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ObjectiveTo predict the presence of Angle Dysgenesis on Anterior Segment Optical Coherence Tomography (ADoA) using deep learning and to correlate ADoA with mutations in known glaucoma genes.DesignA cross-sectional observational study.ParticipantsEight hundred, high definition anterior segment optical coherence tomography (ASOCT) B-scans were included, out of which 340 images (One scan per eye) were used to build the machine learning (ML) model and the rest were used for validation of ADoA. Out of 340 images, 170 scans included PCG (n=27), JOAG (n=86) and POAG (n=57) eyes and the rest were controls. The genetic validation dataset consisted of another 393 images of patients with known mutations compared with 320 images of healthy controlsMethodsADoA was defined as the absence of Schlemm’s canal(SC), the presence of extensive hyper-reflectivity over the region of trabecular meshwork or a hyper-reflective membrane (HM) over the region of the trabecular meshwork. Deep learning was used to classify a given ASOCT image as either having angle dysgenesis or not. ADoA was then specifically looked for, on ASOCT images of patients with mutations in the known genes for glaucoma (MYOC, CYP1B1, FOXC1andLTBP2).Main Outcome measuresUsing Deep learning to identify ADoA in patients with known gene mutations.ResultsOur three optimized deep learning models showed an accuracy > 95%, specificity >97% and sensitivity >96% in detecting angle dysgenesis on ASOCT in the internal test dataset. The area under receiver operating characteristic (AUROC) curve, based on the external validation cohort were 0.91 (95% CI, 0.88 to 0.95), 0.80 (95% CI, 0.75 to 0.86) and 0.86 (95% CI, 0.80 to 0.91) for the three models. Amongst the patients with known gene mutations, ADoA was observed among all the patients withMYOCmutations, as it was also observed among those withCYP1B1, FOXC1and withLTBP2mutations compared to only 5% of those healthy controls (with no glaucoma mutations).ConclusionsThree deep learning models were developed for a consensus-based outcome to objectively identify ADoA among glaucoma patients. All patients withMYOCmutations had ADoA as predicted by the models.

To evaluate the presence of angle dysgenesis on ASOCT (anterior segment optical coherence tomography) (ADoA) as a predictive factor in determining outcomes of selective laser trabeculoplasty (SLT).A prospective clinical cohort study.Patients with juvenile-onset open-angle glaucoma (JOAG) without angle dysgenesis on gonioscopy.JOAG patients with uncontrolled intraocular pressure (IOP), who were to undergo SLT, were evaluated for the presence or absence of ADoA, which was defined as the absence of Schlemm's canal (SC) and/or presence of a hyperreflective membrane (HM) over the trabecular meshwork, as identified on ASOCT before the SLT procedure. Furthermore, the number of ASOCT B-scans in which SC was identified as present, were then quantified. Success of SLT was defined as a reduction of IOP by 20% or more from pre-laser value at 6-month follow-up without any further IOP-lowering medication or surgery. Only 1 repeat SLT was admissible for defining SLT success over the 6-month period. A successful reduction in IOP at 6-month follow-up was correlated with the extent of ADoA.In comparison to pre-SLT IOP, 57.1% eyes (20/35) showed more than 20% reduction in IOP at 6 months with a mean reduction of 7.6 ± 1.8 mm Hg (29.6%). When all 3 observers agreed, SC was identified in 90% eyes (18/20) with success vs 26.6% eyes (4/15) with failure (P.001). All eyes (5/5) with presence of HM showed failure (P.001). All eyes (19/19) in which SC was present in50% ASOCT B scans (25/50 scans/eye) showed success (P.001). On a bias-reduced regression analysis, the identification of SC on any 2 consecutive scans increased the chances of success at 6 months by 8.3 times, whereas the identification of SC in50% of ASOCT scans was associated with a 21.4 times greater chance of success.The presence of SC on ASOCT is a strong predictor for successful IOP reduction after SLT in JOAG eyes.

Purpose: To report a case of bilateral congenital stromal iris cyst in a neonate. Observations: A one-month-old male child was brought with complaints of watering in both eyes and enlargement of the left eye since birth. Examination under anesthesia revealed an elevated IOP in both the eyes. The left eye had buphthalmos with hazy cornea and central corneal scarring. Ultrasound biomicroscopy revealed the presence of a stromal cyst in both the eyes and a cataractous lens in the left eye. While the right eye responded to topical glaucoma medications, the left eye continued to have a high IOP and hence, it was managed surgically. Conclusions and Importance: This rare case of bilateral stromal iris cyst in a neonate presented with a unique diagnostic and management challenge.

A 28-year-old male presented to retina clinic with complains of blurring and distortion in right eye for past 1 week. There was history of implantation of phakic intraocular lens (pIOL) bilaterally 4 months back. Ophthalmic examination revealed a full-thickness macular hole in the right eye. Pars plana vitrectomy with inverted internal limiting membrane flap was planned. Post-operatively, patient had a good gain in vision (20/40) with closure of the hole. Macular hole is an unusual complication of pIOL. A detailed pre-operative fundus screening is indispensable. Early presentation and timely intervention can optimize the visual outcome.