Clinical observation of Van Herick method for evaluating anterior chamber angle width / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore a more convenient and accurate method for evaluating the anterior chamber angle width based on the Van Herick method.METHODS:A total of 58 patients(69 eyes)with age-related cataract who visited our hospital between January and December 2021 were included. They were divided into the chamber angle width ≥1/2 corneal thickness(CT)group(44 eyes of 37 cases)and <1/2CT group(25 eyes of 21 cases)according to the Van Herick method. The central anterior chamber depths and the peripheral anterior chamber angle degrees were measured by ultrasound biomicroscopy.RESULTS: There were statistically significant differences in central anterior chamber depth between the two groups(2.64±0.27 mm vs. 2.23±0.29 mm, P<0.01), and the differences of chamber angle degrees of quadrants of superior, temporal, inferior and nasal compared between two groups were all statistically significant(P<0.01). The difference of chamber angle degrees of quadrants of superior and inferior in chamber angle width ≥1/2CT group was not statistically significant(P>0.05), while the differences of chamber angle degrees of other quadrants were all statistically significant(P<0.05). The differences of chamber angle degrees of quadrants of superior and nasal, temporal and the chamber angle degrees of quadrants of inferior and temporal were all statistically significant in chamber angle width <1/2CT group(P<0.05).CONCLUSION: In the overall evaluation of the anterior chamber angle, it would be more simple, fast and accurate when evaluating the temporal chamber angle width and inferior quadrant of chamber angle width by using the Van Herick method under silt lamp.

Characteristics of anterior segment structure in first-degree relatives of patients with primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the characteristics of anterior segment structure in first-degree relatives of patients with primary angle-closure glaucoma(PACG).METHODS: A total of 48 first-degree relatives of PACG patients aged 40-60 who were treated in the Affiliated Eye Hospital of Nanchang University from September 2020 to October 2022 were selected as the observation group. Additionally, 40 cases(40 eyes)of healthy individuals without glaucoma and family history of glaucoma at the same age group were collected as the control group. They were divided into younger group(40-49 years old)and elder group(50-60 years old). All subjects were examined with ultrasound biomicroscopy(UBM)and were measured using camera measure software. The parameters mainly included anterior chamber depth(ACD), anterior chamber area(ACA), anterior chamber width(ACW), anterior segment depth(ASD), angle open distance(AOD500), trabecular iris angle(TIA), trabecular iris area(TISA500), lens vault(LV), iris curve(IC), iris thickness(IT500), scleral ciliary process angle(SCPA), and iris ciliary process distance(ICPD).RESULTS: ACD, ACA, AOD500, TISA500 and TIA in the observation group were lower than those of the control group, and LV and IC were higher than those of the control group(all P<0.05). ACD, ACA, AOD500, TISA500, and TIA of the elder group were lower than those in the age-matched control group, while LV and IC were larger than those of the age-matched control group(all P<0.05). ACD, AOD500, TISA500, and TIA of the younger observation group were smaller than those of the age-matched control group, but LV and IC were significantly larger than those of the age-matched control group(all P<0.05). ACD, ACA, AOD500, TISA500 and TIA of the elder observation group were significantly lower than those of the younger observation group, and LV and IC were significantly larger than those of the younger observation group(all P<0.05). There was a difference in the distribution of ACD between the observation group and the control group(P<0.05), and the proportion of moderate to severe shallow anterior chambers was 10 times that of the control group. Correlation analysis showed that TISA500 was positively correlated with ACD and ACA, and negatively correlated with LV and IC, and TISA500 was mainly influenced by LV. IC had a positive correlation with LV and a negative correlation with ACD and ACA.CONCLUSION: First-degree relatives of PACG with normal axial length have a high risk of angle closure. The anterior segment structures of first-degree relatives of PACG are more crowded than normal individuals, and the lens forward shift may be the initial influencing factor for narrow angle.

