Publications by authors named "Ahmad A Aref"

57 Publications

Experience with netarsudil 0.02% and latanoprostene bunod 0.024% as adjunctive therapy for glaucoma.

Eur J Ophthalmol 2021 Mar 2:1120672121998913. Epub 2021 Mar 2.

Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA.

Purpose: To assess the effectiveness and safety of adjunctive topical netarsudil 0.02% and latanoprostene bunod 0.024% in patients with glaucoma.

Methods: A retrospective, multi-center, cohort study of patients with glaucoma treated with netarsudil 0.02% or latanoprostene bunod from five tertiary care centers. Inclusion criteria included patients with glaucoma treated with either medication as adjunctive therapy. Outcomes included mean absolute intraocular pressure (IOP) reduction and relative IOP reduction from baseline. Adverse reactions and reasons for discontinuation were reported. One-way analysis of variance, Kruskal-Wallis rank sum test, and Mann Whitney test compared the outcomes.

Results: A total of 95 eyes (95 patients) on netarsudil and 41 eyes (41 patients) on latanoprostene bunod were analyzed. Mean duration of use was 54.3 ± 28 days for netarsudil and 82.9 ± 51.2 days for latanoprostene bunod. At the final visit, mean IOP reduction was 3.9 ± 4.6 mmHg (17.5 ± 6.0%) ( < 0.0001) with netarsudil and 2.9 ± 3.7 mmHg (13.6 ± 16.3%) ( < 0.0001) with latanoprostene bunod. IOP lowering did not depend on baseline number of IOP-lowering medications. The most common reason for discontinuation was non-effectiveness in both groups.

Conclusion: Similar to monotherapy, netarsudil and latanoprostene bunod demonstrated efficacy in lowering IOP when used as adjunctive therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1120672121998913DOI Listing
March 2021

Recent developments in the use of optical coherence tomography for glaucoma.

Curr Opin Ophthalmol 2021 Mar;32(2):98-104

Illinois Eye & Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois, USA.

Purpose Of Review: The aim of this article is to summarize findings of recent reports highlighting the utility of novel optical coherence tomography (OCT) parameters in the diagnosis and monitoring of glaucomatous optic neuropathy.

Recent Findings: Optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular parameters show high levels of diagnostic capability. The Bruch's membrane opening-minimum rim width (BMO-MRW) measurement is a novel ONH parameter obtained using the Spectralis SD-OCT device (Heidelberg Engineering, Inc., Heidelberg, Germany). The inferotemporal BMO-MRW sector shows the highest diagnostic performance for this parameter. Minimum ganglion cell and inner plexiform layer thickness shows the highest diagnostic performance among macular parameters obtained with the Cirrus HD-OCT (Carl Zeiss, Inc., Dublin, CA, USA). Optic nerve head, macular, and retinal nerve fiber layer parameters are not interchangeable across protocols generated by varying OCT manufacturers. Novel machine-learning algorithms show promise with regards to achieving higher levels of diagnostic accuracy using OCT imaging platforms.

Summary: Digital imaging in glaucoma continues to evolve with novel parameters of the optic nerve head, retinal nerve fiber layer, and macula. Diagnostic abilities of these parameters are high and complementary to each other.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICU.0000000000000733DOI Listing
March 2021

Gabapentin for presumed neuropathic ocular pain.

Am J Ophthalmol Case Rep 2020 Sep 22;19:100836. Epub 2020 Jul 22.

Illinois Eye and Ear Infirmary, University of Illinois at Chicago, USA.

Purpose: To report a case of chronic neuropathic ocular pain in a patient without visual complaints.

Observations: A 37-year-old male with a history of bilateral laser-assisted in situ keratomileusis (LASIK) presented with pain symptoms of 8 months duration in the left eye. The prior LASIK surgery was complicated by corneal ectasia in the left eye requiring penetrating keratoplasty and subsequent placement of a glaucoma drainage implant for uncontrolled, elevated intraocular pressure. The patient was evaluated with a complete clinical examination, including Goldmann applanation tonometry, dilated fundus examination, fluorescein angiography, optical coherence tomography, and magnetic resonance imaging. After 3 weeks of treatment with gabapentin 300 mg BID, the patient reported complete resolution of the ocular pain.

Conclusions And Importance: The pathophysiology of neuropathic ocular pain remains poorly understood. Clinical evaluation often reveals minimal ophthalmic exam findings, leading to an underdiagnosis of the condition by ophthalmologists. Gabapentin may be an underutilized medication in the treatment of chronic ocular pain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajoc.2020.100836DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390772PMC
September 2020

Glaucoma Care of Prison Inmates at an Academic Hospital.

JAMA Ophthalmol 2020 04;138(4):358-364

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago.

Importance: Glaucoma care for prison inmates is underrepresented in the literature even though managing the treatment of such patients may provide unique challenges.

Objectives: To evaluate the glaucoma profile of prison inmates treated at an academic ophthalmology center and to report on the medical and surgical management and follow-up metrics.

Design, Setting, And Participants: This retrospective cohort study assessed data from 82 incarcerated patients treated at the glaucoma clinic, an academic referral center at the University of Illinois at Chicago, between January 2013 and December 2017.

