Aerosol beclomethasone dipropionate spray compared with theophylline as primary treatment for chronic mild-to-moderate asthma. The American Academy of Allergy, Asthma and Immunology Beclomethasone Dipropionate-Theophylline Study Group. - Reed, C E; Offord, K P; Nelson, H S; Li, J T; Tinkelman, D G (The Journal of allergy and clinical immunology, 1998)
BACKGROUND: Inhaled corticosteroids and oral theophylline are effective treatments for moderate asthma., OBJECTIVE: We sought to compare the benefits and adverse reactions of theophylline and aerosol beclomethasone spray., METHODS: A multicenter, double-blind, double-placebo, randomized, controlled trial of 1-year duration was performed. Seven hundred forty-seven patients with asthma received either beclomethasone dipropionate aerosol spray (84 microg four times per day) or sustained-release theophylline twice per day in doses adjusted for optimum control of the disease. The main outcome measures were daily diary of symptoms and peak flow rates (recorded on a mark-sense computer-readable form); supplemental bronchodilator use; doctor's office or hospital visits and absence from work or school; spirometry; methacholine testing; adverse experiences; and cortisol blood measurements., RESULTS: Both treatment strategies reduced symptoms promptly and achieved low absenteeism from work or school and low rates of emergency treatment for asthma. Both maintained nearly normal pulmonary function. Beclomethasone was statistically significantly more effective in reducing symptoms, supplemental bronchodilator and systemic glucocorticoid doses, bronchial hyperresponsiveness, and eosinophilia. However, the magnitude of these differences was small. Theophylline caused more headache, nervousness, insomnia, and gastrointestinal distress, and more patients discontinued treatment because of side effects. Beclomethasone caused more oropharyngeal candidiases and hoarseness and reduced morning plasma cortisol levels before and after cosyntropin. It reduced the rate of growth in children. No new cataracts or glaucoma developed., CONCLUSION: Theophylline effectively controlled symptoms at lower than the customarily recommended blood level. The risk/ benefit profiles of these agents suggest that inhaled corticosteroids may be the preferred agent for most adult patients and for some children.
Keywords: Adolescent; Adult; Aerosols; Aged; *Anti-Asthmatic Agents/ad [Administration & Dosage]; Anti-Asthmatic Agents/ae [Adverse Effects]; *Asthma/dt [Drug Therapy]; Asthma/pp [Physiopathology]; *Beclomethasone/ad [Administration & Dosage]; Beclomethasone/ae [Adverse Effects]; Bronchodilator Agents/ad [Administration & Dosage]; Child; Delayed-Action Preparations; Double-Blind Method; Female; Humans; Hydrocortisone/bl [Blood]; Male; Middle Aged; Spirometry; *Theophylline/ad [Administration & Dosage]; Theophylline/ae [Adverse Effects]

[Primary trabeculectomy in the surgery of primary open angle glaucoma]. - Chiselita, D; Poiata, I; Tiutiuca, C; Stanciu, D; Vancea, P P (Oftalmologia (Bucharest, Romania : 1990), 1997)
OBJECTIVE: Comparative analysis of the results of trabeculectomy in the surgery of primary open angle glaucoma (POAG) as the primary therapeutical approach and after the medical treatment failure., MATERIALS AND METHOD: Retrospective study including two therapeutical groups: A (59 patients) with primary trabeculectomy; and B (60 patients) with trabeculectomy following a medical treatment failure; mean follow-up period was 3 years and 5 months., RESULTS: Postoperative drop in intraocular pressure was similar in the two groups; there is no statistical significant difference between the two groups regarding stationary disease (76.27% in group A, versus 73.33% in group B), regressive disease (6.8% versus 6.7% respectively) and progressive disease (18.6% in group A, versus 21.6% in group B). At an intraocular pressure < or = 21 mmHg 13.6% of glaucoma cases do progress. The rate of peroperative and postoperative complications is similar in the two groups., CONCLUSIONS: The prior medical treatment of glaucoma doesn't affect the evolution of operated POAG. Primary trabeculectomy is indicated for non-compliant patients and for patients in whom administration of combined medical treatment for short time periods doesn't lower the intraocular pressure at safe levels. Surgical treatment has the advantage of an important and constant lowering of the intraocular pressure which is an absolute requirement for an efficient control of advanced glaucoma.
Keywords: Aged; Algorithms; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Middle Aged; Ophthalmic Solutions/tu [Therapeutic Use]; Retrospective Studies; *Trabeculectomy; Treatment Outcome

Disease management: from sand table exercise to local achievement. - Bosanquet, N (International journal of health care quality assurance incorporating Leadership in health services, 1997)
Presents an outline of a local pilot project on disease management in Ollerton, Nottinghamshire, UK. Disease management has been a staff college exercise at a national level: the alliance for health in Ollerton involved a purchaser, an acute trust and a practice. Secondary care expertise was used earlier in the disease process to identify patients and to treat them with a more continuous care programme. Disease management began with gastric illness--in examination, review and treatment for H Pylori eradication; extensions are planned to glaucoma and epilepsy. The project involved co-ordinated investment in building extensions, staff skills and records.
Keywords: Asthma/th [Therapy]; Diabetes Mellitus/th [Therapy]; *Disease Management; Glaucoma/th [Therapy]; Health Care Coalitions/og [Organization & Administration]; Health Care Rationing; Humans; Medical Audit; Medical Records/st [Standards]; Patient Selection; Pilot Projects; State Medicine; Stomach Diseases/th [Therapy]; United Kingdom

Acanthamoeba as a 'transient' in the corneal scrape of a poorly compliant soft contact lens wearer with peripheral keratitis. - Newman, W; Hay, J; Browne, B; Seal, D V (Eye (London, England), 1997)
Keywords: *Acanthamoeba/ip [Isolation & Purification]; *Acanthamoeba Keratitis/di [Diagnosis]; Adult; Animals; Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Corneal Ulcer/mi [Microbiology]; *Corneal Ulcer/ps [Parasitology]; Diagnosis, Differential; Humans; Male; Patient Compliance; *Staphylococcal Infections/di [Diagnosis]

Evaluation of glaucoma patients referred to a university clinic during one year. - Vuori, M L; Nikoskelainen, E (Acta ophthalmologica Scandinavica, 1997)
PURPOSE: In the spring of 1994, the post-referral waiting time for glaucoma patients at our institution was approximately 7 months. In an attempt to evaluate and possibly reduce this waiting time we compared the referral criteria to the actual treatment requirements of 472 patients admitted for glaucoma in 1995., RESULTS: 175 patients were referred as glaucoma suspects, 134 as chronic simple glaucoma, and 123 as capsular glaucoma. In addition, 40 patients were referred as other types of glaucoma. Elevated IOP was the main criterion for referral in 133 (76%) of glaucoma suspects. The diagnosis of glaucoma could not, however, be confirmed in 54 (31%) glaucoma suspects. 93 (69%) patients with simple open angle glaucoma and 103 (84%) patients with capsular glaucoma were also referred because of IOP > or = 22 mmHg. Maximally tolerated medication was not used by 44% of open angle glaucoma patients at time of referral., CONCLUSION: The clinical follow-up of glaucoma patients and glaucoma suspects should primarily take place at an ophthalmologist's office and the new effective glaucoma drugs and laser treatments should also be more actively in use. The cooperation between the referring ophthalmologists and the university clinic should be improved. Hospitalisation turned out to be unnecessary because, with a few exceptions, all procedures could have been performed on an out-patient basis, which is a general practice in most glaucoma clinics today. The university clinic should focus only on those patients who need special evaluation or surgical treatment.
Keywords: Adult; Aged; Aged, 80 and over; Chronic Disease; Decision Making; Female; Follow-Up Studies; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/th [Therapy]; *Hospitals, University; Humans; Intraocular Pressure; Male; Middle Aged; *Patient Admission/sn [Statistics & Numerical Data]; Patient Admission/td [Trends]; *Referral and Consultation/sn [Statistics & Numerical Data]; Referral and Consultation/td [Trends]; Retrospective Studies; Waiting Lists

