Biomedical subjects

Joseph Caprioli

Publications and source records attributed to Joseph Caprioli.

At least 19 recordsLinked to original sources

PubMed2006

Gene expression changes in the retina following optic nerve transection.

PURPOSE: To obtain and analyze the gene expression profiles of the retina following optic nerve transection (ONT). METHODS: An axotomy animal model was generated by taking a cross section of the optic nerve with care not to damage the adjacent blood supply. The extent of cell loss was evaluated by counting cells in the ganglion cell layer (GCL) of flat-mounted retinas stained with cresyl violet. Gene expression profiles of control and ONT retinas were analyzed with Agilent's rat oligo microarray slides. Differentially expressed genes were identified from three independent experiments and clustered based on their functions with expression analysis systematic explorer software. Real-time quantitative and semiquantitative RT-PCR were used to validate changes in gene expression levels. RESULTS: Gene expression changes in axotomized retinas were analyzed with rat oligo microarray slides containing 22,575 oligonucleotide probes that represent over 20,000 genes and expressed sequence tags (ESTs). The expression of 493 genes was increased more than 1.5 fold, including 85 that were upregulated more than 2 fold, and the expression of 113 genes was decreased 1.5 fold or more, including 21 that were downregulated more than 2 fold. Differentially expressed genes were clustered based on their functions. Several novel genes expressed in the GCL have been identified and their expression patterns in different tissues were analyzed. Among the genes differentially regulated in retinas with induced retinal ganglion cell (RGC) death, we have identified 13 genes that are mapped to known glaucoma loci and can be considered for mutation screening in patients with inherited forms of glaucoma. CONCLUSIONS: The gene expression profiles of the ONT retinas can be used to identify RGC-expressed genes, which may be essential for the morphological and physiological characteristics of RGCs. The results of this study can also be used to evaluate the molecular changes taking place in the retina in response to RGC loss.

Animals↗

PubMed2006

Frequency-doubling perimetry: comparison with standard automated perimetry to detect glaucoma.

PURPOSE: To compare second generation frequency-doubling perimetry (FDP) with standard automated perimetry (SAP) to detect glaucomatous visual field abnormalities. DESIGN: Prospective, cross-sectional, controlled observational study. METHODS: Fifty eyes of 50 patients with glaucoma with confirmed SAP visual field abnormalities and 42 eyes from 42 normal control subjects were studied. Swedish Interactive Thresholding Algorithm (SITA) standard 24-2 SAP and FDP visual fields were performed. The correlation of global indices and the number of defects on total deviation (TD) and pattern deviation (PD) plots were compared. The spatial concordance of FDP and SAP defect locations was determined. RESULTS: In patients with glaucoma, significant correlations of mean deviation (MD) and pattern standard deviation (PSD) were found between SAP and FDP (P < .001 for MD and P < .001 for PSD), but not in the normal group. FDP had significantly greater defect scores than SAP on total deviation and PD plots in the glaucoma group (P = .028 and P = .01, respectively). In comparison with SAP, sensitivity and specificity of FDP were 92% and 98% with glaucoma hemifield test criteria and 98% and 93% with PSD <5% criteria, respectively. Similarly high diagnostic precision was found with MD and PSD (at 95% specificity; MD and PSD sensitivity was 82% and 90%, respectively). The location of defects within 12 hemifield clusters found with FDP agreed moderately well with those detected with SAP (kappa = .48). CONCLUSIONS: FDP and SAP perform similarly in their ability to detect visual field defects in early to moderate glaucoma. Larger and deeper defects detected with FDP suggests the possibility of earlier detection at high specificity.

Adult↗

PubMed2006

Co-expression of heat shock transcription factors 1 and 2 in rat retinal ganglion cells.

