Darrell Wudunn - Academia.edu (original) (raw)

Papers by Darrell Wudunn

Research paper thumbnail of Effect of temporal corneal phacoemulsification on intraocular pressure in eyes with prior trabeculectomy with an antimetabolite1 , *1

Ophthalmology, 2004

To evaluate the effect of temporal corneal phacoemulsification on intraocular pressure (IOP) in e... more To evaluate the effect of temporal corneal phacoemulsification on intraocular pressure (IOP) in eyes after primary trabeculectomy with intraoperative fluorouracil (5-FU) or mitomycin C (MMC). Retrospective case-control study. Twenty-nine patients who were participants in a prospective randomized double-masked trial comparing the efficacies of intraoperative 5-FU and MMC and who underwent temporal corneal phacoemulsification after the primary trabeculectomy were matched to 29 patients enrolled in the same study who did not undergo cataract surgery. The 2 groups were matched for length of follow-up after the trabeculectomy and the antimetabolite used at the time of trabeculectomy. Comparisons of IOP, visual acuity (VA), and the number of glaucoma medications were made between the 2 groups and within the groups at various follow-up intervals to detect any statistically significant differences. Intraocular pressure before phacoemulsification and at various times postoperatively were compared with IOP in the control group at the matched follow-up times. The mean of all IOP measurements beyond 3 months after phacoemulsification for each subject was significantly higher than the prephacoemulsification IOP (11.8+/-4.2 vs. 8.7+/-4.5 mmHg; P = 0.00003, paired t test). In contrast, the mean IOP remained stable in the control group during the equivalent time period (9.6+/-3.5 vs. 9.1+/-3.1 mmHg; P = 0.42, paired t test). Postphacoemulsification IOP was significantly higher than the corresponding IOP in the time-matched control group (P<0.003, analysis of covariance). Mean VA improved significantly after the phacoemulsification (P = 0.0002) but remained stable in the control group. Temporal corneal phacoemulsification can affect long-term IOP control after trabeculectomy with 5-FU or MMC.

Research paper thumbnail of Combined penetrating keratoplasty and trabeculectomy with mitomycin C11None of the authors has any proprietary or commercial interest in any product mentioned in this article

Ophthalmology, 1999

To evaluate corneal graft survival and intraocular pressure control in eyes that have undergone c... more To evaluate corneal graft survival and intraocular pressure control in eyes that have undergone combined penetrating keratoplasty and trabeculectomy with mitomycin C (MMC). Retrospective noncomparative case series. Penetrating keratoplasty combined with trabeculectomy with MMC and other surgical procedures. Twenty-four eyes of 22 patients undergoing combined penetrating keratoplasty and trabeculectomy with mitomycin C. Corneal graft clarity and intraocular pressure control. The cumulative probability of corneal graft survival was 85% at 1 year and 60% at 2 years. The cumulative probability of adequate pressure control was 67% at 3 months, 55% at 12 months, and 50% at 24 months. The incidence of bleb failure was higher in cases involving additional concomitant procedures, such as anterior vitrectomy, lens implantation or exchange, and drainage tube implantation. Combined penetrating keratoplasty and trabeculectomy with mitomycin C is associated with good corneal graft survival but also a risk of early failure of intraocular pressure control. Other concomitant procedures during the combined penetrating keratoplasty/trabeculectomy may increase the risk of early bleb failure.

Research paper thumbnail of Efficacy of the Ahmed S2 Glaucoma Valve Compared with the Baerveldt 250-mm2 Glaucoma Implant

Ophthalmology, 2008

To compare the efficacy of the Ahmed S2 Glaucoma Valve with the Baerveldt 250-mm(2) Glaucoma Impl... more To compare the efficacy of the Ahmed S2 Glaucoma Valve with the Baerveldt 250-mm(2) Glaucoma Implant in the treatment of adult glaucoma. Comparative case series. Fifty-nine eyes of 59 patients who received the Ahmed S2 Glaucoma Valve and 133 eyes of 133 patients who received the Baerveldt 250-mm(2) Glaucoma Implant by the Indiana University Glaucoma Service from 1996 to 2003. Eyes that had previous drainage implant procedures were excluded from both groups. If both eyes of a single patient received an implant, the second eye to undergo implantation was excluded from the study. Kaplan-Meier survival with success defined as intraocular pressure (IOP) > 5 mmHg and < 22 mmHg and at least 20% reduction from preoperative IOP (with or without antiglaucoma medications) and without loss of light perception. Secondary outcome measures included intraocular pressure, visual acuity, number of glaucoma medications, and surgical complications. The 2 groups were similar with regards to age, gender, race, neovascular glaucoma diagnosis, number of prior ocular surgeries, preoperative IOP, and number of preoperative glaucoma medications. Mean durations of follow-up were 20.0 months for Ahmed eyes and 22.9 months for Baerveldt eyes. Cumulative successes in the Ahmed group were 0.73 at 1 year and 0.62 at 2 years, whereas cumulative successes in the Baerveldt group were 0.92 at 1 year and 0.85 at 2 years (Kaplan-Meier survival functions: P = 0.03, log rank test). Male gender, African descent, neovascular glaucoma, and Ahmed implantation were found to be significant predictors of failure. At last follow-up visit, eyes in the Ahmed group had a significantly higher mean IOP (19.8+/-9.5 vs. 15.8+/-7.9 mmHg, P = 0.003, t test) and more antiglaucoma medications (1.4+/-1.2 vs. 0.9+/-1.1 medications, P = 0.008, Mann-Whitney test) than eyes in the Baerveldt group. Two methods for avoiding hypotony after Baerveldt 250-mm(2) implantation had similar outcomes. Our study suggests that the Ahmed S2 Glaucoma Valve may be less effective at lowering IOP than the Baerveldt 250-mm(2) Glaucoma Implant.

Research paper thumbnail of Clinical Experience with the Baerveldt 250-mm2 Glaucoma Implant

Ophthalmology, 2006

To report the intermediate-term results of the Baerveldt 250-mm2 Glaucoma Implant for treatment o... more To report the intermediate-term results of the Baerveldt 250-mm2 Glaucoma Implant for treatment of adult glaucoma. Retrospective, noncomparative, interventional case series. One hundred eight adult patients (108 eyes) with glaucoma who received a Baerveldt 250-mm2 Glaucoma Implant. Implantation of the Baerveldt 250-mm2 Glaucoma Implant. Intraocular pressure (IOP), visual acuity, number of glaucoma medications, and surgical complications. Success was defined as IOP > or = 6 mmHg and < or = 21 mmHg (with or without antiglaucoma medications), without further glaucoma surgery, devastating complication, or loss of light perception attributable to drainage implantation. Mean age was 63.8+/-16.5 years. Mean postoperative follow-up was 22.8 months (range, 0.2-84.9; interquartile range, 3.9-36.3). Mean preoperative IOP was 36.3+/-13.0 mmHg, on 2.9+/-1.1 antiglaucoma medications. The mean postoperative IOP at final visit was 15.8+/-7.6 mmHg (P<0.0001, paired t test), on 0.8+/-1.0 antiglaucoma medications (P<0.0001, Wilcoxon test). Kaplan-Meier success rates were 0.92 (6 months, n = 81), 0.88 (12 months, n = 75), 0.84 (18 months, n = 68), and 0.79 (24 months, n = 61). The Baerveldt 250-mm2 Glaucoma Implant provides good intermediate-term success for the treatment of adult refractory glaucoma.