Main Outcomes And Measures: Diagnosis, glaucoma severity, medical and surgical interventions, and patient-reported medication adherence were recorded for each visit. Recommended and actual follow-up times were recorded and compared. Data analyses were conducted from January 2013 to December 2018.

Results: In total, 82 patients (161 eyes) had 375 visits during the study period. All patients were male and ranged from 20 to 75 years of age (mean [SD] age, 50.8 [11.9] years). Most participants were black patients (65 [79.3%]). The most common diagnoses were primary open-angle glaucoma (POAG; 53 eyes [32.9%]) and POAG suspect (52 eyes [32.3%]). Glaucoma severity ranged from mild (25 of 77 eyes [32.5%]) to advanced (41 of 77 eyes [53.2%]). Overall, 59 patients (73.2%) were treated medically with up to 4 topical agents (40.0%). Of those treated, 70.0% of patients (95% CI, 57.7%-81.2%) reported medication nonadherence during at least 1 visit. Medication nonadherence was more common among those taking 4 different topical medications (21 of 24 [87.5%]) compared with others taking fewer medications (20 of 35 [57.1%]), for a difference of 30.4% (95% CI, 7.0%-53.6%; P = .02), and among those with advanced disease (22 of 26 [84.6%]) compared with glaucoma suspect (6 of 13 [46.2%]), for a difference of 38.4% (95% CI, 9.3%-67.5%; P = .02). Nineteen office procedures, including laser peripheral iridotomy and laser trabeculoplasty, were performed on 14 eyes. Seventeen incisional glaucoma procedures were performed on 15 eyes, including glaucoma drainage device implant (11 procedures [64.7%]) and trabeculectomy (3 procedures [17.6%]). Only 26.6% of return office visits (95% CI, 21.3%-32.3%) occurred within the recommended follow-up time frame. Furthermore, 93 patients (34.8%; 95% CI, 28.2%-40.0%) were seen more than 1 month after the recommended follow-up.

Conclusions And Relevance: Despite incarceration in prison, where medication administration and appointment attendance are theoretically controlled, the results of this study suggested that substantial medication and follow-up nonadherence exists among inmates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2020.0001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7042904PMC
April 2020

Update in Genetics and Surgical Management of Primary Congenital Glaucoma

Turk J Ophthalmol 2019 12;49(6):347-355

University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences, Chicago, USA

Primary congenital glaucoma (PCG) continues to be an important cause of visual impairment in children despite advances in medical and surgical treatment options. The progressive and blinding nature of the disease, together with the long lifespan of the affected population, necessitates a thorough understanding of the pathophysiology of PCG and the development of long-lasting treatment options. The first part of this review discusses the genetic features and makeup of this disorder, including all currently identified genetic loci (GLC3A, GLC3B, GLC3C and GLC3D) and relevant protein targets important for trabecular and Schlemm canal dysgenesis. These target molecules primarily include CYP1B1, LTBP2, and TEK/Tie2 proteins. Their potential roles in PCG pathogenesis are discussed with the purpose of bringing the readers up to date on the molecular genetics aspect of this disorder. Special emphasis is placed on functional implications of reported genetic mutations in the setting of PCG. The second part of the review focuses on various modifications and refinements to the traditional surgical approaches performed to treat PCG, including advances in goniotomy and trabeculotomy ab externo techniques, glaucoma drainage implant surgery and cyclodiode photocoagulation techniques that ultimately provide safer surgical approaches and more effective intraocular pressure control in the 21 century.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4274/tjo.galenos.2019.28828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961078PMC
December 2019

Netarsudil and latanoprost ophthalmic solution for the reduction of intraocular pressure in open-angle glaucoma or ocular hypertension.

Expert Rev Clin Pharmacol 2019 Dec;12(12):1073-1079

King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.

: Netarsudil and latanoprost ophthalmic solution (0.02%/0.005%) is indicated for intraocular pressure (IOP) lowering in open-angle glaucoma (OAG) or ocular hypertension (OHTN). The once-daily agent combines the mechanism of action for each of the individual components and provides a new avenue for long-term intraocular pressure control. This review aims to cover the agent's current efficacy and safety data and opine as to its role in glaucoma management.: This article will cover Phase II-III clinical efficacy and safety data as well as basic science literature pertaining to the agent's mechanism of action and pharmacodynamics. In selecting articles for inclusion in this review, a literature search using the PubMed database was carried out. Cross-referencing was carried out where applicable. We did not use any date or language restrictions in electronic searches.: Netarsudil and latanoprost ophthalmic solution plays a pivotal role in management of individuals with OAG and OHTN. The agent may be used as first-line therapy to provide substantial IOP-lowering or when additional lowering is indicated and prostaglandins have provided insufficient IOP lowering. The once-daily dosing regimen decreases the risk of inadequate treatment due to nonadherence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/17512433.2019.1701435DOI Listing
December 2019

Intraocular Lens Implantation In The Ciliary Sulcus: Challenges And Risks.

Clin Ophthalmol 2019 27;13:2317-2323. Epub 2019 Nov 27.

Illinois Eye and Ear Infirmary, Chicago, IL, USA.

