Anterior chamber angle in aniridia with and without glaucoma

Abstract

Purpose: We performed a retrospective, comparative study to determine if patients with aniridia and glaucoma had open angles on high-resolution anterior segment optical coherence tomography (OCT) and clinical gonioscopy.

Patients and methods: Forty-three patients (86 eyes) with aniridia had recorded anterior segment OCTs, gonioscopy, or both. Of these patients, 27 (54 eyes) were diagnosed with glaucoma and 16 (32 eyes) had no evidence of glaucoma. All patients had either anterior segment OCT, gonioscopy, or both.

Results: The 43 patients with aniridia had average age of 32±17 years, and 27 (62%) were female. Anterior segment OCT and gonioscopy were recorded in 25 (58%) of the patients and 18 (42%) of the patients had gonioscopy alone. Of the 54 eyes with aniridia and glaucoma, 4 (7%) eyes in 3 patients (11%) had partial or completely closed angles. Of the 32 eyes without glaucoma, all (100%) had open angles. The proportion of open angles in the aniridia with glaucoma eyes was not significantly different compared with the aniridia without glaucoma eyes (P=0.32). Of the 4 eyes with closed angles, all had a history of prior surgery for cataract, glaucoma, and/or keratopathy. The proportion of eyes with prior surgery was significantly higher in eyes with open-angle glaucoma and angle-closure glaucoma compared with eyes without glaucoma (P<0.001 and P=0.002, respectively).

Conclusion: The majority of eyes with aniridia and glaucoma have open anterior chamber angles, similar to patients with aniridia without glaucoma. All eyes with aniridia and glaucoma that had closed angles had a prior history of ocular surgery.

Keywords: aniridia; anterior segment optical coherence tomography (OCT); glaucoma; gonioscopy.

Figure 1

Anterior segment OCT images showing open- and closed-angle findings in aniridia patients. (A) A 12-year-old aniridia patient with glaucoma and open-angle (arrow). (B) A 21-year-old aniridia patient with glaucoma, aphakia, and closed-angle. The asterisk shows an area of angle closure, with iris tissue appositional to the cornea. This patient was treated with lensectomy and goniotomy as an infant, and subsequently with glaucoma drainage implant.