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Ophthalmology. Glaucoma 2023Risk assessment is integral to the management of individuals with ocular hypertension (OHTN). This study aims to determine the predictive accuracy of the Ocular... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Risk assessment is integral to the management of individuals with ocular hypertension (OHTN). This study aims to determine the predictive accuracy of the Ocular Hypertension Treatment Study 5-year risk calculator (OHTS calculator) among treated patients with OHTN by applying it to patients randomized to the Ocular Hypertension Treatment Study (OHTS) medication arm.
DESIGN
Post hoc secondary analysis of a randomized clinical trial.
SUBJECTS
Individuals participating in the OHTS who were randomized to the medication arm. Only participants with complete baseline data in both eyes were included (n = 726).
METHODS
The hazard ratios (HRs) of the medication group in OHTS were compared to the HR used for the OHTS calculator using the z-test statistic to establish the OHTS calculator's generalizability to the OHTS medication arm. The performance of the OHTS calculator among the OHTS medication group was evaluated twice, using both untreated baseline intraocular pressure (IOP) and average treated IOP during the first 24 months for the IOP variable.
MAIN OUTCOME MEASURES
The performance was determined based on the model's accuracy in estimating the risk of reaching an OHTS primary open-angle glaucoma (POAG) end point using calibration chi-square and discriminating between participants who did or did not develop POAG.
RESULTS
The HRs for the OHTS medication arm were not significantly different from those used in the OHTS calculator for untreated OHTN derived from observation arm data (P > 0.1). Based on the calibration chi-square test for the medication group, the OHTS calculator prediction model had good predictive accuracy when using the mean treated IOP and poorer predictive accuracy with the untreated baseline IOP (chi-square 10 and 29, respectively). The model had good discrimination with treated IOP (c-statistic = 0.77), comparable to what has been reported for the OHTS calculator in the OHTS observation group.
CONCLUSIONS
The OHTS calculator can be applied to treated patients with OHTN, and repeat risk calculation after initiating IOP reduction may provide useful information that can aid in disease management.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Humans; Glaucoma, Open-Angle; Ocular Hypertension; Glaucoma; Intraocular Pressure; Tonometry, Ocular
PubMed: 37336266
DOI: 10.1016/j.ogla.2023.06.005 -
Optometry and Vision Science : Official... Aug 2021Systemic corticosteroid use in children is rare because of known risks of adverse effects. The increased prevalence of multisystem inflammatory syndrome associated with...
SIGNIFICANCE
Systemic corticosteroid use in children is rare because of known risks of adverse effects. The increased prevalence of multisystem inflammatory syndrome associated with COVID-19 may change this. It is critical for eye care providers to be aware of potential severe and rapid ocular hypertensive response to prevent irreversible vision loss.
PURPOSE
The purpose of this study was to report the importance of early monitoring of intraocular eye pressure in pediatric patients on systemic steroid medication.
CASE REPORT
A 6-year-old White boy presented with a complaint of headache for 2 weeks. He was on his 19th day of treatment for acute lymphoblastic leukemia with oral dexamethasone and chemotherapy. IOP at presentation was 65 mmHg in both eyes measured with iCare tonometry. Treatment with maximum topical glaucoma therapy reduced IOP to normal levels and eliminated the symptom of headache.
CONCLUSIONS
This case reminds eye care providers to be aware of the potential ocular hypertensive response to systemic steroid treatment and the importance of establishing early monitoring. With the emergence of multisystem inflammatory syndrome in children during the current COVID-19 pandemic, eye care providers may encounter more pediatric patients on systemic corticosteroid treatment than previously and should adjust their examinations appropriately.
Topics: COVID-19; Child; Glaucoma; Humans; Intraocular Pressure; Male; Ocular Hypertension; Pandemics; SARS-CoV-2; Steroids; Systemic Inflammatory Response Syndrome; Tonometry, Ocular
PubMed: 34460447
DOI: 10.1097/OPX.0000000000001747 -
Methods in Molecular Biology (Clifton,... 2018Glaucoma is a common optic neuropathy that leads to vision loss through the degeneration of retinal ganglion cells (RGCs) and their axons. RGC degeneration in glaucoma...
