Yaisiri Panhathai, Panarojwongse Natthanose, Treesit Isaraporn, Choontanom Raveewan, Jatuthong Ornwasee, Iemsomboon Wallop, Funarunart Panrapee
Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand.
Clin Ophthalmol. 2025 Feb 27;19:699-711. doi: 10.2147/OPTH.S498949. eCollection 2025.
To compare the diagnostic accuracy of swept-source anterior segment optical coherence tomography (AS-OCT) with gonioscopy in detecting angle closure among narrow-angle suspected eyes.
A total of 125 eyes determined narrow anterior chamber angles suspected by Van Herick's technique grade 0, 1, or 2 were recruited. AS-OCT was undergone before any contact procedure. Intraocular pressure (IOP) measurements using applanation tonometry and gonioscopy were performed, respectively. AS-OCT images were blindly interpreted by 3 glaucoma specialists, involving both qualitative assessments at 0, 90, 180, and 270 degrees and quantitative analysis using iris-trabecular contact (ITC) index. The sensitivity and specificity of AS-OCT, compared with gonioscopy-the gold standard for identifying anterior chamber angle closure-were calculated.
The mean age was 61±12.9 years, and females constituted 67.6%. Eyes classified by Van Herick's technique as grade 0, 1 and 2 were 16%, 58.40%, and 25.60%, respectively. Closed-angle identified by gonioscopy and AS-OCT were 100 eyes (80%) and 102 eyes (81.60%), respectively. The sensitivity and specificity of AS-OCT in detecting angle-closure were 92.16% (95% CI, 87.44-96.87) and 73.91% (66.22-81.61), respectively. For angle-closure identified by ITC index ≥ 55%, sensitivity was 86.36% (77.53-95.20) and specificity was 92.86 (86.23-99.49). The inter-observer agreement of gonioscopy was moderate (Kappa = 0.55), while the intra-observer and inter-observer agreement of AS-OCT was substantial (Kappa = 0.71-0.80 and Kappa = 0.69, respectively).
AS-OCT enables a contactless qualitative and quantitative assessment of angle-closure in narrow-angle suspected eyes, demonstrating high sensitivity, acceptable specificity, and good inter-observer and intra-observer reliability.
比较扫频源眼前节光学相干断层扫描（AS-OCT）与前房角镜检查在窄角疑似眼中检测房角关闭的诊断准确性。
共纳入125只经范·赫里克技术判定为前房角狭窄可疑的眼睛，分级为0、1或2级。在进行任何接触性检查之前先进行AS-OCT检查。分别使用压平眼压计测量眼压并进行前房角镜检查。3位青光眼专家对AS-OCT图像进行盲法解读，包括在0、90、180和270度处的定性评估以及使用虹膜-小梁接触（ITC）指数进行定量分析。计算AS-OCT与前房角镜检查（用于识别前房角关闭的金标准）相比的敏感性和特异性。
平均年龄为61±12.9岁，女性占67.6%。经范·赫里克技术分类为0级、1级和2级的眼睛分别占16%、58.40%和25.60%。经前房角镜检查和AS-OCT检查确定为房角关闭的眼睛分别有100只（80%）和102只（81.60%）。AS-OCT检测房角关闭的敏感性和特异性分别为92.16%（95%CI，87.44-96.87）和73.91%（66.22-81.61）。对于ITC指数≥55%确定的房角关闭，敏感性为86.36%（77.53-95.20），特异性为92.86（86.23-99.49）。前房角镜检查的观察者间一致性为中等（Kappa=0.55），而AS-OCT的观察者内和观察者间一致性为高度一致（Kappa分别为0.71-0.80和0.69）。
AS-OCT能够对窄角疑似眼中的房角关闭进行非接触式定性和定量评估，具有高敏感性、可接受的特异性以及良好的观察者间和观察者内可靠性。
