Effect of Visibility of the Ciliary Body Processes on Ocular Biometric Parameters in Patients with Primary Angle Closure.

PURPOSE: To evaluate the differences in ocular biometric parameters between eyes with primary angle closure (PAC) with and without visible ciliary body processes (CBP) (PAC+CBP and PAC-CBP) and normal open-angle controls. STUDY DESIGN: Cross-sectional study. METHODS: Eyes with PAC and normal open-angle controls underwent detailed ocular examinations and gonioscopy to determine the visibility of the CBP. The following ocular biometric parameters were determined using A-scan ultrasound biometry: axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and vitreous length (VL). The lens-axial length factor (LAF) and relative lens position (RLP) were also calculated. Continuous variables were assessed by analysis of variance with Bonferroni correction. Multiple linear regression analysis was performed to adjust for confounding factors. Area under the receiver operating characteristic curves were calculated to determine the diagnostic capability of biometric parameters. RESULTS: 84 PAC+CBP eyes, 57 PAC-CBP eyes, and 32 normal open angle control eyes were evaluated. The means of the ocular biometric values were significantly different among the three groups. AL, ACD, LT, VL, LAF, and RLP were also significantly different among the three groups in the multivariate regression analysis. AL, ACD, and VL were lower in the PAC+CBP group and LT, RLP, and LAF were greater in the PAC+CBP group than in the PAC-CBP and control groups. LAF ≥ 2.4 is the cutting point with the highest sensitivity and specificity to differentiate PAC+CBP from PAC-CBP. CONCLUSIONS: The ocular biometric parameters in the PAC+CBP group were more strongly associated with a crowded anterior segment than in the other groups. Visibility of CBP in PAC-affected eyes may serve as a surrogate for an anterior segment crowding mechanism and help to select the most appropriate treatment in individual cases.

Eight-ball hyphema after laser iridotomy in a patient with undiagnosed hypocellular myelodysplastic syndrome.

INTRODUCTION: We report a rare case of unexpected gross hyphema in the right eye (OD) and eight-ball hyphema in the left eye (OS) from a bilateral laser iridotomy in an acute primary angle-closure patient. We also demonstrated the effectiveness of the inferior full-thickness trabeculectomy with daily intracameral air injection as an alternative treatment in eight-ball hyphema. CASE REPORT: An 81-year-old Thai female presented with gross hyphema grade II OD and eight-ball hyphema with blood-stained cornea OS after laser iridotomy. The patient was scheduled for surgery and the preoperative blood test showed bicytopenia. We performed anterior chamber washout OD and an inferior full-thickness trabeculectomy with daily intracameral air injection OS. The hyphema completely resolved on the following day OD and 3 days after surgery OS. The inferior bleb OS did not raise with digital pressure and became nonfunctional in 7 days. No recurrent hyphema was found in both eyes (OU) during 6 months of follow-up. This patient was ultimately diagnosed with hypocellular myelodysplastic syndrome (MDS). CONCLUSION: Gross hyphema after laser iridotomy can be seen in patients with hypocellular MDS. The inferior full-thickness trabeculectomy is an alternative surgical procedure for an eight-ball hyphema.