Glaucoma is a common optic neuropathy that leads to vision loss through the degeneration of retinal ganglion cells (RGCs) and their axons. RGC degeneration in glaucoma is associated with sensitivity to intraocular pressure (IOP) and elevated IOP (also known as ocular hypertension) is the primary modifiable risk factor. Ocular hypertension is the primary characteristic of rodent models for glaucoma research. Intracameral injection of microbeads has evolved as a preferred method of IOP elevation in rodents, particularly in mice. Here, we outline the protocol and method for the Microbead Occlusion Model in mice. We highlight the importance of anesthesia choice and the utilization of glass micropipettes in combination with a micromanipulator and microsyringe pump for the successful execution of the model.
Topics: Animals; Disease Models, Animal; Glaucoma; Injections, Intraocular; Mice; Microinjections; Microspheres; Ocular Hypertension; Retinal Ganglion Cells
PubMed: 29190015
DOI: 10.1007/978-1-4939-7407-8_3 -
Journal Francais D'ophtalmologie Mar 2017
Topics: Algorithms; Humans; Intravitreal Injections; Ocular Hypertension
PubMed: 28284658
DOI: 10.1016/j.jfo.2017.01.003 -
Eye (London, England) Mar 2011There exist ethnic differences in the prevalence of many ocular diseases. The ocular structures affected by these diseases can be imaged with devices that have increased... (Review)
Review
There exist ethnic differences in the prevalence of many ocular diseases. The ocular structures affected by these diseases can be imaged with devices that have increased in complexity over recent years. The purpose of this review is to explore what we mean by the term 'ethnicity' and what we know of ethnic differences in the structures of the eye that are commonly imaged. Finally, the implications of these ethnic differences are discussed in relation to the detection and monitoring of ocular disease that involves imaging instruments.
Topics: Diagnostic Imaging; Eye; Glaucoma; Humans; Ocular Hypertension
PubMed: 21164528
DOI: 10.1038/eye.2010.187 -
Journal of Glaucoma Aug 2013To evaluate published, randomized, prospective, parallel clinical trials utilizing currently approved glaucoma medications to determine what influence, if any, pigment... (Review)
Review
Review of the influence of pigment dispersion and exfoliation glaucoma diagnosis on intraocular pressure in clinical trials evaluating primary open-angle glaucoma and ocular hypertension.
PURPOSE
To evaluate published, randomized, prospective, parallel clinical trials utilizing currently approved glaucoma medications to determine what influence, if any, pigment dispersion (PD) or exfoliation glaucoma (XFG) patients had on the intraocular pressure.
METHODS
A review of clinical trial articles evaluating currently used topical glaucoma medicines. Articles were published between January 1995 and April 2011. If the articles met the inclusion/exclusion criteria, they were analyzed for PD and XFG.
RESULTS
Twenty-four articles were included, containing 49 treatment arms that included PD or XFG patients. The range of PD patients was 0% to 4.5%, with a mean of 1.5±0.9%, and for XFG patients 0% to 6.3%, with a mean of 2.2±2.1%. The treatment arms with PD showed a difference in the intraocular pressures (IOPs), for all studies analyzed together, for the baseline IOPs between clinical trials that did and did not include PD patients (8 AM IOPs: with PD 26.5±0.9 mm Hg and without PD 25.8±1.3 mm Hg, P=0.024; and diurnal curve mean IOPs: with PD 25.3±1.1 mm Hg and without PD 24.5±1.3 mm Hg, P=0.024). The XFG treatment arms showed that there was a difference in the IOPs for all studies analyzed together for diurnal baseline IOPs between clinical trials that did and did not include XFG patients (with XFG 25.2±1.2 mm Hg and without XFG 24.3±1.0 mm Hg, P=0.016).
CONCLUSIONS
Trial designs for prospective, parallel, glaucoma clinical studies that are performed in the United States generally can include PD and XFG patients with only a small impact on the IOP and a low number of such subjects enrolled.
