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PURPOSE To elucidate clinical factors related to the presence of loculation of fluid (LOF) in the posterior choroid in central serous chorioretinopathy (CSC). DESIGN Retrospective, cross-sectional study. METHODS This single-center study included 158 eyes from 158 patients with CSC who were classified into LOF and non-LOF groups. The groups were compared for age, sex, spherical equivalent, axial length, subfoveal choroidal thickness (SCT), and scleral thickness. Using swept-source optical coherence tomography (OCT), we determined the presence of LOF based on B-scan and en face images. Scleral thickness was measured 6 mm posterior to the scleral spur in four directions using anterior segment OCT. RESULTS The 158 eyes were classified into 98 eyes in the LOF group and 60 eyes in the non-LOF group. In univariable analyses, the LOF group was younger (P = .01) and had a higher male ratio (P = .03) and greater SCT (P < .001) than the non-LOF group. All scleral thicknesses at the superior, temporal, inferior, and nasal points were greater in the LOF group than in the non-LOF group (426.2 μm vs. 395.1 μm, 445.7 μm vs. 414.9 μm, 459.2 μm vs. 428.8 μm, 445.4 μm vs. 414.3 μm, all P < .05). Multivariable analyses found that SCT (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.02, P < .001) and mean scleral thickness (OR: 1.02, 95% CI: 1.02-1.03, P = .002) were significantly associated with the presence of LOF. CONCLUSION A thick choroid and thick sclera appeared to be related to the presence of LOF in CSC.

Purpose To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC). Design Prospective, observational study. Participants Six hundred forty-three mainland Chinese with untreated PACS. Methods Participants underwent baseline clinical examinations, including gonioscopy, anterior segment OCT (AS-OCT) imaging, and A-scan ultrasound biometry as part of the Zhongshan Angle Closure Prevention (ZAP) Trial. Primary angle closure suspect was defined as an inability to visualize pigmented trabecular meshwork in 2 or more quadrants based on static gonioscopy. Primary angle closure was defined as development of intraocular pressure above 24 mmHg or peripheral anterior synechiae. Progression was defined as development of PAC or an AAC attack. Multivariable logistic regression models were developed to assess biometric risk factors for progression. Main Outcome Measures Six-year progression from PACS to PAC or AAC. Results Six hundred forty-three untreated eyes (609 nonprogressors, 34 progressors) of 643 participants were analyzed. In a multivariable model with continuous parameters, narrower horizontal angle opening distance of 500 μm from the scleral spur (AOD500; odds ratio [OR], 1.10 per 0.01-mm decrease; P = 0.03), flatter horizontal iris curvature (IC; OR, 1.96 per 0.1-mm decrease; P = 0.01), and older age (OR, 1.11 per 1-year increase; P = 0.01) at baseline were associated significantly with progression (area under the receiver operating characteristic curve [AUC], 0.73). Smaller cumulative gonioscopy score was not associated with progression (OR, 1.03 per 1-modified Shaffer grade decrease; P = 0.85) when replacing horizontal AOD500 in the multivariable model. In a separate multivariable model with categorical parameters, participants in the lowest quartile of horizontal AOD500 (OR, 3.10; P = 0.002) and IC (OR, 2.48; P = 0.014) measurements and 59 years of age or older (OR, 2.68; P = 0.01) at baseline showed higher odds of progression (AUC, 0.72). Conclusions Ocular biometric measurements can help to risk-stratify patients with early angle closure for more severe disease. Anterior segment OCT measurements of biometric parameters describing the angle and iris are predictive of progression from PACS to PAC or AAC, whereas gonioscopy grades are not.

PURPOSE To compare anterior segment and angle parameters between pseudoexfoliation syndrome (PEX) and PEX glaucoma (PEXG) and normal control subjects using anterior segment optical coherence tomography (AS-OCT) imaging. DESIGN Cross-sectional study. METHODS One hundred and two subjects with PEXG, PEX, and normal eyes as the control group were recruited from an academic referral institution. All subjects underwent a complete ophthalmologic examination, axial length measurement, and AS-OCT imaging. Anterior segment and angle parameters were evaluated. RESULTS After excluding 4 eyes because of poor imaging of the scleral spur, data from 34 eyes with PEXG, 33 eyes with PEX, and 31 eyes of normal control subjects were analyzed. Anterior chamber depth was significantly shallower in eyes with PEXG compared with eyes of control subjects (P < .001). The differences in anterior chamber angle parameters (AOD500, AOD750, TISA500,and TISA750) were significant among study groups, with lower values in the PEXG group compared with the PEX and control subject groups. Lens vault (mean [mm]±SD) was higher in the PEXG (0.46 ±0.21) and PEX (0.427 +0.28) groups compared with the control group (0.305+ 0.20). CONCLUSIONS PEXG eyes have the narrowest anterior chamber angle parameters. There is a progressive decrease in angle parameters from control subjects to the PEX group to the PEXG group. Narrow anterior chamber angle and anterior chamber depth may have a role in the progression of PEX to PEXG. Detection of narrow angle in these patients may help clinicians manage the disease more properly.

To assess the anterior scleral thickness (AST) and describe the presence of a visible supraciliary space (SCS) in central serous chorioretinopathy (CSC) patients by swept-source optical coherence tomography (SS-OCT). Cross-sectional comparative study. Three groups were studied: 1) 64 eyes of 54 patients with CSC with persistent subretinal fluid (SRF); 2) 42 fellow eyes of CSC patients without SRF; 3) 65 eyes of 65 controls matched by age, sex and axial length (AL). The AST was measured in the temporal and nasal quadrants at 0, 1, and 2 mm from the scleral spur by SS-OCT. The presence of a visible SCS was also assessed. No differences were observed in the AST0 among the three groups (p≥ 0.665). The temporal AST1 was significantly thicker in the CSC group (530.3 ±67.1 µm) than in the controls (505.5 ±73.9; p=0.041). Mean AST2 was also thicker in the CSC group and the fellow eyes both for the temporal (519.4 ±89.1 µm and 519.8 ±98.5 µm respectively) and nasal quadrants (564.2 ±124.9 µm and 570.5 ±131.0 µm) than in the controls (450.1 ±76.8 and 473.3 ±111.6 µm) (all p≤0.001). A visible SCS was detected in the eyes of 8 CSC patients, in 4 fellow eyes and only in 1 control eye. AST measured by SS-OCT was significantly greater in CSC eyes than in healthy eyes. Also, a visible SCS was detected in CSC eyes. Thus, thicker sclera in CSC eyes could be associated with the physiopathology of this disease.