Peering into the eye: A comprehensive look at ultrasound biomicroscopy (UBM) and its diagnostic value in anterior segment disorders

Background: Ultrasound biomicroscopy (UBM) is a noninvasive imaging modality that enables in?vivo visualization of the structures of the anterior segment of the eye. Unlike routine ophthalmic diagnostic ultrasound which uses frequencies of 5–10 MHz, UBM utilizes ultrasound frequencies in the range of 50–100 MHz. The high?frequency probes in UBM allows for higher resolution and better visualization of subsurface ocular structures, even in the presence of anatomic or pathological obscuration. UBM has qualitative as well as quantitative applications in various disorders affecting the anterior segment of the eye. Despite its huge importance, many clinicians lack in knowledge about the technique and its clinical usefulness. The current educational video aims to address this gap in knowledge by highlighting the technique and various clinical indications of UBM. Purpose: The purpose of this video is to demonstrate the technique of UBM and showcase its quantitative and qualitative implications and importance through various clinical cases. Synopsis: UBM is an imaging technique that assesses the depth of tissue structures by measuring the time delay of the returning ultrasound signal. This modality is capable of measuring the size of various structures within the eye, such as the cornea, iris, ciliary body, sclera, and the depth of the anterior and posterior chamber. To perform a UBM, a transducer is inserted into a specially designed eye cup filled with distilled water, creating a water bath environment. Axial and longitudinal scans can be performed in a similar fashion as in routine diagnostic B?scan ultrasound. Quantitative indications for UBM depicted in this video include measurements of corneal thickness, depth of the anterior chamber, and the width of the angle. The video also showcases how UBM can aid in the diagnosis and management of various anterior segment disorders like angle?closure glaucoma, plateau iris configuration, secondary glaucoma, and anterior uveitis with complicated cataract. Qualitative indications for UBM highlighted in this video include its role in intermediate uveitis, ocular hypotony, ocular surface tumors, cystic lesions of iris, and identifying the location and type of intraocular foreign bodies in the anterior segment based on the type of artifact seen. Additionally, the video shows the applications of UBM in scleral and episcleral pathologies. Highlights: This video will educate clinicians about the technique of UBM and showcase a bouquet of UBM findings in various case scenarios, helping one to better understand the potential of this modality in clinical practice.

Imaging iridotrabecular contact in angle closure

Background: With ultrasound biomicroscopy (UBM), radial scans are taken by using a typical ciliary process, to show the details of the iridocorneal angle, the anterior surface of the ciliary body, and its relation to the posterior iris. Appositional closure represents potentially reversible contact between the peripheral iris and trabecular meshwork. The appositional closure can further be classified according to the configuration of iridotrabecular contact (ITC). UBM can be performed in dark and light conditions, which has been shown to be useful for detecting changes in iridocorneal angle configuration associated with dark and light. Purpose: To image ITC configuration in appositional angle closure and also image iridocorneal angle in dark and bright light room illumination. Synopsis: UBM demonstrates two types of ITC configuration in appositional closure which are, B?type and S?type. It can also demonstrate the presence of sinus of Mapstone in S?type of ITC. Highlights: UBM allows imaging of dynamic changes in the iris and shows that the degree of appositional angle closure is a dynamic process that can change rapidly depending on the lighting conditions.

Automatic evaluation system for ultrasound biomicroscopy images of anterior chamber angle based on deep learning algorithm / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the clinical application value of analysis system for ultrasound biomicroscopy(UBM)images of anterior chamber angle(ACA)based on deep learning algorithm.METHODS: A total of 4 196 UBM images were obtained from 675 patients(1 130 eyes)at the Eye Center of Renmin Hospital of Wuhan University from January 2021 to June 2022 were collected to build an image dataset. Using Unet++network to automatically segment ACA tissue, a support vector machine(SVM)algorithm was developed to automatically classify opening and closing of chamber angle, and an algorithm to automatically locate the sclera spur and measure ACA parameters was developed. Furthermore, a total of 631 UBM images of 127 subjects(221 eyes)at Huangshi Aier Eye Hospital and 594 UBM images of 188 subjects(257 eyes)at Zhongnan Hospital of Wuhan University were selected to evaluate the performance of the system under different environments.RESULTS: The accuracy of the analysis system constructed in this study for chamber angle opening and closing was 95.71%. The intra-class correlation coefficient(ICC)values of all ACA angle parameters were greater than 0.960. ICC values of all ACA thickness parameters were greater than 0.884. The accurate measurement of ACA parameters depended in part on the accurate location of the scleral spur.CONCLUSION: The intelligent analysis system constructed in this study can accurately and effectively evaluate ACA images automatically and is a potential screening tool for the rapid identification of ACA structures.