Research paper thumbnail of Outcomes of sequential tube shunts in complicated glaucoma

Ophthalmology, 2000

To evaluate intraocular pressure (IOP) control, change in visual acuity, and complications in eye... more To evaluate intraocular pressure (IOP) control, change in visual acuity, and complications in eyes that have undergone a second glaucoma tube shunt procedure. Retrospective, noncomparative case series. Twenty-two eyes of 22 patients that have undergone sequential tube implants for management of glaucoma. Parameters analyzed included IOP, visual acuity, and number of hypotensive agent before each shunt procedure and at last follow-up visit. The overall IOP lowering effect attributable to each tube shunt was calculated. Any ocular complications after the second tube shunt were recorded. Success was defined as an IOP between 6 and 21 mm Hg and a 20% reduction in IOP from the second tube shunt procedure. Qualified successes met one of these two requirements at the last follow-up visit. Total failures did not meet any of the above criteria, required additional surgical intervention to lower IOP, or both. Intraocular pressure control, visual acuity preservation, and complications. At the last follow-up visit, the average percent reduction in IOP from both tube shunt procedures was 42+/-21%. The average percent IOP reduction from the second tube shunt was 33+/-17%. Eleven (50%) patients met the criteria for success, 8 (36.4%) patients were qualified successes, and 3 (13.6%) were failures. The median number of hypotensive agents decreased from two to one. Ten patients experienced new or worse pseudophakic bullous keratopathy after the second tube shunt, six of whom underwent penetrating keratoplasty. Thirteen (59%) patients maintained visual acuity within one line of their second tube shunt pre-operative Snellen visual acuity. Seven (32%) patients lost more than 2 lines, and one patient lost light perception. Although corneal morbidity is a common complication, a second tube shunt does not cause higher-than-expected rates of other complications associated with tube shunt surgery. Eyes that undergo a second tube shunt procedure can achieve pressure control, require fewer hypotensive agents, and may maintain stable visual acuity.

Research paper thumbnail of Delayed suprachoroidal hemorrhage after glaucoma filtration procedures1 1The authors have no financial or proprietary interest in any aspect of this study

Ophthalmology, 2001

To determine the incidence of, risk factors for, and outcomes of delayed suprachoroidal hemorrhag... more To determine the incidence of, risk factors for, and outcomes of delayed suprachoroidal hemorrhage (DSCH) after glaucoma filtration surgery.

Research paper thumbnail of Conjunctival advancement versus nonincisional treatment for late-onset glaucoma filtering bleb leaks11None of the authors have any proprietary interests in any products mentioned in this article

Ophthalmology, 2002

To compare the outcomes of conjunctival advancement and nonincisional management of late-onset gl... more To compare the outcomes of conjunctival advancement and nonincisional management of late-onset glaucoma filtering bleb leak. Retrospective, nonrandomized, comparative interventional trial. Fifty-one eyes of 48 persons who underwent management of late-onset glaucoma filtering bleb leak from December 1986 through December 1999 were included. Thirty-seven eyes were included in the nonincisional treatment group (aqueous suppression with lubrication or patching, bandage contact lenses, cyanoacrylate glue, autologous blood injection, or a combination thereof) and 34 eyes were included in the surgical revision group (conjunctival advancement with preservation of the preexisting bleb). Twenty eyes underwent nonincisional treatment before surgical revision and were included in each treatment group. Retrospective chart review of bleb leaks occurring at least 2 months after trabeculectomy. Successful treatment was defined as the resolution of the bleb leak, a final intraocular pressure (IOP) of 21 mmHg or less, and no significant complications such as blebitis, endophthalmitis, or bleb dysesthesia requiring a bleb revision. Cumulative success of closure of the filtering bleb leak, complications resulting from the intervention, IOP before and after treatment, and number of glaucoma medications before and after treatment. The Kaplan-Meier cumulative probability of success at 12 and 24 months were 0.45 and 0.42, respectively, for the nonincisional treatment group and 0.80 and 0.80, respectively, for the surgical revision group. The overall difference between the cumulative success of surgical and nonincisional treatment was statistically significant (P = 0.0001, log-rank test). In the nonincisional treatment group, only 20 of 37 eyes (54%) achieved initial sealing of the bleb leak after the treatment, and of those, almost half (8/20) eventually failed. Reasons for failure included persistent or recurrent leak (n = 21), blebitis or endophthalmitis (n = 6, including 4 with persistent leak), and bleb dysesthesia (n = 2). All eyes in the surgical group achieved closure of the leak, however 7 eventually failed because of leak recurrence (n = 2), elevated IOP (n = 3), or bleb dysesthesia (n = 2), and 11 required additional glaucoma medications. Patients with late bleb leaks managed with conjunctival advancement were more likely to have successful outcomes and less likely to have serious intraocular infections than those managed more conservatively.

Research paper thumbnail of Visual contrast sensitivity in Alzheimer’s disease, mild cognitive impairment, and older adults with cognitive complaints

Neurobiology of Aging, 2013

Deficits in contrast sensitivity (CS) have been reported in Alzheimer&amp... more Deficits in contrast sensitivity (CS) have been reported in Alzheimer's disease (AD). However, the extent of these deficits in prodromal AD stages, including mild cognitive impairment (MCI) or even earlier, has not been investigated. In this study, CS was assessed using frequency doubling technology in older adults with AD (n = 10), amnestic MCI (n = 28), cognitive complaints without performance deficits (CC; n = 20), and healthy controls (HC; n = 29). The association between CS and cognition was also evaluated. Finally, the accuracy of CS measures for classifying MCI versus HC was evaluated. CS deficits were found in AD and MCI, while CC showed intermediate performance between MCI and HC. Upper right visual field CS showed the most significant difference among groups. CS was also associated with cognitive performance. Finally, CS measures accurately classified MCI versus HC. The CS deficits in AD and MCI, and intermediate performance in CC, indicate that these measures are sensitive to early AD-associated changes. Therefore, frequency doubling technology-based measures of CS may have promise as a novel AD biomarker.

