92 results on '"Garudadri CS"'
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2. A Randomized Trial of Brimonidine Versus Timolol in Preserving Visual Function: Results From the Low-pressure Glaucoma Treatment Study.
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Garudadri CS, Choudhari NS, Rao HL, and Senthil S
- Published
- 2011
3. Metacognition and Medicine.
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Garudadri CS
- Subjects
- Humans, Metacognition
- Published
- 2024
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4. Adaptive optics scanning laser ophthalmoscopy may support early diagnosis of glaucoma.
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Choudhari NS, Kumar S, Richhariya A, Krishnamurthy R, Priya R, and Garudadri CS
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- Cross-Sectional Studies, Early Diagnosis, Humans, Lasers, Ophthalmoscopy methods, Pilot Projects, Tomography, Optical Coherence methods, Glaucoma diagnosis, Nerve Fibers
- Abstract
Purpose: To compare image characteristics of retinal nerve fiber layer (RNFL) between glaucoma patients and healthy controls using adaptive optics scanning laser ophthalmoscopy (AOSLO)., Methods: This was a cross-sectional pilot study with two groups: a glaucoma group with patients with moderate or severe glaucoma as per the Hodapp-Parrish-Anderson classification system and a control group with healthy individuals. The optic nerve damage in moderate glaucoma was predominantly located in only one hemisphere; the other hemisphere was un- or minimally affected on optical coherence tomography and automated perimetry and is referred to as early glaucoma. The structure of RNFL bundles and gain (%) in RNFL images with mean pixel values between 15 and 35 were analyzed. Imaging was performed one degree away from the optic disc margin at two and four cardinal clock positions in the glaucoma and control groups, respectively. The field of view was 1.3° at 2.3 μ resolution. We studied one eye per participant., Results: There were 11 glaucoma patients and 7 healthy controls. Imaging was successful at 88% of the locations in controls and early glaucoma; the reflectivity differed significantly (0.51 and 0.56, respectively, P < 0.001) but not the structure of RNFL bundles (Cohen's Kappa 0.11) between them. In patients with moderate and severe glaucoma, imaging was successful only at 46% of the locations; RNFL bundles were not discernible, and RNFL reflectivity did not differ from those with early glaucoma (P < 0.11)., Conclusion: The recorded gain (%) of RNFL images obtained using AOSLO could be an objective indicator of early glaucoma., Competing Interests: None
- Published
- 2022
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5. Estimation of Goldmann applanation tonometer intraocular pressure (IOP) from scleral Schiotz IOP values in eyes with type-1 keratoprostheses.
- Author
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Senthil S, Chary R, Ali MH, Choudhari NS, and Garudadri CS
- Subjects
- Child, Cornea, Cross-Sectional Studies, Humans, Prospective Studies, Reproducibility of Results, Tonometry, Ocular methods, Glaucoma, Intraocular Pressure
- Abstract
Purpose: To validate estimation of Goldmann applanation tonometer (GAT) intraocular pressure (IOP) from scleral Schiotz IOP measurements using a regression model in normal eyes and eyes with type-1 keratoprostheses., Methods: In this prospective cross-sectional study, cohort-1 had 253 normal anterior segment eyes, and cohort-2 had 100 eyes with type-1 keratoprostheses. Scleral Schiotz IOP measurements were used (in a non-linear model) to predict GAT IOP values for these eyes. Accuracy of predicted GAT IOP values was assessed using actual GAT IOP values for normal eyes, while for type-1 keratoprosthetic eyes, finger tension (FT) IOP assessments by an experienced glaucoma specialist were used. Primary outcome was agreement between FT IOP (assessed by an experienced glaucoma specialist) and predicted GAT IOP-derived clusters., Results: The actual values of GAT IOP measurements in normal eyes (n=253; mean age ±SD, 51.35±15.56 years) ranged between 6 mm Hg and 62 mm Hg (mean=22±10.05 mm Hg). Estimated and actual GAT IOP values for normal eyes were very similar (mean difference=0.05 mm Hg with limits of agreement: -5.39 to 5.5 by Bland-Altman plot). Of the 100 eyes with type-1 keratoprostheses, 68 were classified as having digitally normal IOP, 28 as borderline and 4 as high. The agreement between classification by FT assessment and model-predicted GAT IOP values was substantial (Kappa=0.81, 95% CI 0.69 to 0.93). The accuracy of the model in assessing IOP was found to be 91% (95% CI 0.84 to 0.96)., Conclusion: Scleral Schiotz IOP values along with our predictive model can be an alternative objective method to FT IOP in assessing IOP in eyes with type-1 keratoprostheses., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2022
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6. Comparison of Saccadic Eye Movements Among the High-tension Glaucoma, Primary Angle-closure Glaucoma, and Normal-tension Glaucoma.
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Ballae Ganeshrao S, Jaleel A, Madicharla S, Kavya Sri V, Zakir J, Garudadri CS, and Senthil S
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- Humans, Intraocular Pressure, Saccades, Glaucoma, Glaucoma, Angle-Closure diagnosis, Glaucoma, Open-Angle
- Abstract
Prcis: Saccadic eye movements were compared between high-tension glaucoma (HTG), normal-tension glaucoma (NTG), and primary angle-closure glaucoma (PACG). Saccades were differently affected between the subtypes of primary glaucoma., Aim: The aim of the study was to compare saccadic eye movements in eyes with HTG, PACG, and NTG., Methods: Saccadic eye movements were recorded using the eye tracker Eyelink-1000 in 52 participants: 15 HTG, 14 PACG, 8 NTG, and 15 normal controls. All participants underwent a complete ophthalmic and visual field examination. Prosaccades were measured using the gap paradigm. Prosaccades were measured at 3 target eccentricities (5-, 7-, and 10-degree eccentricity). All prosaccade targets were projected outside the area of visual field defect. Saccade latency, average and peak velocity, and amplitude difference of the saccades were compared between glaucoma subtypes., Results: The mean±SD age was lesser in controls compared with glaucoma (P=0.02). The mean age in all the glaucoma subtypes was comparable (P=0.92). The average mean deviation in PACG (-16.66±6.69 dB) was worse (P=0.01) than in HTG (-11.56±6.08 dB) and NTG (-9.55±3.96 dB). The latencies were delayed, average and peak velocities were reduced, and saccades were hypometric in glaucoma compared with controls (P<0.01). Between subtypes, the differences in latency (P<0.01), peak velocity (P=0.02), and amplitude (P=0.02) were significant. Saccadic eye movements were significantly different in NTG compared with other glaucoma subtypes (post hoc analysis; latency (HTG vs. NTG; P<0.01, HTG vs. PACG; P=0.01), peak velocity (HTG vs. NTG; P=0.02) and amplitude difference (HTG vs. NTG; P=0.02)., Conclusions: Saccadic eye movement parameters were differently affected among the glaucoma subtypes. Saccadic parameters were more affected in NTG., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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7. Modifications to Combined Trabeculectomy and Manual Small Incision Cataract Surgery: Outcomes and Adaptability in Resource-constrained Areas.
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Choudhari NS, Mokkarala AJR, Tone B, Khanna R, and Garudadri CS
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- Adult, Aged, Follow-Up Studies, Humans, Intraocular Pressure, Mitomycin, Retrospective Studies, Treatment Outcome, Cataract, Ophthalmology, Trabeculectomy
- Abstract
Precis: We describe standardization and simplification of classic trabeculectomy combined with manual small incision cataract surgery (MSICS) to effectively manage the 2 leading and often coexisting causes of blindness and vision impairment in resource-constrained areas., Purpose: The purpose of this study was to describe modifications to trabeculectomy combined with MSICS and report on the outcomes of this technique. The modifications consist of standardization and simplification of the surgical steps., Methods: Data obtained from adult patients who underwent described surgical technique at rural eye care centers across 3 Indian states between January 2018 and May 2019 were analyzed retrospectively. Complete success was intraocular pressure between 6 and 18 mm Hg without supplementary medication. Qualified success allowed up to 3 topical medication(s). Data are presented as median (first and third quartiles)., Results: We analyzed data of 70 eyes of 70 patients. Ophthalmology fellows performed 27 (38.5%) surgeries, whereas an experienced glaucoma specialist performed 43 (61.4%) surgeries. Patients were 63 (56, 67) years old. The preoperative intraocular pressure was 20 (16, 26) mm Hg on treatment with 3 (2, 3) antiglaucoma medications. Glaucoma was advanced by optic disc structural criteria in 58 (82.8%) eyes. Intraoperative mitomycin C was used in 5 (7.1%) eyes. Follow-up was 12.5 (6, 18) months. At 1 year, complete success (95% confidence interval) achieved was 55% (41-67), whereas qualified success was 83% (68-92) with 0 (0, 1) topical medications. The complete and qualified success rates did not differ between ophthalmology fellows and the glaucoma specialist (P=0.75 and 0.44, respectively)., Conclusions: We present a straightforward, yet effective technique of combined cataract and glaucoma surgery. The technique has a potential for wider applicability, especially in the underserved regions of the world., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
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8. Commentary: Innovations in technology hold promise for glaucoma detection in underserved populations.
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Choudhari NS and Garudadri CS
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- Humans, Reference Standards, Tablets, Technology, Visual Fields, Vulnerable Populations, Glaucoma diagnosis, Visual Field Tests
- Abstract
Competing Interests: None
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- 2021
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9. LVPEI Glaucoma Epidemiology and Molecular Genetic Study: teleophthalmology screening for angle-closure disease in an underserved region.
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Choudhari NS, Chandran P, Rao HL, Jonnadula GB, Addepalli UK, Senthil S, and Garudadri CS
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- Adult, Anterior Chamber, Cross-Sectional Studies, Gonioscopy, Humans, Molecular Biology, Glaucoma, Glaucoma, Angle-Closure diagnosis, Glaucoma, Angle-Closure epidemiology, Glaucoma, Angle-Closure genetics, Ophthalmology, Telemedicine
- Abstract
Objectives: To assess the ability of teleophthalmoscopic grading of peripheral anterior chamber depth (PACD) using the van Herick (vH) technique in detecting gonioscopically occludable angle; and to determine whether combining results from vH grading and ocular biometry can improve the accuracy to diagnose gonioscopically occludable angle METHODS: This cross-sectional study was an offshoot of a rural population-based study, Glaucoma Epidemiology and Molecular Genetic Study (GLEAMS). A masked urban ophthalmologist graded digital slit lamp photographs of PACD by vH technique. Sussman four-mirror lens was used to perform dark room indentation gonioscopy. Cutoff values of the tests were, vH technique: grade ≤ 2, central anterior chamber depth (ACD), as well as axial length: ≤ 25th percentile and lens thickness ≥ 75th percentile value of the study population., Results: We studied 1965 eyes of 1029 adult participants. The vH grade was ≤2 in 188 (9.5%) eyes. The angle was occludable by gonioscopy in 101 (5.1%) eyes. The performance of the vH test to rule out gonioscopically occludable angle was good [negative predictive value (NPV): 97.3%], despite low sensitivity (52.5%), while its efficacy to rule in the condition was low [positive predictive value (PPV): 28.2%] despite high specificity (92.8%). However, test combination strategy increased the PPV nearly twofold (53.8%). The calculated PPV at 10% prevalence of gonioscopically occludable angle was even higher (70.5%)., Conclusions: Van Herick technique can be incorporated into a teleophthalmology program by means of slit lamp photographs of PACD. Combined vH grading and ocular biometry improved the predictability of a gonioscopically occludable angle.
