PURPOSE: To compare the measured values of anterior chamber depth and angle in glaucoma patients using Ultrasound Biomicroscopy (UBM) and Orbscan(TM) IIz Topography. METHODS: We measured the anterior chamber depth and angles of four directions in 26 eyes of 13 primary open angle glaucoma (POAG) patients, 26 eyes of 13 normal tension glaucoma (NTG) patients, and 20 eyes of 10 angle closure glaucoma (ACG) patients, with UBM and Orbscan. RESULTS: The values of anterior chamber depth did not show any difference between UBM and Orbscan. The values for anterior chamber angle in POAG and NTG eyes were not different between UBM and Orbscan, but the values for all anterior chamber angles except the superior angle, measured with UBM were significantly larger than those for ACG measured by Orbscan. CONCLUSIONS: Both UBM and Orbscan showed similar results in the measurement of anterior chamber depth and angle in POAG and NTG patients, but showed different results in the anterior chamber angle for ACG patients. UBM will be more useful in evaluating the anterior chamber angle in ACG patients because it can assess the structures of the anterior chamber angle objectively.
Anterior Chamber* ; Glaucoma ; Glaucoma, Angle-Closure ; Glaucoma, Open-Angle ; Humans ; Low Tension Glaucoma ; Microscopy, Acoustic* ; Ultrasonography*

We performed a prospective study to evaluate the effect of ocular digital massage (ODM) on intraocular pressure (IOP) in eyes that underwent implantation of Ahmed Glaucoma Valve (AGV) for refractory glaucoma. Echographic study(B scan) was also used to visualize the formation of bleb around the implant and change of its size following ODM. There were 14 eyes(13 patients) in which pre-massage IOP was 17.79 +/- 6.19 mmHg and the immediate post-massage lOP showed 11.00 +/- 6.11 mmHg . IOP in 6 hours after ODM was 15.43 +/- 7.32 mmHg . These reductions in lOP were statistically significant (paired t-test, p=0.005). When classified into two groups based on the type of glaucoma and IOP reduction after ODM was compared, there was no statistically significant difference between the group with neovascular glaucoma (NVG) and that with chronic angle closure glaucoma (t-test, p=0.328). The ultrasound study showed well formed bleb around the implant in those eyes with good IOP control. Increase in the size of bleb was shown even in those with marginal/poor IOP control following ODM. There was no significant complication associated with ODM except in one eye with persistent hypotony. In conclusion, ODM showed a significant IOP reduction in short term in eyes with AGV and its relationship with bleb size was well documented with the use of echograph.
Blister ; Glaucoma* ; Glaucoma, Angle-Closure ; Glaucoma, Neovascular ; Intraocular Pressure ; Massage* ; Prospective Studies ; Ultrasonography

PURPOSE: To identify the essential morphologic characteristics concerned with angle closure in chronic primary angle-closure glaucoma (PACG) and to assess the changes in quantified values for angle relationships after laser iridotomy (LI) in them using ultrasound biomicroscopy (UBM). METHODS: Anterior segment imaging and quantitative assessment of angle relationships were obtained in 25 eyes of 25 patients with chronic PACG using UBM (UBM plus2000 system, Paradigm(R) Inc., Utah, USA) before and 2 weeks after LI. RESULTS: The mean anterior chamber depth (ACD), anterior chamber angle (ACA), angle-opening distance (AOD500), and trabecular-iris distance (TID) were 2.16 mm, 12.73 degrees, 0.128 mm, and 0.101 mm, respectively. All our results were significantly smaller than previously reported quantified values in normal adult. In comparison between before and after LI, ACD and iris thickness (IT) did not change significantly, whereas ACA, AOD500, AOD250, and TID all significantly increased after LI. CONCLUSIONS: Using UBM, we identified the essential morphologic characteristics concerned with angle closure in chronic PACG and quantitatively demonstrated the result of treatment based on the changes of angle relationships after LI.
Adult ; Anterior Chamber ; Glaucoma, Angle-Closure* ; Humans ; Iris ; Microscopy, Acoustic ; Ultrasonography* ; Utah