Purpose: This article reviews the current literature on the risks and challenges associated with intraocular lens (IOL) implantation in the ciliary sulcus.

Recent Findings: The development of IOLs designed specifically for placement in the ciliary sulcus continues to be an area of interest for the ophthalmic industry. Currently the one-piece PMMA (polymethylmethacrylate) lens or a three-piece IOL are the best available options for IOL placement in the ciliary sulcus space. Single piece acrylic (SPA) IOLs are not designed for sulcus placement and there is growing evidence of chronic complications related to their use in the ciliary sulcus. Many of these eyes ultimately require surgical intervention, including lens exchange. Endoscopic imaging and ultrasound biomicroscopy (UBM) have enabled a better understanding of ciliary sulcus anatomy and measurements in the living eye.

Summary: When the capsular bag is compromised, IOL placement in the ciliary sulcus is a reasonable option. In these circumstances, appropriate choice of IOL, knowledge of the sulcus anatomy, and correct technique can improve results and reduce postoperative complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S205148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885568PMC
November 2019

Relating glaucomatous visual field loss to retinal oxygen delivery and metabolism.

Acta Ophthalmol 2019 Nov 24;97(7):e968-e972. Epub 2019 Apr 24.

Department of Ophthalmology, University of Southern California, Los Angeles, California, USA.

Purpose: To test the hypothesis that visual field (VF) loss is associated with decreased retinal blood flow, oxygen delivery and metabolism, and with increased retinal oxygen extraction fraction (OEF) in glaucomatous individuals.

Methods: Glaucomatous subjects underwent automated perimetry, dual wavelength scanning laser ophthalmoscopy and Doppler optical coherence tomography imaging in order to measure mean deviation, central retinal arterial and venous diameter equivalents (CRAE and CRVE), oxygen saturation levels and total retinal blood flow (TRBF), respectively. Retinal oxygen delivery, metabolism and extraction fraction were derived from measurements of oxygen saturation and blood flow.

Results: Twenty eyes of 14 subjects were included in the study. Mean deviation was on average -13.76 ± 8.70 dB. Mean CRAE and CRVE were 126 ± 28 and 191 ± 35 μm, respectively. Mean TRBF and oxygen delivery were 34.3 ± 11.7 μl/min and 6.5 ± 2.6 μl O /min, respectively. Mean oxygen metabolism and extraction fraction were 2.1 ± 0.94 μl O /min and 0.34 ± 0.15, respectively. Visual field (VF) loss was associated with reduced CRAE and CRVE, TRBF and oxygen delivery and associated with increased OEF.

Conclusion: Combined measurements of retinal blood flow and oxygen saturation in glaucomatous individuals suggest VF loss is associated with impaired oxygen delivery and augmented OEF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/aos.14120DOI Listing
November 2019

Inpatient and Emergency Room Ophthalmology Consultations at a Tertiary Care Center.

J Ophthalmol 2019 14;2019:7807391. Epub 2019 Feb 14.

University of Illinois at Chicago, Department of Ophthalmology and Visual Sciences, Chicago, IL, USA.

Background: An ophthalmology consultation service is of significant benefit to patients in the hospital and is an instructive component of a residency education program. Ophthalmology consultations in a hospital present unique challenges to those seen in an outpatient clinic, for which the consulting ophthalmologist should be prepared. The purpose of this study was to profile the emergency room and inpatient ophthalmology consultations seen at an academic institution.

Methods: A prospective study of 581 patients was conducted on inpatient and emergency room ophthalmology consultations at the University of Illinois at Chicago over twelve months. Characteristics such as the consulting service, type of and reason for consultation, subspecialty staffing service, diagnosis, and suitability for in-hospital evaluation were recorded.

Results: Consultations were received from either inpatient wards (59.4%) or the Emergency Department (40.6%). The most common inpatient consulting services were internal medicine (22%), followed by neurosurgery (16%) and neurology (7%). All the consultations were categorized as acute (72.3%), chronic (6.0%), or screening (21.7%). Consultations categorized as screening included papilledema (31.0%), fungemia (20.6%), syndromic evaluation (19.8%), visual field evaluation (17.5%), and miscellaneous evaluation (11.1%). We classified the ophthalmic diagnoses into 63 unique diagnoses. Amongst the ophthalmic subspecialties, neuro-ophthalmologic diagnoses were the most common (32.0%), followed by retina (20.1%) and cornea (19.4%). Neuro-ophthalmology had the highest proportion of screening consultations (36.6%), while glaucoma had the least overall number of consultations (10.1%), and the least proportion of screening consultations (3.6%). A significant proportion of nonacute consultations (19.0%) was deemed to be more suitable for outpatient evaluation.

Discussion: Consultation databases can be useful in preparing trainees for in-hospital clinical care. A wide range of ocular pathologies may present to the ophthalmology consultant, from acute trauma to screening for systemic syndromes. Some consultations may be more suitable for outpatient evaluation which may help optimize patient care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/7807391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393906PMC
February 2019

Corneal ectasia associated with postoperative hypotony.

Can J Ophthalmol 2019 02 5;54(1):e40-e43. Epub 2018 Jun 5.