Heat shock protein (HSP) plays an important role in the maintenance of neuronal survival during harmful conditions. Previously, we reported that metabolic stress induces HSP72 in retinal ganglion cells (RGCs) and protects against excitotoxicity, hypoxia and experimental glaucoma. To understand heat shock protein transcriptional mechanisms, we examined the cellular expression of heat shock factors 1 (HSF1) and 2 (HSF2) in the unstressed adult rat retina. Western blotting, immunohistochemistry and RT-PCR showed that mRNA and protein of HSF1 and HSF2 were present in the rat retina and predominantly expressed in RGC layer cells. Western blotting of dissociated RGC suspensions harvested with Thy-1 immuno-labeled magnetic beads confirmed that RGCs expressed HSF1, HSF2 and HSP72. Our findings suggest that both heat shock transcription factors 1 and 2 are linked to the heat shock response in retinal ganglion cells.

Animals↗

PubMed2006

Expression of hermes gene is restricted to the ganglion cells in the retina.

The RNA binding protein with multiple splicing 2, or hermes, is a member of the RRM (RNA recognition motif) family of RNA-binding proteins. In this study, we show that the hermes gene is expressed in the rat retina, and its expression is restricted to the ganglion cell layer. Double in situ hybridization with riboprobes corresponding to the hermes gene and Thy-1, the RGC marker in the retina, showed that the majority of the Thy-1 positive cells in the ganglion cell layer were also hermes positive. This was also shown by co-localization of the hermes in situ hybridization signals with the retrogradely labeled RGCs. Our observations suggest that hermes is expressed in the majority, if not all, of RGCs and is not restricted to only certain RGC types. Hermes in situ hybridization signals were not detected in the retinal sections of optic nerve transected animals, which are characterized by rapid and specific RGC degeneration. The dramatic reduction of the hermes mRNA level in axotomized retinas was also observed by semi-quantitative RT-PCR. The specific expression of hermes in retinal ganglion cells qualifies this gene as a potential RGC marker in the retina. Outside the retina, hermes is expressed in the heart, liver, and kidney, and to a lesser degree in the cerebellum, cortex, lung, and small intestine.

Animals↗

PubMed2006

Trabeculectomy with mitomycin C: outcomes and risk factors for failure in phakic open-angle glaucoma.

PURPOSE: To evaluate long-term tonometric outcomes of trabeculectomy with adjunctive mitomycin C (MMC) and its efficacy in achieving a range of intraocular pressures (IOP) in phakic patients with open-angle glaucoma. DESIGN: Retrospective cohort study. METHODS: Three levels of success were defined by these criteria: (A) IOP < or =18 mmHg and IOP reduction of 20%; (B) IOP < or =15 mmHg and IOP reduction of 25%; and (C) IOP < or =12 and IOP reduction of 30%. Kaplan-Meier survival analyses were used to assess outcomes. Cox's proportional hazard regression analysis was used to identify risk factors for failure. PARTICIPANTS: Two hundred twenty-five phakic patients (292 eyes) with open-angle glaucoma, > or =40 years of age at time of trabeculectomy. MAIN OUTCOME MEASURES: The primary outcome was qualified success rate (with or without medications) according to the defined criteria. Secondary outcomes include IOP level and number of medications at 1 and 3 years after surgery, postoperative complications, and need for further glaucoma surgery. RESULTS: Mean IOP (+/-standard deviation) decreased from 18.8 mmHg (+/-6.1 mmHg) before surgery to 11.3 mmHg (+/-4.5 mmHg) at 1 year and 11.1 mmHg (+/-4.2 mmHg) at 3 years (P<0.001 for both). The mean number of medications decreased from 2.8 (+/-1.0) to 0.4 (+/-0.7) at 1 year and 0.7 (+/-1.0) at 3 years (P<0.001 for both). The success rates were 85%, 84%, and 79% at 1 year for criteria A, B, and C, respectively; and 62%, 56%, and 46% for these criteria, respectively, at 3 years. Postoperative laser suture lysis was associated with a higher rate of failure for criteria B and C (P<0.001 for both), the hazard ratio (HR) was 1.7 for criteria B and 2.0 for criteria C. Prior argon laser trabeculoplasty was associated with higher risk of failure for criteria C (HR = 1.6; P = 0.05). CONCLUSIONS: Trabeculectomy with MMC effectively reduces IOP in phakic open-angle glaucoma, but long-term low IOPs are achieved in only half of the cases. Laser suture lysis after trabeculectomy and prior argon laser trabeculoplasty are associated with a higher risk of failure when low IOPs are required.

