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Degree of Angle Closure and Extent of Peripheral Anterior Synechiae: An Anterior Segment OCT Study
  1. Daniel HW Su,
  2. David S Friedman,
  3. Jovina LS See,
  4. Paul TK Chew,
  5. Yiong-Huak Chan,
  6. Winnifred P Nolan,
  7. Scott D Smith,
  8. David Huang,
  9. Ce Zheng,
  10. Yan Li,
  11. Paul J Foster,
  12. Tin Aung (tin11{at}pacific.net.sg)
  1. Singapore National Eye Centre, Singapore
  2. 2.Wilmer Eye Institute and Johns Hopkins Bloomberg School of Public Health, United States
  3. National University Hospital, Singapore
  4. National University Hospital, Singapore
  5. Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  6. National University Hospital, Singapore
  7. Cole Eye Institute, United States
  8. Doheny Eye Institute, University of Southern California Keck School of Medicine, United States
  9. National University Hospital, Singapore
  10. 6. Doheny Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, United States
  11. Institute of Ophthalmology, London, United Kingdom
  12. Singapore National Eye Centre, Singapore

    Abstract

    Aims: To evaluate the relationship between angle width as determined by anterior segment optical coherence tomography (AS-OCT) and the presence of peripheral anterior synechiae (PAS).

    Methods: This was a prospective observational case series in which 203 subjects with primary angle closure or open angles were recruited. Images of the nasal, temporal and inferior angles were obtained with AS-OCT in dark conditions. Subjects then underwent gonioscopy by an independent examiner who was masked to the AS-OCT findings. PAS were identified by gonioscopy and defined as abnormal adhesions of the iris to the angle that were at least half a clock hour in width and present to the level of the anterior trabecular meshwork or higher. Total clock hours of PAS were recorded.

    Results: Sixty eight subjects (33.5%) were PACS, 76 subjects (37.4%) had PAC/PACG, 14 (6.9%) had primary open angle glaucoma and 45 (22.2%) subjects were normal with open angles. There was a weak, but significant correlation between the angle opening distance (AOD), trabecular iris space area (TISA) and angle recess area (ARA) with clock hours of PAS (Spearman's correlation coefficients = -0.30, -0.32 and -0.32 respectively, p<0.001). The mean values of the AOD, TISA and ARA in the nasal, temporal and inferior quadrants were significantly less in eyes with PAS compared to those without (p<0.001, Mann-Whitney U test). Analysis by quadrant showed that these parameters were smaller in the nasal and temporal quadrants in eyes with PAS (p<0.01).

    Conclusions: Angle width determined by AS-OCT and the extent of PAS were weakly correlated, and angle width was significantly smaller in eyes with PAS.

    • Angle width
    • Anterior segment optical coherence tomography
    • Peripheral anterior synechiae
    • Primary angle closure glaucoma

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