Publications by authors named "Thasarat S Vajaranant"

50 Publications

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

Dietary Antioxidants, Macular Pigment, and Glaucomatous Neurodegeneration: A Review of the Evidence.

Nutrients 2019 May 1;11(5). Epub 2019 May 1.

University of Wisconsin, Department of Ophthalmology and Visual Sciences, 610 N. Walnut Street 1069 WARF Building, Madison, WI 53726, USA.

Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness worldwide, and the prevalence is projected to increase to 112 million worldwide by 2040. Intraocular pressure is currently the only proven modifiable risk factor to treat POAG, but recent evidence suggests a link between antioxidant levels and risk for prevalent glaucoma. Studies have found that antioxidant levels are lower in the serum and aqueous humor of glaucoma patients. In this review, we provide a brief overview of the evidence linking oxidative stress to glaucomatous pathology, followed by an in-depth discussion of epidemiological studies and clinical trials of antioxidant consumption and glaucomatous visual field loss. Lastly, we highlight a possible role for antioxidant carotenoids lutein and zeaxanthin, which accumulate in the retina to form macular pigment, as evidence has emerged supporting an association between macular pigment levels and age-related eye disease, including glaucoma. We conclude that the evidence base is inconsistent in showing causal links between dietary antioxidants and glaucoma risk, and that prospective studies are needed to further investigate the possible relationship between macular pigment levels and glaucoma risk specifically.
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http://dx.doi.org/10.3390/nu11051002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567242PMC
May 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:

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

Beyond Mechanical Trauma-Why the Cornea May Decompensate After Glaucoma Surgery.

JAMA Ophthalmol 2019 May;137(5):479-480

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

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http://dx.doi.org/10.1001/jamaophthalmol.2019.0173DOI Listing
May 2019

Longitudinal Study of Peripapillary Thinning in Sickle Cell Hemoglobinopathies.

Am J Ophthalmol 2019 06 14;202:30-36. Epub 2019 Feb 14.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA. Electronic address:

Purpose: To determine the rate of retinal nerve fiber layer (RNFL) thinning in patients with sickle cell hemoglobinopathies.

Design: This was a prospective cohort study.

Methods: Sixty-seven patients averaging 35.8 ± 11.5 years of age at enrollment with electrophoretically confirmed sickle cell hemoglobinopathies followed by the University of Illinois at Chicago retina clinic for ≥1 year were included. Exclusion criteria included a history of diabetes, uncontrolled hypertension, glaucoma, ocular opacities, other retinopathies, and previous retinal procedures. The optic nerve head RNFL thicknesses were measured with spectral-domain optical coherence tomography (Heidelberg Engineering, Inc) at enrollment and subsequent follow-ups. Linear mixed models were used to estimate rates of thinning.

Results: A total of 122 eyes were followed for 3.8 ± 2.0 years (range 1-8 years). Mean global peripapillary RNFL thickness was 100.9 ± 13.0 μm at baseline. Global peripapillary RNFL thickness decreased at a rate of 0.98 μm per year (95% confidence interval [CI] 0.77-1.19 μm/year). A history of stroke was associated with a faster rate of global RNFL thinning (1.72 ± 0.20 vs 0.79 ± 0.12 μm/year, P < .001), whereas a history of hypertension was associated with a slower rate of thinning (0.33 ± 0.27 vs 1.14 ± 0.12 μm/year, P = .002).

Conclusions: Peripapillary RNFL thinning in patients with sickle cell hemoglobinopathies occurred faster in patients with a history of stroke and slower in patients with controlled hypertension. Future studies will compare these rates to those of healthy age- and race-matched individuals.
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http://dx.doi.org/10.1016/j.ajo.2019.02.006DOI Listing
June 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.
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http://dx.doi.org/10.1016/j.jtos.2019.01.010DOI Listing
April 2019

Brimonidine tartrate for the treatment of glaucoma.

Expert Opin Pharmacother 2019 Jan 8;20(1):115-122. Epub 2018 Nov 8.

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

Introduction: Brimonidine tartrate is a commonly used eyedrop for short- and long-term lowering of intraocular pressure. Its use has been popularized due to its effects on aqueous suppression and uveoscleral outflow, as well as the suggestion of neuroprotection. Although available with alternative preservative vehicles, brimonidine is associated with high rates of local allergy and is contraindicated in breastfeeding women, neonates, young children, and the elderly due to risk of central nervous system depression. Other topical agents with differing advantages have challenged brimonidine's role in the treatment algorithm of ocular hypertension and glaucoma. Areas covered: The authors review the development of topical alpha-adrenergic agonists, with particular attention to the currently available formulations of brimonidine tartrate. Its mechanism of action, pharmacodynamics and safety, and clinical efficacy are analyzed. Expert opinion: Despite clinical familiarity with brimonidine after two decades of use, agents that offer daily dosing, nocturnal effect, and more favorable ocular and systemic side effect profiles have ultimately led to brimonidine's adjunctive use in patients with elevated intraocular pressure or high- or low-tension glaucomas. Still, brimonidine may be advantageous in patients undergoing laser trabeculoplasty or iridotomy, in certain forms of glaucoma, or in pregnant individuals prior to the last trimester, underscoring its clinical importance.
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http://dx.doi.org/10.1080/14656566.2018.1544241DOI Listing
January 2019

Systemic Disease and Long-term Intraocular Pressure Mean, Peak, and Variability in Nonglaucomatous Eyes.

