Clinical anatomy of the anterior chamber angle in congenital aniridia – and consequences for trabeculotomy/cyclophotocoagulation

Abstract

Introduction: Intraocular pressure (IOP) lowering surgery in congenital aniridia glaucoma (CAG) can be complicated by dysgenesis of the limbal region, anterior chamber angle, iris and lens.

Methods: The anterior segments of 23 eyes (17 patients) with congenital aniridia were investigated under general anesthesia using ultrasound biomicroscopy (UBM). The structures of the anterior segment were examined: distance of ciliary body processes from the anterior chamber angle and positioning of Schlemmʹs canal. A surgical plan was created on the basis of these data.

Results: Schlemmʹs canal was detected in 21 of the 23 examined eyes. The mean distance from the anterior chamber angle was 1.3 ± 0.4 mm (range: 0.5 to 2.1 mm). The mean distance between the anterior chamber angle and the ciliary body was 561 ± 301 µm (range: 270-1300 µm). The mean prominence of the ciliary body towards the lens was 799 ± 352 µm (range: 210 – 1660 µm). This resulted in a precise UBM-based trabeculotomy. In addition, the ciliary body was detected and coagulated ab externo with a diode laser probe (810 nm) using diaphanoscopy and UBM.

Conclusions: An initial UBM examination of the anterior segment is essential in eyes with CAG scheduled for trabeculotomy or cyclophotocoagulation. This article is protected by copyright. All rights reserved.

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