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Glaucoma: HELP
Articles by Brian Alan Francis
Based on 55 articles published since 2008
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Between 2008 and 2019, Brian Francis wrote the following 55 articles about Glaucoma.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Structural and functional imaging of aqueous humour outflow: a review. 2018

Huang, Alex S / Francis, Brian A / Weinreb, Robert N. ·Doheny Eye Institute, Los Angeles, California, USA. · Doheny Eye Centers, Department of Ophthalmology, David Geffen School of Medicine at University of California, Los Angeles, California, USA. · Shiley Eye Institute and Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, California, USA. ·Clin Exp Ophthalmol · Pubmed #28898516.

ABSTRACT: Maintaining healthy aqueous humour outflow (AHO) is important for intraocular cellular health and stable vision. Impairment of AHO can lead to increased intraocular pressure, optic nerve damage and concomitant glaucoma. An improved understanding of AHO will lead to improved glaucoma surgeries that enhance native AHO as well as facilitate the development of AHO-targeted pharmaceuticals. Recent AHO imaging has evolved to live human assessment and has focused on the structural evaluation of AHO pathways and the functional documentation of fluid flow. Structural AHO evaluation is predominantly driven by optical coherence tomography, and functional evaluation of flow is performed using various methods, including aqueous angiography. Advances in structural and functional evaluation of AHO are reviewed with discussion of strengths, weaknesses and potential future directions.

2 Review Ab interno Schlemm's Canal Surgery. 2017

Francis, Brian A / Akil, Handan / Bert, Benjamin B. · ·Dev Ophthalmol · Pubmed #28442693.

ABSTRACT: In primary open-angle glaucoma, the site of greatest resistance to aqueous outflow is thought to be the trabecular meshwork (TM) and inner wall of Schlemm's canal. Augmentation of the conventional (trabecular) outflow pathway can facilitate physiologic outflow and subsequently lower intraocular pressure. The most recent approach to enhancing the conventional outflow pathway is via an internal approach to the TM and Schlemm's canal. Ab interno Schlemm's canal surgery includes 4 novel surgical approaches: (1) removal of the TM and inner wall of Schlemm's canal by an internal approach (ab interno trabeculectomy), (2) implantation of a microstent to bypass the TM, (3) disruption of the TM and inner wall of Schlemm's canal via an internal approach (ab interno trabeculotomy), and (4) dilation of Schlemm's canal via an internal approach (ab interno canaloplasty). The first category includes the Trabectome (Neomedix, Tustin, CA, USA), and Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA, USA). The second category includes the iStent (Glaukos, Laguna Hills, CA, USA), as well as the investigational Hydrus Microstent implant (Ivantis, Irvine, CA, USA). The third category includes gonioscopic-assisted transluminal trabeculotomy (iSciences catheter; Ellex, Adelaide, Australia), and 360° suture trabeculotomy (TRAB360, Sight Sciences, Menlo Park, CA, USA). The fourth category includes ab interno canaloplasty or AbiC (Ellex), and Visco360 (Sight Sciences). In contrast to external filtration surgeries, such as trabeculectomy and aqueous tube shunt, these procedures are categorized as internal filtration surgeries and are performed from an internal approach via gonioscopic guidance. Published results suggest that these surgical procedures are both safe and efficacious for the treatment of open-angle glaucoma.

3 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.

4 Review Endoscopic ophthalmic surgery of the anterior segment. 2014

Francis, Brian A / Kwon, Julie / Fellman, Ronald / Noecker, Robert / Samuelson, Thomas / Uram, Martin / Jampel, Henry. ·Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: bfrancis@usc.edu. · University of Medicine and Dentistry New Jersey-Robert Wood Johnson Medical School, Piscataway, New Jersey. · Glaucoma Associates of Texas, Dallas, Texas. · Ophthalmic Consultants of Connecticut, Fairfield, Connecticut. · Minnesota Eye Consultants, Minneapolis, Minnesota. · Retina Consultants of New Jersey, Attending Surgeon, Manhattan Eye, Ear and Throat Hospital, New York, New York. · Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins School of Medicine, Baltimore, Maryland. ·Surv Ophthalmol · Pubmed #23931901.

ABSTRACT: We summarize the uses of anterior segment endoscopic techniques and the basic science and technology of endoscopic cyclophotocoagulation (ECP) as compared with transscleral cyclophotocoagulation. This is followed by an analysis of patient selection for ECP, a description of surgical techniques, and clinical results. In addition, the ophthalmic endoscope has other uses in anterior segment surgeries. We discuss the techniques for these endoscope-assisted surgeries.

5 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.

6 Review Novel glaucoma procedures: a report by the American Academy of Ophthalmology. 2011

Francis, Brian A / Singh, Kuldev / Lin, Shan C / Hodapp, Elizabeth / Jampel, Henry D / Samples, John R / Smith, Scott D. ·University of Southern California, Los Angeles, CA, USA. ·Ophthalmology · Pubmed #21724045.

ABSTRACT: OBJECTIVE: To review the published literature and summarize clinically relevant information about novel, or emerging, surgical techniques for the treatment of open-angle glaucoma and to describe the devices and procedures in proper context of the appropriate patient population, theoretic effects, advantages, and disadvantages. DESIGN: Devices and procedures that have US Food and Drug Administration clearance or are currently in phase III clinical trials in the United States are included: the Fugo blade (Medisurg Ltd., Norristown, PA), Ex-PRESS mini glaucoma shunt (Alcon, Inc., Hunenberg, Switzerland), SOLX Gold Shunt (SOLX Ltd., Boston, MA), excimer laser trabeculotomy (AIDA, Glautec AG, Nurnberg, Germany), canaloplasty (iScience Interventional Corp., Menlo Park, CA), trabeculotomy by internal approach (Trabectome, NeoMedix, Inc., Tustin, CA), and trabecular micro-bypass stent (iStent, Glaukos Corporation, Laguna Hills, CA). METHODS: Literature searches of the PubMed and the Cochrane Library databases were conducted up to October 2009 with no date or language restrictions. MAIN OUTCOME MEASURES: These searches retrieved 192 citations, of which 23 were deemed topically relevant and rated for quality of evidence by the panel methodologist. All studies but one, which was rated as level II evidence, were rated as level III evidence. RESULTS: All of the devices studied showed a statistically significant reduction in intraocular pressure and, in some cases, glaucoma medication use. The success and failure definitions varied among studies, as did the calculated rates. Various types and rates of complications were reported depending on the surgical technique. On the basis of the review of the literature and mechanism of action, the authors also summarized theoretic advantages and disadvantages of each surgery. CONCLUSIONS: The novel glaucoma surgeries studied all show some promise as alternative treatments to lower intraocular pressure in the treatment of open-angle glaucoma. It is not possible to conclude whether these novel procedures are superior, equal to, or inferior to surgery such as trabeculectomy or to one another. The studies provide the basis for future comparative or randomized trials of existing glaucoma surgical techniques and other novel procedures.