Am J Ophthalmol 2018 09 6;193:184-196. Epub 2018 Jul 6.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA; Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA. Electronic address:

Purpose: Elevated intraocular pressure (IOP) is a well-known risk factor in glaucoma development and progression. As most glaucoma risk factors are not modifiable, IOP remains the sole focus of medical and surgical therapy. Identifying modifiable factors and their effects on IOP, such as systemic diseases, is therefore of interest. The objective is to assess the long-term, longitudinal relationship between systemic diseases and IOP mean, peak, and variability, including diabetes, hypertension, body mass index (BMI), and smoking status.

Design: Secondary analysis of randomized clinical trial data.

Methods: Longitudinal IOP and systemic disease data from the Age-Related Eye Disease Study (AREDS), a randomized clinical trial of high-dose antioxidants, was analyzed.

Study Population: A total of 3909 older participants without a reported diagnosis of glaucoma or glaucoma treatment during AREDS with up to 12 years of annual IOP and systemic disease data.

Main Outcome Measures: Independent systemic disease risk factors associated with IOP.

Results: Univariate analysis identified numerous systemic disease factors associated with IOP mean, peak, and variability. Longitudinal adjusted models identified diabetes, obesity, and systolic hypertension as significantly associated with increased IOP, while systemic beta-blocker use was inversely associated.

Conclusions: Results demonstrate a relationship between multiple systemic diseases and IOP; moreover, they demonstrate that systemic diseases influence additional parameters beyond mean IOP, such as IOP peak and variability. Although only to be taken within the context of IOP, these population-level trends reveal potentially modifiable factors in IOP control, and are particularly important in the context of increasing obesity and diabetes prevalence rates in American adults.
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http://dx.doi.org/10.1016/j.ajo.2018.06.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457143PMC
September 2018

Pathophysiology and management of glaucoma associated with phakomatoses.

J Neurosci Res 2019 01 1;97(1):57-69. Epub 2018 Apr 1.

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

The phakomatoses, encephalotrigeminal angiomatosis (ETA; Sturge-Weber Syndrome), neurofibromatosis type 1 (NF1 or von Recklinghausen disease), Von Hippel-Lindau (VHL) disease, tuberous sclerosis (TSC), oculodermal melanocytosis (ODM), and phakomatosis pigmentovascularis are a group of neurocutaneous disorders that have characteristic systemic and ocular manifestations. Through many different mechanisms, they may cause glaucomatous damage of the optic nerve and subsequent vision loss varying from mild to severe. Glaucoma commonly affects patients with ETA (43-72%), orbito-facial NF1 (23-50%), and ODM (10%). Rarely, it may present as neovascular glaucoma in VHL and TSC. In ETA, glaucoma typically occurs ipsilateral to the port-wine stain, which is caused by a mutation in the GNAQ gene. Specifically, mechanical malformation of the anterior chamber angle and elevated episcleral venous pressure has been implicated as causes of glaucoma in ETA. In NF1, which is caused by a mutation in the NF1 tumor suppressor gene, glaucoma commonly occurs ipsilateral to lid plexiform neurofibromas. Histological studies of eyes with NF1 have revealed direct anterior chamber infiltration by neurofibromas, secondary angle closure, fibrovascularization, and developmental angle abnormalities as mechanisms of glaucoma. Lastly, phakomatosis pigmentovascularis is a rare combination of ODM and port-wine stain. Affected patients are at very high risk of developing glaucoma. Despite the many different mechanisms of glaucomatous damage, management follows similar principles as that for congenital glaucoma and primary open angle glaucoma. First-line therapy is topical intraocular pressure-lowering eye drops. Surgical management, including goniotomy, trabeculotomy, trabeculectomy, and tube shunt placement may be required for more severe cases.
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http://dx.doi.org/10.1002/jnr.24241DOI Listing
January 2019

Progressive Bilateral Scleral Pigmentation in a Patient With Ocular Hypertension.

JAMA Ophthalmol 2018 05;136(5):587-588

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

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http://dx.doi.org/10.1001/jamaophthalmol.2017.5148DOI Listing
May 2018

Testosterone Pathway Genetic Polymorphisms in Relation to Primary Open-Angle Glaucoma: An Analysis in Two Large Datasets.

