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Glaucoma: HELP
Articles by Philip P. Chen
Based on 34 articles published since 2010
(Why 34 articles?)
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Between 2010 and 2020, P. P. Chen wrote the following 34 articles about Glaucoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Is diabetes, even without retinopathy, a risk factor for glaucoma filtering surgery failure in the age of anti-fibrosis agents? 2013

Chen, Philip P. · ·Br J Ophthalmol · Pubmed #23591546.

ABSTRACT: -- No abstract --

2 Review Optical coherence tomography angiography in glaucoma. 2019

Bojikian, Karine D / Chen, Philip P / Wen, Joanne C. ·Department of Ophthalmology, University of Washington, Seattle, Washington, USA. ·Curr Opin Ophthalmol · Pubmed #30575618.

ABSTRACT: PURPOSE OF REVIEW: Optical coherence tomography angiography (OCTA) studies have demonstrated reduced microcirculation in the superficial optic nerve, peripapillary retina, and the macula of glaucoma patients. The scope of this review is to outline recent studies using OCTA in glaucoma and highlight how OCTA may help improve diagnosis and follow-up in glaucoma patients. RECENT FINDINGS: OCTA studies have provided evidence of vascular changes in the optic nerve head, peripapillary, and macula region in glaucoma in comparison to glaucoma suspects and normal eyes. Additionally, OCTA can detect longitudinal reduction of peripapillary and macula vessel density in glaucoma patients. It remains unclear whether the reduced microcirculation in glaucoma patients induces the neuronal damage or arises through reduced circulation requirements in damaged tissue. SUMMARY: OCTA is a novel imaging modality that has great potential to enhance our understanding of glaucoma and to improve our ability to detect and treat it.

3 Review The Effect of Anti-Vascular Endothelial Growth Factor Agents on Intraocular Pressure and Glaucoma: A Report by the American Academy of Ophthalmology. 2019

Hoguet, Ambika / Chen, Philip P / Junk, Anna K / Mruthyunjaya, Prithvi / Nouri-Mahdavi, Kouros / Radhakrishnan, Sunita / Takusagawa, Hana L / Chen, Teresa C. ·Ophthalmic Consultants of Boston, Boston, Massachusetts. · Department of Ophthalmology, University of Washington, Seattle, Washington. · Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Miami Veterans Affairs Healthcare System, Miami, Florida. · Byers Eye Institute, Stanford University, Palo Alto, California. · Stein Eye Institute, Los Angeles, California. · Glaucoma Center of San Francisco, Glaucoma Research and Education Group, San Francisco, California. · The Eye Center, Eugene, Oregon, and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon. · Harvard Medical School, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Glaucoma Service, Boston, Massachusetts. ·Ophthalmology · Pubmed #30472176.

ABSTRACT: PURPOSE: To assess the effect of intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents on immediate and long-term intraocular pressure (IOP) elevation and glaucoma. METHODS: Literature searches of the PubMed and Cochrane databases, last conducted in April 2018, yielded 253 unique citations. Of these, 41 met the inclusion criteria and were rated according to the strength of evidence. Two articles were rated level I, 17 were rated level II, and 15 were rated level III; an additional 7 were excluded because of poor study design and lack of relevance to the topic under evaluation. RESULTS: The studies that reported on short-term IOP elevation (i.e., between 0 and 60 minutes) showed that an immediate increase in IOP is seen in all patients when measured between 0 and 30 minutes of intravitreal injection and that the IOP elevation decreases over time. The data on long-term IOP elevation were mixed; 7 studies reported that between 4% and 15% of patients developed sustained elevation of IOP at 9 to 24 months after injection, whereas 6 studies found no long-term change in IOP from 1 to 36 months after injection. Pretreatment with glaucoma medications, anterior chamber tap, vitreous reflux, longer intervals between injections, and longer axial lengths were associated with lower IOP elevations after injection. Data were mixed on the relationship between IOP increase and the type of intravitreal injection, number of intravitreal injections, preexisting glaucoma, and globe decompression before injection. There were no data on the onset or progression of glaucoma in the studies reviewed in this assessment. CONCLUSIONS: Intravitreal injection of anti-VEGF agents results in an immediate and transient increase in IOP. A long-term increase in IOP also may be seen, and further studies are needed to determine at-risk populations. Although there is some suggestion in the literature, there is currently insufficient data to determine the impact of intravitreal anti-VEGF injections on glaucoma progression. Although pretreatment with glaucoma medications, performing anterior chamber paracentesis, or increasing the interval between injections may reduce the impact of transient IOP elevation, the clinical significance and associated risks of these interventions are unknown.

4 Review Glaucoma. 2016

Gupta, Divakar / Chen, Philip P. ·Duke University School of Medicine, Durham, NC, USA. · University of Washington Medical Center, Seattle, WA, USA. ·Am Fam Physician · Pubmed #27175839.

ABSTRACT: Glaucoma is a set of irreversible, progressive optic neuropathies that can lead to severe visual field loss and blindness. The two most common forms of glaucoma, primary open-angle glaucoma and primary angle-closure glaucoma, affect more than 2 million Americans and are increasing in prevalence. Many patients with glaucoma are asymptomatic and do not know they have the disease. Risk factors for primary open-angle glaucoma include older age, black race, Hispanic origin, family history of glaucoma, and diabetes mellitus. Risk factors for primary angle-closure glaucoma include older age, Asian descent, and female sex. Advanced disease at initial presentation and treatment nonadherence put patients with glaucoma at risk of disease progression to blindness. The U.S. Preventive Services Task Force has concluded that the evidence is insufficient to assess the potential benefits and harms of screening for glaucoma in the primary care setting. Regular eye examinations for adults are recommended by the American Academy of Ophthalmology, with the interval depending on patient age and risk factors. Diagnosis of glaucoma requires careful optic nerve evaluation and functional studies assessing a patient's visual field. The goal of treatment with eye drops, laser therapy, or surgery is to slow visual field loss by lowering intraocular pressure. Family physicians can contribute to lowering morbidity from glaucoma through early identification of high-risk patients and by emphasizing treatment adherence in patients with glaucoma.

5 Review Pediatric glaucoma surgery: a report by the American Academy Of Ophthalmology. 2014

Chen, Teresa C / Chen, Philip P / Francis, Brian A / Junk, Anna K / Smith, Scott D / Singh, Kuldev / Lin, Shan C. ·Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, Massachusetts. · Department of Ophthalmology, University of Washington, Seattle, Washington. · Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. · Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida. · Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. · Stanford University School of Medicine, Stanford, California. · Department of Ophthalmology, University of California, San Francisco, San Francisco, California. ·Ophthalmology · Pubmed #25066765.

