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Charles J. Pavlin, MD, FRCSC; Yvonne M. Buys, MD, FRCS; Thillainathan Pathmanathan, MBBChir, FRCS

Arch Ophthalmol. 1998;116:854-857.

Objectives  To evaluate the use of ultrasound biomicroscopy (UBM) in detecting ciliary zonular defects and to describe the UBM signs of such defects.

Methods  Eighteen eyes of 18 patients with clinically suspected zonular abnormalities were evaluated using UBM. Predisposing factors included pseudoexfoliation, congenital spherophakia, surgical procedure, trauma, and the Marfan syndrome.

Results  Of 18 eyes, 11 showed UBM evidence of missing zonules and 11 showed evidence of zonular stretch. Four of the 18 eyes had both missing and stretched zonular fibers. All of the eyes examined showed increased lenticular sphericity in the area of zonular disorder. Nine eyes showed ciliary body flattening. Pupillary block was seen in 5 patients, and angle crowding due to direct iridal rotation was noted in 3.

Conclusions  Ultrasound biomicroscopy can detect zonular loss and stretching directly. Increased lenticular sphericity and ciliary body flattening are signs of zonular defects. Angle closure mechanisms include pupillary block and direct iridal rotation.

From the Ocular Oncology Service, Department of Ophthalmology, Ontario Cancer Institute–Princess Margaret Hospital (Dr Pavlin), and the Department of Ophthalmology, The Toronto Hospital, University of Toronto (Drs Buys and Pathmanathan), Toronto, Ontario. The authors have no financial interest in the ultrasound biomicroscope.

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