Invest Ophthalmol Vis Sci 2018 02;59(2):629-636

Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.

Purpose: Sex hormones may be associated with primary open-angle glaucoma (POAG), although the mechanisms are unclear. We previously observed that gene variants involved with estrogen metabolism were collectively associated with POAG in women but not men; here we assessed gene variants related to testosterone metabolism collectively and POAG risk.

Methods: We used two datasets: one from the United States (3853 cases and 33,480 controls) and another from Australia (1155 cases and 1992 controls). Both datasets contained densely called genotypes imputed to the 1000 Genomes reference panel. We used pathway- and gene-based approaches with Pathway Analysis by Randomization Incorporating Structure (PARIS) software to assess the overall association between a panel of single nucleotide polymorphisms (SNPs) in testosterone metabolism genes and POAG. In sex-stratified analyses, we evaluated POAG overall and POAG subtypes defined by maximum IOP (high-tension [HTG] or normal tension glaucoma [NTG]).

Results: In the US dataset, the SNP panel was not associated with POAG (permuted P = 0.77), although there was an association in the Australian sample (permuted P = 0.018). In both datasets, the SNP panel was associated with POAG in men (permuted P ≤ 0.033) and not women (permuted P ≥ 0.42), but in gene-based analyses, there was no consistency on the main genes responsible for these findings. In both datasets, the testosterone pathway association with HTG was significant (permuted P ≤ 0.011), but again, gene-based analyses showed no consistent driver gene associations.

Conclusions: Collectively, testosterone metabolism pathway SNPs were consistently associated with the high-tension subtype of POAG in two datasets.
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http://dx.doi.org/10.1167/iovs.17-22708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5795896PMC
February 2018

COMPARISON OF VISUAL AND ANATOMICAL OUTCOMES OF EYES UNDERGOING TYPE I BOSTON KERATOPROSTHESIS WITH COMBINATION PARS PLANA VITRECTOMY WITH EYES WITHOUT COMBINATION VITRECTOMY.

Retina 2018 09;38 Suppl 1:S125-S133

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

Purpose: To determine whether 1-year visual and anatomical results after surgery combining pars plana vitrectomy, Boston keratoprosthesis, and a glaucoma drainage device as needed are similar, better, or worse than Boston keratoprosthesis initial implantation alone.

Methods: We performed a retrospective review of adult patients undergoing Boston keratoprosthesis at our institution. Visual acuity outcomes, anatomical results, and complication rates of patients undergoing combination surgery (including pars plana vitrectomy and a posterior glaucoma drainage device) were compared with those undergoing keratoprosthesis placement alone.

Results: There were 70 eyes in the keratoprosthesis alone group and 55 eyes in the keratoprosthesis with pars plana vitrectomy group. Mean follow-up durations were 54.67 months in the keratoprosthesis alone group and 48.41 months in the combination group. Baseline mean Snellen equivalent visual acuities were worse for the combination group compared with the keratoprosthesis alone group (P = 0.027). Visual acuities improved postoperatively by 1 month after keratoprosthesis implantation for both groups and improved three or more lines of Snellen acuity in the majority of eyes for both groups (≥72% by 12 months). Eyes undergoing pars plana vitrectomy had lower rates of de novo (P = 0.015) and significantly lower rates of secondary procedures (P = 0.002) at 1 year. One year complications rates for retroprosthetic membrane formation, retinal detachment, hypotony, cystoid macular edema, epiretinal membrane formation, endophthalmitis, and corneal melting were similar for both groups.

Conclusion: Compared with keratoprosthesis alone, combining keratoprosthesis with pars plana vitrectomy and a glaucoma drainage device as needed, resulted in lower rates of de novo glaucoma, lower rates of additional surgical procedures, similar visual acuity outcomes at 1 year, and did not result in higher complication rates.
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http://dx.doi.org/10.1097/IAE.0000000000002036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6056324PMC
September 2018

Three Dimensional Stimulus Source for Pattern Electroretinography in Mid- and Far-peripheral Retina.

Transl Vis Sci Technol 2018 Jan 19;7(1). Epub 2018 Jan 19.

Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.

Purpose: The pattern electroretinogram (pERG) response reflects, in part, ganglion cell function. However, probing retinal ganglion cell (RGC) function in the mid- and far peripheral retina is difficult with conventional flat-panel pERG stimulus sources. A pattern stimulus source is presented for probing the peripheral retina. Peripheral pERG (ppERG) responses were evaluated versus luminance, reversal rate, and field subtended, and were compared with conventional pERG in healthy eyes.

