Abstract
Purpose :
Accurate assessment of the iridocorneal angle is essential in the diagnosis and management of glaucoma. The standard evaluation by gonioscopy requires practice; its interpretation could be subjective and has several limitations. The addition of imaging techniques such as ultrasound biomicroscopy (UBM) and anterior segment ocular computed tomography (AS-OCT) led to a better understanding of angle structures. This is especially useful in patients with iris pathology, which could represent a risk factor for ocular hypertension and closure angle glaucoma.
Methods :
Retrospective review of 30 eyes (21 patients) with iris cysts and/or masses imaged by both UBM (Quantel, Clermont-Ferrand, France and Sonomed, Lake Success, NY) and the time-domain AS-OCT (Visante™, Carl Zeiss Meditec) at the University of Arizona over 18 months. We analyzed the images by both methods to compare and evaluate the role of imaging techniques in the diagnosis and follow up of iris lesions.
Results :
UBM visualized the entire extent of disease in all 30 eyes, identifying 21 with involvement behind the posterior pigmented iris epithelium and 9 without. AS-OCT fully visualized only the latter 9 lesions (31%; p<0.0001). Deeper penetration by UBM allows visualization of iris lesions in their entirety. Weak penetration through iris and scleral tissues limits AS-OCT imaging, resulting in incomplete views of some lesions and sometimes misleading diagnosis.
Conclusions :
Proper diagnosis and follow up of iris lesions requires complete visualization of the iris, iridocorneal angle, area behind the iris, and the ciliary body. The accurate diagnosis is greatly facilitated by choosing the most appropriate imaging. Our results suggest that iris lesions should be preferentially imaged by UBM.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.