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, Ill. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2018.03.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048191PMC
February 2019

Staged ocular fornix reconstruction for glaucoma drainage device under neoconjunctiva at the time of Boston type 1 Keratoprosthesis implantation.

Ocul Surf 2019 04 8;17(2):336-340. Epub 2019 Feb 8.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States.

Purpose: Glaucoma is the leading cause of vision loss in eyes with Boston Keratoprosthesis (KPro). Glaucoma drainage devices (GDDs) have been shown to be effective in controlling glaucoma with KPro. Cicatricial conjunctival disease with forniceal shortening is a major challenge and limitation to the use of GDD. In our series, we report the success of fornix reconstruction in cicatricial ocular surface disease as a staged procedure prior to a combined KPro/GDD surgery.

Methods: Retrospective case series involving 4 eyes with surface cicatricization. Three patients with chemical burns and one patient with Ectrodactyly Ectodermal Dysplasia-Clefting syndrome. Preoperative data, surgical interventions, and clinical outcomes were reviewed.

Conclusion: This series represents the first report of fornix reconstruction for combined KPro/GDD surgery. Fornix reconstruction with the aid of AMT with or without OMM grafting is a relatively safe and effective way to manage complex cicatricial surface disease associated with corneal scarring and glaucoma, allowing for subsequent successful implantation of GDD and KPro in cases that were otherwise poor surgical candidates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtos.2019.01.010DOI Listing
April 2019

Profile of netarsudil ophthalmic solution and its potential in the treatment of open-angle glaucoma: evidence to date.

Clin Ophthalmol 2018 4;12:1939-1944. Epub 2018 Oct 4.

Department of Ophthalmology and Visual Sciences, Illinois Eye & Ear Infirmary, University of Illinois at Chicago College of Medicine, Chicago, IL, USA,

Netarsudil ophthalmic solution is a novel topical intraocular pressure (IOP)-lowering agent that has recently been approved by the US Food and Drug Administration (FDA) for the treatment of ocular hypertension and open-angle glaucoma. Its unique pharmacology allows for IOP lowering as a result of direct reduction in trabecular outflow resistance in addition to a decrease in episcleral venous pressure and aqueous humor production. The efficacy of netarsudil has been shown in animal studies and human clinical trials. It has been shown to be noninferior to the therapy with topical timolol in individuals with baseline IOP <25 mmHg. Importantly, netarsudil has been shown to reduce IOP to the same degree, regardless of baseline levels. There are no known systemic safety issues associated with netarsudil. The most common local adverse effects relate to conjunctival hyperemia. The once-daily dosing schedule is advantageous for individuals who have difficulties with medication adherence. Further studies of a combination of netarsudil and latanoprost agents are currently underway.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S154001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6177382PMC
October 2018

Cyst Masquerading as Inadvertent Bleb After a Scleral-Fixated Intraocular Lens in Marfan Syndrome: A Case Report.

Ophthalmol Ther 2018 Dec 16;7(2):437-441. Epub 2018 Aug 16.

Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, IL, USA.

Introduction: To present a case of an epithelial inclusion cyst masquerading as an inadvertent bleb in a patient with Marfan syndrome.

Case Report: A woman with Marfan syndrome presented with a subluxed crystalline lens in her right eye, which progressively subluxed over the following 2 years. A lensectomy was performed with placement of an anterior chamber intraocular lens (IOL); however, the patient experienced blurred vision and photopsias and preferred IOL explantation. The IOL was removed and a scleral-fixated posterior chamber IOL was placed. Vision improved with an uncomplicated postoperative course. Five months later, the patient experienced sudden onset redness and sharp pain in this eye. A 3-mm cystic lesion with tan material was found over a prior scleral incision site. Intraocular pressure was normal and no aqueous leaked from the lesion. Owing to concerns of an infected inadvertent bleb, treatment with topical and oral antibiotics was started, but the lesion did not change in appearance and the patient experienced persistent pain. The lesion was surgically excised and histopathology revealed a conjunctival epithelial inclusion cyst with intralesional keratin. A month later, another conjunctival inclusion cyst developed and was excised per patient preference.

Conclusion: Marfan syndrome is characterized by defects in the FBN1 gene and may theoretically lead to an abnormal sclera, increasing the risk of bleb formation after scleral incision. Distinguishing between a filtering bleb and an epithelial inclusion cyst is critical in patient care. Although retained keratin from a cyst may mimic a bleb with purulence, intraocular pressure, aqueous leakage, and response to topical antibiotics may help distinguish between the two.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40123-018-0142-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258571PMC
December 2018

12-Month Outcomes of Goniotomy Performed Using the Kahook Dual Blade Combined with Cataract Surgery in Eyes with Medically Treated Glaucoma.

Adv Ther 2018 09 4;35(9):1460-1469. Epub 2018 Aug 4.

Vance Thompson Vision, Sioux Falls, SD, USA.

Introduction: To describe the 12-month efficacy and safety of goniotomy performed using the Kahook Dual Blade (KDB) in combination with cataract surgery in eyes with medically treated open-angle glaucoma (OAG).

