Transcript Iris morphology evalueted with Optical coherence tomography for

Iris Morphology Analisys with
Optical Coherence Tomography
for Anterior Segment:
Case report
MENDOZA-VELÁSQUEZ CRISTINA M.D., ARROYO-MUÑOZ LETICIA
M.D., GUERRERO-BERGER OSCAR M.D., MACÍAS-MARTÍNEZ JAIME
M.D.
.
FUNDACIÓN HOSPITAL NUESTRA SEÑORA DE LA LUZ. MEXICO
CITY
The authors have no financial interest in the subject
matter of this e-poster
BACKGROUND
Optical coherence tomography (OCT) was introduced in
1991 to image the posterior segment of the eye.
Recently, anterior segment OCT (AS-OCT) has become
available. It allows high-resolution, cross-sectional
images of the anterior segment and can be used in
various clinical situations: investigation of pathological
processes in the anterior segment, evaluation of chamber
angle configurations and measurement dimensions.
1
BACKGROUND
 Iris measurements and its morphology can be study with AS-OCT.
The results may graphically evidence the alterations in patients with
iris specifics features, described only clinically in the past, but now
observed and analyzed with a digital image.
 Benign prostatic hypertrophy (BPH) and pseudoexfoliation are two
pathologies in which are widely described changes in iris
morphology.
 BPH is a common urologic condition in older men that leads to
lower urinary tract symptoms. The usual treatments are the 5-alphareductase inhibitors and alpha-1-adrenergic receptor antagonists
(alpha-1ARA). The alpha-1ARAs, relax smooth muscle included
the iris. These patients had significantly decreased dilatator muscle
thickness and smaller pupil diameters.2
BACKGROUND
 In pseudoexfoliation, iris changes are an early and
consistent feature of the clinical examination.
Histologically, there is presence of degenerative changes
of the estroma , including the sphincter and dilator
muscles. Furthermore, we can observe posterior iris
pigment epithelium degeneration with focal membrane
ruptures.
OBJECTIVE
Analyze the iris morphology with AS-OCT of
patients with clinical alterations of the iris.
MATERIALS
 Noninterventional, cross-sectional study adhered to the
tenets of the Declaration of Helsinki. Written informed
consent was obtained from all subjects.
 We
prospectively
enrolled
6
patients
with
pseudoexfoliation syndrome and 1 with BPH. AS-OCT
were done in both eyes of all patients, evaluating 4 crosssectional iris (nasal, temporal, superior and inferior)
previous topical application of pilocarpine (4 %) 30
minutes before the study. All digital images were
analyzed.
MATERIALS
 Iris thickness was measured
dividing the iris in 3 parts
at the digital image
obtained in 4 crosssectional
iris
(third
external, middle and inner
temporal and nasal iris).
 We used ZEISS Visante
TM OCT Model 1000
(VisanteTM OCT software
version 2.0.
RESULTS
 We analyzed 6 patients with pseudoexfoliation and found that they
had slightly greater thickness at temporal iris external third, this area
corresponding iris sphincter area.
THICKNESS IRIS IN PSEUDOEXFOLIATION PATIENTS
EYE
TIL
NIL
TIET
TIMT
TIIT
NIET
NIMT
NIIT
0º
5.17
5.00
0.60
0.47
0.48
0.60
0.51
0.49
90º
5.22
4.90
0.61
0.46
0.40
0.68
0.52
0.43
0º
4.77
4.92
0.61
0.51
0.51
0.57
0.48
0.50
90º
5.00
4.94
0.58
0.48
0.49
0.60
0.50
0.48
RIGHT
LEFT
TIL:TEMPORAL IRIS LENGTH, NIL: NASAL IRIS LENGTH, TIET:TEMPORAL IRIS EXTERNAL THIRD, TIMT: TEMPORAL IRIS MIDDLE THIRD,
TIIT: TEMPORAL IRIS INTERNAL THIRD, NIET: NASAL IRIS EXTERNAL THIRD, NIMT: NASAL IRIS MIDDLE THIRD, NIIT: NASAL IRIS INTERNAL
THIRD.
RESULTS
1
 Iris thinning observed in the
middle and inner thirds, keeping
on whether a uniform thickness
throughout the whole extent of
the iris.
 FIGURE 1,2,3: AS-OCT of a
patient with pseudoexfoliation
syndrome, we could see the
homogeneous iris morphology
with slightly thickening in
external third.
2
3
RESULTS
We had 1 BPH patient with alpha-1ARA and found an increase in the thickness
greater than 0.1 mm in the external third, area corresponding to the iris
sphincter.
THICKNESS IRIS IN BPH PATIENT
EYE
TIL
NIL
TIET
TIMT
TIIT
NIET
NIMT
NIIT
0º
5.42
5.05
0.59
0.47
0.45
0.59
0.52
0.47
90º
5.78
5.5
0.67
0.46
0.45
0.75
0.46
0.45
0º
4.93
5.27
0.59
0.54
0.47
0.51
0.46
0.49
90º
5.56
5.4
0.67
0.45
0.42
0.69
0.52
0.4
RIGTH
LEFT
TIL:TEMPORAL IRIS LENGTH, NIL: NASAL IRIS LENGTH, TIET:TEMPORAL IRIS EXTERNAL THIRD, TIMT: TEMPORAL IRIS MIDDLE THIRD, TIIT:
TEMPORAL IRIS INTERNAL THIRD, NIET: NASAL IRIS EXTERNAL THIRD, NIMT: NASAL IRIS MIDDLE THIRD, NIIT: NASAL IRIS INTERNAL THIRD.
RESULTS
1
 In the figures 1, 2, 3 and 4 we
could observed the sphincter
area thicker than the rest of the
iris tissue.
2
3
 Observed areas of lower
density in thickened area in
black.
4
DISCUSSION
 There is a difference in iris morphology in patients with a history of
alpha-1ARA use as compared with pseudoexfoliation patients.
 We need expand the sample and have a control group with agematched patients. We have digital images of control group but we
continue the analyze for its.
 In this work we just want to show that the iris morphology is very
specific in patients with some pathology.
 There are no data in the literature regarding how iris measurements
with AS-OCT would correlate with the real iris thickness. However,
because all measurements were done using the same device and in
the same position for all patients, we believe that it would not
significantly alter our results.
 The AS-OCT is a widely used tool that provides rapid
and objective information regarding anterior segment
dimensions and angle configuration. We used it to
evaluate iris structural alterations.
REFERENCES
 1.Doors M., Berendschot T., Brabander J., Webers C.,
Nuijts R. Value of optical coherence tomography for anterior
segment surgery. J. Cataract Refract Surg 2010; 36:1213–1229.
 2.Prata T., Palmiero P.M., Angelilli A., Sbeity Z., De
Moraes C.G., Liebmann J., Ritch R.
Iris Morphologic
Changes Related to alpha-1-Adrenergic Receptor Antagonists.
Implications for Intraoperative Floppy Iris Syndrome.
Ophthalmology 2009;116:877–881.
 3.Schlotzer-Schrehardt U., Naumann G. Ocular and
Systemic Pseudoexfoliation Syndrome. Am J Ophthalmol
2006;141: 921–937.
 E-mail: [email protected]