShunt After a Failed Trabeculectomy in Eyes with Primary Open-Angle Glaucoma: A Retrospective Study

We aimed to find earlier morphological and functional alterations in the retinas of patients treated with hydroxychloroquine (HCQ) This was a prospective cohort study We examined 33 patients (mean age, 5714 [SD, 1102] years) who were affected by various types of rheumatic diseases The mean treatment period was 1247 [SD, 994] months, and the mean total drug intake was 541 [SD, 334] g daily at baseline The control group consisted of 28 subjects with a mean age of 6125 [SD, 216 years] The set of tests encompassed best-corrected visual acuity (BCVA), a multifocal electroretinogram (mfERG), spectral-domain optical coherence tomography (SD-OCT), fundus auto fluorescence (FAF), the 10-2 automated visual field (VF) test (10-2 VF), and frequency-doubling technology (FDT) The mfERG P1 wave density amplitudes decreased in all the rings, from 3110 to 2802 (p = 0008) in the first ring, and from 1829 to 1655 [p < 0001], from 12050 to 1091 [p = 0002], from 953 to 869 [p = 0003], and from 825 to 748 [p = 0001] nanovolts/degree2 in rings 2, 3, 4, and 5, respectively A significant reduction was found also in the N1 wave in the second ring The SD-OCT retinal thickness measurement revealed significant thinning in five sectors, including the outer and inner nasal sectors, the outer and inner temporal sectors, and the inner superior sector The 10-2 VF mean deviation paradoxically improved, while minimal FAF alterations in the retinal pigment epithelium were found in eight eyes mfERGs and SD-OCT were altered in our patients before significant retinal changes occurred

Early morpho-functional changes in patients treated with hydroxychloroquine: a prospective cohort study

Purpose To describe a case of delayed-onset hemorrhagic choroidal detachment (HCD) in a patient affected by primary open-angle glaucoma (POAG) undergone PreserFlo Microshunt implantation Case report description A 76-year-old patient with POAG, under treatment with Dabigatran (a novel oral anticoagulant), underwent an uncomplicated PreserFlo Microshunt implantation in the left eye In the first postoperative day, intraocular pressure (IOP) was 6 mm Hg, conjunctival bleb was diffuse, anterior chamber (AC) deep, and device correctly positioned Twelve days after surgery, the patient had emergency access complaining severe ocular pain and sudden vision loss Ophthalmological evaluation revealed shallow AC and an IOP of 50 mm Hg The fundus examination revealed almost kissing HCD Outcome Immediate topical treatment with atropine, aqueous humor suppressants, and corticosteroids was started Because of high IOP, ocular pain, and the presence of almost kissing HCD, surgical drainage of suprachoroidal hemorrhage and removal of PreserFlo Microshunt were performed An improvement of the clinical condition was observed in the following postoperative days, with partial resolution of the HCD and a decrease of the IOP On the third postoperative day, there was a worsening of the HCD, with a reduction of the AC depth and IOP elevation HCD was drained through the previously performed sclerotomies, associated with pars-plana vitrectomy and silicone-oil tamponade HCD completely resolved during the following 6 weeks, with IOP reduction and partial improvement of visual acuity Conclusion Great attention must be taken in patients with glaucoma under treatment with a novel oral anticoagulant, also when planning PreserFlo Microshunt implantation

Carlo Bruttini

Papers

Anterior Chamber Angle Assessment Techniques: A Review.

Glaucoma and neuroinflammation: An overview

Efficacy and Safety of PreserFlo® MicroShunt After a Failed Trabeculectomy in Eyes with Primary Open-Angle Glaucoma: A Retrospective Study

Early morpho-functional changes in patients treated with hydroxychloroquine: a prospective cohort study

A Case of Delayed-onset Hemorrhagic Choroidal Detachment After PreserFlo Microshunt Implantation in a Glaucoma Patient Under Anticoagulant Therapy.