Hc Agarwal

Ocular parameters in the subgroups of angle closure glaucoma.

Purpose: This study was conducted to compare anatomical parameters, thought to be responsible for causing angle closure glaucoma (ACG), among eyes having acute, subacute or chronic ACG.

Variables Affecting Test-retest Variability Of Heidelberg Retina Tomograph Ii Stereometric Parameters

PurposeTo study the test-retest variability of stereometric parameters on the Heidelberg Retina Tomograph II, a new clinical instrument for glaucoma management. MethodsIn a cross-sectional study of 24 consecutive cases of glaucoma and 26 healthy subjects, Heidelberg Retina Tomograph II stereometric parameters from five consecutive images were obtained for one randomly selected eye of each subject. Test-retest variability was studied using three different statistical methods (coefficient of variance, intraclass correlation coefficient, and Cronbach &agr;). The effect of age, diagnosis, linear cup/disc ratio, visual acuity, and refractive error on test-retest variability on HRT II was analyzed. The repeatability of Moorfields regression analysis and the baseline variability in the progression analysis software was also studied. ResultsUsing coefficient of variance, intraclass correlation coefficient, and Cronbach &agr;, the test-retest variability was found to be lowest for mean cup depth, cup area, cup/disc area ratio, vertical cup/disc ratio and rim/disc area ratio, in that order. Test-retest variability had a significant correlation with age (r = 0.33, P = 0.019) and visual acuity (r = −0.46, P = 0.005). Compared with eyes with astigmatism less than 1 D (mean coefficient of variance = 6.4 ± 4.9), the test-retest variability was higher (P = 0.044) in eyes with astigmatism more than 1D (mean coefficient of variance = 20.0 ± 22.6). Moorfields regression analysis was inconsistent in 52% cases. The average baseline change in progression analysis software was 0.076 ± 0.081. ConclusionThe test-retest variability of Heidelberg Retina Tomograph II stereometric parameters is comparable to that reported for the Heidelberg Retina Tomograph. Eyes with uncorrected astigmatism more than 1 D and poor visual acuity may have a higher variability of Heidelberg Retina Tomograph II stereometric parameters.

Corneal endothelial status in the subtypes of primary angle closure glaucoma

Purpose: To study the corneal endothelium and pachymetry in eyes with different subtypes of primary angle closure glaucoma (PACG), as compared to controls.

Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population

Purpose: A retrospective cohort study was undertaken to evaluate and compare the long‐term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population.

Mitomycin-C in Congenital Glaucoma

BACKGROUND AND OBJECTIVE To evaluate the adjunctive use of mitomycin-C (MMC) during trabeculotomy and trabeculectomy for eyes with high-risk congenital glaucoma. PATIENTS AND METHODS A prospective, randomized, double-blind study was performed to compare the effect of a single, 4-minute intraoperative exposure to 0.2 mg/ml (group 1) or 0.4 mg/ml (group 2) of MMC on trabeculotomy with trabeculectomy in 16 high-risk cases (30 eyes) of congenital glaucoma. RESULTS The preoperative and final postoperative intraocular pressures (IOPs) of the two groups did not differ significantly. At the final follow-up, IOP control (< 21 mm Hg) without medications was achieved in 60% of the eyes in group 1 and in 86.67% of the eyes in group 2 (P = 21). With medication, IOP control was achieved in 86.7% of the eyes of each group. In both groups, the rate of surgical failure was 13.3%. Avascular, thin, sharply demarcated blebs were noted in 33.3% of the eyes from group 1 and in 66.67% of those from group 2 (P = .14). Intraoperative and postoperative hyphema and postoperative hypotony were the complications encountered in both groups, whereas serous choroidal detachment and wound leakage were seen only in group 2. CONCLUSIONS Intraoperative MMC applied at a concentration of 0.2 mg/ml controlled postoperative IOP as effectively as a 0.4-mg/ml concentration in high-risk cases of congenital glaucoma, but with a lower incidence of complications and thin-walled blebs.

Comparison of symptomatic and asymptomatic, chronic, primary angle-closure glaucoma, open-angle glaucoma, and controls.

Purpose: To determine the clinical features and anatomic parameters in asymptomatic (creeping) and symptomatic, chronic, primary angle‐closure glaucoma (PACG) as compared with open‐angle glaucoma (OAG) and with control subjects with normal eyes. Methods: Forty consecutive patients with each of the following four types of eyes were studied (N = 160): eyes with symptomatic PACG, eyes with asymptomatic PACG, eyes with OAG, and the eyes of age‐, sex‐, and refraction‐matched control subjects. The refractive status, keratometry, pachymetry, corneal diameter, anterior chamber depth, lens thickness, axial length, and relative lens position were noted. The groups were compared using a paired t test and analysis of variance. Results: Patients with asymptomatic chronic PACG were older than patients in the symptomatic group, were more often men, and were more likely to have either diabetes mellitus or hypertension. Symptomatic chronic PACG eyes were more hypermetropic. Asymptomatic eyes had more iridotrabecular synechiae and minimal pupillary ruff atrophy as compared with the symptomatic eyes that had largely iridocorneal synechiae and large areas where the ruff was absent. All other clinical and anatomic parameters were statistically similar in the two groups, but differed significantly from OAG and control eyes. Conclusions: The ocular parameters of asymptomatic or creeping angle closure eyes show that these are significantly different from eyes having POAG. Asymptomatic and symptomatic chronic PACG eyes are structurally similar. Open‐angle glaucoma eyes and normal eyes were comparable, but differed from both the chronic angle‐closure glaucoma groups in having a larger corneal diameter, deeper anterior chamber, thinner lens, and a longer axial length. The symptomatic chronic PACG eyes showed more evidence of ischemic damage to the iris, and this could account for the symptoms reported by these patients.

