Anterior Chamber Angle Imaging with Swept-Source Optical Coherence Tomography: Measuring Peripheral Anterior Synechia in Glaucoma – Corrected Proof

Objective: To investigate the use of swept-source optical coherence tomography (OCT) for measuring the area and degree of peripheral anterior synechia (PAS) involvement in patients with angle-closure glaucoma. Design: Cross-sectional study. Participants: Twenty-three eyes with PAS (detected by indentation gonioscopy) from 20 patients with angle-closure glaucoma (20 eyes had primary angle-closure glaucoma and 3 eyes had angle-closure glaucoma secondary to chronic anterior uveitis [n = 2] and Axenfeld–Rieger syndrome [n = 1]). Methods: The anterior chamber angles were evaluated with indentation gonioscopy and imaged by swept-source OCT (Casia OCT, Tomey, Nagoya, Japan) in room light and in the dark using the “angle analysis” protocol, which was composed of 128 radial B-scans each with 512 A-scans (16-mm scan length). The area and degree of PAS involvement were measured in each eye after manual detection of the scleral spur and the anterior irido-angle adhesion by 2 masked observers. The interobserver variability of the PAS measurements was calculated. Main Outcome Measures: The agreement of PAS assessment by gonioscopy and OCT, the area and the degree of PAS involvement, and the intraclass correlation coefficient (ICC) of interobserver PAS measurements. Results: The area of PAS (mean ± standard deviation) was 20.8±16.9 mm2 (range, 3.9–74.9 mm2), and the degree of PAS involvement was 186.5±79.9 degrees (range, 42–314 degrees). There was no difference in the area of PAS (P = 0.90) and the degree of PAS involvement (P = 0.95) between images obtained in room light and in the dark. The interobserver ICCs were 0.99 (95% confidence interval [CI], 0.98–1.00) for the area of PAS and 0.99 (95% CI, 0.97–1.00) for the degree of PAS involvement. There was good agreement of PAS assessment between gonioscopy and OCT images (kappa = 0.79; 95% CI, 0.67–0.91). Conclusions: Swept-source OCT allows visualization and reproducible measurements of the area and degree of PAS involvement, providing a new paradigm for evaluation of PAS progression and risk assessment for development of angle-closure glaucoma. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.