7 Clinical Trial Baseline Fourier-Domain Optical Coherence Tomography Structural Risk Factors for Visual Field Progression in the Advanced Imaging for Glaucoma Study. 2016

Zhang, Xinbo / Dastiridou, Anna / Francis, Brian A / Tan, Ou / Varma, Rohit / Greenfield, David S / Schuman, Joel S / Sehi, Mitra / Chopra, Vikas / Huang, David / Anonymous8250881. ·Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. · Doheny Eye Center and David Geffen School of Medicine at UCLA, Los Angeles, California. · Department of Ophthalmology, University of Southern California Keck School of Medicine, Los Angeles, California. · Bascom Palmer Eye Institute, University of Miami, Miami, Florida. · Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. · Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. Electronic address: davidhuang@alum.mit.edu. ·Am J Ophthalmol · Pubmed #27651070.

ABSTRACT: PURPOSE: To identify baseline structural parameters that predict the progression of visual field (VF) loss in patients with open-angle glaucoma. DESIGN: Multicenter cohort study. METHODS: Participants from the Advanced Imaging for Glaucoma (AIG) study were enrolled and followed up. VF progression is defined as either a confirmed progression event on Humphrey Progression Analysis or a significant (P < .05) negative slope for VF index (VFI). Fourier-domain optical coherence tomography (FDOCT) was used to measure optic disc, peripapillary retinal nerve fiber layer (NFL), and macular ganglion cell complex (GCC) thickness parameters. RESULTS: A total of 277 eyes of 188 participants were followed up for 3.7 ± 2.1 years. VF progression was observed in 83 eyes (30%). Several baseline NFL and GCC parameters, but not disc parameters, were found to be significant predictors of progression on univariate Cox regression analysis. The most accurate single predictors were the GCC focal loss volume (FLV), followed closely by NFL-FLV. An abnormal GCC-FLV at baseline increased risk of progression by a hazard ratio of 3.1. Multivariate Cox analysis showed that combining age and central corneal thickness with GCC-FLV in a composite index called "Glaucoma Composite Progression Index" (GCPI) further improved the accuracy of progression prediction. GCC-FLV and GCPI were both found to be significantly correlated with the annual rate of change in VFI. CONCLUSION: Focal GCC and NFL loss as measured by FDOCT are the strongest predictors for VF progression among the measurements considered. Older age and thinner central corneal thickness can enhance the predictive power using the composite risk model.

8 Clinical Trial Endoscopic cyclophotocoagulation (ECP) in the management of uncontrolled glaucoma with prior aqueous tube shunt. 2011

Francis, Brian Alan / Kawji, A Shahem / Vo, Nguyen Thao / Dustin, Laurie / Chopra, Vikas. ·Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. bfrancis@usc.edu ·J Glaucoma · Pubmed #21048513.

ABSTRACT: PURPOSE: To evaluate the efficacy and safety of endoscopic cyclophotocoagulation (ECP) in the treatment of uncontrolled glaucoma with a prior aqueous tube shunt. METHODS: A prospective, nonrandomized, interventional clinical trial with up to 2 years of follow up included 25 eyes of 25 consecutive glaucoma patients with a previous tube shunt and uncontrolled intraocular pressure (IOP) despite medical therapy. Patients had IOP greater than 21 mm Hg on maximal medications or IOP ≤21 mm Hg but intolerant to medications or using an oral carbonic anhydrase inhibitor. Application of ECP over 360 degrees was performed and subjects were followed for 6 months minimum. Main outcome measures were mean reduction in IOP and medications at 12 months. Success was defined as reduction in IOP of 3 mm Hg and discontinuation of nontolerated glaucoma medications. A failure was defined as continued uncontrolled IOP, vision loss to no light perception, or additional medications or glaucoma surgery required. RESULTS: At 12 months, the mean IOP dropped from 24.02 to 15.36 mm Hg. The mean of the differences was -7.77 mm Hg (-30.8%). The mean number of medications was 3.2 before laser and 1.5 at 12 months (P<0.001). The success rate at 12 months (n=18) was 88% and remained at that level until the end of the follow-up period of 2 years (n=11, P<0.00005). There were no serious complications. CONCLUSIONS: ECP seems to be a safe and effective treatment in patients with uncontrolled IOP with a prior aqueous tube shunt, and is a reasonable option in this group of refractory glaucoma patients.

9 Article Efficacy and safety of ab interno trabeculectomy in juvenile open-angle glaucoma. 2018

Arora, Sourabh / Maeda, Masahiro / Francis, Brian / Maeda, Mariko / Sit, Arthur J / Mosaed, Sameh / Nazarali, Samir / Damji, Karim F. ·Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta. · Yasuma Eye Clinic, Nagoya, Japan. · Department of Ophthalmology, University of Southern California, Los Angeles, CA. · Maeda Eye Clinic, Osaka, Japan. · Department of Ophthalmology, Mayo Clinic, Rochester, MN. · Department of Ophthalmology University of California Irvine, Irvine, CA. · Faculty of Medicine, University of Ottawa, Ottawa, Ont. · Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta.. Electronic address: kdamji@ualberta.ca. ·Can J Ophthalmol · Pubmed #30340716.