Methods: Eleven normally-sighted subjects were recruited. A hemispherical surface was used to present a reversing checkerboard pattern to the peripheral retina, from approximately 35° to 85° of visual field, in all directions. Responses to stimuli presented to peripheral field sectors (superior, nasal, inferior, temporal) were also recorded. Conventional pERG responses were recorded on the same day. Amplitudes and implicit times of waveform peaks were evaluated.

Results: Robust pERG responses from peripheral retina resemble conventional pERG responses but with shorter implicit times and reduced positive component. Responses to high-luminance patterns include high-frequency components resembling flash ERG oscillatory potentials. Negative response component amplitudes increased with increasing pattern luminance, and decreased with increasing reversal rate.

Conclusions: Peripheral-field pERG responses are robust and repeatable; the unique response properties reflect differences between central and peripheral retina. Field-sector response ratios can be used to probe for sectoral dysfunction associated with disease.

Translational Relevance: The ppERG approach provides direct measurement of proximal retinal function beyond the fields probed by conventional perimetry and pERG, providing access to a relatively under studied part of the retina relevant to early stage glaucoma.
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http://dx.doi.org/10.1167/tvst.7.1.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5777171PMC
January 2018

Blepharospasm as a masquerade of glaucomatous visual field defects.

Can J Ophthalmol 2017 Jun 9;52(3):e99-e102. Epub 2017 Jan 9.

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

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http://dx.doi.org/10.1016/j.jcjo.2016.11.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757416PMC
June 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.
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http://dx.doi.org/10.1007/s40135-016-0102-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5435373PMC
September 2016

Topical treatment of glaucoma: established and emerging pharmacology.

Expert Opin Pharmacother 2017 Jun;18(9):885-898

b King Khaled Eye Specialist Hospital , Riyadh , Kingdom of Saudi Arabia.

Introduction: Glaucoma is a collection of optic neuropathies consisting of retinal ganglion cell death and corresponding visual field loss. Glaucoma is the leading cause of irreversible vision loss worldwide and is forecasted to precipitously increase in prevalence in the coming decades. Current treatment options aim to lower intraocular pressure (IOP) via topical or oral therapy, laser treatment to the trabecular meshwork or ciliary body, and incisional surgery. Despite increasing use of trabecular laser therapy, topical therapy remains first-line in the treatment of most forms of glaucoma. Areas covered: Novel glaucoma therapies are a long-standing focus of investigational study. More than two decades have passed since the last United States Food and Drug Administration (FDA) approval of a topical glaucoma drug. Here, the authors review established topical glaucoma drops as well as those currently in FDA phase 2 and 3 clinical trial, nearing clinical use. Expert opinion: Current investigational glaucoma drugs lower IOP, mainly through enhanced trabecular meshwork outflow. Although few emerging therapies show evidence of retinal ganglion cell and optic nerve neuroprotection in animal models, emerging drugs are focused on lowering IOP, similar to established medicines.
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http://dx.doi.org/10.1080/14656566.2017.1328498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794042PMC
June 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.
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http://dx.doi.org/10.1097/IJG.0000000000000659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5453812PMC
June 2017

Age-Related Macular Degeneration and Mortality in the Age-Related Eye Disease Study (AREDS): The Effect of Sex and Time.

Ophthalmol Retina 2017 Jan - Feb;1(1):49-58. Epub 2016 Nov 18.

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

Purpose: Age-related macular degeneration (AMD) shares similar risk factors and pathogeneses with cardiovascular diseases (CVDs). Epidemiologic studies over the past 2 decades analyzing the association between AMD and all-cause and CVD-specific mortality have failed to yield conclusive results. The purpose of this analysis is to investigate the sex-specific association between AMD and all-cause and CVD-specific mortality, and to assess whether duration of follow-up alters the strength of association.

Design: The database of Genotypes and Phenotypes (dbGaP) data set for the Age-Related Eye Disease Study, a randomized clinical trial of high-dose antioxidants in AMD prevention, with participants enrolled from 1992 to 1998 and followed through 2005, was used in the analysis.

Participants: There were 4757 Age-Related Eye Disease Study participants aged 55 through 80 years (mean, 69.4 years; 44.1% male) recruited from 11 retinal specialty clinics. Participants had standard Age-Related Eye Disease Study AMD categories (category 1, n = 1117; category 2, n = 1062; category 3, n = 1621; category 4, n = 957).

Methods: The sex-specific adjusted hazard ratio (HR) between baseline AMD and all-cause and CVD-specific mortality was determined at multiple time points (e.g., 5, 7, 10, and all years), adjusting for age, race, diabetes, hypertension, angina, cancer, smoking, obesity, clinical trial antioxidant treatment category, and education.

Main Outcome Measures: Sex-specific all-cause and CVD-specific mortality.

