Kammerwinkelbeurteilung im klinischen Alltag - Ein Vergleich zwischen der Optischen Kohärenz Tomographie und der Gonioskopie
Background: In glaucoma the structures of the anterior chamber are important for classification, therapy, progression and prognosis. In this context anterior segment optical coherence tomography (AS-OCT) obtains more relevance. This study compares AS-OCT with gonioscopy in diagnostic performance of chamber angle (CA). Patients and methods: 104 consecutive subjects with glaucoma underwent AS-OCT imaging using the Visante-OCT. Results were compared to gonioscopic grading from patient history using the Shaffer system. In addition anterior chamber depth (ACD) assessment using slitlamp examination was evaluated as a prognostic factor for chamber angle width (CAW) and verified by AS-OCT measurement. Results: Average CAW was 29 ° (AS-OCT). 17 % of the CAs that were "wide" in gonioscopy (variance 5 - 55 °) showed a "narrow" CA in AS-OCT. 35 % of the CAs that were "narrow" in gonioscopy (variance 0 - 39 °) showed a "wide" CA in AS-OCT. ACD assessment using slitlamp examination is a good predictor for CAW. In this context the technique provides equal informative value as gonioscopy. In cases of "wide" ACAs it’s even superior. The critical ACD for an increased risk of angle closure is 2,4 mm. Concerning the critical ACD (< 2,4 mm) the technique gave the possibility to estimate, whether the patients were in the crucial range or not. Average ACD was 2,7 mm (AS-OCT). A strong correlation (correlation coefficient 0,83) between ACD and CAW was observed. Variation of 1 mm in the ACD leads to a change of 18,9 ° in the CAW. All patients with angle closure glaucoma were underneath this threshold and 74 % of patients with critical ACD had "narrow" (AS-OCT) CA. Conclusion: In case of routine clinical practice with inexperienced residents or circumstances that make gonioscopy difficult or impossible, optical coherence tomography is an effective alternative to the gold standard and is to some extent superior.
Subject HeadingsGonioskopie [GND]
Glaucoma, angle-closure [MeSH]
Tomography, optical coherence [MeSH]