Research paper thumbnail of Goldmann Applanation Tonometry and Dynamic Contour Tonometry are not Correlated With Central Corneal Thickness in Primary Open Angle Glaucoma

Journal of Glaucoma, 2011

To compare intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) and dynami... more To compare intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) and assess their relationship to central corneal thickness (CCT) in patients with primary open angle glaucoma (OAG). GAT, DCT, and CCT were assessed in 116 patients with OAG [mean age 65.9 (10.5); 59% female] participating in the Indianapolis Glaucoma Progression Study. GAT and DCT were measured in a randomized order followed by CCT (ultrasonic corneal pachymetry) during a single study visit. Bland-Altman plots were used to evaluate the limits of agreement between tonometery methodologies whereas multivariate regression analysis was used to evaluate the influence of CCT on GAT and DCT IOP measurements. IOP values obtained by DCT and GAT showed a strong positive correlation in patients with OAG (r=0.93; P<0.001). Mean IOP measured with DCT [18.4 (5.1) mm Hg] was significantly higher (P<0.001) than GAT IOP measurements [16.5 (4.5) mmHg]. CCT did not seem to influence either GAT or DCT measurements (r=0.1025, P=0.16; r=0.05, P=0.46), respectively. The Bland-Altman data showed that the amount of disagreement between IOP assessment techniques varied, suggesting a proportional bias. In this group of patients with OAG, there was a strong correlation between GAT and DCT measurements of IOP. IOP measured with DCT was consistently higher than IOP measured with GAT. Neither GAT nor DCT measurements were correlated with CCT. This data suggests that factors other than CCT may be involved in the tendency of DCT to produce higher measures of IOP than GAT.

Research paper thumbnail of Morphologic Classification of Filtering Blebs after Glaucoma Filtration Surgery: The Indiana Bleb Appearance Grading Scale

Journal of Glaucoma, 2003

To establish a new classification system for filtering blebs according to clinical morphologic pa... more To establish a new classification system for filtering blebs according to clinical morphologic parameters. The purpose of this classification system is to provide a uniform and objective assessment of bleb appearance and establish a framework system through which outcomes of filtration surgery may be better correlated to clinical morphology.

Research paper thumbnail of Surgical Drainage of Choroidal Effusions Following Glaucoma Surgery

Journal of Glaucoma, 2005

To determine the efficacy and safety of surgical drainage of choroidal effusions that occurs foll... more To determine the efficacy and safety of surgical drainage of choroidal effusions that occurs following glaucoma surgical procedures. Ninety-four choroidal drainage procedures performed at a single institution from 1986 to 2001 were reviewed retrospectively. Sixty-three eyes of 63 persons who underwent one or more drainage procedures for choroidal effusions that developed following glaucoma surgical procedures were identified. Eyes diagnosed with suprachoroidal hemorrhage prior to intervention were excluded. The cases were evaluated for resolution of choroidal detachment, post-drainage complications, visual acuity, and intraocular pressure before and after drainage. Indications for choroidal drainage included flat anterior chamber (25 eyes), decreased vision (22 eyes), and persistent choroidal detachment (16 eyes). Complete resolution of choroidal effusions was achieved in 37 (59%) eyes by 1 month, 51 (81%) eyes by 2 months, and in 57 (90%) eyes by 4 months following the initial drainage procedure. Overall success rate per procedure at 12 months was 77% (60/78). Compared with pre-drainage, intraocular pressure was higher at 6 and 12 months post-drainage (P < 0.0001) and visual acuity was better at 6 and 12 months post-drainage (logMAR, P < 0.0001). Twenty-seven (77%) of 35 phakic eyes developed cataracts during the 12 months post-drainage. Choroidal effusions that develop after glaucoma surgery can usually be drained with minimal complications. Surgical drainage is associated with improved vision and resolution of hypotony. Cataracts may progress following choroidal drainage but this may be due to the pre-drainage hypotony conditions.

Research paper thumbnail of Absorption of Brimonidine 0.1% and 0.15% Ophthalmic Solutions in the Aqueous Humor of Cataract Patients

Journal of Glaucoma, 2008

To determine and compare the human aqueous humor (AH) concentrations of 2 formulations of brimoni... more To determine and compare the human aqueous humor (AH) concentrations of 2 formulations of brimonidine ophthalmic solution [0.1% brimonidine Purite (BP) (average pH 7.4 to 8.0) and 0.15% BP (average pH 6.6 to 7.4)]. Single-center, randomized, controlled, double-masked, prospective study. Twenty-two patients were randomized to receive one 30-microL drop of 0.1% (n=11) or 0.15% BP (n=11) into the eye requiring routine cataract surgery. Solutions were administered approximately 40 to 55 minutes before surgery and AH samples (100 microL) were withdrawn from treated eyes at surgery initiation. Times from instillation to sampling were recorded. Brimonidine AH concentrations were assayed by high performance liquid chromatography-tandem mass spectrometry. Mean brimonidine AH concentrations sampled 52+/-9 and 54+/-8 minutes (P=0.57) after instillation of 0.1% and 0.15% BP solutions were 59.4+/-42.7 and 95.5+/-87.5 ng/mL, respectively (P=0.23). When normalized for concentration differences between the 2 formulations, AH concentrations were similar (P=0.85). Both solutions were well tolerated with no adverse events observed. Brimonidine AH concentrations in human eyes after single doses of 0.1% or 0.15% BP ophthalmic solutions were proportional to the respective concentrations of the brimonidine formulation instilled. The pH difference between these 2 formulations seemed to exert no effect on brimonidine bioavailability or the tolerability of the solution.

Research paper thumbnail of Ocular hypotensive efficacy of bimatoprost 0.03% and travoprost 0.004% in patients with glaucoma or ocular hypertension

Survey of ophthalmology, 2004

To evaluate the IOP-lowering efficacy of bimatoprost and travoprost for the treatment of glaucoma... more To evaluate the IOP-lowering efficacy of bimatoprost and travoprost for the treatment of glaucoma and ocular hypertension.

Research paper thumbnail of Optic nerve head (ONH) topographic analysis by stratus OCT in normal subjects: correlation to disc size, age, and ethnicity

Journal of glaucoma

To study optic nerve head (ONH) topography parameters measured by Stratus optical coherence tomog... more To study optic nerve head (ONH) topography parameters measured by Stratus optical coherence tomography (OCT) in normal subjects and to analyze ONH data for differences in relation to disc size, ethnicity, and age.