Results: Mean follow-up was 9.6 years (range, 0.5-12.5 years), with 1087 deaths (category 1, n = 197 [17.6%]; category 2, n = 200 [18.8%]; category 3, n = 356 [22.0%]; category 4, n = 326 [34.1%]). Sex-stratified models demonstrated sex differences; in women, a significant association between AMD category 4 and all-cause mortality existed compared with category 1 at each period (HR, 1.5-2.3; all P ≤ 0.005); similar category 4 findings were present with CVD-specific mortality, strengthening with shorter periods (HR, 1.9-4.6; all P ≤ 0.01). Among men, a significant association between all AMD stages and all-cause (HR, 1.5-2.3; all P ≤ 0.05) and CVD-specific mortality (HR, 1.6-4.0; all P ≤ 0.05) existed for nearly all periods.

Conclusions: Substantial late AMD cases and deaths exceed those in previous population-based studies to better test mortality-related hypotheses. Age-related macular degeneration was significantly associated with all-cause and CVD-specific mortality. Relationships weakened over a longer duration of follow-up, and sex seems to modify the association. Future analyses are warranted to interrogate the possible clinical usefulness of these relationships.
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http://dx.doi.org/10.1016/j.oret.2016.09.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433027PMC
November 2016

Evidence-Based Approaches to Glaucoma Management During Pregnancy and Lactation.

Curr Ophthalmol Rep 2016 Dec 12;4(4):198-205. Epub 2016 Oct 12.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, 1855 W Taylor St, Chicago, IL, USA.

With increasing maternal age in this decade, there is a parallel rise in the number of pregnant and lactating women affected by glaucoma worldwide. Understanding the diagnosis and management of glaucoma during pregnancy and lactation is essential to preventing blindness from glaucoma in this vulnerable population. This report provides a review of the current literature and offers effective strategies that will overcome the challenges in managing glaucoma during pregnancy and lactation. Practically, glaucoma management during pregnancy and lactation presents a unique challenge for the physician, as the benefit of any treatment must be weighed against the potential risks to the fetus. Prior to initiating or continuing treatment, the physician should be familiar with the various treatment options to manage intraocular pressure during pregnancy and lactation, including the safety of various anti-glaucoma medications as supported by the existing literature and based on the food and drug administration guidelines. A collaborative team effort between the ophthalmologist, obstetrician, and neonatologist in high-risk pregnancies is recommended to optimize care for the mother and fetus.
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http://dx.doi.org/10.1007/s40135-016-0112-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773175PMC
December 2016

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

Visual Impairment and Blindness in Adults in the United States: Demographic and Geographic Variations From 2015 to 2050.

JAMA Ophthalmol 2016 07;134(7):802-9

Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles.

Importance: The number of individuals with visual impairment (VI) and blindness is increasing in the United States and around the globe as a result of shifting demographics and aging populations. Tracking the number and characteristics of individuals with VI and blindness is especially important given the negative effect of these conditions on physical and mental health.

Objectives: To determine the demographic and geographic variations in VI and blindness in adults in the US population in 2015 and to estimate the projected prevalence through 2050.

Design, Setting, And Participants: In this population-based, cross-sectional study, data were pooled from adults 40 years and older from 6 major population-based studies on VI and blindness in the United States. Prevalence of VI and blindness were reported by age, sex, race/ethnicity, and per capita prevalence by state using the US Census projections (January 1, 2015, through December 31, 2050).

Main Outcomes And Measures: Prevalence of VI and blindness.

Results: In 2015, a total of 1.02 million people were blind, and approximately 3.22 million people in the United States had VI (best-corrected visual acuity in the better-seeing eye), whereas up to 8.2 million people had VI due to uncorrected refractive error. By 2050, the numbers of these conditions are projected to double to approximately 2.01 million people with blindness, 6.95 million people with VI, and 16.4 million with VI due to uncorrected refractive error. The highest numbers of these conditions in 2015 were among non-Hispanic white individuals (2.28 million), women (1.84 million), and older adults (1.61 million), and these groups will remain the most affected through 2050. However, African American individuals experience the highest prevalence of visual impairment and blindness. By 2050, the highest prevalence of VI among minorities will shift from African American individuals (15.2% in 2015 to 16.3% in 2050) to Hispanic individuals (9.9% in 2015 to 20.3% in 2050). From 2015 to 2050, the states projected to have the highest per capita prevalence of VI are Florida (2.56% in 2015 to 3.98% in 2050) and Hawaii (2.35% in 2015 and 3.93% in 2050), and the states projected to have the highest projected per capita prevalence of blindness are Mississippi (0.83% in 2015 to 1.25% in 2050) and Louisiana (0.79% in 2015 to 1.20% in 2050).