ABSTRACT: OBJECTIVE: To determine the efficacy and safety of ab interno trabeculectomy with Trabectome in juvenile open-angle glaucoma (JOAG) patients. DESIGN: Prospective cohort study. METHODS: Evaluation of the 12-month results of 2 patient groups receiving ab interno trabeculectomy: group 1, eyes with no prior incisional surgery; group 2, eyes that had prior incisional cataract or glaucoma surgery. RESULTS: Group 1, 40 eyes (average age 31 ± 7 years), had a significant reduction in intraocular pressure (IOP) of 10.6 mm Hg at 12 months from a baseline of 27.4 mm Hg (p = 0.01), and the number of glaucoma medications reduced by 0.4 (p = 0.80). Four eyes (10%) within the study period required a secondary glaucoma surgery. Group 2, 20 eyes (average age 27 ± 8 years), had a significant reduction in IOP of 8.8 mm Hg from a baseline of 27.1 mm Hg (p = 0.06), and the number of glaucoma medications reduced by 1.4 (p = 0.36). Five eyes (25%) from this group underwent a secondary glaucoma surgery within 12 months. CONCLUSION: After 1 year of follow-up, ab interno trabeculectomy appears to be an effective and safe intervention for patients with JOAG; however, a reduction in use of topical medications may not be observed in those receiving ab interno trabeculectomy as a primary procedure.

10 Article Pilot Study of the Effects of Ambient Light Level Variation on Spectral Domain Anterior Segment OCT-Derived Angle Metrics in Caucasians versus Asians. 2018

Dastiridou, Anna / Marion, Kenneth / Niemeyer, Moritz / Francis, Brian / Sadda, Srinivas / Chopra, Vikas. ·a Doheny Image Reading Center , Doheny Eye Institute , Los Angeles , CA , USA. · b Department of Ophthalmology , David Geffen School of Medicine at UCLA , Los Angeles , CA , USA. ·Curr Eye Res · Pubmed #29641953.

ABSTRACT: PURPOSE: To investigate the effects of ambient light level variation on spectral domain anterior segment optical coherence tomography (SD-ΟCT)-derived anterior chamber angle metrics in Caucasians versus Asians. MATERIALS AND METHODS: Caucasian (n = 24) and Asian participants of Chinese ancestry (n = 24) with open angles on gonioscopy had one eye imaged twice at five strictly controlled, ambient light levels. Ethnicity was self-reported. Light levels were strictly controlled using a light meter at 1.0, 0.75, 0.5, 0.25, and 0 foot candle illumination levels. SD-OCT 5-line raster scans at the inferior 270° irido-corneal angle were measured by two trained, masked graders from the Doheny Image Reading Center using customized Image-J software. Schwalbe's line-angle opening distance (SL-AOD) and SL-trabecular iris space area (SL-TISA) in different light meter readings (LMRs) between the two groups were compared. RESULTS: Baseline light SL-AOD and SL-TISA measured 0.464 ± 0.115mm/0.351 ± 0.110mm CONCLUSION: SL-based angle dimensions using SD-OCT are sensitive to changes in ambient illumination in participants with Caucasian and Asian ancestry. Although Caucasian eyes had larger baseline angle opening under bright light conditions, the light-to-dark change in angle dimensions was similar in the two groups.

11 Article Reversible Venting Stitch for Fenestrating Valve-less Glaucoma Shunts. 2017

Akil, Handan / Vu, Priscilla Q / Nguyen, Anhtuan H / Nugent, Alexander / Chopra, Vikas / Francis, Brian A / Tan, James C. ·Department of Ophthalmology, Doheny Eye Institute, University of California, Los Angeles. · Department of Ophthalmology, Irvine School of Medicine, University of California, Irvine, CA. · Department of Ophthalmology, University of Texas at San Antonio, San Antonio, TX. ·J Glaucoma · Pubmed #29045328.

ABSTRACT: PURPOSE: The purpose of this is to describe a venting stitch modification for valveless glaucoma aqueous shunts and characterize early postoperative intraocular pressure (IOP) and glaucoma medication use following the modification. MATERIALS AND METHODS: Retrospective chart review of 61 sequential patients undergoing Baerveldt glaucoma implant (BGI)-350 implantation at the Doheny Eye Institute. Twenty-four patients received a glaucoma shunt with venting stitch modification (modified BGI) and 37 patients received an unmodified shunt (BGI-only). IOP, number of glaucoma medications, and number of hypotony cases (intraocular pressure ≤5 mm Hg) were compared between the groups. T-tests were used for statistical analysis. RESULTS: At postoperative-day 1, mean IOP was significantly lower compared with preoperatively in the modified BGI group (14 mm Hg; reduced by 51%; P<0.0001) but not the BGI-only group (27 mm Hg; P=0.06). IOP difference between groups persisted till immediately before tube opening (P=0.005) and fewer IOP-lowering medications needed in the modified BGI group (P<0.0001). One case (4.2%) of postoperative hypotony was encountered with BGI modification, which resolved after the stitch was removed in clinic. CONCLUSIONS: The venting stitch valveless shunt modification allows for effective, reliable, and safe control of early postoperative IOP.

12 Article Comparison of Glaucoma Progression Detection by Optical Coherence Tomography and Visual Field. 2017

Zhang, Xinbo / Dastiridou, Anna / Francis, Brian A / Tan, Ou / Varma, Rohit / Greenfield, David S / Schuman, Joel S / Huang, David / Anonymous2830921. ·Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. · Doheny Eye Center and David Geffen School of Medicine at UCLA, Los Angeles, California. · University of Southern California Keck School of Medicine, Los Angeles, California. · Bascom Palmer Eye Institute, University of Miami, Miami, Florida. · New York University Medical Center, New York, New York. · Casey Eye Institute, Oregon Health & Science University, Portland, Oregon. Electronic address: davidhuang@alum.mit.edu. ·Am J Ophthalmol · Pubmed #28964806.