Methods: This was a prospective, interventional case series conducted at seven centers in North America. Consecutive patients with medically treated OAG and visually significant cataract underwent phacoemulsification combined with goniotomy (PE + goniotomy) using KDB. Indications for glaucoma surgery included reduction of intraocular pressure (IOP) and reduction of IOP-lowering medications. De-identified data were collected and included pre-, intra-, and postoperative data on IOP, the use of IOP-lowering medications, and adverse events through 12 months of follow-up.

Results: Among 52 eyes undergoing surgery, mean IOP was reduced from 16.8 ± 0.6 mmHg at baseline to 12.4 ± 0.3 mmHg at month 12 (P < 0.001), a 26.2% reduction. Mean IOP across time points ranged from 12.4-13.3 mmHg during follow-up. The mean number of topical IOP-lowering medications was reduced from 1.6 ± 0.2 at baseline to 0.8 ± 0.1 at month 12 (P < 0.05), a 50.0% reduction. At month 12, 57.7% of eyes had IOP reduction ≥ 20% from baseline, and 63.5% were on ≥ 1 fewer IOP-lowering medications. In subgroup analysis, 84.6% of eyes with lower mean baseline IOP were using ≥ 1 fewer medications at month 12, and 100% of eyes with higher mean baseline IOP had IOP reductions ≥ 20%. The most common postoperative adverse events were pain/irritation (n = 4, 7.7%), opacification of the posterior lens capsule (n = 2, 3.8%), and IOP spike > 10 mmHg (n = 2, 3.8%).

Conclusion: PE + goniotomy using the KDB significantly lowers both IOP and dependence on IOP-lowering medications in eyes with OAG. Adverse events were not sight-threatening and typically resolved spontaneously.

Funding: New World Medical, Inc.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12325-018-0755-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133141PMC
September 2018

Goniotomy Using the Kahook Dual Blade in Severe and Refractory Glaucoma: 6-Month Outcomes.

J Glaucoma 2018 10;27(10):849-855

Glaucoma Research Center, Montchoisi Clinic, Swiss Vision Network, Lausanne, Switzerland.

Purpose: The purpose of the study is to describe short-term efficacy and safety of goniotomy with trabecular meshwork excision using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with severe or refractory glaucoma.

Method: Retrospective multicentric case series of 53 eyes with severe or refractory glaucoma as defined by ICD-10 conducted in the United States, Mexico, and Switzerland. Primary efficacy outcome was a ≥20% decrease in intraocular pressure (IOP) from baseline at 6 months. Secondary efficacy outcome measures were probability of achieving an IOP≤14 or 18 mm Hg at 6 months and the mean IOP change from baseline at 6 months. Medication use required to obtain target IOP at last follow up and adverse effects were analyzed.

Results: The proportion of eyes achieving an IOP reduction of >20% from preoperative baseline at 6 months was 57.7% (n=30). The mean IOP decreased from 18.4±6.1 mm Hg at baseline to 13.9±3.5 mm Hg at month 6 (23.9% reduction; P<0.001). At 6 months, 63.5% and 92.3% achieved an IOP≤14 and ≤18 mm Hg, respectively, and the mean number of glaucoma medications was reduced by 1.2±1.3 (36.6%) compared with baseline (P<0.001). The most common adverse event was hyphema (n=29, 34.9%) with spontaneous resolution in all cases. No severe complications were reported. One case presented with uncontrolled IOP and required glaucoma drainage device surgery at 1 month.

Conclusions: Goniotomy with trabecular meshwork excision using the KDB could be an alternative surgery for severe or refractory glaucoma, significantly reducing IOP and medication use at 6 months, with a low rate of complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000001019DOI Listing
October 2018

Late Complications of Single-Piece Intraocular Lens Implantation in the Ciliary Sulcus.

JAMA Ophthalmol 2018 07;136(7):825-826

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2017.6050DOI Listing
July 2018

Assessment of Glaucomatous Damage After Boston Keratoprosthesis Implantation Based on Digital Planimetric Quantification of Visual Fields and Optic Nerve Head Imaging.

Cornea 2018 May;37(5):602-608

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL.

Purpose: To investigate glaucomatous damage in Boston keratoprosthesis type I (KPro) patients through structural analysis of the optic nerve head and digital planimetric quantification of Goldmann visual fields, a novel method of monitoring perimetric changes in KPro patients.

Methods: Records of patients undergoing KPro implantation from 2007 to 2015 at a single institution were reviewed. Parameters related to glaucoma status and KPro outcomes were analyzed.

Results: Twenty-two eyes from 21 patients met inclusion criteria, with mean follow-up of 49.4 months (range 15-90). Mean results for the following parameters before KPro implantation and at last follow-up were (pre-KPro; at last follow-up): best-corrected visual acuity (2.07; 0.70 logMAR), number of glaucoma medications (1.14; 1.05), intraocular pressure (IOP) (18.4; 18.4 mm Hg), vertical cup-to-disc ratio (C/D) (0.48; 0.50), and horizontal C/D (0.52; 0.52). IOP-lowering procedures were performed pre-KPro (5/22), concurrently with KPro (10/22), post-KPro (6/22), or never (6/22). An increase in C/D ≥0.1 and loss of V4e isopter area >30% occurred in 22.7% and 12.5%, respectively. Development of post-KPro glaucoma, progression of preexisting or post-KPro glaucoma, and no glaucoma development as evidenced by an objective assessment of structural and functional parameters were seen in 2/22 (9.1%), 7/22 (31.8%), and 6/22 (27.3%) eyes, respectively.

