scholarly journals Effect of iStent Trabecular Micro-Bypass device on outflow system morphology

2020 ◽  
Vol 2 (4) ◽  
pp. 44-54
Author(s):  
Nicholas Hess ◽  
Nisreen Mesiwala ◽  
Catherine Marando ◽  
Richard A. Bilonick ◽  
Leonard K. Seibold ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Open Angle Glaucoma ◽  
Anterior Segment ◽  
Outer Wall ◽  
Cross Sectional ◽  
Mixed Effects Modeling ◽  
Before And After ◽  
Temporal Quadrant ◽  
Trabecular Bypass ◽  
Outflow Pathway

Purpose: Rigorous clinical testing has established that Schlemm’s canal cross-sectional area (SC-CSA) is reduced in glaucomatous eyes. However, to date, it is unclear whether trabecular bypass procedures impact the morphology of the proximal aqueous outflow tract, or if the introduction of a local region of low outflow resistance adversely affects SC-CSA elsewhere, specifically presenting as SC diminution. This study quantifies changes in the morphology of the distal outflow pathway after iStent Trabecular Micro-Bypass stent (Glaukos Corp, Laguna Hills, CA, USA) implantation in living eyes by anterior segment optical coherence tomography (OCT). Design: This was a prospective observational study. Subjects: This study included six patients (eight eyes) with primary-open angle glaucoma. Methods: Patients underwent iStent placement in the nasal anterior chamber angle quadrant. OCT imaging was obtained of both nasal and temporal eye quadrants before and after surgery. For each SC parameter, an average of ten consecutive, evenly spaced measurements were manually obtained over a 1 mm segment of SC on FIJI ImageJ. Linear mixed effects modeling quantified the effect of the iStent on these parameters. Main outcome measures: Main outcome measures were changes in SC-CSA, inner-to-outer wall distance (IOD), and trabecular meshwork (TM) thickness following iStent placement. Results: Following iStent placement, total SC-CSA increased an average of 1,039.12 μm2 (P = 0.05). Individually, there were no significant changes in SC-CSA in the nasal or temporal quadrants. Total SC-IOD and nasal SC-IOD increased an average of 2.35 μm (P = 0.01) and 2.96 μm (P = 0.04), respectively. There were no significant changes in temporal quadrant SC-IOD. There were no significant changes in TM thickness in either quadrant. Conclusions: Implantation of the iStent Trabecular Micro-Bypass stent significantly increases SC-IOD in the nasal quadrant at the location of implant, with no evidence of SC diminution in the temporal quadrant. It remains unclear how these observations relate to the surgical efficacy of trabecular bypass procedures.

scholarly journals Morphological changes in the trabecular meshwork and Schlemm’s canal after treatment with topical intraocular pressure-lowering agents

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ji-Hye Park ◽  
Hyun Woo Chung ◽  
Eun Gyu Yoon ◽  
Min Jung Ji ◽  
Chungkwon Yoo ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Trabecular Meshwork ◽  
Morphological Changes ◽  
Open Angle Glaucoma ◽  
Anterior Segment ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Before And After ◽  
Treatment Naïve ◽  
Aqueous Outflow

AbstractGlaucoma treatment is usually initiated with topical medication that lowers the intraocular pressure (IOP) by reducing the aqueous production, enhancing the aqueous outflow, or both. However, the effect of topical IOP-lowering medications on the microstructures of the aqueous outflow pathway are relatively unknown. In this retrospective, observational study, 56 treatment-naïve patients with primary open-angle glaucoma were enrolled. Images of the nasal and temporal corneoscleral limbus were obtained using anterior segment optical coherence tomography (AS-OCT). The conjunctival vessels and iris anatomy were used as landmarks to select the same limbal area scan, and the trabecular meshwork (TM) width, TM thickness, and Schlemm’s canal (SC) area were measured before and after using the IOP-lowering agents for 3 months. Among the 56 patients enrolled, 33 patients used prostaglandin (PG) analogues, and 23 patients used dorzolamide/timolol fixed combination (DTFC). After 3 months of DTFC usage, the TM width, TM thickness, and SC area did not show significant changes in either the nasal or temporal sectors. Conversely, after prostaglandin analog usage, the TM thickness significantly increased, and the SC area significantly decreased (all P < 0.01). These findings warrant a deeper investigation into their relationship to aqueous outflow through the conventional and unconventional outflow pathways after treatment with PG analogues.