Adult↗

PubMed2006

Comparison of retinal nerve fiber layer thickness and optic disk algorithms with optical coherence tomography to detect glaucoma.

PURPOSE: To compare the performance of the retinal nerve fiber layer (RNFL) thickness and optic disk algorithms as determined by optical coherence tomography to detect glaucoma. DESIGN: Observational cross-sectional study. METHODS: setting: Academic tertiary-care center. study population: One eye from 42 control subjects and 65 patients with open-angle glaucoma with visual acuity of > or =20/40, and no other ocular pathologic condition. observation procedures: Two optical coherence tomography algorithms were used: "fast RNFL thickness" and "fast optic disk." main outcome measures: Area under the receiver operating characteristic curves and sensitivities at fixed specificities were used. Discriminating ability of the average RNFL thickness and RNFL thickness in clock-hour sectors and quadrants was compared with the parameters that were derived from the fast optic disk algorithm. Classification and regression trees were used to determine the best combination of parameters for the detection of glaucoma. RESULTS: The average visual field mean deviation (+/-SD) was 0.0 +/- 1.3 and -5.3 +/- 5.0 dB in the control and glaucoma groups, respectively. The RNFL thickness at the 7 o'clock sector, inferior quadrant, and the vertical C/D ratio had the highest area under the receiver operating characteristic curves (0.93 +/- 0.02, 0.92 +/- 0.03, and 0.90 +/- 0.03, respectively). At 90% specificity, the best sensitivities (+/-SE) from each algorithm were 86% +/- 3% for RNFL thickness at the 7 o'clock sector and 79% +/- 4% for horizontal integrated rim width (estimated rim area). The combination of inferior quadrant RNFL thickness and vertical C/D ratio achieved the best classification (misclassification rate, 6.2%). CONCLUSION: The fast optic disk algorithm performs as well as the fast RNFL thickness algorithm for discrimination of glaucoma from normal eyes. A combination of the two algorithms may provide enhanced diagnostic performance.

Adult↗

PubMed2006

Trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma: outcomes and risk factors for failure.

PURPOSE: To evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure. DESIGN: Retrospective cohort study. METHODS: Seventy-three pseudophakic patients (89 eyes) with primary open-angle, normal-tension, exfoliative, or pigmentary glaucoma were recruited. Success rates were defined according to three criteria: (A) intraocular pressure (IOP) < or = 18 mm Hg and IOP reduction > or = 20%; (B) IOP < or = 15 mm Hg and IOP reduction > or = 25%; and (C) IOP < or = 12 mm Hg and IOP reduction > or = 30%. IOP, visual acuity, complications, and additional interventions were documented after surgery. Cox's proportional hazard regression analysis was used to identify risk factors for failure. RESULTS: Mean IOP (+/-SD) decreased from a preoperative value of 18.8 +/- 6.6 mm Hg to 10.2 +/- 5.1 mm Hg at one year and to 10.0 +/- 4.2 at two years (P < .001 for both). Average number of preoperative medications decreased from 3.0 +/- 1.1 to 0.5 +/- 1.0 at one year and to 0.5 +/- 0.9 at two years (P < .001 for both). For criteria A, B, and C, success rates (+/-SE) were 87% +/- 4%, 83% +/- 5%, and 76% +/- 5% at 1 year and 67% +/- 4%, 58% +/- 8%, and 50% +/- 7 at two years. Laser suture lysis was performed in 30 eyes, and 11% of those required a second glaucoma procedure. CONCLUSION: Increasing age, use of a limbus-based conjunctival flap, and performance of laser suture lysis were factors that were associated with a smaller risk of failure. Present findings indicate that trabeculectomy with mitomycin C provides acceptable long-term success rates in pseudophakic patients, with a low incidence of complications.