ABSTRACT: PURPOSE: To compare longitudinal glaucoma progression detection using optical coherence tomography (OCT) and visual field (VF). DESIGN: Validity assessment. METHODS: We analyzed subjects with more than 4 semi-annual follow-up visits (every 6 months) in the multicenter Advanced Imaging for Glaucoma Study. Fourier-domain optical coherence tomography (OCT) was used to map the thickness of the peripapillary retinal nerve fiber layer (NFL) and ganglion cell complex (GCC). OCT-based progression detection was defined as a significant negative trend for either NFL or GCC. VF progression was reached if either the event or trend analysis reached significance. RESULTS: The analysis included 356 glaucoma suspect/preperimetric glaucoma (GS/PPG) eyes and 153 perimetric glaucoma (PG) eyes. Follow-up length was 54.1 ± 16.2 months for GS/PPG eyes and 56.7 ± 16.0 for PG eyes. Progression was detected in 62.1% of PG eyes and 59.8% of GS/PPG eyes by OCT, significantly (P < .001) more than the detection rate of 41.8% and 27.3% by VF. In severity-stratified analysis of PG eyes, OCT had significantly higher detection rate than VF in mild PG (63.1% vs. 38.7%, P < .001), but not in moderate and advanced PG. The rate of NFL thinning slowed dramatically in advanced PG, but GCC thinning rate remained relatively steady and allowed good progression detection even in advanced disease. The Kaplan-Meier time-to-event analyses showed that OCT detected progression earlier than VF in both PG and GS/PPG groups. CONCLUSIONS: OCT is more sensitive than VF for the detection of progression in early glaucoma. While the utility of NFL declines in advanced glaucoma, GCC remains a sensitive progression detector from early to advanced stages.

13 Article Repeatability, reproducibility, agreement characteristics of 2 SD-OCT devices for anterior chamber angle measurements. 2017

Akil, Handan / Dastiridou, Anna / Marion, Kenneth / Francis, Brian / Chopra, Vikas. ·Doheny Eye Institute, Doheny Image Reading Center, Los Angeles, California. · Doheny Eye Institute, Doheny Image Reading Center, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine, Los Angeles, California. · Doheny Eye Institute, Doheny Image Reading Center, Los Angeles, California; Department of Ophthalmology, David Geffen School of Medicine, Los Angeles, California. Electronic address: vchopra@doheny.org. ·Can J Ophthalmol · Pubmed #28457285.

ABSTRACT: OBJECTIVE: To evaluate the agreement, reproducibility, and repeatability of 2 spectral domain optical coherence tomography (SD-OCT) devices in Schwalbe's line (SL)-based anterior chamber angle parameters. METHODS: The inferior anterior chamber angle of 65 eyes from 65 participants (33 right eyes and 32 left eyes) were scanned twice with the Nidek RS 3000 Advanced SD-OCT and Cirrus SD-OCT. SL angle opening distance (SL-AOD) and SL trabecular-iris-space area (SL-TISA) were graded by masked certified graders at the Doheny Image Reading Center. RESULTS: The mean SL-AOD/SL-TISA was 617.3 ± 237.9 µm/0.211 ± 0.086 mm CONCLUSION: Both devices were able to provide consistent angle measurements, but repeatability and reproducibility were better in Cirrus SD-OCT than in Nidek RS 3000 Advanced SD-OCT.

14 Article Effects of diurnal, lighting, and angle-of-incidence variation on anterior segment optical coherence tomography (AS-OCT) angle metrics. 2017

Akil, Handan / Dastiridou, Anna / Marion, Kenneth / Francis, Brian A / Chopra, Vikas. ·Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA. · Department of Ophthalmology, David Geffen School of Medicine, Los Angeles, CA, USA. · Doheny Image Reading Center, Doheny Eye Institute, 1355 San Pablo Street, Los Angeles, CA, 90033, USA. vchopra@doheny.org. · Department of Ophthalmology, David Geffen School of Medicine, Los Angeles, CA, USA. vchopra@doheny.org. ·BMC Ophthalmol · Pubmed #28335747.

ABSTRACT: BACKGROUND: First reported study to assess the effect of diurnal variation on anterior chamber angle measurements, as well as, to re-test the effects of lighting and angle-of-incidence variation on anterior chamber angle (ACA) measurements acquired by time-domain anterior segment optical coherence tomography (AS-OCT). METHODS: A total of 30 eyes from 15 healthy, normal subjects underwent anterior chamber imaging using a Visante time-domain AS-OCT according to an IRB-approved protocol. For each eye, the inferior angle was imaged twice in the morning (8 am - 10 am) and then again in the afternoon (3 pm - 5 pm), under light meter-controlled conditions with ambient room lighting 'ON' and lights 'OFF', and at 5° angle of incidence increments. The ACA metrics measured for each eye were: angle opening distance (AOD, measured 500 and 750 μm anterior from scleral spur), the trabecular-iris-space area (TISA, measured 500 and 750 μm anterior from scleral spur), and scleral spur angle. Measurements were performed by masked, certified Reading Center graders using the Visante's Internal Measurement Tool. Differences in measurements between morning and afternoon, lighting variations, and angle of incidence were compared. RESULTS: Mean age of the participants was 31.2 years (range 23-58). Anterior chamber angle metrics did not differ significantly from morning to afternoon imaging, or when the angle of incidence was offset by 5° in either direction away from the inferior angle 6 o'clock position. (p-value 0.13-0.93). Angle metrics at the inferior corneal limbus, 6 o'clock position (IC270), with room lighting 'OFF', showed a significant decrease (p < 0.05) compared to room lighting 'ON'. CONCLUSIONS: There does not appear to be significant diurnal variation in AS-OCT parameters in normal individuals, but lighting conditions need to be strictly controlled since variation in lighting led to significant variability in AS-OCT parameters. No changes in ACA parameters were noted by varying the angle-of-incidence, which gives confidence in being able to perform longitudinal studies in approximately the same area (plus/minus 5° of original scan location).

15 Article Implantation of a second glaucoma drainage device. 2017

Francis, Brian A / Fernandes, Rodrigo A B / Akil, Handan / Chopra, Vikas / Diniz, Bruno / Tan, James / Huang, Alex. ·Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. BFrancis@doheny.org. · Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil. · Doheny Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA. ·Graefes Arch Clin Exp Ophthalmol · Pubmed #28176011.

