Browsing by Author "Noorani, Sahar"
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Item Cataract Surgery and Intraocular Pressure (IOP)(2018-01-23) Noorani, Sahar; Deng, Ted; Yang, Alex; AlSalem, Munsif; Bowman, Wayne; Whitson, Jess; Blomquist, Preston; Mootha, Vinod; Adams-Huet, Beverley; Li, Xilong; Kooner, KaranjitPURPOSE: The effect of cataract surgery on IOP in patients with glaucoma is not well understood. We sought to analyze fluctuations in IOP in controls, glaucoma suspects, and patients with mild, moderate, and severe primary open angle glaucoma (POAG) undergoing cataract surgery in a well-diversified population. METHODS: In an IRB-approved retrospective study, 236 controls (Group A), 37 glaucoma suspects (Group B), and 96 patients with POAG (mild, moderate, severe; Groups C-E) were recruited. One eye was randomly selected per patient. Exclusion criteria included: <18 years, secondary glaucoma, one functional eye, or follow-up <3 months. Data collected included age, race, gender, glaucoma family history, CCT, axial length (AXL), anterior chamber depth (ACD), lens thickness (LT), IOP, and visual acuity (VA). Post-operative IOP and VA were determined at several intervals. Linear trends over groups A-E were made with a Jonckheere-Terpstra test. χ2 analyses were used to evaluate differences between groups A-E. Wilcoxon Rank-Sum test was used to evaluate postoperative changes. Multiple linear regression was used to evaluate predictors of IOP change at 1 year. RESULTS: IOP reduction at 1 year in groups A-E were 8.6%, 8.1%, 10.8%, 18.3%, and 9.1%, respectively. Medications at 1 year did not change significantly. In POAG eyes, higher pre-op IOP and more medications were predictive of a higher reduction in IOP at 1 year (β= -0.62, -1.60; p<0.05). In control eyes, higher pre-op IOP and higher CCT were predictive of more IOP reduction at 1 year (β= -0.53, -0.02; p<0.05). DISCUSSION: In this population, all groups showed reduction of IOP after cataract surgery. Among the glaucoma groups, severe glaucoma patients had the lowest reduction of IOP (9.1%), most probably due to reduced outflow facility. However, the medication load stayed unchanged in all groups. In the control group, pre-op IOP and thicker CCT determined post-op IOP reduction. CONCLUSION: IOP reduction one year after cataract surgery in glaucomatous eyes is dependent on higher pre-op IOP and increased glaucoma medications. In non-glaucomatous eyes, higher pre-op IOP and thick CCT determine the degree of post-operative IOP reduction.Item MLT (Micropulse Laser Trabeculoplasty) or Not?(2018-01-23) Deng, Ted; Noorani, Sahar; Yang, Alex; AlSalem, Munsif; Huet, Beverley; Li, Xilong; Kooner, KaranjitPURPOSE/RELEVANCE: MLT has been shown to be a relatively safe treatment for reducing IOPs in small studies. We wished to determine the efficacy and safety of MLT as an adjunctive therapy in a large diverse patient population with medically uncontrolled mild, moderate, and severe primary open angle glaucoma (POAG) and how patient characteristics may influence outcomes. METHODS: In an IRB-approved single surgeon, retrospective study, 102 patients who received MLT were reviewed. One eye was randomly selected per patient. Patients were excluded if they were <18 years old, had secondary glaucoma, only one functional eye, intraocular surgery three months prior to MLT, or laser trabeculoplasty one year prior to MLT. Over 50 variables were collected including: age, sex, race, BMI, FHx of glaucoma, C/D, visual field defect (VFD), CCT, vision, complications from MLT, additional glaucoma treatments after MLT, pre and post-op IOP, etc. Chi square goodness of fit and one-way ANOVA tests were used to determine any differences in characteristics between patient groups. Multivariate regression analysis was performed amongst candidates who had not failed treatment at six months. RESULTS: Demographics of the 102 eyes and IOP changes overtime for failure, non-failure, mild, moderate, and severe glaucoma groups are summarized in adjunct Table 1 and Figure 1. Average IOP reduction at 1 year post MLT (n=41) was 17.24% (p<.001). Thirty-six patients (35.3%) failed treatment. Positive family history; increased BMI, age, CCT, pre-op medications; East Indian race; and worse pre-op vision were significantly correlated with lower IOP reductions (respectively, p<.001.) While, mild VFD, female gender, black race, and increased pre-op IOP were significantly correlated with greater IOP reductions (respectively, p<.001.) CONCLUSION: Our study has shown MLT at one year is a safe procedure that may offer additional IOP reduction (17.24%) for patients with medically uncontrolled POAG. Predictors for better response are: younger age, lower BMI, black race, female gender, no family history, thin CCT, better vision, and less advanced.Item Power of OCT-A (Optical Coherence Tomography Angiography) in Glaucoma(2018-01-23) Yang, Alex; Deng, Ted; Noorani, Sahar; Li, Xilong; AlSalem, Munsif; Adams-Huet, Beverley; Kooner, KaranjitPURPOSE/RELEVANCE: OCT-A is a new non-invasive, motion contrast micro-vascular imaging modality. Using OCT-A, we analyzed vessel density measurements and structural properties in controls, glaucoma suspects and patients with mild, moderate and severe glaucoma. METHODS: In an IRB approved retrospective study, 69 controls, 36 glaucoma suspects, 54 mild glaucoma, 25 moderate glaucoma, and 12 severe glaucoma patients were studied. One eye was randomly selected per patient. Collected data included: age, race, gender, family history of glaucoma, CCT, IOP, visual field (VF) MD and PSD, cup/disc ratio (C/D), and OCT-A scanning parameters: global and sectoral optic nerve fiber thickness, ganglion cell complex thickness, disc vessel densities, retinal vessel densities, and the foveal avascular zone area. A Jonckheere-Terpstra, chi-square, independent t-test, and correlation matrix were used to determine differences between controls and glaucoma groups. RESULTS: Optic disc and retinal vessel densities showed a significant decrease as the glaucoma progressed, from mild to severe form, 52.9% to 43.1% and 48.1% to 43.4%, respectively (p<0.01). Nerve fiber layer thickness decreased from 83.0μm to 60.1μm, respectively (p<0.01). Both structural properties and vessel densities were effective at determining glaucoma stage, but neither variable was superior to the other (p=0.21). Between controls and glaucoma suspects, we noticed structural property differences, but not vessel density differences (p≤0.05). DISCUSSION: The vessel densities and structural properties from OCT-A have a significant decreasing trend as glaucoma progresses and they support the clinical diagnosis of glaucoma based on VF damage. However, in glaucoma suspects, the structural properties were reduced compared to controls, while vessel densities remained unchanged. This could suggest that structural damage may occur before vessel damage in glaucoma suspects when there is no VF defect. CONCLUSION: Optic disc and retinal vessel densities and structural properties assessed by OCT-A can provide an objective measure of glaucoma damage in the eye. Our study has shown that structural damage may occur before vessel density damage in glaucoma suspects.