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

PURPOSE: To report a case of a cyclodialysis cleft that was successfully managed with gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap. CASE SUMMARY: A 44-year-old man complaining of blurred vision in the left eye after blunt trauma was referred to our hospital. The intraocular pressure (IOP) was 4 mmHg and the visual acuity was counting finger. Gonioscopy examination revealed cyclodialysis cleft from 3 to 6 o'clock and fundus examination revealed macular folds. After the failure of conservative medical therapy and laser photocoagulation, gonioscopically guided transscleral cyclopexy using partial-thickness scleral flap was performed. Four months later, the IOP was 18 mmHg, the visual acuity was 0.8, and fundus examination showed the disappearance of the macular folds. CONCLUSIONS: Transscleral cyclopexy using partial-thickness scleral flap is a safe and effective method to treat hypotony maculopathy due to cyclodialysis and to minimize pupil distortion.
Adult ; Fingers ; Gonioscopy ; Humans ; Intraocular Pressure ; Light Coagulation ; Methods ; Pupil ; Visual Acuity

PURPOSE: To evaluate a new gonioscopy score and preoperative factors as a potential predictor for intraocular pressure (IOP) reduction after phacoemulsification. METHODS: This is a retrospective review of 182 eyes with glaucoma of either open or narrow angles that underwent phacoemulsification. Preoperative variables such as age, IOP, refractive errors, anterior chamber depth (ACD), axial length, and lens position were evaluated at 6 months after surgery. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants. To determine variables associated with IOP change at 6 months, univariate and multivariate linear regression analysis was performed. RESULTS: The mean age of the patients was 72.8 ± 9.5 years and the average preoperative IOP was 16.4 ± 3.7 mmHg with 1.2 glaucoma medications. The mean IOP reduction after phacoemulsification was 2.7 ± 2.2 mmHg at postoperative 6 months. Preoperative IOP (β = 0.55, p < 0.001), gonioscopy score (β = −0.29, p < 0.001), ACD (β = −0.67, p = 0.02), and IOP/ACD ratio (β = 0.58, p = 0.01) were associated with IOP reduction at 6 months. CONCLUSIONS: Preoperative predictors for IOP reduction after phacoemulsification were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio in patients with glaucoma. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.
Anterior Chamber ; Glaucoma ; Gonioscopy ; Humans ; Intraocular Pressure ; Linear Models ; Phacoemulsification ; Refractive Errors ; Retrospective Studies

This study was aimed to report a case of serous retinal detachment following laser peripheral iridotomy (LPI) for the treatment of angle closure secondary to posterior scleritis. A 55-year-old man with bilateral ocular pain, redness, and headache was referred to Keimyung University Dongsan Medical Center. At the initial examination, his visual acuity was 1.0 in the both eyes. The intraocular pressure (IOP) was 25 mmHg in the right eye and 28 mmHg in the left eye. Slit lamp examination showed a shallow anterior chamber, which was found to be Shaffer grade I by gonioscopy. There were no specific findings in the fundus, except a slightly edematous disc margin in both eyes. LPI was performed on both eyes. Fourth day after LPI, the patient complained of a central scotoma and visual disturbance of the left eye, in which the visual acuity had decreased to 0.06. The optical coherence tomography showed serous retinal detachment at the posterior pole. Fluorescein angiography revealed a focal leakage in the superotemporal area, as well as multiple hyperfluorescence lesions. Posterior scleritis of the left eye was diagnosed. Systemic steroid therapy was initiated and the area with the leakage was treated by focal laser photocoagulation. Two weeks later, the serous retinal detachment of the left eye resolved and visual acuity improved to 0.63. Laser peripheral iridotomy can exacerbate serous retinal detachment in patients with posterior scleritis that presented as acute angle closure.
Anterior Chamber ; Fluorescein Angiography ; Gonioscopy ; Headache ; Humans ; Intraocular Pressure ; Light Coagulation ; Middle Aged ; Retinal Detachment* ; Retinaldehyde* ; Scleritis* ; Scotoma ; Slit Lamp ; Tomography, Optical Coherence ; Visual Acuity