Topics: Antihypertensive Agents; Clinical Trials as Topic; Exfoliation Syndrome; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Retinal Pigment Epithelium
PubMed: 22274674
DOI: 10.1097/IJG.0b013e31824484e6 -
Indian Journal of Ophthalmology Aug 2022A 43-year-old male patient presented with acute blurring of vision in both eyes associated with photophobia, redness, and mild pain following coronavirus disease 2019...
A 43-year-old male patient presented with acute blurring of vision in both eyes associated with photophobia, redness, and mild pain following coronavirus disease 2019 (Covid-19) infection. Clinical examination revealed extensive pigment dusting in the corneal endothelium and the trabecular meshwork with de-pigmentation bands in the iris periphery. The patient was managed empirically with topical anti-glaucoma medications for high intra-ocular pressure. The patient was prescribed systemic antibiotics including cephalosporins and amoxicillin for respiratory symptoms. A rare condition called bilateral acute de-pigmentation of iris (BADI) was suspected after ruling out common entities, for example, viral kerato-uveitis, pigment dispersion syndrome, and Fuchs iridocyclitis. Covid-19 infection and systemic antibiotics including cephalosporins have shown to cause BADI in the literature. The patient responded well with good outcome.
Topics: Adult; Anti-Bacterial Agents; COVID-19; Cephalosporins; Glaucoma; Humans; Iris; Male; Ocular Hypertension; Pigmentation; Pigmentation Disorders
PubMed: 35918989
DOI: 10.4103/ijo.IJO_75_22 -
Indian Journal of Ophthalmology Aug 2022
Topics: COVID-19; Humans; Iris; Iris Diseases; Ocular Hypertension
PubMed: 35918990
DOI: 10.4103/ijo.IJO_1297_22 -
Journal of Glaucoma Nov 2022Kahook Dual Blade (KDB) goniotomy can successfully lower intraocular pressure in some patients with uveitis-associated ocular hypertension or glaucoma.
PRCIS
Kahook Dual Blade (KDB) goniotomy can successfully lower intraocular pressure in some patients with uveitis-associated ocular hypertension or glaucoma.
PURPOSE
The purpose of this study was to report a case series of patients that underwent KDB goniotomy at a single institution for uveitis-associated ocular hypertension or glaucoma with an open angle.
METHODS
We performed a retrospective chart review of all patients with uveitis-associated ocular hypertension or glaucoma who underwent KDB goniotomy with trabecular meshwork excision alone or in combination with phacoemulsification cataract surgery at a single center between August 2017 and February 2020. The case series included 45 eyes of 37 patients. All eyes developed ocular hypertension refractory to maximum-tolerated medical therapy and required surgical intervention. Two eyes were excluded as they were lost to follow-up before 5 months postoperatively. Surgical success was defined as reaching the goal intraocular pressure or lower for each patient, including ongoing medical therapy.
RESULTS
At most recent follow-up, 25 (55.6%) of 45 eyes had an intraocular pressure that was at goal. Mean follow-up time was 15.2±12.1 months ranging from 0.5 to 36 months postoperatively, considering that patients were eliminated from the data analysis once they required a second surgery. The mean number of preoperative medications, including oral carbonic anhydrase inhibitors was 3.7±1.2 medications. The mean number of postoperative medications through the last clinic visit was 2.5±1.9 medications for a mean reduction of 1.2±1.6 medications ( P -value <0.0001*).
CONCLUSIONS
This larger case series shows that some patients with uveitis-associated ocular hypertension or glaucoma with an open angle may have success with KDB goniotomy.
Topics: Humans; Trabeculectomy; Glaucoma, Open-Angle; Intraocular Pressure; Retrospective Studies; Treatment Outcome; Glaucoma; Ocular Hypertension; Uveitis
PubMed: 35980845
DOI: 10.1097/IJG.0000000000002099 -
Archives of Ophthalmology (Chicago,... Jun 2002
Topics: Antihypertensive Agents; Clinical Trials as Topic; Glaucoma, Open-Angle; Humans; Intraocular Pressure; Ocular Hypertension; Ophthalmic Solutions; Risk Factors
PubMed: 12049591
DOI: 10.1001/archopht.120.6.829