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- 2020
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10. Visual impairment in pseudoexfoliation from four tertiary centres in India.
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Rao A, Raj N, Pradhan A, Senthil S, Garudadri CS, Verma PVKS, and Gupta P
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- Aged, Female, Follow-Up Studies, Humans, Incidence, India epidemiology, Intraocular Pressure, Male, Prognosis, Prospective Studies, Vision, Low diagnosis, Vision, Low epidemiology, Visual Acuity, Exfoliation Syndrome complications, Glaucoma complications, Ocular Hypertension complications, Vision, Low etiology
- Abstract
Purpose: To analyse the disease burden of pseudoexfoliation (PXF) disease stages from East and South India., Design: Prospective hospital based study of patients seen at 4 tertiary centres., Subjects, Participants, And/or Controls: Consecutive old and new patients of pseudoexfoliation with normal intraocular pressure (IOP), raised IOP (PXF with Ocular hypertension, OHT) and irreversible disc/field changes (pseudoexfoliation glaucoma, PXG) seen from April 2016-March 2017 at a tertiary centre in Odisha, East India and 3 centres in Andhra Pradesh and Telangana, South India, recruited into the prospective study were screened for baseline characteristics., Methods: The clinical and demographic details including visual acuity, laterality, intraocular pressure (IOP) with details of medical/surgical therapy at presentation were collected from the hospital database at all 4 centres., Intervention or Exposure: The World Health Organization WHO visual criteria were used for defining visual impairment/absolute blindness in different disease stages., Outcome Measures: The visual impairment/blindness rates with comorbidities in the anterior/posterior segment in PXF, OHT and PXG at baseline were compared and the influence of age, IOP fluctuations and laterality was analysed using multivariate logistic regression., Results: Of 6284 PXF eyes (of 3142 patients) included from all centres, OHT and PXG was seen in 2.1% and 29% respectively which included 3676 (>50%) bilateral PXF eyes. Reversible visual impairment rates caused by PXF associated co-morbidities in PXF and OHT were 33% and 26% respectively with cataract being the major cause (67% in PXF and 74% in OHT). Irreversible blindness rate was higher in bilateral PXG eyes (30.5%) compared to bilateral PXF (23.2%) or bilateral OHT (21.6%) with overall absolute blindness rates of 28.2% at presentation. Older age (p<0.001), bilaterality and higher baseline IOP were significantly associated with higher rates of blindness in PXF eyes., Conclusion and Relevance: Pseudoexfoliation is associated with ≥30% visual impairment across all stages and 28% absolute blindness rate which is a huge hidden burden of glaucoma. Adequate disease staging and assessment of comorbidities is required for accurate prognostication at baseline and reducing avoidable pseudoexfoliation blindness., Competing Interests: The authors have declared that no competing interests exist.
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- 2020
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11. Steroid-induced glaucoma and blindness in vernal keratoconjunctivitis.
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Senthil S, Thakur M, Rao HL, Mohamed A, Jonnadula GB, Sangwan V, and Garudadri CS
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- Adolescent, Adult, Age Distribution, Blindness epidemiology, Child, Female, Glaucoma epidemiology, Humans, India epidemiology, Logistic Models, Male, Prevalence, Retrospective Studies, Sex Distribution, Young Adult, Blindness chemically induced, Conjunctivitis, Allergic drug therapy, Glaucoma chemically induced, Steroids adverse effects
- Abstract
Purpose: To report the clinical features, treatment outcomes and blindness associated with steroid-induced glaucoma in vernal keratoconjunctivitis (VKC)., Materials and Methods: Records of patients with VKC, who visited our tertiary centre from 1992 and 2009, were reviewed and those with steroid-induced glaucoma were included in the study. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg on two consecutive visits (ocular hypertension) and/or glaucomatous optic disc damage. Blindness was defined as best corrected visual acuity of ≤20/400 or visual field <10°., Results: Of the 4062 VKC subjects, 91 (157 eyes) had steroid-induced glaucoma (SIG), showing a prevalence of 2.24%. Of these 87% were men. The median (IQR) age at onset of VKC was 12 years (7-17). At presentation, the median duration of VKC was 48 months (24-72) and the median duration of steroid usage was 24 months (12-36). The median cup-to-disc ratio (CDR) was 0.9 (0.7-0.9) and median mean deviation was -21.9 dB (-30.0 to -10.2). IOP was medically controlled in 66% eyes (104/157) and 34% eyes (53/157) needed glaucoma surgery. High presenting IOP (OR: 1.04; p=0.05) and increased duration of steroid usage (OR: 1.07; p=0.02) were significantly associated with need for glaucoma surgery. At presentation, 29/91 subjects (31.8%) were bilaterally blind due to SIG. Higher CDR at presentation was significantly associated with blindness in this cohort (p=0.02)., Conclusion: In this cohort of VKC with SIG, the disease predominantly affected adolescent males. Glaucoma was severe with one-third needing surgery and one-third blind due to SIG., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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12. Toward Better Health Outcomes in Rural and Under-served Areas: L. V. Prasad Eye Institute's Diagonal Model of Glaucoma Care.
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Choudhari NS, Mundhe G, Khanna R, Rathi V, and Garudadri CS
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- Adult, Aged, Aged, 80 and over, Case-Control Studies, Female, Humans, Male, Middle Aged, Retrospective Studies, Delivery of Health Care organization & administration, Glaucoma therapy, Ophthalmology organization & administration, Rural Health Services organization & administration
- Abstract
Purpose : L. V. Prasad Eye Institute has adopted horizontal approach of eye care delivery for the past 22 years at one of its rural secondary centers. The recent implementation of a diagonal model for enhancing glaucoma care at this center and its outcomes are reported. Methods : This was a retrospective case-control study. We included newly and consecutively diagnosed adult glaucoma patients. A comprehensive ophthalmologist provided glaucoma care. During the study period, an experienced glaucoma specialist supported the care for 2 days every month in a structured format that consisted of triaging glaucoma patients for defined protocols of therapy along with hands-on and remote online guidance to the comprehensive ophthalmologist. The data from the worst or single eye were analyzed. Results : We have included 231 patients (151 study and 80 historical controls). Sixty (75%) control patients were managed at the study center and 20 (25%) were referred. The comprehensive ophthalmologist managed 70 (48.2%) study patients and co-managed 75 (51.7%) with the glaucoma specialist. The latter changed the diagnosis in 15 eyes and altered the treatment plan in 44 eyes. Six were excluded. Successful outcome was achieved in 52 (65%) eyes in the control group and 120 (84.5%) eyes in the study group ( P < .01). Additionally, study group did better in terms of case detection rate, compliance to treatment and saving on expenses for patients. Conclusion : The new model has shown better clinical outcomes of glaucoma care in an under-served geographic area. The model has the potential for wider applicability.
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- 2019
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13. Combination of Simple Diagnostic Tests to Detect Primary Angle Closure Disease in a Resource-constrained Region.
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Choudhari NS, George R, Asokan R, Khanna R, Vijaya L, and Garudadri CS
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- Adult, Aged, Area Under Curve, Cross-Sectional Studies, Diagnostic Tests, Routine, Female, Humans, Male, Middle Aged, Poverty Areas, Predictive Value of Tests, Sensitivity and Specificity, Diagnostic Techniques, Ophthalmological, Glaucoma, Angle-Closure diagnosis
- Abstract
Purpose : To report on diagnostic accuracy of van Herick (vH) technique performed by a vision technician (VT) as well as on efficacy of a combination of vH technique and central anterior chamber depth (ACD) in detection of primary angle closure disease. Methods : Data was obtained from two cohorts; rural clinic setting (n = 111), and rural population-based research setting (n = 888). Van Herick grading was performed by a VT in first cohort and a glaucoma specialist in second cohort. A reference standard four-mirror gonioscopy was performed by a glaucoma specialist in both cohorts. We did preferential sampling. Cut-off levels for vH technique and central ACD were grade 2 and 25
th percentile value, respectively. Data from one eye per participant was analyzed. Results : Three hundred and forty (34%) eyes were gonioscopically occludable. Area under receiver operating characteristic curve (95% confidence interval) for vH test was 0.83 (0.76, 0.9) and 0.81 (0.78, 0.84) in first and second cohorts, respectively. Simultaneous testing achieved sensitivity of 87.8% while sequential testing achieved specificity of 99.3%. Negative predictive value* of simultaneous testing was 98.3% compared to 96.6% of vH technique while positive predictive value* of sequential testing was 86% compared to 49.3% of vH technique. (*at 10% prevalence of gonioscopically occludable angle) Conclusions : Diagnostic accuracy of vH grading was similar when performed by a VT and a glaucoma specialist. While test combination was effective to rule in, vH technique may suffice to rule out the disease. Implications of these findings for resource-constrained regions are discussed.- Published
- 2019
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14. Comparison of peripapillary and subfoveal choroidal thickness in normal versus primary open-angle glaucoma (POAG) subjects using spectral domain optical coherence tomography (SD-OCT) and swept source optical coherence tomography (SS-OCT).
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Komma S, Chhablani J, Ali MH, Garudadri CS, and Senthil S
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Objective: To elucidate the difference between choroidal thickness (CT) in primary open-angle glaucoma (POAG) and normal subjects and to compare the CT measured using spectral domain optical coherence tomography (SD-OCT) and swept source optical coherence tomography (SS-OCT)., Methods and Analysis: This cross-sectional observational study included 25 eyes of 17 POAG subjects (cases) and 31 eyes of 20 normal subjects (controls). All the patients underwent complete ophthalmologic examination, enhanced depth imaging, SD-OCT and SS-OCT. In both controls and cases, the CT was measured in seven predetermined points in macular and peripapillary area and were compared., Results: Choroid was significantly thicker on SS-OCT compared with SD-OCT in peripapillary and macular area in both cases and controls, except for inferior peripapillary in controls. The CT was not different from glaucoma and controls in peripapillary or macular area on SD-OCT (p>0.05), however, the CT was significantly thicker in glaucoma compared with controls in peripapillary area on SS-OCT (p<0.05) except inferior peripapillary (p=0.13). There was good intraobserver (±20 µm) and interobserver (±55 µm and ±45 µm) agreement on both SD-OCT and SS-OCT respectively.On SD-OCT, choroid was thinnest at the temporal peripapillary and thickest at subfoveal location in controls. In POAG, choroid was thinnest at inferior peripapillary region and thickest (500 µm) nasal to the fovea. On SS-OCT, choroid was thinnest at inferior peripapillary and thickest at the temporal peripapillary area in both cases and controls., Conclusion: CT measurements on SS-OCT were higher than the SD-OCT measurements possibly due to better delineation of the sclerochoroidal junction on SS-OCT. CT was significantly thicker in glaucoma subjects compared with controls in peripapillary area on SS-OCT but not in macular area., Competing Interests: Competing interests: None declared.
- Published
- 2019
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15. Prevalence of Primary Glaucoma as Diagnosed by Study Optometrists of L. V. Prasad eye Institute - Glaucoma Epidemiology and Molecular Genetics Study.
