JinWoo Park, HwangGyun Kim, SangWoo Park

1
Ultrasound Biomicroscopic Evaluation of Changes
after Glaucoma Triple Procedure in Eyes with
Primary Angle-Closure Glaucoma

• Jin-Woo Park, Hwang-Gyun Kim, Sang-Woo Park
• Department of Ophthalmology, Chonnam National
  University Medical School Hospital, Gwangju,
  Korea

2
Introduction

• To evaluate morphological changes of anterior
  segments after glaucoma triple procedure by
  comparing with trabeculectomy in eyes with
  primary angle-closure glaucoma (PACG) using
  ultrasound biomicroscopy (UBM).

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Material and Methods

• Thirty-six eyes with PACG were enrolled in this
  study. Nineteen eyes had been undergone triple
  procedures and seventeen eyes trabeculectomy
  only. We measured the parameters of anterior
  segment before and after each procedures by using
  UBM(Model 840, Zeiss-Humphrey Instruments Inc.,
  San Leandro, California, USA). Each patient was
  examined in a supine position with illuminated
  conditions by single examiner. We scanned 3
  position of the anterior chamber angle(3,6 and 9
  o'clock). The images were analyzed using
  Image-pro plus 4.0 (Media Cybernetics, Silver
  Spring, MD) software program.

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Figure 1. The parameters of the UBM were anterior
chamber depth (ACD), trabecular ciliary process
distance (TCPD), iris-ciliary process distance
along TCPD line (ICPD), iris thickness along TCPD
line (ID), scleral ciliary process angle (SCPA),
scleral iris angle (SIA).
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Figure 2. Angle-opening distance (AOD) was
measured on the line perpendicular to the
trabecular meshwork at a point 500 ?m from the
scleral spur. The trabecular-iris angle (?1) was
measured with the iris recess and the arms of the
angle passing through a point on the trabecular
meshwork 500 ?m from the scleral spur and the
point on the iris perpendicularly opposite.
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Figure 3. Angle recess area (ARA) was bounded by
corneal endothelium out to a distance of 750 ?m
from the scleral spur, trabecular meshwork and
anterior iris surface point perpendicular to the
trabecular meshwork at a point 750 ?m from the
scleral spur.
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Results

• In trabeculectomy group ACD, AOD500, and ARA
  parameters were statistically significantly
  increased (Table 2). In glaucoma triple
  procedures group, except ICPD and ID, all
  parameters statistically significantly increased
  (Table 3).

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Table 1. Patients dermographics
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Table 2. Preoperative and postoperative UBM
parameters in trabeculectomy group.
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Table 3. Preoperative and postoperative UBM
parameters in triple group
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Figure 4. Preoperative and postoperative UBM
findings of type B angle-closure glaucoma in
trabeculectomy group. In type B angle-closure
glaucoma, iridocorneal contact starts from iris
root.

• Preop.

• Postop.

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Figure 5. Preoperative and postoperative UBM
findings of type B angle-closure glaucoma in
glaucoma triple operation group.

• Preop.

• Postop.

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Figure 6. Preoperative and postoperative UBM
findings of type S angle -closure glaucoma in
trabeculectomy group. In type S angle-closure
glaucoma, iridocorneal contact occurred at the
vicinity of Schwalbes line and still remained
narrow space at the bottom of the angle.

• Preop.

• Postop.

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Figure 7. Preoperative and postoperative UBM
findings of type S angle-closure glaucoma in
glaucoma triple operation group.

• Preop.

• Postop.

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Conclusions

• UBM showed indirect evidence that ciliary body
  process position was moved back and deepening of
  anterior chamber depth and widening of angle was
  observed in triple procedure group, but widening
  of angle and deepening of anterior chamber depth
  could be observed without change of ciliary body
  position in trabeculectomy group.