Indications for penetrating keratoplasty in India. - Dandona, L; Ragu, K; Janarthanan, M; Naduvilath, T J; Shenoy, R; Rao, G N (Indian journal of ophthalmology, 1997)
Indications for penetrating keratoplasty (PK) in the developing world from a large series are not well documented. This study was done to evaluate the indications for PK in a major eye care institution in India. The records for a consecutive series of 1,964 PKs were analysed and multiple logistic regression was used to study the effect of age, socioeconomic status and sex on the indications for PK. The indications for PK were corneal scarring in 551 (28.1%) including adherent leukoma in 147 (7.5%), regrafts in 336 (17.1%), active infectious keratitis in 239 (12.2%), aphakic bullous keratopathy in 231 (11.8%), pseudophakic bullous keratopathy in 209 (10.6%), corneal dystrophies in 165 (8.4%) including Fuchs' dystrophy in 23 (1.2%), keratoconus in 118 (6%), and miscellaneous in 115 (5.9%). The odds that the patient belonged to lower socioeconomic status were significantly higher if the PK was done for active infectious keratitis (odds ratio 2.73, p < 0.0001), corneal scarring (odds ratio 1.72, p = 0.0009) or regraft (odds ratio 1.44, p = 0.047). Corneal scarring, including adherent leukoma, and active infectious keratitis are relatively more common indications whereas keratoconus, pseudophakic bullous keratopathy and Fuchs' dystrophy are less common indications for PK in India than reported from the developed world. Indications for PK which carry a poorer prognosis for graft survival are relatively more common in India than in the developed world.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Corneal Diseases/di [Diagnosis]; *Corneal Diseases/su [Surgery]; Developing Countries; Female; Graft Survival; Humans; India; Infant; Infant, Newborn; Keratoplasty, Penetrating/td [Trends]; *Keratoplasty, Penetrating; Male; Middle Aged; Regression Analysis; Retrospective Studies; Social Class; Treatment Outcome

The Bristol Shared Care Glaucoma Study--validity of measurements and patient satisfaction. - Gray, S F; Spencer, I C; Spry, P G; Brookes, S T; Baker, I A; Peters, T J; Sparrow, J M; Easty, D L (Journal of public health medicine, 1997)
BACKGROUND: The aims of the study were to determine (1) whether community optometrists are able to make valid measurements of visual parameters in patients with established or suspect primary open angle glaucoma and (2) patient satisfaction with follow-up by community optometrists., METHODS: A randomized study was carried out in the former county of Avon in South West England with patients allocated to follow-up by the hospital eye service or by community optometrists. The subjects were 403 patients with established or suspected primary open angle glaucoma attending Bristol Eye Hospital and meeting defined inclusion and exclusion criteria. The main outcome measures were 91) measurements of key visual parameters (intraocular pressure, visual fields and cup/disc ratio) made by hospital eye service and community optometrists, compared with a research clinic reference standard at baseline, and (2) patient satisfaction at baseline and at six months., RESULTS: Community optometrists were able to make measurements of comparable accuracy to those made in the hospital eye service. Patients were significantly more satisfied with a number of aspects of care provided by community optometrists, particularly those relating to waiting times, compared with those from the hospital eye service., CONCLUSIONS: Community optometrists are able to make measurements of key visual parameters in patients with established or suspect primary open angle glaucoma which are of comparable quality to the hospital eye service. Follow-up by community optometrists is acceptable to patients. The costs of each option are reported elsewhere.
Keywords: Aged; Aged, 80 and over; *Community Health Services/st [Standards]; Female; Follow-Up Studies; *Glaucoma, Open-Angle/di [Diagnosis]; Humans; Male; Middle Aged; *Optometry/st [Standards]; *Patient Satisfaction/sn [Statistics & Numerical Data]; Reproducibility of Results; United Kingdom; *Vision Tests/st [Standards]; Workforce

[Improved eyedrop administration and compliance in glaucoma patients. A clinical study]. - Busche, S; Gramer, E (Klinische Monatsblatter fur Augenheilkunde, 1997)
BACKGROUND: Poor compliance can be dangerous to successful medical treatment of glaucoma. Among other things one reason for non-compliance represents the inability of the patients to place drops in the eye appropriately. Therefore information regarding the patients ability to administer an eyedrop safely are a prerequisite to determining a therapy scheme which ensures the compliance of glaucoma patients., PATIENTS AND METHODS: 100 glaucoma patients on medical therapy who first presented in the outpatient glaucoma clinic of the University Eye Hospital of Wurzburg were examined by standardised questionnaire and ability tests. We evaluated: 1. Can the eyedrop administration of glaucoma patients be improved by a standardised instruction? 2. Can the eyedrop administration be improved by the use of a drop aid (Autodrop)? 3. Can the accuracy of aiming and the manual ability be evaluated with a target-test on a sheet of paper with a series of concentric circles? 4. How do patients on combined therapy distinguish between their different bottles and where is the dosage regimen noted? 5. What kind of distinguishing marks of eyedrop-bottles do the patients prefer?, RESULTS: 1. Before verbal instruction 76% of the patients applied the eyedrops appropriately, after instruction 94% (p < 0.001) were capable. Touching the eye with the tip of the dropper was reduced significantly. Touching the eye before instruction was found in 63% of the patients, after instruction it was found in 41% (p < 0.001). 2. When patients used the drop aid 81% were able to place a drop in the eye appropriately. Only by 46% of the patients the Autodrop was welcomed. 3. 16% of the patients were not able to place a drop within 1.5 cm of the center of the target (according to the size of an eye). 4. 47% of the patients who use more than one eyedrop bottle admitted problems in distinguishing the bottles, only 38% of the patients read the labels. 5. 76% of the patients would prefer markable stickers of different colours for the bottom of the bottles to improve distinguishing the bottles in combined therapy., CONCLUSION: Instruction improves eyedrop administration in 18% of our patients. In combined therapy with several drugs new distinguishing marks are requested by the patients. To improve compliance combination preparations should be administered if available.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; *Drug Delivery Systems/is [Instrumentation]; Drug Therapy, Combination; Equipment Design; Female; *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; Male; Middle Aged; *Miotics/ad [Administration & Dosage]; Ophthalmic Solutions; *Parasympathomimetics/ad [Administration & Dosage]; Patient Acceptance of Health Care; *Patient Compliance; *Self Administration/is [Instrumentation]; Self Administration/px [Psychology]

A sight for sore eyes. - Furber, J (Nursing times, 1997)
Keywords: Glaucoma/nu [Nursing]; Humans; *Job Description; Nurse Practitioners/st [Standards]; *Nurse Practitioners; Nursing Research; *Ophthalmology; Optometry; Patient Satisfaction