PURPOSE: To compare the iris parameters (iris thickness [IT] and volume) measured at different locations on iris determined using iris base (IB) and scleral spur (SS) in healthy Saudi eyes and factors affecting the differences. METHODS: Healthy eyes of Saudi persons were evaluated using anterior segment optical coherence tomography (AS-OCT). The IT was measured using Image J software and OCT scans in the horizontal axis in light on and light off condition. First IB was used as reference, and then, SS was used as reference for these measurements. RESULTS: One hundred healthy eye's AS-OCT scan was studied. The IT at the temporal side of the horizontal axis at 750 μ away from IB with lights on was 0.526 ± 0.08 μ, whereas it was 0.52 ± 0.08 μ from SS. The difference was significantly more in IB than SS method (P = 0.005). This difference if IT in SS and IB method was not affected by gender (Mann–Whitney P = 0.3), type of refractive error (K W P = 0.7), and level of illumination (K W P = 0.7). CONCLUSION: IT and IV measured using IB provided reliable data but overestimates compared to SS method. In the absence of SS visibility, IB could be alternative to assess iris parameters.

A cyclodialysis cleft is a rare disease that is produced as a result of a separation of the longitudinal fibers of the ciliary body muscle from the scleral spur. A stepwise approach is the best course of action to treat cyclodialysis, starting with medical therapy and continuing with more invasive surgical options. We report a case of ocular hypotony due a traumatic cyclodialysis successfully resolved with transscleral cryotherapy.

PURPOSE: To assess anatomic changes after laser peripheral iridotomy (LPI) and predictors of angle widening based on anterior segment (AS) OCT and angle opening based on gonioscopy. DESIGN: Prospective observational study. PARTICIPANTS: Primary angle-closure suspects (PACSs) 50 to 70 years of age. METHODS: Participants of the Zhongshan Angle Closure Prevention (ZAP) Trial underwent gonioscopy and AS-OCT imaging at baseline and 2 weeks after LPI. Primary angle-closure suspect was defined as the inability to visualize pigmented trabecular meshwork in 2 or more quadrants on static gonioscopy. Laser peripheral iridotomy was performed on 1 eye per patient in superior (between 11 and 1 o'clock) or temporal or nasal locations (at or below 10:30 or 1:30 o'clock). Biometric parameters in horizontal and vertical AS-OCT scans were measured and averaged. Linear and logistic regression modeling were performed to determine predictors of angle widening, defined as change in mean angle opening distance measured at 750 μm from the scleral spur (AOD750); poor angle widening, defined as the lowest quintile of change in mean AOD750; and poor angle opening, defined as residual PACS after LPI based on gonioscopy. MAIN OUTCOME MEASURES: Anatomic changes and predictors of angle widening and opening after LPI. RESULTS: Four hundred fifty-four patients were included in the analysis. Two hundred nineteen underwent superior LPI and 235 underwent temporal or nasal LPI. Significant changes were found among most biometric parameters (P < 0.006) after LPI, including greater AOD750 (P < 0.001). One hundred twenty eyes (26.4%) showed residual PACS after LPI. In multivariate regression analysis, superior LPI location (P = 0.004), smaller AOD750 (P < 0.001), and greater iris curvature (P < 0.001), were predictive of greater angle widening. Temporal or nasal LPI locations (odds ratio [OR], 2.60, P < 0.001) was predictive of poor angle widening. Smaller mean gonioscopy grade (OR, 0.34, 1-grade increment) was predictive of poor angle opening. CONCLUSIONS: Superior LPI location results in significantly greater angle widening compared with temporal or nasal locations in a Chinese population with PACS. This supports consideration of superior LPI locations to optimize anatomic changes after LPI.

PurposeTo evaluate the performance of swept source optical coherence tomography (SS-OCT) to detect gonioscopic angle closure using different classification algorithms.MethodsThis was a cross-sectional study of 2028 subjects without ophthalmic symptoms recruited from a community-based clinic. All subjects underwent gonioscopy and SS-OCT (Casia, Tomey Corporation, Nagoya, Japan) under dark room conditions. For each eye, 8 out of 128 frames (22.5° interval) were selected to measure anterior chamber parameters namely anterior chamber width, depth, area and volume (ACW, ACD, ACA, and ACV), lens vault (LV), iris curvature (IC), iris thickness (IT) from 750 µm and 2000 µm from the scleral spur, iris area and iris volume. Five diagnostic algorithms—stepwise logistic regression, random forest, multivariate adaptive regression splines, recursive partitioning and Naïve Bayes were evaluated for detection of gonioscopic angle closure (defined as ≥2 closed quadrants). The performance of the horizontal frame was compared with that of other meridians.ResultsData from 1988 subjects, including 143 (7.2%) with gonioscopic angle closure, were available for analysis. They were divided into two groups: training (1391, 70%) and validation (597, 30%). The best algorithm for detecting gonioscopic angle closure was stepwise logistic regression with an area under the curve of 0.91 (95% CI 0.88 to 0.93) using all parameters, and 0.88 (95% CI 0.82 to 0.93) using only ACA, LV and IC of the horizontal meridian scan.ConclusionsA stepwise logistic regression model incorporating SS-OCT measurements has a high diagnostic ability to detect gonioscopic angle closure.

To assess anterior segment anatomic parameters in school-aged children with spontaneously regressed retinopathy of prematurity (sr-ROP) and in children born preterm without ROP history (preT). sr-ROP and preT children were compared with healthy, born at term children (control group). Biometric characteristics were measured with the IOLMaster. Iridocorneal angle structure was evaluated using Visante AS-OCT, and angle opening distance, trabecular iris space area and scleral spur angle were calculated. Best-corrected visual acuity (BCVA) was measured with the ETDRS chart. We examined 22 eyes of 11 children with sr-ROP, 26 eyes of 13 preT children and 24 eyes of 12 healthy controls, with a median age of 8 years. sr-ROP children exhibited worse mean BCVA and reduced AL compared to controls (p = 0.001 and p = 0.007, respectively). A narrower iridocorneal angle was found in sr-ROP compared to the preT and the control groups. Preterm children were found to have similar anterior chamber angle metrics compared to the full-term control group. In this study, school-aged children with a history of sr-ROP had narrower angles compared to preterm- and term-born children. AS-OCT demonstrated structural differences of the iridocorneal angle in sr-ROP, possibly reflecting a mild developmental arrest of the anterior segment.