Anterior chamber particles are associated with reduction of intraocular pressure after selective laser trabeculoplasty

2020 ◽  
pp. bjophthalmol-2019-315445
Author(s):  
Alexei N Kulikov ◽  
Dmitrii S Maltsev ◽  
Alina A Kazak ◽  
Maria A Burnasheva
Keyword(s):  
Optical Coherence Tomography ◽  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Open Angle Glaucoma ◽  
Anterior Segment ◽  
Optical Coherence ◽  
Selective Laser Trabeculoplasty ◽  
Cross Sectional ◽  
Laser Trabeculoplasty ◽  
The Mean

PurposeTo study the correlation between intraocular pressure (IOP) reduction and the number of hyper-reflective particles appearing in the anterior chamber following selective laser trabeculoplasty (SLT).Material and methodsIn this prospective interventional study, we included primary open-angle glaucoma patients. All participants received a standardised SLT session, which consisted of 100 pulses of 0.9 mJ over 360°. Anterior segment optical coherence tomography (4×4 mm volume scan, 101 horizontal cross-sectional scans) and applanation tonometry were performed before SLT and 15 min, 1 day, 1 week, 1 month and 3 months after. Particles were counted on cross-sectional scans using a standardised algorithm.ResultsIn this study, we included 25 patients (25 eyes), 14 males and 11 females, with a mean age of 68.9±10.5 and baseline IOP of 21.4±4.5 mm Hg. IOP at month 1 and month 3 after SLT was 18.0±4.0 and 17.4±3.3 mm Hg, respectively. The mean number of anterior chamber particles before and 15 min after SLT was 0.62±0.2 and 7.1±2.0 particles/mm2, respectively (p=0.036). There was a statistically significant correlation between the mean number of anterior chamber particles 15 min after SLT and IOP reduction at 1 month (r=0.62, p=0.03) and 3 months (r=0.71, p=0.01).ConclusionThe number of the anterior chamber particles graded using anterior segment optical coherence tomography after the procedure correlates with the IOP-lowering effect of SLT.

scholarly journals Comparative Study of the Effects of 1% Atropine on the Anterior Segment

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Yue Zhou ◽  
Xiao Bo Huang ◽  
Qi Cai ◽  
Jun Jie Li ◽  
Yao Jia Xiong ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Univariate Analysis ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Muscle Thickness ◽  
Ultrasound Biomicroscopy ◽  
Cross Sectional ◽  
Ciliary Process ◽  
Before And After ◽  
Anterior Segment Parameters

Purpose. To investigate the influences of atropine on changes in anterior segment geometry, as measured by ultrasound biomicroscopy in children. Methods. A prospective observational study was performed. Anterior segment parameters were obtained by UBM before and after the instillation of 1% atropine. Univariate linear regression was performed to identify the variables contributing to the changes in the trabecular meshwork-iris angle (TIA). Results. The study included 21 boys and 37 girls with a mean age of 10.79 ± 2.53 years. Anterior chamber parameters including the central anterior chamber depth, TIA, angle opening distance at 500 μm from the scleral spur, iris thickness 750 μm and 1500 μm from the scleral spur, trabecular-ciliary angle (TCA), trabecular-ciliary process distance, sclera-iris angle (SIA), and sclera-ciliary process angle significantly increased after cycloplegia ( P < 0.05 ). In contrast, the lens vault, iris cross-sectional area, and maximum ciliary muscle thickness significantly decreased after cycloplegia. Univariate analysis identified the change in TCA and the change in SIA and the TIA before mydriasis as determinants of the change in TIA. Conclusions. Atropine causes statistically significant changes in various anterior segment parameters in children. The change in anterior chamber angle is associated with the change in TCA and the change in SIA and the TIA before mydriasis.

