The morphologic and quantitative evaluation of ocular anterior chamber parameters after laser peripheral iridotomy in primary angle-closure glaucoma eyes / 中华实验眼科杂志

Background Pentacam anterior segment analysis system (Pentacam) is more accurate in the quantitative evaluation of ocular anterior segment in primary angle-closure glaucoma (PACG) eyes than slit lamp microscope and ultrasound biomicroscope (UBM).However,its accuracy in the earlier stage of PACG before and after YAG laser peripheral iridotomy (LPI) is not fully elucidated.Objective This study was to assess the effect of YAG LPI in PACG patients with Pentacam.Methods A prospective self-controlled study was performed.Thirtyfive fellow eyes (pre-clinical stage of PACG) of acute PACG and 35 fellow eyes of chronic PACG were included in the Second Hospital of Hebei Medical University from July,2012 to December,2013.YAG LPI was performed on the eyes,and the parameters of ocular anterior segment including central anterior chamber depth (ACD),anterior chamber volume (ACV) and peripheral anterior chamber angle (ACA) were measured and compared by Pentacam before and 1 day,7 days,28 days after operation.This study was approved by the Ethic Committee of the Second Hospital of Hebei Medical University and informed consent was obtained from all subjects.Results In pre-clinical stage of PACG eyes,the postoperative ACD and ACV values were increased in comparison with preoperation,showing significant differences among various time points (ACD:F =6.783,P =0.004;ACV:F =19.090,P =0.000),and no significant difference was found in ACA among different time points (F =0.153,P =0.928).In the fellow eyes of chronic PACG,the postoperative ACD and ACV values were larger than those of preoperation,with significant differences among various time points (ACD:F =21.576,P =0.000;ACV:F =47.506,P =0.000),and no significant difference was found in ACA among different time points (F=0.581,P=0.629).The change values of ACD and ACV were (0.064±0.022) mm and (27.840±4.963) mm3 in the eyes of pre-clinical stage of PACG,and those in the fellow eyes of chronic PACG were (0.047-± 0.020) mm and (21.000 ± 3.278) mm3,showing significant differences between the two groups (ACD:t=2.783,P=0.008;ACV:t=5.749,P=0.000).Conclusions Pentacam allows easy,fast,automatic and non-contact quantification and three-dimension image of the anterior chamber parameters before and after YAG LPI in pre-clinical stage of PACG eyes and fellow eyes of chronic PACG.The ACD deepens and ACV increases after LPI in glaucomous eyes,especially in the pre-clinical stage of PACG eyes.

Sínquise cintilante ou colesterolosis bulbi de câmara anterior em paciente lactente / Synchisis scintillans or cholesterolosis bulbi of the anterior chamber in an infant patient

Este trabalho tem por objetivo relatar um caso de sínquise cintilante de câmara anterior em lactente sem causa elucidada. O paciente apresentou desvio no olhar desde o nascimento. Antecedentes pessoais e familiares sem anormalidades. Ao exame em OE: Esotropia constante, nistagmo horizontal, leucocoria e microftalmia, já em OD: sem anormalidades. Ultrassonografia (USG) em OE: redução do comprimento axial, retina aplicada e vítreo hiperecogênico. Aventaram-se hipóteses de persistência de vítreo primário hiperplásico, catarata congênita e retinoblastoma, e solicitou-se tomografia de crânio e cavidade orbitária (TC). Paciente retornou após 6 meses trazendo resultado da TC cuja única alteração evidenciada era OE com áreas hiperatenuantes e sem sinais de calcificação. Ao exame em OD: reflexo pupilar direto positivo e consensual negativo e em OE: hiperemia conjuntival, análise de reflexo pupilar, inviabilizada por presença de sínquises cintilantes de coloração ocre na câmara anterior, que não estava presente no exame inicial. Solicitou-se nova USG, evidenciando: ecos puntiformes na cavidade vítrea, sugerindo hemorragia, espessamento de hialoide posterior, retina aplicada e coroide com espessura aumentada. A sínquise cintilante ou “colesterolosis bulbi” é um processo degenerativo comumente secundário a trauma, inflamação ou hemorragia intraocular. Cursa com deposição de cristais de colesterol (provenientes do cristalino em degeneração ou do próprio vítreo) na cavidade vítrea, espaço sub-retiniano e, mais raramente, na câmara anterior. Sugerese que o fenômeno decorra de traumas, catarata de longa duração, hifema, glaucoma secundário ou descolamento de retina e mais raramente, de uveítes, neoplasias ou vasculopatias. Até o presente, não há relato na literatura de sínquise cintilante de câmara anterior envolvendo um lactente.

