Manish Panday

Outcomes of bleb excision with free autologous conjunctival patch grafting for bleb leak and hypotony after glaucoma filtering surgery.

PurposeTo determine the outcomes of bleb excision with free autologous conjunctival patch grafting for bleb leak and hypotony after glaucoma filtering surgery. Patients and MethodsRetrospective, consecutive, noncomparative case series. Outcome measures were closure of bleb leak, intraocular pressure (IOP), and best corrected visual acuity after patch grafting and complications from intervention. Complete success was defined as resolution of the bleb leak or hypotony, with IOP between 6 and 18 mm Hg. ResultsFifty-eight eyes (57 patients) were included: 51 with bleb leaks and 7 with hypotonous maculopathy without a bleb leak. Eight eyes required scleral flap resuturing and 2 required scleral patch grafts in addition to free conjunctival patch grafting. The mean postoperative follow-up period was 112.65±128.74 weeks (median 80.0 wk). At 6 weeks and final follow-up, the IOP increased from baseline of 4.41±4.61 mm Hg (median 4.00 mm Hg) to 11.98±6.25 mm Hg (median 11.50 mm Hg) (P<0.001) and 12.67±4.83 mm Hg (median 12.00) (P<0.001), respectively. Visual acuity increased from baseline of 0.87±0.95 logMAR (median 0.60) to 0.65±0.80 logMAR (median 0.48) (P=0.001) and 0.76±0.93 logMAR (median 0.48) (P=0.35) at 6 weeks and last follow–up, respectively. The complete and qualified success rates at the final follow-up were 75.8% and 79.3%, respectively. Failure events occurred in 12 (20.6%) eyes, including 2 eyes with hypotony, 5 with raised IOP, and 3 with postoperative bleb leaks. ConclusionsFree conjunctival patch grafting is a successful procedure for bleb repair and hypotony providing moderate IOP control with minimal postoperative complications in majority of patients.

Six-year incidence of angle-closure disease in a South Indian population: the Chennai Eye Disease Incidence Study.

PURPOSE To estimate the 6-year incidence of primary angle-closure (PAC) disease among adult population aged 40 years and older from rural and urban south India. DESIGN Population-based longitudinal study. METHODS A complete ophthalmologic examination, including applanation tonometry, gonioscopy, biometry, stereoscopic fundus examination, and automated perimetry was performed at both baseline and at the 6-year follow up at base hospital. Incident PAC disease was defined as the development of PAC disease during the 6-year follow-up in phakic subjects without PAC disease at baseline. Diagnosis was made using the International Society Geographical and Epidemiological Ophthalmology classification. RESULTS The data were analyzed for 3350 subjects (mean age, 56.4 ± 8.9 years; 1547 males, 1803 females) for a diagnosis of PAC disease at baseline and at follow-up examinations. The incidence of PAC disease was identified in 134 subjects (6-year incidence rate, 4.0%; 95% confidence interval (CI), 3.3-4.7). Among the 134 subjects, 88 subjects (2.6%, 95% CI, 2.1-3.2) were primary angle-closure suspects; 37 subjects (1.1%, 95% CI, 0.7-1.5) had primary angle closure, and 9 subjects (0.3%, 95% CI, 0.1-0.4) had primary angle-closure glaucoma. There was an inverse relationship between the incidence of PAC disease and the cataract surgery rates. Significant risk factors for PAC disease on logistic regressions were higher intraocular pressure, increased lens thickness, shorter axial length, shallow anterior chamber depth, anteriorly positioned lens, and hyperopia. CONCLUSIONS The average incidence of PAC disease per year was 0.7%. All biometric parameters were found to be strong predictors for the incidence of PAC disease.

Predictors for incidence of primary open-angle glaucoma in a South Indian population: the Chennai eye disease incidence study.

OBJECTIVE To determine the 6-year incidence of primary open-angle glaucoma (POAG) and its associated predictors. DESIGN Population-based cohort study. PARTICIPANTS A total of 4316 subjects without POAG at baseline who were 40 years of age and older from a south Indian population. METHODS Participants were examined at baseline and after a 6-year interval. Detailed ophthalmic examination included applanation tonometry, gonioscopy, pachymetry, optic disc evaluation, and automated perimetry. Glaucoma was defined using the International Society of Geographical and Epidemiological Ophthalmology Classification. Multivariable logistic regression was performed to identify the baseline risk factors that could predict the incident POAG. MAIN OUTCOME MEASURES Six-year incidence of POAG and its associated risk factors. RESULTS In 6 years, incident POAG developed in 129 subjects (2.9%; 95% confidence interval [CI], 2.4-3.4; male-to-female ratio, 65:64). Baseline age was a risk factor. In reference to the group 40 to 49 years of age, the incidence increased from 2.3 (95% CI, 1.4-3.7) for the group 50 to 59 years of age to 3.5 (95% CI, 2.2-5.7) for the group 60 to 69 years of age (P<0.001). Other baseline risk predictors were urban residence (odds ratio [OR], 1.6; 95% CI, 1.1-2.2; P = 0.01), higher intraocular pressure (IOP; OR, 2.0; 95% CI, 1.5-2.6 per 10 mmHg; P<0.001), myopia (OR, 1.7; 95%, CI, 1.1-2.5; P<0.001), and axial length (OR, 1.5; 95% CI, 1.0-2.2 per millimeter; P = 0.03). Thinner corneas with higher IOP at baseline had the highest incidence of POAG. In 80% of the urban population and 100% of the rural population, incident glaucoma was previously undetected. CONCLUSIONS A significant proportion of this population demonstrated incident POAG. The baseline risk factors could help in identifying those at highest risk of disease.