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Addepalli UK, Jonnadula GB, Garudadri CS, Khanna RC, and Papas EB
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- Adult, Age Distribution, Aged, Female, Humans, India epidemiology, Male, Middle Aged, Prevalence, Glaucoma epidemiology
- Abstract
Purpose: To report the prevalence of primary glaucoma as identified by study optometrists of the L. V. Prasad Eye Institute - Glaucoma Epidemiology and Molecular Genetics Study (LVPEI-GLEAMS)., Methods: Two study optometrists and a total number of 3833 individuals participated in the LVPEI-GLEAMS. All subjects underwent a complete medical history and comprehensive eye examination including slit lamp photography, imaging of anterior and posterior segment, frequency doubling technology and standard automated perimetry including gonioscopy with a Sussman 4 mirror goniolens, post dilated evaluation of the optic disc and fundus was done with a 90 D lens by the study optometrist. A diagnosis of primary open angle glaucoma (POAG), primary angle closure suspect (PACS), primary angle closure (PAC), primary angle closure glaucoma (PACG), normal tension glaucoma (NTG), glaucoma/disc suspect or no glaucoma was made based on the clinical examination., Results: Estimated prevalence of OAG (POAG and NTG) was 1.07% (0.74-1.39), PACS 2.03% (1.58-2.48), PAC 1.77% (1.35-2.19), PACG 0.21% (0.06-0.35) as identified by the study optometrists on site., Conclusions: Prevalence of all the categories of primary glaucoma, as reported by the study optometrists of LVPEI-GLEAMS was comparable to previous findings of other regions in South India.
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- 2019
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16. Diagnostic Accuracy of Van Herick Technique to Detect Pre-Disease States of Primary Angle Closure Glaucoma in a Resource Constraint Region.
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Choudhari NS, Chanda S, Khanna R, Senthil S, and Garudadri CS
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- Adult, Aged, Aged, 80 and over, Anterior Chamber pathology, Area Under Curve, Humans, Middle Aged, Predictive Value of Tests, Rural Population statistics & numerical data, Diagnostic Techniques, Ophthalmological, Glaucoma, Angle-Closure diagnosis
- Abstract
Objectives: To critically evaluate diagnostic accuracy of the van Herick (vH) technique in detection of gonioscopically occludable angle in a rural population and to explore ways to improve accuracy of the technique Methods: The study cohort was formed by two-stage cluster random sampling. Peripheral anterior chamber depth grading was performed, using both traditional and modified (photographic comparison) vH techniques, under dark adapted and standard lighting conditions by a comprehensive ophthalmologist masked to the clinical features. The cut-off criterion for vH test was 25% of peripheral corneal thickness. The reference standard was dark room 4-mirror indentation gonioscopy performed by an experienced glaucoma specialist. This study adhered to the STARD guidelines for reporting diagnostic accuracy studies., Results: We studied 111 eyes of 111 participants. The median age was 62 years. The angle was occludable by gonioscopy in 69 (62%) eyes; 58 eyes were primary angle closure suspects and 11 were primary angle closure patients. The likelihood ratio (95% confidence interval (CI)) of the positive (LR+) and negative (LR‒) result by the traditional vH technique was 5.17 (2.43, 11) and 0.30 (0.20, 0.46), respectively. The LR+ by reducing and LR‒ by elevating the cut-off grade of the traditional vH technique were 9.4 (2.3, 37.4) and 0.08 (0.02, 0.31), respectively. The area under receiver operating characteristic curve did not differ significantly by photographic comparison or lighting condition (p = 0.13)., Conclusions: vH grading can be considered as a triage test before gonioscopy. The value of the vH technique to the diagnostic strategy is discussed.
- Published
- 2019
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17. Comparison of Visual Field Progression Rates Among the High Tension Glaucoma, Primary Angle Closure Glaucoma, and Normal Tension Glaucoma.
- Author
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Ballae Ganeshrao S, Senthil S, Choudhari N, Sri Durgam S, and Garudadri CS
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- Adult, Aged, Disease Progression, Female, Filtering Surgery, Follow-Up Studies, Glaucoma, Angle-Closure physiopathology, Glaucoma, Angle-Closure surgery, Glaucoma, Open-Angle physiopathology, Glaucoma, Open-Angle surgery, Humans, Intraocular Pressure physiology, Iridectomy, Laser Therapy, Low Tension Glaucoma physiopathology, Low Tension Glaucoma surgery, Male, Middle Aged, Nerve Fibers pathology, Optic Disk pathology, Retinal Ganglion Cells pathology, Retrospective Studies, Scotoma physiopathology, Tonometry, Ocular, Visual Field Tests, Glaucoma, Angle-Closure diagnosis, Glaucoma, Open-Angle diagnosis, Low Tension Glaucoma diagnosis, Scotoma diagnosis, Visual Fields physiology
- Abstract
Purpose: To compare the visual field (VF) progression among high tension glaucoma (HTG), primary angle closure glaucoma (PACG), and normal tension glaucoma (NTG) subjects in routine clinical care., Methods: All patients had ≥5 VF tests using HFA, 24-2, SITA-standard strategy. We compared the progression between glaucoma subtypes after matching the VFs for baseline severity (mean deviation [MD]) and the age at presentation. Global VF progression was evaluated by linear regression analysis (LRA) of MD. For local VF progression, scotoma expansion (SE) defined as appearance of new scotoma and scotoma deepening (SD) defined by pointwise LRA were calculated. SE and SD were analyzed in three VF zones: superior arcuate (SA), inferior arcuate (IA), and central (C)., Results: A total of 310 HTG, 304 PACG, and 165 NTG eyes were included. When VFs were matched by baseline MD, a greater number (n = 20/76) of eyes with HTG showed significant progression compared to PACG (n = 9/76; P = 0.04). The number of progressing eyes were not significantly different between HTG and NTG (n = 11/76; P = 0.10) and between NTG and PACG (P = 0.65). When the baseline VFs were matched by age, the number of eyes showing significant progression were similar in all the subtypes. SA zone in HTG and NTG showed greater SE and SD compared to other zones (P < 0.05), whereas IA zone in PACG showed greater SE and SD compared to other zones (P < 0.05)., Conclusions: In our cohort of treated primary glaucoma with matched baseline severity, a greater proportion of HTG eyes progressed faster compared to PACG. SA zone in HTG and NTG and IA zone in PACG showed greater VF progression.
- Published
- 2019
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18. Comparison of the New Low-Cost Nonvalved Glaucoma Drainage Device with Ahmed Glaucoma Valve in Refractory Pediatric Glaucoma in Indian Eyes.
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Senthil S, Gollakota S, Ali MH, Turaga K, Badakere S, Krishnamurthy R, and Garudadri CS
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- Child, Child, Preschool, Female, Follow-Up Studies, Glaucoma epidemiology, Glaucoma physiopathology, Humans, Incidence, India epidemiology, Infant, Male, Postoperative Period, Reoperation, Retrospective Studies, Tonometry, Ocular, Glaucoma surgery, Glaucoma Drainage Implants, Intraocular Pressure physiology, Visual Acuity
- Abstract
Purpose: To compare outcomes of a nonvalved glaucoma drainage device (the Aurolab aqueous drainage device [AADI] with a valved glaucoma drainage device (the Ahmed glaucoma valve [AGV]) in refractory pediatric glaucoma., Design: Retrospective interventional case series., Participants: One hundred sixteen eyes of 97 children with refractory pediatric glaucoma., Methods: Children (≤16 years) treated with drainage implants from January 2007 through December 2016 with a minimum follow-up of 6 months (operated by a single surgeon) were included. Success was defined as intraocular pressure (IOP) ≥6 mmHg or ≤21 mmHg (complete without antiglaucoma medications [AGMs] and qualified with AGM); repeat glaucoma surgery or loss of light perception was failure., Main Outcome Measures: Comparison of success rates and complications with AADI (350 mm
2 ) and silicone AGV (models FP7 [182-mm2 surface area] and FP8 [102-mm2 surface area]) implantation., Results: Outcomes of 116 eyes of 97 children (AADI, 36 eyes; AGV, 85 eyes; FP7, n = 14; FP8, n = 72) were analyzed. Median follow-up for AADI was 16.8 months (interquartile range [IQR], 11.7-24.5 months) and for AGV was 27 months (IQR, 15.3-52.3 months). Preoperative parameters (age, IOP, number of AGMs) were similar in both groups except number of previous nonglaucoma surgeries, which were significantly more in AADI (P = 0.05). Qualified success was similar (P = 0.81) in both groups, 91% and 88% at 1 year and 81% and 84% at 3 years with AADI and AGV, respectively. With AADI, the complete success was significantly more (41.8% vs.13.7%; P < 0.005). The postoperative mean IOP (12.6±5.5 mmHg vs. 17.6±6.8 mmHg; P = 0.001), median number of AGMs (1 [IQR, 0-2] vs. 2 [IQR, 1-3]; P < 0.001), and hypertensive phase (16.5% [n = 7] vs. 40% [n = 34]; P = 0.02) were significantly less in AADI compared with AGV. Transient complications (AADI, 30.5% [n = 11/36] vs. AGV, 21.1% [n = 18/85]; P = 0.26), sight-threatening complications (AADI, 13.9% [n = 5/36) vs. AGV, 7% [n = 6/85]; P = 0.22), and complications needing intervention (AADI, 19.4% [n = 7/36] vs. AGV, 14.1% [n = 12/85]; P = 0.46) were similar in both groups., Conclusions: In refractory pediatric glaucoma, both AGV and AADI showed similar qualified success and complication rates at 1 and 3 years. However, the AADI showed greater complete success, better IOP control, less need for AGM, and lesser incidence of an hypertensive phase., (Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)- Published
- 2018
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19. Outcomes of Silicone Ahmed Glaucoma Valve Implantation in Refractory Pediatric Glaucoma.
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Senthil S, Turaga K, Mohammed HA, Krishnamurthy R, Badakere S, Dikshit S, Choudhari N, Mandal AK, and Garudadri CS
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- Adolescent, Child, Child, Preschool, Female, Follow-Up Studies, Humans, Hydrophthalmos physiopathology, Intraocular Pressure physiology, Male, Optic Nerve Diseases surgery, Postoperative Complications, Reoperation, Retrospective Studies, Risk Factors, Silicone Elastomers, Tonometry, Ocular, Treatment Outcome, Visual Acuity physiology, Glaucoma Drainage Implants, Hydrophthalmos surgery, Prosthesis Implantation methods
- Abstract
Purpose: The purpose of this study was to report the outcomes of Silicone Ahmed Glaucoma Valve (AGV) implantation in the management of refractory pediatric glaucoma., Methods: Between 2007 and 2015, 76 eyes of 64 children aged 16 years or younger underwent AGV implantation. We included 65 eyes of 53 children with follow up ≥6 months; 24 eyes had primary congenital glaucoma (PCG) and 41 eyes had secondary pediatric glaucoma (SPG). Success was defined as IOP>5 and ≤21 mm Hg with or without topical antiglaucoma medications; considered failure, when repeat glaucoma surgery was need or loss of light perception. Primary outcome measure was success of AGV in refractory pediatric glaucomas and secondary outcome measure was comparison of outcomes in PCG and SPG., Results: The median age at AGV implantation was 3 years (interquartile range, 2, 12), and median follow up was 27 months (15, 39). The overall cumulative success probability was 88% [95% confidence interval (CI), 76%-94%] at 1 year and was maintained up to 4 years. The success probability in PCG was 91% (80.8%-100%), and SPG was 83% (72%-96%) at 1 year and 4 years (P=0.49). Among the preoperative factors, number of previous intraocular surgeries (hazard ratio of 2.24; 95% CI, 1.14-4.37, was significantly associated with failure; P=0.01). Tube-related complications (16%) were similar in both the groups. One eye in each group had sight-threatening complication., Conclusions: AGV implantation had good success rate in refractory pediatric glaucoma. The success rates were similar in PCG and SPG as were the complications. Number of prior intraocular surgeries was a risk factor for failure.
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- 2018
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20. Is Ahmed Glaucoma Valve Consistent in Performance?