Clinical relevance: Given the association of scleral characteristics with many ophthalmological diseases, there is an important need to measure the anterior scleral thickness (AST).Background: This study examined the AST by swept-source optical coherence tomography (SS-OCT) in a large healthy population, assessing also the reproducibility of AST measurements and the correlation with different parameters.Methods: Cross-sectional study in 605 eyes of 605 subjects. AST measurements were made in the temporal and nasal quadrants at 1 (AST1) and 3 mm (AST3) from the scleral spur using SS-OCT. These dimensions were then assessed for associations in a multivariate model with the factors age, sex, refractive error, conjunctival-Tenon capsule thickness (CTT), anterior chamber angle (ACA), intraocular pressure (IOP), iris thickness (IT), limbus-sulcus distance (LSD), and ciliary muscle thickness (CMT). The reproducibility of the AST measurements was determined in 30 of the participants.Results: The mean age was 42.6 ± 17.3 years (range 5 to 86 years). The following means were recorded: AST1 was 522.3 ± 65.7 µm (355 to 761) and 558.4 ± 71.5 µm (357 to 889); AST2 was 513.3 ± 67.3 µm (343 to 732) and 574.4 ± 71.6 µm (389 to 789), and AST3 548.8 ± 71.9 µm (356 to 762) and 590.1 ± 76.6 µm (414 to 873) in the temporal and nasal quadrants respectively, being thicker the nasal quadrant (all p < 0.001). A positive correlation was detected between AST and age, sex, temporal ACA and LSD (all p ≤ 0.043), being negative the correlation with CMT (p ≤ 0.044). No correlation was observed between AST measurements and refractive error, CTT and IT (p ≥ 0.064). The reproducibility of AST measurements was excellent (intraclass correlation coefficient ≥0.951).Conclusions: SS-OCT allows for in vivo AST measurements. Our data contained a wide range of measurements, showing an association between AST and age, sex, ACA, LSD and CMT.

AimsTo validate a deep learning (DL) algorithm (DLA) for 360° angle assessment on swept-source optical coherence tomography (SS-OCT) (CASIA SS-1000, Tomey Corporation, Nagoya, Japan).MethodsThis was a reliability analysis from a cross-sectional study. An independent test set of 39 936 SS-OCT scans from 312 phakic subjects (128 SS-OCT meridional scans per eye) was analysed. Participants above 50 years with no previous history of intraocular surgery were consecutively recruited from glaucoma clinics. Indentation gonioscopy and dark room SS-OCT were performed. Gonioscopic angle closure was defined as non-visibility of the posterior trabecular meshwork in ≥180° of the angle. For each subject, all images were analysed by a DL-based network based on the VGG-16 architecture, for gonioscopic angle-closure detection. Area under receiver operating characteristic curves (AUCs) and other diagnostic performance indicators were calculated for the DLA (index test) against gonioscopy (reference standard).ResultsApproximately 80% of the participants were Chinese, and more than half were women (57.4%). The prevalence of gonioscopic angle closure in this hospital-based sample was 20.2%. After analysing a total of 39 936 SS-OCT scans, the AUC of the DLA was 0.85 (95% CI:0.80 to 0.90, with sensitivity of 83% and a specificity of 87%) to classify gonioscopic angle closure with the optimal cut-off value of >35% of circumferential angle closure.ConclusionsThe DLA exhibited good diagnostic performance for detection of gonioscopic angle closure on 360° SS-OCT scans in a glaucoma clinic setting. Such an algorithm, independent of the identification of the scleral spur, may be the foundation for a non-contact, fast and reproducible ‘automated gonioscopy’ in future.

BACKGROUND/OBJECTIVES: To evaluate biometric changes throughout the anterior chamber during accommodation and presbyopia using single image acquisition swept-source anterior-segment optical coherence tomography (AS-OCT). SUBJECT/METHODS: Anterior-segment images were obtained using a new swept-source AS-OCT device (ANTERION, Heidelberg Engineering) from healthy volunteers (n = 71) across two centers in this prospective observational case series. In one image acquisition, cornea through posterior lens, including the ciliary muscle on both sides of the right eye, was imaged. Subjects undertook no accommodative effort and −1, −3, and −5 D of target vergence. Two-way repeated measures ANOVA modeling was performed for ciliary muscle measurements, lens parameters, aqueous depth (AD), and pupil diameter (PD). The first ANOVA factor was accommodative stimuli, and the second factor included age and refractive status. RESULTS: Maximum ciliary muscle thickness increased with accommodative stimuli (p

Summary Purpose To compare the anterior segment optical coherence tomography (AS-OCT) measurements of eyes with pigment dispersion syndrome (PDS) and ocular hypertension (OHT) before and after neodymium:yttrium-aluminum-garnet (Nd:YAG) laser peripheral iridotomy (LPI). Methods A total of 23 eyes of 23 patients with PDS and OHT with features of PDS were included in this retrospective study. All of the eyes with PDS and OHT were examined by AS-OCT before and after Nd:YAG LPI. Anterior chamber depth, angle opening distance 500, angle opening distance 750, trabecular iris space 500, trabecular iris space 750 and scleral spur angle, iris bowing and iris shape were measured with AS-OCT by the same examiner. Results The differences in all parameters before and after Nd:YAG LPI were statistically significant. Iris configuration was concave in all eyes prior to iridotomy. After Nd:YAG laser iridotomy, the iris configuration became convex in 7 eyes, flat in 9 eyes and remained concave in 7 eyes. Conclusion Nd:YAG laser peripheral iridotomy is an effective method for reversing the iris concavity and iris bowing in pigment dispersion syndrome.

Purpose: Obtaining a better understanding of the pathogenesis of primary angle-closure disease (PACD) still requires studies that provide measurements of anterior and posterior biometric characteristics together and that assess the relationship between them. Methods: In total, 201 eyes were enrolled in this cross-sectional study: 50 normal controls, 49 primary angle-closure suspect (PACS), 38 primary angle closure (PAC), and 64 primary angle-closure glaucoma (PACG) eyes. The anterior and posterior structural features were measured by anterior segment optical coherence tomography and swept-source optical coherence tomography. Results: All PACD groups had smaller anterior chamber depth (ACD), anterior chamber area (ACA), anterior chamber volume (ACV), angle opening distance at 750 μm from the scleral spur (AOD750), trabecular–iris space area at 750 μm from the scleral spur (TISA750), and angle recess area (ARA), as well as a larger lens vault (LV), than controls (all P < 0.001). The PACS and PAC groups had thicker iris thickness at 750 μm from the scleral spur (IT750) than controls (P = 0.017 and P = 0.002, respectively). Choroidal thickness (CT) was not statistically different among normal, PACS, PAC, and PACG eyes. Univariate and multivariate linear regression analysis revealed a significant association between thinner IT750 and increased CT in PACD eyes (P = 0.031, univariate analysis; P = 0.008, multivariate analysis). Conclusion: Thinner iris thickness was associated with increased CT in PACD eyes; however, the underlying mechanism needs further investigation.