ABSTRACT: OBJECTIVE: To review the current published literature to evaluate the success rates and long-term problems associated with surgery for pediatric glaucoma. METHODS: Literature searches of the PubMed and Cochrane Library databases were last conducted in May 2012. The search yielded 838 potentially relevant citations, of which 273 were in non-English languages. The titles and abstracts of these articles were reviewed by the authors, and 364 were selected for possible further review. Members of the Ophthalmic Technology Assessment Committee Glaucoma Panel reviewed the full text of these articles and used the 36 that met inclusion and exclusion criteria for this Ophthalmic Technology Assessment. There were no studies on the topic that provided level I evidence. The assessment included only level II and level III studies. RESULTS: Surgeons treat pediatric glaucoma most commonly with goniotomy, trabeculotomy, trabeculectomy, combined trabeculotomy and trabeculectomy, tube shunt surgery, cyclodestruction, and deep sclerectomy. Certain surgical options seem better for specific diagnoses, such as primary congenital glaucoma, aphakic glaucoma, and glaucomas associated with other ocular or systemic anomalies. CONCLUSIONS: There are many surgical options for the treatment of the pediatric glaucomas. The relative efficacy of these various procedures for particular diagnoses and clinical situations should be weighed against the specific risks associated with the procedures for individual patients.

6 Review The effect of cataract extraction on intraocular pressure. 2014

Slabaugh, Mark A / Chen, Philip P. ·Department of Ophthalmology, University of Washington, Seattle, Washington, USA. ·Curr Opin Ophthalmol · Pubmed #24463416.

ABSTRACT: PURPOSE OF REVIEW: To examine the current literature covering the long-term effect of cataract extraction on intraocular pressure (IOP). RECENT FINDINGS: As a result of the high rate of cataract surgery, the impact on IOP continues to be the subject of multiple studies in different populations. Recent publications include those that distinguish patients with open angles from those with more narrow angles, as well as prospective analyses that address the impact of regression to the mean and other types of bias on the effect of postoperative IOP lowering. SUMMARY: There are sufficient data to suggest that cataract surgery provides a lowering effect on IOP in the long term. This effect appears to be proportional to preoperative IOP. Eyes with higher preoperative IOP have the greatest average lowering, whereas eyes with IOP in the lower range of statistically normal tend to have an IOP that is unchanged from baseline or even higher following cataract surgery. In patients with narrow angles, the IOP-lowering effect appears to also be proportional to the degree of anterior chamber deepening induced by cataract surgery.

7 Review Evaluation of the anterior chamber angle in glaucoma: a report by the american academy of ophthalmology. 2013

Smith, Scott D / Singh, Kuldev / Lin, Shan C / Chen, Philip P / Chen, Teresa C / Francis, Brian A / Jampel, Henry D. ·Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates. ·Ophthalmology · Pubmed #23978623.

ABSTRACT: OBJECTIVE: To assess the published literature pertaining to the association between anterior segment imaging and gonioscopy and to determine whether such imaging aids in the diagnosis of primary angle closure (PAC). METHODS: Literature searches of the PubMed and Cochrane Library databases were last conducted on July 6, 2011. The searches yielded 371 unique citations. Members of the Ophthalmic Technology Assessment Committee Glaucoma Panel reviewed the titles and abstracts of these articles and selected 134 of possible clinical significance for further review. The panel reviewed the full text of these articles and identified 79 studies meeting the inclusion criteria, for which the panel methodologist assigned a level of evidence based on a standardized grading scheme adopted by the American Academy of Ophthalmology. Three, 70, and 6 studies were rated as providing level I, II, and III evidence, respectively. RESULTS: Quantitative and qualitative parameters defined from ultrasound biomicroscopy (UBM), anterior segment optical coherence tomography (OCT), Scheimpflug photography, and the scanning peripheral anterior chamber depth analyzer (SPAC) demonstrate a strong association with the results of gonioscopy. There is substantial variability in the type of information obtained from each imaging method. Imaging of structures posterior to the iris is possible only with UBM. Direct imaging of the anterior chamber angle (ACA) is possible using UBM and OCT. The ability to acquire OCT images in a completely dark environment allows greater sensitivity in detecting eyes with appositional angle closure. Noncontact imaging using OCT, Scheimpflug photography, or SPAC makes these methods more attractive for large-scale PAC screening than contact imaging using UBM. CONCLUSIONS: Although there is evidence suggesting that anterior segment imaging provides useful information in the evaluation of PAC, none of these imaging methods provides sufficient information about the ACA anatomy to be considered a substitute for gonioscopy. Longitudinal studies are needed to validate the diagnostic significance of the parameters measured by these instruments for prospectively identifying individuals at risk for PAC. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

8 Article Forecasting future Humphrey Visual Fields using deep learning. 2019

Wen, Joanne C / Lee, Cecilia S / Keane, Pearse A / Xiao, Sa / Rokem, Ariel S / Chen, Philip P / Wu, Yue / Lee, Aaron Y. ·Department of Ophthalmology, University of Washington, Seattle, WA, United States of America. · NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital, Moorfields Eye Hospital NHS Foundation Trust and University College London (UCL) Institute of Ophthalmology, London, United Kingdom. · eScience Institute, University of Washington, Seattle, WA, United States of America. ·PLoS One · Pubmed #30951547.

ABSTRACT: PURPOSE: To determine if deep learning networks could be trained to forecast future 24-2 Humphrey Visual Fields (HVFs). METHODS: All data points from consecutive 24-2 HVFs from 1998 to 2018 were extracted from a university database. Ten-fold cross validation with a held out test set was used to develop the three main phases of model development: model architecture selection, dataset combination selection, and time-interval model training with transfer learning, to train a deep learning artificial neural network capable of generating a point-wise visual field prediction. The point-wise mean absolute error (PMAE) and difference in Mean Deviation (MD) between predicted and actual future HVF were calculated. RESULTS: More than 1.7 million perimetry points were extracted to the hundredth decibel from 32,443 24-2 HVFs. The best performing model with 20 million trainable parameters, CascadeNet-5, was selected. The overall point-wise PMAE for the test set was 2.47 dB (95% CI: 2.45 dB to 2.48 dB), and deep learning showed a statistically significant improvement over linear models. The 100 fully trained models successfully predicted future HVFs in glaucomatous eyes up to 5.5 years in the future with a correlation of 0.92 between the MD of predicted and actual future HVF and an average difference of 0.41 dB. CONCLUSIONS: Using unfiltered real-world datasets, deep learning networks show the ability to not only learn spatio-temporal HVF changes but also to generate predictions for future HVFs up to 5.5 years, given only a single HVF.