Conclusions: Clinicians should strive to vigilantly monitor for glaucoma despite the inherent difficulties in tonometry, optic nerve visualization and imaging, and visual field testing in KPro patients. Meticulous glaucoma surveillance with structural and functional testing combined with earlier IOP-lowering surgical intervention may result in decreased rates of glaucomatous vision loss in KPro patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICO.0000000000001544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5878109PMC
May 2018

Detecting Visual Field Progression.

Ophthalmology 2017 12;124(12S):S51-S56

Department of Ophthalmology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address:

Timely detection of glaucomatous progression is crucial in the delivery of glaucoma care. Clinical judgment may be used to make this assessment, but relatively modest agreement among practitioners supports the use of complementary methods. Event-based analyses take into account expected localized test-retest variabilities in sensitivity, and trend-based analyses are helpful for determining and predicting overall visual function. Landmark clinical trials have used various visual field progression criteria as end points with variable performances. Short- and long-term fluctuations as well as inadequate testing frequency are limitations in visual field analysis for glaucomatous progression. Ongoing improvements in statistical techniques as well as incorporation of functional and structural measures into a single model likely will lead to an enhanced ability to detect glaucomatous progression and will allow for more timely and appropriate therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ophtha.2017.05.010DOI Listing
December 2017

Goniotomy with a single-use dual blade: Short-term results.

J Cataract Refract Surg 2017 09;43(9):1197-1201

From Vance Thompson Vision (Greenwood, Berdahl), Sioux Falls, South Dakota, the University of Colorado School of Medicine (Seibold), Aurora, Colorado, the New York Eye Surgery Center (Radcliffe), New York, New York, the Mayo Clinic (Dorairaj), Jacksonville and the Eye Institute (Darlington), Melbourne, Florida, the University of Illinois (Aref, Román), Chicago, Illinois, New World Medical, Inc. (Abdullah, Bahjri), Rancho Cucamonga, California, and B Through C, LLC (Jasek), Burleson, Texas, USA; Asociación para Evitar la Ceguera (Lazcano-Gomez), Mexico City, Mexico.

Purpose: To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of a single-use dual blade (Kahook) in patients with mild to end-stage glaucoma.

Setting: International multicenter ophthalmic care centers.

Design: Prospective interventional case series.

Methods: Consecutive patients with glaucoma who had phacoemulsification plus goniotomy with the single-use dual blade were enrolled in this study. Each center collected deidentified clinical data, including preoperative and postoperative IOP, medication use, adverse events, and whether additional surgery was required during a 6-month follow-up.

Results: Of the 71 eyes included in this study, 70% had primary open-angle glaucoma. Other diagnoses included angle-closure, pigmentary, pseudoexfoliative, and normal-tension glaucoma. Sixty-five percent of eyes were classified as having mild to moderate glaucoma and 35%, severe glaucoma. The mean baseline IOP decreased from 17.4 mm Hg ± 5.2 (SD) to 12.8 ± 2.6 mm Hg 6 months postoperatively and the hypotensive medication use decreased from 1.6 ± 1.3 to 0.9 ± 1.0, respectively (P < .001 and P = .005, respectively). The most common observation was blood reflux during surgery (39.4%).

Conclusion: Single-use dual blade goniotomy plus phacoemulsification resulted in a significant and sustained reduction in IOP and a decrease in glaucoma medications after 6 months of follow-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcrs.2017.06.046DOI Listing
September 2017

Circumscribed Iris Elevation in a Middle-Aged Woman.

JAMA Ophthalmol 2017 09;135(9):999-1000

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2017.0479DOI Listing
September 2017

Innovative approaches to glaucoma management of Boston keratoprosthesis type 1.

Curr Ophthalmol Rep 2016 Sep 26;4(3):147-153. Epub 2016 Jul 26.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, IL, USA.

Glaucoma remains a prevalent disorder and visual limiting factor after Boston keratoprosthesis type 1 implantation. Patients with glaucoma have worse initial and late visual acuity outcomes after otherwise successful keratoprosthesis implantation. Management of glaucoma in the setting of a keratoprosthesis is challenging because of relatively rapid progression and an inability to accurately measure intraocular pressure (IOP). In addition, there are no standard guidelines for glaucoma surveillance and monitoring after keratoprosthesis surgery. This report provides a review of the current literature and offers innovative strategies that will overcome the challenges in managing glaucoma in the setting of a Boston keratoprosthesis type 1 implant. The topics that will be discussed in this section include alternative methods for IOP measurement, rationales and surgical techniques for a pars plana tube placement for glaucoma drainage device, effective medical and laser treatment, the risk for IOP elevations after YAG laser, and practical guides to glaucoma surveillance and monitoring.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40135-016-0102-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435373PMC
September 2016

The Sensimed Triggerfish contact lens sensor: efficacy, safety, and patient perspectives.

Clin Ophthalmol 2017 8;11:875-882. Epub 2017 May 8.

Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA.