Purpose. This study investigated how a conscious change in ocular accommodation affects intraocular pressure (IOP) and ocular biometrics in healthy adult volunteers of different ages. Methods. Thirty-five healthy volunteers without ocular disease or past ocular surgery, and with refractive error between −3.50 and +2.50 diopters, were stratified into 20, 40, and 60 year old (y.o.) age groups. Baseline measurements of central cornea thickness, anterior chamber depth, anterior chamber angle, cornea diameter, pupil size, and ciliary muscle thickness were made by autorefraction and optical coherence tomography (OCT), while IOP was measured by pneumotonometry. Each subject’s right eye focused on a target 40 cm away. Three different tests were performed in random order: (1) 10 minutes of nonaccommodation (gazing at the target through lenses that allowed clear vision without accommodating), (2) 10 minutes of accommodation (addition of a minus 3 diopter lens), and (3) 10 minutes of alternating between accommodation and nonaccommodation (1-minute intervals). IOP was measured immediately after each test. A 20-minute rest period was provided between tests. Data from 31 subjects were included in the study. ANOVA and paired t-tests were used for statistical analyses. Results. Following alternating accommodation, IOP decreased by 0.7 mmHg in the right eye when all age groups were combined ( p = 0.029). Accommodation or nonaccommodation alone did not decrease IOP. Compared to the 20 y.o. group, the 60 y.o. group had a thicker ciliary muscle within 75 μm of the scleral spur, a thinner ciliary muscle at 125–300 μm from the scleral spur, narrower anterior chamber angles, shallower anterior chambers, and smaller pupils during accommodation and nonaccommodation ( p ’s

Purpose: This study was designed to determine whether the anterior scleral thickness is affected by axial elongation and to investigate the association between anterior scleral thickness and various ocular parameters in myopic eyes. Methods: This cross-sectional study included 79 healthy myopic participants. Anterior scleral thickness was measured in 8 meridians (superior-nasal, superior, superior-temporal, temporal [T], inferior-temporal, inferior [I], inferior-nasal, and nasal [N]) using anterior segment optical coherence tomography. Bruch’s membrane opening (BMO) area, width of β-parapapillary atrophy with and without Bruch’s membrane (PPA+BM and PPA−BM), and the global peripapillary and subfoveal choroidal thickness were additionally measured. Age- and sex-adjusted partial correlation analysis and linear regression analysis were performed to examine the effects of axial length and various ocular parameters on anterior scleral thickness in myopic eyes. Results: The mean age of the included participants was 27.03 ± 2.70 years. Overall, the anterior scleral thickness varied topographically according to the meridians and distance from the scleral spur. In the partial correlation analysis controlled for the effect of age and sex, increasing axial length was related to anterior scleral thinning at several measurement points along the T, I, and N meridians. Among the several ocular parameters, multivariate linear regression analysis with age, sex, and axial length as covariates revealed that central corneal thickness, intraocular pressure, and BMO area were significantly associated with anterior scleral thickness. Conclusion: In conclusion, there was a close relationship between the anterior scleral thickness and several ocular parameters in myopic eyes. These features should be taken into consideration when managing myopia, and our results might have important implications for understanding the pathogenesis of scleral changes during axial elongation.

Objective of surgery The indications for CyPass trimming are based on the standard protocol for endothelial protection of the Department of Ophthalmology at the Dietrich Bonhoeffer Hospital Neubrandenburg. The CyPass stent should be shortened to a maximum reach up to the scleral spur. Indications The indications for CyPass trimming are based on two main criteria: the position of the CyPass in relation to the structures of the anterior chamber angle and the presence of corneal endothelial cell loss. Contraindications There are no contraindications. Surgical technique The operation shown in the video available online is performed with the patient under local anesthesia. The incisions are created individually and depend on the position of the CyPass stent. Through a 1.2 mm corneal paracentesis opposite to the stent, the anterior chamber is filled with a cohesive viscoelastic material and the stent is stabilized with a 20-gauge vitreous forceps and then cut with 20-gauge bent vitreous scissors through another 1.4-1.8 mm paracentesis, 3-4 h away from the stent visualized by gonioscopy. In some cases, surgical goniosynechiolysis in the area of the stent is required. The anterior end of the stent is cut as deep as possible. After aspiration of the viscoelastic material and possibly blood, the anterior chamber is toned with balanced salt solution (BSS) and the paracenteses are hydrated. Corneal suturing is not necessary. Results Up to November 2019 65 CyPass stents in 64 eyes have been trimmed using this method. Iridodialysis occurred in 1 eye, in 12 eyes slight self-limiting bleeding and in 2 eyes an iris defect. Conclusion The procedure shown enables a safe microsurgical shortening of the CyPass stent with few complications. The risk of intraoperative expulsive bleeding or postoperative fistulation is markedly reduced.

This study compared the test–retest variabilities and measurement agreement of anterior chamber angle (ACA) dimensions measured by two anterior segment swept-source optical coherence tomography (SS-OCT)—the ANTERION (Heidelberg Engineering, Heidelberg, Germany) and CASIAII (Tomey, Nagoya, Japan). Thirty-eight subjects, 18 patients with primary angle closure and 20 healthy participants with open angles, were included. The mean age was 54.7 ± 15.8 years (range: 26–75 years). One eye of each subject was randomly selected for anterior segment imaging by ANTERION and CASIAII, using the same scan pattern (6 evenly spaced radial scans across the anterior segment for three times) in the same visit. The between- and within-instrument agreement and repeatability coefficients of angle open distance (AOD500), trabecular-iris space area (TISA500), lens vault (LV), scleral spur-scleral spur distance (SSD), anterior chamber depth (ACD), and pupil diameter (PD) were measured. The anterior and posterior boundaries of the cornea, iris, and lens were automatically segmented by the SS-OCT instruments; the scleral spur was manually located by a single masked observer. There were significant differences between ANTERION and CASIAII measurements; the SSD, PD, and ACD were smaller whereas AOD500 and TISA500 were greater in ANTERION compared with CASIAII (P 2 ranged between 0.866 and 0.998) although the between-instrument agreement was poor; the spans of 95% limits of between-instrument agreement were ≥ 1.5-folds than the within-instrument agreement for either instrument. Whereas both SS-OCT instruments showed low test–retest measurement variabilities, the repeatability coefficients of AOD500, TISA500, ACD, and PD were slightly smaller for CASIAII than ANTERION (P ≤ 0.012).