Plateau iris / 国际眼科杂志(Guoji Yanke Zazhi)

Primary angle closure glaucoma(PACG)is the leading type of glaucoma in Asia, especially in China. PACG still has a high proportion of angle closure after laser peripheral iridectomy(LPI). Plateau iris is one of the non-pupillary blockage factors that cause angle closure. With the wide application of ultrasound biomicroscopy(UBM)in ophthalmology, the understanding of plateau iris has been deepened continually. This paper will elaborate the concept, mechanism, prevalence, relationship with angle closure, diagnostic criteria and the treatment of plateau iris, aiming to have a deeper understanding of the relationship between plateau iris and PACG, and to provide references for the treatment and research of PACG in the future.

Comparison of uveal parameters between acute primary angle-closure eyes and fellow eyes in South Indian population

Purpose: To analyze the ocular biometric parameters of eyes with acute primary angle closure (APAC) as compared to fellow eyes. Methods: A cross?sectional study was conducted on 27 patients presenting with recent onset APAC to a tertiary eye institute in India. Anterior and posterior ocular biometric parameters were measured simultaneously by anterior segment optical coherence tomography (AS?OCT), A?scan, ultrasound biomicroscopy (UBM), and B?mode ultrasonogram (USG). The parameters measured were anterior chamber depth (ACD), anterior chamber angle (ACA), angle opening distance (AOD500, AOD750), lens vault (LV), axial length (AL), ciliary body thickness maximum (CBTmax) and at the point of scleral spur (CBT0), anterior placement of the ciliary body (APCB), and retinochoroidal thickness (RCS). Results: Mean age � SD of patients with APAC was 55.66 � 7.2 years with female preponderance (21:6 patients). Mean presenting IOP � SD of the affected eye and fellow eye were 54.74 � 11.67 mm Hg and 18.7 � 11.67 mm Hg, respectively. Eyes with APAC had statistically significant narrower anterior ocular biometric parameters, higher LV, decreased ciliary body thickness, more APCB, and longer AL than the fellow eyes. CBTmax is the only variable that had significance (? = ?0.421,95% CI: ?0.806 to ? 0.035, P = 0.034) in the univariate analysis with RCS thickness in APAC eyes. Further, there was a correlation between CBT0 and APCB with CBTmax both in univariate (? = 0.894, P < 0.0001 and ? = ?0.351, P = 0.039) and multivariable analysis (? = 0.911, P < 0.0001 and ? = ?0.416, P = 0.016). Conclusion: Compared to the fellow eyes, APAC eyes had different ocular biometric parameters. In addition to known biometric parameters associated with pupillary block (narrower anterior biometric parameters?ACA, ACD, and AOD), our study found multiple nonpupillary block factors such as higher lens vault and thinner and more anteriorly placed ciliary body to be associated with APAC.

Ultrasound biomicroscopy as a tool in the evaluation and management of ocular hypotony in uveitis

Purpose: Chronic uveitis can lead to hypotony that may result in severe visual impairment. We highlight the use of ultrasound biomicroscopy (UBM) as an imaging tool to decide the modality of therapy and management of uveitic hypotony. Methods: This was a retrospective hospital?based interventional case?series study that included a total of 36 eyes of 25 patients with uveitic hypotony seen between January 1997 and January 2020. Results: Thirty?six eyes of 25 patients with uveitic ocular hypotony were included. Unilateral involvement was seen in 56%. The median age of presentation was 21 years with a median follow?up of 21.5 months. Anterior uveitis was noted in 13.88%, intermediate uveitis in 52.77%, and panuveitis in 33.33% eyes. UBM findings commonly noted were pars plana membranes, supraciliary effusion, blunted ciliary process, and ciliary body traction. Other findings included ciliochoroidal detachment and ciliary body edema. Moreover, 22.2% eyes were managed with medical therapy alone, whereas 77.8% eyes received both medical and surgical intervention based on UBM findings. Furthermore, 66.7% eyes showed improvement in intraocular pressure, 13.9% eyes maintained the same IOP, whereas 19.4% eyes had worsening of IOP at final follow?up. Conclusion: We found UBM as a useful imaging tool in evaluating and judiciously deciding the mode of management of uveitic hypotony.