Intraocular pressure, a major modifiable risk factor for glaucoma, has been shown to fluctuate throughout the day in patients with glaucoma. The detection and measurement of this fluctuation may help guide the clinical management of glaucomatous individuals. The Sensimed Triggerfish contact lens sensor (CLS), which has recently gained approval for marketing in the USA, is designed to detect intraocular pressure-related changes in an eye over a 24-hour period. This review will provide an overview of the Triggerfish CLS, as well as summarize current clinical data pertaining to the device. Overall, the current evidence suggests that the Triggerfish CLS is safe and well tolerated, and provides reproducible results. One challenge of using the Triggerfish CLS is that it may only provide data on relative changes in intraocular pressure rather than absolute intraocular pressure. In addition, its validity at estimating intraocular pressure compared to other methods is still controversial. Despite these limitations, recent studies suggest a myriad of potential indications for the Triggerfish CLS, including predicting glaucomatous progression and predicting efficacy of glaucoma treatment. With further research, the Triggerfish CLS may become a useful tool for eye care practitioners.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S109708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428792PMC
May 2017

Glaucoma Drainage Implant Surgery.

Dev Ophthalmol 2017 25;59:43-52. Epub 2017 Apr 25.

Glaucoma drainage implant (GDI) surgery represents a significant advance in the treatment of refractory glaucomas. Recent randomized clinical trials have compared the efficacy and safety of this technique to standard trabeculectomy. Several types of implant are currently available and differ in surface area, shape, composition, and the presence or absence of a flow-restricting valve. Two separate prospective, randomized clinical trials comparing 2 types of GDI have reported results after 5 years of follow-up. GDIs may be placed in the anterior chamber, ciliary sulcus, or pars plana. Several types of patch graft material may be utilized to prevent tube erosion. Potential complications of GDI surgery may relate to immediate or late-onset hypotony, motility disturbances, corneal decompensation, or tube erosion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000458485DOI Listing
September 2017

M&S Smart System Contrast Sensitivity Measurements Compared With Standard Visual Function Measurements in Primary Open-Angle Glaucoma Patients.

J Glaucoma 2017 Jun;26(6):528-533

*Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL †Saint Louis University, St. Louis, MO.

Purpose: To evaluate the nature and extent of letter contrast sensitivity (CS) deficits in glaucoma patients using a commercially available computer-based system (M&S Smart System II) and to compare the letter CS measurements to standard clinical measures of visual function.

Methods: Ninety-four subjects with primary open-angle glaucoma participated. Each subject underwent visual acuity, letter CS, and standard automated perimetry testing (Humphrey SITA 24-2). All subjects had a best-corrected visual acuity (BCVA) of 0.3 log MAR (20/40 Snellen equivalent) or better and reliable standard automated perimetry (fixation losses, false positives, and false negatives <33%). CS functions were estimated from the letter CS and BCVA measurements. The area under the CS function (AUCSF), which is a combined index of CS and BCVA, was derived and analyzed.

Results: The mean (± SD) BCVA was 0.08±0.10 log MAR (∼20/25 Snellen equivalent), the mean CS was 1.38±0.17, and the mean Humphrey Visual Field mean deviation (HVF MD) was -7.22±8.10 dB. Letter CS and HVF MD correlated significantly (r=0.51, P<0.001). BCVA correlated significantly with letter CS (r=-0.22, P=0.03), but not with HVF MD (r=-0.12, P=0.26). A subset of the subject sample (∼20%) had moderate to no field loss (≤-6 dB MD) and minimal to no BCVA loss (≤0.3 log MAR), but had poor letter CS. AUCSF was correlated significantly with HVF MD (r=0.46, P<0.001).

Conclusions: The present study is the first to evaluate letter CS in glaucoma using the digital M&S Smart System II display. Letter CS correlated significantly with standard HVF MD measurements, suggesting that letter CS may provide a useful adjunct test of visual function for glaucoma patients. In addition, the significant correlation between HVF MD and the combined index of CS and BCVA (AUCSF) suggests that this measure may also be useful for quantifying visual dysfunction in glaucoma patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000000659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453812PMC
June 2017

A Review of Selective Laser Trabeculoplasty: Recent Findings and Current Perspectives.

Ophthalmol Ther 2017 Jun 3;6(1):19-32. Epub 2017 Mar 3.

University of Illinois Eye and Ear Infirmary, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.

Selective laser trabeculoplasty (SLT) has been widely used in the clinical management of glaucoma, both as primary and adjunctive treatment. As new evidence continues to arise, we review the current literature in terms of indications and efficacy, surgical technique, postoperative care, repeatability, and complications of this therapy. SLT has been shown to be effective in various glaucomas, including primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), steroid-induced glaucoma, pseudoexfoliation glaucoma (PXFG), and primary angle-closure glaucoma (PACG), as well as other glaucoma subtypes. Relatively high preoperative intraocular pressure (IOP) may predict surgical success, while other parameters that have been studied do not seem to affect the outcome. Different techniques for performing the procedure have recently been explored, revealing that minor modifications may lead to a more favorable or safer clinical outcome. The utilization of postoperative medications remains controversial based on the current evidence. A short-term IOP increase may complicate SLT and can also persist in certain cases such as in exfoliation glaucoma. The efficacy and safety of repeat SLT are shown in multiple studies, and the timing of repeat procedures may affect the success rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40123-017-0082-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449301PMC
June 2017

Sustained drug delivery for glaucoma: current data and future trends.

