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Janet Leath, Carmelina Trimboli-Heidler, Mohamad Jaafar; Ultrasound Biomicroscopy in Congenital and Aphakic Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):78.
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Our purpose was to test the hypothesis that anterior segment anatomy is 1) predictive of disease course and 2) instrumental in prospective surgical planning for children with congenital and aphakic glaucoma. Dynamic ultrasound biomicroscopy affords ophthalmologists the opportunity to assess the anterior segment in 3 dimensions and to assess structures not visible by direct observation such as iris thickness, anterior chamber depth, and ciliary body dimensions. An understanding and characterization of the anatomic abnormalities in eyes with uncontrolled intraocular pressure may help plan an anatomic approach to surgical intervention.
We evaluated 8 patients with congenital glaucoma, 8 patients with aphakic glaucoma, and 10 age-matched controls without glaucoma nor any history of intraocular surgery. Patient ages ranged from 2 months to 12 years old. Each patient underwent ultrasound biomicroscopy with 4 quadrant analysis of corneal thickness centrally and peripherally, angle of corneal approach, anterior chamber depth, thickness of iris at the pupil, thickness of iris midway from insertion to pupil, and thickness of iris at insertion, ciliary body thickness, ciliary body rotation, presence or absence of a Soemmering ring, the maximal thickness of Soemmering ring. Each patient was categorized into clinical categories based upon intraocular pressure ranges, age at onset of glaucoma, and response to both medical and surgical therapy.
We found that several anterior segment parameters had significant differences among the three groups. Patients with congenital glaucoma all had thicker corneas, larger anterior chamber depth, thicker iris at insertion, and thinner iris near the pupil. The aphakic glaucoma patients had statistically smaller anterior chamber depth, and higher pressures correlated directly with presence and size of Sommering rings.
An understanding and characterization of the anatomic abnormalities in eyes with uncontrolled intraocular pressure may help predict prognosis. This information may also guide treatment in selecting location for glaucoma surgery in terms of clock hour location and also whether to intervene at the angle, to utilize filtering or tube surgery, or to opt for ciliary body laser intervention. Future studies will be needed to correlate pre-operative anatomy with results after surgical intervention.
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