Survival analysis and visual outcome in a large series of corneal transplants in India. - Dandona, L; Naduvilath, T J; Janarthanan, M; Ragu, K; Rao, G N (The British journal of ophthalmology, 1997)
AIM/BACKGROUND: The public health significance of corneal transplantation in dealing with corneal blindness in the developing world would depend upon the survival rate of transplants. This study was done to analyse the survival rate of corneal transplants in a large series in India, and to evaluate the influence of various risk factors on transplant survival., METHODS: The records of a series of 1725 cases of corneal transplants carried out during 1987-95 at a tertiary eye care institution in India were reviewed. The Kaplan-Meier method was used to determine 5 year survival rates of corneal transplants performed for the various categories of preoperative diagnosis. Multivariate Cox proportional hazards regression was used to assess how preoperative diagnosis, socioeconomic status, age, sex, vascularisation of host cornea, quality of donor cornea, and training status of surgeon influenced transplant survival. The effect of these variables on visual outcome was assessed using multiple logistic regression., RESULTS: The survival rates at 1, 2, and 5 years for all corneal transplants performed for the first time in 1389 cases were 79.6% (95% confidence interval = 77.3-81.9%), 68.7% (65.7-71.7%) and 46.5% (41.7-51.3%). The 5 year survival rate was highest if the corneal transplant was done for keratoconus (95.1% (84.8-100%)) and lowest if carried out for previous transplant failure (21.2% (13.8-28.6%)). The relative risk of transplant failure was higher if the preoperative diagnosis was previous transplant failure (2.04 (1.62-2.55)), aphakic bullous keratopathy (1.78 (1.38-2.28)), corneal clouding due to miscellaneous causes including congenital conditions and glaucoma (1.63 (1.21-2.19)), or adherent leucoma (1.11 (0.81-1.51)) than for the other preoperative diagnoses. Patients with lower socioeconomic status had higher relative risk of transplant failure (1.28 (1.16-1.42)), as did patients < 10 years of age (1.42 (1.23-1.64)). Higher relative risk of transplant failure was associated with vascularisation of the host cornea before transplantation (1.15 (1.04-1.27)), and with the use of fair quality donor cornea for transplantation compared with excellent, very good, or good quality donor cornea (1.26 (1.06-1.52)). Before corneal transplant 80.2% of the eyes were blind (visual acuity < 3/60), whereas at last follow up 41.8% eyes were blind. The odds of having visual acuity > 6/18 were higher if the transplant was done for keratoconus (9.99 (6.10-16.36)) or corneal dystrophies (1.77 (1.21-2.58)) than for the other preoperative diagnoses., CONCLUSION: Reasonable success with corneal transplantation is possible in the developing world if data from this part of the world regarding the different survival rates for the various preoperative diagnoses and the influence of risk factors on transplant survival and visual outcome are taken into account while determining priority for transplant cases in the present situation of limited availability of donor corneas.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Blindness/ep [Epidemiology]; *Blindness/su [Surgery]; Child; Corneal Diseases/ep [Epidemiology]; *Corneal Diseases/su [Surgery]; Female; *Graft Survival; Humans; India/ep [Epidemiology]; *Keratoplasty, Penetrating/sn [Statistics & Numerical Data]; Male; Middle Aged; Postoperative Care; Preoperative Care; Proportional Hazards Models; Risk Factors; Treatment Failure; Visual Acuity

Extended wear in perspective. - Brennan, N A; Coles, M L (Optometry and vision science : official publication of the American Academy of Optometry, 1997)
BACKGROUND: Convenience and safety are major motivating factors in the choice of a mode of correction for refractive errors. Extended wear of contact lenses is associated with greater convenience than daily wear, but questions remain concerning the safety and risks associated with this modality. This paper investigates the hurdles that have rendered extended wear an unfavorable option thus far and seeks to identify strategies to overcome these obstacles., METHOD: We review the history of extended contact lens wear, focusing on soft extended wear for cosmetic use. Results of incidence and relative risk studies for the major complications are scrutinized. The factors that are associated with increased risk together with mechanisms which have been proposed on based on scientific research are analyzed to derive strategies for preventing adverse reactions in extended wear., RESULT: Infectious keratitis associated with extended wear of contact lenses has been identified by the community as a major issue, although the degree of concern may be disproportionate. Current perceptions of the relative risk of extended wear versus daily wear in the context of the risk for nonwearers may be misplaced, and the role of eye closure versus consistency and duration of wear remains open to debate. In the minds of practitioners and patients, other adverse reactions may be of greater significance in rejecting extended wear. Nonetheless, the potential extent of injury from infection demands attention. Studies collectively attest that corneal hypoxia during extended wear is a potential causative mechanism in infectious keratitis, suggesting that the provision of higher oxygen levels to the cornea will reduce morbidity rates from this unwanted complication. However, the issues of stagnation of the post-lens tear film during eye closure, mechanical properties of the lens, and lens movement remain unresolved and may prove to be contributing factors to adverse responses., CONCLUSIONS: Attention to oxygen permeability and mechanical properties of soft contact lenses should solve the remaining problems with extended wear. Materials currently under development promise to meet at least some of the desired properties and may lead to the long-awaited advent of safe extended wear.
Keywords: Animals; Contact Lenses, Extended-Wear/ae [Adverse Effects]; *Contact Lenses, Extended-Wear; Cornea/ph [Physiology]; Eye Infections, Bacterial/et [Etiology]; Humans; Keratitis/mi [Microbiology]; Oxygen/me [Metabolism]; *Refractive Errors/th [Therapy]; Risk Factors; Safety

Keeping an eye on vision: new tools to preserve sight and quality of life. A roundtable discussion, Part 2. - Butler, R N; Faye, E E; Guazzo, E; Kupfer, C (Geriatrics, 1997)
Research is pointing the way to new therapies for the eye diseases of aging. A gene that appears related to glaucoma has been identified, and a safe and effective inhibitor for aldose reductase is being sought for patients with diabetic retinopathy. Refinements in cataract surgery continue to improve the high success rate of this procedure. Physicians can educate their patients to participate in vision protection, through control of blood sugars, compliance with glaucoma medications, and the use of the Amsler grid by those at risk for macular degeneration. When vision cannot be corrected to the normal range, low vision rehabilitation offers magnification and new high-tech devices for optimizing independent patient function.
Keywords: Age Factors; *Aged; Cataract/et [Etiology]; Cataract/pc [Prevention & Control]; Diabetic Retinopathy/et [Etiology]; Diabetic Retinopathy/pc [Prevention & Control]; Eye Diseases/di [Diagnosis]; *Eye Diseases/pc [Prevention & Control]; Female; Glaucoma/et [Etiology]; Glaucoma/pc [Prevention & Control]; Humans; Macular Degeneration/et [Etiology]; Macular Degeneration/pc [Prevention & Control]; Male; Research; Risk Factors; Vision Disorders/et [Etiology]; *Vision Disorders/rh [Rehabilitation]

[Microsurgery of cataracts in glaucoma]. - Izak, M; Hazuchova, A; Michalidesova, A (Ceska a slovenska oftalmologie : casopis Ceske oftalmologicke spolecnosti a Slovenske oftalmologicke spolecnosti, 1997)
In a group of 205 implantations of artificial intraocular lenses in 172 patients with glaucoma the authors demonstrate that microsurgery of cataract with implantation, in particular of posterior chamber lenses, has also a permanent hypotonic effect. 155 eyes (75.6%) with primary glaucoma were operated and 50 eyes (24.4%) with secondary glaucoma, 198 times (96.6%) primary implantation was used and 7 times (3.4%) secondary implantation. The highest ratio in the group was formed by extracapsular extractions in 95.0%, intracapsular extractions in 3% and phacoemulsification in 2%. One of the greatest obstacles of microsurgery of cataract in eyes affected with glaucoma is the narrow pupil. The authors give an account of possible solutions of this problem. Vision of 5/10 or better with correction was achieved in 68.8%. The most frequent cause of reduced vision of less than 5/50 was atrophy of the TZN in 11.25% Permanent compensation of intraocular pressure without further treatment was observed in 64.4% during a mean follow-up period of 66.7 months.
Keywords: Adult; Aged; Aged, 80 and over; *Cataract/co [Complications]; *Cataract Extraction; *Glaucoma/co [Complications]; Humans; *Lenses, Intraocular; *Microsurgery; Middle Aged; Postoperative Complications

Reconstruction of trabecular tissue from human trabecular cells as a multicellular spheroid. - Matsuo, T; Matsuo, N (Acta medica Okayama, 1997)
To understand the development of the trabecular meshwork of the eye, floating cellular aggregates (multicellular spheroids) were formed from human trabecular cells in a non-adherent environment of culture and incubated for up to one month. Dissociated trabecular cells formed multicellular spheroids within one day in the non-adherent environment, and apoptosis continued to occur in the spheroids which had been initially filled with cells. The final structure after one month appeared as a meshwork of cells with large extracellular spaces. Epidermal and basic fibroblast growth factor (EGF and bFGF) protected trabecular cells in the spheroids from apoptosis and, as a result, kept the spheroids filled with cells even after one month. In the absence of excess EGF or bFGF, the multicellular spheroids grown in vitro from human trabecular cells mimicked the mesh-like structure of normal trabecular tissue. In contrast, under an excess of these growth factors, spheroids of high cellularity, resembling the abnormal trabecular tissues of patients with congenital glaucoma, were formed.
Keywords: Humans; Spheroids, Cellular; *Trabecular Meshwork/cy [Cytology]

