Slit-lamp-adapted optical coherence tomography (SL-OCT) was recently introduced for anterior segment imaging and goniometry [1]. In the present report we used SL-OCT in the diagnosis and follow-up of pupillary block glaucoma.

An 80-year-old man presented with acute glaucoma of the right eye after pharmacological mydriasis. Medical history revealed phacoemulsification that had been carried out elsewhere, complicated by intra-vitreal loss of cortex material 2 years ago. He had been treated by subsequent anterior vitrectomy and Artisan lens implantation.

At presentation at our department, he had an intra-ocular pressure of 52 mmHg. Slit-lamp biomicroscopy showed a peripheral flattened anterior chamber, and no peripheral iridectomy was recognizable. SL-OCT confirmed the absence of peripheral iridectomy, a pupillary block due to the claw lens and bulging of the posterior chamber with secondary angle closure. We measured a central depth of the anterior chamber of 0.91 mm (Fig. 1A). After laser iridectomy the situation stabilized and the central depth became 1.94 mm (Fig. 1B).

Fig. 1
figure 1

Panel A shows slit-lamp-adapted optical coherence tomography (15 mm scan) of the patient with acute glaucoma due to the iris-fixed Artisan lens (the inset shows the slit-lamp biomicroscopy). The depth of the anterior chamber is decreased (bar) due to a pupillary block induced by an Artisan lens (arrowhead). Note that the anterior chamber flattening is limited by the haptics of the intraocular lens. Panel B shows slit-lamp-adapted optical coherence tomography (15 mm scan) after laser iridectomy has deepened the anterior chamber. The depth of the anterior chamber has become normal again. The inset shows a patent iris defect, visible (arrow) on a 7.2 mm scan

Full size image

Comment

Examination of the anterior segment anatomy is nowadays facilitated by digital devices like the very high frequency ultrasound scan [2]. In this report we used a newly developed method: slit-lamp-adapted optical coherence tomography. SL-OCT allows non-invasive, high-resolution imaging in acute angle-closure glaucoma and may thus be helpful with the differential diagnosis of pupillary block glaucoma and the documentation of the surgical result.