Biomedical subjects

Kouros Nouri-Mahdavi

Publications and source records attributed to Kouros Nouri-Mahdavi.

13 recordsLinked to original sources

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

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

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↗

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↗

PubMed2004

Visual field changes after cataract extraction: the AGIS experience.

PURPOSE: To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of glaucomatous scotomas. DESIGN: Experimental study with no control group. METHODS: One hundred fifty-eight eyes (of 140 patients) from the Advanced Glaucoma Intervention Study with at least two reliable visual fields within a year both before and after cataract surgery were included. Average mean deviation (MD), pattern standard deviation (PSD), and corrected pattern standard deviation (CPSD) were compared before and after cataract extraction. To evaluate changes in scotoma size, the number of abnormal points (P < .05) on the pattern deviation plot was compared before and after surgery. We described an index ("scotoma depth index") to investigate changes of scotoma depth after surgery. RESULTS: Mean values for MD, PSD, and CPSD were -13.2, 6.4, and 5.9 dB before and -11.9, 6.8, and 6.2 dB after cataract surgery (P < or = .001 for all comparisons). Mean (+/- SD) number of abnormal points on pattern deviation plot was 26.7 +/- 9.4 and 27.5 +/- 9.0 before and after cataract surgery, respectively (P = .02). Scotoma depth index did not change after cataract extraction (-19.3 vs -19.2 dB, P = .90). CONCLUSIONS: Cataract extraction caused generalized improvement of the visual field, which was most marked in eyes with less advanced glaucomatous damage. Although the enlargement of scotomas was statistically significant, it was not clinically meaningful. No improvement of sensitivity was observed in the deepest part of the scotomas.

Aged↗

PubMed2004

Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study.

PURPOSE: To investigate the risk factors associated with visual field (VF) progression in the Advanced Glaucoma Intervention Study (AGIS) with pointwise linear regression (PLR) analysis of serial VFs. DESIGN: Prospective, multicenter, randomized clinical trial. PARTICIPANTS: Five hundred nine eyes of 401 patients from the AGIS with a baseline VF score of or=7 VF examinations, and >or=3 years of follow-up were selected. MAIN OUTCOME MEASURE: Visual field progression. METHODS: This is a cohort study of patients enrolled in a prospective randomized clinical trial (AGIS). Worsening of a test location on PLR analysis was defined as a change of threshold sensitivity of >or=1.00 decibels a year, with P<or=0.01. Visual field progression was defined as worsening of at least 2 test locations within a Glaucoma Hemifield Test cluster with PLR analysis. Multivariate logistic regression was used to determine risk factors associated with VF worsening. Intraocular pressure (IOP) fluctuation was defined as standard deviation of the IOP at all visits after the initial surgery. RESULTS: The mean (+/- standard deviation) follow-up time and baseline AGIS score were 7.4 (+/-1.7) years and 7.7 (+/-4.4), respectively. Visual field progression was detected with PLR analysis in 151 eyes (30%). Older age at the initial intervention (P = 0.0012; odds ratio [OR], 1.30; 95% confidence interval [CI], 1.11-1.50), larger IOP fluctuation (P = 0.0013; OR, 1.31; 95% CI, 1.12-1.54), increasing number of glaucoma interventions (P = 0.01; OR, 1.74; 95% CI, 1.14-2.64), and longer follow-up (P = 0.02; OR, 1.19; 95% CI, 1.03-1.38) were associated with increased odds of VF progression. When regression analyses were repeated in eyes with and without a history of cataract extraction, IOP fluctuation was the only variable to be consistently associated with VF progression. CONCLUSION: Both increasing age and greater IOP fluctuation increase the odds of VF progression by 30% (for each 5-year increment in age and 1-mmHg increase in IOP fluctuation). The higher risk conferred by IOP fluctuation was consistently observed in eyes with and without a history of cataract extraction.

Adult↗

PubMed2004

Prediction of visual field progression in glaucoma.

