Diagnostic Value of Modern Methods of Ocular Anterior Segment Visualization in Intumescent Cataract

Purpose: tо evaluate the diagnostic capabilities of optical coherence tomography (OCT), Scheimpflug camera and ultrasound biomicroscopy (UBM) in examining topography of the ocular anterior segment and lens in mature intumescent cataract. Patients and methods. 23 eyes with mature intumescent cataract were examined using OCT (RTVue-100, Optovue, USA), Scheimpflug camera (Pentacam HR, Oculus, Germany) and UBM (UD 8000, Tomey, Japan). We examined the anterior chamber depth, profile and magnitude of the anterior chamber angle, distance “trabecula-iris at 500 microns”, thickness of the liquid lenticular mass layer, lens thickness, Zinn ligament length within four segments, equatorial angle. Results. We managed to measure the anterior chamber depth using UBM and Scheimpflug camera. UBM measurement was 1.96 ± 0.14 mm, Scheimpflug camera — 1.91 ± 0.11 mm. We revealed narrowing of the anterior chamber angle up to 11.54 ± 2.19° in UMB examination, to 11.49 ± 2.17° in OCT measuring and to 11.63 ± 2.21° in examining by Scheimpflug camera. Distance “trabecula-iris 500” was 0.212 ± 0.037 mm in UMB examination, 0.218 ± 0.042 mm — by means of OCT, Scheimpflug camera measurement was unsuccessful. The rest parameters were examined only by UBM. The lens thickness was 5.26 ± 0.13 mm. The anterior layer of liquid lenticular mass was 0.85 ± 0.06 mm. Zinn ligament length in the outer segment was 0.708 ± 0.072 mm, in the internal segment — 0.731 ± 0.089 mm, in the superior segment — 0.704 ± 0.084 mm, in the inferior segment — 0.876 ± 0.089 mm. The equatorial angle in two opposite segments was 32.52 ± 0.92°. Conclusion. Ultrasound biomicroscopy has the biggest value in examining topography of the ocular anterior segment and lens in mature intumescent cataract, since only this method allows achieving the whole complex of data necessary to evaluate the swelling lens parameters. This can serve as a basis for developing the appropriate tactics of surgical intervention.

1. Тахчиди Х.П., Егорова Э.В., Толчинская А.И. Интраокулярная коррекция в хирургии осложненных катаракт. М.: Изд-во «Новое в медицине», 2004. 170 с. [Takhchidi Kh.P, Egorova E.V, Tolchinskaya A.I. Intraocular correction in compli cated cataract surgery. Moscow: “Novoe v meditsine”, 2004. 170 p. (In Russ.)].

2. Avramides S., Traianidis P., Sakkias G. Cataract surgery and lens implantation in eyes wits exfoliation syndrome. J. Cataract refract. Surg. 1997;23(4):583–587. doi. org/10.1016/s0886-3350(97)80219-2

3. Chakrabarti A., Singh S., Krishnadas R. Phacoemulsification in eyes with white cataract. J. Cataract. Refract. Surg. 2000;26:1041–1047. DOI: 10.1016/s0886-3350(00)00525-3

4. Jacob S., Agarwal A., Agarwal S. Trypan blue as an adjunct for safe phacoemulsification in eyes with white cataract. J. Cataract. Refract. Surg. 2002;28:1819–1825. DOI: 10.1016/s0886-3350(01)01316-5

5. Bhattacharjee K., Bhattacharjee H., Goswami BJ., Sarma P. Capsulorhexis in in tumescent cataract. J. Cataract. Refract. Surg. 1999;25:1045–1047. DOI: 10.1016/ S0886-3350(99)00123-6

6. Gimbel H.V., Willerscheidt A.B. What to do with limited view: the intumescent cataract. J. Cataract.Refract. Surg. 1993;19(5):657–661. DOI: 10.1016/s08863350(13)80739-0

7. Jaffe N.S., Horwitz J. Lens alteration. In: Podos S.M, Yanoff M, eds. Textbook of Ophthalmogy. Vol. 3: Lens and Cataract. New York: Gower Medical Publishing; 1992. P. 8.1–8.16.

8. Figueiredo C.G., Figueiredo J., Figueiredo G. Brazilian technique for prevention of the Argentinean flag sign in white cataract. J. Cataract Refract. Surg. 2012;38:1531– 1536. DOI: 10.1016/j.jcrs.2012.07.002

9. Pavlin C.J., Harasiewicz K., Sherar M., Foster S. Subsurface ultrasound microscopic imaging of the intact eye. Ophthalmology. 1990;97:244–250. DOI: 10.1016/S01616420(90)32598-8

10. Panek W.C., Cristensen R., Lee D., et al. Biometric variables in patients with occludable anterior chamber angles. Am. J. Ophthalmol. 1990;110:185–188. DOI: 10.1016/s0002-9394(14)76989-2

11. Havlina M., Stunfand S., Hvala A. Ultrastructure of anterior lens capsule of intumescent white cataract. Acta Ophthalmol. 2011;89:367–370. DOI: 10.1111/j.1755-3768.2010.02102.x