Aged↗

PubMed2006

Diagnosing glaucoma progression: current practice and promising technologies.

PURPOSE OF REVIEW: An update on recent work is provided that has broadened our understanding of the evaluation of visual function and structure, and their use in evaluating glaucoma progression. RECENT FINDINGS: The challenge of determining visual-field progression and the implications of long-term fluctuation are reviewed and data to support the magnitude of the fluctuation are cited. The use of confirmatory testing can limit the over diagnosis of glaucoma progression. Focusing visual-field testing on the locations of present scotomas or using frequency doubling technology may provide new approaches to assessing visual function. New standardized techniques to interpret visual fields, including neural networks, unsupervised machine learning and pointwise linear regression, may provide more quantitative means for visual-field interpretation. These techniques, along with structural evaluation of the optic nerve and nerve fiber layer, are essential in glaucoma management. Optic-nerve-head photography is still a mainstay in evaluating glaucoma progression, although many technologies including scanning laser tomography, scanning laser polarimetry and optical coherence tomography offer more quantitative means to follow structural change. These modalities, in different ways, show promise in providing additional information regarding the stability of glaucoma. SUMMARY: Identifying the functional visual component as well as structural changes is essential in evaluating glaucoma progression. New techniques of testing and evaluating visual fields, the optic-nerve head, and the retinal nerve fiber layer offer exciting opportunities to more accurately identify glaucoma progression, and are likely to become more central as imaging devices and software support develop further.

Diagnostic Techniques, Ophthalmological↗

PubMed2006

Outcomes of laser suture lysis after initial trabeculectomy with adjunctive mitomycin C.

PURPOSE: To evaluate and compare outcomes of eyes that underwent laser suture lysis (LSL) after initial trabeculectomy with mitomycin C (MMC) to those that did not require such an intervention. METHODS: We reviewed the charts of consecutive patients with open-angle glaucoma who underwent initial trabeculectomy with mitomycin C at the Jules Stein Eye Institute between 1998 and 2003. Primary outcome measures were intraocular pressure (IOP) control at 1 year and success rate of trabeculectomy according to following criteria: criteria A, IOP < 21 mm Hg with >or=20% IOP reduction and criteria B, IOP < 15 mm Hg with >or=30% IOP reduction. Kaplan-Meier survival analysis and Cox's proportional hazards regression analysis were used to estimate and determine influence of laser suture lysis on success rates after trabeculectomy. RESULTS: Laser suture lysis was performed in 95 eyes (84 patients) whereas 146 eyes (121 patients) did not require it. IOP was significantly higher at 12 months in laser suture lysis eyes compared with non-laser suture lysis eyes (12.9 +/- 5.2 mm Hg versus 11.0 +/- 4.1 mm Hg; P = 0.04). Laser suture lysis eyes also had decreased success rates with criteria B (57% compared with 73% at 1 year for non-LSL eyes; P = 0.005). However, only late laser suture lysis (last LSL session >10 days after trabeculectomy) was associated with worse outcome in Cox's proportional hazards model using criteria B (HR = 2.26; P = 0.004). Late hypotony occurred in 4% and 1% of non-LSL and LSL eyes, respectively. CONCLUSIONS: Eyes that undergo laser suture lysis >10 days after initial trabeculectomy with mitomycin C are more likely to have poorer long-term IOP control than eyes not requiring laser suture lysis or eyes undergoing laser suture lysis <or=10 days after surgery.

Aged↗

PubMed2006

Pointwise linear regression analysis for detection of visual field progression with absolute versus corrected threshold sensitivities.

