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Celso Tello

Publications and source records attributed to Celso Tello.

11 recordsLinked to original sources
PubMed2006

Angle closure in highly myopic eyes.

PURPOSE: Patients with angle-closure glaucoma and high myopia are uncommon. We evaluated the clinical characteristics of all patients with angle closure and high myopia in our database and propose possible mechanisms for angle closure in these atypical patients. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Our database of 17938 patients was searched for patients with myopia of spherical equivalent of more than -6.0 diopters and angle closure. Data recorded included age at time of initial consultation, gender, slit-lamp examination results, gonioscopy results, biometric parameters, ultrasound biomicroscopy results (from 1993 onward), clinical diagnosis, and therapy. RESULTS: Twenty patients (11 females, 9 males) were identified. Mean age at the time of consultation was 52.9+/-19.3 years. Angle-closure diagnoses included primary pupillary block (9 patients), pupillary block in an eye with keratoconus (1 patient), pupillary block secondary to a pupillary membrane associated with retinopathy of prematurity (1 patient), plateau iris configuration and syndrome (3 patients), phacomorphic glaucoma in Weill-Marchesani syndrome (2 patients), malignant glaucoma secondary to a scleral buckle (2 patients), miotic-induced angle closure (1 patient), and Marfan syndrome (1 patient). CONCLUSIONS: Angle closure can occur in eyes with high myopia. Causes of angle closure other than relative pupillary block are more common than in the general angle-closure glaucoma population. Careful gonioscopy accompanied by biometry and ultrasound biomicroscopy can lead to the correct diagnosis and individualized management in these eyes.

Adult↗
PubMed2006

Ultrasound biomicroscopy in asymmetric pigment dispersion syndrome and pigmentary glaucoma.

OBJECTIVE: To identify differences in anterior chamber anatomy among patients with asymmetric pigment dispersion syndrome and no other discernible cause for the asymmetry. METHODS: Ultrasound biomicroscopy and A-scan biometry were performed on both eyes of 13 patients with asymmetric pigment dispersion syndrome without a known cause for asymmetric involvement. A radial perpendicular image in the horizontal temporal meridian detailing the scleral spur, angle anatomy, and iris configuration was obtained for each eye by 2 examiners. RESULTS: There were no differences in lens thickness (P = .33), refractive error (P = .84), or axial length (P = .99) between more and less affected eyes. However, the mean +/- SD iris concavity (P<.001), iris-lens contact distance (P = .02), and distance from the scleral spur to the iris insertion (0.42 +/- 0.11 vs 0.29 +/- 0.06 mm) (P = .002) were greater in the more affected eye of each patient. CONCLUSION: A more posterior iris insertion predisposes to the phenotypic expression of pigment dispersion syndrome.

Adult↗
PubMed2006

The ISNT rule and differentiation of normal from glaucomatous eyes.

OBJECTIVE: To determine whether the ISNT rule (that normal eyes show a characteristic configuration for disc rim thickness of inferior > or = superior > or = nasal > or = temporal), widely used for clinical evaluation of the optic nerve head, can differentiate normal from glaucomatous eyes. METHODS: All subjects underwent complete eye examination, including achromatic automated perimetry, simultaneous stereoscopic disc photography, and confocal scanning laser ophthalmoscopy. Subjects with normal eyes had no evidence of glaucoma or ocular hypertension and had normal perimetry measurements. Subjects with glaucoma had a reproducible visual field defect. One eye from each subject was randomly enrolled. The ISNT rule was assessed by masked evaluation of disc photographs at the 3, 6, 9, and 12 o'clock positions. RESULTS: Sixty-six subjects with normal eyes (33 black and 33 white individuals) and 43 with open-angle glaucoma (15 black and 28 white individuals) were enrolled. The ISNT rule was intact in 52 (79%) of 66 normal eyes and 12 (28%) of 43 glaucomatous eyes (P<.001). Multiple logistic regression indicated that the odds ratio for glaucoma associated with violation of the ISNT rule was 6.04 (95% confidence interval, 1.74-20.95) after adjustment for age; race was not a confounder of this association. CONCLUSION: The ISNT rule is useful in differentiating normal from glaucomatous optic nerves and is unaffected by race.

Adult↗
PubMed2006

Clinical utility of intraocular pressure monitoring outside of normal office hours in patients with glaucoma.