12. Николашин С.И., Фабрикантов О.Л., Цуканкова М.А., Пирогова Е.С. Хирургическое лечение зрелой набухающей катаракты. Вестник офтальмологии. 2016;2:62–68. [Nikolashin S.I., Fabrikantov O.L., Tsukankova M.A., Pirogova E.S. Surgical treatment of mature intumescent cataract. Annals of ophthalmology = Vestnik oftal’mologii. 2016;132(2):62–68 (In Russ.)]. DOI: 10.17116/oftal ma2016132262-68

13. Хасанова Н.Х., Амирова Ф.С. Анатомические особенности глаз при на бухающей катаракте и вторичной глаукоме. Офтальмологический журнал. 1980;6:380–381. [Khasanova N.Kh., Amirova F.S. Anatomic peculiarities of the eye in swelling cataract and secondary glaucoma. Journal of Ophthalmology (Ukraine) = Oftal’mologicheskiy zhurnal. 1980;6:380–381 (In Russ.)].

14. Тахчиди Х.П., Егорова Э.В., Узунян Д.Г. Ультразвуковая биомикроскопия глаза в диагностике патологии переднего сегмента глаза. М.: «Микрохирургия глаза», 2007. 126 с. [Takhchidi Kh.P., Egorova E.V., Uzunyan D.G. Ultrasound biomicroscopy in the diagnosis of the anterior ocular segment. Moscow: “Mikrokh irurgiya glaza”, 2007. 126 p. (In Russ.)].

15. Basti S. Different faces of the white cataract: a phaco surgeon’s perspective. Aust N Z J Ophthalmol. 1999;27:53–56. DOI: 10.1046/j.1440-1606.1999.00150.x

16. Балашевич Л.И., Качанов А.Б. Клиническая корнеотопография и аберрометрия. М.: «Микрохирургия глаза», 2008. 167 с. [Balashevich L.I., Kachanov A.B. Clinical corneal topography and aberrometry. Moscow: “Eye Microsurgery”, 2008. 167 p. (In Russ.)].

17. Goebels S., Pattmöller M., Eppig T. Comparison of 3 biometry devices in cataract patients. J. Cataract Refract. Surg. 2015;41(11):2387–2393. DOI: 10.1016/j. jcrs.2015.05.028

18. Офтальмология. Национальное руководство. С.Э. Аветисов, ред. М.: ГЭОТАР-Медиа, 2011. 944 с. [Ophthalmology. National guidance. Ed. by S.E. Avetisov. Moscow: “GEOTAR–Media”, 2011. 128 p. (In Russ.)].

19. Щуко А.Г., Малышев В.В. Оптическая когерентная томография в диагностике глазных болезней. М.: ГЭОТАР–Медиа, 2010. 128 с. [Shchuko A.G., Maly shev V.V. Optical coherence tomography in the diagnosis of ocular diseases. Mos cow: “GEOTAR–Media”, 2010. 128 p. (In Russ.)].

20. Алехина Л.П., Люткевич В.Г. Оптическая когерентная томография угла передней камеры в оценке состояния переднего отрезка глаза. Вестник новых медицинских технологий. 2012;19(2):331–333. [Alekhina L.P., Lyutkevich V.G. Optical coherent tomography of the front camera angle in the assessment of the eye’s front segment state. Journal of new medical technologies = Vestnik novykh meditsinskikh tekhnologii. 2012;19(2):331–333 (In Russ.)].

21. Качанов А.Б., Ефимов О.А. Сравнительное исследование морфометрических показателей роговицы и хрусталика с помощью шеймпфлюг камеры «Pentacam», ультразвукового А-скана «Ocusacan» и оптического когерентного томографа переднего отрезка глаза «Visante». Офтальмохирургия. 2012;2:63–71. [Kachanov A.B., Efimov O.A. Comparative investigation of morpho metric data of cornea and lens measured by “Ocuscan”, “Visante” and “Pentacam” devices. Opthalmosurgery = Oftal’mokhirurgiya. 2012;2:63–71 (In Russ.)].

22. Мошетова Л.К., Кочергин С.А., Алексеев И.Б. Анатомо-функциональные изменения переднего отрезка после факоэмульсификации катаракты при первичной закрытоугольной глаукоме. Глаукома. 2011;2:44–51. [Moshetova L.K., Kochergin S.A., Alekseev I.B. Anatomic-functional changes in anterior chamber after phacoemulsification in eyes with primary angle-closure glaucoma. Glaucoma = Glaukoma. 2011;2:44–51 (In Russ.)].

23. Щуко А.Г., Жукова С.И., Юрьева Т.Н. Ультразвуковая диагностика в офтальмологии. М.: «Офтальмология», 2013. 128 с. [Shchuko A.G., Zhukova S.I., Yur’eva T.N.. Ultrasound diagnosis in ophthalmology. Moscow: “Oftal’mologiya”, 2013. 128 p. (In Russ.)].