Research paper thumbnail of Levels of bimatoprost acid in the aqueous humour after bimatoprost treatment of patients with cataract

British Journal of Ophthalmology, 2007

To determine the aqueous humour concentration of the acid hydrolysis products of bimatoprost and ... more To determine the aqueous humour concentration of the acid hydrolysis products of bimatoprost and latanoprost after a single topical dose of bimatoprost 0.03% or latanoprost 0.005% in humans. Randomised, controlled, double-masked, prospective study. 48 eyes of 48 patients scheduled for routine cataract surgery were randomised in an 8:2:2 ratio to treatment with a single 30 mul drop of bimatoprost 0.03%, latanoprost 0.005% or placebo at 1, 3, 6 or 12 h before the scheduled cataract surgery. Aqueous humour samples were withdrawn at the beginning of the surgical procedure and analysed using high-performance liquid chromatography-tandem mass spectrometry. Bimatoprost acid (17-phenyl trinor prostaglandin F2alpha) was detected in aqueous samples at a mean concentration of 5.0 nM at hour 1, 6.7 nM at hour 3 and 1.9 nM at hour 6 after bimatoprost treatment. After latanoprost treatment, the mean concentration of latanoprost acid (13,14-dihydro-17-phenyl trinor prostaglandin F2alpha) in aqueous samples was 29.1 nM at hour 1, 41.3 nM at hour 3 and 2.5 nM at hour 6. Acid metabolites were below the limit of quantitation in all samples taken 12 h after dosing and in all samples from placebo-treated patients. None of the samples from latanoprost-treated patients contained quantifiable levels of non-metabolised latanoprost. Non-metabolised bimatoprost was detected in aqueous samples at a mean concentration of 6.6 nM at hour 1 and 2.4 nM at hour 3 after bimatoprost treatment. Low levels of bimatoprost acid were detected in aqueous humour samples from patients with cataract treated with a single dose of bimatoprost. Latanoprost acid concentrations in samples from patients treated with latanoprost were at least sixfold higher. These results suggest that bimatoprost acid in the aqueous humour does not sufficiently account for the ocular hypotensive efficacy of bimatoprost.

Research paper thumbnail of Up-regulation of Brain-Derived Neurotrophic Factor Expression by Brimonidine in Rat Retinal Ganglion Cells

Archives of Ophthalmology, 2002

... Up-regulation of Brain-Derived Neurotrophic Factor Expression by Brimonidine in Rat Retinal G... more ... Up-regulation of Brain-Derived Neurotrophic Factor Expression by Brimonidine in Rat Retinal Ganglion Cells Hua Gao, MD, PhD; Xiaoxi Qiao, MD, PhD; Louis B. Cantor, MD; Darrell WuDunn, MD, PhD. Arch Ophthalmol. 2002;120:797-803. ABSTRACT ...

Research paper thumbnail of Shunt revision versus additional tube shunt implantation after failed tube shunt surgery in refractory glaucoma

American Journal of Ophthalmology, 2000

To compare tube shunt revision with additional tube shunt after failed tube shunt surgery. We ide... more To compare tube shunt revision with additional tube shunt after failed tube shunt surgery. We identified 281 patients who underwent a primary tube shunt procedure from 1985 to 1998 at Indiana University and reviewed 33 eyes of 33 patients that had failed and required further surgery. Shunt revision was performed in 12, whereas an additional shunt was placed in 21 eyes. Intraocular pressure, antiglaucoma medications, visual acuity, and complications were noted. Success was defined as at least a 25% reduction in intraocular pressure that was deemed clinically adequate. Qualified success was defined as a 25% intraocular pressure reduction but with additional medications or a significant reduction in medications with stable intraocular pressure for preoperative intraocular pressure less than 21 mm Hg. Preoperative intraocular pressures (mean +/- 95% confidence interval) for the revision and additional tube groups were 28.8 +/- 5.8 mm Hg and 29.8 +/- 2.7 mm Hg (P =.73), with an average follow-up period of 25.2 months (range, 3 to 108 months) and 34.8 months (range, 6 to 84 months), respectively. Final mean intraocular pressure was 25.3 +/- 6.7 mm Hg for the revision group and 17.7 +/- 3.4 mm Hg for the additional tube group (P =.037). Forty-two percent in the revision group versus 62% in the additional tube group achieved at least a qualified success (P =.30, Fisher exact test). Corneal edema was a common complication, especially in the additional tube group. Limitations of this study include the small sample sizes and the uneven distribution of neovascular glaucoma between the two groups (six of 12 in the revision group vs two of 21 in the additional tube group; P =.015, Fisher exact test). Our series showed that after failed tube shunt surgery, an additional tube shunt offers better intraocular pressure control than revision by excision of an encapsulated bleb.

Research paper thumbnail of Central Corneal Thickness and Visual Field Loss in Fellow Eyes of Patients With Open-Angle Glaucoma

American Journal of Ophthalmology, 2007

To determine the relationship of central corneal thickness (CCT) and visual field loss between fe... more To determine the relationship of central corneal thickness (CCT) and visual field loss between fellow eyes in primary open-angle glaucoma. Retrospective, observational case series. Records review of glaucoma patients seen at local Veterans Administration eye clinic. Those with CCT measurements performed within one month of visual field testing were included. Patients were excluded with vision below 20/40 or disease that would affect visual fields. Intrasubject (between fellow eyes) differences in CCT, mean deviation (MD), and pattern standard deviation (PSD) were calculated by subtracting left eye value from right eye value. Of the 100 subjects (94 males), the Spearman correlation coefficient between intrasubject differences in CCT vs intrasubject differences in MD was 0.36 (P = .0003). The Spearman correlation for differences in CCT vs differences in PSD was -0.31 (P = .0019). Our study suggests that worse visual field changes tend to occur in the eye with the thinner cornea.

Research paper thumbnail of Reply

American Journal of Ophthalmology, 2013

Research paper thumbnail of A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy

American Journal of Ophthalmology, 2002

To compare the safety and efficacy of intraoperative 5-fluorouracil (5-FU) or Intraoperative mito... more To compare the safety and efficacy of intraoperative 5-fluorouracil (5-FU) or Intraoperative mitomycin C (MMC) in eyes undergoing primary trabeculectomy. Prospective double-masked randomized clinical trial. One hundred fifteen eyes of 103 patients with uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy or laser were prospectively randomized in a double-masked fashion to one of two treatment groups in a single institution setting. Subject's eyes underwent primary trabeculectomy with either topical 5-FU (50 mg/ml for 5 minutes) or topical MMC (0.2 mg/ml for 2 minutes). Primary outcome measures included the number of eyes achieving target pressures of 21, 18, 15, and 12 mm Hg at 6 and 12 months postoperatively. Secondary outcome measures included IOP, best-corrected visual acuity, complications, and interventions. Of the 115 eyes, 57 received 5-FU while 58 received MMC. A target IOP of 21 mm Hg at 6 months was achieved in 53 of 56 (95%) eyes in the 5-FU group and 54 of 57 (95%) eyes in the MMC group (P = 1.00). At 12 months, 45 of 48 (94%) eyes in the 5-FU group met a target IOP of 21 mm Hg while 48 of 54 (89%) eyes in the MMC group did (P =.49). The most common complications in each group were persistent choroidal effusions and bleb leak. Our study suggests that intraoperative topical 5-FU is at least as effective as intraoperative topical MMC in reducing IOP of eyes undergoing primary trabeculectomy.