scholarly journals Use of and confidence in administering outcome measures among clinical prosthetists: Results from a national survey and mixed-methods training program

2014 ◽  
Vol 39 (4) ◽  
pp. 314-321 ◽  
Author(s):  
Ignacio Gaunaurd ◽  
Susan E Spaulding ◽  
Dagmar Amtmann ◽  
Rana Salem ◽  
Robert Gailey ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Routine Practice ◽  
Timed Up And Go ◽  
Cross Sectional ◽  
Interactive Training ◽  
Study Results ◽  
Before And After ◽  
Formally Trained

Background: Outcome measures can be used in prosthetic practices to evaluate interventions, inform decision making, monitor progress, document outcomes, and justify services. Strategies to enhance prosthetists’ ability to use outcome measures are needed to facilitate their adoption in routine practice. Objective: To assess prosthetists’ use of outcome measures and evaluate the effects of training on their confidence in administering performance-based measures. Study design: Cross-sectional and single-group pretest–posttest survey. Methods: Seventy-nine certified prosthetists (mean of 16.0 years of clinical experience) were surveyed about their experiences with 20 standardized outcome measures. Prosthetists were formally trained by the investigators to administer the Timed Up and Go and Amputee Mobility Predictor. Prosthetists’ confidence in administering the Timed Up and Go and Amputee Mobility Predictor was measured before and after training. Results: The majority of prosthetists (62%) were classified as non-routine outcome measure users. Confidence administering the Timed Up and Go and Amputee Mobility Predictor prior to training was low-to-moderate across the study sample. Training significantly (p < 0.0001) improved prosthetists’ confidence in administering both instruments. Conclusion: Prosthetists in this study reported limited use of and confidence with standardized outcome measures. Interactive training resulted in a statistically significant increase of prosthetists’ confidence in administering the Timed Up and Go and Amputee Mobility Predictor and may facilitate use of outcome measures in clinical practice. Clinical relevance Frequency of outcome measure use in the care of persons with limb loss has not been studied. Study results suggest that prosthetists may not regularly use standardized outcome measures and report limited confidence in administering them. Training enhances confidence and may encourage use of outcome measures in clinical practice.

scholarly journals Influence of political and medical leaders on parental perception of vaccination: a cross-sectional survey in Australia

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025866 ◽  
Author(s):  
Elissa J Zhang ◽  
Abrar Ahmad Chughtai ◽  
Anita Heywood ◽  
Chandini Raina MacIntyre
Keyword(s):  
Outcome Measures ◽  
Parental Attitudes ◽  
Total Sample ◽  
Cross Sectional Study ◽  
Vaccine Hesitancy ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Market Research Company ◽  
Before And After

ObjectivesThe aim of this survey was to investigate parental vaccination attitudes and responses to vaccine-related media messages from political and medical leaders.DesignThis was a cross-sectional study using a semiquantitative questionnaire. Data were analysed using descriptive statistics, X2tests and logistic regression.SettingData were collected from a web-based questionnaire distributed in Australia by a market research company in May of 2017.Participants411 participants with at least one child under 5 were included in this study. The sample was designed to be representative of Australia in terms of gender and state of residence.Primary and secondary outcome measuresThe primary outcome measures were parental attitudes towards childhood immunisation before and after viewing vaccine-related messages from political and medical leaders, including Donald Trump (USA), Pauline Hanson (Australia) and Michael Gannon (Australia). Parents were classified as having ‘susceptible’ (not fixed) or ‘fixed’ (positive or negative) views towards vaccination based on a series of questions.ResultsParents with fixed vaccination views constituted 23.8% (n=98) of the total sample; 21.7% (n=89) were pro-vaccination and 2.2% (n=9) were anti-vaccination. The remaining 76.2% of participants were classified as having susceptible views towards vaccination. Susceptible parents were more likely to report a change in their willingness to vaccinate after watching vaccine-related messages compared with fixed-view parents, regardless of whether the messaging was positive or negative (Trump OR 2.54, 95% CI (1.29 to 5.00); Hanson OR 2.64, 95% CI (1.26 to 5.52); Gannon OR 2.64, 95% CI (1.26 to 5.52)). Susceptible parents were more likely than fixed-view parents to report increased vaccine hesitancy after viewing negative vaccine messages (Trump OR 2.14, 95% CI (1.11 to 4.14), Hanson OR 2.34, 95% CI (1.21 to 4.50)).ConclusionsThe findings suggest that most parents including the vaccinating majorty are susceptible to vaccine messaging from political and medical leaders. Categorising parents as ‘fixed-view’ or ‘susceptible’ can be a useful strategy for designing and implementing future vaccine promotion interventions.

