Fig. 5.6 The two slits meet Ð Þnished

Fig. 5.7 Read the value from the scale

angle closure. If you measure the right eye you must only use the right ocular and vice versa for the left eye.

5.2.3Additional Procedures in Gonioscopy

The chamber angle can also be analyzed using several additional procedures including anterior

segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM) and PentacamScheimpßug imaging. These procedures and their sophisticated software provide useful parameters including the width of the chamber angle and anterior chamber volume and nicely show the relative positions of the iris, lens and cornea (see Chap. 8).

5.3Documentation of the Structures of the Chamber Angle

Your interpretations and drawings of the chamber angle need to be understandable by other ophthalmologists.

The most important part of the chamber angle is the functional, posterior trabecular meshwork. If it is partially or totally covered by iris tissue, then angle closure is deÞnitely present. So you have to document whether the trabecular meshwork is seen or not seen, adding the number of degrees where it is visible.

Increase the validity by adding the depth of the central anterior chamber (less or more than 2 mm) and the width of the pupil during examination. Add the peripheral conÞguration of the iris (Q queer or c concave, R regular or f ßat, S steep or convex or b bowing forward) and the peripheral insertion of the iris (A, B, C, D, E). For the angle width use the grading system you are used to. If you perform dynamic or indentation gonioscopy, document the results, e.g. IG open in indentation gonioscopy the iridocorneal appositions are opened, or IG closed in indentation gonioscopy the angle remains closed (this is synechial closure).

You may also use the sophisticated documentation suggested by Spaeth.

Besides a written description, you can also include a drawn diagram of the chamber angle.

We suggest that you draw a circle and divide it in four sectors of 90¡: superior, nasal, inferior, temporal. Inside each sector you designate the most posterior structure of the chamber angle that is visible (SS for scleral spur visible but anterior ciliary band not visible; TM for trabecular meshwork visible but scleral spur not visible,

etc.). You can add the grade of the pigmentation (Scheie 0Ð4). Details about the iris (insertion, angularity, conÞguration) are not included.

TM +3

TM TM

SS

+4

Or you can use numbers, but be sure not to mix up the different grading systems. Inside each sector you can insert the grade of the angle opening (e.g., Shaffer) and outside each sector you can add speciÞc Þndings, such as PAS, new vessels, etc.

RE: PAS 10−12

2

2 2

3

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