Extended wear disposable soft contact lenses as an alternative to photorefractive keratectomy: report of 4 years experience. - Buckley, C A; Buckley, C J; Griffiths, J (Australian and New Zealand journal of ophthalmology, 1997)
PURPOSE: To establish whether, in a well-informed population, the use of extended wear disposable soft contact lenses (EWDSCL) poses an unacceptable risk to vision and corneal health due to complications associated with their use., METHODS: A 4 year retrospective review of EWDSCL, involving 371 patients in Melbourne from a single general ophthalmology practice. The important aspects of this group were that all patients were given written instructions about the methods of ensuring initial and ongoing cleanliness of lenses, no lenses were cleaned and reinserted, and no solutions other than the saline in the original packaging, and comfort crops, were used. Two types of EWDSCL were used in powers from -9.0 to +6.0 D, and with an initial aim of 4 weeks uninterrupted extended wear. Follow-up was from 2 to 52 months, with an average of 24 months., RESULTS: Of the 354 patients followed up, 236 (66%) regularly wore them on an extended overnight basis, and of these 180 (76%) wore them for the suggested 4 week period before renewal of lenses. In the 471 eyes of 236 patients, adverse reactions occurred at the following rates, marginal infiltrates (12 cases, 2.5%); corneal oedema (10 cases, 2%) peripheral corneal vascularization (2 cases, 0.4%); and presumed infective keratitis (1 case, 0.2%). No eyes lost one or more lines of Snellen acuity., CONCLUSIONS: When disposable soft contact lenses do not come into contact with cleaning solutions, saline from bottles or aerosol cans, or storage cases, their use on an extended wear basis (up to 4 weeks continuous) appears to be associated with a low risk of minor or major complications. The results of this review indicate that controlled usage of EWDSCL is safer than previous reports have indicated.
Keywords: Adolescent; Adult; Aged; Child; Contact Lenses, Extended-Wear/ae [Adverse Effects]; *Contact Lenses, Extended-Wear; Cornea/pp [Physiopathology]; *Disposable Equipment; Female; Follow-Up Studies; Humans; Lasers, Excimer; Male; Middle Aged; Patient Satisfaction; *Photorefractive Keratectomy; Refractive Errors/pp [Physiopathology]; *Refractive Errors/th [Therapy]; Retrospective Studies; Time Factors; Treatment Outcome; Visual Acuity/ph [Physiology]

Lensification of the posterior corneal surface. An unusual proliferation of lens epithelial cells. - Kohnen, T; Koch, D D; Font, R L (Ophthalmology, 1997)
BACKGROUND: Abnormal proliferation of lens epithelial cells occurs in a variety of situations, such as anterior and posterior subcapsular cataracts and secondary cataract formation. The purpose of this report is to document an unusual occurrence of diffuse proliferation of lens epithelium and capsule along the posterior corneal surface., METHODS: The authors performed penetrating keratoplasty to remove an edematous and scarred cornea is a 19-year-old Indian man. Three years previously, the patient had undergone penetrating keratoplasty and extracapsular cataract extraction to treat a nonhealing corneal ulcer. The keratectomy specimen was processed for conventional light microscopy. Five-micrometer sections were stained with hematoxylin-eosin and the periodic acid-Schiff methods., RESULTS: Intraoperatively, the eye was found to be aphakic with an intact posterior capsule. The iris tissue consisted of fibrotic, pigmented remnants adherent to the peripheral cornea for 360 degrees, closing the angle and capsular fornix. Histologically, cataractous lens material including proliferated lens epithelial cells and capsule diffusely lined the posterior corneal surface along a thick retrocorneal fibrous membrane., CONCLUSIONS: This case represents a new category of lens epithelial cell proliferation or migration or both that covers entirely the posterior corneal surface. The authors believe the term lensification is appropriate for the condition described herein.
Keywords: Adult; Cataract Extraction; Cell Division; Cicatrix/su [Surgery]; *Cornea/pa [Pathology]; Cornea/su [Surgery]; Corneal Edema/su [Surgery]; Epithelium/pa [Pathology]; Humans; Lasers, Excimer; *Lens, Crystalline/pa [Pathology]; Male; Photorefractive Keratectomy; Postoperative Complications/su [Surgery]; Reoperation

Racial variations in treatment for glaucoma and cataract among Medicare recipients. - Wang, F; Javitt, J C; Tielsch, J M (Ophthalmic epidemiology, 1997)
PURPOSE: To identify the location of barriers to treatment for glaucoma and cataract among African-American Medicare beneficiaries., METHODS: We examined the receipt of eye care in general and care for glaucoma and cataract in particular among black and white Medicare beneficiaries using 1991 Medicare physician claims data. Racial differences in treatment for glaucoma and cataract were examined both for the Medicare population as a whole and for identified eye care users. The results were compared to the expected value of black-white difference based on population prevalence data for each specific condition., RESULTS: Thirty percent of black beneficiaries and 45% of white Medicare beneficiaries used eye care services in 1991. After adjusting for the expected difference in prevalence, black beneficiaries were half as likely to be surgically treated for glaucoma compared to white beneficiaries, and 80% as likely for cataract. When the analysis was restricted to those using eye care services, blacks continued to have lower than expected rates of treatment for glaucoma (observed RR = 3.2, 95% confidence interval = 3.1-3.4 vs an expected RR of 4.3, 95% confidence interval = 3.5-5.4), but a higher rate of treatment for cataract (RR = 1.2, 95% confidence interval = 1.2-1.3). Among those with physician-diagnosed glaucoma and cataract, blacks were more likely to undergo surgical treatment for these conditions than whites (RR = 1.5 for glaucoma, 95% confidence interval = 1.4-1.5; RR = 1.2 for cataract, 95% confidence interval = 1.2-1.3)., CONCLUSION: Barriers to treatment for glaucoma and cataract among black Medicare beneficiaries involve primarily limitations in access to the eye care system. The undertreatment for glaucoma among black beneficiaries was reduced, but not eliminated, after removing the effect of unequal access to the eye care system.
Keywords: *African Americans/sn [Statistics & Numerical Data]; Aged; Aged, 80 and over; Cataract/di [Diagnosis]; Cataract/eh [Ethnology]; *Cataract/th [Therapy]; *European Continental Ancestry Group/sn [Statistics & Numerical Data]; Female; Glaucoma/di [Diagnosis]; Glaucoma/eh [Ethnology]; *Glaucoma/th [Therapy]; *Health Services/sn [Statistics & Numerical Data]; Health Services Accessibility/sn [Statistics & Numerical Data]; Humans; Male; *Medicare/sn [Statistics & Numerical Data]; Retrospective Studies; United States

Application of rapid scanning retinal thickness analysis in retinal diseases. - Asrani, S; Zeimer, R; Goldberg, M F; Zou, S (Ophthalmology, 1997)
PURPOSE: The authors have further developed their method of retinal thickness analysis to rapidly generate multiple optical cross sections of the retina and provide thickness maps at the posterior pole. The potential use of this method was evaluated in a number of macular disorders., METHODS: A commercial prototype of the scanning retinal thickness analyzer was used to examine patients with a variety of macular diseases. A laser slit beam was projected on the retina and scanned across a 2- X 2-mm retinal area in 200 to 400 msec. The images of the intersection of the laser slit beam with the retina were recorded digitally and used for visualization of disease. Nine scans were combined, and an operator-free algorithm generated a three-dimensional thickness map at the posterior pole., RESULTS: Cysts could be visualized in macular edema associated with diabetes mellitus and with retinal vein occlusion. The retinal thickness map quantitated the location, extent, and height of the edema. In serous detachment, the extent and the height of the retinal pigment epithelial elevation could be documented. In cases of suspected macular holes and pseudoholes, the diagnosis was considered more reliable than with conventional biomicroscopy. The extent of epiretinal membranes, the sites of adherence, and associated intraretinal cystic changes were identified. In glaucoma, the anatomic course of localized loss of neuronal retinal tissue could be traced., CONCLUSIONS: Scanning retinal thickness analysis provided multiple optical cross sections of the retina and yielded information useful in the diagnosis and monitoring of macular diseases. The three-dimensional thickness map provided quantitative information that may be useful for clinical management.
Keywords: *Anatomy, Cross-Sectional/mt [Methods]; Diabetic Retinopathy/di [Diagnosis]; Female; Fovea Centralis/pa [Pathology]; Glaucoma/di [Diagnosis]; Humans; *Lasers; Macular Edema/di [Diagnosis]; Male; Reference Values; *Retina/pa [Pathology]; *Retinal Diseases/di [Diagnosis]; Retinal Perforations/di [Diagnosis]

