Browsing by Subject "Trabeculectomy"
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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 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 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.