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Choudhari NS, Badakere SV, Richhariya A, Chittajallu SNSH, Senthil S, and Garudadri CS
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Purpose: To investigate the mechanism of action and consistency in flow characteristics of the Ahmed glaucoma valve (AGV) under simulated physiological conditions in-vitro and to evaluate whether resistance during priming has any effect on performance of the device., Methods: Each newly opened AGV device was connected to a digital manometer and was primed with normal saline. The device was then placed in a saline bath and connected to an open manometer, a digital manometer, and an infusion pump. Saline was infused at a rate of 3 μL/min for 24 hours. Digital manometer readings were recorded at 4 Hz., Results: Data obtained from 9 devices are presented as medians (ranges). The priming pressure was 1130 (835, 1625) mm Hg. Pressure versus time curves showed two distinct phases; transient and steady phases. The transient phase peak pressure was 24 (13, 45) mm Hg. In the steady phase, opening and closing pressures were 13 (10, 17) and 7 (4, 9) mm Hg, respectively; the valve leaflets briefly opened every 73.9 (51, 76.6) minutes and the fluctuation of pressure (difference between opening and closing pressures) was 6 (3, 9) mm Hg. The Spearman correlation coefficient between priming and opening and priming and closing pressure was ρ = -0.13 ( P = 0.72) and ρ = -0.36 ( P = 0.33), respectively., Conclusions: The device showed functionality like a valve. The resistance during priming did not affect opening and closing pressures of the AGV. This study showed variable in vitro performance of the AGV., Translational Relevance: These laboratory findings might, at least partly, explain the variability in the clinical outcome of the device.
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- 2018
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21. Outcomes of lensectomy and risk factors for failure in spherophakic eyes with secondary glaucoma.
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Rao DP, John PJ, Ali MH, Kekunnaya R, Jalali S, Garudadri CS, and Senthil S
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- Adolescent, Child, Female, Glaucoma etiology, Glaucoma physiopathology, Humans, Intraocular Pressure physiology, Lens Subluxation complications, Lens Subluxation physiopathology, Male, Retrospective Studies, Risk Factors, Visual Acuity physiology, Glaucoma surgery, Lens Subluxation surgery, Lens, Crystalline surgery, Ophthalmologic Surgical Procedures
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Purpose: To report the outcomes of lensectomy in spherophakic eyes with subluxated or dislocated crystalline lenses and secondary glaucoma., Methods: Lensectomy was performed in 52 eyes, 36 eyes with lens subluxation and 16 eyes with lens dislocation with secondary glaucoma from 1991 to 2016. Glaucoma was diagnosed based on intraocular pressure (IOP) ≥22 mm Hg and/or glaucomatous optic disc damage. Complete success was defined as IOP ≥5 and ≤21 mm Hg without antiglaucoma medications (AGMs) or surgery, and eyes needing oral AGM or surgical intervention for IOP control or those with complication causing loss of light perception were considered failure., Results: Median (IQR) age at lensectomy was 12 (6-18) years, and median spherical equivalent was -14.5D (-23.7to -13). Median follow-up was 30.6 (5.4-103.4) months. Median logMAR (logarithm of minimal angle of resolution) visual acuity improved from 0.95 (0.6-1.8) to 0.4 (0.2-1.3) after lensectomy (p=0.01). Median IOP decreased from 22 mm Hg (17-31) to 14 mm Hg (11-19) at final follow-up (p=0.01). Median number of AGM decreased from 2 (2-3) to 1 (0-2) at final follow-up (p<0.0001), and glaucoma surgery was needed in four eyes (7.7% eyes). Complete success probability was 69% at 1 year and 51% at 5 years. Younger age (<6 years), higher presenting IOP (>32 mm Hg) and larger cup to disc ratio at presentation were found to be significant risk factors for failure., Conclusion: Lensectomy was effective in controlling IOP in close to half of all eyes with spherophakia and secondary glaucoma, 40% eyes needed AGM and only 7.7% eyes needed glaucoma surgery for IOP control. In this cohort, younger age, higher IOP and larger cup to disc ratio at presentation were risk factors for poor glaucoma control after lensectomy., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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22. Comparison of Scleral Tono-Pen Intraocular Pressure Measurements with Goldmann Applanation Tonometry.
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Badakere SV, Choudhari NS, Rao HL, Chary CR, Garudadri CS, and Senthil S
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- Adult, Cross-Sectional Studies, Female, Healthy Volunteers, Humans, Male, Middle Aged, Tonometry, Ocular methods, Intraocular Pressure physiology, Sclera physiology, Tonometry, Ocular instrumentation
- Abstract
Significance: Measuring the intraocular pressure (IOP) on the sclera can be an alternative to conventional corneal measurement in eyes with scarred corneas. However, these measurements have to be evaluated prior in normal eyes. Our study aimed to evaluate scleral IOP using Tono-Pen and compared it with corneal Goldmann applanation measurements., Purpose: The aim of this study was to evaluate the ability of limbal and scleral Tono-Pen IOP readings to predict central corneal Goldmann applanation tonometry (GAT) readings in eyes with normal corneas., Methods: In a cross-sectional study, 115 eyes of 115 patients attending a tertiary eye care center underwent GAT on the central cornea followed by Tono-Pen readings at the central cornea, at the limbus, and at the sclera. Bland-Altman plots were used to determine the agreement between different methods of IOP measurement., Results: The median IOP (interquartile range) by GAT performed on the central cornea was 18 (16, 24) mmHg, and the IOP ranged from 10 to 54 mmHg. The median IOPs (interquartile range) by Tono-Pen obtained at central cornea, limbus, and sclera were 16 (13, 23), 23 (17, 28), and 33 (27, 44) mmHg, respectively. The Pearson correlation coefficient and the 95% limits of agreement between GAT readings and Tono-Pen readings at the central cornea were 0.9 (P < .001) and -4.9 to 8.74 mmHg, respectively. The correlation coefficient between GAT readings and Tono-Pen readings at the limbus and GAT readings and Tono-Pen readings at the sclera was 0.46 (P < .001) and 0.23 (P = .01), respectively. The 95% limits of agreement between these pairs of readings were -20.55 to 13.66 and -44.02 to 13.37 mmHg, respectively., Conclusions: This study showed limited ability of Tono-Pen readings obtained at the limbus and sclera to predict the central corneal GAT IOP readings in eyes with normal corneas at various IOP ranges.
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- 2018
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23. Outcomes of Bleb Repair for Delayed Bleb Leaks and Sweating Blebs.
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Senthil S, Basia A, Rao HL, Choudhari N, Dikshit S, Mandal AK, and Garudadri CS
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- Adult, Female, Glaucoma physiopathology, Humans, Intraocular Pressure physiology, Male, Middle Aged, Ocular Hypotension etiology, Ocular Hypotension physiopathology, Postoperative Complications, Reoperation, Retrospective Studies, Surgical Wound Dehiscence etiology, Surgical Wound Dehiscence physiopathology, Tonometry, Ocular, Transplantation, Autologous, Treatment Failure, Conjunctiva transplantation, Glaucoma surgery, Ocular Hypotension surgery, Surgical Wound Dehiscence surgery, Trabeculectomy adverse effects
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Purpose: To report the outcomes of bleb repair for delayed onset leaking blebs and sweating blebs following glaucoma filtering surgery., Materials and Methods: Medical records of 76 eyes of 76 subjects that underwent bleb repair for either leaking bleb or sweating bleb between 1990 and 2015 were reviewed. Complete success was resolution of bleb leak and or hypotony with intraocular pressure ≥5 and ≤21 mm Hg with no antiglaucoma medication., Results: There were 45 eyes with leaking bleb and 31 eyes with sweating bleb that underwent bleb repair by either conjunctival autograft or conjunctival advancement (P=0.11). Before bleb repair, complications like blebitis and hypotony maculopathy were significantly higher in sweating bleb group (13/31) compared with bleb leak group (5/45) (P=0.002). Median follow-up after bleb repair was >2 years in both groups (P=0.69). After repair, eyes in leaking bleb group had higher immediate (P=0.01) and long-term intraocular pressure elevation (P=0.06) compared with sweating bleb group. Complete success probability in sweating bleb group was significantly better (88%, 78%, and 71%) compared with leaking bleb group (54%, 45%, and 40%) at 1, 3, and 6 years, respectively (P=0.01). One eye in each group had blebitis, 2 eyes in leaking bleb group and 1 eye in sweating bleb group needed repeat glaucoma intervention., Conclusions: Higher complication rate before bleb repair in eyes with sweating bleb warrants early bleb repair. Bleb repair helped retain bleb function in majority of the eyes with sweating blebs, strengthening our recommendation.
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- 2018
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24. Do Intraocular Pressure Measurements Under Anesthesia Reflect the Awake Condition?
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Nakka M, Kumar PS, Koshy PG, Rout US, Garudadri CS, and Senthil S
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- Manometry, Wakefulness, Anesthesia, Intraocular Pressure
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- 2018
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25. Intermediate Term Outcomes of Early Posttrabeculectomy Bleb Leaks Managed by Large Diameter Soft Bandage Contact Lens.
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Gollakota S, Garudadri CS, Mohamed A, and Senthil S
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- Adult, Alkylating Agents administration & dosage, Bandages, Female, Glaucoma surgery, Humans, Intraocular Pressure, Male, Middle Aged, Mitomycin administration & dosage, Tonometry, Ocular, Contact Lenses, Hydrophilic, Ostomy, Postoperative Complications, Surgical Wound Dehiscence therapy, Trabeculectomy adverse effects
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Purpose: To study the outcomes of large diameter soft bandage contact lens (BCL) in managing early trabeculectomy bleb leak., Materials and Methods: Of 972 eyes that underwent fornix-based trabeculectomy between 2011 and 2015, 19 eyes with bleb leak with at least 1 year follow-up were eligible. Bleb leak was conservatively managed using large diameter BCL (≥15.5 mm in diameter). Success was defined as complete, if bleb leak resolved and the intraocular pressure (IOP) was ≥5 and ≤18 mm Hg with no additional antiglaucoma medication and failure if surgical intervention was needed., Results: Mean age (±SD) of subjects was 43.5±11.9 years. Mitomycin C was used in 15/19 eyes. Median time (interquartile range) from trabeculectomy to bleb leak was 9 days (interquartile range: 8 to 19 d). Bleb leak was treated with 15.5 mm BCL in 16 eyes and 17 mm lens in 3 eyes. Bleb leak resolved with BCL in 17 [89.5%; 95% confidence interval (95% CI), 68.6-97] and 2 eyes (10.5%; 95% CI, 2-31) required bleb resuturing. Mean duration of BCL wear for bleb leak resolution was 23.7±8.9 days. Mean IOP increased from 5.8±2.7 to 12.5±3.1 mm Hg after resolution of bleb leak (P<0.05). At 16 months, complete success probability of trabeculectomy was 89.4% (95% CI, 75.6%-100%)., Conclusions: Large diameter BCL was effective in the management of early bleb leak with good intermediate term success for IOP control. We suggest a trial of soft contact lens of appropriate diameter to manage early bleb leaks, before planning any invasive intervention.
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- 2017
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26. Re: Yu et al.: Risk of visual field progression in glaucoma patients with progressive retinal nerve fiber layer thinning (Ophthalmology. 2016;123:1201-1210).
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Garudadri CS, Thomas R, Basu S, and Senthil S
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- Disease Progression, Humans, Intraocular Pressure, Nerve Fibers, Optic Disk, Retinal Ganglion Cells, Tomography, Optical Coherence, Visual Field Tests, Glaucoma, Visual Fields
- Published
- 2017
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27. Structural and functional assessment of macula to diagnose glaucoma.