PURPOSE The aim of this study was to analyze the predictive value of swept-source optical coherence tomography (SS-OCT) derived anterior-segment volumetric parameters such as anterior chamber volume (ACV) in the long-term follow-up of primary angle closure disease (PACD). DESIGN Longitudinal observational study. METHODS In this single-center longitudinal observational study, PACD patients undergoing laser peripheral iridotomy (LPI) were recruited. Anterior segment images of the patients were captured using SS-OCT before LPI, and at 1 week, 1 month, 3 months, 6 months, and 1 year after LPI. Ninety eyes of 81 subjects were enrolled, and 72 eyes of 72 subjects finished the 1 year follow-up. Data of all the 81 subjects were included for analysis. Intraocular pressure (IOP) elevation was defined as IOP >21 mm Hg at any time point after LPI. The association between baseline trabecular-iris space area 750 μm from scleral spur (TISA750), ACV and iris volume (IV), and IOP elevation were analyzed using logistic regression. RESULTS Eighty-one subjects were included, 59 were female, and 22 were male, with a mean age of 60.98± 9.44 years. IOP elevation appeared in 14 eyes. Mean TISA750 was negatively associated with IOP elevation (OR = 0.94, P = 0.02). The correlation of TISA750 with IOP elevation varies across quadrants and there was only significant association in temporal TISA750 (OR = 0.98, P = 0.046), whereas in the other 3 quadrants, there was no significant association. Greater ACV was associated with lower risk of IOP elevation (OR = 0.80, P = 0.031), whereas IV was not associated with IOP elevation. CONCLUSIONS ACV is a reliable and accurate predictor for the outcome of PACD. Due to its 3-dimensional nature, the robustness of ACV is greater than traditional angle width parameters such as TISA750.

PReCIS:: Angle location of the XEN implant both in isolated and in combined procedures did not appear to influence long-term outcomes. However, more posterior stent placements seem to be associated with increased early postoperative complications. Purpose The purpose of this study was to assess success and safety outcomes of different levels of insertion of the XEN45 gel stent in the angle in standalone and combined procedures. Methods This was a cross-sectional study of patients in whom XEN had been implanted without intraoperative gonioscopy. Automated gonioscopy was used for postoperative analysis of the XEN location, classified as anterior or posterior relative to the scleral spur. Absolute success was defined as ≥20% intraocular pressure decrease from baseline and ranging from 6 to 21 mm Hg without medication and qualified success if medicated. The need for additional drainage surgery was considered failure, but needling was allowed. Clinical data were retrieved from patient files. Results Gonioscopy-assisted XEN location was performed on 42 eyes of 33 patients (14 isolated and 28 combined procedures) on average 18±9 months after surgery. Absolute (32% vs. 35%; P>0.99) and qualified (44% vs. 65%; P=0.22) success was similar in both anterior and posterior placements, respectively. Kaplan-Meier survival analysis yielded similar median survival times for both groups. The distribution of XEN insertion level in the angle was similar in standalone and combined procedures (P=0.75). Although overall safety outcome measures did not differ significantly, the proportion of intraoperative and early postoperative complications was higher in posterior XEN placements (P=0.03). Conclusions Different locations of XEN45 did not seem to significantly impact late success and safety outcomes, although stents inserted more posteriorly may be associated with a higher rate of early complications. Combined implantation of XEN with phacoemulsification does not seem to influence stent location in the iridocorneal angle in a setting without intraoperative gonioscopy.

PRECIS Iridotrabecular contact (ITC), a measure of angle closure, can be quantified along with other angle parameters on anterior segment optical coherence tomography (ASOCT). Hence, angle changes and angle closure mechanisms can be detected predicting the efficacy of iridotomy. PURPOSE To assess 360-degree ITC and ocular parameter changes, after laser peripheral iridotomy (LPI), in primary angle-closure disease (PACD) subgroups. METHODOLOGY This was a prospective observational study including 90 subjects, 30 each of primary angle-closure suspect (PACS), primary angle closure (PAC), and primary angle-closure glaucoma (PACG). Anterior segment OCT parameters were measured before and 3 weeks after LPI ITC: central anterior chamber depth, lens vault, angle-opening distance, angle recess area, trabecular iris space area, trabecular iris angle at 500 and 750 μm from scleral spur. RESULTS ITC was highest in PACG, 81.43%±22.39%, followed by PAC, 28.53%±21.30%, and PACS, 10.76%± 8.54% (P=0.011). There was a significant decrease in ITC in all 3 groups after iridotomy (P

Background To quantitatively assess anterior chamber angle (ACA) structure by anterior segment optical coherence tomography (AS-OCT) and develop a model to evaluate angle width as defined by gonioscopy. Methods The ACAs of each quadrant were evaluated by gonioscopy, classified by the Scheie grading system, and assigned into one of the three grades: small angle (SA), moderate angle (MA), and large angle (LA). The eyes were imaged by AS-OCT, and ACA structural parameters including angle opening distance at the scleral spur (AODSS) and at 750 μm anterior to the scleral spur (AOD750), trabecular-iris space area at 750 μm anterior to the scleral spur (TISA750), and a newly defined parameter “light intersection distance” (LID), were measured. The ACA structural data were used to construct an ordered logistic regression model for assignment of ACAs to one of the three angle grades. The validity of the model was then tested. Results A total of 169 quadrants from 53 subjects were included in the analysis, of which 111 quadrants were included in the modeling data and 58 in the testing data. In pairwise comparisons of SA, MA, and LA by ANOVA, the measured parameters were as follows: AOD750 (0.174 ± 0.060 vs. 0.249 ± 0.068 vs. 0.376 ± 0.114 mm; P 2; P P Conclusions The AS-OCT-based multiple ACA grades model was demonstrated as a non-contact approach for ACA assessment with high speed and high spatial resolution, providing guidance for diagnosis of angle closure.

