Subject(s)
Aqueous Humor/metabolism , Crystallins/metabolism , Eye Injuries/diagnosis , Lens, Crystalline/injuries , Uveitis/diagnosis , Wounds, Nonpenetrating/diagnosis , Adult , Blotting, Western , Eye Injuries/metabolism , Female , Humans , Lens, Crystalline/metabolism , Uveitis/etiology , Uveitis/metabolism , Wounds, Nonpenetrating/metabolismSubject(s)
Amyloidosis/complications , Intraocular Pressure , Ocular Hypotension/etiology , Retinal Detachment/etiology , Retinal Hemorrhage/etiology , Trabeculectomy/adverse effects , C-Reactive Protein/metabolism , Female , Glaucoma/surgery , Humans , Middle Aged , Ocular Hypotension/physiopathology , Retinal Detachment/physiopathology , Retinal Hemorrhage/physiopathology , Serum , Serum Amyloid A Protein/metabolismABSTRACT
PURPOSE: To propose a new surgical technique for optimized visualization of the chamber angle using scleral indentation under an operating microscope in goniosynechialysis (GSL). PATIENTS AND METHODS: Six volunteers with normal chamber angle and five patients with synechial angle closure glaucoma were examined. Scleral indentation 2 mm posterior to the limbus was performed during observation of chamber angle. Width of trabecular meshwork in images was recorded through a CCD camera mounted on an operating microscope. Trabecular-iris angle and trabecular-corneal angle obtained by ultrasound biomicroscopy were used for the parameters for the angle configuration. GSL with scleral indentation was performed in the patients. RESULTS: According to the visibility of the chamber angle, width of trabecular meshwork in images significantly increased from 0.34 +/- 0.08 mm equivalent (mean +/- SD) to 0.67 +/- 0.14 mm equivalent (P = 0.0001) with scleral indentation. According to the angle configurations, trabecular-iris angle significantly increased from 39.6 +/- 3.8 degrees to 47.5 +/- 6.6 degrees (P = 0.0016), and trabecular-corneal angle significantly decreased from 169.8 +/- 5.5 degrees to 158.7 +/- 5.4 degrees (P < 0.0001). All patients were successfully treated with GSL using scleral indentation. CONCLUSION: Scleral indentation provided the surgeon an optimized visualization of the anterior chamber angle. Deepening of the chamber angle and steeping in trabecular-corneal curvature probably induced the plane of the trabecular meshwork less oblique to the surgeon's visual axis. This enhanced visualization promises the accuracy and safety of GSL.