Research paper thumbnail of Effect of temporal corneal phacoemulsification on intraocular pressure in eyes with prior trabeculectomy with an antimetabolite1 , *1

Ophthalmology, 2004

To evaluate the effect of temporal corneal phacoemulsification on intraocular pressure (IOP) in e... more To evaluate the effect of temporal corneal phacoemulsification on intraocular pressure (IOP) in eyes after primary trabeculectomy with intraoperative fluorouracil (5-FU) or mitomycin C (MMC). Retrospective case-control study. Twenty-nine patients who were participants in a prospective randomized double-masked trial comparing the efficacies of intraoperative 5-FU and MMC and who underwent temporal corneal phacoemulsification after the primary trabeculectomy were matched to 29 patients enrolled in the same study who did not undergo cataract surgery. The 2 groups were matched for length of follow-up after the trabeculectomy and the antimetabolite used at the time of trabeculectomy. Comparisons of IOP, visual acuity (VA), and the number of glaucoma medications were made between the 2 groups and within the groups at various follow-up intervals to detect any statistically significant differences. Intraocular pressure before phacoemulsification and at various times postoperatively were compared with IOP in the control group at the matched follow-up times. The mean of all IOP measurements beyond 3 months after phacoemulsification for each subject was significantly higher than the prephacoemulsification IOP (11.8+/-4.2 vs. 8.7+/-4.5 mmHg; P = 0.00003, paired t test). In contrast, the mean IOP remained stable in the control group during the equivalent time period (9.6+/-3.5 vs. 9.1+/-3.1 mmHg; P = 0.42, paired t test). Postphacoemulsification IOP was significantly higher than the corresponding IOP in the time-matched control group (P<0.003, analysis of covariance). Mean VA improved significantly after the phacoemulsification (P = 0.0002) but remained stable in the control group. Temporal corneal phacoemulsification can affect long-term IOP control after trabeculectomy with 5-FU or MMC.

Research paper thumbnail of Combined penetrating keratoplasty and trabeculectomy with mitomycin C11None of the authors has any proprietary or commercial interest in any product mentioned in this article

Ophthalmology, 1999

To evaluate corneal graft survival and intraocular pressure control in eyes that have undergone c... more To evaluate corneal graft survival and intraocular pressure control in eyes that have undergone combined penetrating keratoplasty and trabeculectomy with mitomycin C (MMC). Retrospective noncomparative case series. Penetrating keratoplasty combined with trabeculectomy with MMC and other surgical procedures. Twenty-four eyes of 22 patients undergoing combined penetrating keratoplasty and trabeculectomy with mitomycin C. Corneal graft clarity and intraocular pressure control. The cumulative probability of corneal graft survival was 85% at 1 year and 60% at 2 years. The cumulative probability of adequate pressure control was 67% at 3 months, 55% at 12 months, and 50% at 24 months. The incidence of bleb failure was higher in cases involving additional concomitant procedures, such as anterior vitrectomy, lens implantation or exchange, and drainage tube implantation. Combined penetrating keratoplasty and trabeculectomy with mitomycin C is associated with good corneal graft survival but also a risk of early failure of intraocular pressure control. Other concomitant procedures during the combined penetrating keratoplasty/trabeculectomy may increase the risk of early bleb failure.

Research paper thumbnail of Efficacy of the Ahmed S2 Glaucoma Valve Compared with the Baerveldt 250-mm2 Glaucoma Implant

Ophthalmology, 2008

To compare the efficacy of the Ahmed S2 Glaucoma Valve with the Baerveldt 250-mm(2) Glaucoma Impl... more To compare the efficacy of the Ahmed S2 Glaucoma Valve with the Baerveldt 250-mm(2) Glaucoma Implant in the treatment of adult glaucoma. Comparative case series. Fifty-nine eyes of 59 patients who received the Ahmed S2 Glaucoma Valve and 133 eyes of 133 patients who received the Baerveldt 250-mm(2) Glaucoma Implant by the Indiana University Glaucoma Service from 1996 to 2003. Eyes that had previous drainage implant procedures were excluded from both groups. If both eyes of a single patient received an implant, the second eye to undergo implantation was excluded from the study. Kaplan-Meier survival with success defined as intraocular pressure (IOP) > 5 mmHg and < 22 mmHg and at least 20% reduction from preoperative IOP (with or without antiglaucoma medications) and without loss of light perception. Secondary outcome measures included intraocular pressure, visual acuity, number of glaucoma medications, and surgical complications. The 2 groups were similar with regards to age, gender, race, neovascular glaucoma diagnosis, number of prior ocular surgeries, preoperative IOP, and number of preoperative glaucoma medications. Mean durations of follow-up were 20.0 months for Ahmed eyes and 22.9 months for Baerveldt eyes. Cumulative successes in the Ahmed group were 0.73 at 1 year and 0.62 at 2 years, whereas cumulative successes in the Baerveldt group were 0.92 at 1 year and 0.85 at 2 years (Kaplan-Meier survival functions: P = 0.03, log rank test). Male gender, African descent, neovascular glaucoma, and Ahmed implantation were found to be significant predictors of failure. At last follow-up visit, eyes in the Ahmed group had a significantly higher mean IOP (19.8+/-9.5 vs. 15.8+/-7.9 mmHg, P = 0.003, t test) and more antiglaucoma medications (1.4+/-1.2 vs. 0.9+/-1.1 medications, P = 0.008, Mann-Whitney test) than eyes in the Baerveldt group. Two methods for avoiding hypotony after Baerveldt 250-mm(2) implantation had similar outcomes. Our study suggests that the Ahmed S2 Glaucoma Valve may be less effective at lowering IOP than the Baerveldt 250-mm(2) Glaucoma Implant.

Research paper thumbnail of Clinical Experience with the Baerveldt 250-mm2 Glaucoma Implant

Ophthalmology, 2006

To report the intermediate-term results of the Baerveldt 250-mm2 Glaucoma Implant for treatment o... more To report the intermediate-term results of the Baerveldt 250-mm2 Glaucoma Implant for treatment of adult glaucoma. Retrospective, noncomparative, interventional case series. One hundred eight adult patients (108 eyes) with glaucoma who received a Baerveldt 250-mm2 Glaucoma Implant. Implantation of the Baerveldt 250-mm2 Glaucoma Implant. Intraocular pressure (IOP), visual acuity, number of glaucoma medications, and surgical complications. Success was defined as IOP > or = 6 mmHg and < or = 21 mmHg (with or without antiglaucoma medications), without further glaucoma surgery, devastating complication, or loss of light perception attributable to drainage implantation. Mean age was 63.8+/-16.5 years. Mean postoperative follow-up was 22.8 months (range, 0.2-84.9; interquartile range, 3.9-36.3). Mean preoperative IOP was 36.3+/-13.0 mmHg, on 2.9+/-1.1 antiglaucoma medications. The mean postoperative IOP at final visit was 15.8+/-7.6 mmHg (P<0.0001, paired t test), on 0.8+/-1.0 antiglaucoma medications (P<0.0001, Wilcoxon test). Kaplan-Meier success rates were 0.92 (6 months, n = 81), 0.88 (12 months, n = 75), 0.84 (18 months, n = 68), and 0.79 (24 months, n = 61). The Baerveldt 250-mm2 Glaucoma Implant provides good intermediate-term success for the treatment of adult refractory glaucoma.