PURPOSE: To compare the performance of point-wise linear regression analysis (PLR) with total deviation (TD) versus corrected or pattern deviation (PD) threshold sensitivities for detection of visual field progression. METHODS: Four hundred two eyes (402 patients) enrolled in the Advanced Glaucoma Intervention Study (AGIS) were selected. Criteria for progression according to PLR were a slope or=2 worsening points within the same Glaucoma Hemifield Test cluster. PLR was performed on TD and PD threshold sensitivities and compared to clinical evaluation. Eyes were classified into three groups based on mean deviation (MD): mild (MD>or=-6 dB), moderately advanced (-6 dB>MD>or=-12 dB), and advanced (MD<-12 dB) glaucoma. RESULTS: Visual field progression was observed in 154 (38%), 85 (21%), and 175 (44%) eyes, according to PLR(TD) and PLR(PD), and clinical evaluation. The pair-wise agreement between clinicians and PLR(TD) was significantly greater than that of clinicians and PLR(PD) (kappa=0.48, 95% CI: 0.44-0.52 vs. kappa=0.31, 95% CI: 0.27-0.35). Agreement between PLR(TD) and PLR(PD) decreased with increasing glaucoma severity: kappa (95% CI)=0.60 (0.52-0.67), 0.41 (0.35-0.47), and 0.33 (0.27-0.40) for mild, moderately advanced, and advanced glaucoma, respectively. CONCLUSIONS: Point-wise linear regression analysis on TD threshold sensitivities performed better than the same analysis on PD when clinical evaluation was used as a reference. Agreement between the two methods was less in moderately advanced and advanced glaucoma.

Adult↗

PubMed2005

Feasibility and efficacy of a mass switch from latanoprost to bimatoprost in glaucoma patients in a prepaid Health Maintenance Organization.

OBJECTIVE: To assess the feasibility of an automatic switch of a large number of patients with glaucoma or suspicion of glaucoma from latanoprost to bimatoprost, and to compare the efficacy of the 2 prostaglandin analogs before and after the switch. DESIGN: Retrospective nonrandomized comparison. PARTICIPANTS: Forty-three thousand four hundred forty-one California patients and 538 patients at one Southern California clinical facility of a nationwide prepaid health maintenance organization (HMO) who were on either prostaglandin between March 2002 and December 2003 (21 months). METHODS: Beginning in April 2002, patients on latanoprost were systemically switched to bimatoprost by the HMO pharmacy service after obtaining approval from the entire ophthalmology staff. PART 1: computerized dispensing records of California patients were retrieved. PART 2: medical records of patients at one clinical facility were reviewed. MAIN OUTCOME MEASURES: Rates of switching or switching back from one prostaglandin to another, intraocular pressure (IOP) control, and intolerability. RESULTS: PART 1: 17847 patients initially received latanoprost. Of them, 84.8% were switched from latanoprost to bimatoprost, and 13.0% were switched back to latanoprost. Twenty-five thousand five hundred ninety-four patients were started on bimatoprost without previous experience with latanoprost. Of them, 8.6% were later switched to latanoprost use instead. Patients who had previous experience with latanoprost had a statistically significantly higher rate of switching back to latanoprost after a period of bimatoprost use when compared with those who had no prior experience with latanoprost (13.0% vs. 8.6%, respectively; P<0.0001). PART 2: 309 patients were switched from latanoprost to bimatoprost. The mean IOP reduction of 0.51+/-2.77 mmHg (95% confidence interval, 0.20-0.82) after the switch was statistically significant (P = 0.001). Forty-one patients (13.3%) had a decrease of >3 mmHg of IOP. The statistical significance of the IOP reduction after the switch remains in the monotherapy group (P = 0.005) but not in the multitherapy group (P = 0.058). Thirty-three patients (10.7%) who were switched from latanoprost to bimatoprost discontinued bimatoprost and resumed latanoprost. CONCLUSION: A systematic pharmacy-level switch from latanoprost to bimatoprost in a nationwide HMO achieved a high switch rate, with little switching back. There was a small but statistically significant reduction in mean IOP after the switch. An appreciable proportion of patients switched had a clinically significant reduction of IOP.