ABSTRACT: PURPOSE: To evaluate success rates in controlling intraocular pressure (IOP) after implantation of a second glaucoma drainage device (GDD) with a Baerveldt glaucoma implant in patients with refractory glaucoma, with a secondary aim of reducing the need for postoperative glaucoma medications. MATERIAL AND METHODS: This retrospective, noncomparative, interventional study included patients undergoing a second GDD for uncontrolled glaucoma from a tertiary care glaucoma service. Data were obtained from the medical records for the preoperative period and after the 1st, 15th, and 30th day, 3, 6, and 12 months, and then yearly until the last postoperative visit. Visual acuity, IOP, and number of glaucoma medications (NGM) from the follow-up visits were compared to baseline. Success and failure criteria were analyzed based on IOP level or need of glaucoma medications. RESULTS: Forty-nine patients were studied, with a mean follow-up time of 25 ± 21 months. The mean preoperative IOP was 23.7 ± 8.2 mmHg, and decreased to 14.8 ± 4.0 mmHg after 1 year, 14.4 ± 3.9 mmHg after 2 years, and 16.6 ± 8.5 mmHg after 3 years. The mean preoperative NGM was 3.4 ± 1.3, and decreased to 2.0 ± 1.8 after 1 year, 2.5 ± 1.6 after 2 years, and 2.8 ± 2.0 after 3 years. Absolute success was 9% after 1 year for a postoperative IOP between 5 and 18 mmHg, and 76% for a postoperative IOP between 5 and 21 mmHg. The qualified success was 88% at the first and second years and 83% at the third year. CONCLUSION: With up to 3 years of follow-up, a second glaucoma drainage device was successful in reducing IOP to below 21 mmHg, but not as successful below 18 mmHg. The success rate is improved with the use of glaucoma medications with up to 3 years of follow-up.

16 Article Retinal vessel density from optical coherence tomography angiography to differentiate early glaucoma, pre-perimetric glaucoma and normal eyes. 2017

Akil, Handan / Huang, Alex S / Francis, Brian A / Sadda, Sirinivas R / Chopra, Vikas. ·Doheny Eye Institute, Doheny Image Reading Center, Los Angeles, CA, United States. · Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States. ·PLoS One · Pubmed #28152070.

ABSTRACT: PURPOSE: To evaluate optic nerve vascular density using swept source optical coherence tomography angiography (OCTA) in patients with early primary open angle glaucoma (POAG), pre-perimetric glaucoma and normal eyes. METHODS: This is a prospective, observational study including 56 eyes in total and divided into 3 groups; 20 eyes with mild POAG, 20 pre-perimetric glaucoma eyes, and 16 age-matched normal eyes as controls. The optic disc region was imaged by a 1050-nm-wavelength swept-source OCT system (DRI OCT Triton, TOPCON). Vessel density was assessed as the ratio of the area occupied by the vessels in 3 distinct regions: 1) within the optic nerve head; 2) in the 3 mm papillary region around the optic disc; and 3) in the peripapillary region, defined as a 700-μm-wide elliptical annulus around the disc. The potential associations between vessel density and structural, functional measures were analyzed. RESULTS: There was a statistically significant difference for the peripapillary vessel density, optic nerve head vessel density, and papillary vessel density among all the groups (p<0.001). Control eyes showed a significant difference for all measured vessel densities compared to glaucomatous eyes (p values from 0.001 to 0.024). There was a statistically significant difference between control and pre-perimetric glaucoma eyes for peripapillary, optic nerve head and papillary vessel density values (p values from 0.001 to 0.007). The optic nerve head vessel density, superior and inferior papillary area vessel density (Pearson r = 0.512, 0.436, 0.523 respectively) were highly correlated with mean overall, superior and inferior RNFL thickness in POAG eyes (p = 0.04, p = 0.02 and p = 0.04 respectively). Multiple linear regression analysis of POAG group showed that optic nerve head vessel density in POAG group was more strongly linked to RNFL thickness than to any other variables. CONCLUSIONS: Eyes with mild POAG could be differentiated from pre-perimetric glaucoma eyes, which also could be differentiated from normal eyes using OCTA-derived retinal vessel density measurements.

17 Article Choroidal thickness and structural glaucoma parameters in glaucomatous, preperimetric glaucomatous, and healthy eyes using swept-source OCT. 2017

Akil, Handan / Al-Sheikh, Mayss / Falavarjani, Khalil Ghasemi / Francis, Brian / Chopra, Vikas. ·Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, CA - USA. ·Eur J Ophthalmol · Pubmed #28106238.

ABSTRACT: PURPOSE: To evaluate choroidal thickness (CT) and its relationship with retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer thickness (GCIPLT) in glaucomatous, preperimetric glaucomatous, and healthy eyes using swept-source optical coherence tomography (SS-OCT). METHODS: Fifty eyes with primary open-angle glaucoma, 20 eyes with preperimetric glaucoma, and 20 age-matched healthy eyes were enrolled. Three-dimensional wide-field (12 × 9 mm) images were obtained using a SS-OCT instrument. Peripapillary CT and RNFL thickness, as well as macular CT and GCIPLT, were recorded. The correlation of the CT with nerve fiber layer and GCIPLT measurements was assessed. The association between CT and potential confounding variables including age, sex, axial length, intraocular pressure, and central corneal thickness was also examined. RESULTS: Mean peripapillary CTs were 111.7 ± 41.7, 127.7 ± 40.1, and 120.8 ± 35.4 μm in glaucomatous, preperimetric glaucomatous, and normal eyes, respectively. There was statistically significant but weak correlation for the mean RNFL and mean peripapillary CT in glaucomatous subjects (r = 0.341, p = 0.04). There was a significant correlation between RNFL thickness and peripapillary CT in 1, 2, 5, and 6 clock hours of glaucomatous eyes (r = 0.410, p = 0.005; r = 0.316, p = 0.03; r = 0.346, p = 0.02; r = 0.35, p = 0.04, respectively). Mean macular CT was 181.5 ± 70.5, 187.4 ± 65.5, and 185.4 ± 76.4 μm in glaucomatous, preperimetric glaucomatous, and healthy eyes, respectively (p = 0.7). There was no statistically significant correlation between the mean GCIPLT and mean macular CT in all subjects (p>0.05). CONCLUSIONS: Choroidal thinning and its correlation with other parameters in patients with glaucoma should be further investigated with the proprietary software of SS-OCT.