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*

PURPOSE: To report a case of secondary pigmentary glaucoma due to clofazimine treatment for extensive drug-resistant tuberculosis. CASE SUMMARY: A 23-year-old man presented with blurred vision in both eyes. The patient started to take clofazimine for extensive drug-resistant tuberculosis six months prior, after which his facial skin color changed to a dark-brown. Intraocular pressure (IOP) was 50 mm Hg in the right eye and 48 mm Hg in the left eye. Slit lamp examination revealed corneal edema, opacity, and flare in the anterior chamber in both eyes. A color vision test revealed a mild color defect in both eyes. Visual field (VF) test revealed superior temporal VF loss in the left eye. Gonioscopy revealed open angles with high pigmentation in the trabecular meshwork in both eyes. The patient was diagnosed with pigmentary glaucoma, and maximum tolerated medical therapy was performed. However, the IOP was uncontrolled. Trabeculectomy was performed in both eyes. Postoperative IOP was measured to be 12 mm Hg in both eyes without medication, and visual acuity measured 20/22 in the right eye and 20/17 in the left eye. CONCLUSIONS: To the best of our knowledge, this report is the first case of clofazimine being a possible cause of pigmentary glaucoma in a patient with extensive drug-resistant tuberculosis.
Anterior Chamber ; Clofazimine ; Color Vision ; Corneal Edema ; Glaucoma, Open-Angle* ; Gonioscopy ; Humans ; Intraocular Pressure ; Pigmentation ; Skin Pigmentation ; Slit Lamp ; Trabecular Meshwork ; Trabeculectomy ; Tuberculosis, Multidrug-Resistant* ; Visual Acuity ; Visual Fields ; Young Adult

PURPOSE: To compare the clinical and anterior segment anatomical features in primary angle closure sub-groups based on configurations of iris root insertion. METHODS: Primary angle closure patients were imaged using anterior segment optical coherence tomography. Anterior chamber depth, iris curvature, iris thickness (IT) at the scleral spur and 500, 750, and 1,500 µm from the scleral spur (IT(0), IT(500), IT(750), and IT(1500)), lens vault, iris area, angle opening distance (AOD(500)), angle recess area (ARA(750)), and trabecular iris space area (TISA(750)) were measured. Iris root insertion was categorized into a non-basal insertion group (NBG) and basal insertion group (BG). RESULTS: In total, 43 eyes of 39 participants belonged to the NBG and 89 eyes of 53 participants to the BG. The mean age of participants was greater in the NBG than the BG (62.7 ± 5.7 vs. 59.8 ± 7.3 years, p = 0.043), and the baseline intraocular pressure was higher in the BG than the NBG (16.4 ± 4.4 vs. 14.9 ± 3.3 mmHg, p = 0.037). The BG showed a greater IT(0) (0.265 ± 0.04 vs. 0.214 ± 0.03 mm, p < 0.001) and iris area (1.59 ± 0.24 vs. 1.52 ± 0.27 mm2, p = 0.045), lower ARA(750) (0.112 ± 0.08 vs. 0.154 ± 0.08 mm2, p = 0.017) and AOD(500) (0.165 ± 0.07 vs. 0.202 ± 0.08 mm, p = 0.014) compared to the NBG. CONCLUSIONS: The BG had a narrower anterior chamber angle, thicker peripheral iris, and higher pretreatment intraocular pressure.
Anterior Eye Segment/*diagnostic imaging ; Female ; Glaucoma, Angle-Closure/diagnosis/physiopathology/*surgery ; Gonioscopy ; Humans ; *Intraocular Pressure ; Iridectomy/*methods ; Iris/diagnostic imaging/*surgery ; Lens, Crystalline/diagnostic imaging ; Male ; Middle Aged ; Prospective Studies ; Tomography, Optical Coherence/*methods