Is prophylactic laser peripheral iridotomy for primary angle closure suspects a risk factor for cataract progression? The Chennai Eye Disease Incidence Study

Background To report the risk of cataract progression among primary angle closure suspects (PACS) 6 years after they underwent laser peripheral iridotomy (LPI). Methods In the Chennai Eye Disease Incidence Study, 6 years after their baseline evaluation, 4421 subjects were examined again. As part of a detailed evaluation cataract was graded using the Lens Opacities Classification System II; progression was defined as change of cataract by two or more grades or history of cataract surgery in the 6-year period. Only bilaterally phakic subjects with less than N2 or C2 or P2 cataract at baseline with no history of any form of glaucoma, primary angle closure and pseudoexfoliation were included. Results There were 3205 eligible subjects. Of these, 190 had undergone LPI for PACS. In comparison to the study population, they were significantly older (p<0.001), female (p=0.008), urban residents (p=0.001) and patients with hypertension (p<0.001). During the intervening period, 53 subjects had undergone cataract surgery. The cataract progression rate was significantly greater (OR 1.7, 95% CI 1.3 to 2.4, p<0.001) in those who had undergone LPI. For the study population the baseline risk factors for progression of cataract were age (p<0.001), female gender (p=0.01), diabetes (p<0.001) and LPI (p<0.001). Diabetes and female gender were significant risk factors for nuclear and cortical cataract progression; LPI was a risk factor only for cortical cataract (OR 1.6, 95% CI 1.1 to 2.3, p=0.007). Conclusions There was significant cataract progression in 6 years following LPI for PACS.

Baseline Risk Factors for Incidence of Blindness in a South Indian Population: The Chennai Eye Disease Incidence Study

PURPOSE To report the baseline risk factors and causes for incident blindness. METHODS Six years after the baseline study, 4419 subjects from the cohort underwent a detailed examination at the base hospital. Incident blindness was defined by World Health Organization criteria as visual acuity of less than 6/120 (3/60) and/or a visual field of less than 10° in the better-seeing eye at the 6-year follow-up, provided that the eye had a visual acuity of better than or equal to 6/120 (3/60) and visual field greater than 10° at baseline. For incident monocular blindness, both eyes should have visual acuity of more than 6/120 (3/60) at baseline and developed visual acuity of less than 6/120 (3/60) in one eye at 6-year follow-up. RESULTS For incident blindness, 21 participants (0.48%, 95% confidence interval [CI], 0.3-0.7) became blind; significant baseline risk factors were increasing age (P = 0.001), smokeless tobacco use (P < 0.001), and no history of cataract surgery (P = 0.02). Incident monocular blindness was found in 132 participants (3.8%, 95% CI, 3.7-3.8); it was significantly more (P < 0.001) in the rural population (5.4%, 95% CI, 5.4-5.5) than in the urban population (1.9%, 95% CI, 1.8-1.9). Baseline risk factors (P < 0.001) were increasing age and rural residence, and no history of cataract surgery was a protective factor (P = 0.03). CONCLUSIONS Increasing age was a significant risk factor for blindness and monocular blindness. No history of cataract surgery was a risk factor for blindness and a protective factor for monocular blindness.

Comparison of saccadic reaction time between normal and glaucoma using an eye movement perimeter

Aim: To compare the saccadic reaction time (SRT) in both the central and peripheral visual field in normal and glaucomatous eyes using eye movement perimetery (EMP). Materials and Methods: Fifty-four normal and 25 glaucoma subjects underwent EMP and visual field testing on the Humphrey Field Analyser (HFA) 24-2 program. The EMP is based on infrared tracking of the corneal reflex. Fifty-four test locations corresponding to the locations on the 24-2 HFA program were tested. SRTs at different eccentricities and for different severities of glaucoma were compared between normal and glaucoma subjects. Results: Mean SRT was calculated for both normal and glaucoma subjects. Mann-Whitney U test showed statistically significant (P < 0.001) differences in SRTs between normal and glaucoma subjects in all zones. Conclusion: SRT was prolonged in eyes with glaucoma across different eccentricities.

Six-year incidence of visually significant age-related cataract: the Chennai eye disease incidence study.

The aim of this study is to report the 6‐year incidence of age‐related cataract in a population‐based study.

The Prevalence of Pseudoexfoliation and the Long-term Changes in Eyes With Pseudoexfoliation in a South Indian Population.