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Rao HL, Hussain RS, Januwada M, Pillutla LN, Begum VU, Chaitanya A, Senthil S, and Garudadri CS
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- Area Under Curve, Cross-Sectional Studies, Female, Glaucoma physiopathology, Humans, India, Intraocular Pressure, Male, Middle Aged, Nerve Fibers, Optic Disk pathology, Prospective Studies, Retinal Ganglion Cells pathology, Sensitivity and Specificity, Visual Field Tests, Glaucoma diagnosis, Macula Lutea pathology, Tomography, Optical Coherence
- Abstract
PurposeTo compare the diagnostic abilities of structural (ganglion cell-inner plexiform layer (GCIPL) thickness measured using spectral domain optical coherence tomography (SDOCT)) and functional (visual sensitivities measured using standard automated perimetry (SAP) and microperimetry (MP)) assessments of macula in glaucoma.MethodsIn a prospective study, 46 control eyes (28 subjects) and 61 glaucoma eyes (46 patients) underwent visual sensitivity estimation at macula (central 10°) by SAP and MP, and GCIPL thickness measurement at macula by SDOCT. Glaucoma was diagnosed by experts based on the optic disc and retinal nerve fiber layer changes. Area under the receiver-operating characteristic (AUC) curves and sensitivities at 95% specificity were used to assess the diagnostic ability of visual sensitivity and GCIPL measurements at various macular sectors.ResultsAUCs of GCIPL parameters ranged between 0.58 and 0.79. AUCs of SAP and MP sensitivities ranged between 0.59 and 0.71, and 0.59 and 0.72, respectively. There were no statistically significant differences between the AUCs of corresponding sector measurements (P>0.10 for all comparisons). Sensitivities at 95% specificities ranged from 31-59% for GCIPL parameters, 16-34% for SAP, and 8-38% for MP parameters. Sensitivities were significantly better with GCIPL compared with SAP and MP parameters in diagnosing glaucoma. Inferotemporal, inferior, and superotemporal sector measurements of GCIPL and visual sensitivity showed the best abilities to diagnose glaucoma.ConclusionsComparing the diagnostic abilities of structural and functional tests at macula in glaucoma, GCIPL thickness measurements with SDOCT performed better than the visual sensitivity measurements by SAP and MP.
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- 2017
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28. Glaucoma associated with iridocorneal endothelial syndrome in 203 Indian subjects.
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Chandran P, Rao HL, Mandal AK, Choudhari NS, Garudadri CS, and Senthil S
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- Adult, Corneal Edema diagnosis, Corneal Edema etiology, Corneal Edema therapy, Corneal Transplantation, Female, Follow-Up Studies, Glaucoma etiology, Humans, India, Intraocular Pressure, Iridocorneal Endothelial Syndrome complications, Iris physiopathology, Male, Middle Aged, Retrospective Studies, Glaucoma diagnosis, Iridocorneal Endothelial Syndrome diagnosis
- Abstract
Purpose: To report the demographic profile, clinical features, and prevalence of glaucoma and its management in patients with Iridocorneal endothelial (ICE) syndrome., Methods: Retrospective review of 203 consecutive subjects with ICE syndrome at a tertiary eye care centre between January 1988 and June 2013., Results: ICE syndrome was present in 223 eyes of 203 subjects, 124 (61%) were female and 79 (39%) were male. The median age at presentation was 43 years (1st (Q1) and 3rd (Q3) quartile; 34, 51 years). ICE syndrome was unilateral in 183 (90%) subjects, and bilateral in 20 (10%) subjects. The most common clinical variant was progressive iris atrophy (PIA, 115; 52% eyes), followed by Chandler syndrome (CS, 87; 39% eyes) and Cogan-Reese syndrome (CRS, 21; 9% eyes). Glaucoma was found in 156 eyes (70%) at presentation and the median (Q1, Q3) intraocular pressure in eyes with glaucoma was 24 (16, 38) mm Hg. Seven eyes developed glaucoma during the follow-up period, increasing the percentage of eyes with glaucoma to 73%. Intraocular pressure was managed medically in 81 eyes (50%) and the other 82 eyes (50%) required surgical intervention. Corneal edema was present in 124 eyes (56%) of which, 32 eyes (14%) required keratoplasty., Conclusions: In our study on ICE syndrome in Indian population, the presentation was predominantly uniocular and more common in middle aged women. Progressive iris atrophy was the most common clinical variant. ICE syndrome was associated with glaucoma in over 70% of the eyes and half of the eyes had corneal edema.
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- 2017
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29. Correction: Etiology and Management of Raised Intraocular Pressure following Posterior Chamber Phakic Intraocular Lens Implantation in Myopic Eyes.
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Senthil S, Choudhari NS, Vaddavalli PK, Murthy S, Reddy JC, and Garudadri CS
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[This corrects the article DOI: 10.1371/journal.pone.0165469.].
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- 2017
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30. Etiology and Management of Raised Intraocular Pressure following Posterior Chamber Phakic Intraocular Lens Implantation in Myopic Eyes.
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Senthil S, Choudhari NS, Vaddavalli PK, Murthy S, Reddy JC, and Garudadri CS
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Aim: To evaluate the etiology and management of elevated intraocular pressure (IOP) following posterior chamber phakic implantable collamer lens (ICL) surgery., Methods: Between 2009 and 2015, 638 eyes of 359 subjects with refractive myopia, underwent V4b and V4c (CentraFLOW) model ICL implantation. Ocular hypertension (OHT) was defined as IOP of ≥ 22 mm Hg on two separate occasions and elevated IOP with corresponding optic disc or visual field damage was defined as glaucoma., Results: Elevated IOP ≥ 22 mm Hg was noted in 33 eyes of 30 subjects (33/638; 5.17%). Median age of subjects with raised IOP was 26 years (Inter quartile range (IQR):22, 29) and median refarctive error was -16 diopters (-19.5, -13). The median follow up was 7.8 months (IQR:0.3, 17.6) and median time for postoperative IOP rise was 12 days, (IQR:2, 24). The various etiologies for elevated IOP were steroid response in 21 eyes (64%; 10 eyes with V4b, 11 eyes with V4c), retained viscoelastic in 5 eyes (15%) (3 with V4b, 2 with V4c), pupillary block in four eyes (12%; 3 with V4b, 1 with V4c), malignant glaucoma in one eye (3%, V4b), and missed pre-existing Juvenile open angle glaucoma (JOAG) in two eyes (6% with V4b). Elevated IOP in 31 eyes resolved with conservative management. One eye (centraFLOW design) with central aquaport block by viscoelastic, needed AC wash and one eye with malignant glaucoma needed parsplana vitrectomy and hyaloidotomy. Ten eyes required longterm (>2 months) antiglaucoma medications (AGM) for IOP control. Except the two eyes with JOAG, none had disc and field damage., Conclusion: In our series, OHT was seen in 4.85% and glaucoma in 0.3% eyes that underwent V4b and V4c model ICL implantation. Multiple etiologies were noted and steroid induced ocular hypertension was the most common cause of elevated IOP followed by retained viscoelastic and pupillary block. One third of these eyes required longterm AGM for IOP control., Competing Interests: The authors have no competing interests to declare.
- Published
- 2016
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31. How Often the Goldmann Applanation Tonometer Should be Checked for Calibration Error?
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Choudhari NS, Rao HL, Ramavath S, Rekha G, Rao A, Senthil S, and Garudadri CS
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- Equipment Failure, Humans, Intraocular Pressure physiology, Probability, Reproducibility of Results, Slit Lamp, Tertiary Care Centers, Calibration standards, Tonometry, Ocular instrumentation
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Purpose: To evaluate the frequency of Goldmann applanation tonometer (GAT) calibration error (CE) check., Methods: One observer at each of the 3 tertiary care ophthalmic centers was involved. The tonometers were checked at baseline for CE. A tonometer was defined as faulty when CE exceeded 2 mm Hg at any testing level. Faulty GATs were repaired in-house. Subsequent CE check was done once per month for 6 months. GATs were divided into 3 groups: group 1 (G1)≤1 year, group 2 (G2)>1 to 10 years, and group 3 (G3)>10 years of usage., Results: In total, 76 slit-lamp mounted GATs were included. The number of GATs in groups 1 to 3 was 19, 36, and 21, respectively. Seven (9.2%) tonometers were faulty at the baseline. None in G1, 5 in G2, and 16 in G3 demonstrated unacceptable CE over the study course (P<0.01). The survival function of G1 tonometers was 1.0 throughout, whereas that (95% confidence interval) of the G2 and G3 tonometers were 0.97 (0.81-0.99) and 0.76 (0.51-0.89) at 1 month, and 0.86 (0.69-0.93) and 0.23 (0.08-0.43) at 6 months, respectively. The probability of CE development increased with increasing age of the tonometer. The frequency of use of the tonometer was not associated with the development of CE (odds ratio=1.00)., Conclusions: CE occurs more frequently in older tonometers. Although newer GATs (<1 y old) can be checked twice yearly, GATs older than a year should be checked at least monthly.
- Published
- 2016
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32. A Simplified (Screening) Approach to Check the Calibration Status of the Goldmann Applanation Tonometer.
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Choudhari NS, Ramavath S, Rekha G, Rao A, Rao HL, Senthil S, and Garudadri CS
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- Calibration, Equipment Design, Female, Glaucoma physiopathology, Humans, Male, Prospective Studies, Reproducibility of Results, Tonometry, Ocular instrumentation, Glaucoma diagnosis, Intraocular Pressure physiology, Tonometry, Ocular standards
- Abstract
Background: To investigate whether a lower-end calibration error check alone can identify a Goldmann applanation tonometer (GAT) with acceptable calibration error as per Asia-Pacific Glaucoma Society (APGS) and World Glaucoma Association (WGA) guidelines., Methods: This was a multicentric prospective study in a tertiary eye-care institutional setting. Seventy-six slit-lamp-mounted Haag-Streit GATs (Model AT 900 C/M) were included in the study. All GATs were checked for calibration error at 0, 20, and 60 mm Hg testing levels as recommended by the manufacturer. The ability of 2 screening criteria (calibration error within ±1 or ±2 mm Hg, respectively, at the 0 mm Hg testing level without using the calibration error check weight bar) to identify a tonometer within acceptable calibration limits defined by APGS (calibration error within ±2, ±3, and ±4 mm Hg at 0, 20, and 60 mm Hg testing levels, respectively) and WGA (calibration error within ±1 mm Hg at all testing levels) was determined., Main Outcome Measure: The negative likelihood ratio of the screening criteria RESULTS:: Five (6.6%) and 42 (55%) GATs were outside of the APGS and the WGA calibration limits, respectively. Negative likelihood ratios of the first and the second screening criteria at the APGS definition of calibration error tolerance were 0.11 and 0.25, respectively, and at that of the WGA definition of calibration error tolerance were 0.38 and 0.90, respectively., Conclusions: The screening criteria of calibration error within ±1 mm Hg at the 0 mm Hg testing level seem to be clinically useful to detect GAT with an acceptable calibration error as per the APGS guideline.
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- 2016
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33. Re: Jabbarvand et al.: Endophthalmitis occurring after cataract surgery: outcomes of more than 480 000 cataract surgeries, epidemiologic features, and risk factors (Ophthalmology 2016;123:295-301).
