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Session Title: Imaging I
Session Date/Time: Sunday 06/10/2013 | 14:30-16:00
Paper Time: 15:10
Venue: Elicium 1 (First Floor)
First Author: : E.Egorova RUSSIA
Co Author(s): : U. Fayzieva
Investigation of the anatomic topographic features of iridocilliary zone in patients with primary angle-closure glaucoma (PACG) in cases of pseudoexfoliative syndrome (PES) by means ultrasound biomicroscopy (UBM). The degree of PES manifestation was evaluated by UBM in accordance with classification by Egorova E.V. (2007)
The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia. The eye clinic at the Ministry of Heath of the Republic of Uzbekistan
93 Uzbek patients (176 eyes) with hyperopic type of eyes (axial length was 22.5 mm and less) have been selected for this investigation. The main group included 64 patients (122 eyes) with PACG and different degrees of lens opacity. Clinically PES symptoms were found by slit-lamp biomicroscopy only in 9 patients. The comparative group included 29 patients (54 eyes) without glaucoma and with clinical symptoms PES, and with transparent lens. The lens thickness was no statistically significant (р>0.1) differences between patients with PACG (5.13 ± 0.06 mm) and normal subjects (4.92 ± 0.05 mm). However, lens more anteriorly located in PACG group than in control group. The average age was not statistically significant in two groups and was 56±1.3 and 53±1.7 years, respectively. Complete ophthalmic examinations included measurement of visual acuity, Maklakov applanation tonometry, visual field testing, slit-lamp biomicroscopy, gonioscopy, A-scan biometry. Parameters of iridocilliary structures and area, volume, configuration of posterior chambers were measured by the UBM, model 840 (Zeiss-Humphrey Instruments), as well as ciliary zonules length, posterior chamber depth and cilliary sulcus length. The measurements were performed on the superior, lateral, inferior, and medial segments of iridocilliary zone.
The presence of flakes of pseudoexfoliative material was revealed on iridocilliary structures in all patients with PACG by means UBM. The pseudoexfoliative flakes were associated with zonule system weakness. Difference of cilliary zonule fibers length (0.2-0.7 mm) was revealed in various segments with an alteration of space correlation between iridocilliary structures. The asymmetry of iridocilliary structures parameters and disturbance of their topographic relationships have been found by UBM in cases of PES with zonules damage and let to a combination of eye blocks in one eye. In segments of cilliary zonule fibers stretching (0.68±0.02 mm) the UBM reflected a picture of relative pupillary block: the posterior chamber preserved a triangular form but its depth (0.65±0.01mm) was more than normal (0.58±0.01 mm). Sulcus cilliaris had not deviations from the norm and was 0.21±0.01mm. In opposite segment a sharp reduction of visualized cilliary zonule fibers (0.27±0.02 mm) was revealed. UBM reflected a picture of plateau iris syndrome: iris had a flat profile, processes of cilliary body were rotated forwards, closing the sulcus cilliaris. The posterior chamber maintained a triangular form, but its depth 0.46±0.1mm was less than norm (0.58±0.01 mm) and less than parameters of relative pupillary block (0.65±0.01mm).
PES was diagnosed in cases of PACG in Uzbek patients over 50 years independently of presence clinical symptoms by UBM. PES was accompanied by alterations of topographic relationships of iridocilliary zonule structures due to zonule system weakness. In these situations an appearance of intraocular blocks combination is possible: pupillary and block of plateau iris syndrome that requires differentially treatment of PACG. Lens phacoemulsification with foldable IOL implantation may be pathogenic operation in cases of eye blocks combinations in patients with PACG complicated with PES.
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