Glaucoma is the second leading cause of blindness in the adult population of India. Diagnosis and management depends on categorization of Glaucoma into open or closed angle. : To compare the accuracy of Gonioscopy and Anterior Segment Optical Coherence Tomography (ASOCT) in studying the structures of anterior chamber angle of the eye and find out the agreement between them in detecting angle closure. Cross -sectional observational study. The present study is a hospital based cross-sectional study of patients between 20 to 80 years of age with Glaucoma attending the outdoor patient department in a tertiary care government hospital (New civil hospital), Surat. Patients having Corneal Opacity, and anti-Glaucoma surgeries done were excluded. All diagnosed cases of Glaucoma were evaluated by Gonioscopy in the dark with a Goldman 3 mirror lens Gonioscope at high (16x) magnification for static assessment (without indentation). A narrow slit beam, 2mm* 1mm, was cast during Gonioscopy, avoiding direct illumination over the pupil. The angle in each quadrant was graded with the Shaffer grading system. Anterior Segment OCT was done by TOPCON 3D OCT-1 MAESTRO machine. Imaging was performed in dark room conditions. Patients were imaged gazing straight ahead. Imaging of a single meridional section of the Anterior Chamber Angle at superior, inferior, temporal and nasal quadrants were performed. Grading of Anterior Chamber Angles on AS-OCT is termed as Closed if there is no visualization of Scleral Spur and/or any degree of irido-trabecular contact. kappa value, sensitivity & specificity, positive & negative likelihood ratio. Total 50 Glaucoma patients were examined by Gonioscopy and AS OCT. Total number of Angles examined were 400. Total number of Angles closed on Gonioscopy were 136 (34%). Total number of Angles closed on AS OCT were 190 (47.5%). Agreement between Gonioscopy and AS OCT in detecting angle closure in all 4 quadrants was ‘Moderate to Good’ by Kappa Value.

This study evaluated age-related trabecular meshwork (TM) height variations in the eyes of adults in different age groups. We hypothesised that a reduction in TM occurs with increasing age. This retrospective, cross-sectional, observational study was conducted at Yonsei University Gangnam Severance Hospital between January 2015 and June 2019. We randomly included 250 eyes of 125 patients who underwent anterior segment optical coherence tomography (AS-OCT). The distance from the scleral spur to Schwalbe’s line in patients with normal open anterior chamber angle was measured using AS-OCT. Results were stratified based on patients’ age group—≤40, 41–50, 51–60, 61–70, 71–80, and 81–92 years. Thereafter, the results were compared among the age groups. The mean TM height of the patients was 770.929 ± 76.776 μm. TM height was 853.188 ± 94.117 μm in patients aged ≤40 years; it was 815.309 ± 75.723, 798.115 ± 66.040, 770.942 ± 52.774, 726.716 ± 63.979, and 715.968 ± 63.403 μm in patients aged 41–50, 51–60, 61–70, 71–80, and 81–92 years, respectively. The TM height tended to decrease with increasing age (P

To compare the reproducibility and agreement of anterior chamber angle (ACA) parameters and metrics obtained by four different anterior segment-optical coherence tomography (AS-OCT) devices. In this prospective study, 30 eyes from 15 normal subjects underwent anterior segment angle scanning using the Spectralis, Cirrus, and Optovue spectral domain optical coherence tomography (SD-OCT), as well as the Visante time-domain optical coherence tomography (TD-OCT). For each eye, the scan line was performed perpendicularly on the inferior (270°) angle, and the inferior ACA image was acquired 2 times. Inter-instrument and intra-instrument, as well as inter-observer and intra-observer reproducibility of anterior chamber angle metrics, Schwalbe’s line (SL) to scleral spur (SS) distance (TM-Span), angle opening distance (AOD), and trabecular iris space area (TISA) measurements, were evaluated by intraclass correlation coefficients (ICCs) and Bland-Altman plots with limits of agreement (LoA). For this cohort of 30 eyes of 15 normal subjects, the mean TM-Span, AOD, and TISA were 0.966 ± 0.198 mm, 0.750 ± 0.205 mm, and 0.286 ± 0.090 mm2 from the Spectralis; 0.929 ± 0.113 mm, 0.717 ± 0.120 mm, and 0.267 ± 0.095 mm2 from the Cirrus; 0.923 ± 0.191 mm, 0.683 ± 0.161 mm, and 0.265 ± 0.072 mm2 from the Optovue; and 0.970 ± 0.070 mm, 0.705 ± 0.150 mm, and 0.279 ± 0.065 mm2 from the Visante. The intra-instrument (ICCs > 0.838), intra-grader (ICCs > 0.910), and inter-grader (ICCs > 0.869) agreement were good. Agreement between the four instruments was also good with ICCs from 0.901 to 0.967 for TM-Span, 0.887 to 0.941 for AOD, and 0.923 to 0.961 for TISA. Consistent and reproducible ACA measurements could be obtained from multiple AS-OCT devices including both SD- and TD-OCT instruments. These findings have relevance when considering multiple imaging devices in future studies.

Purpose To investigate the diagnostic capability of scleral spur length in discriminating eyes with primary open-angle glaucoma (POAG) from healthy eyes. Methods Seventy-eight eyes of 78 patients with POAG and 93 eyes of 93 age-, sex- and axial length-matched healthy subjects were included. The scleral spur length was measured using swept-source optical coherence tomography. Receiver operating characteristic (ROC) curves were derived based on the measurements. Results The scleral spur length was significantly shorter in POAG eyes compared with healthy eyes (Method I, 164.91 ± 23.36 vs. 197.60 ± 25.32 μm; Method II, 145.15 ± 16.59 vs. 166.95 ± 19.31 μm; Method III, 162.33 ± 22.83 vs. 185.12 ± 23.58 μm, respectively; all p p p = 0.009) groups. Conclusions The scleral spur length had a good discriminating capability between POAG and healthy eyes, and it could be a novel biomarker for POAG evaluation clinically.

Purpose To characterize the relationship between mean and sectoral variation of anterior chamber angle (ACA) width using anterior segment (AS)-OCT. Design Cross-sectional study with sectoral variation of anterior chamber angle width as the main outcome measure. Participants Participants 50 years of age or older were identified from the Chinese American Eye Study (CHES), a population-based epidemiologic study in Los Angeles, California. Methods Participants underwent a complete ocular examination including gonioscopy and AS-OCT imaging. Primary angle-closure disease (PACD) was defined as inability to visualize pigmented trabecular meshwork in 3 or more quadrants. Four AS-OCT images from 1 eye per participant were analyzed, and parameters describing ACA width were measured at 500 and 750 μm from the scleral spur: angle opening distance (AOD500 and AOD750), trabecular iris space area (TISA500 and TISA750), and scleral spur angle (SSA500 andSSA750). The relationship between mean and sectoral variation of ACA width was assessed using locally weighted scatterplot smoothing (LOWESS) regression, change-point analyses, and Spearman correlation coefficients. Results Six hundred seventy-four eyes (337 with PACD, 337 without PACD) from 674 participants were analyzed. Overall, sectoral variation of ACA width decreased as mean ACA width decreased. This relationship was divided into 2 phases based on the change-point analysis. Sectoral variation of ACA width was correlated strongly and significantly (P Conclusions Correlations between mean and sectoral variation of ACA width strengthen as the severity of angle narrowing worsens. This relationship likely reflects anatomic changes related to chronic angle closure and may be relevant for refining current definitions and management of PACD.