scholarly journals Assessment of Anterior Segment Measurements with Swept Source Optical Coherence Tomography before and after Ab Interno Trabeculotomy (Trabectome) Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Handan Akil ◽  
Ping Huang ◽  
Vikas Chopra ◽  
Brian Francis
Keyword(s):  
Optical Coherence Tomography ◽  
Cataract Surgery ◽  
Anterior Chamber ◽  
Open Angle Glaucoma ◽  
Anterior Segment ◽  
Open Angle ◽  
Swept Source ◽  
Significant Difference ◽  
Trabectome Surgery ◽  
Before And After

Purpose. To compare the changes of anterior segment parameters, assessed by swept source anterior segment optical coherence tomography (AS-OCT) after combined Trabectome-cataract surgery and Trabectome-only surgery in open angle glaucoma patients.Methods. Thirty-eight eyes of 24 patients with open angle glaucoma were scanned with swept source AS-OCT before and 4 weeks after combined Trabectome-cataract or Trabectome-only surgery. Intraocular pressure, number of medications, and AS-OCT parameters, such as angle opening distance at 500 and 750 μm from the scleral spur (AOD500 and AOD750), trabecular-iris space area at 500 and 750 mm2(TISA500, TISA750), angle recess area at 500 and 750 mm2(ARA500, ARA750), trabecular iris angle (TIA), anterior chamber depth (ACD), anterior chamber width (ACW), and anterior chamber volume (ACV), were obtained before the surgery. These parameters were compared to evaluate whether the outcome of the surgery differed among the patients after the surgery. The width of the trabecular cleft was also measured for both groups.Results. The reduction of IOP and number of medications was found to be statistically significant in both groups (p<0.001). ACD, ACV, and angle parameters such as AOD 500/750, TISA 500/750, ARA 500/750, and TIA500 showed significantly greater changes from the preoperative values to postoperative 1st month values in combined Trabectome-cataract surgery group (p<0.05), whereas Trabectome-only group did not show statistically significant difference (p>0.05). There was no statistically significant difference between two groups for the width of the trabecular cleft (p=0.7).Conclusion. Anterior chamber angle parameters measured with swept source AS-OCT may be useful for evaluating glaucoma patients before and after Trabectome surgery with or without cataract surgery.

scholarly journals Effect of prostaglandin analogues on anterior scleral thickness and corneal thickness in patients with primary open-angle glaucoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ji-Hye Park ◽  
Chungkwon Yoo ◽  
Hyun Woo Chung ◽  
Yong Yeon Kim
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Open Angle ◽  
Prostaglandin Analogues ◽  
First Line Therapy ◽  
Significant Difference ◽  
Before And After ◽  
Treatment Naïve