Ultrasonographic features of adenoma of the nonpigmented ciliary epithelium / 中华眼底病杂志

Objective:To analyze the ultrasonographic features of adenoma of the nonpigmented ciliary epithelium (ANPCE).Methods:A retrospective series of case studies. From January 2014 to October 2021, 31 patients (31 eyes) with ANPCE (ANPCE group) were diagnosed in the eye center of Beijing Tongren Eye Center of Beijing Tongren Hospital, Capital Medical University, and 17 patients (17 eyes) with ciliary body melanoma (control group) diagnosed at the same time were selected as the control group. There was no significant difference in age ( t=-0.564) and sex composition ratio ( χ 2=0.182) between the two groups ( P=0.576, 0.670). All patients underwent ultrasound biomicroscopy to obtain the measurement parameters: tumor height, maximum basal diameter, maximum diameter, ratio of maximum diameter to basal diameter and ratio of maximum diameter to height; tumor location, shape, internal echogenicity intensity, echogenicity uniformity, degree of sound attenuation, invasion of iris, anterior displacement of the iris, lens subluxation were observed. The measurement parameters and observation indexes of the two groups were compared by independent sample t-test and χ 2 test. Receiver operating characteristic (ROC) curve was drawn, area under the ROC curve (AUC) was determined, and parameter indicators with differential diagnosis value were screened. Results:The maximum diameter, height, maximum basal diameter, ratio of the maximum diameter to the maximum basal diameter, and the ratio of the maximum diameter to the height of the tumors in the ANPCE group and the control group were 5.64±0.98 mm, 4.24±0.59 mm, 3.66±0.71 mm, 1.58±0.34, 1.34±0.19 and 7.82±2.03 mm, 4.47±2.44 mm, 7.02±1.96 mm, 1.13±0.16, 2.09±1.06. The maximum diameter, the maximum basal diameter, and the ratio of the maximum diameter to the height of the tumor in the ANPCE group were all smaller than those of the control group, and the ratio of the maximum diameter to the maximum basal diameter was greater than that of the control group, and the differences were statistically significant ( t=-4.159,-6.808, -2.924, 6.257; P<0.05). The tumors in the ANPCE group were mainly spherical (87.1%, 27/31), with no significant acoustic attenuation (77.4%, 24/31), less invading the root iris (77.4%, 24/31), and the tumors were mostly located in the ciliary body coronal (74.2%, 23/31); tumors in the control group were mainly hemispherical (47.1%, 8/17) or spherical (47.1%, 8/17), with significant sound attenuation (76.5%, 13/17), most of the tumors invaded the iris (70.6%, 12/17), and the tumors were mostly located from the pars plana to the coronal (76.5%, 13/17). There were statistically significant differences in the position, shape, sound attenuation degree, and whether it invaded the iris between the two groups of eyes ( χ 2=15.132, 19.767, 13.118, 10.581; P<0.05). The results of ROC curve analysis showed that the ratio of the largest diameter to the largest base diameter, the degree of sound attenuation and the AUC of whether the iris was violated were higher, which were 0.881, 0.769, and 0.740, respectively. Conclusions:Ultrasound biomicroscopy is helpful in the diagnosis and differential diagnosis of ANPCE and ciliary body melanoma. The ratio of maximum diameter to maximum basal diameter, the degree of sound attenuation and whether it invades the root iris are important parameters to distinguish the two tumors.

Application of Ultrasound Biomicroscopy in Longterm Follow-up Post Modified CO / 中国医学科学院学报

Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO

Bilateral Chandler's syndrome: Uncommon entity diagnosed by ultrasound biomicroscopy and confocal microscopy

A 22?year?old female presented with bilateral, progressive diminution of vision. Slit?lamp examination revealed bilateral sectoral corneal edema. Gonioscopy showed broad?based peripheral anterior synechiae and a membrane obscuring angle structure in both the eyes. On ultrasound biomicroscopy (UBM), a membrane extending from corneal endothelium to anterior iris surface causing traction was seen. Confocal microscopy showed an "epithelium?like" transformation of the corneal endothelium. This case demonstrates a bilateral Chandler variant of the iridocorneal endothelial (ICE) syndrome where the diagnosis of Chandler's disease was confirmed by confocal microscopy, after the mechanism of secondary angle closure was demonstrated by the UBM.

