Abstract
Purpose :
Pediatric Eversional Angle Closure with Headache (PEACH) is a childhood variant intermittent angle closure glaucoma characterized by 1) recurrent frontal headache, 2) iris laxity on dynamic gonioscopy, and 3) concentric visual field loss on Frequency Doubling Technology perimetry. Prior reports demonstrate nearly universal symptom improvement with laser peripheral iridotomy (LPI), but gonioscopy findings in these patients have not been reported. This retrospective observational study evaluates gonioscopy findings in PEACH eyes pre- and post- LPI.
Methods :
We retrospectively analyzed 166 eyes of 91 subjects (5 to 18 years) with PEACH who had LPI (VISULAS YAG III, Zeiss, Jena, Germany) between March 2011 and September 2020. Dynamic gonioscopy was performed using a 4-mirror gonio lens and graded using the Spaeth system before (n=166) and after (n=98) LPI. Frequency percentages were calculated for all variables. Iris insertion, angle width, and pigment were evaluated with Wilcoxen’s signed-rank test and iris configuration with chi-square.
Results :
Iris configuration of Q was the most sensitive index (92%) for PEACH diagnosis, most commonly presenting as (R)Q (82.7%). Other common findings: 75.95% of eyes had iris insertion deep to the ciliary body (Spaeth D, range A-E), 50.6% had iris angle width of 40 degrees (range 0-55°), and 54.2% of subjects had concentric iris folds. Significant portions of eyes had pigment dust anterior to Schwalbe’s line (42.8%) with only a minority showing synechiae (15.7%). Iris insertion became less deep after LPI (p<0.001), mean angle width decreased from 40±7 to 34±6 degrees (p<0.001), and mean pigment increased from 1±1 to 2±1 (p=0.03). Significantly, in eyes in perpetual Q pre-LPI, 87.5% reverted to Spaeth R post-LPI. In baseline (R)Q eyes, 93.7% reverted to R [X2(20,N=96)=33.6,p<0.001]. Thus LPI may impart resistance to reverse pupillary block in PEACH.
Conclusions :
Gonioscopy is a sensitive tool essential to the diagnosis and monitoring of PEACH patients, and must be considered alongside historical and perimetric factors to arrive at an accurate diagnosis and verify effective therapy. The iridocorneal angle structures change in response to LPI and may be mechanistically related to improvements in PEACH symptomatology.
This is a 2021 ARVO Annual Meeting abstract.