Biomedical subjects

Donald L Budenz

Publications and source records attributed to Donald L Budenz.

28 records · Page 2Linked to original sources

PubMed2003

Risk factors for hypotony maculopathy.

PURPOSE: To determine the risk factors for hypotony maculopathy. DESIGN: Retrospective case control study. PARTICIPANTS: Two hundred twenty-eight eyes of 228 patients with hypotony from one medical center. METHODS: Chart review of patients with hypotony from January 1988 to April 2001. Hypotony was defined as intraocular pressure of 5 mmHg or less. Cases of hypotony maculopathy had retinal or choroidal folds or both within the arcades. Controls had hypotony alone. Risk factors were evaluated using multiple logistic regression analysis. MAIN OUTCOME MEASURES: Risk factors for hypotony maculopathy, including age, gender, race, refractive error, systemic illness, intraocular pressure, primary filtering surgery, use of antifibrotic agents, and presence of choroidal effusion. RESULTS: Eighty-one case eyes with hypotony maculopathy and 147 control eyes with hypotony alone were identified. The mean age of patients with hypotony maculopathy was 50.5 years +/- 18.7 compared with 70.6 years +/- 12.7 for the control patients (P < 0.001). More patients with hypotony maculopathy were male, 54.3% (44 of 81), than controls, 33.6% (49 of 147) (P = 0.004). The refractive error was -3.02 +/- 3.67 diopters (D) for phakic eyes with hypotony maculopathy (n = 31), whereas the phakic control eyes' (n = 30) refractive error was -0.61 D +/- 2.00 (P = 0.003). Choroidal effusion was found in 21% (17 of 81) of the case eyes at diagnosis and 52.4% (77 of 147) of the control eyes (P < 0.001). Race distribution and use of antifibrotics was similar for both groups. In multivariate analyses, young age, male gender, no history of diabetes, and absence of choroidal effusion predicted the development of hypotony maculopathy; in phakic eyes myopia was also a risk factor for hypotony maculopathy. CONCLUSIONS: Young age, male gender, and myopia are significant risk factors for hypotony maculopathy. A history of diabetes and the presence of choroidal effusion are associated with a decreased risk for hypotony maculopathy.

Age Factors↗

PubMed2002

Comparison of glaucomatous visual field defects using standard full threshold and Swedish interactive threshold algorithms.

OBJECTIVES: To compare the severity, size, and depth of glaucomatous visual field defects using standard full threshold (FT), Swedish interactive threshold algorithm (SITA) standard (SS), and SITA fast (SF) algorithms of the Humphrey perimeter. METHODS: A prospective observational case series of 77 patients with glaucoma performed FT, SS, and SF 30-2 white-on-white testing programs on the same day on 2 occasions for 1 month. The severity of defects was compared using the mean deviation, pattern standard deviation, Advanced Glaucoma Intervention Study, and Hodapp-Anderson-Parrish severity scores. The sizes of defects were compared using the total number of abnormal points on the pattern deviation plot that fit standard criteria for glaucomatous visual field defects. The depths of the defects were compared using the sum of the threshold values for points identified in the pattern deviation plot as fitting criteria for glaucomatous defects. RESULTS: The mean deviations were slightly better using the SS (-9.6 +/- 7.1 dB) or the SF (-9.1 +/- 6.7 dB) algorithm compared with the FT algorithm (-10.3 +/- 7.1 dB) (P<.005). There were no significant differences in pattern standard deviations between SS (8.6 +/- 4.0, P =.08) and SF (8.1 +/- 3.6, P =.19) compared with FT (8.3 +/- 3.3), although the pattern standard deviation was higher in SS fields compared with SF fields (P<.001). Advanced Glaucoma Intervention Study scores were slightly better when the SS (7.5 +/- 5.6) or SF (7.2 +/- 5.4) algorithm was used compared with the FT algorithm (8.6 +/- 5.4) (P<.001). The sizes of glaucomatous defects were slightly larger using the SS (20.9 +/- 10.7) algorithm compared with the FT algorithm (19.2 +/- 10.9) (P =.004) but not the SF algorithm (20.0 +/- 10.6) (P =.11). The depth of defects measured by the SS (220.4 +/- 108.0 dB) and SF (219.8 +/- 101.3 dB) algorithms was significantly shallower compared with that measured by the FT algorithm (152.3 +/- 79.1 dB) (P<.001). There were no significant differences in Hodapp-Anderson-Parrish severity scores among algorithms (P =.12). CONCLUSIONS: Glaucomatous defects are measured significantly shallower using the new SITA algorithms but are approximately the same size and severity compared with FT measurements. Care should be taken when using threshold values to compare glaucomatous defects in a patient when converting from FT to SITA algorithms.