9 Article Smaller-incision Revision of Trabeculectomy With Mitomycin: Long-term Outcomes and Complications. 2019

Chen, Philip P / Moeller, Kristy L. ·Department of Ophthalmology, University of Washington, Seattle, WA. ·J Glaucoma · Pubmed #30394979.

ABSTRACT: PURPOSE: The purpose of this study was to assess long-term outcomes and complications of smaller-incision trabeculectomy revision with mitomycin (MMC) in glaucoma patients. METHODS: Review of patients undergoing trabeculectomy revision with MMC for inadequate intraocular pressure (IOP) control. After dissection of subconjunctival fibrosis through a smaller (median, 5 mm) incision, MMC was topically applied and episcleral fibrosis was incised. Failure was defined as reoperation for glaucoma, or IOP reduction < 20% over 3 follow up visits. RESULTS: Forty eyes (40 patients; mean age, 67±13 y) underwent revision; 9 revisions were combined with other surgery. Mean baseline IOP was 20.6±6.2 mm Hg on 2.6±1.4 glaucoma medications after 2.4±1.3 incisional ocular surgeries. At final follow-up (70±34 mo), 27 successful eyes (67.5%) had IOP of 9.2±2.4 mm Hg on 0.6±0.9 medications. Eleven eyes (27.5%) required reoperation for glaucoma, 7 (63%) within 7 months after revision. The Kaplan-Meier estimate of success at years 1, 2, 3, and 5 postoperatively was 77.5%, 72.2%, 69.5%, and 69.5%, respectively. Recovery of visual acuity to within 2 lines of baseline was 1.7±2.4 weeks (median 1). Complications included sustained hypotony (IOP, ≤5 mm Hg) in 2 eyes (1 also with corneal decompensation), 1 eye with wound leak, and 2 eyes with bleb leak (1 requiring surgical repair). CONCLUSIONS: Smaller-incision trabeculectomy revision with MMC resulted in substantial, sustained IOP reduction in most eyes with poorly functioning filtering blebs, with few serious complications and rapid recovery of baseline visual acuity in most eyes.

10 Article Spectral-Domain OCT: Helping the Clinician Diagnose Glaucoma: A Report by the American Academy of Ophthalmology. 2018

Chen, Teresa C / Hoguet, Ambika / Junk, Anna K / Nouri-Mahdavi, Kouros / Radhakrishnan, Sunita / Takusagawa, Hana L / Chen, Philip P. ·Harvard Medical School, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Glaucoma Service, Boston, Massachusetts. · Ophthalmic Consultants of Boston, Boston, Massachusetts. · Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Miami Veterans Affairs Healthcare System, Miami, Florida. · Jules Stein Eye Institute, Los Angeles, California. · Glaucoma Center of San Francisco, Glaucoma Research and Education Group, San Francisco, California. · The Eye Center, Eugene, Oregon, and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon. · Department of Ophthalmology, University of Washington, Seattle, Washington. ·Ophthalmology · Pubmed #30322450.

ABSTRACT: PURPOSE: To review the current published literature on the use of spectral domain (SD) OCT to help detect changes associated with the diagnosis of glaucoma. METHODS: Searches of the peer-reviewed literature were conducted on June 11, 2014, November 7, 2016, August 8, 2017, and April 19, 2018, in the PubMed and Cochrane Library databases and included only articles published since the last glaucoma imaging Ophthalmic Technology Assessment, which included articles up until February 2006. The abstracts of these 708 articles were examined to exclude reviews and non-English articles. After inclusion and exclusion criteria were applied, 74 articles were selected, and the panel methodologist (K.N.-M.) assigned ratings to them according to the level of evidence. Two articles were rated level I, 57 articles were rated level II, and the 15 level III articles were excluded. RESULTS: Spectral-domain OCT is capable of detecting damage to the retinal nerve fiber layer (RNFL), macula, and optic nerve in patients with preperimetric and perimetric glaucoma (level I and II evidence). The most commonly studied single parameter was RNFL thickness. Of note, RNFL thickness measurements are not interchangeable between instruments. Various commercially available SD OCT instruments have similar abilities to distinguish patients with known glaucoma from normal subjects. Despite different software protocols, all SD OCT instruments are able to detect the same typical pattern of glaucomatous RNFL loss that affects primarily the inferior, inferior temporal, superior, and superior temporal regions of the optic nerve (level II evidence). Across many SD OCT instruments, macular imaging also can detect a preferential inferior, inferior temporal, and superior temporal thinning in patients with glaucoma compared with controls. Best disc parameters for detecting glaucomatous nerve damage are global rim area, inferior rim area, and vertical cup-to-disc ratio. Studies suggest that newer reference-plane independent optic nerve parameters may have the same or better detection capability when compared with older reference-plane dependent disc parameters (level II evidence). CONCLUSIONS: Structural glaucomatous damage can be detected by SD OCT. Optic nerve, RNFL, and macular parameters can help the clinician distinguish the anatomic changes that are associated with patients with glaucoma when compared with normal subjects.

11 Article Laser Peripheral Iridotomy in Primary Angle Closure: A Report by the American Academy of Ophthalmology. 2018

Radhakrishnan, Sunita / Chen, Philip P / Junk, Anna K / Nouri-Mahdavi, Kouros / Chen, Teresa C. ·Glaucoma Center of San Francisco, Glaucoma Research and Education Group, San Francisco, California. · Department of Ophthalmology, University of Washington, Seattle, Washington. · Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida and Miami Veterans Affairs Healthcare System, Miami, Florida. · Stein Eye Institute, Los Angeles, California. · Harvard Medical School, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Glaucoma Service, Boston, Massachusetts. ·Ophthalmology · Pubmed #29482864.

