Biomedical subjects

Undraa Altangerel

Publications and source records attributed to Undraa Altangerel.

8 recordsLinked to original sources

PubMed2006

Subconjunctival sodium hyaluronate 2.3% in trabeculectomy: a prospective randomized clinical trial.

PURPOSE: To investigate the efficacy of subconjunctival sodium hyaluronate 2.3% in increasing the success rate of glaucoma filtering surgery and promoting filtering blebs with characteristics presumed to predict better success. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Fifty-five patients scheduled for glaucoma surgery. INTERVENTION: Patients underwent routine trabeculectomy, with or without phacoemulsification and intraocular lens implantation. In the study group (n = 28), sodium hyaluronate 2.3% was injected between the scleral and conjunctival flaps at the conclusion of the surgery. In the control group (n = 27), balanced salt solution (BSS) was injected in the same fashion, in an unmasked design. MAIN OUTCOMES MEASURES: Surgical success was defined as (1) a complete success if the intraocular pressure (IOP) was 21 mmHg or less without any antiglaucoma medication, and (2) a qualified success if the IOP was 21 mmHg or less, with or without antiglaucoma medication. Patients requiring additional surgery, including needling, or with IOP more than 21 mmHg, even when receiving antiglaucoma medications, were considered to have failed treatment. Success rates in both groups were compared using Kaplan-Meier survival curves and the log-rank test. The morphologic characteristics of the filtering blebs were evaluated using the Indiana Bleb Appearance Grading Scale. Other outcome measures were IOP, visual acuity, need for antiglaucoma medication, and any complications. RESULTS: Fifty-two patients completed the study (27 in the study group and 25 in the control group), with a mean follow-up of 12.3 months. Complete success rates were 77.8% for the study group and 84.0% for the control group 12 months after surgery (P>0.5); qualified success rates were 88.9% for the study group and 92.0% for the control group (P>0.6). Mean IOP decreased from 26.0+/-10.0 mmHg to 11.6+/-4.1 mmHg in the study eyes (P<0.001) and from 24.9+/-9.7 mmHg to 13.0+/-4.1 mmHg in the control eyes (P<0.001). Intraocular pressure measurements in both groups were similar at all visits (P>0.05). The study eyes had more diffuse blebs than the control eyes (62.5% > or =4 clock-hours vs. 22.7%; P = 0.012). Postoperative complications were similar in the study eyes (14.8%) and the control eyes (20.0%; P>0.6). CONCLUSIONS: There was no difference in success rates in patients who received subconjunctival sodium hyaluronate 2.3% compared to BSS injections. Subconjunctival sodium hyaluronate 2.3% was associated with more diffuse blebs after filtering surgery.

Acetates↗

PubMed2006

Assessment of function related to vision (AFREV).

OBJECTIVES: To evaluate the relationship of a performance-based measure of visual functioning to clinical and subjective measures in glaucoma patients. DESIGN: Cross-sectional survey of glaucoma patients. PARTICIPANTS: Forty-three patients with primary open-angle glaucoma. METHODS: Patients were evaluated using a novel performance-based measure, the Assessment of Function Related to Vision (AFREV), standard clinical tests of visual function, and the National Eye Institute's Visual Functioning Questionnaire (NEI-VFQ-25), a self-reported quality of life measure. Correlations of the AFREV scores with visual field scores, monocular and binocular visual acuity, contrast sensitivity scores, and NEI-VFQ scores were calculated. Rasch analysis was used to estimate the visual ability required by each task of AFREV for a particular response (item measures) and to estimate the visual ability of each patient (person measures). MAIN OUTCOME MEASURES: AFREV and NEI-VFQ total scores. RESULTS: The AFREV total scores were highly correlated with contrast sensitivity (r = 0.772), binocular visual acuity (r = -0.768), better-eye visual acuity (r = -0.737), worse-eye visual acuity (r = -0.675), and Estermann visual field efficiency scores (r = 0.606) as well as with NEI-VFQ scores (r = 0.70). The resulting index, constructed from 5 items of the AFREV, is unidimensional, thereby satisfying the primary assumption of the Rasch model. The Rasch person-item map demonstrates that the "putting stick into holes" and "reading small print" tests require the most visual ability. CONCLUSIONS: The AFREV performance-based measure, a new test of a spectrum of activities, correlates well with some standard measures of visual function and certain aspects of self-report assessments. AFREV appears to be a valid measure of performance ability that may provide information not obtainable from standard measures of visual function or subjective surveys.