OBJECTIVE: To determine whether intraocular pressure (IOP) monitoring outside of normal office hours adds clinically useful information. METHODS: We reviewed the records of all patients with glaucoma who were admitted for 24-hour IOP monitoring during 3 years. Applanation IOP was recorded in the sitting position from 7 am until midnight and in the supine position at 6 am. RESULTS: Thirty-two patients (22 women and 10 men) were enrolled (mean +/- SD age, 67.3 +/- 12.1 years). Mean +/- SD 24-hour IOP was 13.0 +/- 2.2 mm Hg. Mean +/- SD peak 24-hour IOP (16.8 +/- 3.2 mm Hg) was significantly higher than peak office IOP (14.7 +/- 3.2 mm Hg) (P<.001). Peak IOP was recorded outside of office hours in at least 1 eye in 22 patients (69%). Mean IOP fluctuation during 24-hour monitoring (6.9 +/- 2.9 mm Hg) was significantly greater than that during office hours (3.8 +/- 2.3 mm Hg) (P<.001). Peak 24-hour IOP was higher than the peak IOP noted during previous office visits in 40 eyes (62%). Results of 24-hour IOP monitoring led to immediate treatment change in 23 eyes (36%). CONCLUSIONS: In glaucoma patients with advanced disease or progression that are disproportionate to known IOP measurements, 24-hour monitoring of IOP may reveal a greater role for pressure-related risk for glaucoma progression than previously suspected and may alter treatment strategies.

Aged↗
PubMed2006

Central corneal thickness is not related to anterior scleral thickness or axial length.

PURPOSE: To examine the relationship between central corneal thickness (CCT), scleral thickness (ST), refractive error, and axial length. METHODS: One hundred forty eyes of 140 patients with no previous history of intraocular surgery were enrolled. Axial length, CCT, and ST were measured ultrasonically. Radial ultrasound biomicroscopy (UBM) images were obtained by a single examiner scanning the temporal corneoscleral limbus. ST was measured independently on the UBM images by two masked observers at scleral spur (ST1) and 2.0 and 3.0 mm posterior to it (ST2 and ST3). RESULTS: Mean patient age was 57.0+/-15.7 (SD) years, and mean refractive error was -1.3+/-5.0 diopters. Intraclass correlation coefficients >0.75 indicated excellent agreement between the two observers for all ST measurements. There was a positive and significant correlation between CCT and ST1 (r=0.27, P=0.001) but not between CCT and ST2 (r=0.02, P=0.8), ST3 (r=0.06, P=0.5), refractive error (r=0.08, P=0.3), or axial length (r=0.07, P=0.4). CONCLUSIONS: CCT correlates with ST only at the scleral spur and is unrelated to refractive error or axial length. This study does not support the hypothesis that a thin CCT is a surrogate marker for abnormal scleral or laminar thickness as an independent cause of increased glaucoma risk.

Body Weights and Measures↗
PubMed2006

Assessment of a race-specific normative HRT-III database to differentiate glaucomatous from normal eyes.

PURPOSE: To determine if a new, normative, race-specific database enhances the ability of confocal scanning laser ophthalmoscopy to differentiate normal from glaucomatous eyes. METHODS: One eye of eligible normal and glaucoma patients was enrolled. All subjects underwent a complete ophthalmologic examination, standard achromatic perimetry (SITA-SAP, 24-2), and confocal scanning laser ophthalmoscopy [Heidelberg retinal tomograph (HRT-II)] within 1 month of enrollment. Racial groups were defined by self-report. Glaucoma was defined by the existence of reproducible SAP loss (pattern standard deviation <5% and/or Glaucoma Hemifield Test outside normal limits) on 2 consecutive fields. Normal subjects had 2 normal visual fields (pattern standard deviation >5% and Glaucoma Hemifield Test within 97% normal limits) and a normal clinical examination. HRT-II examinations were exported to the HRT-III software, which includes a large race-specific normative database consisting of 733 white and 215 black eyes. Moorfields regression analysis (MRA) for the most abnormal optic disc sector was compared between the HRT-II (MRA2) and the HRT-III software before (MRA3-B) and after (MRA3-A) adjustment for race. Sectors outside the 99.9% confidence interval limits ("outside normal limits") were determined to be abnormal. RESULTS: We enrolled 124 black (52 glaucoma, 72 normal) and 96 white (32 glaucoma, 64 normal) subjects. Mean age was 51+/-13 years and 50+/-16 years for blacks and whites, respectively (P = 0.45). Visual field mean deviation was -7.3+/-6.7 db for glaucomatous eyes and -0.4+/-1.1 db for normal eyes (P < 0.001). Sensitivity and specificity for the HRT-II was 71.9% and 95.3%, respectively, for white subjects and 50.0% and 98.6%, respectively, for black subjects. Using the expanded HRT-III database, analysis yielded a sensitivity of 81.3% and specificity of 93.8% for whites and a sensitivity of 71.2% and specificity of 86.1% for blacks. After an adjustment for black ethnicity was made in the HRT-III program, the sensitivity and specificity for blacks was 65.4% and 90.3%, respectively. CONCLUSIONS: A new, larger, race-specific HRT-III database increases sensitivity while maintaining specificity for whites and increases sensitivity but decreases specificity for blacks. New software and databases based on race require careful scrutiny before use in clinical practice.