Adolescent↗

PubMed2005

Expression of phosphorylated c-Jun N-terminal protein kinase (JNK) in experimental glaucoma in rats.

To examine the expression of phosphorylated c-Jun N-terminal kinase (JNK) in cells in the retinal ganglion cell layer of glaucoma, intraocular pressure (IOP) of adult Wistar rats was elevated unilaterally by repeated trabecular argon laser photocoagulation 5 days after intracameral injection of India ink. Animals were euthanized after 3 days, and 1, 2, and 5 weeks of IOP elevation. Immunohistochemistry with specific antibodies against phosphorylated JNK was performed on retinas. Retrograde labeling using Fluorogold and fluorescence immunohistochemistry was performed on retinas 5 weeks after IOP elevation. TdT-mediated biotin-dUTP nick end labeling (TUNEL) was performed on the retinal sections to determine the rate of cell death. There was increased IOP (52.3%) from 3 days to 5 weeks after repeated trabecular laser photocoagulation. Mean number of TUNEL-positive cells in the retinal ganglion cell layer of eyes with experimental glaucoma was 0.43, 0.36, 0.57, and 0.19 per retinal section at 3 days, and 1, 2 and 5 weeks, respectively. No TUNEL-positive cells were noted in controls. In parallel to TUNEL, significantly increased numbers of phosphorylated JNK-labeled cells in the retinal ganglion cell layer were noted at 3 days (9.95 versus 4.15; P=0.005), 1 week (7.65 versus 4.00; P=0.006), 2 weeks (9.13 versus 4.48; P=0.032), and 5 weeks (8.06 versus 4.96; P=0.017) of IOP elevation when compared with contralateral control eyes. Fluorogold labeled RGCs were co-localized with increased phosphorylated JNK immunoreactivity. Some TUNEL-positive cells were phosphorylated JNK immuno-positive. Phosphorylation of JNK occurs in experimental glaucoma and may play a role in retinal ganglion cell death.

Animals↗

PubMed2005

Calpain and N-methyl-d-aspartate (NMDA)-induced excitotoxicity in rat retinas.

Calpain-mediated proteolysis has been implicated as a major process in neuronal cell death in both acute insults and the chronic neurodegenerative disorders in the central nerves system. However, activation of calpain also plays a protective function in the early phase of excitotoxic neuronal death. The exact role of calpains in neuronal death and recovery after exposure to N-methyl-D-aspartate (NMDA) is not clearly known. The purpose of present study was to examine the involvement of mu- and m-calpain in NMDA-induced excitotoxicity in the adult rat retina. Increased immunoreactivity of mu-calpain was noted in RGC layer cells and in the inner nuclear layer with maximal expression at 12 h after NMDA injection. This was further confirmed with Western blotting. TdT-mediated biotin-dUTP nick end labeling (TUNEL) positive cells in the inner retina co-localized with moderate or intense mu-calpain immunoreactivity. In contrast, there was no remarkable change in m-calpain immunoreactivity at any time point after NMDA injection. Simultaneous injection of 2 nmol of a calpain inhibitor (calpain inhibitor II) significantly reduced the number of TUNEL-positive cells in the inner retina at 18 h after NMDA injection and preserved RGC-like cells counted at 7 days after injection. The results of this study showed that mu-calpain may be involved in mediating NMDA-induced excitotoxicity in the rat retina and calpain inhibitors may play a therapeutic role in NMDA related disease.

Animals↗

PubMed2005

Pointwise linear regression for evaluation of visual field outcomes and comparison with the advanced glaucoma intervention study methods.

