Ruiz Department of Ophthalmology and Visual Science, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
Robert Cizik Eye Clinic, Houston, TX.
J Glaucoma. 2020 Nov;29(11):1036-1042. doi: 10.1097/IJG.0000000000001664.
PRéCIS:: The potential parameters for differentiating pupillary block (PB) from plateau iris configuration (PIC) on anterior segment optical coherence tomography (ASOCT) are lens/pupil size parameters and angles. Further study is needed to determine a landmark peripheral to the centroid of the iris.
Investigate anterior segment parameters to distinguish between 2 mechanisms of angle closure, PB and PIC, using swept-source Fourier domain ASOCT.
Retrospective ASOCT images from narrow angle eyes were reviewed. PIC was defined either by ultrasound biomicroscopy and/or clinically when an iridoplasty was performed. Images were read by a masked reader using Anterior Chamber Analysis and Interpretation software to identify scleral spur landmarks and calculate anterior chamber, peripheral angle, iris size, iris shape, and lens/pupil size parameters. ASOCT parameters were summarized and compared using the 2-sample t test. Thresholds and area under receiver operating characteristic curve were calculated using logistic regression analysis.
One hundred eyes (66 PB and 34 PIC) of 100 participants were reviewed. Of all ASOCT parameters, iris length in each quadrant, pupil arc, lens/pupil parameters (pupil arc, lens vault, and pupil diameter), all pupillary margin-center point-scleral spur landmark (PM-C-SSL) parameters, and all except superior central iris vault parameters were significantly different between PB and PIC. On threshold evaluation, lens/pupil parameters had the greatest area under receiver operating characteristic curve values (0.77 to 0.80), followed by PM-C-SSL angles (0.71 to 0.75).
We propose that the pupil size parameters and PM-C-SSL angle are the most reliable novel ASOCT parameters to distinguish between PB and PIC eyes. These parameters do not rely on the visibility of the posterior iris surface, which is difficult to identify with ASOCT, but may be ambient lighting dependent.
目的：使用扫频源傅里叶域光学相干断层扫描（ASOCT）研究眼前节参数，以区分瞳孔阻滞（PB）和房角关闭（PIC）两种机制。
患者和方法：回顾窄角眼的 ASOCT 图像。通过超声生物显微镜和/或当进行虹膜成形术时临床诊断 PIC。图像由一位使用前房分析和解释软件的掩蔽读者进行阅读，以识别巩膜突标志物并计算前房、周边角、虹膜大小、虹膜形状和晶状体/瞳孔大小参数。使用两样本 t 检验总结和比较 ASOCT 参数。使用逻辑回归分析计算阈值和受试者工作特征曲线下面积。
结果：共回顾了 100 名参与者的 100 只眼（66 只 PB 和 34 只 PIC）。在所有 ASOCT 参数中，每个象限的虹膜长度、瞳孔弧、晶状体/瞳孔参数（瞳孔弧、晶状体穹窿和瞳孔直径）、所有瞳孔缘-中心点-巩膜突标志物（PM-C-SSL）参数以及除了上中央虹膜穹窿参数在 PB 和 PIC 之间均有显著差异。在阈值评估中，晶状体/瞳孔参数的受试者工作特征曲线下面积值最大（0.77 至 0.80），其次是 PM-C-SSL 角度（0.71 至 0.75）。
结论：我们提出，瞳孔大小参数和 PM-C-SSL 角度是区分 PB 和 PIC 眼的最可靠的新型 ASOCT 参数。这些参数不依赖于 ASOCT 难以识别的后虹膜表面的可见性，但可能依赖于环境光照。