Adult↗
PubMed2005

Ciliary body thickness increases with increasing axial myopia.

PURPOSE: To assess the relationship between ciliary body thickness and refractive error. DESIGN: Prospective observational case series. METHODS: We enrolled 75 eyes of 75 patients with no history of intraocular surgery or use of anti-glaucoma medication. Axial length was measured by A-scan ultrasonography. Ciliary body thickness (CBT) was measured by two masked observers on radial-section images of the temporal corneoscleral limbus, acquired with ultrasound biomicroscopy (UBM) at 2 and 3 mm posterior to the scleral spur (CBT2 and CBT3, respectively). RESULTS: Refractive error was inversely correlated with CBT2 and CBT3 (r = -.64 and r = -.52, P < .0001, respectively). Axial length was correlated with CBT (r = .66 and r = .57, P < .0001, for CBT2 and CBT3, respectively). CONCLUSION: CBT increases with increasing myopia and axial length.

Body Weights and Measures↗
PubMed2004

Effect of pupillary dilation on retinal nerve fiber layer thickness measurements using optical coherence tomography.

PURPOSE: To evaluate the effect of pupillary dilation on retinal nerve fiber layer thickness (RNFL) measurements using optical coherence tomography (OCT-3). METHODS: Randomly chosen eyes of healthy individuals were scanned before and after pupillary dilation by two trained operators (R.G.O., R.V.) using OCT-3 (Carl Zeiss Meditec, Inc., Dublin, CA). Fast and regular RNFL (256 A-scans) OCT-3 protocols (software version A1.1) were used in each scanning session. RNFL thickness measurements before and after dilation were compared. RESULTS: Ten eyes of 10 subjects (6 females, 4 males) were enrolled. Mean age was 32.0 +/- 11.2 years (range, 21 to 52 years). Mean pupillary diameter before and after dilation was 2.9 +/- 0.6 mm and 7.6 +/- 0.8 mm, respectively (P < 0.0001, paired t-test). There was no significant difference in RNFL thickness measurements before and after dilation using both fast and regular RNFL protocols (P > or = 0.05 for all comparisons, paired t-test). Mean coefficients of variation for mean RNFL thickness measurements were 15.3% before and 13.7% after dilation for operator 1; and 10.8% before and 12.7% after dilation for operator 2 for the fast RNFL protocol and 11.3% versus 10.4% and 12.9 versus 11.1%, respectively, for the regular RNFL protocol. CONCLUSION: Pupillary dilation is not necessary in all subjects to obtain reproducible RNFL thickness measurements using OCT-3.

Adult↗
PubMed2004

Scanning protocol choice affects optical coherence tomography (OCT-3) measurements.

PURPOSE: To determine the optimal OCT-3 scanning protocol. METHODS: Normal subjects, ocular hypertensive, and open-angle glaucoma patients were enrolled. The "fast" RNFL scan protocol consists of 3 consecutive circular scans, each containing 256 A-scans obtained in a single 1.92 second session. The "regular" RNFL scan protocol contains 3 separate circular scans, each of which consists of 512 A-scans and is obtained in 1.28 seconds (total 3.84 seconds). A customized 256-point scan was created from the 512-point "regular" RNFL scan by extracting the RNFL measurements from every second point. Mean RNFL thickness measurements and mean coefficients of variation (CV) were calculated for each of the scan types. RESULTS: Thirty-one eyes with visual field defects (31 glaucoma eyes) and 30 eyes with normal fields (10 normal and 20 ocular hypertensive eyes) were enrolled. There was no difference in RNFL thickness or CV between fast, regular, or customized RNFL scans in the eyes with VF defects (P > 0.05 for all comparisons). Although eyes with normal fields showed no difference in CV between fast, regular, and customized RNFL scans (P > 0.05 for all comparisons), there was a thicker RNFL measurement using the fast RNFL scan (P = 0.01). CONCLUSIONS: Optimal sampling density for OCT-3 assessment of parapapillary RNFL thickness is not more than 256 axial determinations. Although both scanning protocols have good reproducibility, the scanning protocol should remain constant during serial OCT-3 evaluation.

Adult↗
PubMed2002

Angle closure: classification, concepts, and the role of ultrasound biomicroscopy in diagnosis and treatment.

The angle closure glaucomas are a diverse group of disorders characterized by mechanical blockage of the trabecular meshwork by the peripheral iris leading to elevated intraocular pressure and glaucoma. Understanding the pathophysiologic mechanisms underlying these disorders is essential for both diagnosis and management. This review covers the anatomy, etiology, classification, and therapy of the various angle closure glaucomas and the role that ultrasound biomicroscopy has played in helping us understand these diseases.

Diagnosis, Differential↗