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Assessment of Anterior Chamber Changes after Laser Peripheral Iridotomy using Anterior Segment OCT. Joshua C. Teichman, MD Richard Lee, MD Andrea Butler, BSc Thomas B. Klein, MD FRCSC Iqbal Ike K. Ahmed, MD FRCSC Department of Ophthalmology University of Toronto.

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assessment of anterior chamber changes after laser peripheral iridotomy using anterior segment oct

Assessment of Anterior Chamber Changes after Laser Peripheral Iridotomy using Anterior Segment OCT

Joshua C. Teichman, MD

Richard Lee, MD

Andrea Butler, BSc

Thomas B. Klein, MD FRCSC

Iqbal Ike K. Ahmed, MD FRCSC

Department of Ophthalmology

University of Toronto

Financial Disclosure: None of the authors have any financial interest in the contents of this poster.

background
Background
  • Gonioscopy is the gold standard for evaluating angle anatomy, and the results of laser peripheral iridotomy (LPI)
    • Subjective, semi-quantitative, affected by pressure and lighting, and difficult to perform
  • Anterior segment OCT (AS-OCT) may offer a precise, objective, non-contact alternative to gonioscopic evaluation
purpose
Purpose
  • To compare the anatomical changes that occur in the anterior chamber after laser peripheral iridotomy (LPI) using anterior segment optical coherence tomography (AS-OCT)
methods
Methods
  • Using AS-OCT 74 patients with closed or occludable angles, as determined clinically, were imaged before and after LPI
  • Low resolution scans of the horizontal and vertical meridians were obtained, as well as high resolution scans of all four quadrants
  • Scans were conducted in the dark
  • Patients who had previous surgery that would alter angle anatomy were excluded
data measures1
Data Measures

Anterior chamber depth (ACD)

Lens rise (LR:AC)

Iris convexity (IC)

results division into groups
Results - Division into Groups
  • Patients could be divided into two groups
    • Angles opened significantly after LPI, defined as a change in TIA of > 4°
    • Angles did not open significantly after LPI, defined as a change in TIA of < 4°
  • There were 37 patients in each group
pre and post lpi images
Pre and Post LPI Images

Minimal change in angle

after LPI

Significant change in

angle after LPI

conclusions
Conclusions
  • In the group of patients whose angles opened significantly after LPI (change in TIA of > 4°):
    • AOD500increased significantly
    • ICdecreased significantly
  • In the group of patients whose angles did not open significantly after LPI (change in TIA of < 4°):
    • No significant change in AOD500
    • IC decreased significantly
  • This may demonstrate that their narrow angles are likely due to a combined mechanism of pupil block and plateau iris
conclusions1
Conclusions
  • AS-OCT was useful in the objective measurement of iridocorneal angles before and after LPI
  • AS-OCT appears to be helpful in differentiating mechanisms of narrow angles:
    • Pupil block
    • Lens-related
    • Plateau iris
  • AS-OCT may be useful in predicting the effect of LPI preoperatively