ABSTRACT: PURPOSE: To examine the efficacy and complications of laser peripheral iridotomy (LPI) in subjects with primary angle closure (PAC). METHODS: Literature searches in the PubMed and Cochrane databases were last conducted in August 2017 and yielded 300 unique citations. Of these, 36 met the inclusion criteria and were rated according to the strength of evidence; 6 articles were rated level I, 11 articles were rated level II, and 19 articles were rated level III. RESULTS: Reported outcomes were change in angle width, effect on intraocular pressure (IOP) control, disease progression, and complications. Most of the studies (29/36, 81%) included only Asian subjects. Angle width (measured by gonioscopy, ultrasound biomicroscopy, and anterior segment OCT) increased after LPI in all stages of angle closure. Gonioscopically defined persistent angle closure after LPI was reported in 2% to 57% of eyes across the disease spectrum. Baseline factors associated with persistent angle closure included narrower angle and parameters representing nonpupillary block mechanisms of angle closure, such as a thick iris, an anteriorly positioned ciliary body, or a greater lens vault. After LPI, further treatment to control IOP was reported in 0%-8% of PAC suspect (PACS), 42% to 67% of PAC, 21% to 47% of acute PAC (APAC), and 83%-100% of PAC glaucoma (PACG) eyes. Progression to PACG ranged from 0% to 0.3% per year in PACS and 0% to 4% per year in PAC. Complications after LPI included IOP spike (8-17 mmHg increase from baseline in 6%-10%), dysphotopsia (2%-11%), anterior chamber bleeding (30%-41%), and cataract progression (23%-39%). CONCLUSIONS: Laser peripheral iridotomy increases angle width in all stages of primary angle closure and has a good safety profile. Most PACS eyes do not receive further intervention, whereas many PAC and APAC eyes, and most PACG eyes, receive further treatment. Progression to PACG is uncommon in PACS and PAC. There are limited data on the comparative efficacy of LPI versus other treatments for the various stages of angle closure; 1 randomized controlled trial each demonstrated superiority of cataract surgery over LPI in APAC and of clear lens extraction over LPI in PACG or PAC with IOP above 30 mmHg.

12 Article Intraocular Pressure After Phacoemulsification in Open-angle Glaucoma Patients With Uncontrolled or Marginally Controlled Glaucoma and/or With Severe Visual Field Loss. 2018

Bojikian, Karine D / Chen, Philip P. ·Department of Ophthalmology, University of Washington, Seattle, WA. ·J Glaucoma · Pubmed #29303878.

ABSTRACT: BACKGROUND/AIMS: To evaluate intraocular pressure (IOP) after phacoemulsification in open-angle glaucoma (OAG) patients with uncontrolled or marginally controlled glaucoma and/or severe visual field (VF) loss. PATIENTS AND METHODS: Retrospective case series of OAG patients without prior glaucoma surgery undergoing phacoemulsification. Uncontrolled or marginally controlled glaucoma was defined as IOP>21 mm Hg despite maximally tolerated medications or requiring >3 topical drugs for IOP control. Severe VF loss was defined as VF mean deviation ≤-12 dB. Eyes with postoperative IOP elevation were identified using 4 different definitions. RESULTS: Of 56 eyes (56 patients), 10 eyes (17.8%) had IOP elevation ≥10 mm Hg at postoperative day 1. At 1 year (N=45), the average preoperative IOP of 14.3±3.5 mm Hg decreased to 13.8±3.6 mm Hg (P=0.312), and number of medications of 3.2±1.1 decreased to 2.8±1.2 (P=0.165). Eleven eyes (24.4%) had increase in IOP of ≥3 mm Hg, whereas 14 eyes (31.1%) had decrease of ≥3 mm Hg. Nine eyes (20.0%) had higher IOP without medication changes and 9 eyes (20.0%) required additional medications or surgery for IOP control; 3 eyes (6.7%) required trabeculectomy. Higher IOP at 1 year was associated with IOP elevation ≥10 mm Hg at postoperative week 1 (P=0.020). CONCLUSIONS: Phacoemulsification resulted in nonsignificant 1-year IOP change in OAG patients with uncontrolled or marginally controlled glaucoma and/or with severe VF loss. Although 40% of eyes had higher IOP after phacoemulsification at 1-year postoperatively, only 6.7% required trabeculectomy.

13 Article The Primary Tube Versus Trabeculectomy Study: Methodology of a Multicenter Randomized Clinical Trial Comparing Tube Shunt Surgery and Trabeculectomy with Mitomycin C. 2018

Gedde, Steven J / Chen, Philip P / Heuer, Dale K / Singh, Kuldev / Wright, Martha M / Feuer, William J / Schiffman, Joyce C / Shi, Wei / Anonymous3620930. ·Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: sgedde@med.miami.edu. · Department of Ophthalmology, University of Washington, Seattle, Washington. · Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin. · Department of Ophthalmology, Stanford University, Palo Alto, California. · Department of Ophthalmology, University of Minnesota, Minneapolis, Minnesota. · Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. ·Ophthalmology · Pubmed #29248173.

ABSTRACT: PURPOSE: To describe the methodology of the Primary Tube Versus Trabeculectomy (PTVT) Study. DESIGN: Multicenter randomized clinical trial. PARTICIPANTS: Patients with medically uncontrolled glaucoma and no prior incisional ocular surgery. METHODS: Patients are being enrolled at 16 clinical centers and randomly assigned to treatment with a tube shunt (350-mm MAIN OUTCOME MEASURES: The primary outcome measure is the rate of surgical failure, defined as intraocular pressure (IOP) more than 21 mmHg or reduced by less than 20% from baseline, IOP of 5 mmHg or less, reoperation for glaucoma, or loss of light perception vision. Secondary outcome measures include IOP, glaucoma medical therapy, visual acuity, visual fields, and surgical complications. CONCLUSIONS: Practice patterns vary in the surgical management of glaucoma, and opinions differ among surgeons regarding the preferred primary operation for glaucoma. The PTVT Study will provide valuable information comparing the 2 most commonly performed glaucoma surgical procedures.

14 Article Practice Preferences for Glaucoma Surgery: A Survey of the American Glaucoma Society. 2017

Vinod, Kateki / Gedde, Steven J / Feuer, William J / Panarelli, Joseph F / Chang, Ta C / Chen, Philip P / Parrish, Richard K. ·*Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine, New York, NY †Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL ‡Department of Ophthalmology, University of Washington, Seattle, WA. ·J Glaucoma · Pubmed #28692597.

ABSTRACT: PURPOSE: The purpose of this study is to assess surgical practice patterns among the American Glaucoma Society (AGS) membership. METHODS: An anonymous online survey evaluating the use of glaucoma surgeries in various clinical settings was redistributed to AGS members. Survey responses were compared with prior results from 1996, 2002, and 2008 to determine shifts in surgical practice patterns. Questions were added to assess the preferred approach to primary incisional glaucoma surgery and phacoemulsification combined with glaucoma surgery. RESULTS: A total of 252 of 1091 (23%) subscribers to the AGS-net participated in the survey. Percentage use (mean±SD) of trabeculectomy with mitomycin C (MMC), glaucoma drainage device (GDD), and minimally invasive glaucoma surgery (MIGS) as an initial surgery in patients with primary open angle glaucoma was 59%±30%, 23%±23%, and 14%±20%, respectively. Phacoemulsification cataract extraction alone was the preferred surgical approach in 44%±32% of patients with primary open angle glaucoma and visually significant cataract, and phacoemulsification cataract extraction was combined with trabeculectomy with MMC in 24%±23%, with MIGS in 22%±27%, and with GDD in 9%±14%. Although trabeculectomy was selected most frequently to surgically manage glaucoma in 8 of 8 clinical settings in 1996, GDD was preferred in 7 of 8 clinical settings in 2016. CONCLUSIONS: The use of GDD has increased and that of trabeculectomy has concurrently decreased over the past 2 decades. Trabeculectomy with MMC is the most popular primary incisional surgery when performed alone or in combination with phacoemulsification cataract extraction. Surgeons frequently manage coexistent cataract and glaucoma with cataract extraction alone, rather than as a combined cataract and glaucoma procedure.