Conclusions And Relevance: These data suggest that vision screening for refractive error and early eye disease may reduce or prevent a high proportion of individuals from experiencing unnecessary vision loss and blindness, decrease associated costs to the US economy for medical services and lost productivity, and contribute to better quality of life. Targeted education and screening programs for non-Hispanic white women and minorities should become increasingly important because of the projected growth of these populations and their relative contribution to the overall numbers of these conditions.
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http://dx.doi.org/10.1001/jamaophthalmol.2016.1284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116104PMC
July 2016

Effects of Hormone Therapy on Intraocular Pressure: The Women's Health Initiative-Sight Exam Study.

Am J Ophthalmol 2016 May 3;165:115-24. Epub 2016 Mar 3.

Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.

Purpose: Previous studies suggest that hormone therapy favorably affects intraocular pressure (IOP). Here, we examined the association between hormone therapy use and IOP in the context of a large randomized trial.

Design: Secondary data analysis from a randomized controlled trial.

Methods: We used data from the Women's Health Initiative-Sight Exam (WHISE). Women with prior hysterectomy received oral conjugated equine estrogen (0.625 mg/day) or placebo. Women with a uterus received estrogen plus progestin (medroxyprogesterone acetate 2.5 mg/day) or placebo. IOP was measured 5 years after randomization. Adjusted linear regression models were used to assess the association between hormone therapy and IOP.

Results: The WHISE included 1668 women in the estrogen-alone trial (aged 63-86, mean 72 years) and 2679 women in the estrogen-plus-progestin trial (aged 63-87, mean 72 years). In multivariate analyses, compared to placebo treatment, treatment with estrogen alone was associated with a 0.5 mm Hg reduction of the IOP in the right eye (95% CI: -0.8, -0.1, P = .005) and a 0.6 mm Hg (95% CI: -0.9, -0.3, P < .001) reduction of the IOP in the left eye. In the estrogen-plus-progestin trial, there was no significant difference in IOP between the treatment and placebo groups (P = .30 right eye and P = .43 left eye).

Conclusions: This study represents an IOP analysis in the largest hormone trial available. Estrogen-alone therapy in postmenopausal women is associated with a small but significant IOP reduction of 0.5 mm Hg. The clinical significance of this small decrease remains to be determined.
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http://dx.doi.org/10.1016/j.ajo.2016.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4870123PMC
May 2016

Hypotony Maculopathy: Clinical Presentation and Therapeutic Methods.

Ophthalmol Ther 2015 Dec 8;4(2):79-88. Epub 2015 Aug 8.

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

Introduction: Hypotony maculopathy is ocular hypotony complicated by papilledema and/or folding of the retina and choroid in the posterior pole. Our objective was to examine the current literature regarding hypotony maculopathy and treatment methods.

Methods: A systematic review of the English-language literature was conducted by performing a broad search of PubMed from 1972 through 2015 using the keywords hypotony maculopathy and hypotony. Additional articles were identified from bibliographies of relevant articles.

Results: Hypotony maculopathy was infrequent before the introduction of antimetabolite agents in glaucoma-filtering surgery, and the incidence of this entity is now up to 20%. Risk factors for developing hypotony maculopathy include male gender, young age, myopia, and primary filtering surgery. Correctly identifying the etiology of hypotony is essential for successful treatment. Treatment of hypotony maculopathy includes procedures to elevate the intraocular pressure, thus reversing the collapse of the scleral wall and chorioretinal wrinkling.

Conclusion: This review discusses the definition, clinical presentation, pathophysiology, incidence and risk factors, prevention and treatment of hypotony maculopathy.
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http://dx.doi.org/10.1007/s40123-015-0037-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675727PMC
December 2015

Outcomes of pars plana glaucoma drainage implant in Boston type 1 keratoprosthesis surgery.

J Glaucoma 2014 Jan;23(1):e39-44

Illinois Eye & Ear Infirmary, University of Illinois at Chicago School of Medicine, Chicago, IL.

Purpose: Glaucoma drainage implantation in conjunction with Boston Type 1 Keratoprosthesis placement is a surgical option in controlling postoperative glaucoma. The purpose of this study is to report outcomes of combined pars plana vitrectomy and glaucoma drainage implantation with corneal patch graft in Boston Type 1 Keratoprosthesis patients.

Patients And Methods: A retrospective review of patients who underwent pars plana glaucoma drainage implantation in combination with Boston Type 1 Keratoprosthesis was performed. Preoperative and postoperative parameters collected and analyzed included: visual acuity, intraocular pressure, number of glaucoma medications to achieve intraocular pressure control, bandage contact lens fit, and postoperative complications.