Research paper thumbnail of Outcomes of sequential tube shunts in complicated glaucoma

Ophthalmology, 2000

To evaluate intraocular pressure (IOP) control, change in visual acuity, and complications in eye... more To evaluate intraocular pressure (IOP) control, change in visual acuity, and complications in eyes that have undergone a second glaucoma tube shunt procedure. Retrospective, noncomparative case series. Twenty-two eyes of 22 patients that have undergone sequential tube implants for management of glaucoma. Parameters analyzed included IOP, visual acuity, and number of hypotensive agent before each shunt procedure and at last follow-up visit. The overall IOP lowering effect attributable to each tube shunt was calculated. Any ocular complications after the second tube shunt were recorded. Success was defined as an IOP between 6 and 21 mm Hg and a 20% reduction in IOP from the second tube shunt procedure. Qualified successes met one of these two requirements at the last follow-up visit. Total failures did not meet any of the above criteria, required additional surgical intervention to lower IOP, or both. Intraocular pressure control, visual acuity preservation, and complications. At the last follow-up visit, the average percent reduction in IOP from both tube shunt procedures was 42+/-21%. The average percent IOP reduction from the second tube shunt was 33+/-17%. Eleven (50%) patients met the criteria for success, 8 (36.4%) patients were qualified successes, and 3 (13.6%) were failures. The median number of hypotensive agents decreased from two to one. Ten patients experienced new or worse pseudophakic bullous keratopathy after the second tube shunt, six of whom underwent penetrating keratoplasty. Thirteen (59%) patients maintained visual acuity within one line of their second tube shunt pre-operative Snellen visual acuity. Seven (32%) patients lost more than 2 lines, and one patient lost light perception. Although corneal morbidity is a common complication, a second tube shunt does not cause higher-than-expected rates of other complications associated with tube shunt surgery. Eyes that undergo a second tube shunt procedure can achieve pressure control, require fewer hypotensive agents, and may maintain stable visual acuity.

Research paper thumbnail of Delayed suprachoroidal hemorrhage after glaucoma filtration procedures1 1The authors have no financial or proprietary interest in any aspect of this study

Ophthalmology, 2001

To determine the incidence of, risk factors for, and outcomes of delayed suprachoroidal hemorrhag... more To determine the incidence of, risk factors for, and outcomes of delayed suprachoroidal hemorrhage (DSCH) after glaucoma filtration surgery.

Research paper thumbnail of Conjunctival advancement versus nonincisional treatment for late-onset glaucoma filtering bleb leaks11None of the authors have any proprietary interests in any products mentioned in this article

Ophthalmology, 2002

To compare the outcomes of conjunctival advancement and nonincisional management of late-onset gl... more To compare the outcomes of conjunctival advancement and nonincisional management of late-onset glaucoma filtering bleb leak. Retrospective, nonrandomized, comparative interventional trial. Fifty-one eyes of 48 persons who underwent management of late-onset glaucoma filtering bleb leak from December 1986 through December 1999 were included. Thirty-seven eyes were included in the nonincisional treatment group (aqueous suppression with lubrication or patching, bandage contact lenses, cyanoacrylate glue, autologous blood injection, or a combination thereof) and 34 eyes were included in the surgical revision group (conjunctival advancement with preservation of the preexisting bleb). Twenty eyes underwent nonincisional treatment before surgical revision and were included in each treatment group. Retrospective chart review of bleb leaks occurring at least 2 months after trabeculectomy. Successful treatment was defined as the resolution of the bleb leak, a final intraocular pressure (IOP) of 21 mmHg or less, and no significant complications such as blebitis, endophthalmitis, or bleb dysesthesia requiring a bleb revision. Cumulative success of closure of the filtering bleb leak, complications resulting from the intervention, IOP before and after treatment, and number of glaucoma medications before and after treatment. The Kaplan-Meier cumulative probability of success at 12 and 24 months were 0.45 and 0.42, respectively, for the nonincisional treatment group and 0.80 and 0.80, respectively, for the surgical revision group. The overall difference between the cumulative success of surgical and nonincisional treatment was statistically significant (P = 0.0001, log-rank test). In the nonincisional treatment group, only 20 of 37 eyes (54%) achieved initial sealing of the bleb leak after the treatment, and of those, almost half (8/20) eventually failed. Reasons for failure included persistent or recurrent leak (n = 21), blebitis or endophthalmitis (n = 6, including 4 with persistent leak), and bleb dysesthesia (n = 2). All eyes in the surgical group achieved closure of the leak, however 7 eventually failed because of leak recurrence (n = 2), elevated IOP (n = 3), or bleb dysesthesia (n = 2), and 11 required additional glaucoma medications. Patients with late bleb leaks managed with conjunctival advancement were more likely to have successful outcomes and less likely to have serious intraocular infections than those managed more conservatively.

Research paper thumbnail of Visual contrast sensitivity in Alzheimer’s disease, mild cognitive impairment, and older adults with cognitive complaints

Neurobiology of Aging, 2013

Deficits in contrast sensitivity (CS) have been reported in Alzheimer&amp... more Deficits in contrast sensitivity (CS) have been reported in Alzheimer's disease (AD). However, the extent of these deficits in prodromal AD stages, including mild cognitive impairment (MCI) or even earlier, has not been investigated. In this study, CS was assessed using frequency doubling technology in older adults with AD (n = 10), amnestic MCI (n = 28), cognitive complaints without performance deficits (CC; n = 20), and healthy controls (HC; n = 29). The association between CS and cognition was also evaluated. Finally, the accuracy of CS measures for classifying MCI versus HC was evaluated. CS deficits were found in AD and MCI, while CC showed intermediate performance between MCI and HC. Upper right visual field CS showed the most significant difference among groups. CS was also associated with cognitive performance. Finally, CS measures accurately classified MCI versus HC. The CS deficits in AD and MCI, and intermediate performance in CC, indicate that these measures are sensitive to early AD-associated changes. Therefore, frequency doubling technology-based measures of CS may have promise as a novel AD biomarker.