PURPOSE: To determine the probability of future glaucomatous visual field (VF) progression with clinical and perimetric data. METHODS: One hundred sixty-one eyes of patients (161) enrolled in the Advanced Glaucoma Intervention Study (AGIS) with >or=8 years of follow-up and a baseline VF score <or=16 were selected. VF progression at 8 years was determined with point-wise linear regression (PLR) analysis, using a two-omitting algorithm. The course of VF series over the first 4 years of follow-up was quantified by an index, the sum of slopes, which is the sum of all slopes of VF thresholds with P < 0.05 when PLR was performed on the 4-year data. The following parameters were included in a logistic regression model to predict 8-year outcomes from the first 4 years of follow-up: intervention sequence, age, AGIS VF score, mean IOP, IOP fluctuation, and sum of slopes. RESULTS: Sixty-four (40%) eyes progressed after 8 years as determined by PLR analysis. Two parameters were predictive of subsequent VF progression, as identified at 8 years (predictive power: 76%): more negative sum of slopes (i.e., faster or more extensive deterioration; P < 0.001) and older age at 4 years (P = 0.049). When sum of slopes alone was used to predict outcomes at 8 years, the predictive power was the same. CONCLUSIONS: The VF sum of slopes can be used to estimate the probability of subsequent VF worsening with reasonable, clinically useful accuracy. This probability may be combined with other clinical information for more effective clinical predictions and treatment decisions.

Aged↗

PubMed2003

Evaluation of the hypertensive phase after insertion of the Ahmed Glaucoma Valve.

PURPOSE: To investigate the postoperative hypertensive phase (HP) in patients undergoing glaucoma drainage implant surgery. DESIGN: Interventional case series. METHODS: A retrospective chart review of 156 consecutive eyes (139 patients) who underwent placement of an Ahmed Glaucoma Valve (AGV) with a follow-up of >or=3 months was performed. Main outcome measures were occurrence and resolution of the HP and intraocular pressure (IOP) control. The HP was defined as IOP > 21 mm Hg during the first 3 months after surgery. Resolution of the HP was defined as an IOP < 22 mm Hg and an IOP reduction of 3 mm Hg with the same or fewer number of glaucoma medications. RESULTS: An HP was observed in 88 eyes (56%). It occurred after a mean of 5.0 weeks (median, 4 weeks; range, 1-13 weeks) with an average (+/- standard deviation) peak IOP of 30.1 (+/- 7.5) mm Hg. Resolution of the HP occurred in 19 of 68 eyes (28%) with available data. Eyes with an HP had a higher mean IOP and needed more medications 6 to 12 months after surgery than eyes without an HP (17.2 +/- 5.6 vs 14.3 +/- 5.8 mm Hg; P =.012 and 1.7 +/- 1.2 vs 0.3 +/- 0.6 medications; P <.001, respectively). CONCLUSION: A hypertensive phase occurs frequently after implantation of the AGV. However, it resolves in only a minority of eyes. The majority of eyes with an HP have no significant improvement of IOP control and continue to require the same number of glaucoma medications as they did during the HP.

Adolescent↗

PubMed2003

Long anterior zonules and pigment dispersion.

PURPOSE: To describe pigment dispersion associated with long anterior zonules. DESIGN: Multicenter observational case series. METHODS: Fifteen patients, seven of whom were treated for glaucoma or ocular hypertension, were identified with long anterior zonules and pigment dispersion. Transmission electron microscopy was performed on one anterior capsule specimen. RESULTS: All patients had anterior zonules that inserted centrally on the lens capsule. Signs of pigment dispersion included corneal endothelial pigmentation, loss of the pupillary ruff, and variable trabecular meshwork pigmentation. Ultrasound biomicroscopy verified the lack of posterior iris insertion and concavity. There was no exfoliation material. Transmission electron microscopy showed zonular lamellae with adherent pigment granules, and no exfoliation material. CONCLUSIONS: Long anterior zonules inserted onto the central lens capsule may cause mechanical disruption of the pigment epithelium at the pupillary ruff and central iris leading to pigment dispersion.

Adult↗