Glaucoma in southern India.
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Glaucoma, Open-Angle↗
Biomedical subjects
Chandrasekhar Garudadri
Publications and source records attributed to Chandrasekhar Garudadri.
Enzymatic sclerostomy: pilot human study.
OBJECTIVE: To evaluate the feasibility and safety of enzymatic sclerostomy as a new modality to lower intraocular pressure in patients with open-angle glaucoma. METHODS: This single-center, prospective, noncomparative, interventional case series included 15 blind symptomatic eyes of 15 patients with primary open-angle glaucoma. Enzymatic sclerostomy was performed with the patient under topical or peribulbar anesthesia. A specially designed polymethylmethacrylate enzyme applicator filled with a mean +/- SD of 123 +/- 13 microg of collagenase was introduced through a 5-mm peritomy, and affixed to the limbus by means of cyanoacrylate tissue glue. After 22 to 24 hours, the applicators were removed and the patients were followed up for 1 year. Intraocular pressure changes from baseline and complications related to the procedure were the main outcome measures. RESULTS: Controlled thinning of the treated sclera associated with aqueous percolation and shallow filtration bleb was seen in all eyes in the immediate postoperative period. The mean +/- SD intraocular pressure decreased from 43.5 +/- 9.8 mm Hg (while the patients were receiving a mean +/- SD of 1.75 +/- 0.75 antiglaucoma medications) preoperatively to 24.8 +/- 10.6 mm Hg (a 43.0% decrease from baseline with no antiglaucoma medication) on the first postoperative day and to 34.8 +/- 10.5 mm Hg (a 20.0% decrease from baseline with no antiglaucoma medication) at the end of 1 year. Ophthalmic adverse effects were limited to the treated area and included immediate postoperative transient conjunctival reaction ranging from mild chemosis to conjunctival maceration. Immediate full-thickness perforation developed in 1 eye; the patient was treated and excluded from data analysis. Two eyes developed symptoms related to increase in intraocular pressure after 9 months; the patients were treated and excluded from further data analysis. No systemic complications were noted. CONCLUSIONS: Enzymatic sclerostomy demonstrated immediate and sustained intraocular pressure reduction and provided symptomatic relief in blind eyes with primary open-angle glaucoma. The procedure, however, needs further technical refinement.
Aged↗
Correlating structure with function in end-stage glaucoma.
BACKGROUND AND OBJECTIVE: To correlate structure and function in eyes with end-stage glaucoma. PATIENTS AND METHODS: Fifty-six eyes of 48 patients with glaucoma presenting with end-stage glaucoma underwent scanning laser polarimetry (SLP) imaging using a commercially available GDx-variable corneal compensator unit (GDx-VCC; Laser Diagnostics Technologies, Inc., San Diego, CA). End-stage glaucoma was defined by both disc appearance and standard automated perimetry visual field criteria. Standard automated perimetry parameters included: mean deviation, pattern standard deviation, and total deviation plot. GDx parameters included: TSNIT average, superior average, inferior average, TSNIT standard deviation, and nerve fiber indicator. RESULTS: The visual field mean deviation was -26.75 +/- 3.50 dB. The remaining retinal nerve fiber layer measured in this group of eyes was: TSNIT average, 29.76 +/- 5.81 microm; superior average, 30.76 +/- 6.25 microm; and inferior average, 31.14 +/- 7.20 microm. A low structure-function correlation was found when analyzing separately the superior and inferior hemifields (R2 = 0.00001, R2 = 0.0016, respectively). CONCLUSIONS: In eyes with end-stage glaucoma, very thin but existing retinal nerve fiber layer is found on SLP. Such values rarely dropped below 10 to 20 microm. A flattening of the GDx TSNIT pattern was seen, and the correlation between structure and function was not evident.
Adult↗