Research paper thumbnail of Goldmann Applanation Tonometry and Dynamic Contour Tonometry are not Correlated With Central Corneal Thickness in Primary Open Angle Glaucoma

Journal of Glaucoma, 2011

To compare intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) and dynami... more To compare intraocular pressure (IOP) measured by Goldmann applanation tonometry (GAT) and dynamic contour tonometry (DCT) and assess their relationship to central corneal thickness (CCT) in patients with primary open angle glaucoma (OAG). GAT, DCT, and CCT were assessed in 116 patients with OAG [mean age 65.9 (10.5); 59% female] participating in the Indianapolis Glaucoma Progression Study. GAT and DCT were measured in a randomized order followed by CCT (ultrasonic corneal pachymetry) during a single study visit. Bland-Altman plots were used to evaluate the limits of agreement between tonometery methodologies whereas multivariate regression analysis was used to evaluate the influence of CCT on GAT and DCT IOP measurements. IOP values obtained by DCT and GAT showed a strong positive correlation in patients with OAG (r=0.93; P<0.001). Mean IOP measured with DCT [18.4 (5.1) mm Hg] was significantly higher (P<0.001) than GAT IOP measurements [16.5 (4.5) mmHg]. CCT did not seem to influence either GAT or DCT measurements (r=0.1025, P=0.16; r=0.05, P=0.46), respectively. The Bland-Altman data showed that the amount of disagreement between IOP assessment techniques varied, suggesting a proportional bias. In this group of patients with OAG, there was a strong correlation between GAT and DCT measurements of IOP. IOP measured with DCT was consistently higher than IOP measured with GAT. Neither GAT nor DCT measurements were correlated with CCT. This data suggests that factors other than CCT may be involved in the tendency of DCT to produce higher measures of IOP than GAT.

Research paper thumbnail of Morphologic Classification of Filtering Blebs after Glaucoma Filtration Surgery: The Indiana Bleb Appearance Grading Scale

Journal of Glaucoma, 2003

To establish a new classification system for filtering blebs according to clinical morphologic pa... more To establish a new classification system for filtering blebs according to clinical morphologic parameters. The purpose of this classification system is to provide a uniform and objective assessment of bleb appearance and establish a framework system through which outcomes of filtration surgery may be better correlated to clinical morphology.

Research paper thumbnail of Surgical Drainage of Choroidal Effusions Following Glaucoma Surgery

Journal of Glaucoma, 2005

To determine the efficacy and safety of surgical drainage of choroidal effusions that occurs foll... more To determine the efficacy and safety of surgical drainage of choroidal effusions that occurs following glaucoma surgical procedures. Ninety-four choroidal drainage procedures performed at a single institution from 1986 to 2001 were reviewed retrospectively. Sixty-three eyes of 63 persons who underwent one or more drainage procedures for choroidal effusions that developed following glaucoma surgical procedures were identified. Eyes diagnosed with suprachoroidal hemorrhage prior to intervention were excluded. The cases were evaluated for resolution of choroidal detachment, post-drainage complications, visual acuity, and intraocular pressure before and after drainage. Indications for choroidal drainage included flat anterior chamber (25 eyes), decreased vision (22 eyes), and persistent choroidal detachment (16 eyes). Complete resolution of choroidal effusions was achieved in 37 (59%) eyes by 1 month, 51 (81%) eyes by 2 months, and in 57 (90%) eyes by 4 months following the initial drainage procedure. Overall success rate per procedure at 12 months was 77% (60/78). Compared with pre-drainage, intraocular pressure was higher at 6 and 12 months post-drainage (P < 0.0001) and visual acuity was better at 6 and 12 months post-drainage (logMAR, P < 0.0001). Twenty-seven (77%) of 35 phakic eyes developed cataracts during the 12 months post-drainage. Choroidal effusions that develop after glaucoma surgery can usually be drained with minimal complications. Surgical drainage is associated with improved vision and resolution of hypotony. Cataracts may progress following choroidal drainage but this may be due to the pre-drainage hypotony conditions.

Research paper thumbnail of Absorption of Brimonidine 0.1% and 0.15% Ophthalmic Solutions in the Aqueous Humor of Cataract Patients

Journal of Glaucoma, 2008

To determine and compare the human aqueous humor (AH) concentrations of 2 formulations of brimoni... more To determine and compare the human aqueous humor (AH) concentrations of 2 formulations of brimonidine ophthalmic solution [0.1% brimonidine Purite (BP) (average pH 7.4 to 8.0) and 0.15% BP (average pH 6.6 to 7.4)]. Single-center, randomized, controlled, double-masked, prospective study. Twenty-two patients were randomized to receive one 30-microL drop of 0.1% (n=11) or 0.15% BP (n=11) into the eye requiring routine cataract surgery. Solutions were administered approximately 40 to 55 minutes before surgery and AH samples (100 microL) were withdrawn from treated eyes at surgery initiation. Times from instillation to sampling were recorded. Brimonidine AH concentrations were assayed by high performance liquid chromatography-tandem mass spectrometry. Mean brimonidine AH concentrations sampled 52+/-9 and 54+/-8 minutes (P=0.57) after instillation of 0.1% and 0.15% BP solutions were 59.4+/-42.7 and 95.5+/-87.5 ng/mL, respectively (P=0.23). When normalized for concentration differences between the 2 formulations, AH concentrations were similar (P=0.85). Both solutions were well tolerated with no adverse events observed. Brimonidine AH concentrations in human eyes after single doses of 0.1% or 0.15% BP ophthalmic solutions were proportional to the respective concentrations of the brimonidine formulation instilled. The pH difference between these 2 formulations seemed to exert no effect on brimonidine bioavailability or the tolerability of the solution.

Research paper thumbnail of Ocular hypotensive efficacy of bimatoprost 0.03% and travoprost 0.004% in patients with glaucoma or ocular hypertension

Survey of ophthalmology, 2004

To evaluate the IOP-lowering efficacy of bimatoprost and travoprost for the treatment of glaucoma... more To evaluate the IOP-lowering efficacy of bimatoprost and travoprost for the treatment of glaucoma and ocular hypertension.

Research paper thumbnail of Optic nerve head (ONH) topographic analysis by stratus OCT in normal subjects: correlation to disc size, age, and ethnicity

Journal of glaucoma

To study optic nerve head (ONH) topography parameters measured by Stratus optical coherence tomog... more To study optic nerve head (ONH) topography parameters measured by Stratus optical coherence tomography (OCT) in normal subjects and to analyze ONH data for differences in relation to disc size, ethnicity, and age.

