OBJECTIVE: The aim of this paper was to create a Portable Gonioscopy System (PGS) that is effcient and cost-effective in documenting iridocorneal angles. METHODS: A 4-mirror gonioscopy prism lens was attached to a portable USB microscope with a built-in camera. The microscope was then connected to a laptop for viewing of the images. A lubricant was instilled and the portable gonioscope was placed parallel to the cornea for viewing and recording of iridocorneal angles. Images were fled and stored in a laptop. RESULTS: The portable gonioscopy system allowed suffcient viewing and recording of the iridocorneal angles. The total cost of producing the portable gonioscopy system was PHP 25,000.00. CONCLUSION Iridocorneal angles can be visualized and recorded using the portable gonioscopy system. This device requires skill and expertise from professional prototypist to create. Like gonioscopy, this system also has a steep learning curve. The researchers are continuously improving the device adding more features and making it more affordable and easier to use.
gonioscopy

Gonioscopy

Glaucoma will continue to be the leading cause of irreversible blindness worldwide.1,2 A recent metaanalysis done by Tham and coworkers projected an increase of 74% in the total number of people with glaucoma, from 64.3 million in 2013 to 76 million by 2020, and to 111.8 million by the year 2040.2 With this recent forecast, Asia will have the greatest number of both primary open angle glaucoma and primary angle closure glaucoma (PACG), comprising 18.8 million (79.8%) and 9 million (58.4%) respectively.2 Since half of the world’s PACG will come from Asia, an effective reduction in the real incidence and prevention of visual loss from this devastating disease will depend on the accurate assessment of the anterior chamber angle and early detection of appositional closure
Gonioscopy

PURPOSE: To introduce a novel adjuvant technique to locate cyclodialysis cleft using a laser pointer in a gonioscopic view. CASE SUMMARY: A 36-year-old man complaining of blurred vision in his left eye after blunt trauma 2 weeks prior was referred to our hospital. Gonioscopy showed a cyclodialysis cleft from 3 to 4 o'clock and fundus revealed hypotonic maculopathy. After the failure of medical treatment, we tried various interventions such as injection of viscoelastic agent into the anterior chamber and intravitreal gas tamponade with transconjunctival cryotherapy. Since those were not successful, we decided to treat the patient with direct cyclopexy. For the preoperative localization of the cleft, we tried a new technique that uses a laser pointer. On gonioscopic examination, an assistant shot the laser toward the limbal area where the suspicious cleft was located. We were able to precisely locate the cyclodialysis cleft if the laser pointer light was seen through the cleft in the gonioscopic view. With the aid of a laser a pointer, the cleft was successfully closed. CONCLUSIONS: Localization with a laser pointer is simple, safe, rapid, and helpful for planning surgical repair of a cyclodialysis cleft without expensive equipment.
Adult ; Anterior Chamber ; Cryotherapy ; Gonioscopy ; Humans ; Methods*

Transpupillary argon laser cyclophotocoagulation has been proposed as an alternative to conventional glaucoma surgery. The procedure involves phoptocoagulation of cilliary process to decrease intraocular pressure by reducing aqueous production. We report our experience with 3 advanced glaucoma patients, who received transpuillary cyclophotocoagulation. Their ciliary process was well visualized by gonioscopy. All visible process were treated up to a maximum of 1800 at one setting and treated again a few weeks later, so total transpupiJIary argon laser cyclophotocoagulation were performed 3 or 4 times. After surgery, each patient was maintained on preoperative glaucoma medication. As a result of this study, one of these patients was sucessfully controled and other one of them had effect of 20mmHg Intraocular pressure reduction.
Argon* ; Glaucoma ; Gonioscopy ; Humans ; Intraocular Pressure

OBJECTIVETo assess the agreement between gonioscopy and ultrasound biomicroscopy (UBM) in detecting angle closure in Chinese patients with shallow anterior chamber.

METHODSAn observational comparative study of the two different examination methods was conducted. Patients with normal intraocular pressure and temporal peripheral anterior chamber depth less than a quarter of corneal thickness based on slit lamp examination were included in this study from December 2007 to May 2009 in the outpatient clinic of First Hospital of Tsinghua University. Gonioscopy was performed with a Goldman goniolens in dark room first and followed by full beam light and indentation. If the filtering trabecular meshwork was invisible or any peripheral anterior synechia was found, that quadrant of the angle was considered closed. UBM was first undertaken in a darkened room then repeated with normal room lighting. If iridotrabecular apposition was showed, that quadrant of the angle was considered closed. The status of angle closure of each quadrant with different methods was recorded.

RESULTS85 eyes of 46 patients were included in this study. The agreement between gonioscopy and UBM was poor (Κ<0.4) with Kappa analysis in both dark and light conditions in each quadrant. The accordance of agreement between gonioscopy and UBM was hardly affected by age or sex, while in dark condition, eyes with deeper anterior chamber (P=0.005) or plateau iris configuration tended to produce different results (P=0.075) in the 2 methods.

CONCLUSIONGonioscopy and UBM are both indispensable methods for detecting angle closure, neither can completely replace the other.