18 Article Pilot Study of Lamina Cribrosa Intensity Measurements in Glaucoma Using Swept-Source Optical Coherence Tomography. 2017

Srinivas, Sowmya / Dastiridou, Anna / Durbin, Mary K / Nittala, Muneeswar G / Huang, Alex A / Tan, James C H / Francis, Brian A / Sadda, Srinivas R / Chopra, Vikas. ·*Doheny Image Reading Center, Doheny Eye Institute ‡Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles †Carl Zeiss Meditec Inc., Dublin, CA. ·J Glaucoma · Pubmed #27977479.

ABSTRACT: PURPOSE: To compare the lamina cribrosa (LC) intensity in glaucoma-suspect eyes and eyes with mild to moderate glaucoma using swept-source optical coherence tomography. METHODS: Optic disc volume scans were collected using swept-source optical coherence tomography in 19 clinically defined glaucoma-suspect eyes and 29 eyes with mild to moderate glaucoma. LC intensity was measured using Image J software, and the resultant values were normalized using the retinal pigment epithelium and vitreous signal. RESULTS: Mean age was 53.7±18.5 years in the glaucoma-suspect eyes and 63.0±16.1 years in the eyes with mild to moderate glaucoma (P=0.161). Significant differences in LC intensity were observed between the 2 groups, with median LC intensity values of 0.96 and 0.86 units in the glaucoma-suspect and the mild to moderate glaucoma groups, respectively (P<0.001). A weak positive correlation was found between mean deviation and normalized LC intensity (r=0.344; P=0.018). CONCLUSIONS: Intensity measurement of the LC is a potential novel parameter which warrants further study in the setting of glaucoma.

19 Article Endoscopic cyclophotocoagulation versus second glaucoma drainage device after prior aqueous tube shunt surgery. 2017

Murakami, Yohko / Akil, Handan / Chahal, Jasdeep / Dustin, Laurie / Tan, James / Chopra, Vikas / Francis, Brian. ·Department of Ophthalmology, University of California San Francisco, School of Medicine, San Francisco, California, USA. · Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, California, USA. · Department of Biostatistics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. ·Clin Exp Ophthalmol · Pubmed #27570215.

ABSTRACT: BACKGROUND: To evaluate the efficacy in controlling intraocular pressure (IOP) with endoscopic cyclophotocoagulation (ECP) versus implantation of a second glaucoma drainage device (GDD-2) in the treatment of uncontrolled glaucoma with a prior aqueous tube shunt. DESIGN: A nonrandomized retrospective chart review. PARTICIPANTS: Patients with refractory glaucoma following a failed initial tube shunt (Baerveldt Glaucoma Implant 350), who underwent ECP or GDD-2 with Baerveldt Glaucoma Implant as a second surgery. Twenty-five eyes underwent ECP, and 48 eyes received a GDD-2. METHODS: ECP or second tube-shunt surgery. MAIN OUTCOME MEASURES: Reduction in IOP and antiglaucoma medications, and Kaplan-Meier survival with success defined as lOP ≥ 5 mmHg and ≤ 21 mmHg and ≥ 20% reduction from preoperative IOP. Secondary outcome measures were visual acuity and the presence of any postoperative complications. RESULTS: Both ECP and GDD-2 significantly lowered IOP (Student's t test) and number of antiglaucoma medications (Wilcoxon paired signed rank test). There were no significant differences in postoperative IOP (Student's t test) or antiglaucoma medications (Mann Whitney test) between ECP and GDD-2 at 6 and 12 months. There was also no difference in the Kaplan-Meier survival outcomes between the two groups. CONCLUSION: Both ECP and GDD-2 are both effective as second surgeries for refractory glaucoma that has failed a prior aqueous shunt.

20 Article Anterior Chamber Angle Morphometry Measurement Changes to Ambient Illumination Scaling in Visante Time Domain Optical Coherence Tomography. 2017

Marion, Kenneth M / Dastiridou, Anna / Niemeyer, Moritz / Francis, Brian A / Sadda, Srinivas R / Chopra, Vikas. ·a Doheny Eye Institute, Doheny Image Reading Center , Los Angeles , CA , USA. ·Curr Eye Res · Pubmed #27420338.

ABSTRACT: PURPOSE: To test the effect of ambient illumination scaling on the reproducibility and reliability anterior chamber metrics using the Visante time domain optical coherence tomography (TD-OCT) instrument. MATERIALS AND METHODS: The inferior irido-corneal angles of 25 normal, healthy eyes were imaged twice with the Zeiss Visante TD-OCT under five strictly controlled ambient light conditions (foot candles (fc) measured with a light meter at camera/eye interface). Each eye was imaged 10 times totaling 250 assessments. Angle opening distance (AOD500/750), trabecular iris space area (TISA500/750), and scleral spur (SS) angle were graded twice by masked, trained graders at the Doheny Imaging Reading Center using the Visante's intrinsic tools. Lighting effects on measurements, intra-/inter-grader and acquisition analyses, and Bland-Altman plots were computed using Statistical Package for Social Science (SPSS Inc. version 18.0, Armonk, NY). RESULTS: With a near linear relationship of angle metrics to lights levels (R CONCLUSIONS: The results of this study show the high sensitivity of the anterior chamber to changes in the illumination. The slight decrease in light had a corresponding large decrease in Anterior Chamber Angle (ACA) metrics. With clinical diagnoses and treatments of eye diseases relying on these angle measurements, these findings emphasize the importance of strictly controlling light conditions in order to obtain reproducible measurements of anterior chamber geometry.

21 Article Aqueous Angiography-Mediated Guidance of Trabecular Bypass Improves Angiographic Outflow in Human Enucleated Eyes. 2016

Huang, Alex S / Saraswathy, Sindhu / Dastiridou, Anna / Begian, Alan / Mohindroo, Chirayu / Tan, James C H / Francis, Brian A / Hinton, David R / Weinreb, Robert N. ·Doheny Eye Institute, Los Angeles, California, United States 2Department of Ophthalmology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, United States. · Doheny Eye Institute, Los Angeles, California, United States. · Department of Ophthalmology, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, California, United States. · Department of Ophthalmology and Pathology, University of Southern California, Los Angeles, California, United States. · Hamilton Glaucoma Center and Shiley Eye Institute, University of California-San Diego, San Diego, California, United States. ·Invest Ophthalmol Vis Sci · Pubmed #27588614.

