Objective: To assess the ability of high-definition optical coherence tomography (HD-OCT) to image the anterior chamber angle. Methods: Forty-five consecutive subjects with phakic eyes underwent gonioscopy and anterior chamber angle imaging with HD-OCT adapted with a 60-diopter aspheric lens mounted over the imaging aperture. The patients' fixation was directed to the side using an external fixation light, and scans were taken of the temporal and nasal quadrants. The visibility of angle structures was assessed and the diagnosis of angle closure using HD-OCT was compared with that of gonioscopy. Results: The majority of subjects were Chinese (91.1%) and female (62.2%). Cross-sectional HD-OCT allowed in vivo visualization of the scleral spur in 71 of 90 quadrants (78.9%) and the termination of the Descemet membrane (Schwalbe line) in 84 of 90 quadrants (93.3%). It was possible to image the trabecular meshwork in 56 quadrants (62.2%). Angle closure was observed in 17 eyes with gonioscopy and 12 eyes with HD-OCT (P=.12, McNemar test). The 2 modalities showed good agreement for angle closure diagnosis by quadrant (κ=0.65). Conclusion: The adapted HD-OCT provided magnified views of the anterior chamber angle and allowed visualization of the Schwalbe line and trabecular meshwork in most eyes.
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