Activities of Daily Living↗

PubMed2005

Knowledge of chronology of optic disc stereophotographs influences the determination of glaucomatous change.

PURPOSE: To determine the influence of knowledge of the chronology with which stereoscopic photographs of the optic disc were obtained on how the photographs are interpreted. DESIGN: Case series. PARTICIPANTS: Disc photographs of patients enrolled in the Advanced Glaucoma Intervention Study and Collaborative Initial Glaucoma Treatment Study studies from Wills Eye Hospital. METHODS: Two sets of interpretable optic disc stereo slides were included for evaluation. All patients had a follow-up of at least 5 years with baseline and follow-up photographs. Three observers (1 glaucoma attending physician and 2 glaucoma fellows) evaluated the stereophotographs in chronological order to identify the clinical impression of glaucomatous change (glaucomatous deterioration or improvement) based on information such as neuroretinal rim width, nerve fiber layer defects, rim color, peripapillary atrophy, disc hemorrhages, and blood vessel alterations. Three months later, the slide pairs were shuffled so the observers were masked to the chronological sequence. The photographs were reevaluated to determine if there was glaucomatous change. MAIN OUTCOME MEASURES: Agreement between the 2 readings was measured for each observer individually and for the 3 observers collectively. The difference between the number of photographic pairs identified as worse when chronological order was known versus unknown was evaluated using a chi-square test. Intraobserver and interobserver agreement were assessed in terms of kappa values. RESULTS: Intraobserver agreement between chronologically masked and unmasked readings was 61%, 64%, and 71% for the 3 observers, respectively. Average intraobserver agreement between masked and unmasked readings was 65% (kappa, 0.35). Agreement in identifying change (either deterioration or improvement) was 59%, 70%, and 68%, respectively, for each observer. Agreement in identifying stability was 63%, 62%, and 73%, respectively. The number of cases identified as having deteriorated was significantly higher (101 vs. 54) when the observer knew the chronological order with which the photographs were taken (P=0.007). Interobserver agreement was higher when the chronology of photographs was known (kappa, 0.68+/-0.05 for unmasked evaluation; kappa, 0.30+/-0.05 for masked evaluation). CONCLUSIONS: When disc photographs are read with knowledge of the chronology with which they were obtained, the observations differ considerably from when the readings are made without this knowledge.

Chronology as Topic↗

PubMed2005

The usefulness of a new method of testing for a relative afferent pupillary defect in patients with ocular hypertension and glaucoma.

PURPOSE: To evaluate the validity of different methods of relative afferent pupillary defect (RAPD) detection and assess the usefulness of detecting an RAPD in glaucoma patients. METHODS: For this prospective observational study, we enrolled 70 of 153 consecutive glaucoma patients coming for examination. Exclusion criteria were cloudy corneas, recent surgery, fixed pupils, and other diseases producing RAPDs. Inclusion criteria were any type of glaucoma and absence of any exclusion criterion. Patients were examined for an RAPD by the swinging flashlight method (SFM), a magnifier-assisted swinging flashlight method (MAM), and automated pupillography. The SFM and MAM results were compared with those obtained by pupillography. Receiver operating characteristic curves and the area under the curve (AUC) were determined. Correlations of other optic disc and visual field indices of glaucoma damage with RAPD were determined. RESULTS: We confirmed RAPDs in 39 (56%) of the subjects by pupillography, finding a sensitivity of 41% and 84% and a specificity of 90% and 76% for SFM and MAM, respectively. The AUC was 0.86 for MAM and 0.61 for SFM. The correlations (r) between RAPD with intereye differences in the optic disc and visual field indices of glaucoma damage were moderate. CONCLUSIONS: A modified swinging flashlight test with magnification increases the sensitivity of the test in detecting an RAPD. Because the detection of an RAPD may precede apparent optic disc and visual field damage, looking for an RAPD may be an important part of the assessment of patients with glaucoma.

Aged↗

PubMed2003

Reliability of the disk damage likelihood scale.