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Dave V, Dikshit S, Tyagi M, Garudadri CS, and Basu S
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- Anti-Bacterial Agents, Cataract, Eye Infections, Bacterial, Humans, Incidence, Postoperative Complications, Retrospective Studies, Risk Factors, Cataract Extraction, Endophthalmitis
- Published
- 2016
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34. Outcomes of Primary Trabeculectomy With Mitomycin-C in Glaucoma Secondary to Iridocorneal Endothelial Syndrome.
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Chandran P, Rao HL, Mandal AK, Choudhari NS, Garudadri CS, and Senthil S
- Subjects
- Female, Follow-Up Studies, Glaucoma etiology, Glaucoma physiopathology, Humans, Intraoperative Period, Iridocorneal Endothelial Syndrome complications, Iridocorneal Endothelial Syndrome physiopathology, Male, Middle Aged, Nucleic Acid Synthesis Inhibitors therapeutic use, Tonometry, Ocular, Treatment Outcome, Glaucoma surgery, Intraocular Pressure, Iridocorneal Endothelial Syndrome therapy, Mitomycin therapeutic use, Trabeculectomy methods
- Abstract
Purpose: To report the outcomes of primary trabeculectomy with mitomycin-C (MMC) in eyes with glaucoma secondary to iridocorneal endothelial (ICE) syndrome., Methods: We included 16 eyes of 15 subjects with ICE syndrome who underwent primary trabeculectomy with MMC between 1991 and 2013. Surgical success was defined as complete when the intraocular pressure (IOP) was ≥5 and ≤21 mm Hg with no additional antiglaucoma medication (AGM) or surgery and as qualified if IOP was controlled with AGM., Results: The median age (interquartile range) of subjects at the time of trabeculectomy was 41 years (37, 44 y) and the median follow-up period was 23 months (7, 79 mo). Postoperatively, the median IOP significantly reduced from 36 (26, 43) to 14 mm Hg (12, 17 mm Hg) (P<0.001) and median number of AGMs reduced from 3 (2, 4) to 0 (0, 0) (P<0.001). The percentage of complete success was 75% at 6 months, 64% at 12 months, 57% at 36 months, and 33% at 60 months. The percentage of qualified success was 94% at 6 months, 82% at 12 months, 71% at 36 months, and 60% at 60 months. Five eyes failed during the follow-up period. The mean (±SD) number of glaucoma surgeries per eye was 1.3±0.5. Eight eyes developed corneal edema at a median follow-up of 78.5 months and 4 eyes underwent keratoplasty., Conclusions: Primary trabeculectomy with MMC offers moderate surgical success in patients with ICE syndrome. Maintaining long-term IOP control and corneal clarity in these eyes is a big challenge.
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- 2016
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35. Optic nerve head parameters of high-definition optical coherence tomography and Heidelberg retina tomogram in perimetric and preperimetric glaucoma.
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Begum VU, Addepalli UK, Senthil S, Garudadri CS, and Rao HL
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- Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, ROC Curve, Retina pathology, Glaucoma diagnosis, Intraocular Pressure, Optic Disk pathology, Tomography, Optical Coherence methods, Visual Field Tests methods, Visual Fields
- Abstract
Background: Heidelberg retina tomogram (HRT) and optical coherence tomography (OCT) are two widely used imaging modalities to evaluate the optic nerve head (ONH) in glaucoma., Purpose: To compare the ONH parameters of HRT3 and high-definition OCT (HD-OCT) and evaluate their diagnostic abilities in perimetric and preperimetric glaucoma., Design: Cross-sectional analysis., Methods: 35 control eyes (24 subjects), 21 preperimetric glaucoma eyes (15 patients), and 64 perimetric glaucoma eyes (44 patients) from the Longitudinal Glaucoma Evaluation Study underwent HRT3 and HD-OCT examinations., Statistical Analysis: Agreement between the ONH parameters of HRT and HD-OCT were assessed using Bland-Altman plots. Diagnostic abilities of ONH parameters were evaluated using area under the receiver operating characteristic curves (AUCs), sensitivity at fixed specificity, and likelihood ratios (LR)., Results: Optic disc area, vertical cup to disc ratio, and cup volume with HD-OCT were larger than with HRT, while the rim area was smaller with HD-OCT (P < 0.001 for all comparisons). AUCs of all HD-OCT ONH parameters (0.90-0.97 in perimetric and 0.62-0.71 in preperimetric glaucoma) were comparable (P > 0.10) to the corresponding HRT ONH parameters (0.81-0.95 in perimetric and 0.55-0.72 in preperimetric glaucoma). LRs associated with diagnostic categorization of ONH parameters of both HD-OCT and HRT were associated with larger effects on posttest probability of perimetric compared to preperimetric glaucoma., Conclusions: ONH measurements of HD-OCT and HRT3 cannot be used interchangeably. Though the diagnostic abilities of ONH parameters of HD-OCT and HRT in glaucoma were comparable, the same were significantly lower in preperimetric compared to perimetric glaucoma.
- Published
- 2016
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36. Comparison of Cataract Surgery Alone Versus Cataract Surgery Combined With Trabeculectomy in the Management of Phacomorphic Glaucoma.
- Author
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Senthil S, Chinta S, Rao HL, Choudhari NS, Pathak-Ray V, Mandal AK, and Garudadri CS
- Subjects
- Aged, Female, Glaucoma, Angle-Closure etiology, Humans, Intraocular Pressure physiology, Male, Middle Aged, Retrospective Studies, Tonometry, Ocular, Treatment Outcome, Visual Acuity physiology, Cataract Extraction methods, Glaucoma, Angle-Closure surgery, Lens Diseases complications, Lens, Crystalline pathology, Trabeculectomy methods
- Abstract
Purpose: To compare the outcomes of cataract surgery alone versus combined cataract surgery with trabeculectomy in eyes with phacomorphic glaucoma., Materials and Methods: In a retrospective comparative case series, 126 eyes of phacomorphic glaucoma presenting within 4 weeks of onset between 1993 and 2012, with at least 6 months of postoperative follow-up were included. Group 1 included 63 eyes with cataract surgery only and group 2 included 63 eyes with combined cataract surgery and trabeculectomy. Primary outcome measure was intraocular pressure (IOP) ≤21 mm Hg (without antiglaucoma medication) 6 months after surgery., Results: The median (interquartile range) preoperative IOP in group 1 was 36 mm Hg (30 to 50 mm Hg) and group 2 was 40 mm Hg (32 to 48 mm Hg) (P=0.34). The median duration of phacomorphic attack was 7 days (3 to 12 d) in group 1 and 7 days (3 to 15 d) in group 2 (P=0.39). The median duration of postoperative follow-up was 23 months in group 1 and 30 months in group 2 (P=0.89). Six months after surgery, 97% of the eyes in group 1 and 100% in group 2 achieved IOP≤21 mm Hg without antiglaucoma medications with a median postoperative IOP of 12 mm Hg in both the groups (P=0.09). The median Log MAR visual acuity was significantly better in group 1 compared with group 2 (0.2 vs. 0.3, P<0.001). The percentage of eyes that achieved visual acuity better than 20/40 at 3 months was 62% in group 1 versus 19% in group 2 and at 6 months it was 75% in group 1 versus 38% in group 2 (P<0.001)., Conclusions: In our cohort of phacomorphic glaucoma presenting within 4 weeks of onset, cataract surgery and combined surgery resulted in similar IOP control at 6 months. However, cataract surgery alone resulted in better and faster visual recovery.
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- 2016
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37. Diagnostic Abilities of Variable and Enhanced Corneal Compensation Algorithms of GDx in Different Severities of Glaucoma.
- Author
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Yadav RK, Begum VU, Addepalli UK, Senthil S, Garudadri CS, and Rao HL
- Subjects
- Adult, Area Under Curve, Case-Control Studies, Female, Glaucoma classification, Humans, Intraocular Pressure physiology, Likelihood Functions, Male, Middle Aged, Prospective Studies, ROC Curve, Sensitivity and Specificity, Severity of Illness Index, Visual Fields physiology, Algorithms, Cornea physiology, Glaucoma diagnosis, Nerve Fibers pathology, Retinal Ganglion Cells pathology, Scanning Laser Polarimetry methods
- Abstract
Purpose: To compare the abilities of retinal nerve fiber layer (RNFL) parameters of variable corneal compensation (VCC) and enhanced corneal compensation (ECC) algorithms of scanning laser polarimetry (GDx) in detecting various severities of glaucoma., Methods: Two hundred and eighty-five eyes of 194 subjects from the Longitudinal Glaucoma Evaluation Study who underwent GDx VCC and ECC imaging were evaluated. Abilities of RNFL parameters of GDx VCC and ECC to diagnose glaucoma were compared using area under receiver operating characteristic curves (AUC), sensitivities at fixed specificities, and likelihood ratios., Results: After excluding 5 eyes that failed to satisfy manufacturer-recommended quality parameters with ECC and 68 with VCC, 56 eyes of 41 normal subjects and 161 eyes of 121 glaucoma patients [36 eyes with preperimetric glaucoma, 52 eyes with early (MD>-6 dB), 34 with moderate (MD between -6 and -12 dB), and 39 with severe glaucoma (MD<-12 dB)] were included for the analysis. Inferior RNFL, average RNFL, and nerve fiber indicator parameters showed the best AUCs and sensitivities both with GDx VCC and ECC in diagnosing all severities of glaucoma. AUCs and sensitivities of all RNFL parameters were comparable between the VCC and ECC algorithms (P>0.20 for all comparisons). Likelihood ratios associated with the diagnostic categorization of RNFL parameters were comparable between the VCC and ECC algorithms., Conclusion: In scans satisfying the manufacturer-recommended quality parameters, which were significantly greater with ECC than VCC algorithm, diagnostic abilities of GDx ECC and VCC in glaucoma were similar.
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- 2016
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38. Comparing the Structure-Function Relationship at the Macula With Standard Automated Perimetry and Microperimetry.
- Author
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Rao HL, Januwada M, Hussain RS, Pillutla LN, Begum VU, Chaitanya A, Senthil S, and Garudadri CS
- Subjects
- Adult, Aged, Case-Control Studies, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Prospective Studies, Tomography, Optical Coherence methods, Visual Field Tests methods, Glaucoma physiopathology, Macula Lutea physiopathology, Optic Nerve Diseases physiopathology, Retinal Ganglion Cells physiology, Visual Fields physiology
- Abstract
Purpose: To compare the structure-function relationship between ganglion cell-inner plexiform layer (GCIPL) thickness measurements using spectral-domain optical coherence tomography (SDOCT) and visual sensitivities measured using standard automated perimetry (SAP) and microperimetry (MP) at the macula in glaucoma., Methods: In a prospective study, 45 control eyes (29 subjects) and 60 glaucoma eyes (45 patients) underwent visual sensitivity estimation at the macula (central 10°) by SAP and MP, and GCIPL thickness measurement at the macula by SDOCT. Structure-function relationships between GCILP thickness and visual sensitivity loss with SAP and MP at various macular sectors were assessed using the Hood and Kardon model. To compare structure-function relationship with SAP and MP, we calculated the number of data points falling outside the 5th and the 95th percentile values of the Hood and Kardon model with each of the perimeters., Results: The number of points falling outside the 5th and 95th percentile values of the Hood and Kardon model ranged from 28 (superior sector) to 48 (inferonasal sector) with SAP and 33 (superior sector) to 49 (inferonasal sector) with MP. The difference in the number of points falling outside the 5th and 95th percentile values with SAP and MP was statistically insignificant (P > 0.05, χ(2) test) for all the sectors., Conclusions: Visual sensitivity measurements of both SAP and MP demonstrated a similar relationship with the GCIPL measurements of SDOCT at the macula in glaucoma.
