Novel diagnostic indicators for acute angle closure secondary to lens subluxation based on anterior segment and lens parameters
Yizhen Tang,
Yan Gao,
Xiaowei Yu,
Hongyu Zhong,
Guanchen Gong,
Feng Mei,
Zhigang Fan,
Yan Shi
Affiliations
Yizhen Tang
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China; Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China
Yan Gao
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China; Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China
Xiaowei Yu
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China; Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China
Hongyu Zhong
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China; Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China
Guanchen Gong
Department of Ophthalmology, Zhangjiajie People's Hospital, Zhangjiajie, China
Feng Mei
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China; Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China
Zhigang Fan
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China; Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China; Corresponding author. Beijing Tongren Eye Center Research Ward, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China.
Yan Shi
Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, 100730, China; Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China; Corresponding author. Beijing Tongren Eye Center Research Ward, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Beijing Ophthalmology & Visual Sciences Key Laboratory, Capital Medical University, Beijing, 100730, China.
Purpose: To explore stable and sensitive indicators for clinical diagnosis of acute angle closure (AAC) secondary to lens subluxation (LS) through quantitative analysis of CASIA 2 imaging.Design: A prospective cross-sectional study. Methods: Setting: Clinical practice.Participants: 23 patients with unilateral acute angle closure secondary to lens subluxation and 23 cataract patients without lens subluxation were recruited. Lens subluxation was confirmed by ultrasound biomicroscope diagnosis. The contralateral eyes without LS served as fellow control group. The cataract eyes without LS were enrolled in blank control group.Intervention: Participants underwent ophthalmologic examinations including slit-lamp biomicroscope, best corrected visual acuity, intraocular pressure, central corneal thickness measurement, axial length, gonioscopy, ultrasound biomicroscope and 360-degree anterior chamber and crystalline lens scan protocols of CASIA 2 system.Main outcome measures: Automated circumferential anterior segment and lens morphological parameters under anterior segment optical coherence tomography were analyzed via three-dimensional analysis. Results: Significant differences were found in the front and back radius of the lens, the front and back radius of steep curvature of the lens, lens thickness, lens decentration, lens diameter, iris-trabecular contact (ITC) index, ITC area, anterior chamber depth (ACD), lens vault (LV), and iris volume between LS and controls. Among these parameters, LV, the anterior radius of steep curvature of the lens and ACD demonstrated the highest prediction power (AUC = 0.87, 0.89, and 0.86, respectively). The prediction power of tilt/axis was much higher in the Gaussian Naive Bayes model (AUCs = 0.90) than in the logistic model (AUCs = 0.74). Combination of LV_mean, LV_std, tilt and tilt axis in Gaussian Naive Bayes model presented as most stable and excellent diagnostic markers for AAC secondary to LS (AUCs = 0.98). Conclusions: The combination of markers including lens tilt and lens vault in the mathematic model facilitate clinical work as it not only provides novel diagnostic indications and possible prompt treatment for AAC secondary to lens subluxations, but also enhances our understanding of the pathogenic role of zonulopathy in angle closure glaucoma.