Inter-instrument agreement and influence of central corneal thickness on measurements with Goldmann, pneumotonometer and noncontact tonometer in glaucomatous eyes.

PURPOSE This study was conducted to compare the intraocular pressure (IOP) measurements by the Goldman applanation tonometer (GAT), non contact tonometer (NCT) and the ocular blood flow (OBF) pneumotonometer in different IOP ranges in glaucomatous eyes. The effect of central corneal thickness (CCT) on IOP measurement in chronic glaucomatous eyes using the three different tonometers was also evaluated. MATERIALS AND METHODS IOP measurements of 130 eyes of primary glaucoma patients were performed using GAT by an ophthalmologist while NCT and OBF-pneumotonometer measurements were performed by an experienced optometrist. The IOP values were compared amongst the three instruments in the three different IOP ranges (0-18 mmHg, > 18 to 25 mmHg, > 25 mmHg). CCT was also measured in all patients. RESULTS The mean of paired difference between GAT and NCT was 0.9 +/- 3.1 mmHg while that between GAT and OBF-pneumotonometer was 0.3 +/- 3.4 mmHg. The OBF-pneumotonometer and NCT were more affected by corneal thickness (0.41 mmHg and 0.4 mmHg / 10 micro corneal thickness respectively) while GAT was the least affected by corneal thickness (0.3 mmHg / 10 micro corneal thickness) though the difference was not statistically significant ( P =0.42). CONCLUSION With appropriate correction for corneal thickness the NCT and OBF-pneumotonometer can be used as reliably as GAT in following up glaucomatous patients.

Effect of Changing From Concomitant Timolol Pilocarpine to Bimatoprost Monotherapy on Ocular Blood Flow and IOP in Primary Chronic Angle Closure Glaucoma

The aim of the present prospective masked study was to assess the effect of bimatoprost monotherapy on ocular blood flow and intraocular pressure (IOP) in eyes of primary chronic angle closure glaucoma patients already on concomitant timolol and pilocarpine. Thirty two patients of bilateral primary chronic angle closure glaucoma (PCACG) on topical timolol 0.5% twice a day and pilocarpine 2% three times daily were switched over to bimatoprost 0.03% once daily in both eyes. Intraocular pressure (IOP) and pulsatile ocular blood flow (POBF) were recorded before and after starting bimatoprost and were followed up every four weeks for three months. Bimatoprost had statistically significant (p < 0.05) mean IOP reduction from 19.3 +/- 6.6 to 13.5 +/- 4.5 mmHg (30.5%) and there was improvement from 858 +/- 260 to 1261 +/- 321 microL/min (46.8%) in mean pulsatile ocular blood flow (p < 0.05). Conjunctival hyperemia (32%) was the most common adverse effect of bimatoprost. Bimatoprost 0.03% monotherapy improved ocular blood flow and provided a better diurnal IOP control than concomitant timolol-pilocarpine in eyes with primary chronic angle closure glaucoma and was found to be well tolerated.

Evaluation of contact versus non-contact diode laser cyclophotocoagulation for refractory glaucomas using similar energy settings.

Purpose: To compare the efficacy of contact and non‐contact techniques of diode transscleral cyclophotocoagulation (TSCPC) in patients with refractory glaucoma in a prospective randomized manner.

Peak pressures: Crossover study of timolol and latanoprost

Purpose To compare the diurnal efficacy and action on peak intraocular pressures (IOP) of 0.005% latanoprost and 0.5% timolol as primary therapy in 60 eyes having dark brown irides with primary open angle glaucoma (POAG). Methods A prospective, comparative, observer-masked, crossover, interventional trial including the mean of both eyes of 30 patients with POAG who were randomly started on either latanoprost once daily or timolol twice daily. Three months after treatment with one drug, the second drug was substituted. A masked observer carried out diurnal assessments of IOP before the start of therapy and at 3 and 7 months. The fourth month was the washout period for the first drug. Results The average baseline IOP was 23.36 ± 2.14 mm Hg, which was reduced by 8.8 ± 2.2 mmHg with latanoprost (p<0.01) and by 6.75 ± 1.9 mm Hg with timolol (p=0.01). The reduction was greater for latanoprost (p<0.005). The average peak IOP at baseline was 27.6 ± 2.22 mmHg. The effective fall in IOP at the time of new peaks in subsequent diurnal recordings of IOP compared to the baseline diurnal curve was 8.9 mm Hg with latanoprost (p<0.005) and 5.77 mm Hg with timolol (p<0.01). This difference in IOP reduction between the two drugs was statistically significant (p<0.01). Latanoprost had a lower efficacy in peak IOP reduction in eyes with evening peak of IOP than in those with morning peak (p<0.005). The efficacy of timolol was lower overall compared to latanoprost, but was similar in all circadian rhythms. The shift in timing of IOP peak was greater with latanoprost compared to timolol (4.34 hours vs –0.72 hours, p<0.01). A total of 90% of patients on latanoprost and 33.3% on timolol achieved a reduction of >30% in baseline mean IOP. The average of the trough IOP recorded in each of the individual baseline IOP curves was 19.05 ± 2.05 mm Hg. Conclusions Greater mean and peak IOP reduction was achieved with latanoprost compared to timolol. Dampening of the circadian rhythm was better with latanoprost. Latanoprost appears to be more effective than timolol at all points in time with greater efficacy in eyes with morning peaks compared to evening peaks.