ABSTRACT: PURPOSE: To assess the ability of trabecular micro-bypass stents to improve aqueous humor outflow (AHO) in regions initially devoid of AHO as assessed by aqueous angiography. METHODS: Enucleated human eyes (14 total from 7 males and 3 females [ages 52-84]) were obtained from an eye bank within 48 hours of death. Eyes were oriented by inferior oblique insertion, and aqueous angiography was performed with indocyanine green (ICG; 0.4%) or fluorescein (2.5%) at 10 mm Hg. With an angiographer, infrared and fluorescent images were acquired. Concurrent anterior segment optical coherence tomography (OCT) was performed, and fixable fluorescent dextrans were introduced into the eye for histologic analysis of angiographically positive and negative areas. Experimentally, some eyes (n = 11) first received ICG aqueous angiography to determine angiographic patterns. These eyes then underwent trabecular micro-bypass sham or stent placement in regions initially devoid of angiographic signal. This was followed by fluorescein aqueous angiography to query the effects. RESULTS: Aqueous angiography in human eyes yielded high-quality images with segmental patterns. Distally, angiographically positive but not negative areas demonstrated intrascleral lumens on OCT images. Aqueous angiography with fluorescent dextrans led to their trapping in AHO pathways. Trabecular bypass but not sham in regions initially devoid of ICG aqueous angiography led to increased aqueous angiography as assessed by fluorescein (P = 0.043). CONCLUSIONS: Using sequential aqueous angiography in an enucleated human eye model system, regions initially without angiographic flow or signal could be recruited for AHO using a trabecular bypass stent.

22 Article Repeatability of selective laser trabeculoplasty for open-angle glaucoma. 2016

Francis, Brian A / Loewen, Nils / Hong, Bryan / Dustin, Laurie / Kaplowitz, Kevin / Kinast, Robert / Bacharach, Jason / Radhakrishnan, Sunita / Iwach, Andrew / Rudavska, Lidiya / Ichhpujani, Parul / Katz, L Jay. ·Department of Ophthalmology, David Geffen School of Medicine at UCLA, Doheny Eye Institute, 800 Fairmount Avenue, Suite 215, Pasadena, Los Angeles, CA, 91105, USA. bfrancis@doheny.org. · Department of Ophthalmology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA. · Department of Ophthalmology, Thomas Jefferson School of Medicine, Wills Eye Institute, Philadelphia, PA, USA. · Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. · Department of Ophthalmology, Stony Brook University, Stony Brook, NY, USA. · North Bay Eye Associates, Sonoma County, CA, USA. · Glaucoma Center of San Francisco, San Francisco, CA, USA. · Research and Education Group, San Francisco, CA, USA. · Wills Eye Hospital, Thomas Jefferson University Medical School, Philadelphia, PA, USA. ·BMC Ophthalmol · Pubmed #27464887.

ABSTRACT: BACKGROUND: To analyze the results of repeat selective laser trabeculoplasty (SLT). INCLUSION CRITERIA: participants with primary or secondary open-angle glaucoma (excluding uveitic) who had undergone SLT 360° (SLT 1) with diminution of response over time followed by repeat SLT 360° (SLT 2). Six months of follow-up were required and at least 6 months in between SLT 1 and 2. The main outcome measures were IOP reduction at 6 and 12 months and a comparison of the response between SLT 1 and 2. RESULTS: One hundred thirty-seven patients met the inclusion criteria. If only one eye had repeat treatment, that eye was chosen; if both eyes qualified, one was chosen at random. The baseline intraocular pressure (IOP) for SLT 1 = 20.3+/- 5.2 mmHg and SLT 2 = 19.4 +/- 5.0 was reduced to 16.4 +/- 3.9 and 16.7 +/- 4.7 at 1 year, respectively (p < .001). Medication use was not significantly changed, and was 2.2 +/- 1.2 at baseline for SLT 1 and 2.1 +/- 1.3 for SLT 2, and at 1 year was 1.9 +/- 1.3 and 2.2 +/- 1.2, respectively. A subanalysis of 62 patients matched for equivalent baselines showed a baseline IOP = 18.7 +/- 3.8 for SLT 1 and 18.7 +/- 3.5 for SLT 2, reduced to 16.0 +/- 4.3 and 15.3 +/- 3.8 at 1 year (p < .001). CONCLUSION: Repeat SLT laser (360-degree treatment, followed by a loss of effect over time, then a second 360-degree treatment) in this population resulted in IOP lowering similar to that of the initial treatment.

23 Article Steroid-induced glaucoma treated with trabecular ablation in a matched comparison with primary open-angle glaucoma. 2016

Dang, Yalong / Kaplowitz, Kevin / Parikh, Hardik A / Roy, Pritha / Loewen, Ralitsa T / Francis, Brian A / Loewen, Nils A. ·Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. · Department of Ophthalmology, Loma Linda University Veterans Affairs, Loma Linda, California, USA. · Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA. · Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA. ·Clin Exp Ophthalmol · Pubmed #27341769.

