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ABSTRACT: To examine the development and management of glaucoma in patients with ocular chemical burns.
Retrospective, observational case series.
setting: University of Washington Eye Clinics. patient population: Twenty-nine eyes (18 patients) with ocular chemical burns seen between 1997 and 2010 with a minimum of 3 months of follow-up. observation procedure: Eyes were graded using the Roper-Hall scale. main outcome measures: Long-term use of glaucoma medications (3 months or more) and need for glaucoma surgery.
The mean age was 45 ± 17 years, with a mean follow-up of 75 ± 47 months (median, 66 months). Roper-Hall grade III or IV eyes (n = 20) had significantly higher intraocular pressure at presentation (35.9 vs 16.4 mm Hg; P = .001) and over follow-up were more likely to require long-term glaucoma medications (P = .003) or to undergo glaucoma surgery (P = .016) than Roper-Hall grade I or II eyes. Thirteen eyes (12 Roper-Hall grade III or IV) underwent glaucoma surgery. Eight eyes underwent glaucoma tube implant surgery; 4 required at least 1 revision. Seven eyes underwent diode laser cyclophotocoagulation; 4 required repeat treatment. Most (89%) eyes had controlled intraocular pressure at the last follow-up. However, 76% of eyes with visual acuity of 20/200 or worse at initial evaluation did not have improved vision at the last follow-up.
Eyes with Roper-Hall grade III or IV ocular chemical burns were more likely to have glaucoma and to require surgery for it. Outcomes of glaucoma management generally were good, although tube implant surgeries often had complications requiring revision.
American journal of ophthalmology 05/2012; 154(3):481-485.e1. · 3.83 Impact Factor
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ABSTRACT: To evaluate continued visual field (VF) progression in eyes with prior VF progression from open-angle glaucoma, using event-based criteria.
Retrospective observational case series of 70 eyes (70 patients) with open-angle glaucoma, treated for at least 2 years, that had earlier shown 1 step of VF progression. Further VF progression required a worsening of 3 adjacent points at the same location on 2 consecutive VF tests. Potential risk factors for continued progression were evaluated.
The mean follow-up was 127±43 months. Thirty-seven eyes (55%) continued to progress. At 5, 10, and 15 years after the initial VF, the Kaplan-Meier estimate of the risk of developing 2 steps of progression was 18%, 53%, and 71%. A shorter time to the first step of progression was significantly associated with further progression (P<0.001), as was slope of the VF mean deviation (P<0.001) and pattern standard deviation (P=0.041). Eyes with further progression had higher mean IOP after the first step of progression (P=0.026). Among 37 eyes with 2 steps of progression, the estimate of the risk of progressing further was 32% at 10 years after the initial VF.
Eyes with a relatively shorter time to initial VF progression from open-angle glaucoma are likely to continue to progress over long-term follow-up. More aggressive treatment in such eyes might reduce the likelihood of further VF progression.
Journal of glaucoma 02/2010; 19(9):598-603. · 1.74 Impact Factor
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Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society 12/2009; 29(4):358-62. · 1.09 Impact Factor
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ABSTRACT: An 18-year-old woman developed pancreatitis and a thrombotic microangiopathy but no electrolyte abnormalities. She required intubation hours after admission and was not able to communicate for 8 days. Upon recovering consciousness, she reported severely impaired vision in both eyes, but ophthalmologic evaluation and neuroimaging were not obtained until several days later. Ophthalmologic examination documented retinal infarcts and profound binocular vision loss with hourglass bilateral homonymous hemianopic visual field loss. MRI showed signal abnormalities restricted to the area of the lateral geniculate bodies (LGBs) with characteristics most suggestive of hemorrhagic infarction. Very few cases of isolated bilateral LBG lesions have been reported. Damage has been attributed to myelinolysis from osmotic demyelination or to infarction from microvascular occlusion. This case conforms more to microvascular infarction. The vulnerability of the LGB to selective microvascular infarction may be based on a combination of its unique architecture and high metabolic demand.
Journal of Neuro-Ophthalmology 10/2007; 27(3):169-75. · 1.45 Impact Factor
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ABSTRACT: To evaluate noncompliance with follow-up in normal-tension glaucoma (NTG) suspects.
Retrospective cohort study.
We reviewed 203 patient charts at a university eye clinic, identified as NTG suspects from a database of optic disk photographs. Noncompliance was defined as less than one year of follow-up and/or fewer than two completed visual field (VF) tests.
Twenty-two patients (11%) were excluded because at least two VF tests were not ordered. The 181 patients analyzed included 45 (25%) non-Whites and 16 (9%) non-English speakers. Eighty-three patients (46%) were noncompliant. These patients were significantly younger (50.5 +/- 15.0 years vs 55.1 +/- 12.8 years; P = .028), were more likely to speak English (P = .023), and were more likely to have no or unknown health insurance (P < .001).
Almost half of NTG suspects lacked appropriate follow-up. Lack of health insurance may be a significant barrier to compliance with follow-up in this population.
American Journal of Ophthalmology 08/2007; 144(2):310-1. · 4.22 Impact Factor
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ABSTRACT: To compare the intraocular pressure (IOP) of patients infected with human immunodeficiency virus (HIV) and treated with highly active antiretroviral therapy (HAART) to a control group and to determine whether HAART reverses the previously reported reduction in IOP associated with HIV infection.
Retrospective case control study.
Review of patients with HIV infection on HAART compared with a matched control group.
Among 64 patients and 56 control subjects, no significant difference in IOP was found (P =.520), nor was correlation noted between IOP and either CD4+ T-lymphocyte counts, or viral load.
When HIV infection is treated with HAART, IOP is not significantly different from that of control subjects.
American Journal of Ophthalmology 09/2003; 136(2):360-1. · 4.22 Impact Factor