Adult↗

PubMed2002

The Ocular Hypertension Treatment Study: reproducibility of cup/disk ratio measurements over time at an optic disc reading center.

PURPOSE: To determine the reproducibility over time of visual estimates of the horizontal cup/disk ratio by trained technicians from optic disk stereophotographs. METHODS: Baseline optic disk stereophotographs are graded at entry and regraded annually in a masked fashion. The 1,636 participants in the Ocular Hypertension Treatment Study (OHTS) undergo stereoscopic optic disk photography at study entry and annually thereafter. Stereophotographs are graded independently by two technicians at the Optic Disc Reading Center. If the readers' estimates of horizontal cup/disk ratio differ by more than 0.2 disk diameters (DD), they attempt to reach a consensus; if they cannot, the horizontal cup/disk ratio is adjudicated by a glaucoma specialist. RESULTS: The percent of regradings differing by 0.2 DD or more from the estimate of horizontal cup/disk ratio made at entry was 4%, 6%, and 7%, respectively at years 1, 2, and 3. The percent differing by more than 0.2 DD was 1% or less at all years. Intraclass correlation coefficients were 0.93, 0.92, and 0.92, respectively. Estimates of horizontal cup/disk ratio from sequential full-frame photographs and simultaneous split-frame photographs appeared comparable and equally reproducible. Gradings by technicians were comparable to gradings by glaucoma specialists. CONCLUSIONS: High reproducibility between repeated gradings of baseline horizontal cup/disk ratio was achieved by trained technicians adhering to a rigorous protocol. Horizontal cup/disk ratio measurements in OHTS are sufficiently reproducible to provide information about the relationship of cup/disk ratio to the prognosis of individuals with ocular hypertension.

Certification↗

PubMed2002

Baseline visual field characteristics in the ocular hypertension treatment study.

PURPOSE: The Ocular Hypertension Treatment Study (OHTS) seeks to evaluate the safety and efficacy of topical ocular hypotensive medication in preventing or delaying the onset of visual field loss and/or optic nerve damage in ocular hypertensive subjects at risk for developing primary open-angle glaucoma. This study evaluates the baseline visual field test characteristics (visual field status, reliability properties, etc.) of patients who underwent eligibility visual field testing for entry to the OHTS. DESIGN: Cross-sectional study of baseline data as part of a longitudinal randomized clinical trial. PARTICIPANTS: Two thousand eight hundred nineteen ocular hypertensive individuals, aged 40 to 80 (mean age, 55). METHODS: Subjects underwent at least two Humphrey Field Analyzer Program 30-2 Full Threshold visual field examinations in both eyes for study eligibility. A third examination was performed if a prior test was abnormal, questionable, or unreliable. For final eligibility, two sets of visual field examinations had to meet OHTS criteria for reliability and had to be classified as "normal." All OHTS visual field tests of potential subjects were submitted for eligibility assessment to the OHTS Visual Field Reading Center. MAIN OUTCOME MEASURES: The percentage of visual fields that were normal and reliable according to OHTS criteria. RESULTS: Of the subset of 2304 subjects who completed the eligibility assessments, 1828 (79%) were OHTS-eligible based on visual field test requirements. A third eligibility test was required for 11% of all eyes because of unreliable, questionable, or abnormal test results. With the 33% fixation loss cutoff in the OHTS, 97% of all eligibility visual field examinations were reliable and 3% were unreliable. The most frequent cause (69.5%) of unreliability was excessive fixation losses. CONCLUSIONS: Permitting one repeat test after an abnormal or unreliable test allowed an extra 560 patients to be "eligible" for the study based on visual field tests. A clinical screening review of otherwise normal and reliable tests was not restrictive. The adoption of a 33% fixation loss cutoff significantly reduced the number of required retests and prevented study rejection of 89 patients.