15 Article Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Eyes With Glaucoma and Single-Hemifield Visual Field Loss. 2017

Chen, Chieh-Li / Bojikian, Karine D / Wen, Joanne C / Zhang, Qinqin / Xin, Chen / Mudumbai, Raghu C / Johnstone, Murray A / Chen, Philip P / Wang, Ruikang K. ·Department of Ophthalmology, University of Washington, Seattle2Department of Bioengineering, University of Washington, Seattle. · Department of Ophthalmology, University of Washington, Seattle. · Department of Bioengineering, University of Washington, Seattle. ·JAMA Ophthalmol · Pubmed #28358939.

ABSTRACT: Importance: Understanding the differences in vascular microcirculation of the peripapillary retinal nerve fiber layer (RNFL) between the hemispheres in eyes with glaucoma with single-hemifield visual field (VF) defects may provide insight into the pathophysiology of glaucoma. Objective: To investigate the changes in the microcirculation of the peripapillary RNFL of eyes with glaucoma by using optical microangiography. Design, Setting, and Participants: Eyes with glaucoma and single-hemifield VF defect and normal eyes underwent scanning using an optical microangiography system covering a 6.7 × 6.7-mm2 area centered at the optic nerve head. The RNFL microcirculation was measured within an annulus region centered at the optic nerve head divided into superior and inferior hemispheres. Blood flux index (the mean flow signal intensity in the vessels) and vessel area density (the percentage of the detected vessels in the annulus) were measured. Main Outcomes and Measures: Differences in microcirculation between the hemispheres in eyes with glaucoma and normal eyes and correlations among blood flow metrics, VF thresholds, and clinical optical coherence tomography structural measurements were assessed. Results: Twenty-one eyes from 21 patients with glaucoma (7 men and 14 women; mean [SD] age, 63.7 [9.9] years) and 20 eyes from 20 healthy control individuals (9 men and 11 women; mean [SD] age, 68.3 [10.7] years) were studied. In eyes with glaucoma, the abnormal hemisphere showed a thinner RNFL (mean [SE] difference, 23.5 [4.5] μm; 95% CI, 15.1-32.0 µm; P < .001), lower RNFL blood flux index (mean [SE] difference, 0.04 [0.01]; 95% CI, 0.02-0.05; P < .001), and less vessel area density (mean [SE] difference, 0.08% [0.02%]; 95% CI, 0.05%-0.10%; P < .001) than did the normal hemisphere. Compared with normal eyes, reduced RNFL microcirculation was found in the normal hemisphere of eyes with glaucoma, measured by mean [SE] differences in blood flux index (0.06 [0.01]; 95% CI, 0.04-0.09; P < .001) and vessel area density (0.04% [0.02%]; 95% CI, 0.02%-0.08%; P = .003) but not in RNFL thickness (3.4 [4.7] μm; 95% CI, -6.2 to 12.9 µm; P = .48). Strong correlations were found between the blood flux index and VF mean deviation (Spearman ρ = 0.44; P = .045) and RNFL thickness (Spearman ρ = 0.65; P = .001) in the normal hemisphere of the eye with glaucoma. Conclusions and Relevance: Reduced RNFL microcirculation was detected in the normal hemisphere of eyes with glaucoma, with strong correspondence with VF loss and RNFL thinning. Although the results suggest that vascular dysfunction precedes structural changes seen in glaucoma, longitudinal studies would be needed to confirm this finding.

16 Article Refractive Outcome of Cataract Surgery in Eyes With Prior Trabeculectomy: Risk Factors for Postoperative Myopia. 2017

Yeh, Oliver L / Bojikian, Karine D / Slabaugh, Mark A / Chen, Philip P. ·Department of Ophthalmology, University of Washington, Seattle, WA. ·J Glaucoma · Pubmed #27661991.

ABSTRACT: PURPOSE: To examine refractive outcomes after phacoemulsification in eyes with prior trabeculectomy. DESIGN: Retrospective observational case-control study METHODS:: Comparison of eyes of glaucoma patients undergoing cataract surgery after trabeculectomy (study group) with a matched group with medically controlled glaucoma (control group). Laser interferometry was used to obtain ocular biometry. We measured the difference between the expected and actual postoperative refraction using third-generation and fourth-generation intraocular lens (IOL) prediction formulae (Haigis, Holladay 2, Hoffer Q, and SRK-T). A residual difference of >1.0 D of hyperopia or myopia was considered a "refractive surprise." RESULTS: In total, 86 eyes (85 patients) were included, including 23 eyes (22 patients) in the study group and 63 eyes (63 patients) in the control group. The mean follow-up was 12.2±4.1 months. Eyes (n=13) with trabeculectomy and a preoperative intraocular pressure (IOP)≤9 mm Hg had significantly more large myopic surprises than the control group for all IOL formulae (P=0.015 Haigis, P=0.003 Holladay 2, P=0.004 Hoffer Q, P=0.003 SRK-T). Eyes (n=10) with trabeculectomy and preoperative IOP>9 mm Hg, however, did not have significantly more myopic errors than the control (P>0.05, all formulae). An "IOP spike" defined as a >50% rise in IOP from baseline within 1 month of cataract surgery in the subgroup with preoperative IOP≤9 mm Hg (n=8) was associated with increased risk of large myopic surprise (3/8 subset vs. 1/63 control eyes for all formulae; P=0.004 Haigis, P=0.004 Holladay 2, P=0.001 Hoffer Q, P=0.004 SRK-T) as well as for large myopic and hyperopic surprises overall (4/8 subset vs. ≤2/63 depending upon formulae; all P≤0.001). CONCLUSIONS: Low posttrabeculectomy IOP (≤9 mm Hg) is a risk factor for significant myopic surprise when undergoing subsequent cataract surgery despite using laser interferometry to measure ocular biometry and later generation formulae to determine IOL power. In addition, an IOP spike was associated with a 50% risk for large refractive surprise in this low IOP group.