In-office screening for age-related hearing and vision loss. - Abyad, A (Geriatrics, 1997)
Impairment in hearing and vision are common for persons age 65 and older, and severe impairments may result in dependencies in daily activities. Hearing loss with age often results in diminished ability to communicate with others and may lead to isolation, depression, and cognitive changes. A hearing evaluation involving simple screening tools in important for early recognition and treatment of otologic conditions. Cataracts, macular degeneration, diabetic retinopathy, and glaucoma are the most sight-threatening ocular diseases of aging. Visual loss usually occurs gradually and may go unrecognised for some time. Primary care screening is important to preserve sight and prevent disability and loss of function.
Keywords: Aged; *Blindness/di [Diagnosis]; Blindness/et [Etiology]; *Diabetic Retinopathy/di [Diagnosis]; Female; *Geriatric Assessment; *Glaucoma/di [Diagnosis]; Glaucoma/su [Surgery]; *Hearing Loss, Sensorineural/di [Diagnosis]; Hearing Tests; Humans; Macular Degeneration/co [Complications]; Male; *Office Visits

Fluorescein angiographic evaluation of the effect of latanoprost treatment on blood-retinal barrier integrity: a review of studies conducted on pseudophakic glaucoma patients and on phakic and aphakic monkeys. - Hoyng, P F; Rulo, A H; Greve, E L; Astin, M; Gjotterberg, M (Survey of ophthalmology, 1997)
Endogenous prostaglandins (PGs) have been claimed to play a role in the development of cystoid macular edema (CME). Two fluorescein angiographic studies evaluating the effect of latanoprost, a new ocular hypotensive PG analogue, on blood-retinal barrier integrity are, therefore, reviewed here. In the first study, six of eight unilaterally aphakic cynomolgus monkeys were treated bilaterally once daily for six months with 0.035% latanoprost (seven times the clinically used oculohypotensive concentration). Two of the animals served as controls. Fluorescein angiography of the fundus after one, three and six months of treatment revealed no leakage of fluorescein in any of the 16 eyes. In another study, pseudophakic eyes of 16 glaucoma patients who received twice-daily treatment with 0.006% latanoprost for four weeks were compared to eight patients treated with placebo. Biomicroscopic examination did not reveal any signs of CME and only one placebo-treated eye revealed a slight perifoveal leakage of fluorescein. These studies suggest that topically-applied latanoprost does not have a fluorescein angiographically detectable direct effect on the integrity of the blood-retinal barrier system in phakic or aphakic monkey eyes or in pseudophakic human eyes. This does not rule out the occurrence of CME in eyes more susceptible to CME, due to vitreous loss, posterior capsulotomy, or other postoperative situations. Especially in those eyes a study with latanoprost is proposed. Since, fluorescein angiography is a rather crude method of detecting abnormalities of the blood-retinal barriers, vitreous fluorometry in addition is suggested.
Keywords: Animals; Aphakia, Postcataract/dt [Drug Therapy]; *Aphakia, Postcataract/pp [Physiopathology]; *Blood-Retinal Barrier/ph [Physiology]; Capillary Permeability/de [Drug Effects]; Capillary Permeability/ph [Physiology]; *Fluorescein Angiography; Glaucoma/dt [Drug Therapy]; *Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; *Lenses, Intraocular; Macaca fascicularis; *Prostaglandins F, Synthetic/tu [Therapeutic Use]

Contact lens-related microbial keratitis: Part II: Pathophysiology. - Liesegang, T J (Cornea, 1997)
The literature is reviewed concerning the pathophysiologic effects of contact-lens wear, the microbiology of contact-lens wear, the change in microflora with contact-lens wear, the contamination of contact lenses and contact-lens products, patient compliance, and corneal interaction with the contact lens. Hypoxia and hypercapnia are the most significant changes in the cornea as a result of contact-lens wear. Changes take place in the conjunctival flora in patients with contact lenses. Compliance of patients and contamination of contact lenses and contact-lens products are significant risk factors. The corneal interaction with the contact lens can overwhelm the protective mechanisms of the cornea, increasing the ability of microbes to adhere to the cornea and progress to microbial keratitis. Some of the factors associated with microbial keratitis are modifiable and should stimulate the contact-lens industry to develop better contact lenses and contact lens products and also permit ophthalmologists to obtain better informed consent from their patients.
Keywords: Adhesiveness; Animals; Bacteria/ip [Isolation & Purification]; Bacterial Physiological Phenomena; Biofilms/gd [Growth & Development]; Conjunctiva/mi [Microbiology]; *Contact Lenses/ae [Adverse Effects]; Cornea/mi [Microbiology]; *Cornea/pp [Physiopathology]; Corneal Ulcer/mi [Microbiology]; *Corneal Ulcer/pp [Physiopathology]; Equipment Contamination; Eye Infections, Bacterial/et [Etiology]; *Eye Infections, Bacterial/pp [Physiopathology]; Humans; Risk Factors

The typical pattern of superficial punctate keratopathy in wearers of extended wear disposable contact lenses. - Watanabe, K; Hamano, H (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1997)
PURPOSE: We investigated both the incidence and types of corneal epithelial complications associated with extended wear of the Acuvue disposable soft contact lens, in particular with respect to risk factors for the typical pattern of superficial punctate keratopathy (SPK)., METHODS: We conducted a retrospective study of 5,478 eyes. Clinical characteristics of the corneal epithelial complications, tear volumes, and patient compliance were analyzed., RESULTS: A total of 3.6% (197 eyes/5,478 eyes) were observed to have a corneal epithelial complication on at least one examination during the entire follow-up period. Among the 197 eyes, 112 eyes were observed to have a complication during the initial 2 weeks of trial lens use. This included nine eyes that developed SPK with only daily wear use of the lenses. Sixty-eight eyes were beginners with no previous contact lens experience. SPK was observed in 193 eyes and corneal infiltrates in four eyes, although there were no cases of corneal epithelial erosion or corneal ulcer. With respect to type of SPK, a "smile mark" pattern confined to the area below the pupil was observed in 179 eyes (3.3%)., CONCLUSIONS: The typical pattern of SPK was observed in 3.3% of users of extended wear disposable soft contact lenses, although the condition usually improved with the use of artificial tears.
Keywords: Adolescent; Adult; Aged; *Contact Lenses, Extended-Wear/ae [Adverse Effects]; *Cornea/pa [Pathology]; Corneal Diseases/ep [Epidemiology]; *Corneal Diseases/et [Etiology]; Corneal Ulcer/ep [Epidemiology]; Corneal Ulcer/et [Etiology]; *Disposable Equipment; Epithelium/pa [Pathology]; Follow-Up Studies; Humans; Incidence; Japan/ep [Epidemiology]; Middle Aged; Retrospective Studies; Risk Factors; Tears/ph [Physiology]

