RESUMEN
PURPOSE: This study was conducted in order to investigate the effect of accommodation on the iris morphology and iridolenticular contact, in eyes with Pigment Dispersion Syndrome and Pigmentary Glaucoma, using high-resolution ultrasound. METHODS: We performed a prospective observational study, examining a group of 30 Pigment Dispersion Syndrome and Pigmentary Glaucoma patients (49 eyes) and a smaller group of eight 'normals' non-Pigment Dispersion Syndrome patients (8 eyes). All patients underwent ultrasound biomicroscopy, before and during accommodation. RESULTS: The iris profile before accommodation was found convex in 48.5%, flat in 19.7% and concave in 31.8%. Following accommodation the iris configuration remained unchanged in 66.2%, increased in concavity in 20.3% and decreased in concavity in 13.5%. CONCLUSIONS: The effect of accommodation on iris configuration and accommodation is highly variable. From our experience the measurement of iris configuration using ultrasound biomicroscopy may not be a useful method of evaluating the effect of different treatments on iris configuration.
Asunto(s)
Acomodación Ocular , Síndrome de Exfoliación/fisiopatología , Iris/fisiopatología , Adulto , Anciano , Envejecimiento/fisiología , Síndrome de Exfoliación/diagnóstico por imagen , Síndrome de Exfoliación/patología , Femenino , Humanos , Iris/diagnóstico por imagen , Iris/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , UltrasonografíaRESUMEN
UNLABELLED: The work has been presented at The Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, Fort Lauterdale, Florida, May 1999. PURPOSE: To evaluate inter- and intraobserver variability of the R/D score in assessing the iris configuration in Pigment Dispersion Syndrome patients. METHODS: Fifty-seven high-resolution ultrasound biomicroscopy images were obtained by a single ophthalmologist. All images were examined twice by each of three ophthalmologists, the second assessment being at least 2 weeks after the first. Each observer was masked to their colleagues' and their previous measurements. R/D scores were calculated at each examination. Agreement between and amongst observers was assessed using Bland-Altman plots. In addition, the R/D scores were categorised and reassessed using the Kappa statistic. RESULTS: Intraobserver variability was small, the average differences between first and second scores of each observer being less than 0.01 units. Agreement within observers was 89% or higher, with Kappa values of 0.8 or higher, indicating almost perfect agreement. Interobserver variability was, however, greater. Although there was substantial agreement between two of the observers (87% agreement, first assessment; 80%, second assessment with respective kappa statistics of 0.78 and 0.66), they only moderately agreed with the other observer (kappa statistics between 0.55 and 0.68). CONCLUSIONS: This study suggests that when using R/D scores to demonstrate changes in iris configuration, assessments should preferably be made by the same observer.