Ultrasonographic biomicroscopy, Scheimpflug photography, and novel provocative tests in contralateral eyes of Chinese patients initially seen with acute angle closure.
OBJECTIVE
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.


METHODS
Prospective case-control study.


METHODS
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.


METHODS
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 micro m 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 microm was 0.14 U less for cases, with a mean of 0.26 U in controls, making the angle-opening distance at 500 microm, on average, 54% less among cases. Scheimpflug photographs revealed an adjusted angle width of 21.6 degrees for controls and 15.1 degrees 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.
Friedman
David S
DS
Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, Johns Hopkins Medical Institute, Baltimore, MD, USA. David.Friedman@jhu.edu
Gazzard
Gus
G
Foster
Paul
P
Devereux
Joe
J
Broman
Aimee
A
Quigley
Harry
H
Tielsch
James
J
Seah
Steve
S
D000208:Acute Disease; D000867:Anterior Chamber / Q000000981:diagnostic imaging / Q000473:pathology; D044466:Asian People; D001699:Biometry; D003315:Cornea / Q000000981:diagnostic imaging / Q000473:pathology; D005123:Eye / Q000473:pathology*; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000208:ethnology / Q000473:pathology*; D006068:Gonioscopy; D006801:Humans; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D008916:Miotics / Q000008:administration & dosage; D010781:Photography; D010862:Pilocarpine / Q000008:administration & dosage; D011446:Prospective Studies; D012846:Singapore / Q000453:epidemiology; D014129:Trabecular Meshwork / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography
D008916:Miotics; D010862:Pilocarpine