17 Article Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Glaucoma Using Optical Coherence Tomography-Based Microangiography. 2016

Chen, Chieh-Li / Zhang, Anqi / Bojikian, Karine D / Wen, Joanne C / Zhang, Qinqin / Xin, Chen / Mudumbai, Raghu C / Johnstone, Murray A / Chen, Philip P / Wang, Ruikang K. ·Department of Bioengineering, University of Washington, Seattle, Washington, United States 2Department of Ophthalmology, University of Washington, Seattle, Washington, United States. · Department of Bioengineering, University of Washington, Seattle, Washington, United States. · Department of Ophthalmology, University of Washington, Seattle, Washington, United States. · Department of Bioengineering, University of Washington, Seattle, Washington, United States 3Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. ·Invest Ophthalmol Vis Sci · Pubmed #27442341.

ABSTRACT: PURPOSE: To investigate the vascular microcirculation changes in the retinal nerve fiber layer (RNFL) in normal, glaucoma suspect, and open-angle glaucoma (OAG) groups using optical coherence tomography-based microangiography (OMAG). METHODS: One eye from each subject was scanned with a Cirrus HD-OCT 5000-based OMAG prototype system montage scanning protocol centered at the optic nerve head (ONH). Blood flow signals were extracted using OMAG algorithm. Retinal nerve fiber layer vascular microcirculation was measured by calculating the blood flux index and vessel area density within a 1.2-mm width annulus centered at the ONH with exclusion of big retinal vessels. One-way ANOVA were performed to analyze the RNFL microcirculation among groups. Linear-regression models were constructed to analyze the correlation between RNFL microcirculation and clinical parameters. Discrimination capabilities of the flow metrics were assessed with the area under the receiver operating characteristic curve (AROC). RESULTS: Twenty normal, 26 glaucoma suspect, and 42 OAG subjects were enrolled. Eyes from OAG subjects and glaucoma suspects showed significantly lower blood flux index compared with normal eyes (P ≤ 0.0015). Retinal nerve fiber layer blood flow metrics showed significant correlations with visual field indices and structural changes in glaucomatous eyes (P ≤ 0.0123). Similar discrimination capability of blood flux index compared with RNFL thickness was found in both disease groups. CONCLUSIONS: Peripapillary RNFL vascular microcirculation measured as blood flux index by OMAG showed significant differences among OAG, glaucoma suspect, and normal controls and was significantly correlated with functional and structural defects. Retinal nerve fiber layer microcirculation measurement using OMAG may help physicians monitor glaucoma.

18 Article Lamina depth and thickness correlate with glaucoma severity. 2016

Kim, Martha / Bojikian, Karine D / Slabaugh, Mark A / Ding, Leona / Chen, Philip P. ·Department of Ophthalmology, Dongguk University Ilsan Hospital, Goyang, Korea; Department of Ophthalmology, University of Washington, Seattle, WA, USA, . · Department of Ophthalmology, University of Washington, Seattle, WA, USA. ·Indian J Ophthalmol · Pubmed #27380974.

ABSTRACT: PURPOSE: To evaluate the correlation between lamina cribrosa (LC) morphology and glaucoma severity in patients with primary forms of open-angle glaucoma (OAG) using enhanced depth imaging spectral-domain optical coherence tomography (SD-OCT) and Humphrey visual field test (HVF). SUBJECTS AND METHODS: Patients with OAG (n = 166), divided into normal-tension glaucoma (NTG) and high-tension glaucoma (HTG) groups (n = 66 and n = 100), were imaged using SD-OCT to obtain horizontal B-scan images of the optic nerve head (ONH). Laminar depth (LD) and laminar thickness (LT) were measured at the center of ONH. RESULTS: The mean (±standard deviation) values of LD, LT, and visual field mean deviation (MD) were 555.4 ± 142.3 μm, 179.9 ± 49.7 μm, and - 5.7 ± 6.4 dB, respectively. In the multivariate linear regression analysis, LD, LT, and intraocular pressure (IOP) were significantly correlated with MD (P = 0.007, P = 0.037, and P = 0.004, respectively). In the subgroup analyses, only LD was associated with MD in the NTG group (n = 66), whereas LT and IOP were correlated with MD in the HTG group (n = 100). Neither axial length nor central corneal thickness was associated with LD or LT. CONCLUSIONS: Glaucoma severity, as measured by HVF MD, shows significant correlations with LD and LT, with greater severity associated with increasing LD and decreasing LT. Normal- and high-tension OAG patients have different associations with LD and LT, which implies that the pathogenesis of these two entities might be different.

19 Article Combined Ahmed Glaucoma Valve Placement, Intravitreal Fluocinolone Acetonide Implantation and Cataract Extraction for Chronic Uveitis. 2016

Chang, Ingrid T / Gupta, Divakar / Slabaugh, Mark A / Vemulakonda, Gurunadh A / Chen, Philip P. ·Department of Ophthalmology, University of Washington, Seattle, WA. ·J Glaucoma · Pubmed #27300641.

ABSTRACT: PURPOSE: To report the outcomes of combined Ahmed glaucoma valve (AGV) placement, intravitreal fluocinolone acetonide implant, and cataract extraction procedure in the treatment of chronic noninfectious uveitis. PATIENTS AND METHODS: Retrospective case series of patients with chronic noninfectious uveitis who underwent AGV placement, intravitreal fluocinolone acetonide implantation, and cataract extraction in a single surgical session performed at 1 institution from January 2009 to November 2014. Outcome measures included intraocular pressure (IOP) and glaucoma medication use. Secondary outcome measures included visual acuity, systemic anti-inflammatory medications, number of uveitis flares, and complications. RESULTS: Fifteen eyes of 10 patients were studied, with a mean age of 40.3±15.7 and mean follow-up duration of 26 months (range, 13 to 39 mo). Before surgery, the IOP was 18.5±7.3 mm Hg and patients were using 1.5±1.5 topical glaucoma medications. At the 12-month follow-up, IOP was 12.8±3.2 mm Hg (P=0.01) and patients were using 0.5±0.8 (P=0.03) topical glaucoma medications. At 36 months of follow-up, late, nonsustained hypotony had occurred in 3 eyes (20%), and 1 eye (6%) had received a second AGV for IOP control. Before treatment, patients had 2.7±1.5 uveitis flares in the year before surgery while on an average of 2.1±0.6 systemic anti-inflammatory medications, which decreased to an average of 0.1±0.3 (P<0.01) flares the year after surgery while on an average of 0.4±1.1 (P<0.01) systemic medications. CONCLUSION: Combined AGV, intravitreal fluocinolone acetonide implant, and cataract extraction is effective in controlling IOP and reducing the number of glaucoma medications at 12 months after treatment in patients with chronic uveitis.