OBJECTIVE: To investigate pointwise linear regression (PLR) for longitudinal evaluation of visual fields and to compare results with those of the Advanced Glaucoma Intervention Study (AGIS) criteria. METHODS: We selected 509 eyes (401 patients) from the AGIS with 3 or more years of follow-up, 7 or more visual field examinations, and an AGIS reference score of 16 or lower. Visual field change at test locations was defined as a change of threshold sensitivity of 1 dB/y or higher and P<or=.01. Several sets of criteria were investigated for defining change of visual field series with PLR. MAIN OUTCOME MEASURES: Progression or improvement of visual field series with PLR and AGIS criteria. RESULTS: Mean (SD) follow-up time and baseline AGIS score were 7.4 (1.7) years and 7.7 (4.4), respectively. Pairwise agreement between AGIS and various PLR criteria ranged from 52% to 64% with the kappa statistic varying between 0.22 (95% confidence interval, 0.15-0.29) and 0.30 (95% confidence interval, 0.22-0.38). One hundred thirty-eight (27%) and 151 (30%) eyes progressed (85 eyes or 17% detected by both methods) while 72 (14%) and 11 (2%) eyes improved (5 eyes or 1% detected by both methods) based on AGIS and the most rigorous PLR criteria, respectively. CONCLUSIONS: Based on rigorous, clinically relevant criteria, PLR detects progression in a similar proportion of eyes compared with AGIS criteria. Pointwise linear regression may be superior to AGIS methods since it identifies fewer visual field series as improving.

Adult↗

PubMed2005

Outcomes of small-incision cataract surgery in eyes with preexisting Ahmed Glaucoma Valves.

PURPOSE: To investigate outcomes of phacoemulsification in eyes with functioning Ahmed Glaucoma Valves (AGVs). DESIGN: Observational case series. METHODS: We reviewed records of 19 patients (23 eyes) who had a clear-cornea phacoemulsification >/=3 months after insertion of an AGV between 1997 and 2002. The main outcome measures were intraocular pressure (IOP) control, number of medications, complications, and further glaucoma surgery. RESULTS: The median interval between AGV surgery and phacoemulsification was 0.7 years with an average (+/-SD) follow-up time of 1.6 (+/-0.6) years (range: 0.9 to 3.0 years). Four eyes (17%) had an IOP increase >10 mm Hg on day one. The mean IOP or number of medications did not significantly change after phacoemulsification at one month or thereafter (P > .05). One eye (4%) required a second AGV. CONCLUSIONS: Small-incision cataract surgery is consistent with maintenance of IOP control in eyes with functioning AGV. A minority of the eyes will require repeat glaucoma surgery.

Adult↗

PubMed2005

Comparison of safety and efficacy between silicone and polypropylene Ahmed glaucoma valves in refractory glaucoma.

OBJECTIVE: To compare the safety and efficacy of polypropylene and silicone Ahmed glaucoma valves (AGVs) over 1 year of follow-up. DESIGN: Retrospective comparative study. PARTICIPANTS: Fifty consecutive patients with polypropylene and 49 consecutive patients with silicone AGV implantation. METHODS: Our hospital instituted a formulary conversion of the glaucoma aqueous drainage device from polypropylene to silicone AGVs in January 2003. We reviewed the polypropylene AGVs within 7 months before and the silicone AGVs within 7 months after the date of conversion performed on patients with glaucoma refractory to medical treatment and filtering procedures, without previous drainage devices or cyclodestructive procedures, and with a minimum of 12 months' follow-up. Surgical success was defined as an intraocular pressure (IOP) reduction of > or =20% and a final IOP of >5 and <22 mmHg, without additional surgical intervention for IOP control, loss of light perception, or serious complications. MAIN OUTCOME MEASURES: The 2 groups were compared for IOP control, visual outcome, complication rate, and surgical success rate. RESULTS: Significant IOP reductions occurred after polypropylene AGV implantation (from 32.4+/-11.3 mmHg to 16.5+/-6.9 mmHg, P<0.0001) and silicone AGV implantation (from 32.6+/-12.6 mmHg to 14.7+/-6.9 mmHg, P<0.0001). The silicone group had a lower mean IOP than the polypropylene group at all postoperative visits, but the differences were significant only at 3 months postoperatively (P = 0.014). In addition, the silicone group was associated with a rate of insufficient IOP control as the reason of failure (IOP of > or =22 mmHg or IOP reduction of <20%) lower (4.1%) than that of the polypropylene group (20.0%, P = 0.015), but a rate of non-tube related serious complications (16.3%) higher than that of the polypropylene AGV (4.0%, P = 0.042). CONCLUSION: After 1 year of follow-up, the silicone AGV is at least as effective as the polypropylene AGV in IOP reduction but may be associated with a higher rate of complications. These differences are important for surgeons converting to use of the silicone AGV in patients with glaucoma refractory to other forms of treatment.

