Purpose To examine the diagnostic value of a modifiedGoldmanngonioscopic technique as part of the dark room provocative test (DRPT) in detecting primary closure of the anterior chamber angle.
Methods Theobservational clinical studyincluded suspects of primary angle closure. For gonioscopy, we used a conventional one-mirrorGoldmanngonioscopic lens and a modified one-mirrorGoldmanngonioscopic lens in which a black membrane covered the main lens surface so that light could not directly fall onto the fundus. Using both lenses, we assessed the anterior chamber angle configuration at room light and after 3 minutes of dark adaptation. Intraocular pressure (IOP) was measured in room light conditions at baseline and after 1.5 hours of dark adaptation. The DRPT was positive, if IOP increased by ≥8 mmHg after 1.5 hours of dark adaptation.
Results The study included 90 subjects (90 eyes). Among 48 (53%) eyes with a positive DRPT, modified gonioscopy as compared with conventional gonioscopy detected a significantly higher number of eyes with closed angle quadrants after 3 minutes dark adaptation (43(89%) eyes versus 32 (66%) eyes;P=0.007). Kappa statistics showed a better agreement betweenmodified gonioscopy anda positive DRPT (k=0.73;P<0.001;sensitivity:89.6%;specificity:83.3%)than betweenconventionalgonioscopy anda positive DRPT(k=0.561;P<0.001;sensitivity:66.7%;specificity:90.5%).
Conclusions Modified gonioscopy using a one-mirrorGoldmanngoniolens with the central surface covered as compared with conventional gonioscopy with a conventional goniolens had a higher diagnostic precision in predicting primary angle closure in the dark room provocative test. |