PURPOSE: To identify the impact of the presence of peripheral anterior synechia (PAS) on the depth of the anterior segment in patients with a shallow anterior chamber after laser iridotomy (LI) by analyzing changes in the anterior segment biometry using ultrasound biomicroscopy (UBM). METHODS: Twenty eyes of 20 patients with PAS and shallow anterior chamber, and another 20 eyes of 20 patients with shallow anterior chamber without PAS were studied. The changes in the anterior segment biometry for each group of patients were examined using gonioscopy and UBM before and after the LI. RESULTS: The central corneal thicknesses and scleral thicknesses of the two groups did not show significant differences (p > 0.05). The anterior chamber depths, anterior chamber angles, trabecular meshwork-iris distances, and angle-opening distances 500 increased significantly after the peripheral LI (p < 0.05) in both groups. However, the difference in the increases in the anterior segment biometries between the two groups was not statistically significant. CONCLUSIONS: LI can increase the depth of the anterior chamber regardless of the presence of PAS.
Anterior Chamber ; Biometry ; Eye ; Gonioscopy ; Humans ; Microscopy, Acoustic

PURPOSE: To report the relationship between the extent of rupture of the trabecular meshwork and intraocular pressure changes in traumatic hyphema patients. METHODS: Ninety-five trabecular meshwork rupture patients were selected from a group of traumatic hyphema patients. Identification and measurement of the rupture of the trabecular meshwork were performed by gonioscopy, and intraocular pressure was measured by Goldmann applanation tonometry until 3 months after the trauma. RESULTS: There were statistically significant differences of IOP between the traumatic eyes and the contralateral eyes at day 2, 3, 5, and 1 month (p=0.000, 0.018, 0.001, 0.040, respectively). IOP was highest at the 2nd day post-trauma, and dropped by the 5th day, after which it rose slightly. The relationship between the extent of trabecular meshwork rupture and the difference of IOP was positive at the 2nd day post-trauma (r=0.259) and negative at the 6th day post-trauma (r=-0.296); these differences are statistically significant (p=0.020, p=0.041, respectively). CONCLUSIONS: A rupture of the trabecular meshwork can be measured using gonioscopy, and the change of IOP in a trabecular meshwork rupture increases as the extent of the rupture of the trabecular meshwork increases.
Eye ; Gonioscopy ; Humans ; Hyphema ; Intraocular Pressure ; Manometry ; Rupture ; Trabecular Meshwork

PURPOSE: To report a case of traumatic hypotony maculopathy treated by intravitreal air injection. CASE SUMMARY: A 20-year-old female presented with decreased visual acuity in the left eye 2 days after trauma. Best corrected visual acuity (BCVA) was 0.5 and the intraocular pressure (IOP) was 5 mm Hg. Indirect ophthalmoscopy revealed chorioretinal folds in the macular area. Gonioscopy showed angle recession from 4 to 7 o'clock. Initially, pressure patching and conservative management were performed on the left eye 10 days after examination. However, deterioration of the chorioretinal fold was observed without any change in IOP. Finally, intravitreal air injection (0.5 cc) was performed 10 days after the start of conservative treatments. Following air injection, the normalization of IOP and gradual reduction of chorioretinal fold was observed. BCVA improved to 1.0 and IOP was maintained between 12 and 14 mm Hg for 24 months after the air injection. CONCLUSIONS: Intravitreal air injection may safely and effectively treat traumatic hypotony maculopathy.
Female ; Gonioscopy ; Humans ; Intraocular Pressure ; Ophthalmoscopy ; Visual Acuity ; Young Adult

PURPOSE: Cyclodialysis clefts occur when the meridional ciliary muscle fibers become separated from the scleral spur, thereby providing a new drainage pathway of aqueous humor into the suprachoroidal space. Although the mechanism by which cyclodialysis lowers IOP is both of the hyposecretion of aqueous humor and the increased uveoscleral outflow, cyclodialysis clefts do not always cause hypotony. METHODS: The authors retrospectively analyzed the data of 9 eyes of 9 patients who had been diagnosed as traumatic cyclodialysis cleft by gonioscopic examination. RESULTS: Only 4 of the 9 eyes showed hypotony. This hypotony occurred 3 to 13 days (mean 7.3 days) after trauma. Conservative treatment combined with air injection was done in 4 patients with hypotony. In 3 eyes, IOP was normalized 7~10 days after the above treatment. The remaining one eye had an extensive cyclodialysis of 6 o clock and was treated with argon laser. But normalization of IOP was not achieved within the follow up period. Only cyclodialysis clefts of relatively small range were closed spontaneously or with only conservative management. Also posterior synechiae was found in one of the four eyes with hypotony, and was found in three of the four eyes without hypotony. CONCLUSION: Whether hypotony in cyclodialysis patients occur or not depends on the individual ability of scar formation in the cyclodialysis cleft against the anti-proliferative properties of aqueous humor.
Aqueous Humor ; Argon ; Cicatrix ; Drainage ; Follow-Up Studies ; Gonioscopy ; Humans ; Inflammation ; Retrospective Studies