Research paper thumbnail of Levels of bimatoprost acid in the aqueous humour after bimatoprost treatment of patients with cataract

British Journal of Ophthalmology, 2007

To determine the aqueous humour concentration of the acid hydrolysis products of bimatoprost and ... more To determine the aqueous humour concentration of the acid hydrolysis products of bimatoprost and latanoprost after a single topical dose of bimatoprost 0.03% or latanoprost 0.005% in humans. Randomised, controlled, double-masked, prospective study. 48 eyes of 48 patients scheduled for routine cataract surgery were randomised in an 8:2:2 ratio to treatment with a single 30 mul drop of bimatoprost 0.03%, latanoprost 0.005% or placebo at 1, 3, 6 or 12 h before the scheduled cataract surgery. Aqueous humour samples were withdrawn at the beginning of the surgical procedure and analysed using high-performance liquid chromatography-tandem mass spectrometry. Bimatoprost acid (17-phenyl trinor prostaglandin F2alpha) was detected in aqueous samples at a mean concentration of 5.0 nM at hour 1, 6.7 nM at hour 3 and 1.9 nM at hour 6 after bimatoprost treatment. After latanoprost treatment, the mean concentration of latanoprost acid (13,14-dihydro-17-phenyl trinor prostaglandin F2alpha) in aqueous samples was 29.1 nM at hour 1, 41.3 nM at hour 3 and 2.5 nM at hour 6. Acid metabolites were below the limit of quantitation in all samples taken 12 h after dosing and in all samples from placebo-treated patients. None of the samples from latanoprost-treated patients contained quantifiable levels of non-metabolised latanoprost. Non-metabolised bimatoprost was detected in aqueous samples at a mean concentration of 6.6 nM at hour 1 and 2.4 nM at hour 3 after bimatoprost treatment. Low levels of bimatoprost acid were detected in aqueous humour samples from patients with cataract treated with a single dose of bimatoprost. Latanoprost acid concentrations in samples from patients treated with latanoprost were at least sixfold higher. These results suggest that bimatoprost acid in the aqueous humour does not sufficiently account for the ocular hypotensive efficacy of bimatoprost.

Research paper thumbnail of Up-regulation of Brain-Derived Neurotrophic Factor Expression by Brimonidine in Rat Retinal Ganglion Cells

Archives of Ophthalmology, 2002

... Up-regulation of Brain-Derived Neurotrophic Factor Expression by Brimonidine in Rat Retinal G... more ... Up-regulation of Brain-Derived Neurotrophic Factor Expression by Brimonidine in Rat Retinal Ganglion Cells Hua Gao, MD, PhD; Xiaoxi Qiao, MD, PhD; Louis B. Cantor, MD; Darrell WuDunn, MD, PhD. Arch Ophthalmol. 2002;120:797-803. ABSTRACT ...

Research paper thumbnail of Shunt revision versus additional tube shunt implantation after failed tube shunt surgery in refractory glaucoma

American Journal of Ophthalmology, 2000

To compare tube shunt revision with additional tube shunt after failed tube shunt surgery. We ide... more To compare tube shunt revision with additional tube shunt after failed tube shunt surgery. We identified 281 patients who underwent a primary tube shunt procedure from 1985 to 1998 at Indiana University and reviewed 33 eyes of 33 patients that had failed and required further surgery. Shunt revision was performed in 12, whereas an additional shunt was placed in 21 eyes. Intraocular pressure, antiglaucoma medications, visual acuity, and complications were noted. Success was defined as at least a 25% reduction in intraocular pressure that was deemed clinically adequate. Qualified success was defined as a 25% intraocular pressure reduction but with additional medications or a significant reduction in medications with stable intraocular pressure for preoperative intraocular pressure less than 21 mm Hg. Preoperative intraocular pressures (mean +/- 95% confidence interval) for the revision and additional tube groups were 28.8 +/- 5.8 mm Hg and 29.8 +/- 2.7 mm Hg (P =.73), with an average follow-up period of 25.2 months (range, 3 to 108 months) and 34.8 months (range, 6 to 84 months), respectively. Final mean intraocular pressure was 25.3 +/- 6.7 mm Hg for the revision group and 17.7 +/- 3.4 mm Hg for the additional tube group (P =.037). Forty-two percent in the revision group versus 62% in the additional tube group achieved at least a qualified success (P =.30, Fisher exact test). Corneal edema was a common complication, especially in the additional tube group. Limitations of this study include the small sample sizes and the uneven distribution of neovascular glaucoma between the two groups (six of 12 in the revision group vs two of 21 in the additional tube group; P =.015, Fisher exact test). Our series showed that after failed tube shunt surgery, an additional tube shunt offers better intraocular pressure control than revision by excision of an encapsulated bleb.

Research paper thumbnail of Central Corneal Thickness and Visual Field Loss in Fellow Eyes of Patients With Open-Angle Glaucoma

American Journal of Ophthalmology, 2007

To determine the relationship of central corneal thickness (CCT) and visual field loss between fe... more To determine the relationship of central corneal thickness (CCT) and visual field loss between fellow eyes in primary open-angle glaucoma. Retrospective, observational case series. Records review of glaucoma patients seen at local Veterans Administration eye clinic. Those with CCT measurements performed within one month of visual field testing were included. Patients were excluded with vision below 20/40 or disease that would affect visual fields. Intrasubject (between fellow eyes) differences in CCT, mean deviation (MD), and pattern standard deviation (PSD) were calculated by subtracting left eye value from right eye value. Of the 100 subjects (94 males), the Spearman correlation coefficient between intrasubject differences in CCT vs intrasubject differences in MD was 0.36 (P = .0003). The Spearman correlation for differences in CCT vs differences in PSD was -0.31 (P = .0019). Our study suggests that worse visual field changes tend to occur in the eye with the thinner cornea.

Research paper thumbnail of Reply

American Journal of Ophthalmology, 2013

Research paper thumbnail of A prospective randomized trial comparing intraoperative 5-fluorouracil vs mitomycin C in primary trabeculectomy

American Journal of Ophthalmology, 2002

To compare the safety and efficacy of intraoperative 5-fluorouracil (5-FU) or Intraoperative mito... more To compare the safety and efficacy of intraoperative 5-fluorouracil (5-FU) or Intraoperative mitomycin C (MMC) in eyes undergoing primary trabeculectomy. Prospective double-masked randomized clinical trial. One hundred fifteen eyes of 103 patients with uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy or laser were prospectively randomized in a double-masked fashion to one of two treatment groups in a single institution setting. Subject's eyes underwent primary trabeculectomy with either topical 5-FU (50 mg/ml for 5 minutes) or topical MMC (0.2 mg/ml for 2 minutes). Primary outcome measures included the number of eyes achieving target pressures of 21, 18, 15, and 12 mm Hg at 6 and 12 months postoperatively. Secondary outcome measures included IOP, best-corrected visual acuity, complications, and interventions. Of the 115 eyes, 57 received 5-FU while 58 received MMC. A target IOP of 21 mm Hg at 6 months was achieved in 53 of 56 (95%) eyes in the 5-FU group and 54 of 57 (95%) eyes in the MMC group (P = 1.00). At 12 months, 45 of 48 (94%) eyes in the 5-FU group met a target IOP of 21 mm Hg while 48 of 54 (89%) eyes in the MMC group did (P =.49). The most common complications in each group were persistent choroidal effusions and bleb leak. Our study suggests that intraoperative topical 5-FU is at least as effective as intraoperative topical MMC in reducing IOP of eyes undergoing primary trabeculectomy.