PURPOSE: To report the reliability of the glaucoma disk damage likelihood scale (DDLS) in comparison to the Armaly cup/disk ratio by determining the interobserver and intraobserver agreement for optic disk stereo photographs and the interobserver agreement for in vivo patient measurements of the optic disk. DESIGN: Observational case series. METHODS: Optic disk photographs: 48 stereo pairs of optic nerve photographs were selected from patients with a spectrum of glaucomatous visual field loss. Two masked observers graded the optic disk photographs three times according to the DDLS and Armaly cup/disk ratio. Interobserver and intraobserver agreements were calculated using the test-retest method. Patient measurements: three observers performed in vivo patient measurements on 34 eyes of glaucoma clinic patients and made a single determination of the DDLS stage and Armaly cup/disk ratio, based on the indirect biomicroscopic examination. Level of interobserver agreement was tabulated. RESULTS: Optic disk photographs: interobserver and intraobserver agreement for the vertical DDLS measurement was greater than for two determinations (clinical impression and measured) of the vertical Armaly cup/disk ratio (interobserver: 85% vs 68% and 74%, respectively; intraobserver grader 1: 97% vs 89% and 80%, grader 2: 99% vs 95% and 89%, respectively). In vivo patient measurements: the interobserver agreement for the DDLS and Armaly cup/disk ratio was similar (70.1% vs 67.6%, respectively). CONCLUSIONS: For the stereo optic disk photographs, the inter- and intra-observer agreement for the DDLS is greater than the Armaly cup/disk ratio. For the in vivo patient measurements, the level of agreement for the DDLS and the Armaly cup/disk ratio is similar.

Diagnostic Techniques, Ophthalmological↗

PubMed2003

Visual function, disability, and psychological impact of glaucoma.

PURPOSE OF REVIEW: This report briefly reviews recent instruments designed to test the visual function and quality of life of patients with glaucoma. RECENT FINDINGS: Several investigators have examined the functional status and vision-related quality of life among patients with glaucoma. These studies have shown that patients with glaucoma experience diminished visual function and poorer quality of life. SUMMARY: Because glaucoma and its treatment, either medical or surgical, can affect global quality of life as well as vision-related functioning, the assessment of both general and visual system health status is relevant.

Disability Evaluation↗

PubMed2002

The disc damage likelihood scale: reproducibility of a new method of estimating the amount of optic nerve damage caused by glaucoma.

PURPOSE: The major objective of this study was to test the reproducibility of a new method of estimating the amount of optic disc damage in patients with glaucoma. METHODS: The Disc Damage Likelihood Scale (DDLS) is based on the appearance of the neuroretinal rim of the optic disc corrected for disc diameter. The eight stages, extending from no damage to far advanced damage, are based on the width of the neuroretinal rim or the circumferential extent of absence of neuroretinal rim. Reproducibility was measured by two masked observers staging 48 optic nerve stereoscopic photographs by two different methods, the cup/disc ratio (c/d) and the DDLS. Also, reproducibility was assessed by three observers examining 34 eyes of 24 patients. RESULTS: With regard to the photographs, the intraobserver and interobserver reproducibility was better using the DDLS than the c/d ratio (98% versus 85% for intraobserver of reproducibility, and 85% versus 74% for interobserver reproducibility). The DDLS correlated better with the Humphrey Visual Field than did any Heidelberg Retina Tomograph parameter. CONCLUSION: In a clinical setting, the DDLS is as reproducible as, or more reproducible than, the c/d ratio system of estimating the amount of disc damage in patients with glaucoma.

Diagnostic Techniques, Ophthalmological↗

PubMedDate not supplied

Intracameral 2.3% sodium hyaluronate to treat postoperative hypotony in patients with glaucoma.

BACKGROUND AND OBJECTIVE: To evaluate the intracameral use of Healon5 (2.3% sodium hyaluronate) (Advanced Medical Optics, Santa Ana, CA) in patients with hypotony. PATIENTS AND METHODS: Fifteen consecutive patients with glaucoma who had hypotony for at least 7 days were prospectively recruited. Indications for the intracameral injection of Healon5 were an intraocular pressure (IOP) of less than 6 mm Hg with negative results on Seidel test. RESULTS: The mean IOP readings at baseline, 1 to 2 weeks post-injection, and 4 to 6 weeks post-injection were 3.8 +/- 1.58, 6.58 +/- 2.62, and 6.50 +/- 2.24 mm Hg, respectively. The increase in IOP at both follow-up points was significant (P < .01). The visual acuity improvement was small but significant at the 4 to 6 week point (P = .05). In the early-onset cases, IOP increased significantly from baseline at both follow-up points (P< .05), but visual acuity did not. No significant change from baseline IOP or visual acuity occurred among the late-onset cases. The existing hypotony-related conditions consistently improved by the 4 to 6 week point. CONCLUSIONS: Intracameral injection of Healon5 raised IOP more in early-onset hypotony cases than in late-onset cases. Although the improvements in IOP and visual acuity were statistically significant, the overall clinical picture did not change because the endpoint IOP was still hypotonus. Twenty percent of the patients had IOP spikes that required medical treatment.

Adjuvants, Immunologic↗