Purpose: To quantitatively assess anterior chamber and angle parameters by anterior segment optical coherence tomography (AS-OCT) in myopic eyes undergoing Implantable Collamer Lens (ICL V4c) implantation. Methods: Prospective noncomparative observational case series. Pre and postoperative (1st and 3rd month) AS-OCT angle parameters (anterior chamber depth [ACD], anterior chamber angle [ACA], Angle opening distance [AOD], trabecular iris space area [TISA], scleral spur angle [SSA]) were evaluated in 32 eyes (16 patients). SPSS version 20 with paired t-test for intragroup and Mann-Whitney U value test for intergroup comparisons. Results: It included 6 (37.5%) males and 10 (62.5%) females. Preoperative ACA of 34.6 ± 2.3° reduced to 32.2 ± 2.4°, 31.9 ± 2.5° at 1 and 3 months postoperatively (P = 0.001). Preoperative mean AOD500, AOD750, TISA500, TISA750, SSA of 0.34 ± 0.06 mm, 0.52 ± 0.15 mm, 0.09 ± 0.02 mm2, 0.20 ± 0.04 mm2, 34.27 ± 4.6° decreased to 0.32 ± 0.06 mm, 0.48 ± 0.15 mm, 0.08 ± 0.02 mm2, 0.17 ± 0.05 mm2, 32.5 ± 4.3° at 1-month (P = 0.001); 0.32 ± 0.06 mm, 0.47 ± 0.13 mm, 0.08 ± 0.02 mm2, 0.17 ± 0.05 mm2 and 32.4 ± 4.6° (P = 0.001) at 3-months, respectively. Correlation analysis between preoperative ACD/intraocular pressure (IOP) was − 0.62 (P = 0.0002) [1st month], −0.40 (0.024) [third month]; between IOP/postoperative ACA, AOD500, AOD750, TISA500, TISA750, SSA was − 0.04 (0.81), −0.03 (0.85), −0.08 (0.64), −0.12 (0.48), −0.10 (0.57), −0.06 (0.73) at 1 month; −0.09 (0.58), 0.04 (0.78), 0.12 (0.48), −0.02 (0.9), −0.04 (0.79), 0.02 (0.88) at 3 months; between ICL vault/ACA, AOD500, AOD750, TISA500, TISA750, SSA was 0.38 (0.02), 0.24 (0.17), 0.21 (0.25), 0.05 (0.75), 0.15 (0.41), 0.27 (0.13) at 1st month; 0.19 (0.28), 0.06 (0.71), −0.03 (0.85), 0.005 (0.97), 0.05 (0.78), 0.07 (0.68) at 3rd month. Conclusion: Postoperatively significant angle narrowing was noted. There was a negative correlation between IOP and preoperative ACD. There was no significant correlation between IOP and ICL vault with postoperative AS-OCT angle parameters.

During blunt ocular trauma, the anteroposterior compressive forces confronted lead to consequent equatorial expansion of the globe. This may result in ciliary body trauma, typically manifesting as angle recession or cyclodialysis. The authors hypothesize that a likely asymmetric contraction between the longitudinal and circular ciliary fibers, and an intrinsic weak "oblique buffer zone" creates a plane of separation between the 2, resulting in angle recession. When stronger forces are met with, the equatorial expansion of the sclera may outperform the ability of the ciliary body to follow it, and the taut longitudinal ciliary fibers may subsequently disinsert from the scleral spur causing cyclodialysis. In addition to this, the routinely thought dismembering aqueous jets directed toward the angle may also accentuate ciliary body trauma. Therefore, the vivid distractive external forces along with the complex ciliary muscle anatomy and differential functionality may play a crucial role in causation of post-traumatic angle recession and cyclodialysis.

PURPOSE To quantitatively analyze the angle anatomy in eyes with a Boston type 1 keratoprosthesis (KPro) using anterior segment optical coherence tomography (AS-OCT) and to assess the diagnostic ability of AS-OCT in KPro-associated glaucoma. METHODS AS-OCT (RTVue) images from KPro eyes with and without glaucoma were reviewed. The angle opening distance at 500 μm from the scleral spur (AOD500), trabecular-iris angle at 500 μm from the scleral spur (TIA500), and trabecular-iris surface area at 500 μm from the scleral spur (TISA500) were measured by 2 observers masked to the diagnosis. The measurements for each visible quadrant were compared between KPro eyes with and without glaucoma. RESULTS Twenty-two eyes with glaucoma and 17 eyes without glaucoma from 39 patients with KPro were included. Of the 4 quadrants imaged, the temporal angle was the most visible (79.5%) and angle measurements of the temporal quadrant were the only ones that differentiated the 2 groups: the mean AOD500, TIA500, and TISA500 were significantly lower in KPro eyes with glaucoma than without glaucoma (388.2 ± 234.4 μm vs. 624.5 ± 310.5 μm, P = 0.02; 26.1 ± 14.0 degrees vs. 39.1 ± 17.1 degrees, P = 0.03; and 0.15 ± 0.09 mm vs. 0.23 ± 0.12 mm, P = 0.03; respectively). The highest area under the receiver operating characteristic curve for detecting glaucoma was 0.75 for temporal TIA500 (95% confidence interval 0.57-0.94, P = 0.02) with 50% specificity at 80% of sensitivity and a cutoff value of 37 degrees. CONCLUSIONS The temporal angle was the most visible on AS-OCT in eyes with a KPro. Significant narrowing of the temporal angle detected on AS-OCT was associated with glaucoma in these eyes.