PURPOSE: To clarify the ciliary body and choroidal detachment after panretinal photocoagulation and to inspect complications by ciliary body and choroidal detachment after panretinal photocoagulation. METHODS: A dynamic, in vivo examination using ultrasound biomicroscope (UBM) was performed on 12 eyes of 11 patients before, immediately after, and 3 and 7 days after panretinal photocoagulation. IOP measurement was performed on each occasions, and the spot size, and spot number of laser applications of each patient was measured. RESULTS: Three days after photocoagulation, ciliochoroidal detachment was observed in 6 of the 12 eyes, but none was observed at 7 days. The retinal surface area that had been treated was associated with the development of detachment. No significant IOP change according to the ciliochoroidal detachment was present. CONCLUSIONS: Although ciliochoroidal detachment was asymptomatic and transient in this study, potential hazards such as angle closure glaucoma necessitate careful attention in the planning of panretinal photocoagulation. UBM is a useful tool for the evaluation of ciliochoroidal detachment after photocoagulation.
Choroid* ; Ciliary Body* ; Glaucoma, Angle-Closure ; Humans ; Light Coagulation* ; Retinaldehyde ; Ultrasonography*

Biometric measurements were made by ultrasonography in 30 eyes of 25 patients (18 Women and 7 men, mean 67.9 yrs) with acute angle closure glaucoma against 52 eyes of 26 age-matched normal persons (20 women and 6 men, mean 65.1 yrs) in order to analyze an affecting factor of lens in acute primary angle closure glaucoma. The 26 eyes of 30 patients' eyes was subjects older than 60 years of age and mean intraocular pressure was 57.06 +/- 16.764 mmHg The mean anterior chamber depth of these patients (1.895 +/- 0.193 mm) was 0.95mm shallower than one of controls (2.840 +/- 0.324 mm). The mean lens thickness was slgmtlCantly larger tor pal1ents (patients 5.024 +/- 0.498 mm, controls 4.168 +/- 0.524 mm, p=0.001). The mean axial length was 0.6 mm shorter for patients (patients 22.385 +/- 0.840 mm, controls 22.985 +/- 0.838 mm, p<0.01). The relative lens position was significantly smaller for patients (patients 0.194, controls 0.214, p=0.0001), but relative posterior capsule position was similar in two groups. The study suggested that the increased thickness and forward positioning of lens was one of important factors for anterior chamber angle closure in primary angle closure glaucoma.
Anterior Chamber ; Female ; Glaucoma, Angle-Closure* ; Humans ; Intraocular Pressure ; Male ; Ultrasonography

In order to measure the ocular dimensions with aging, the anterior chamber depth and the lens thickness were measured using contact ultrasonography and anterior chamber photography in normal human eyes. There were 141 women (241 eyes) and 76 men (130 eyes) between the ages of 10 and 70 years. The lens thickness was increased and the anterior chamber depth was decreased with aging in both sexes. The anterior chamber depth showed an accelerated decrease between the 4th and 5th decades in females and the ratio of anterior chamber depth to axial length was smaller in females than in males after the 5th decade. The results suggest that the prevalence of angle closure glaucoma increased in female after middle age.
Aging* ; Anterior Chamber ; Female ; Glaucoma, Angle-Closure ; Humans ; Male ; Middle Aged ; Photography ; Prevalence ; Ultrasonography

PURPOSE: To determine the efficacy and safety of the dark-room prone-position test (DRPT) for intermittent angle closure (IAC) and to investigate the correlation between A-scan ultrasound biometric measurements and the results of DRPT. METHODS: Medical records were reviewed of 37 eyes in 24 patients who were diagnosed with IAC and received DRPT. The increase of intraocular pressure (IOP) induced by DRPT and the results from A-scan ultrasound biometric measurements were obtained. An increase in IOP of at least 8 mmHg from baseline was considered a positive result for DRPT. Associations between the increase of IOP induced by DRPT and the parameters of A-scan biometry were tested by linear regression analysis. RESULTS: The DRPT results were positive in 28 eyes of 19 patients. After DRPT, the IOP returned to near-baseline levels within 2 hours in all patients; some patients were treated with anti-glaucoma eye drops. Lens thickness was significantly correlated with the amount of IOP elevation induced by DRPT (r=0.338, p=0.041). CONCLUSIONS: DRPT is a safe and effective test in patients with IAC. DRPT can be used effectively to make a concrete diagnosis of IAC. Lens thickness appears to be associated with a positive response to DRPT.
Adult ; Aged ; *Darkness ; *Diagnostic Techniques, Ophthalmological/standards ; Female ; Glaucoma, Angle-Closure/*diagnosis ; Humans ; Male ; Middle Aged ; *Prone Position ; Ultrasonography