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- 2015
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39. Re: Peters et al.: Threat to fixation at diagnosis and lifetime risk of visual impairment in open-angle glaucoma (Ophthalmology 2015;122:1034-9).
- Author
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Rao DP, Rao HL, and Garudadri CS
- Subjects
- Female, Humans, Male, Fixation, Ocular physiology, Glaucoma, Open-Angle diagnosis, Vision Disorders diagnosis, Visual Fields physiology
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- 2015
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40. Reference Standard Test and the Diagnostic Ability of Spectral Domain Optical Coherence Tomography in Glaucoma.
- Author
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Rao HL, Yadav RK, Addepalli UK, Begum VU, Senthil S, Choudhari NS, and Garudadri CS
- Subjects
- Adult, Aged, Cross-Sectional Studies, Female, Humans, Intraocular Pressure, Male, Middle Aged, Nerve Fibers pathology, Photography, ROC Curve, Reference Standards, Retinal Ganglion Cells pathology, Sensitivity and Specificity, Glaucoma diagnosis, Optic Disk pathology, Tomography, Optical Coherence standards, Visual Fields physiology
- Abstract
Purpose: To evaluate the relationship between the reference standard used to diagnose glaucoma and the diagnostic ability of spectral domain optical coherence tomograph (SDOCT)., Methods: In a cross-sectional study, 280 eyes of 175 consecutive subjects, referred to a tertiary eye care center for glaucoma evaluation, underwent optic disc photography, visual field (VF) examination, and SDOCT examination. The cohort was divided into glaucoma and control groups based on 3 reference standards for glaucoma diagnosis: first based on the optic disc classification (179 glaucoma and 101 control eyes), second on VF classification (glaucoma hemifield test outside normal limits and pattern SD with P-value of <5%, 130 glaucoma and 150 control eyes), and third on the presence of both glaucomatous optic disc and glaucomatous VF (125 glaucoma and 155 control eyes). Relationship between the reference standards and the diagnostic parameters of SDOCT were evaluated using areas under the receiver operating characteristic curve, sensitivity, and specificity., Results: Areas under the receiver operating characteristic curve and sensitivities of most of the SDOCT parameters obtained with the 3 reference standards (ranging from 0.74 to 0.88 and 72% to 88%, respectively) were comparable (P>0.05). However, specificities of SDOCT parameters were significantly greater (P<0.05) with optic disc classification as reference standard (74% to 88%) compared with VF classification as reference standard (57% to 74%)., Conclusions: Diagnostic parameters of SDOCT that was significantly affected by reference standard was the specificity, which was greater with optic disc classification as the reference standard. This has to be considered when comparing the diagnostic ability of SDOCT across studies.
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- 2015
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41. Late postoperative choroidal detachment following an uneventful cataract surgery in a patient on topical latanoprost.
- Author
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Krishnamurthy R, Senthil S, and Garudadri CS
- Subjects
- Administration, Topical, Anterior Chamber pathology, Antihypertensive Agents adverse effects, Antihypertensive Agents therapeutic use, Cataract complications, Glaucoma, Open-Angle prevention & control, Glaucoma, Open-Angle surgery, Humans, Latanoprost, Male, Medication Errors, Middle Aged, Ocular Hypotension etiology, Phacoemulsification, Postoperative Care, Postoperative Complications, Prostaglandins F, Synthetic administration & dosage, Prostaglandins F, Synthetic therapeutic use, Tonometry, Ocular, Trabeculectomy, Visual Acuity, Cataract Extraction methods, Choroid pathology, Choroid Diseases etiology, Glaucoma, Open-Angle drug therapy, Intraocular Pressure drug effects, Lens Implantation, Intraocular, Prostaglandins F, Synthetic adverse effects
- Abstract
Topical latanoprost is a most effective and commonly used antiglaucoma medication. Use of prostaglandin analogues (PGA) in the early postoperative period is controversial due to its proinflammatory properties. We report a case of a 64-year-old man with primary open angle glaucoma, post-trabeculectomy 17 years prior, with good intraocular pressure (IOP) control on topical levobunolol 0.5% and latanoprost 0.005%. He underwent a clear corneal phacoemulsification surgery in his left eye and the PGA was stopped. He had an uneventful postoperative course and was prescribed eyeglasses at 4-week follow-up. Two weeks later, he presented to the emergency department with decreased vision in the left eye, flat anterior chamber, IOP of 00 mm Hg and 360° choroidal detachment. The continued use of topical latanoprost in the operated eye was implicated as the cause. This case illustrates the serious vision-threatening side effect of PGA when used in the early postoperative period., (2015 BMJ Publishing Group Ltd.)
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- 2015
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42. Comparing spectral-domain optical coherence tomography and standard automated perimetry to diagnose glaucomatous optic neuropathy.
- Author
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Rao HL, Yadav RK, Addepalli UK, Begum VU, Senthil S, Choudhari NS, and Garudadri CS
- Subjects
- Cross-Sectional Studies, False Positive Reactions, Female, Humans, Intraocular Pressure physiology, Male, Middle Aged, Photography, Predictive Value of Tests, Reproducibility of Results, Sensitivity and Specificity, Visual Fields physiology, Glaucoma diagnosis, Nerve Fibers pathology, Optic Disk pathology, Optic Nerve Diseases diagnosis, Retinal Ganglion Cells pathology, Tomography, Optical Coherence methods, Visual Field Tests methods
- Abstract
Purpose: To compare the abilities of standard automated perimetry (SAP) and spectral-domain optical coherence tomography (SDOCT) in diagnosing eyes with glaucomatous optic neuropathy (GON)., Methods: In a cross-sectional study, 280 eyes of 175 subjects referred to tertiary eye care center by general ophthalmologists for a glaucoma evaluation underwent retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) imaging with SDOCT. All subjects had at least 2 reliable and repeatable SAP. Two glaucoma experts masked to clinical and SAP results classified the optic nerves into GON and nonglaucomatous groups based on digital optic disc photographs. Ability of SDOCT parameters and SAP to discriminate GON eyes from nonglaucomatous eyes was evaluated using sensitivity, specificity, and likelihood ratios (LR)., Results: Experts classified 179 eyes into GON and 101 eyes into nonglaucomatous group. Sensitivity of SAP (69.8%) was significantly lower (P<0.05) than that of inferior quadrant RNFL thickness (83.8%), average RNFL thickness (77.2%), GCC focal loss volume (FLV, 81.5%), and global loss volume (GLV, 82.6%). Specificity and positive LR of SAP (95% and14.1, respectively) were significantly greater than those of all RNFL parameters, FLV (84.2% and 5.1) and GLV (82.2% and 4.6). Negative LR of SAP (0.32) was significantly inferior to that of inferior quadrant RNFL thickness (0.22), FLV (0.22), and GLV (0.21)., Conclusions: Most of the RNFL and GCC parameters of SDOCT had better sensitivities and negative LRs to diagnose GON compared with SAP. The specificities and positive LRs of most SDOCT parameters were inferior to that of SAP.
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- 2015
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43. Structure-Function Relationship in Glaucoma Using Ganglion Cell-Inner Plexiform Layer Thickness Measurements.
- Author
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Rao HL, Qasim M, Hussain RS, Januwada M, Pillutla LN, Begum VU, Chaitanya A, Senthil S, and Garudadri CS
- Subjects
- Cross-Sectional Studies, Humans, Middle Aged, Prospective Studies, Glaucoma pathology, Retinal Ganglion Cells pathology, Tomography, Optical Coherence
- Abstract
Purpose: To evaluate the structure-function relationship between ganglion cell-inner plexiform layer (GCIPL) thickness at the macula and 10-2 standard automated perimetry (SAP) in glaucoma and to evaluate the relationship using a recently proposed linear model., Methods: In a cross-sectional analysis, structure-function relationship was determined in 50 glaucomatous eyes (40 patients, mean deviation: -15.4 ± 7.5 dB) and 21 control eyes (13 subjects, mean deviation: -3.4 ± 3.0 dB), which had undergone 10-2 SAP and GCIPL imaging on the same day. Functional loss was derived from total deviation numerical values on 10-2 SAP and calculated on both a linear (reciprocal of Lambert) and a decibel scale after accounting for the retinal ganglion cell displacement at the macula. Strength of relationship was reported as coefficient of determination (R2) of the linear regression models fitted to the data separately for different sectors. The relationship was also evaluated using a linear model., Results: The R2 for the associations between GCIPL thickness sectors and the corresponding sector SAP total deviation values ranged from 0.19 (for superonasal GCIPL sector) to 0.60 (for average GCIPL thickness) when functional loss was calculated on the decibel scale and 0.16 (for superonasal sector) to 0.54 (for inferior sector) on the linear scale. All associations were statistically significant (P < 0.05). The linear model fitted the data reasonably well., Conclusions: Significant structure-function associations were found between GCIPL thickness measurements at the macula and the functional loss measured on 10-2 SAP in glaucoma. Best fit was found for the inferior and average GCIPL sector thickness. The linear model was useful to study the structure-function relationship.
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- 2015
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44. Comparing glaucoma progression on 24-2 and 10-2 visual field examinations.
- Author
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Rao HL, Begum VU, Khadka D, Mandal AK, Senthil S, and Garudadri CS
- Subjects
- Aged, Disease Progression, Humans, Intraocular Pressure physiology, Middle Aged, Physical Examination methods, Retrospective Studies, Vision Disorders physiopathology, Visual Field Tests methods, Glaucoma physiopathology, Visual Fields physiology
- Abstract
Purpose: To compare the rate of mean deviation (MD) change on 24-2 versus 10-2 VFs in treated glaucomatous eyes with 5 or more examinations., Methods: In a retrospective study, 24-2 and 10-2 VFs of 131 glaucoma patients (167 eyes) who had undergone at least 5 VFs examinations during their follow-up were analyzed. All these patients had VF defects both on 24-2 and 10-2 VFs. Rates of MD change were calculated using best linear unbiased predictions (BLUP)., Results: Median age, MD on 24-2 VF at baseline, number of VFs performed during follow-up and follow-up duration were 55 years, -16.9 dB, 9 and 9 years respectively. Median rate of MD change was significantly greater (p<0.001) on 10-2 VF (-0.26 dB/year; interquartile range [IQR]: -0.47, -0.11) compared to 24-2 VFs (-0.19 dB/year; IQR: -0.41, -0.03). Comparing the rates of MD change in eyes with different severities of VF loss (early [MD better than -6 dB], moderate [-6 dB to -12 dB], advanced [-12 to -20 dB] and severe [MD worse than -20 dB]) at baseline (based on the MD on 24-2 VF), median rate of MD change was comparable between 10-2 and 24-2 VFs in mild (-0.45 dB/year vs. -0.40 dB/year, P = 0.42) and moderate (-0.32 dB/year vs. -0.40 dB/year, P = 0.26) VF loss categories, while the same were significantly greater on 10-2 VFs in advanced (-0.28 dB/year vs. -0.21 dB/year, P = 0.04) and severe (-0.18 dB/year vs. -0.06 dB/year, P<0.001) VF loss categories., Conclusions: In patients with VF defects both on 24-2 and 10-2 VFs, evaluating the rate of MD change on 10-2 VFs may help in better estimation of glaucoma progression, especially so in eyes with advanced glaucoma at baseline.
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- 2015
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45. The ISNT rule in glaucoma: revisiting with spectral domain optical coherence tomography.