Adult↗

PubMed2002

Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes.

OBJECTIVE: To investigate clinical factors, causative organisms, treatments, and visual acuity and intraocular pressure outcomes associated with delayed-onset, bleb-associated endophthalmitis. DESIGN: Retrospective, noncomparative, consecutive case series. PARTICIPANTS: All patients treated for bleb-associated endophthalmitis at Bascom Palmer Eye Institute between January 1, 1996, and July 1, 2001. All patients had prior glaucoma filtering surgery. Patients with inadvertent functioning blebs after cataract extraction were excluded. MAIN OUTCOME MEASURES: Visual acuity outcomes and intraocular pressure control after endophthalmitis. RESULTS: An antifibrotic agent was used in 40 (82%) of the 49 eyes identified, including mitomycin-C in 33 (67%) and 5-fluorouracil (5-FU) in 7 (14%). The mean interval between the initial filtering surgery and endophthalmitis diagnosis was 5.0 years (range, 0.7-12.2 years). The mean follow-up time after treatment for endophthalmitis was 6.9 months (range, 1-60 months). As recorded in the medical record, potential risk factors and clinical features among the study population included history of bleb leak in 13 (27%) eyes, bleb manipulations in 15 (31%) (needling in 3 [6%], compression sutures in 2 [4%], laser suture lysis in 6 [12%], bleb revision in 5 [10%], and autologous blood injection in 2 [4%]), bleb defects in 6 (12%), inferior bleb location 6 (12%), and nasolacrimal duct obstruction in 1 (2%). The most common causative organisms were Streptococcus species in 15 eyes (31%) and Staphylococcus species in 11 eyes (22%). Final visual acuities in the vitrectomy group (n = 22) versus the initial tap group (n = 26) were as follows: > or = 20/40 (5% versus 15%), 20/50 to 20/400 (32% versus 54%), and < 5/200 (64% versus 31%). Eleven (22%) patients eventually underwent enucleation or evisceration secondary to pain and/or poor vision (light perception to no light perception). In 4 (11%) of the 38 eyes not enucleated, intraocular pressures were poorly controlled at last follow-up (>21 mmHg) after treatment of endophthalmitis. CONCLUSIONS: Streptococcus species and Staphylococcus species were the most common causative organisms in the current series of patients with delayed-onset bleb-associated endophthalmitis. Despite successful treatment of the infection, visual outcomes are generally poor.

Adult↗

PubMed2002

Sensitivity and specificity of the Swedish interactive threshold algorithm for glaucomatous visual field defects.

PURPOSE: To determine the sensitivity and specificity of two new visual field algorithms in detecting glaucomatous visual field defects: (1) Swedish interactive threshold algorithm (SITA) standard and (2) SITA fast. DESIGN: Prospective observational case series. PARTICIPANTS: Ninety normal subjects and 82 glaucoma patients. TESTING: Central 30 degrees fields were performed with the Humphrey visual field analyzer 30-2 program (Humphrey Systems, Dublin, CA) using full threshold, SITA standard, and SITA fast algorithms on the same day for two or more sessions within a 1-month period. MAIN OUTCOME MEASURES: Sensitivity and specificity in detecting glaucomatous visual field defects with SITA standard and SITA fast using full threshold testing as the reference standard. RESULTS: The sensitivity of SITA standard and SITA fast in detecting glaucomatous defects overall was 98% and 95%, respectively. In the subset of mild glaucomatous field defects (26 patients), sensitivity of SITA standard was 92% versus 85% with SITA fast. Sensitivity was 100% for both algorithms in moderate to severe glaucomatous defects. Specificity for glaucoma defects using SITA standard and SITA fast was 96% for both algorithms. SITA standard reduced test-taking time from full threshold by 52% in normal subjects and 47% in glaucoma patients (P < 0.001). SITA fast reduced test-taking time by 72% in normal subjects and 65% in glaucoma patients (P < 0.001). Mean deviation values were 0.4 dB and 0.8 dB better in SITA standard and SITA fast fields, respectively, in normal subjects (P < 0.001), and 0.7 dB and 1.2 dB in SITA standard and SITA fast fields, respectively, in glaucoma patients (P < 0.001) compared with full threshold values. CONCLUSIONS: The new algorithms for measuring visual fields, SITA standard and SITA fast, have excellent sensitivity and specificity for glaucomatous visual field loss with considerable savings in time.