The propose of this article is presenting a case report of Synchisis scintillans of the anterior chamber in an infant patient without any elucidation. The patient’s initial complaint was “strabismus since birth”. There was not found any other personal or family abnormalities. On examination: OS: Esotropia maintained, horizontal nystagmus, microphthalmia and leukocoria. OD: no abnormalities. Ultrasonography (USG) OS: reduction of the axial length, retinal applied and hyperechoic vitreous. Raised hypotheses were persistence of hyperplastic primary vitreous, congenital cataract and retinoblastoma, and there was also requested cranial and orbital cavity tomography (TC). The patient returned after six months with TC showing as sole evidenced hyperattenuating areas without signs of calcification on OS. On examination: OD showing direct pupillary reflex positive and consensual pupillary reflex negative. OS: conjunctival hyperemia and analysis of pupillary reflex frustrated by the presence of sparkling colored ocher in the anterior chamber. We asked for a new USG, which showed: punctate echoes in the vitreous cavity, suggesting hemorrhage; thickening of the posterior hyaloids; choroid and retina were attached, both with increased thickness. The synchisis scintillans or “colesterolosis bulbi” is a degenerative process commonly secondary to trauma, inflammation or intraocular hemorrhage. Evolves with deposition of cholesterol crystals (from degeneration of the lens or vitreous itself) in the vitreous cavity, subretinal space and rarely, in the anterior chamber. There are evidences that the phenomenon could arise from severe trauma, long-term cataract, hyphema, glaucoma or retinal detachment and, even more rarely, uveitis, neoplasias or vascular disorders. Until this case, there was no report of Synchisis scintillans in the anterior chamber involving an infant.

Measurements of anterior chamber depth, white-to-white distance, anterior chamber angle, and pupil diameter using two Scheimpflug imaging devices / Medida da profundidade da câmara anterior, distância branco a branco, ângulo da câmara anterior e diâmetro pupilar usando dois dispositivos de imagens de Scheimpflug

Purpose: To compare the ocular anterior chamber depth, white-to-white distance, anterior chamber angle, and pupil diameter, as measured with two different Scheimpflug imaging devices. Methods: This transversal study included 80 right eyes from 80 subjects aged from 20 to 40 years. Their spherical equivalents ranged from -4.25 to +1.00 diopters (D). Each eye's anterior chamber depth, white-to-white distance, anterior chamber angle, and pupil diameter, were measured for far vision using both the Galilei G4 (double Scheimpflug camera) and the Pentacam HR (single Scheimpflug camera) systems. Results: Mean anterior chamber depths were calculated as 3.12 ± 0.23 mm and 3.19 ± 0.24 mm when measured with the Galilei G4 and the Pentacam HR, respectively. The mean white-to-white distance measured was 11.84 ± 0.31 mm and 11.90 ± 0.43 mm when measured with the Galilei G4 and the Pentacam HR, respectively. Mean pupil diameters were measured as 3.22 ± 0.58 mm and 3.22 ± 0.52 mm when measured with the Galilei G4 and the Pentacam HR, respectively. Finally, the mean anterior chamber angle was 34.30 ± 2.86 degrees when it was measured with the Galilei G4, and 39.26 ± 2.85 degrees when measured with the Pentacam HR. A comparative analysis revealed that the Galilei G4 yielded a significantly lower (P<0.05) measurement for the anterior chamber depth, anterior chamber angle, and pupil diameter, than the Pentacam HR system. Comparable values (P>0.05) for both devices were obtained for the white-to-white distance measurements. Conclusion: The Galilei G4 and Pentacam HR Scheimpflug systems cannot be used interchangeably because they produce significant measurement differences. .

Objetivo: Avaliar a medida da profundidade da câmara anterior, distância branco a branco, ângulo da câmara anterior e diâmetro pupilar usando dois dispositivos de imagens de Scheimpflug diferentes. Métodos: Este estudo transversal incluiu 80 olhos direitos de 80 indivíduos com idades entre 20 e 40 anos. O equivalente esférico variou de -4,25 a +1,00 dioptrias (D). A profundidade da câmara anterior de cada olho, a distância branco a branco, o ângulo da câmara anterior e o diâmetro pupilar, foram medidos para visão de longe usando tanto o Galilei G4 (câmera de Scheimpflug dupla) e os sistemas Pentacam HR (câmera de Scheimpflug simples). Resultados: A profundidade média da câmara anterior foi 3,12 ± 0,23 mm e 3,19 ± 0,24 mm, usando o Galilei G4 e o Pentacam HR, respectivamente. A distância média da medida de branco a branco com o Galilei G4 foi 11,84 ± 0,31 mm e com o HR Pentacam foi 11,90 ± 0,43 mm. A média do diâmetro pupilar foi 3,22 ± 0,58 mm e 3,22 ± 0,52 mm, medidos com o Galilei G4 e o Pentacam HR, respectivamente. Finalmente, a média do ângulo da câmara anterior foi de 34,30 ± 2,86 graus quando foi medido com o G4 Galileu, e 39,26 ± 2,85 graus com o Pentacam HR. A comparação revelou que o dispositivo Galilei G4 mediu significativamente menor (P<0,05) profundidade da câmara anterior, ângulo da câmara anterior e diâmetro da pupila do que o sistema de Pentacam HR, enquanto valores comparáveis (P>0,05) entre os dois dispositivos Scheimpflug foram obtidos para as medidas da distância branco a branco. Conclusão: O Galileu G4 e o Pentacam HR não podem ser usados indiferentemente, devido ás diferenças entre os dois aparelhos terem sido significativas sob o ponto de vista clínico. .