Effect of time and washing on the adhesion of Acanthamoeba to extended wear disposable hydrogel contact lenses. - Ramachandran, L; Janakiraman, D; Sharma, S; Rao, G N (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1997)
PURPOSE: This study was undertaken to determine the extent of adhesion of cysts and trophozoites of Acanthamoeba to worn disposable hydrogel lenses and to study the effect of time, lens material, and washing on the adhesion., METHODS: Etafilcon A (58% water content) and Polymacon (38% water content) lenses worn on a 6 night extended wear basis and collected aseptically in PBS pH 7.2, were used for the study. Unworn lenses of the same materials were used as controls. Segments of lenses were incubated in Acanthamoeba suspension (cysts and trophozoites) and examined at 0, 5, and 24 hours, either washed or unwashed, for adherent Acanthamoeba. The amoebae adherent per square mm surface of the lens were enumerated. Levels of adhesion in various groups were compared using Wilcoxon sign rank test., RESULTS: At 0 hours, unwashed worn Polymacon lenses showed significantly greater adherence than Etafilcon A lenses compared to the controls (P = 0.0469). However, there was no difference at 5 and 24 hours exposure time between the lenses. At 24 hours the adhesion of Acanthamoeba was greater for washed worn lenses of both types compared to washed lenses of controls (P = 0.002, 0.012)., CONCLUSIONS: Amoebae adhered with equal affinity to both types of lenses but adhered with greater affinity to worn lenses than unworn lenses. Adhesion of Acanthamoeba to worn disposable lenses may be a factor in the pathogenesis of Acanthamoeba keratitis in disposable lens wearers.
Keywords: *Acanthamoeba/me [Metabolism]; Adhesiveness; Adolescent; Adult; Animals; Biofilms/de [Drug Effects]; *Biofilms; Contact Lens Solutions/pd [Pharmacology]; *Contact Lenses, Extended-Wear; *Disposable Equipment; Female; Follow-Up Studies; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Male; *Polyethylene Glycols; Time Factors

The role of Serratia marcescens in soft contact lens associated ocular infections. A review. - Parment, P A (Acta ophthalmologica Scandinavica, 1997)
Serratia marcescens is a Gram negative rod which for a century and a half was considered a harmless saphrophyte. However, medical technology and the use of antibacterial agents have created ecological niches for this bacterium, which is now a medical problem. The bacterium is encountered in connection with contact lens keratitis, often associated with contaminated contact lens solutions. The concentrations of chlorhexidin and thiomersal required in contact lens solution to suppress the bacterium have been proved toxic to the eye. Modern contact lens solutions with biguanids have rapid killing kinetics, while in solutions with polyquaternium S. marcescens can survive in reduced numbers for up to 72 hours. The adherence of a specific isolate of Serratia to hydrogel lenses increased with decreased water content of the lenses. However, there has been no correlation between hydrophobicity markers or hemagglutinins and adherence to contact lenses or urinary tract epithelium. When handling medical plastic devices, such as contact lenses, strictly enforced hygiene remains the most important method to combat environmental bacteria such as Serratia marcescens.
Keywords: Animals; Bacterial Adhesion; Contact Lens Solutions/ae [Adverse Effects]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Cornea/mi [Microbiology]; Disinfectants/tu [Therapeutic Use]; Equipment Contamination; Eye Infections, Bacterial/dt [Drug Therapy]; *Eye Infections, Bacterial/et [Etiology]; Hemagglutinins/me [Metabolism]; Humans; Keratitis/dt [Drug Therapy]; *Keratitis/mi [Microbiology]; Serratia Infections/dt [Drug Therapy]; *Serratia Infections/et [Etiology]; *Serratia marcescens/ph [Physiology]

Corneal chromoblastomycosis. - Barton, K; Miller, D; Pflugfelder, S C (Cornea, 1997)
PURPOSE: We sought to illustrate the difficulty in managing uncommon, pigmented mold-related corneal ulceration and to highlight the role of itraconazole in treating these patients., METHOD: We describe the management and clinical course of a patient with a recurring corneal infection caused by Fonsecaea pedrosoi and discuss this experience in the light of existing literature on management of cutaneous chromoblastomycosis., RESULTS: A corneal ulcer caused by this organism healed initially on treatment with topical and systemic antifungal medication, but infection recurred in the deep stroma 4 months after cessation of therapy. After failure to respond to a further period of medical therapy, a small therapeutic penetrating keratoplasty was performed. Culture of a fibrinous membrane from the anterior iris surface demonstrated intraocular fungal infection, and postoperatively, an episode of marked fibrinous uveitis developed, suggesting the presence of viable intraocular fungal elements. A large penetrating keratoplasty was therefore performed with excision of involved iris in combination with extracapsular cataract extraction. F. pedrosoi was again cultured from the fibrinous membrane adherent to the iris and from the anterior lens capsule. Postoperatively the patient received a 5-month course of systemic itraconazole, and no further recurrences have been encountered after a further 2 months., CONCLUSION: F. pedrosoi is the organism most commonly isolated from the chronic cutaneous mycosis, chromoblastomycosis, and is relatively resistant to medical therapy. As has been reported for cutaneous disease, surgery in combination with systemic itraconazole may provide the best chance of cure in corneal chromoblastomycosis.
Keywords: *Antifungal Agents/tu [Therapeutic Use]; Cataract Extraction; Combined Modality Therapy; Cornea/mi [Microbiology]; Cornea/pa [Pathology]; Cornea/su [Surgery]; Corneal Ulcer/mi [Microbiology]; Corneal Ulcer/pa [Pathology]; *Corneal Ulcer/th [Therapy]; Eye Infections, Fungal/et [Etiology]; Eye Infections, Fungal/pa [Pathology]; *Eye Infections, Fungal/th [Therapy]; Follow-Up Studies; Humans; *Itraconazole/tu [Therapeutic Use]; *Keratoplasty, Penetrating; Male; Middle Aged; Mitosporic Fungi/ip [Isolation & Purification]; Mycoses/et [Etiology]; Mycoses/pa [Pathology]; *Mycoses/th [Therapy]; Recurrence

Validation of a questionnaire for comparing the tolerability of ophthalmic medications. - Barber, B L; Strahlman, E R; Laibovitz, R; Guess, H A; Reines, S A (Ophthalmology, 1997)
PURPOSE: The Comparison of Ophthalmic Medications for Tolerability (COMTOL) questionnaire was developed for use in clinical trials to compare the tolerability of topical ophthalmic medications used in the treatment of glaucoma. The questionnaire captures the frequency and bother of common side effects (i.e., ocular and other local effects, and effects on visual function) of topical therapy for lowering intraocular pressure. In addition, the questionnaire measures the extent to which these side effects and any associated limitations in routine living activities interfere with health-related quality of life, medication compliance, and patient satisfaction with the medication. This study was designed to assess the measurement characteristics of the COMTOL questionnaire., METHODS: The internal consistency, reliability, reproducibility, construct validity, discriminant validity, and responsiveness of the questionnaire were assessed in 70 adult patients with glaucoma in a clinical trial comparing timolol and pilocarpine., RESULTS: The questionnaire showed good-to-excellent internal consistency (0.73 to 0.98), reliability (0.76 to 0.94), and reproducibility (0.75 to 0.93). In general, there was a strong correlation in the expected direction between the frequency and bother of side effects and patient-perceived global measures. The questionnaire discriminated between patients receiving timolol and patients receiving pilocarpine. The questionnaire demonstrated significant responsiveness to change., CONCLUSIONS: The COMTOL questionnaire showed acceptable measurement characteristics for inclusion as a tolerability measure to supplement spontaneous adverse event reporting in clinical trials of topical ophthalmic therapy.
Erratum in (EIN)
Keywords: *Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Aged, 80 and over; Eye Diseases/ci [Chemically Induced]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Health Status Indicators; Humans; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; *Parasympathomimetics/ae [Adverse Effects]; Parasympathomimetics/tu [Therapeutic Use]; *Pilocarpine/ae [Adverse Effects]; Pilocarpine/tu [Therapeutic Use]; Reproducibility of Results; *Surveys and Questionnaires/st [Standards]; *Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]