PURPOSE: To report a case of acute angle-closure glaucoma secondary to spontaneous suprachoroidal hemorrhage in a hemodialysis patient. CASE SUMMARY: A 71-year-old man visited our clinic after 3 days of vision loss and ocular pain in the right eye. He had been treated with hemodialysis using heparin due to diabetic nephropathy. Visual acuity (VA) was hand motion in the right eye and 0.2 in the left eye. The intraocular pressure (IOP) was 58 mmHg in the right eye and 15 mmHg in the left eye. Gonioscopic examination revealed a closed angle in the right eye. Fundus examination of the right eye showed a massive hemorrhagic retinal detachment and ultrasound sonography revealed a dome-shaped retinal detachment with suprachoroidal hemorrhage in the right eye. The patient was treated with topical aqueous suppressants and cycloplegics. After two weeks of medical treatment, VA in the right eye was still hand motion and IOP was 8 mmHg. Gonioscopic examination showed a wide-open angle in the right eye. During the two-month observation period, VA in the right eye did not recover, however there was no sign of IOP elevation or symptoms of ocular pain. CONCLUSIONS: Spontaneous suprachoroidal hemorrhage can occur in patients who receive hemodialysis with heparin. This spontaneous suprachoroidal hemorrhage can be subsequently accompanied by acute angle-closure glaucoma. Spontaneous decrease of suprachoroidal hemorrhage, loss of angle-closure, and decline of IOP can be expected by treating with topical aqueous suppressants and cycloplegics.
Aged ; Diabetic Nephropathies ; Glaucoma, Angle-Closure* ; Hand ; Hemorrhage* ; Heparin ; Humans ; Intraocular Pressure ; Mydriatics ; Renal Dialysis ; Retinal Detachment ; Ultrasonography ; Visual Acuity

In order to evaluate the morphologic types of appositional angle-closure glaucoma, biometric measurements were made in angle-closure glaucoma patients using Ultrasound biomicroscopy (UBM). Twenty-six patients with primary angle-closure glaucoma and 21 cataract patients with as a control group were examined. The angle-closure glaucomatous eyes were classified as type B in which the angle closure started at the bottom of the angle and type S in which the angle closure occurred in the vicinity of Schwalbe's line. The trabecular-ciliary process distance (TCPD, type B; 873.20+/-86.77 microm, type S; 832.52+/-82.96 microm, control; 1233.50+/-73.01 microm, p = 0.000) and the angle opening distance (AOD500, type B; 89.75+/-63.27 microm, type S; 88.85+/-72.95 microm, control; 304.40+/-104.30 microm, p = 0.000) were significantly shorter in patients with angle closure vice control group. No significant difference were noted in the three groups of patients in regards to iris thickness or ciliary process-iris angle. In this study, we have demonstrated that there are two types of appositional angle-closure and have shown the forward rotation of the ciliary process without changes of the ciliary process-iris angle in cases of angle-closure glaucoma.
Adult ; Aged ; Aged, 80 and over ; Anterior Chamber/*ultrasonography ; Comparative Study ; Female ; Glaucoma, Angle-Closure/*ultrasonography ; Gonioscopy/methods ; Human ; Male ; Middle Age ; Prospective Studies ; Weights and Measures

BACKGROUNDPrimary angle-closure glaucoma (PACG) is a major cause of visual morbidity in East Asia. Dark-room provocative test (DRPT) has been used to determine which narrow angles have the risk to develop angle closure. However, the accuracy of DRPT might be altered because that after emerging from the dark room, the configuration of the angle is affected by the light of the slit-lamp and the appositionally closed angle reopens. The aim of this study was to examine the pupillary diameter in different light conditions and use it as a parameter to assess the accuracy of dark-room provocative test.

METHODSPatients with suspected primary angle-closure glaucoma undergoing DRPT were recruited. The anterior chamber angle was examined by anterior segment optical coherence tomography under the following conditions: (1) in standard room illumination; (2) after short-term dark-adaptation and (3) after DRPT. Mean values of pupil size and numbers of appositionally closed angle under different conditions were compared.

RESULTSA total of 47 eyes of 47 patients were analyzed. The pupil size after DRPT was smaller than that after short-term dark-adaptation (P < 0.001) and smaller than that in standard room illumination (P = 0.026). The numbers of appositionally closed angles after short-term dark-adaptation were significantly larger than those after DRPT (P < 0.001). There was no significant difference between the numbers of appositionally closed angles in standard room illumination and after DRPT (P = 0.157).

CONCLUSIONSConstriction of pupil size immediately after prolonged dark room provocative test may lead to change in the angle configuration, which may lead to false negative results. We suggest a modified protocol of recording intraocular pressure immediately after DRPT and performing gonioscopy following short-term dark adaptation to improve the accuracy of angle closure assessment.

Adult ; Aged ; Dark Adaptation ; Diagnostic Techniques, Ophthalmological ; Female ; Glaucoma, Angle-Closure ; diagnosis ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity ; Ultrasonography