Accuracy of estimating angle closure by slit-lamp anterior chamber depth examination / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To verify the accuracy of Van Herick method and slit-lamp anterior chamber depth examination in estimating angle closure. <p>METHODS: Totally 52 patients(100 eyes)over 40 years old were randomly selected from our outpatient department from June 2018 to January 2019.Their anterior chamber depth were examined by the methods of Van Herick method and the improved method to sort out peripheral anterior chamber depth are less than or equal to 1/3 CT and more than 1/4 CT and peripheral anterior chamber depth are less than or equal to 1/4 CT. Van Herick's anterior chamber depth inspection method and improved anterior chamber depth inspection method were checked for consistency, and then gonioscopic inspection and UBM inspection under darkroom were performed to check whether the peripheral angle was closed. In order to know whether there was any difference between gonioscopic and UBM inspection for angle closure, the consistency of the two verification results was checked. <p>RESULTS: Peripheral anterior chamber depth are less than or equal to 1/3 CT and more than 1/4 CT by the methods of Van Herick, the positive incidence of angle closure in angioscopy and ultrasound biomicroscopy are 39% and 43% respectively, Peripheral anterior chamber depth are less than or equal to 1/3 CT and more than 1/4 CT by the improved methods, the positive incidence of angle closure in angioscopy and ultrasound biomicroscopyare 46% and 42% respectively. In the patients whose peripheral anterior chamber depth checked by angioscopy and ultrasound biomicroscopy is less than or equal to 1/4 CT estimated by Van Herick method, the positive rate of angle closure was 67% and 89%, respectively. In the patients whose peripheral anterior chamber depth checked by angioscopy and ultrasound biomicroscopy is less than or equal to 1/4 CT estimated by the improved method, the positive rate of angle closure was 67% and 89%, respectively. The consistency test of the Van Herick method and the improved method showed good consistency(Kappa value: 0.85), when peripheral anterior chamber depth are less than or equal to 1/3 CT and more than 1/4 CT. peripheral anterior chamber depth(>1/4 CT), and good consistency(Kappa value: 0.83)when estimating peripheral anterior chamber depth ≤1/4 CT. According to the consistency test of the results of angioscopy and ultrasound biomicroscopy, when the Van Herick method estimated the depth of peripheral anterior chamber are less than or equal to 1/3 CT and more than 1/4 CT, the consistency was general(Kappa value: 0.73). When the Van Herick method estimated the depth of peripheral anterior chamber is less than or equal to 1/4 CT, the consistency was general(Kappa value: 0.40). According to the consistency test of the results of angioscopy and ultrasound biomicroscopy, when the improved method estimated the depth of peripheral anterior chamber are less than or equal to 1/3 CT and more than 1/4 CT, the consistency was good(Kappa value: 0.75). When the improved method estimated the depth of peripheral anterior chamber is less than or equal to 1/4 CT, the consistency was poor(Kappa value: 0). <p>CONCLUSION: The slit lamp anterior chamber depth examination has a certain false negative rate in estimating the angle closure in the population, but its accuracy is high, and it is still suitable for the preliminary examination of estimating the angle closure.

Evaluation of coronary artery hemodynamics and its relationship with atherosclerosis in west diet fed LDL‐R knockout mice by ultrasound bio‐microscopy / 中华超声影像学杂志

