Browsing by Subject "Intraocular Pressure"
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Item Argon Laser Trabeculoplasty (ALT): Predictors of Failure(2013-01-22) Chang, Eric; Markel, Nathan; Kooner, Karanjit; Adams-Huet, Beverley; Li, XilongPURPOSE. ALT is widely used to control intraocular pressure (IOP) in glaucoma. We wished to determine predictive factors for long term success of ALT performed by supervised residents in training on patients at a local VA Hospital in Dallas. METHODS. Charts of patients with primary open angle glaucoma who underwent ALT between 2001 and 2011 were reviewed retrospectively. Those with follow up < 3 months, prior ALT/SLT, filtering procedure or inadequate data were excluded. The dependent variable was time to failure after ALT. Failure was defined as any additional medication, ALT/SLT or glaucoma filtering surgery. All patients were treated with 360 ° ALT. Logistic regression and receiver operating characteristic (ROC) analysis was performed to assess correlation between time to failure after ALT and age, pre-op IOP, C/D ratio, visual field defect, family history, refractive error, hypertension, diabetes, number of medications, laser energy used, central corneal thickness. RESULTS. Evaluable data was obtained on 206 patients; mean age 65, 98% male, and 61% black. 40.8% (84/206) were classified as ALT failures. Failure and non-failure patients had equal follow-up duration of median 2 yr. Pre-ALT LogMar (mean (SD) 0.25 (.3) vs. 0.35 (.3)), no. of glaucoma medications (2.9 (1.0) vs. 3.3 (1.0)), and myopia (46% vs. 61%) differed, respectively, between ALT failures and non-failures (p<0.05). In multivariable logistic regression models, after adjusting for age, hypertension, and diabetes, we found that myopia was protective (odds ratio (OR) =0.39, 95% CI 0.21-0.78, p=0.005) but that higher laser energy ((OR=1.6 for a 20k increase in energy, 95% CI: 1.1-2.4, p=0.005) was associated with increased risk associated for ALT failure; model ROC AUC = 0.70 (95% CI: 0.63-0.78). DISCUSSION. Our VA patients were mainly males but had good ethnical diversity. Better response in myopia may be related to thickness of trabecular meshwork while poorer response to increased laser energy may be from thermal damage. Patients using more than three meds were on systemic carbonic anhydrase inhibitors CONCLUSIONS. ALT results were better in patients who used more than 3 meds, were myopic and required less laser energy.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 [News](1985-03-21) Floyd, CarolItem Selective Laser Trabeculoplasty (SLT): Predictors of Failure(2013-01-22) Markel, Nathan L.; Huet, Beverley; Li, Xilong; Kooner, Karanjit; Chang, Eric J.PURPOSE. SLT is widely used to control intraocular pressure (IOP) in glaucoma. We wished to determine predictive factors for long term success of SLT performed by full time faculty at a University Eye Clinic in Dallas. METHODS. Charts of patients with primary open angle glaucoma who underwent SLT between 2001 and 2011 were reviewed retrospectively. Those with follow up < 3 months, prior ALT/SLT, filtering procedure or inadequate data were excluded. The dependent variable was time to failure after SLT. Failure was defined as any additional medication, ALT/SLT, or glaucoma filtering surgery. All patients were treated with 360° SLT. Logistic regression and receiver operating characteristic (ROC) analysis was performed to assess correlation between time to failure after SLT and age, pre-op IOP, C/D ratio, visual field defect (VFD), family history of glaucoma, refractive error, hypertension, diabetes, number of medications, laser energy used, central corneal thickness. Results. Evaluable data was obtained on 189 patients; mean age 64, 44% male, 56% female, 49% white, 32% black, 12% Hispanic and 7 % others. 29.6% (56/189) were classified as SLT failures. Failure and non-failure patients had equal follow-up duration of median 2 yr. Age and laser energy were not significant predictors of SLT. In multivariable logistic regression models, statistically significant risk factors associated with SLT failure were family history of glaucoma (odds ratio (OR) = 1.7, 95% CI: 1.1-2.7, p=0.02), higher pre-op IOP (OR =1.1, 95%CI: 1.0-1.15, p=0.03), and moderate to severe VFD (OR =2.6, 95% CI: 1.3-5.2, p=0.006); ROC AUC = 0.71 (95% CI : 0.62-0.80). CONCLUSIONS. SLT results were better in patients without family history of glaucoma and who had lower pre-op IOP and mild to moderate visual field defects.