[Principles of effectiveness control in therapy of glaucoma]. - Gloor, B; Meier-Gibbons, F (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 1996)
There are two levels at which the efficacy of glaucoma therapy can be determined: first, the therapeutic trial and second, the experience gained when treating individual patients in the daily practice. At each level, various difficulties arise. At either level, however, the main problem is that there is no way to check on patient compliance. A trial on the efficacy of glaucoma therapy needs to be thoroughly planned and performed, correct statistical methods must be used, and the therapy must be critically evaluated a review of studies on glaucoma therapy for the years 1988 and 1993 showed the difficulties in planning and enforcing a correct study design. Most studies suffer from lack of adaptation to the characteristic features of primary open-angle glaucoma, the most important of all being its chronic course with minimal changes over many years once pressure is regulated. Thus, long-term studies are mandatory with simultaneous assessment of intraocular pressure (IOP), the visual field and the morphology of the optic nerve head (ONH). Measurement of the IOP is the parameter that can be most reliably checked on. Increased IOP represents the main cause for glaucoma damage-not the damage itself. For the early detection of glaucoma, morphometry of the ONH is the most reliable method, but it is still quite rough. The use of perimetry for early detection and follow-up of glaucoma is overestimated. Given the above-mentioned characteristic features of the disease, sufficient damage with corresponding perimetric and morphometric changes does not occur in the short time periods chosen for therapeutic trials. The future will show whether the blood supply of the ONH will be of primary interest in glaucoma detection and control of treatment efficacy. New and promising methods for measurement of the blood supply of the ONH are emerging. Last but not least, control of efficacy in glaucoma treatment should include cost-effect analyses. Such studies are almost nonexistent at present.
Keywords: Clinical Trials as Topic; *Glaucoma/th [Therapy]; Glaucoma, Open-Angle/th [Therapy]; Humans; Intraocular Pressure; Optic Disk/pa [Pathology]; Treatment Outcome; Visual Fields

Liver transplantation for hepatitis B cirrhosis: clinical sequela of passive immunization. - al-Hemsi, B; McGory, R W; Shepard, B; Ishitani, M B; Stevenson, W C; McCullough, C; Pruett, T L (Clinical transplantation, 1996)
UNLABELLED: Aggressive administration of hepatitis B immune globulin (HBIg) has been shown to prevent hepatitis B viral (HBV) infection of the allograft; however, the clinical sequela of such therapy has not been previously described. We reviewed our experience with high dose, intravenous infusion of an intramuscular HBIg preparation to assess the effectiveness and complications of such therapy. Thirty three orthotopic liver transplants (OLTx) were performed in 32 patients with chronic HBV cirrhosis at the University of Virginia between March 1990 and June 1995. Twenty-nine of 32 (91%) patients remain free of HBV recurrence (defined by undetectable serum HBsAg and HBV-DNA) after a mean of 21 months (2-54 months), with one patient requiring retransplantation. Three (10%) patients died of non-HBV causes (two vascular events, one infectious event). Twenty episodes of acute cellular rejection were treated in 18 patients (two had two episodes). Sixteen rejections occurred within 18 d of transplant, 19 by day 120, and one late rejection occurred at 18 months owing to medication non-compliance. Eighteen patients had at least one documented infection. Six patients were treated for CMV infection (five empirically). Eight patients were treated for HSV infections (seven mild herpetic labialis and one herpetic keratitis). Four patients had documented fungal infection (one mucormycosis pneumonia and three minor superficial mucosal infections). With the exception of one necrotizing pneumonia, 11 bacterial infections were successfully treated with conventional antimicrobial agents. No patient developed post-transplant lymphoproliferative disorder. Symptoms associated with HBIg infusion were intermittent but frequent and consisted of myalgias, predominantly back pain (90%), headache (20%) and flushing (5%). No patient experienced anaphylaxis, fever, rash, arthritis or hypotension. Despite the potential for mercury toxicity and HCV transmission in the HBIg formulations currently available in the United States, serum mercury levels remained below standards for industrial exposure (60 micrograms/ml), and only one individual developed post-transplant HCV infection after receiving multiple units of unscreened blood prior to 1991., SUMMARY: High-dose HBIg prevented HBV infection of the allograft in 29 of 32 patients transplanted for HBV cirrhosis with three non-HBV associated deaths. The intravenous infusion of HBIg was frequently associated with minor side effects that were safely tolerated by patients. The risk of HCV transmission and mercury toxicity are minimal, but support the need for a new intravenous formulation of HBIg. HBIg therapy successfully decreased post-OLTx HBV recurrence with no clinical events associated with immunosuppression. Patients did non experience allergic or infusion-related complications that altered or terminated therapy. Manufacturing modifications of HBIg may allow for improved patient tolerance and decreased risks.
Keywords: Adult; Aged; Chronic Disease; Disease-Free Survival; Female; Graft Rejection/et [Etiology]; *Hepatitis B/co [Complications]; Humans; *Immunization, Passive; Immunoglobulins/ae [Adverse Effects]; Infections/et [Etiology]; *Liver Cirrhosis/su [Surgery]; *Liver Cirrhosis/vi [Virology]; Liver Transplantation/ae [Adverse Effects]; *Liver Transplantation/im [Immunology]; Male; Middle Aged; Recurrence

The effect of a medication alarm device on patient compliance with topical pilocarpine. - Laster, S F; Martin, J L; Fleming, J B (Journal of the American Optometric Association, 1996)
BACKGROUND: This study was performed to investigate the use of an electronic medication alarm device (Prescript TimeCap) to enhance compliance in glaucoma patients taking pilocarpine., METHODS: Thirteen subjects were selected who had been diagnosed with open-angle glaucoma and were receiving 1 drop of pilocarpine solution 4 times a day in both eyes. For each subject, the study was divided into 2 30-day phases, one with the medication alarm device and the other without. Thus, each subject served as his or her own control. Compliance was measured based on the amount of pilocarpine used and by patient questionnaire. In addition, the subjects completed a post-study questionnaire regarding the ease of use of the TimeCap and whether it helped them remember to take their medication., RESULTS: When subjects used the TimeCap, they administered an average of 2.867 g (P < 0.0001) more pilocarpine over the 30 days than during the period without it. Subjects also estimated a significant difference in compliance level, 95.8 percent with the alarm device versus 83.1 percent without it (p < 0.01). All subjects reported no difficulty using the TimeCap, and all reported that it helped them remember to take their medication., CONCLUSIONS: These results are highly suggestive that the TimeCap is an effective compliance aid for glaucoma patients on pilocarpine.
Keywords: Administration, Topical; *Drug Administration Schedule; Drug Packaging; *Equipment and Supplies; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; *Muscarinic Agonists/ad [Administration & Dosage]; Ophthalmic Solutions; *Patient Compliance; *Pilocarpine/ad [Administration & Dosage]; Surveys and Questionnaires

Cost effectiveness of screening for primary open angle glaucoma. - Boivin, J F; McGregor, M; Archer, C (Journal of medical screening, 1996)
OBJECTIVES AND SETTING: To determine the cost effectiveness of screening for glaucoma., METHODS: Information on treatment efficacy, diagnostic methods, epidemiological characteristics of glaucoma, and costs were determined from the literature, from administrative databases, and from experts. Scenarios with different screening frequency, age, participation in screening, compliance with treatment, treatment efficacy, and diagnostic tests were examined., RESULTS: The initial scenario comprised three-yearly screening of subjects aged 40-79 by funduscopy and tonometry, followed by perimetry when abnormalities were discovered. The assumption of levels of participation in screening and of compliance with treatment of 75%, and treatment efficacy of 50% resulted in a cost of $C100,000 per year of blindness prevented. A scenario in which screening was restricted to subjects aged 65-79, with the same input variables, would prevent 81% of the cases of blindness prevented with scenario 1, at a cost of $C42,000 per year of blindness prevented. Screening with tonometry only as the initial diagnostic test in subjects aged 65-79 would result in a cost of $C36,000 per year of blindness prevented, but would only prevent 59% of the cases prevented with scenario 1., CONCLUSIONS: There is as yet no proof that treatment of glaucoma or of high intraocular pressure will arrest the progression of glaucoma to blindness. Even when treatment efficacy is assumed to be as high as 50%, however, the cost effectiveness of most glaucoma screening programmes considered would not be competitive.
Keywords: Adult; Aged; *Cost-Benefit Analysis; Fluorescein Angiography/ec [Economics]; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/ec [Economics]; Glaucoma, Open-Angle/th [Therapy]; Humans; Middle Aged; Outcome Assessment, Health Care; Tonometry, Ocular/ec [Economics]; Treatment Outcome; Visual Field Tests/ec [Economics]