Results: Twenty eyes of 20 patients were identified; 95% had preoperative diagnosis of glaucoma, utilizing on an average 2.5 medications with an average intraocular pressure of 19.8 mm Hg (±6.3 mm Hg; range, 9 to 32.8 mm Hg). After placement of the pars plana glaucoma drainage implant, an average intraocular pressure of 19 mm Hg (±7.0 mm Hg; range, 8 to 30 mm Hg) by scleral pneumotonometry was achieved and 85% were deemed to have normal pressures by digital palpation. An average of 2.1 intraocular pressure-lowering medications were required on last follow-up. Average follow-up was 31.6 months (±17.4 mo; range, 12.3 to 71.6 mo). Two eyes required glaucoma drainage implant explantation: one eye due to endophthalmitis from a nonhealing corneal ulcer and the other eye due to corneal melt. None of our patients experienced conjunctival erosion over a pars plana positioned glaucoma drainage implant or tube.

Conclusions: For the long-term management of glaucoma in keratoprosthesis patients, a posteriorly placed pars plana glaucoma drainage implant with corneal patch graft in conjunction with keratoprosthesis has a low risk of erosion and postoperative complications.
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http://dx.doi.org/10.1097/IJG.0b013e31829e55f8DOI Listing
January 2014

Effect of hemodialysis on intraocular pressure and ocular perfusion pressure.

JAMA Ophthalmol 2013 Dec;131(12):1525-31

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

Importance: Elevated intraocular pressure (IOP) and decreased ocular perfusion pressure (OPP) are risk factors for glaucoma development and progression. Unrecognized significant IOP elevation or OPP reduction during hemodialysis (HD) could lead to glaucomatous optic nerve damage and subsequent visual loss.

Objective: To evaluate changes in IOP and OPP during HD.

Design, Setting, And Participants: A cross-sectional observational study was conducted in patients undergoing HD at an ambulatory care clinic at the University of Illinois at Chicago.

Exposures: Forty-nine patients (97 eyes) undergoing HD were enrolled. Exclusion criteria included preexisting corneal abnormalities, history of corneal surgery, allergy to topical anesthetic agents, and current eye infection. Nine patients had previous diagnoses of open-angle glaucoma (OAG) or suspected glaucoma. At 3 time points, IOP was measured using a pneumatonometer and blood pressure was recorded. Measurements were made with the patient in a seated position approximately 15 minutes before starting HD (T1), approximately 2 hours after starting HD (T2), and approximately 15 minutes after ending HD (T3). Mean arterial pressure (MAP) and OPP (systolic, diastolic, and mean OPP) were calculated.

Main Outcomes And Measures: Intraocular pressure and OPP.

Results: From T1 to T3, IOP significantly increased by 3.1 mm Hg (both eyes, P < .001), MAP significantly decreased by 5.8 mm Hg (P = .05), and all OPP measures significantly decreased from baseline (all P ≤ .02). Using previously reported thresholds of increased glaucoma development and progression risk, 53% of the right eyes (26 of 49) and 46% of the left eyes (22 of 48) had a systolic OPP of 101 mm Hg or less, 71% of the right eyes (35 of 49) and 73% of the left eyes (35 of 48) had a diastolic OPP of 55 mm Hg or less, and 63% of the right eyes (31 of 49) and 65% of the left eyes (31 of 48) had a mean OPP of 42 mm Hg or less.

Conclusions And Relevance: Significantly increased IOP and decreased OPP occur during HD, bringing both to levels that increase the risk of glaucoma development and progression. Clinicians should consider HD history in patients who have glaucoma progression, even when IOP has been well controlled. Such patients may benefit from IOP and blood pressure monitoring during HD sessions to minimize OPP changes resulting from IOP spikes and/or suboptimal blood pressure.
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http://dx.doi.org/10.1001/jamaophthalmol.2013.5599DOI Listing
December 2013

Risk of glaucoma after early bilateral oophorectomy.

Menopause 2014 Apr;21(4):391-8

From the 1Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL; Divisions of 2Epidemiology and 3Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; 4Department of Psychiatry, University of Illinois at Chicago, Chicago, IL; 5Department of Ophthalmology and Channing Division of Network Medicine, Harvard Medical School, Boston, MA; and Departments of 6Ophthalmology, 7Internal Medicine, and 8Neurology, Mayo Clinic, Rochester, MN.

Objective: Because early estrogen deficiency may increase the susceptibility of the optic nerve to glaucoma, we studied the association of early bilateral oophorectomy with glaucoma.

Methods: In the Mayo Clinic Cohort Study of Oophorectomy and Aging, we studied the risk of glaucoma by comparing women who underwent bilateral oophorectomy from 1950 to 1987 with age-matched referent women who did not undergo unilateral or bilateral oophorectomy. Glaucoma diagnostic codes were identified in the records linkage system of the Rochester Epidemiology Project. Hazard ratios (HRs) were calculated during a median follow-up of 25.5 years. Analyses were stratified by age at the time of bilateral oophorectomy (in tertiles).