PURPOSE: To report a case of hyphema after selective laser trabeculoplasty (SLT) in a patient with pseudoexfoliative glaucoma. CASE SUMMARY: A 77-year-old female was referred for elevation of intraocular pressure (IOP). Previously, she had been diagnosed with pseudoexfoliative glaucoma in the right eye and was using topical IOP-lowering agents. The best corrected visual acuity was 20/100 in the right eye and 20/40 in the left eye. IOP, measured with Goldmann applanation tonometer, was 32 mm Hg in the right eye and 20 mm Hg in the left eye. Gonioscopy revealed open-angle glaucoma with +2 trabecular meshwork pigmentation but without peripheral anterior synechiae or neovascularization. SLT was performed in the right eye. Two days later, the patient had sudden onset of blurred vision and pain in the right eye. Visual acuity was limited to light perception, and IOP was 34 mm Hg in the right eye. Slit-lamp examination revealed 1.1 mm hyphema with 4+ red blood cell count in the anterior chamber. Three weeks after the SLT, hyphema in the right eye disappeared, but IOP was measured to be 42 mm Hg. The patient underwent trabeculectomy in the right eye. CONCLUSIONS: SLT is an effective means of lowering IOP with low risk of complications. However, hyphema can rarely occur after SLT and can affect the outcome of the treatment.
Aged ; Anterior Chamber ; Erythrocyte Count ; Female ; Glaucoma ; Glaucoma, Open-Angle ; Gonioscopy ; Humans ; Hyphema* ; Intraocular Pressure ; Pigmentation ; Shiga Toxin 1 ; Trabecular Meshwork ; Trabeculectomy* ; Visual Acuity

PURPOSE: To investigate and compare the progression of medically treated primary open angle glaucoma according to the baseline intraocular pressure (IOP). METHODS: This study included a total of 345 eyes from 345 patients (mean follow-up period, 4.5 years). Eyes were classified into either conventional normal tension glaucoma (cNTG, < or =21 mmHg) or conventional high-tension glaucoma (cHTG, >21 mmHg) groups according to the conventional cut-off value of the IOP. Additionally, the median IOP (15 mmHg) was used to create two other groups (median NTG [mNTG] < or =15 mmHg and median HTG [mHTG] >15 mmHg). Using these values, 306, 39, 153, and 192 eyes were assigned to the cNTG, cHTG, mNTG, and mHTG groups, respectively. Glaucoma progression was determined either by optic disc/retinal nerve fiber layer photographs or serial visual field data. RESULTS: Mean reduction of IOP after medical treatment and of central corneal thickness was lower in the cNTG group, while the prevalence of disc hemorrhage and baseline visual field mean deviation did not differ between the cNTG and cHTG groups. A mean reduction in the IOP was observed after medical treatment, and central corneal thickness was lower in the mNTG group; disc hemorrhage was more frequent in the mNTG than in the mHTG group. Among the 345 analyzed eyes, 100 (29%) showed progression during the follow-up period. In the cHTG group, a higher baseline IOP (hazard ratio, 1.147; p = 0.024) was associated with glaucoma progression. Disc hemorrhage (hazard ratio, 15.533; p < 0.001) was also strongly associated with progression in the mNTG group. CONCLUSIONS: Baseline IOP was a significant risk factor for glaucoma progression in cHTG patients (10% of our total participants), while disc hemorrhage showed the strongest association with progression in the mNTG group, indicating that a cut-off value other than the conventional 21 mmHg is required to define true low-tension glaucoma in populations where NTG predominates among all glaucoma patients.
Aged ; Disease Progression ; Female ; Glaucoma, Open-Angle/*diagnosis ; Gonioscopy ; Humans ; Intraocular Pressure ; Low Tension Glaucoma/*diagnosis ; Male ; Middle Aged ; Nerve Fibers/pathology ; Optic Disk/pathology ; Optic Nerve Diseases/*diagnosis ; Photography/standards ; Retinal Ganglion Cells/pathology ; Retrospective Studies ; Tomography, Optical Coherence ; Tonometry, Ocular ; Vision Disorders/diagnosis ; Visual Field Tests/standards ; Visual Fields

No abstract available.
Chronic Disease ; Cryopyrin-Associated Periodic Syndromes/*complications/diagnosis ; Gonioscopy ; Humans ; *Intraocular Pressure ; Male ; Microscopy, Acoustic ; Middle Aged ; Ocular Hypertension/diagnosis/*etiology/physiopathology ; Rare Diseases