- Author
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Rao HL, Yadav RK, Addepalli UK, Begum VU, Senthil S, Choudhari NS, and Garudadri CS
- Subjects
- Aged, Cross-Sectional Studies, False Negative Reactions, Female, Humans, Likelihood Functions, Male, Middle Aged, Predictive Value of Tests, Sensitivity and Specificity, Severity of Illness Index, Vision Disorders diagnosis, Visual Fields, Diagnostic Techniques, Ophthalmological, Glaucoma, Open-Angle diagnosis, Optic Disk pathology, Optic Nerve Diseases diagnosis, Tomography, Optical Coherence methods
- Abstract
Purpose: To evaluate the ability of the neuroretinal rim (NRR) rules determined using spectral domain optical coherence tomography (SDOCT) in diagnosing glaucoma and to study the effect of optic disc size and disease severity on the diagnostic ability of these rules., Methods: In a cross-sectional study, 125 eyes of 96 glaucoma patients and 96 eyes of 72 control subjects underwent optic nerve head (ONH) imaging with SDOCT. Inferior (I), superior (S), nasal (N) and temporal (T) NRR areas were automatically determined by the sdoct software. Diagnostic abilities of ISNT (I > S > N > T), IT (I > T) and ST (S > T) rules in glaucoma were evaluated using sensitivity, specificity and likelihood ratios (LR). Effect of optic disc size and disease severity [based on mean deviation (MD) on visual fields] on the diagnostic ability of the NRR rules was evaluated using regression models., Results: Sensitivities of ISNT, IT and ST rules were 80.8%, 60.0% and 29.6%, respectively, and the specificities were 32.3%, 84.4% and 93.8%, respectively. Positive LRs of ISNT, IT and ST rules were 1.19, 3.84 and 4.74, respectively, and negative LRs were 0.60, 0.47 and 0.75, respectively. Sensitivities of ISNT (coefficient: -1.06, p = 0.02) and IT (-0.71, 0.05) rules decreased with increasing disc size. Positive LR of IT rule increased significantly (-0.01, 0.04) with decreasing MD, and negative LR of IT rule decreased (got better) significantly (0.26, 0.05) with decreasing disc size., Conclusions: Neuroretinal rim rules, as determined by SDOCT, do not allow robust differentiation of glaucomatous from non-glaucomatous discs., (© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)
- Published
- 2015
- Full Text
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46. Re: Charlson et al.: Nocturnal systemic hypotension increases the risk of glaucoma progression (Ophthalmology 2014;121:2004-12).
- Author
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Krishnamurthy R, Rao HL, Senthil S, and Garudadri CS
- Subjects
- Female, Humans, Male, Blood Pressure physiology, Circadian Rhythm physiology, Glaucoma physiopathology, Hypotension physiopathology, Intraocular Pressure physiology
- Published
- 2015
- Full Text
- View/download PDF
47. Atypical birefringence pattern and the diagnostic ability of scanning laser polarimetry with enhanced corneal compensation in glaucoma.
- Author
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Rao HL, Yadav RK, Begum VU, Addepalli UK, Senthil S, Choudhari NS, and Garudadri CS
- Subjects
- Adult, Birefringence, Cross-Sectional Studies, Female, Humans, Intraocular Pressure, Male, Middle Aged, ROC Curve, Visual Acuity physiology, Visual Field Tests, Visual Fields physiology, Cornea physiology, Glaucoma diagnosis, Nerve Fibers pathology, Retinal Ganglion Cells pathology, Scanning Laser Polarimetry methods
- Abstract
Purpose: To evaluate the effect of typical scan score (TSS), when within the acceptable limits, on the diagnostic performance of retinal nerve fibre layer (RNFL) parameters with the enhanced corneal compensation (ECC) protocol of scanning laser polarimetry (SLP) in glaucoma., Methods: In a cross-sectional study, 203 eyes of 160 glaucoma patients and 140 eyes of 104 control subjects underwent RNFL imaging with the ECC protocol of SLP. TSS was used to quantify atypical birefringence pattern (ABP) images. Influence of TSS on the diagnostic ability of SLP parameters was evaluated by receiver operating characteristic (ROC) regression models after adjusting for the effect of disease severity [based on mean deviation (MD)] on standard automated perimetry)., Results: Diagnostic abilities of all RNFL parameters of SLP increased when the TSS values were higher. This effect was statistically significant for TSNIT (coefficient: 0.08, p<0.001) and inferior average parameters (coefficient: 0.06, p=0.002) but not for nerve fibre indicator (NFI, coefficient: 0.03, p=0.21). In early glaucoma (MD of -5 dB), predicted area under ROC curve (AUC) for TSNIT average parameter improved from 0.642 at a TSS of 90 to 0.845 at a TSS of 100. In advanced glaucoma (MD of -15 dB), AUC for TSNIT average improved from 0.832 at a TSS of 90 to 0.947 at 100., Conclusion: Diagnostic performances of TSNIT and inferior average RNFL parameters with ECC protocol of SLP were significantly influenced by TSS even when the TSS values were within the acceptable limits. Diagnostic ability of NFI was unaffected by TSS values., (© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)
- Published
- 2015
- Full Text
- View/download PDF
48. Role of visual field reliability indices in ruling out glaucoma.
- Author
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Rao HL, Yadav RK, Begum VU, Addepalli UK, Choudhari NS, Senthil S, and Garudadri CS
- Subjects
- Adult, Algorithms, Cross-Sectional Studies, False Positive Reactions, Female, Health Status Indicators, Humans, Intraocular Pressure, Male, Middle Aged, Ocular Hypertension diagnosis, Predictive Value of Tests, Reproducibility of Results, Tonometry, Ocular, Visual Acuity physiology, Glaucoma diagnosis, Optic Disk pathology, Optic Nerve Diseases diagnosis, Visual Field Tests standards, Visual Fields
- Abstract
Importance: Standard automated perimetry is the current criterion standard for assessment of visual field (VF) loss in glaucoma. The 3 commonly used reliability indices to judge the quality of standard automated perimetry results are fixation losses (FLs) and false-positive (FP) and false-negative (FN) response rates. However, the influence of reliability indices, when within the manufacturer-recommended limits, on VF classification has been sparsely studied., Objective: To evaluate the role of VF reliability indices in ruling out glaucoma., Design, Setting, and Participants: A cross-sectional study of 291 eyes of 291 participants referred to a tertiary eye care facility by general ophthalmologists. The participants were suspected to have glaucoma based on optic disc appearance, but the eyes were judged to be normal with physiological cupping by glaucoma experts on masked evaluation of optic disc photographs. All participants underwent VF testing with the Swedish interactive threshold algorithm standard 24-2 program., Main Outcomes and Measures: Logistic regression models were used to evaluate the associations between reliability indices and FP classifications on VF testing (glaucoma hemifield test as outside normal limits and pattern standard deviation with P < .05)., Results: Median FL, FP, and FN response rates were 7%, 1%, and 2%, respectively. Among the 241 participants with reliable VF results (FL <20% and FP response rate <15%), the VF classification was normal in 188 (78.0%) and glaucoma (FP) in 53 (22.0%). Probability of FP VF classification was associated with FN response rates (odds ratio [OR], 1.36; 95% CI, 1.25-1.48, P < .001) but did not appear to be associated with FLs (OR, 0.96; 95% CI, 0.90-1.03, P = .30) or FP response rates (OR, 0.96; 95% CI, 0.83-1.12, P = .64). Predicted probability of FP VF classification was 9% (95% CI, 6%-14%), 40% (32%-49%), and 82% (68%-91%) at FN response rates of 0%, 8%, and 16%, respectively., Conclusions and Relevance: This study suggests that FN response rates have an effect on the ability of automated VF assessments to rule out glaucoma. Since FN response rates are ignored by the manufacturer while flagging a test as unreliable, clinicians and researchers may benefit by realizing that FN response rates can lead to FP VF classification, even when their frequencies are small.
- Published
- 2015
- Full Text
- View/download PDF
49. Factors affecting the ability of the spectral domain optical coherence tomograph to detect photographic retinal nerve fiber layer defects.
- Author
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Rao HL, Addepalli UK, Yadav RK, Choudhari NS, Senthil S, and Garudadri CS
- Subjects
- Adult, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Glaucoma diagnosis, Nerve Fibers pathology, Tomography, Optical Coherence methods
- Abstract
Purpose: To evaluate the ability of normative database classification (color-coded maps) of spectral domain optical coherence tomograph (SDOCT) in detecting wedge shaped retinal nerve fiber layer (RNFL) defects identified on photographs and the factors affecting the ability of SDOCT in detecting these RNFL defects., Methods: In a cross-sectional study, 238 eyes (476 RNFL quadrants) of 172 normal subjects and 85 eyes (103 RNFL quadrants with wedge shaped RNFL defects) of 66 glaucoma patients underwent RNFL imaging with SDOCT. Logistic regression models were used to evaluate the factors associated with false positive and false negative RNFL classifications of the color-coded maps of SDOCT., Results: False positive classification at a p value of <5% was seen in 108 of 476 quadrants (22.8%). False negative classification at a p value of <5% was seen in 16 of 103 quadrants (15.5%). Of the 103 quadrants with RNFL defects, 64 showed a corresponding VF defect in the opposite hemisphere and 39 were preperimetric. Higher signal strength index (SSI) of the scan was less likely to have a false positive classification (odds ratio: 0.97, p = 0.01). Presence of an associated visual field defect (odds ratio: 0.17, p = 0.01) and inferior quadrant RNFL defects as compared to superior (odds ratio: 0.24, p = 0.04) were less likely to show false negative classifications., Conclusions: Scans with lower signal strengths were more likely to show false positive RNFL classifications, and preperimetric and superior quadrant RNFL defects were more likely to show false negative classifications on color-coded maps of SDOCT.
- Published
- 2014
- Full Text
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50. Role of oral doxycycline and large diameter bandage contact lens in the management of early post-trabeculectomy bleb leak.
- Author
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Kiranmaye T, Garudadri CS, and Senthil S
- Subjects
- Administration, Oral, Adult, Anastomotic Leak diagnosis, Bandages, Female, Follow-Up Studies, Glaucoma, Open-Angle diagnosis, Humans, Necrosis etiology, Necrosis pathology, Ophthalmic Solutions, Postoperative Complications diagnosis, Postoperative Complications therapy, Risk Assessment, Role, Steroids administration & dosage, Tonometry, Ocular methods, Trabeculectomy methods, Treatment Outcome, Anastomotic Leak therapy, Conjunctiva pathology, Contact Lenses, Doxycycline administration & dosage, Glaucoma, Open-Angle surgery, Trabeculectomy adverse effects
- Abstract
A 27-year-old man with juvenile open angle glaucoma and medically uncontrolled intraocular pressure (IOP) underwent a trabeculectomy with mitomycin C in his right eye. One week postoperatively, he developed ischaemic necrosis of the conjunctiva with a bleb leak. This was managed conservatively with oral doxycycline 100 mg twice daily along with a topical low-dose steroid, antibiotic and cycloplegic and a large diameter bandage contact lens (BCL). There was dramatic improvement in the bleb appearance, the necrosis healed and the leak resolved. The patient had well-controlled IOP with a diffuse healthy bleb at 4 weeks, which was maintained at 2 years. This case illustrates the utility and importance of oral doxycycline in the management of early post-trabeculectomy conjunctival necrosis and the use of BCL in the management of a bleb leak. This safe and non-invasive method not only hastened the recovery but also helped in maintaining good bleb function., (2014 BMJ Publishing Group Ltd.)
- Published
- 2014
- Full Text
- View/download PDF
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