Adult↗

PubMed2002

Combined cataract extraction and Baerveldt glaucoma drainage implant: indications and outcomes.

PURPOSE: To report the indications and outcomes of simultaneous cataract extraction (CE) and Baerveldt glaucoma drainage implant surgery. DESIGN: Noncomparative, interventional, retrospective, consecutive case series. PARTICIPANTS: Thirty-three eyes of 33 patients. INTERVENTION: Combined phacoemulsification CE and Baerveldt glaucoma drainage implant (BGI) surgery at two tertiary care referral centers. MAIN OUTCOME MEASURES: Visual acuity, intraocular pressure (IOP), and complications. RESULTS: The study included 33 eyes of 33 patients followed for an average of 15.4 months (range, 3.0-46.9). The most common indication for combined CE and Baerveldt glaucoma drainage implant surgery was a history of prior failed trabeculectomy. Postoperative visual acuity at last follow-up was > or =20/40 in 12 of 33 patients (36%). IOP was reduced from a mean (+/- standard deviation) of 21 +/- 7.3 mmHg preoperatively to 13.1 +/- 3.5 mmHg at last follow-up visit ( P < 0.001). The number of antiglaucoma medications was reduced from a mean (+/- standard deviation) of 2.3 +/- 1.0 preoperatively to 0.7 +/- 1.1 at last follow-up (P < 0.001). Three eyes met our criteria for failure, and cumulative survival of the glaucoma surgery at 18 months was 89%. Intraoperative complications were all related to the cataract surgery, whereas early and late postoperative complications were related both to the CE and BGI surgery. CONCLUSIONS: Combined CE and Baerveldt glaucoma drainage implant placement seems to be a safe and effective surgical option and may be preferred in certain clinical situations.

Adult↗

PubMed2002

Tube fenestrations in Baerveldt Glaucoma Implant surgery: 1-year results compared with standard implant surgery.

PURPOSE: To evaluate the efficacy and safety of tube fenestrations in eyes undergoing polyglactin suture-ligated Baerveldt Glaucoma Implant surgery. PATIENTS AND METHODS: The authors performed a retrospective nonrandomized comparative interventional study of consecutive cases of 111 eyes of 111 patients with refractory glaucoma who received polyglactin (Vicryl) suture-ligated Baerveldt 350 implants as a single procedure. In 69 of these cases (group 1), fenestrations were placed anterior to the ligature using a suture needle. In 42 cases (group 2), no fenestrations were performed. Main outcome measures included intraocular pressure, visual acuity, and complications. RESULTS: Mean (+/- SD) preoperative intraocular pressure was 36.7 +/- 10.2 mm Hg in group 1 and 28.3 +/- 10.3 mm Hg in group 2 (P <0.001). Postoperative mean intraocular pressure was lower in group 1 than in group 2 at day 1 (20.2 +/- 12.8 vs. 29.3 +/- 1.9 mm Hg, P <0.001) and week 1 (18.3 +/- 10.4 vs. 23.7 +/- 8.6 mm Hg, P = 0.006), but was virtually identical at 1 year (12.7 +/- 4.9 vs. 12.6 +/- 4.4 mm Hg, P = 0.95). Number of glaucoma medications used by group 1 patients was significantly lower up to 3 months (P </=0.05). Complication rates were similar in both groups. After tube opening at a mean of 36 +/- 4.7 days, there was an equal and sustained intraocular pressure reduction in both groups in patients taking a similar number of glaucoma medicines up to 12 months after surgery. CONCLUSION: Tube fenestrations provide safe and effective short-term intraocular pressure control with fewer glaucoma medications in a ligated nonvalved glaucoma drainage implant, with comparable intraocular pressure control and medications required at 1 year. However, not all patients have sustained reduction of intraocular pressure in the immediate postoperative period with fenestrations, making the effect somewhat unpredictable.

