In vivo imaging of the human zonular apparatus with high-resolution ultrasound biomicroscopy.

BACKGROUND: To investigate the potential of high-resolution ultrasound biomicroscopy (UBM) for studying the zonular apparatus of human beings in vivo. METHODS: Using transducer frequencies of 34 MHz and 50 MHz, criteria were developed to identify transcorneal and transscleral sections that allowed reproducible identification of the different fiber groups of the zonular architecture. For that purpose, 10 volunteers between the ages of 14 and 41 years underwent high-resolution ultrasound biomicroscopy under conditions of consensual far- and near-accommodation. The online video recordings of the respective UBM investigations were afterwards analyzed image by image. Good visibility of zonular fibers was obtained when the ultrasound wave propagation comprised an angle close to 90 degrees with the fiber orientation and when the oscillations of the UBM scan had a strict radial orientation towards the limbus and avoided, simultaneously, the ciliary processes. RESULTS: In all the volunteers, high-resolution ultrasound biomicroscopy imaged the zonular fiber groups known from histology. In addition, it detected fibers that do not follow the course of the inner ciliary body surface but take a direct route from the ora serrata to the lens. It also demonstrated that fibers that seem to change direction at crossings with other fibers. Under conditions of near-accommodation, the zonular fibers showed signs of relaxation. CONCLUSIONS: High-resolution ultrasound biomicroscopy seems well suited for in vivo investigations of the zonular apparatus and of accommodation in man. The results support the fundamental features of the Helmholtz theory on accommodation.

Argon laser trabeculoplasty: long-term follow-up of at least 5 years.

This retrospective study evaluates the long-term follow-up of 331 eyes of 219 patients treated with argon laser trabeculoplasty (ALT). A total of 258 eyes were included with a follow-up of at least 5 years. Success was defined as an intraocular pressure of under 22 mm Hg with a stable visual field and optic nerve head. Overall, 22% (58/258) were regulated after 5 years (glaucoma chronicum simplex 26%, pigment dispersion glaucoma 31%, pseudoexfoliation glaucoma 19%, angle-closure glaucoma 14%, secondary glaucoma 7%). Filtration surgery was performed in 13% (33/258) mainly (73%) in the first 3 years after ALT. Repeat ALT was done in 43% of the eyes, and 60% of these eyes with repeat ALT underwent filtration surgery in the first year. With repeat ALT the overall success rate increased to 38%. High initial intraocular pressure and the stage of glaucoma documented by the visual field loss correlated with the failure of ALT. These results indicate that ALT and re-ALT were effective in glaucomatous eyes, yet there was a substantial diminishing effect as time progressed. Therefore, close follow-up on ALT-treated patients is necessary.