20 Article Optic nerve head perfusion in normal eyes and eyes with glaucoma using optical coherence tomography-based microangiography. 2016

Chen, Chieh-Li / Bojikian, Karine D / Gupta, Divakar / Wen, Joanne C / Zhang, Qinqin / Xin, Chen / Kono, Rei / Mudumbai, Raghu C / Johnstone, Murray A / Chen, Philip P / Wang, Ruikang K. ·1 Department of Bioengineering, 2 Department of Ophthalmology, University of Washington, Seattle, WA, USA ; 3 Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China. ·Quant Imaging Med Surg · Pubmed #27190764.

ABSTRACT: BACKGROUND: To investigate the differences of perfusion in the optic nerve head (ONH) between normal and glaucomatous eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. METHODS: One eye from each subject was scanned with a 68 kHz Cirrus 5000 HD-OCT-based OMAG prototype system centered at the ONH (Carl Zeiss Meditec Inc, Dublin, CA, USA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. En face OMAG images for preLC were generated using signals with highest blood flow signal intensity. ONH perfusion was quantified as flux, vessel area density, and normalized flux within the ONH. Standard t-tests were performed to analyze the ONH perfusion differences between normal and glaucomatous eyes. Linear regression models were constructed to analyze the correlation between ONH perfusion and other clinical measurements. RESULTS: Twenty normal and 21 glaucoma subjects were enrolled. Glaucomatous eyes had significantly lower ONH perfusion in preLC in all three perfusion metrics compared to normal eyes (P≤0.0003). Significant correlations between ONH perfusion and disease severity as well as structural changes were detected in glaucomatous eyes (P≤0.012). CONCLUSIONS: ONH perfusion detected by OMAG showed significant differences between glaucoma and normal controls and was significantly correlated with disease severity and structural defects in glaucomatous eyes. ONH perfusion measurement using OMAG may provide useful information for detection and monitoring of glaucoma.

21 Article Optic Disc Perfusion in Primary Open Angle and Normal Tension Glaucoma Eyes Using Optical Coherence Tomography-Based Microangiography. 2016

Bojikian, Karine D / Chen, Chieh-Li / Wen, Joanne C / Zhang, Qinqin / Xin, Chen / Gupta, Divakar / Mudumbai, Raghu C / Johnstone, Murray A / Wang, Ruikang K / Chen, Philip P. ·Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America. · Department of Bioengineering, University of Washington, Seattle, Washington, United States of America. · Department of Ophthalmology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. ·PLoS One · Pubmed #27149261.

ABSTRACT: PURPOSE: To investigate optic disc perfusion differences in normal, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG) eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. DESIGN: Cross-sectional, observational study. SUBJECTS: Twenty-eight normal, 30 POAG, and 31 NTG subjects. METHODS: One eye from each subject was scanned with a 68 kHz Cirrus HD-OCT 5,000-based OMAG prototype system centered at the optic nerve head (ONH) (Carl Zeiss Meditec Inc, Dublin, CA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. MAIN OUTCOME MEASURES: Optic disc perfusion, quantified as flux, vessel area density, and normalized flux (flux normalized by the vessel area) within the ONH. RESULTS: Glaucomatous eyes had significantly lower optic disc perfusion in preLC in all three perfusion metrics (p<0.0001) compared to normal eyes. The visual field (VF) mean deviation (MD) and pattern standard deviation (PSD) were similar between the POAG and NTG groups, and no differences in optic disc perfusion were observed between POAG and NTG. Univariate analysis revealed significant correlation between optic disc perfusion and VF MD, VF PSD, and rim area in both POAG and NTG groups (p≤0.0288). However, normalized optic disc perfusion was correlated with some structural measures (retinal nerve fiber layer thickness and ONH cup/disc ratio) only in POAG eyes. CONCLUSIONS: Optic disc perfusion detected with OMAG was significantly reduced in POAG and NTG groups compared to normal controls, but no difference was seen between POAG and NTG groups with similar levels of VF damage. Disc perfusion was significantly correlated with VF MD, VF PSD, and rim area in glaucomatous eyes. Vascular changes at the optic disc as measured using OMAG may provide useful information for diagnosis and monitoring of glaucoma.

22 Article Refusal of Trabeculectomy for the Fellow Eye in Collaborative Initial Glaucoma Treatment Study (CIGTS) Participants. 2016

Gupta, Divakar / Musch, David C / Niziol, Leslie M / Chen, Philip P. ·Duke Eye Center, Duke University Medical Center, Durham, North Carolina. Electronic address: divakar.gupta@duke.edu. · Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan. · Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan. · Department of Ophthalmology, University of Washington, Seattle, Washington. ·Am J Ophthalmol · Pubmed #27013068.

ABSTRACT: PURPOSE: To understand the reasons for refusal of fellow eye surgical treatment for glaucoma after first eye trabeculectomy. DESIGN: Post hoc analysis of data collected in a multicenter, randomized clinical trial. METHODS: Data from participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS) who were randomized to and underwent initial trabeculectomy on their study eye, and whose fellow eye was eligible for surgical treatment, were analyzed. Participant demographic data and characteristics, surgical data from the study eye, and quality-of-life survey results were compared between groups that received or refused trabeculectomy in their fellow eye. The main outcome measure was patient refusal of fellow eye surgery for glaucoma. RESULTS: Of 159 participants who were randomized to and underwent trabeculectomy on their study eye and had a fellow eye that was eligible for surgery, 30 (19%) refused fellow eye surgery. Eligible patients who refused fellow eye trabeculectomy did not differ significantly in visual function or local eye symptoms from those that underwent fellow eye trabeculectomy (all P > .05). In a multivariable analysis of data, increased fellow eye preoperative intraocular pressure (IOP) was associated with decreased odds (OR = 0.89, P = .0188), study eye hypotony at 3 months postoperatively was associated with increased odds (OR = 7.24, P = .0125), and argon suture lysis procedure was associated with decreased odds (OR = 0.38, P = .0385) of surgery refusal. CONCLUSIONS: Refusal of fellow eye surgery was not uncommonly encountered in the CIGTS. Those who refused fellow eye surgery had lower fellow eye IOP and were more likely to have had hypotony after study eye trabeculectomy.

23 Article Incidence and risk factors for traumatic intraocular pressure elevation and traumatic glaucoma after open-globe injury. 2015

Bojikian, K D / Stein, A L / Slabaugh, M A / Chen, P P. ·Department of Ophthalmology, University of Washington, Seattle, WA, USA. ·Eye (Lond) · Pubmed #26381097.