AbstractProstaglandin (PG) analogues are usually prescribed as a first-line therapy in patients with glaucoma because of its once-daily dosing benefit and effective intraocular pressure (IOP) reduction. However, the mechanism of PG analogues is not completely understood. In this study, we investigated the effect of PG analogues on the anterior scleral thickness (AST) in treatment-naïve eyes with primary open-angle glaucoma using anterior segment optical coherence tomography. The AST was measured at the location of the scleral spur, 1000 μm, and 2000 μm posterior to the scleral spur and was compared before and after using the medications for 3 months and 1 year. Among 54 patients enrolled in this study, 31 patients used prostaglandin analogues and 23 patients used dorzolamide/timolol fixed combination (DTFC) drugs. There was no significant difference in untreated IOP, glaucoma severity, and baseline AST values between the two groups. While there was no significant changes in AST after using the DTFC drugs, the AST at all 3 locations showed a significant reduction in both the nasal and temporal sectors after using PG analogues for 1 year (all, P < 0.05). These findings suggest that the AST reduction after using PG analogues might be related with the increased uveoscleral outflow.

Hip-Abductor Muscle Performance in Participants after 45 Seconds of Resisted Sidestepping Using an Elastic Band

2006 ◽  
Vol 15 (1) ◽  
pp. 1-11 ◽  
Author(s):  
James W. Youdas ◽  
Erica F. Loder ◽  
Jody L. Moldenhauer ◽  
Christine R. Paulsen ◽  
John H. Hollman
Keyword(s):  
Outcome Measures ◽  
Simple Procedure ◽  
Muscle Performance ◽  
Elastic Band ◽  
Cross Sectional ◽  
Men And Women ◽  
Lower Extremity Injuries ◽  
Impaired Performance ◽  
Before And After ◽  
Hip Abductor

Context:Hip-abductor weakness is associated with many lower extremity injuries. A simple procedure to assess hip-abductor performance is necessary in patient populations.Objective:To describe the change in pelvic-on-femoral position of the stance limb before and after 45 seconds of resisted sidestepping.Design:Cross-sectional comparative.Setting:Laboratory.Participants:24 healthy women (24.6 ± 3.5 years) and 14 healthy men (24.5 ± 3.0 years).Main Outcome Measures:Pelvic-on-femoral position in degrees in single-leg stance before and after 45 seconds of resisted sidestepping.Results:The difference between the baseline and postexercise measurements for both men and women was significant (P< .05). The effect of the resisted-sidestepping exercise on the hip abductors was not statistically different between men and women.Conclusions:Forty-five seconds of resisted sidestepping using an elastic band produced a change in pelvic-on-femoral position in healthy adults. This test might be useful to detect impaired performance in hip abductors of patients with injury elsewhere in the musculoskeletal system.

Surgical resection of the sclera is a non-penetrating operation for the treatment of patients with primary open-angle and secondary glaucoma

GlaucomaNews ◽  
2020 ◽  
pp. 62-65
Author(s):  
А.Y. Kazantseva ◽  
◽  
O.A. Rumyantseva ◽  
Keyword(s):  
Surgical Resection ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Secondary Glaucoma ◽  
Ophthalmological Examination ◽  
Open Angle ◽  
Visual Functions ◽  
Dynamic Observation ◽  
Uveoscleral Outflow ◽  
Outflow Pathway

Purpose. To evaluate the effectiveness of surgical resection of the sclera in patients with primary open-angle and secondary glaucoma. Materials and methods. The study included 84 patients with POAG and SG stages III-IV and decompensated IOP level (not higher than 32 mm Hg). In order to normalize the increased ophthalmotonus, a non - penetrating operation was performed-surgical resection of the sclera (SRS). The patients underwent complex ophthalmological examination and dynamic observation. Result. In the studied groups of patients after surgical treatment there was a decrease in elevated IOP levels by 33.42%, an improvement in the coefficient of ease of outflow and a weakening of the hypotensive regime. Stabilization of visual functions was observed in all patients. Summary. The proposed new SRS technique provides a smooth decrease in IOP, preservation of visual functions and is not accompanied by intra-and postoperative complications. Key words: primary open-angle glaucoma, surgical resection of sclera, secondary glaucoma, uveoscleral outflow pathway (USPO), intraocular pressure, EO coefficient .

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