Results: Of 1,044 women who underwent bilateral oophorectomy before menopause, 147 developed glaucoma. Of 1,070 referent women, 133 developed glaucoma. Women who underwent bilateral oophorectomy showed no increased risk of glaucoma in the overall group (HR, 1.12; 95% CI, 0.89-1.42). However, women who underwent oophorectomy before the age of 43 years (n = 344; first tertile) had a significantly increased risk of glaucoma (HR, 1.60; 95% CI, 1.15-2.23). The results did not change after adjustment for hypertension, obesity, diabetes, or disorders of lipid metabolism at baseline. Approximately 11% of women who had undergone bilateral oophorectomy before the age of 43 years were treated with estrogen up to the age of 50 years; however, treatment did not reduce the association (HR, 1.59; 95% CI, 0.81-3.13).

Conclusions: Bilateral oophorectomy before the age of 43 years may increase the risk of glaucoma, and estrogen treatment does not seem to attenuate the risk.
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http://dx.doi.org/10.1097/GME.0b013e31829fd081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880394PMC
April 2014

Anterior segment optical coherence tomography for the quantitative evaluation of the anterior segment following Boston keratoprosthesis.

PLoS One 2013 5;8(8):e70673. Epub 2013 Aug 5.

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

Objective: To quantitatively evaluate the anterior segment using anterior segment optical coherence tomography (AS-OCT) following Boston keratoprosthesis type 1.

Methods: A retrospective study consisted of AS-OCT imaging at a single time point postoperatively in 52 eyes. Main outcomes measures include anatomical and functional anterior chamber depth (ACD), angle (ACA) and peripheral and proximal synechiae.

Results: The mean time point of imaging was 19.3 months postoperatively. Average anatomical and functional ACD was 2.0 and 0.21 mm respectively, and mean ACA ranged from 2.5° to 6.14° in representative meridians. An average of 8.7 clock hours of angle closure was observed in the 25 eyes in which all meridians were imaged. The majority of eyes showed peripheral (86.5%) and proximal (67.3%) synechiae.

Conclusions: AS-OCT is a useful tool for quantitative evaluation of anterior segment and angle after keratoprosthesis, which is otherwise poorly visible. The majority of eyes showed shallow ACD, extensive angle closure and synechiae formation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0070673PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734235PMC
March 2014

Correlation between corneal and scleral pneumatonometry: an alternative method for intraocular pressure measurement.

Am J Ophthalmol 2013 Nov 12;156(5):902-906.e1. Epub 2013 Aug 12.

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

Purpose: To evaluate scleral pneumatonometry as an alternative method for measuring intraocular pressure (IOP).

Design: Prospective cross-sectional study.

Methods: Adult subjects with healthy eyes were recruited from the Comprehensive Eye Service at the University of Illinois Eye and Ear Infirmary from August 2008 through February 2009. Study measurements included corneal pneumatonometry (IOPk), scleral pneumatonometry (IOPs), axial length (AL), spherical equivalent (SE), and central corneal thickness (CCT). Main outcome measures were scleral IOP and corneal IOP.

Results: Analysis included a monocular data set from single eyes of 97 subjects (age: 18-82 years). IOPs was consistently higher than IOPk, and correlated positively with IOPk (r = 0.57, P < .0001), age (r = 0.51, P < .0001), and SE (r = 0.32, P = .0002). The difference between scleral and corneal IOP (IOPs - IOPk) correlated positively with IOPs (r = 0.89, P < .0001), age (r = 0.57, P < .0001), and SE (r = 0.34, P < 0.0001). Bland-Altman analysis for agreement between scleral and corneal pneumatonometry measurements showed a mean difference of 8.08 mm Hg, with the 95% limit of agreement between -3.47 and 19.64 mm Hg. Regression analysis yielded the following equation: IOPk = 11.9 + 0.32(IOPs) - 0.05(Age).

Conclusions: Scleral pneumatonometry correlates positively with corneal pneumatonometry and is more accurate at lower values and in younger patients. When adjusted for age, scleral pneumatonometry may be an adequate alternative in situations where corneal measurements are impractical.
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http://dx.doi.org/10.1016/j.ajo.2013.05.045DOI Listing
November 2013

Epithelial downgrowth after Ahmed implantation presenting as a peritubular fibrovascular membrane.

J Glaucoma 2013 Aug;22(6):e11-3

Department of Ophthalmology & Visual Sciences, Illinois Eye and Ear Infirmary, Chicago, IL 60612, USA.

This is a case report of a 54-year-old woman with chronic uveitis who developed epithelial downgrowth after an Ahmed valve implantation. The epithelial downgrowth presented in an unusual fashion, as a peritubular fibrovascular membrane. Our case suggests that in patients who have undergone glaucoma drainage implantation with clinical features such as persistent hypotony and atypical inflammatory cells, high clinical suspicion for epithelial downgrowth and careful search for potential fistulas are necessary, even without an obvious wound leak.
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http://dx.doi.org/10.1097/IJG.0b013e318255d9eeDOI Listing
August 2013