Case Series: Scheimpflug Angle Width Insufficient to Rule Out Iridocorneal Angle Closure Risk

Introduction Intraocular pressure fluctuation has been suspected to be associated with glaucomatous progression in patients with low in-office pressures, particularly in eyes with narrow angles. Pentacam Scheimpflug imaging may be used to supplement other methods of angle assessment and offers the following parameters: anterior chamber angle width and anterior chamber volume and depth. Case Reports Two cases are presented in which glaucomatous progression was possibly associated with intraocular pressure fluctuations due to intermittent, asymptomatic angle closure. Pentacam angle width measurements initially offered possible false reassurance that these 2 eyes only had open-angle glaucoma components, potentially misguiding management. Darkroom gonioscopy and anterior segment optical coherence tomography subsequently showed occludable angles. Conclusion Pentacam Scheimpflug anterior chamber width measurements may not correlate with the modified Shaffer gonioscopy grading system. Anterior segment optical coherence tomography also may show iridotrabecular contact or near touch anterior to the scleral spur when Pentacam tomography shows a more open angle width. This discrepancy between Pentacam and the other techniques may be due to the inability of Scheimpflug imaging to truly view the angle apex. If using Pentacam, anterior chamber volume and depth may be more suitable ancillary parameters to supplement the gonioscopy assessment of angles in patients with or at risk of glaucoma. Through these cases featuring suspected intraocular pressure fluctuations possibly associated with intermittent closure, it is proposed that Pentacam angle width measurements alone may be insufficient to rule out an angle closure component to glaucoma progression.