Purpose: To evaluate the effects of age on the morphologies of the crystalline lens, ciliary muscle (CM), Schlemm’s canal (SC), and trabecular meshwork (TM) using swept-source optical coherence tomography (SS-OCT).Methods: Images of the crystalline lens and iridocorneal angle were obtained in healthy participants’ eyes using SS-OCT. Morphological parameters of the crystalline lens, CM, and TM/SC were measured, and the relationship between these parameters and age was evaluated.Results: A total of 62 healthy participants were enrolled, with an age range of 7–79 years. With adjustments for the effects of axial length and sex, both the nasal and temporal SC cross-sectional areas (CSA) and the cross-sectional area of the CM (CMA), distance from the scleral spur to the inner apex of the ciliary muscle (IA-SS), and nasal SC volume were negatively correlated with age (P ≤ 0.041). Meanwhile, the lens thickness (LT) (P < 0.001) and lens vault (LV) (P < 0.001) were positively correlated with age, and the radius of the curvature of the anterior lens (ALR) was negatively correlated with age (P < 0.001).Conclusion: Increasing age was associated with a thicker crystalline lens, a steeper anterior lens curvature, an anteriorly located and smaller CM, and a narrower SC.Clinical Trial Registration:https://register.clinicaltrials.gov/prs/app/action/Select Protocol?sid=S000A3JZ&selectaction=Edit&uid=U00019K7&ts=4&cx=-c5xxp8, identifier [NCT04576884].

PURPOSE To analyze anatomical factors contributing to angle closure based on anterior segment optical coherence tomography (AS-OCT) imaging. METHODS A total of 238 patients with angle closure and 1122 normal controls were consecutively recruited for this study. Participants' eyes were imaged using AS-OCT under the same darkened ambient light conditions. The following parameters were analyzed: central anterior chamber depth (ACD); anterior chamber area (ACA); anterior chamber volume (ACV), anterior chamber width (ACW); corneal diameter (CD); posterior cornea curvature (PCC); anterior cornea curvature (ACC); maximum iris thickness (ITM); iris thickness at 750 um (IT750) and 2000 um (IT2000) from the scleral spur; iris curvature (IC); iris area (IA); lens vault (LV); angle opening distance (AOD); trabecular iris space area at 500 um (TISA500) and 750 um (TISA750) from the scleral spur; angle recess area (ARA). Lasso regression models were used to detect the collinearity of parameters. The multivariable logistic regression was performed to determine the independent association between angle closure and those parameters included in Lasso regression model. Also Factor analysis was performed to extract a few underlying factors (components) from these parameters. RESULTS Lasso regression showed that ACD, ACV, PCC, IT750, IT2000 and LV were screened in the model. The multivariable logistic regression indicated that ACV, PCC, IT750 and LV were significantly associated with angle closure. Factor analyses revealed that 4 factors, each with its closely associated clusters of variables, produced the best results: ACA, ACV and ACD (Factor 1); LV, tIC and nIC, (Factor 2); ACW, CD and PCC (Factor 3); and tITM, tIT2000, tIT750, nIT2000 and nIT750 (Factor 4). CONCLUSIONS Four separate mechanisms were showed to be involved in the pathogenesis of angle closure, from anterior chamber dimensions, lens, iris and cornea respectively. The parameters ACV, PCC, IT750, and LV are more predominant in determining angle closure.

This study aimed to evaluate the scleral spur length (SSL) in response to different accommodation stimuli states, as well as the correlation with Schlemm’s canal (SC) and trabecular meshwork (TM). 74 children were recruited for this study. The 0D, − 4D, and − 8.0 D accommodation stimuli state was achieved by looking at a variable distance optotype. The ciliary muscle (CM), scleral spur (SS), SC, and TM were imaged by swept-source optical coherence tomography. The SSL (Method III) increased significantly from 221.56 ± 30.74 μm at base state to 234.99 ± 30.11 μm at − 4D accommodation stimuli state (p = 0.028) and increased to 250.09 ± 29.87 μm at − 8D accommodation stimuli state (p = 0.011). Method III had the largest areas under receiver operating characteristic (ROC) curves (0.798, 95% CI 0.721–0.875). Moreover, CM 1, SC, and trabecular meshwork length (TML) were significantly correlated with SSL (Method III) (p

Purpose To quantitatively evaluate the inter-annotator variability of clinicians tracing the contours of anatomical layers of the iridocorneal angle on digital gonio photographs, thus providing a baseline for the validation of automated analysis algorithms. Methods Using a software annotation tool on a common set of 20 images, five experienced ophthalmologists highlighted the contours of five anatomical layers of interest: iris root (IR), ciliary body band (CBB), scleral spur (SS), trabecular meshwork (TM), and cornea (C). Inter-annotator variability was assessed by (1) comparing the number of times ophthalmologists delineated each layer in the dataset; (2) quantifying how the consensus area for each layer (i.e., the intersection area of observers' delineations) varied with the consensus threshold; and (3) calculating agreement among annotators using average per-layer precision, sensitivity, and Dice score. Results The SS showed the largest difference in annotation frequency (31%) and the minimum overall agreement in terms of consensus size (∼28% of the labeled pixels). The average annotator's per-layer statistics showed consistent patterns, with lower agreement on the CBB and SS (average Dice score ranges of 0.61-0.7 and 0.73-0.78, respectively) and better agreement on the IR, TM, and C (average Dice score ranges of 0.97-0.98, 0.84-0.9, and 0.93-0.96, respectively). Conclusions There was considerable inter-annotator variation in identifying contours of some anatomical layers in digital gonio photographs. Our pilot indicates that agreement was best on IR, TM, and C but poorer for CBB and SS. Translational Relevance This study provides a comprehensive description of inter-annotator agreement on digital gonio photographs segmentation as a baseline for validating deep learning models for automated gonioscopy.

Objective To evaluate choroidal thickness (CT), corneal parameters, and scleral thickness (ST) in patients with systemic sclerosis (SSc) and to determine their relationship with disease-related quality of life (QoL). Methods The study included 38 patients with SSc and 40 healthy controls. A detailed ocular examination was performed on all participants. Corneal parameters such as K1, K2, Km, corneal volume (CV), central corneal thickness (CCT), and ST at a distance of 1000, 2000, and 3000 mu m from the scleral spur were measured. CT was measured at five points, including the subfoveal area and the temporal and nasal points at radii of 750.0 and 1500.0 mu m. The scleroderma health assessment questionnaire (SHAQ) was administered to SSc patients to investigate the disease-related QoL. Results Individuals with SSc had thicker ST at all distances from the scleral spur (P=0.008, P=0.001, P=0.002, respectively). All corneal parameters were significantly lower in the SSc group than in the control group (P < 0.05). Moreover, SSc patients had significantly lower median CT at N750.0, N1500.0, T750.0, and T1500.0 points and thinner subfoveal CT than healthy controls (P < 0.05). There was a weak-moderate negative correlation between ST and the components of the SHAQ scale and SHAQ-global. Conclusion Despite not having ocular involvement, SSc patients had thicker ST but thinner CT and corneal parameters than healthy controls. This may indicate subclinical inflammation in patients with SSc. Only ST was affected by organ involvement and QoL among the ocular parameters.