Purpose:To report the prevalence, long-term changes and associated factors for pseudoexfoliation (PEX) in a population aged 40 years and above from rural and urban south India. Materials and Methods:At baseline (the Chennai Glaucoma Study), 7774 subjects were examined. After 6 years, as a part of the incidence study, 133 of the 290 subjects diagnosed with PEX at baseline were reexamined for long-term changes. Participants had detailed examination at base hospital. Results:At baseline PEX was noted in 290 [3.73%, 95% confidence interval (CI), 3.3-4.2] subjects. It was associated with glaucoma in 24 (8.3%), ocular hypertension (OHT) in 21 (7.2%), and occludable angles in 24 (8.3%) subjects. The age-adjusted and sex-adjusted prevalence was 3.41% (95% CI, 3.39-3.43). Increasing age was a significant associated factor. Using the 40- to 49-year age group as a reference, the odds ratio increased from 8.4 (95% CI, 4.1-17.1) for the 50- to 59-year age group to 51.2 (95% CI, 25.8-101.6) for the 70 years and above age group. Other associated factors were rural residence (P<0.001), higher intraocular pressure (P<0.001), cataract (P<0.001), being underweight (P=0.01), manual labor (P=0.03), and aphakia (P<0.001). Of the 133 subjects reexamined, 8 (6.0%) subjects developed glaucoma and all had OHT at baseline. Rates of cataract surgery were (P<0.001) higher in subjects with PEX. Conclusion:Prevalence of PEX was higher in rural population and baseline OHT was a significant factor for conversion to glaucoma.

Six-Year Incidence and Baseline Risk Factors for Pseudoexfoliation in a South Indian Population: The Chennai Eye Disease Incidence Study

OBJECTIVE To estimate the 6-year incidence of pseudoexfoliation and its risk factors in a South Indian population. DESIGN Longitudinal population-based study. PARTICIPANTS Subjects 40 years of age or older without pseudoexfoliation at baseline. METHODS Participants were examined at baseline and after a 6-year interval. The presence of pseudoexfoliation was looked for after pupillary dilation in either or both eyes at 1 or more locations. Glaucoma was defined using the International Society of Geographical and Epidemiological Ophthalmology Classification. Logistic regression was performed to identify the baseline risk factors that could predict the incident pseudoexfoliation. MAIN OUTCOME MEASURES Six-year incidence, associated risk factors, and rural-versus-urban differences. RESULTS From the study cohort of 4228 subjects, 87 subjects (male-to-female ratio, 48:39; rural-to-urban ratio, 69:18) demonstrated incident pseudoexfoliation (2.03%; 95% confidence interval [CI], 1.6-2.5; rural: -2.86%; 95% CI, 1.6-2.5; urban: 0.96%; 95% CI, 0.5-1.4). Pseudoexfoliation was associated with glaucoma in 1 subject (1.1%), with primary angle-closure suspicion in 10 subjects (11.5%), and with ocular hypertension in 2 subjects (2.2%). Significant predictive baseline risk factors were older age (P < 0.001), rural residence (P < 0.001), illiteracy (P = 0.02), pseudophakia (P = 0.04), and nuclear cataract (P = 0.05). With reference to the 40-to-49-year age group, the risk of incidence increased from 4.7 (95% CI, 2.4-9.4) for the 50-to-59-year age group to 12.9 (95% CI, 6.1-27.2) for 70 years of age and older group. CONCLUSIONS In 6 years, pseudoexfoliation developed in 2.03% of the population. Rural and urban incidence was significantly different.

Six-year incidence of ocular hypertension in a South Indian population: the Chennai eye disease incidence study

Aims To report the 6-year incidence and risk factors for ocular hypertension (OHT) in a population-based study in southern India. Methods 6 years after baseline evaluation, 56.9% subjects (participants:non-participants, 4421:3353) were re-examined at the base hospital. Incident OHT was defined as an intraocular pressure above the 97.5th centile for the population with no evidence of glaucoma in the 2852 phakic subjects, 40 years or older. Subjects with trauma, laser or incisional surgery at baseline or follow-up were excluded (total exclusions: 1569). Results Incidence of OHT at 6 years was 62/2852 subjects (2.17% (95% CI 1.64% to 2.71%, men:women, 36:26)). Incidence was higher in the rural cohort as compared with the urban cohort (80.6% vs 19.4%, p<0.001). A higher baseline intraocular pressure (with increasing OR: 16–18 mm Hg (OR 4.0, 95% CI 2.1 to 7.9), 19–21 mm Hg (OR 11.4, 95% CI 5.7 to 22.9), 22–24 mm Hg (OR 42.6, 95% CI 11.0 to 164.8, in the urban cohort)) and increasing age (50–59 years (OR 1.9, 95% CI 1.1 to 3.3), 70 years and above (OR 3.6, 95% CI 1.2 to 10.6)) were significantly associated risk factors for incident OHT. Conclusions A significant proportion of this normal population converted to OHT. A higher incidence of conversion was seen in the rural population.