To evaluate the relationship between atherosclerosis and hemodynamic of coronary artery in mice detecting by ultrasound bio‐microscopy flow imaging . Methods Double 14 20‐week‐old LDL‐R‐/‐and C57BL/6 male mice were selected ,and randomly divided into two groups in each genotype according to weight . Each two groups were fed to 28 weeks or 36 weeks age respectively with west diet . Coronary artery hemodynamics in these mice were assessed in vivo by Vevo ?2100 ultrasound imaging system ,then the intima‐media thickness( IM T ) of aorta in histopathology were analyzed . T he differences of coronary artery hemodynamic parameters such as maximum velocity ( Vmax ) ,mean velocity ( Vmean) and velocity time integral ( V T I) were compared between mice of different genotypes of the same week and mice of different weeks of the same genotype . And the relationship between coronary artery hemodynamic in ultrasound and aortic IM T in histopathology were analyzed . Results ① All coronary hemodynamic parameters in LDL‐R‐/‐ mice were significantly lower than those of wild‐type mice except the Vmax between two 28‐week‐old genotypes group at the same weeks of age of different genotypes ( all P ＜0 .05) . But there was no significant difference in coronary artery hemodynamic parameters between mice of the same genotype at different weeks of age( P ＞0 .05) . ②T he histopathological measurements of aortic IM T in LDL‐R‐/‐mice were significantly higher than those of wild type mice ( all P ＜ 0 .05 ) ,and those of 36‐week‐old mice were significantly higher than those of 28‐week‐old mice ( all P ＜ 0 .05 ) . ③ All coronary hemodynamic parameters such as Vmax ,Vmean and V TI were negatively correlated with pathological measurements of aortic IM T ( r ＝ －0 .532 , －0 .423 , －0 .524 ; all P ＜ 0 .05 ) . Conclusions The parameters of coronary artery hemodynamics obtained by ultrasound bio‐microscopy are well correlated with the pathological results of atherosclerosis . Ultrasound bio‐microscopic flow imaging can be used as a new method to evaluate the degree of atherosclerosis in mice by detecting the hemodynamic parameters of coronary artery .

Agreement of central vault measurements between UBM and anterior segment OCT in posterior chamber intraocular lens implanted eyes / 中华实验眼科杂志

Objective To compare the agreement of central vault measurements between anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in the eyes with posterior chamber phakic intraocular lens implantation and analyze the association sculus to sculus (STS) diameter and white-to-white (WTW) diameter of cornea with central vault.Methods A cross-sectional study was carried out.Medical records of 150 phakic eyes of 75 myopic patients who underwent implantable collamer lens (ICL) surgery for the correction of myopia were collected in Chongqing Aier Eye Hospital from December 2017 to March 2018.The postoperative central vault were measured with AS-OCT and UBM.Intraclass correlation coefficient (ICC) and Bland-Altman plot were used to evaluate the repeatability and agreement of the measurements between two devices.The affecting factors of central vault measurements were assessed.Results Mean central vault in the 150 phakic eyes after ICL surgery was (0.73±0.25)mm by AS-OCT and (0.76-±0.31)mm by UBM,respectively with the ICC of 0.91 for the measurements of AS-OCT and UBM.Bland-Altman analysis showed that the 95％ limits of agreement of central vault measurements were-0.38-0.31 mm between the two devices.Five values were beyond the 95％ consistency interval,and the maximum absolute value of the difference was is 0.31 mm,which was beyond the clinical acceptable range,showing an non-interchangeable difference in the central vault measurements between the devices in ICL implanted eyes.WTW was a affecting factor for vault with a regression equation of Y=0.145 3X-0.960 1 (t =2.272,P＜0.05).Horizontal and vertical STS were the indirect affecting factors for vault by the association with WTW with the regression equation of Y=0.524 1X+5.362 4 and Y=0.613 4X+4.658 3,respectively.Conclusions Central vault measured by UBM is higher that than AS-OCT after ICL surgery,and the measurements are uninterchangeable between the two devices.Accurate measurement of STS distance is essential for the selection of appropriate lens before operation.

Conjunctival myxoma: A case report with unique high frequency ultrasound (UBM) findings

A 39-year-old female presented with a painless yellow-pink tumor on her right eye. High-frequency ultrasound imaging revealed an epibulbar lesion with homogenous low internal reflectivity and no evidence of intraocular invasion. The patient underwent excisional biopsy leading to a pathology diagnosis of myxoma. Additional surgical margins as well as adjuvant cryotherapy margins were followed by extensive conjunctival repair. Herein, we report on a conjunctival myxoma with unique ultrasonographic findings.

A case of human leukocyte antigen B-27-associated ocular hypotony successfully treated with golimumab

A 42-year-old male presented to us after an episode of acute anterior human leukocyte antigen (HLA)-B27-associated uveitis, and intraocular pressure (IOP) in the right eye was 4 mmHg. Ultrasound biomicroscopy revealed ciliary body edema with supraciliary effusion. He was on a frequent topical corticosteroid, and oral steroid in addition to receiving a periocular injection depot corticosteroid 20 days back. He was started on treatment with subcutaneous golimumab (GLM). After a month, his IOP in the right eye was 14 mm of Hg with UBM showing resolution of ciliary body edema. GLM can be useful in the management of steroid-resistant cases of HLA B-27-associated ocular hypotony.