Aged↗

PubMed2005

Sequential office pressure measurements in the management of glaucoma.

PURPOSE: To evaluate the usefulness of day-long sequential office measurements of intraocular pressure (IOP) to make therapeutic decisions in patients with progressive glaucomatous damage despite apparently 'controlled' IOP. METHODS: We reviewed the records of 93 consecutive glaucoma patients (185 eyes) who underwent sequential office IOP measurements (every hour from 7 AM to 5 PM on a single day). These included 53 patients with normal-tension glaucoma (NTG), 12 glaucoma suspects (GS), and 28 patients with primary open-angle glaucoma (POAG) whose visual field deteriorated despite apparently 'controlled' IOP. Only one eye per patient was included in the study. RESULTS: The pattern of the day-long IOP curve was similar in the 3 groups of patients. IOPs were highest in the early morning hours in all groups. The mean +/- SD of the IOP range was 5 +/- 2 mm Hg. An IOP > 21 mm Hg was found in 3 eyes (3%), whereas a range of IOPs > 5 mm Hg was detected in 33 eyes (35%). In the NTG group, there was a significant correlation between visual field deterioration and the peak and range of IOP (P = 0.0002 and P = 0.05, respectively). CONCLUSIONS: Day-long sequential office IOP measurements are useful in selected patients who demonstrate progressive glaucomatous damage. Early morning measurements are most frequently highest. The range of IOP may be as important, or more important than, the peak IOP level.

Aged↗

PubMed2004

Identifying early glaucoma with optical coherence tomography.

PURPOSE: To evaluate performance of optical coherence tomography (OCT) for detection of early glaucoma. DESIGN: Observational case-control study. METHODS SETTING: University-based tertiary care center. STUDY POPULATION: One eye from 50 normals, 42 glaucoma suspects, and 59 early glaucoma patients meeting the following criteria: visual field (VF) mean deviation > or =-6.00 dB, age > or =40 years, spherical refractive error < or =5 diopters, astigmatism < or =3 diopters, and visual acuity > or =20/30. OBSERVATION PROCEDURE: Early glaucoma by VF (EGVF) was described as repeatable abnormal achromatic VFs based on predefined criteria. Glaucoma suspects (GS) were defined as presence of glaucomatous disk appearance with normal achromatic VFs. OUTCOME MEASURES: Average nerve fiber layer thickness (NFLT) and NFLT in each of four quadrants and 12 clock-hour sectors. Receiver operating characteristic curves and sensitivity and specificity were used to assess the performance of OCT. RESULTS: Average NFLT was 128.4 +/- 15.4, 102.0 +/- 25.4, and 86.5 +/- 31.5 microm in normal, GS, and EGVF eyes, respectively. Normal eyes were different from both glaucoma groups (P <.001); NFLT in the superior quadrant and at the 11 o'clock position had the highest area under the receiver operating characteristic curve (.840 and.933) in the GS and EGVF groups (P =.03). The sensitivity of the OCT for detection of glaucoma was 71% and 85% for the GS and EGVF groups with specificity fixed at 90%. CONCLUSION: The OCT discriminates well between eyes with early perimetric glaucoma and normal eyes. However, its performance is less adequate in eyes with suspicious disk and normal VFs.

Adult↗