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POSTGRADUATE SECTION
Year : 2021  |  Volume : 9  |  Issue : 1  |  Page : 46-47

Scheimpflug imaging system: Opening up the black box of iris bombe


1 Medical Officer, Department of Cataract and Refractive Surgery, Tiruchirappalli, Tamil Nadu, India
2 Medical Officer, Glaucoma and Research, Tiruchirappalli, Tamil Nadu, India
3 Head of the Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Tiruchirappalli, Tamil Nadu, India
4 Chief Medical Officer, Mahathma Eye Hospital Private Limited, Tiruchirappalli, Tamil Nadu, India

Date of Submission13-Sep-2020
Date of Decision31-Dec-2020
Date of Acceptance12-Jan-2021
Date of Web Publication10-Apr-2021

Correspondence Address:
Prasanna Venkatesh Ramesh
Mahathma Eye Hospital Pvt. Ltd., No.6, Seshapuram, Thennur, Trichy-620 017, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_195_20

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How to cite this article:
Ramesh SV, Ramesh PV, Ramesh MK, Rajasekaran R. Scheimpflug imaging system: Opening up the black box of iris bombe. J Clin Ophthalmol Res 2021;9:46-7

How to cite this URL:
Ramesh SV, Ramesh PV, Ramesh MK, Rajasekaran R. Scheimpflug imaging system: Opening up the black box of iris bombe. J Clin Ophthalmol Res [serial online] 2021 [cited 2021 Jun 22];9:46-7. Available from: https://www.jcor.in/text.asp?2021/9/1/46/313470



Iris bombe [Figure 1]a and [Figure 1]b is the apposition of iris to lens, preventing aqueous flow from the posterior to the anterior chamber. Thus, pressure in the posterior chamber rises, resulting in anterior bowing of peripheral iris and obstruction of trabecular meshwork, inducing an acute attack of angle closure.[1],[2] In this patient anterior iris bowing, touches the corneal endothelium peripherally [Figure 1]c,[Figure 1]d,[Figure 1]e,[Figure 1]f. Despite laser peripheral iridotomies, iris bombe developed with chronic iridocyclitis and central posterior synechiae (occlusio pupillae).[3] Scheimpflug imaging is a potential tool for monitoring 360° peripheral irido-corneal touch and evaluating treatment response objectively. Incidentally, the posterior segment evaluation in B-scan ultrasonography [Figure 2] revealed the features suggestive of membranes in the vitreous cavity, probably due to a sequelae of vitritis.
Figure 1: (a) Apposition of the iris to the phakic lens posteriorly resulting in the anterior bowing of the peripheral iris with chronic iridocyclitis revealed by the old keratic precipitates (red arrows). (b) Central posterior synechiael (occlusio pupillae) membrane obscuring the lens surface. (c and d) Anterior segment optical coherence tomography reveals iris bowing forward and touching the corneal endothelium in the periphery. (e) Horizontal cut section (0&s#176;–180°) view in the Scheimpflug imaging system revealing the peripheral irido-corneal touch. (f) Vertical cut section (101°–281°) view in the Scheimpflug imaging system revealing the peripheral irido-corneal touch

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Figure 2: B-scan ultrasonography reveals the features suggestive of membranes in the vitreous cavity, probably due to a sequelae of vitritis

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Although Scheimpflug imaging has left its footprint in the field of cornea, its application for anterior chamber evaluation remains untapped.

The major advantages of these devices are the noncontact nature of examination, repeatability, and range of quantitative and qualitative information they provide. They provide quantitative information with digital calipers which helps us objectively measure between any two points. Angle visualization in a noncontact, objective examination is a significant development in anterior segment imaging, which opens up the black box of iris bombe. It takes 25 radial scans of anterior chamber, hence providing us with visualization of 50 peripheral anterior synechiae regions of iris bombe thus providing us with enough data for a three dimensional mind's eye view of the angles in such scenarios. In addition, it has ease of image acquisition which does not require extensive training. A potential issue with these devices are their cost. Newer technologies are nearly always expensive, but a part of their expenses are typically balanced by the accompanied increase in the accuracy of the diagnosis. In addition, there is often a trend for reduction in cost with increasing availability of latest instruments.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Moorthy RS, Mermoud A, Baerveldt G, Minckler DS, Lee PP, Rao NA. Glaucoma associated with uveitis. Surv Ophthalmol. 1997;41:361-94.  Back to cited text no. 1
    
2.
Ritch R. Pathophysiology of glaucoma in uveitis. Trans Ophthalmol Soc UK 1981;101:321-4.  Back to cited text no. 2
    
3.
Agrawal RV, Murthy S, Sangwan V, Biswas J. Current approach in diagnosis and management of anterior uveitis. Indian J Ophthalmol 2010;58:11-9.  Back to cited text no. 3
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