Glaucoma due to ciliary body cysts and pseudoplateau iris: a systematic review of the literature / Glaucoma associado a cistos de corpo ciliar e íris pseudoplateau: revisão sistemática da literatura

ABSTRACT The diagnosis of angle-closure glaucoma secondary to iridociliary cysts is challenging and lacks compiled literature support. We present a rare case of bilateral angle-closure glaucoma associated with pseudoplateau iris due to multiple ciliary cysts and conducted a systematic review of the literature to find similar case reports published between November 2006 and November 2016. Only 19 case reports present treatment modalities, and most cases required more than one therapeutic approach for controlling the intraocular pressure. Pseudoplateau iris attributed to iridociliary cysts should be considered in the differential diagnosis of patients with narrow angles, particularly those with ocular hypertension and glaucoma, in which management is complex. In addition to gonioscopy, ultrasound biomicroscopy is considered the conclusive method for accurate diagnosis.

RESUMO O diagnóstico de glaucoma de ângulo fechado secundário a cistos iridociliares é desafiador e não possui suporte da literatura compilada. Apresentamos um caso bilateral raro de glaucoma de ângulo fechado associado à íris pseudoplateau devido a cistos ciliares múltiplos e realizamos uma revisão sistemática da literatura de relatos de casos similares publicados entre novembro de 2006 e novembro de 2016. Apenas 19 relatos de casos apresentaram as modalidades de tratamento e na maioria deles foi necessário mais de uma abordagem terapêutica para controlar a pressão intra-ocular. Íris pseudoplateau atribuída a cistos iridociliários deve ser considerada no diagnóstico diferencial de pacientes com ângulos estreitos, particularmente aqueles com hipertensão ocular e glaucoma, em que o manejo é complexo. Além da go nioscopia, a biomicroscopia ultra-sônica é considerada o método conclusivo para o diagnóstico correto.

Ultrasound biomicroscopy image patterns in normal upper eyelid and congenital ptosis in the Indian population

Purpose: To study the features of upper eyelid in healthy individual and different types of congenital ptosis in the Indian population using ultrasound biomicroscopy (UBM). Methods: This was a prospective observational study at a tertiary care center. Eyelid structure of healthy individuals with no eyelid abnormalities (n = 19); simple congenital ptosis (n = 33) cases; Marcus Gunn jaw-winking ptosis (MGJWP, n = 7) cases, and blepharophimosis-ptosis-epicanthus inversus syndrome (BPES, n = 20) cases were studied on a vertical UBM scan using 50-MHz probe. Lid-thickness, tarsal-thickness, orbicularis oculi and levator-Muller-orbital septum-conjunctival (LMSC) complex were measured in primary gaze. Comparison was made between four groups and results were statistically analyzed using ANOVA test. In normal individuals, LMSC measurements were repeated in down-gaze imaging. Results: Skin with subcutaneous tissue, LMSC complex and pre-aponeurotic fat-pad appeared echodense while orbicularis oculi and tarsus appeared echolucent. In primary gaze, mean thickness (± standard deviation) of the eyelid, tarsus, orbicularis oculi and LMSC, respectively, were: 1.612 ± 0.205, 0.907 ± 0.098, 0.336 ± 0.083, and 0.785 ± 0.135 mm in normal individual. LMSC showed 46.64% increase in thickness on down-gaze. The mean eyelid thickness and LMSC were thicker in MGJWP and BPES as compared to normal. In different types of congenital ptosis cases, various patterns of UBM imaging were observed. Conclusion: UBM allows noninvasive imaging of eyelid structures with good anatomical correspondence in normal eyelids and study the structural alterations of eyelids in different types of congenital ptosis. UBM can be used to highlight the anatomical difference in normal eyelids that may help modify the surgery for better cosmetic outcomes. Furthermore, it has the potential to be used in preoperative evaluation and operative planning in certain types of acquired ptosis, which needs to be evaluated.