ABSTRACT: PURPOSE: To examine traumatic intraocular pressure (IOP) elevation and glaucoma after open-globe injury. DESIGN: Retrospective, observational case series. METHODS: Review of patients with open-globe repair at the University of Washington from May 1997 through July 2010. Traumatic IOP elevation and glaucoma were defined respectively as intraocular pressure (IOP) ≥22 mm Hg at >1 visit or need for glaucoma medication, and long-term (at least 3 months) glaucoma medication use or glaucoma surgery. RESULTS: We included 515 eyes (515 patients). The mean follow-up was 12.6±20.1 months. One hundred twenty eyes (23.3%) developed traumatic IOP elevation, of which 32 (6.2%) developed glaucoma; six eyes (1.2%) required glaucoma surgery. The mean time to development of traumatic IOP elevation was 1.5±3.4 months (range 1 day to 2 years). Kaplan-Meier 6- and 12-month estimates for development of traumatic IOP elevation were 27.2 and 32.4%, respectively, and for development of traumatic glaucoma were 7.1 and 11.0%, respectively. Multivariate regression revealed associations between traumatic IOP elevation and older age, and traumatic glaucoma and prior penetrating keratoplasty, initial vitreous hemorrhage, Zone II injury, and penetrating keratoplasty after open-globe repair. Traumatic glaucoma was controlled (IOP <22 mm Hg) in 78.1% of eyes at final follow-up, with mean IOP of 18.2 mm Hg on 1.7 medications. CONCLUSIONS: Traumatic IOP elevation and glaucoma were common after visually salvageable open-globe injury. Most cases developed within 6 months, although longer follow-up remains important for case detection. Penetrating keratoplasty before or after repair, and vitreous hemorrhage were notable risk factors.

24 Article The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients: A Report by the American Academy of Ophthalmology. 2015

Chen, Philip P / Lin, Shan C / Junk, Anna K / Radhakrishnan, Sunita / Singh, Kuldev / Chen, Teresa C. ·Department of Ophthalmology, University of Washington, Seattle, Washington. · Department of Ophthalmology, University of California, San Francisco, San Francisco, California. · Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami; Miami Veterans Affairs Medical Center, Miami, Florida. · Glaucoma Center of San Francisco; Glaucoma Research and Education Group, San Francisco, California. · Stanford University School of Medicine, Stanford, California. · Harvard Medical School, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Glaucoma Service, Boston, Massachusetts. ·Ophthalmology · Pubmed #25943711.

ABSTRACT: OBJECTIVE: To examine effects of phacoemulsification on longer-term intraocular pressure (IOP) in patients with medically treated primary open-angle glaucoma (POAG; including normal-tension glaucoma), pseudoexfoliation glaucoma (PXG), or primary angle-closure glaucoma (PACG), without prior or concurrent incisional glaucoma surgery. METHODS: PubMed and Cochrane database searches, last conducted in December 2014, yielded 541 unique citations. Panel members reviewed titles and abstracts and selected 86 for further review. The panel reviewed these articles and identified 32 studies meeting the inclusion criteria, for which the panel methodologist assigned a level of evidence based on standardized grading adopted by the American Academy of Ophthalmology. One, 15, and 16 studies were rated as providing level I, II, and III evidence, respectively. RESULTS: All follow-up, IOP, and medication data listed are weighted means. In general, the studies reported on patients using few glaucoma medications (1.5-1.9 before surgery among the different diagnoses). For POAG, 9 studies (total, 461 patients; follow-up, 17 months) showed that phacoemulsification reduced IOP by 13% and glaucoma medications by 12%. For PXG, 5 studies (total, 132 patients; follow-up, 34 months) showed phacoemulsification reduced IOP by 20% and glaucoma medications by 35%. For chronic PACG, 12 studies (total, 495 patients; follow-up, 16 months) showed phacoemulsification reduced IOP by 30% and glaucoma medications by 58%. Patients with acute PACG (4 studies; total, 119 patients; follow-up, 24 months) had a 71% reduction from presenting IOP and rarely required long-term glaucoma medications when phacoemulsification was performed soon after medical reduction of IOP. Trabeculectomy after phacoemulsification was uncommon; the median rate reported within 6 to 24 months of follow-up in patients with controlled POAG, PXG, or PACG was 0% and was 7% in patients with uncontrolled chronic PACG. CONCLUSIONS: Phacoemulsification typically results in small, moderate, and marked reductions of IOP and medications for patients with POAG, PXG, and PACG, respectively, and using 1 to 2 medications before surgery. Trabeculectomy within 6 to 24 months after phacoemulsification is rare in such patients. However, reports on its effects in eyes with advanced disease or poor IOP control before surgery are few, particularly for POAG and PXG.

25 Article Prevalence of self-reported early glaucoma eye drop bottle exhaustion and associated risk factors: a patient survey. 2014

Moore, Daniel B / Walton, Charlene / Moeller, Kristy L / Slabaugh, Mark A / Mudumbai, Raghu C / Chen, Philip P. ·Department of Ophthalmology, University of Washington, 325 Ninth Ave, Seattle, WA 98104-2499, USA. pchen@uw.edu. ·BMC Ophthalmol · Pubmed #24927769.

ABSTRACT: BACKGROUND: One barrier to patient adherence with chronic topical glaucoma treatment is an inadequate amount of medication available between prescription refills. We examined the self-reported prevalence of early exhaustion of glaucoma eye drops prior to a scheduled refill, and associated risk factors. METHODS: This cross-sectional survey was performed at a University-based clinical practice. Glaucoma patients at the University of Washington who were experienced with eye drop application and were on a steady regimen of self-administered glaucoma drops in both eyes took a survey at the time of clinic examination. The main outcome measure was self-reported early eye drop bottle exhaustion. RESULTS: 236 patients were eligible and chose to participate. In general, patients included were relatively healthy (mean 2.3 comorbid medical conditions). Sixty patients (25.4%) reported any problem with early exhaustion of eye drop bottles, and this was associated with visual acuity ≤ 20/70 in the better eye (P = .049). Twelve patients (5.1%) reported that they "often" (5-7 times per year), "usually" (8-11 times per year) or "always" ran out of eye drops prior to a scheduled refill. Patients affected by this higher level (≥ 5 times yearly) of eye drop bottle exhaustion were more likely to have poor visual acuity in their worse eye ≤  20/70 (P = .015) and had significantly lower worse-eye logMAR (P = .043). CONCLUSIONS: Self-reported early glaucoma bottle exhaustion regularly affected 5% of patients in our population and 25% reported early exhaustion at least once; the main risk factor was poor vision in at least one eye. These results may not be generalizable to a broad patient population, or to those inexperienced with eye drop self-administration. However, this pilot study compels further evaluation and consideration of early eye drop bottle exhaustion in glaucoma patients.

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