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Ultrasonographic Biomicroscopy, Scheimpflug Photography, and Novel Provocative Tests in Contralateral Eyes of Chinese Patients Initially Seen With Acute Angle Closure
David S. Friedman, MD, MPH;
Gus Gazzard, MD;
Paul Foster, MD;
Joe Devereux, MD;
Aimee Broman;
Harry Quigley, MD;
James Tielsch, PhD;
Steve Seah, MD
Arch Ophthalmol. 2003;121:633-642.
Objectives To compare ocular biometry of the contralateral eyes of individuals seen with acute angle closure (AAC) with eyes of population-based control subjects, and to assess novel provocative tests to study the mechanism of AAC.
Design Prospective case-control study.
Participants Chinese persons seen as incident cases of AAC and Chinese population-based controls.
Methods Slitlamp assessment, ultrasonographic biomicroscopy, Scheimpflug photography, and provocative testing were performed.
Main Outcome Measures Ocular biometric parameters including anterior chamber depth, limbal anterior chamber depth, axial length, lens thickness, and radius of corneal curvature were obtained. Ultrasonographic biomicroscopy parameters that include the angle-opening distance at 500 µm and the angle-recess area were noted. Scheimpflug photography produced a single measure of angle width.
Results Contralateral eyes of cases of AAC had shorter axial lengths, shallower anterior chamber depths, thicker lenses, and steeper radii of corneal curvature (P<.01). After adjusting for age and sex, cases had a mean adjusted axial length that was 1.2 mm shorter, an optical anterior chamber depth that was 0.63 mm shallower (24% shallower than controls), and lenses that were, on average, 0.35 mm thicker (P<.01). Furthermore, using multiple logistic regression to adjust for age and sex, patients with primary angle-closure glaucoma were 19 times as likely to have a shallower limbal anterior chamber depth (25%; 95% confidence interval, 8.3-45.2). Adjusting for age and sex, the mean angle-opening distance at 500 µm was 0.14 U less for cases, with a mean of 0.26 U in controls, making the angle-opening distance at 500 µm, on average, 54% less among cases. Scheimpflug photographs revealed an adjusted angle width of 21.6° for controls and 15.1° for cases (P<.05). Dynamic testing showed that the angle of control eyes tended to shallow less when going from light to dark and tended to open more when given 1 drop of pilocarpine hydrochloride.
Conclusions Contralateral eyes of individuals having an AAC attack tend to be shorter and have more crowded anterior segments than those of healthy controls. These static measures of ocular biometry indicate why some individuals are predisposed to AAC. Dynamic measures of the response to luminance changes and pilocarpine therapy indicate that differential reactions to these stimuli are also associated with an AAC attack.
From the Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, Johns Hopkins Medical Institute (Drs Friedman, Quigley, and Tielsch and Ms Broman) and the Department of International Health, Johns Hopkins Bloomberg School of Public Health (Drs Friedman and Tielsch), Baltimore, Md; Singapore National Eye Centre (Drs Gazzard, Devereux, and Seah) and the Singapore Eye Research Institute (Drs Gazzard and Foster), Singapore, Republic of Singapore; and The Institute of Ophthalmology (Drs Gazzard and Foster), and the Glaucoma Research Unit, MoorfieldsEye Hospital (Dr Foster), London, England.
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