Authors:
Ahmad A Aref

Curr Opin Ophthalmol 2017 Mar;28(2):169-174

Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois, USA.

Purpose Of Review: Sustained drug delivery has been recognized as a need for patients with ocular hypertension or glaucomatous optic neuropathy. Several sustained drug delivery systems and devices are currently on the horizon. This review aims to summarize initial results with these platforms, as reported in the literature, and also provide insight into their possible role in the glaucoma treatment paradigm.

Recent Findings: Sustained drug delivery systems currently on the horizon include the topical bimatoprost ocular insert, travoprost and latanoprost punctal plugs, latanoprost-eluting contact lenses, bimatoprost and travoprost intraocular implants, as well as several other therapies in earlier stages of development. Delivery strategies differ with respect to ocular site of implantation, ocular hypotensive agent, and duration of efficacy. Efficacy and safety outcomes with these devices are favorable thus far.

Summary: The glaucoma treatment paradigm is currently in a state of flux as sustained drug delivery systems bring promise to individuals suffering from ocular hypertension or glaucoma. Several options will likely become available in the near future to ease the burden of daily administration of chronic therapy with intraocular pressure-lowering agents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICU.0000000000000334DOI Listing
March 2017

Primary Baerveldt Shunt Implantation: Outcomes and Complications.

Ophthalmol Ther 2016 Dec 25;5(2):253-262. Epub 2016 Jul 25.

Illinois Eye and Ear Infirmary, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.

Introduction: This study is a retrospective case series to evaluate the outcomes and complications of Baerveldt glaucoma implant surgery (BGI) in patients without prior cataract or incisional glaucoma surgery.

Methods: Patients who underwent 350-mm BGI through the Glaucoma Service of the University of Illinois at Chicago between 2010 and 2015 were included in this study. Outcome measures included age, sex, ethnicity, operated eye, preoperative diagnosis, preoperative, and sequential postoperative intraocular pressure (IOP), visual acuity, glaucoma medications, and postoperative complication and interventions. Statistical analyses were performed using the two-sided Student t test for continuous variables.

Results: Thirty-seven patients were studied. IOP was consistently and statistically significantly lower at 3 months (17.4 ± 6.4, p = 3 × 10), 6 months (13.9 ± 5.1, p = 2 × 10), 1 year (12.2 ± 4.0, p = 9 × 10), and 2 years (14.6 ± 3.3, p = 0.0004) postoperatively compared to IOP at baseline (27.5 ± 8.1). Fewer glaucoma medications were used at 3 months (2.8 ± 1.3, p = 0.04), 6 months (2.6 ± 1.2, p = 0.02), 1 year (2.7 ± 1.7, p = 0.04), and 2 years (2.0 ± 1.2, p = 0.03) postoperatively compared to baseline (3.4 ± 1.1). A total of six cases (16%) had failure. A total of five patients (15%) had postoperative complications. Mean Snellen visual acuity was not statistically different at 6 months (0.5 ± 0.6, p = 0.88) or 1 year (0.4 ± 0.4, p = 0.57) postoperatively from baseline (0.5 ± 0.6).

Conclusions: Primary BGI is effective at reducing IOP and the medication burden in patients suffering glaucomatous optic neuropathy. Further randomized prospective studies are needed to compare various procedures in the primary surgical management of patients with uncontrolled glaucoma.

Funding: This study was funded by an unrestricted grant from Research to Prevent Blindness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40123-016-0056-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125118PMC
December 2016

Author's Reply.

J Ophthalmic Vis Res 2015 Oct-Dec;10(4):503-4

Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/2008-322X.176895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795407PMC
April 2016

Current management of glaucoma and vascular occlusive disease.

Authors:
Ahmad A Aref

Curr Opin Ophthalmol 2016 Mar;27(2):140-5

Illinois Eye and Ear Infirmary, University of Illinois College of Medicine, Chicago, Illinois, USA.

Purpose Of Review: This article summarizes recent findings pertaining to advancements in the treatment of glaucomas secondary to vascular occlusive disease to maximize visual outcomes.

Recent Findings: Retinal ischemia leads to a local increase in transcription of proteins responsible for aberrant angiogenesis and subsequent neovascular glaucoma. Antivascular endothelial growth factor (VEGF) therapy is helpful in the management of this condition. Although bevacizumab and ranibizumab offer relatively short-term effects, preliminary studies suggest that aflibercept may allow for longer term treatment. Preoperative anti-VEGF injection therapy improves outcomes after trabeculectomy and glaucoma drainage implant surgeries. The treatments for vascular occlusive disease may lead to intraocular pressure elevation and subsequent glaucoma. Aflibercept appears to be a safer agent in this regard.

Summary: Prompt diagnosis and management of glaucomas associated with vascular occlusive disease are required to allow for the best possible outcome. Novel anti-VEGF agents, particularly aflibercept, should be strongly considered in the management of these conditions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICU.0000000000000239DOI Listing
March 2016