ABSTRACT: BACKGROUND: To evaluate the outcomes of trabectome-mediated ab interno trabeculectomy in patients with steroid-induced glaucoma (SIG). DESIGN: A retrospective, observational cohort study performed in the Department of Ophthalmology, University of Pittsburgh Medical Center. PARTICIPANTS: The data of 60 patients with SIG and 484 controls with primary open-angle glaucoma (POAG) matched by age, gender and glaucoma index were collected from the Trabectome Study Group database. METHODS: Reduction of intraocular pressure (IOP) and medications were compared between POAG and SIG by multivariate regression. Kaplan-Meier was used for survival analysis. Success was defined as IOP ≤21 mmHg and at least 20% IOP reduction from baseline for any two consecutive visits after 3 months without secondary glaucoma surgery. Postoperative IOP and number of medications were compared with baseline in the SIG subgroups by the Wilcoxon test. MAIN OUTCOME MEASURES: Intraocular pressure reduction and 1-year success rate. RESULTS: Patients with SIG had a higher baseline IOP (31.4 ± 10.4 vs. 24.1 ± 7.6 mmHg, P < 0.01) and obtained a greater IOP reduction than controls with POAG (48.4% vs. 31.5%, P < 0.01). Multivariate regression showed that patients with SIG had an IOP reduction of 6.7 ± 1.1 mmHg more than those with POAG. Survival rates at 12 months were comparable at 86% in the SIG group and 85% in the POAG group (P = 0.47). Patients with SIG with a high baseline IOP, younger age and advanced glaucoma experienced a larger IOP drop. CONCLUSION: Trabectome appears to be an effective surgical treatment in reducing IOP for patients with SIG.

24 Article Clinical results of ab interno trabeculotomy using the Trabectome in patients with pigmentary glaucoma compared to primary open angle glaucoma. 2016

Akil, Handan / Chopra, Vikas / Huang, Alex / Loewen, Nils / Noguchi, Jonathan / Francis, Brian A. ·Doheny Eye Institute, Doheny Image Reading Center, Los Angeles, California, USA. HAkil@doheny.org. · Doheny Eye Institute, Doheny Image Reading Center, Los Angeles, California, USA. · Department of Ophthalmology, David Geffen School of Medicine, Los Angeles, California, USA. · Department of Ophthalmology, University of Pittsburgh, Pennsylvania, USA. · University of California, San Diego School of Medicine, La Jolla, California, USA. ·Clin Exp Ophthalmol · Pubmed #26946187.

ABSTRACT: BACKGROUND: To evaluate outcomes of Trabectome on pigmentary glaucoma (PG) patients compared to matched controls with primary open angle glaucoma (POAG). DESIGN: Prospective comparison study PARTICIPANTS: A total of 101 POAG cases were matched with 101 PG cases. METHODS: Data of the patients diagnosed with PG or POAG was obtained from Trabectome Study Group Database. A one-to-one exact matching was performed between POAG and pigmentary cases based on type of surgery, baseline IOP and baseline number of glaucoma medications. IOP and number of glaucoma medications were compared between groups by Wilcoxon test. Success was defined as IOP ≤ 21 mmHg, at least 20% IOP reduction from baseline for two consecutive visits after 3 months and no secondary surgery. MAIN OUTCOME MEASURES: Success rate after Trabectome surgery in PG patients. RESULTS: Baseline IOP for PG is 24.4 ± 7.7 mmHg and 24.2 ± 7.5 mmHg for POAG (P = 1.0), while baseline number of glaucoma medications was 2.8 ± 1.2 mmHg for PG and 2.8 ± 1.2 mmHg for POAG (P = 1.0). Postoperative IOP values at 12 months were 17.1 ± 5.0 for PG cases and 15.9 ± 4.2 mmHg for POAG cases. Postoperative number of glaucoma medications at 12 month was 2.1 ± 1.4 in PG cases and 2.4 ± 1.3 in POAG cases. There was no statistically significant difference between groups in IOP or number of medications at any time point. Survival rate at 12 months was 92% and 86% in PG and POAG, respectively (P = 0.47). Six PG cases and nine POAG cases required secondary surgery. CONCLUSION: Trabectome provides similar outcomes to PG patients and POAG patients.

25 Article Regression Analysis of Optical Coherence Tomography Disc Variables for Glaucoma Diagnosis. 2016

Richter, Grace M / Zhang, Xinbo / Tan, Ou / Francis, Brian A / Chopra, Vikas / Greenfield, David S / Varma, Rohit / Schuman, Joel S / Huang, David / Anonymous1130859. ·*USC Eye Institute, Department of Ophthalmology, Keck School of Medicine of University of Southern California, Los Angeles, CA ‡Doheny Eye Institute, University of California, Los Angeles †Casey Eye Institute, Oregon Health & Science University, Portland, OR §Bascom Palmer Eye Institute, University of Miami, Miami, FL ∥Eye and Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA. ·J Glaucoma · Pubmed #26900833.

ABSTRACT: PURPOSE: To report diagnostic accuracy of optical coherence tomography (OCT) disc variables using both time-domain (TD) and Fourier-domain (FD) OCT, and to improve the use of OCT disc variable measurements for glaucoma diagnosis through regression analyses that adjust for optic disc size and axial length-based magnification error. DESIGN: Observational, cross-sectional. PARTICIPANTS: In total, 180 normal eyes of 112 participants and 180 eyes of 138 participants with perimetric glaucoma from the Advanced Imaging for Glaucoma Study. METHODS: Diagnostic variables evaluated from TD-OCT and FD-OCT were: disc area, rim area, rim volume, optic nerve head volume, vertical cup-to-disc ratio (CDR), and horizontal CDR. These were compared with overall retinal nerve fiber layer thickness and ganglion cell complex. Regression analyses were performed that corrected for optic disc size and axial length. Area-under-receiver-operating curves (AUROC) were used to assess diagnostic accuracy before and after the adjustments. An index based on multiple logistic regression that combined optic disc variables with axial length was also explored with the aim of improving diagnostic accuracy of disc variables. MAIN OUTCOME MEASURE: Comparison of diagnostic accuracy of disc variables, as measured by AUROC. RESULTS: The unadjusted disc variables with the highest diagnostic accuracies were: rim volume for TD-OCT (AUROC=0.864) and vertical CDR (AUROC=0.874) for FD-OCT. Magnification correction significantly worsened diagnostic accuracy for rim variables, and while optic disc size adjustments partially restored diagnostic accuracy, the adjusted AUROCs were still lower. Axial length adjustments to disc variables in the form of multiple logistic regression indices led to a slight but insignificant improvement in diagnostic accuracy. CONCLUSIONS: Our various regression approaches were not able to significantly improve disc-based OCT glaucoma diagnosis. However, disc rim area and vertical CDR had very high diagnostic accuracy, and these disc variables can serve to complement additional OCT measurements for diagnosis of glaucoma.

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