Aged↗

PubMed2002

Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma.

PURPOSE: To describe the surgical technique and clinical outcomes of a procedure for refractory glaucoma, concurrent Baerveldt glaucoma implant (BGI) and trabeculectomy with mitomycin C. MATERIALS AND METHODS: Medical records of all patients who underwent combined Prolene-ligated BGI and trabeculectomy with mitomycin C were retrospectively reviewed. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual acuity, and complications. Kaplan-Meier survival analysis was used to determine success, defined as IOP < 22 mm Hg, no reoperation for glaucoma, and no loss of light perception vision. RESULTS: The mean +/- SD follow-up period for 38 eyes of 36 patients was 34 +/- 36 months (range, 3-121 months), during which 18 of 38 eyes (47%) required laser suture lysis of the Prolene suture. Intraocular pressure was reduced from a mean (+/- SD) preoperative value of 35.7 +/- 12.8 to 12.7 +/- 4.7 mm Hg at 1-year follow-up and 11.9 +/- 5.5 mm Hg at the last follow-up visit ( < 0.001). Number of medicines used for glaucoma was reduced from a mean +/- SD preoperative value of 2.5 +/- 0.9 to 0.5 +/- 0.6 at 1-year follow-up and 0.6 +/- 0.8 at the last follow-up visit ( < 0.001). LogMar visual acuity remained stable at mean of 1.15 +/- 0.85 preoperatively, compared with 1.14 +/- 1.05 at 1-year follow-up, but declined to 1.61 +/- 1.01 at the last follow-up visit, a loss of an average of four lines of vision ( = 0.004). Cumulative success was 91% at year 1, 86% at year 2, and 81% at year 3. Three eyes (8%) had suprachoroidal hemorrhages, one eye (3%) needed reoperation for an extruded implant, one (3%) eye had poor vision due to chronic hypotony, three eyes (8%) required additional glaucoma surgery during the postoperative period, and one eye (3%) needed revision of the implant for pressure control. CONCLUSIONS: Combined BGI and mitomycin C trabeculectomy provides excellent postoperative IOP control in patients with refractory glaucoma.

Adult↗

PubMedDate not supplied

Implantation of second glaucoma drainage devices after failure of primary devices.

BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of implantation of a second glaucoma drainage device for eyes that have failed a primary device. PATIENTS AND METHODS: Medical records of patients receiving a primary glaucoma drainage device at Bascom Palmer Eye Institute from January 1987 to October 1998 were reviewed, of which 18 eyes of 18 patients were studied. Patients failing a primary glaucoma drainage procedure and receiving a second glaucoma drainage device were included in this study. The second eye in the same patient was excluded if a second drainage implant was required. All patients received a second device in a standardized fashion with the drainage tube inserted in the anterior chamber. Main outcome measures included: visual acuity, intraocular pressure (IOP), antiglaucomatous medication, length of follow up, and surface area of glaucoma drainage device. Success was defined as an IOP less than or equal to 21 mm Hg with or without medications, and at least a 20% reduction in IOP, without the need for additional glaucoma procedures. RESULTS: The mean postoperative IOP (19.6 +/- 9.4 mm Hg; range, 8-50 mm Hg) was significantly (P = 0.006) lower than the mean preoperative IOP (29.5 +/- 8.1 mm Hg; range, 20-52 mm Hg) at last follow up (mean 19.6 +/- 13.6 months; range, 6-47 months). The mean number of postoperative antiglaucomatous medications (2.2 +/- 1.2; range 0-4) was statistically similar (P = 0.2) to mean preoperative number of antiglaucomatous medications (2.6 +/- 1.2, range 1-4). Using Kaplan-Meier estimates, successful IOP reduction was observed in 89%, 83%, 63%, and 37% of eyes at 6 months, 1, 2, and 3 years, respectively. Four patients (21%) had a decline in visual acuity. CONCLUSIONS: Implantation of secondary glaucoma drainage devices may be useful in eyes that have failed primary devices.

Adult↗