Influence of diurnal variation on the intraocular pressure measurement of treated primary open-angle glaucoma during office hours. - Rota-Bartelink, A M; Pitt, A; Story, I (Journal of glaucoma, 1996)
PURPOSE: Intraocular pressure has been shown in past studies to vary diurnally. The purpose of this study was to establish whether patients treated with timolol maleate for primary open-angle glaucoma should be reviewed at a specific time of day, within normal clinical hours (9 a.m. to 5 p.m.). It is normal practice to schedule review appointments into either morning or afternoon clinic sessions. This may result in abnormally high intraocular pressure values being missed., METHODS: The intraocular pressure of 28 people with primary open-angle glaucoma was measured by means of a Goldmann applanator on an hourly basis between the hours of 9 a.m. and 5 p.m. All subjects continued their antiglaucoma therapy of timolol maleate throughout the measurement period., RESULTS: The intraocular pressure increased significantly (p = 0.0008) throughout the measurement period, with maximal intraocular pressure values occurring at 5 p.m. in the afternoon., CONCLUSION: Although monitoring intraocular pressure values should not be the only consideration in glaucoma management, undetected rises in pressure may precede the development of optic disc cupping or visual field loss. The variability of intraocular pressure values has important implications in the scheduling of glaucoma intraocular pressure review measurements for the purposes of continuing treatment.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Aged; Appointments and Schedules; *Circadian Rhythm/ph [Physiology]; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Office Visits; Timolol/tu [Therapeutic Use]; Tonometry, Ocular

Dorzolamide versus pilocarpine as adjunctive therapies to timolol: a comparison of patient preference and impact on daily life. - Laibovitz, R; Boyle, J; Snyder, E; Strohmaier, K; Adamsons, I (Clinical therapeutics, 1996)
The purpose of this study was to compare 2% dorzolamide three times daily with 2% pilocarpine four times daily to determine patient preference, tolerability, and impact on daily life in patients concurrently receiving 0.5% timolol twice daily for treatment of elevated intraocular pressure (IOP). Seventy-five patients were enrolled in this 4-week, randomized, two-period, crossover study. The Comparison of Ophthalmic Medications for Tolerability questionnaire was used to assess patient preference and perception of side effects and activity limitations resulting from the study medications. IOP measurements were obtained 2 hours after drops were instilled and visual field tests were performed at baseline and at the end of each crossover period. Significantly more patients receiving pilocarpine than dorzolamide reported adverse experiences and discontinued the drug because of these adverse experiences. Similarly, patients reported more interference with their daily life because of side effects and activity limitations when receiving pilocarpine. Vision difficulties, accommodation difficulties, and brow ache were reported more often and were considered more bothersome by patients receiving pilocarpine. Bitter/unusual taste was reported more frequently and was considered more bothersome by patients receiving dorzolamide. Patients also reported missing fewer doses and were more satisfied with their medication when receiving dorzolamide. All of these changes were considered statistically significant. IOP control was not significantly different with either dorzolamide or pilocarpine. However, patients experienced a significant worsening of the mean defect of automated visual field examinations when receiving pilocarpine. At the end of the study, among patients with a preference, dorzolamide was preferred to pilocarpine by a ratio of more than 9:1. Overall, 81.9% of patients preferred dorzolamide. Thus dorzolamide demonstrated better tolerability and less adverse impact on daily life than pilocarpine.
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; *Antihypertensive Agents/tu [Therapeutic Use]; Cross-Over Studies; Drug Therapy, Combination; Female; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Satisfaction; Pilocarpine/ae [Adverse Effects]; *Pilocarpine/tu [Therapeutic Use]; Sulfonamides/ae [Adverse Effects]; *Sulfonamides/tu [Therapeutic Use]; Thiophenes/ae [Adverse Effects]; *Thiophenes/tu [Therapeutic Use]; *Timolol/tu [Therapeutic Use]; Visual Fields/de [Drug Effects]

A comparative evaluation of pilocarpine 1% and clonidine 0.125% versus timolol 0.5%. - Sihota, R; Agarwal, H C; Rajashekar, Y L (Indian journal of ophthalmology, 1996)
All the presently available antiglaucoma medications have either local or systemic adverse effects. Combinations of drugs are being used not only to increase the effectivity and compliance but also to decrease the incidence and magnitude of side effects. The single dose response of open angle glaucoma eyes to pilocarpine 1%, clonidine 0.125%, a combination of pilocarpine 1% and clonidine 0.125%, and timolol 0.5% was studied in a double blind, masked, cross over study. Over a period of twelve hours the effectivity of the combination of pilocarpine 1% and clonidine 0.125% was significantly more than that of either drug alone and was found to be similar to that of timolol 0.5%. No local or systemic adverse effects were seen.
Keywords: Administration, Topical; Adrenergic alpha-Agonists/ad [Administration & Dosage]; *Adrenergic alpha-Agonists/tu [Therapeutic Use]; Adrenergic beta-Antagonists/ad [Administration & Dosage]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Blood Pressure/de [Drug Effects]; Clonidine/ad [Administration & Dosage]; *Clonidine/tu [Therapeutic Use]; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Muscarinic Agonists/ad [Administration & Dosage]; *Muscarinic Agonists/tu [Therapeutic Use]; Ophthalmic Solutions; Pilocarpine/ad [Administration & Dosage]; *Pilocarpine/tu [Therapeutic Use]; Timolol/ad [Administration & Dosage]; *Timolol/tu [Therapeutic Use]

Patient noncompliance with wearing and replacement schedules of disposable contact lenses. - Smith, S K (Journal of the American Optometric Association, 1996)
BACKGROUND: Corneal ulcers related to contact lens wear are four to 15 times more likely to occur with extended wear lenses versus daily wear lenses. The introduction of disposable contact lenses raised hopes that this product would reduce complications related to contact lens wear. Such has proven not to be the case, especially when patients are noncompliant with the prescribed wear and care regimen., METHODS: The ordering patterns of a group of 145 patients wearing disposable contact lenses were monitored for a period of one year, 5 months in an attempt to identify those individuals who were potentially noncompliant in their wearing schedules., RESULTS: Up to 69 percent of the patients studied were identified as potentially noncompliant. A program to counsel and re-educate these patients about proper disposable contact lens wear was proposed., CONCLUSIONS: Eye care professionals have a legal and ethical responsibility to provide appropriate follow-up care for patients. The ability to track ordering patterns of patients who wear disposable contact lenses provides a valuable tool to use in identifying patients who could be putting themselves at risk to develop complications related to contact lens wear.
Keywords: *Contact Lenses/sn [Statistics & Numerical Data]; Corneal Ulcer/ep [Epidemiology]; Corneal Ulcer/et [Etiology]; Corneal Ulcer/pc [Prevention & Control]; Disposable Equipment; Follow-Up Studies; Humans; Prevalence; Retrospective Studies; *Treatment Refusal/sn [Statistics & Numerical Data]

Factors affecting Staphylococcus epidermidis adhesion to contact lenses. - Fleiszig, S M; Evans, D J; Mowrey-McKee, M F; Payor, R; Zaidi, T S; Vallas, V; Muller, E; Pier, G B (Optometry and vision science : official publication of the American Academy of Optometry, 1996)
BACKGROUND: Staphylococcus epidermidis is a major causative agent of infectious keratitis associated with contact lens wear. Adhesion of this bacterium to contact lenses may contribute to the pathogenesis of infection and could be influenced by lens surface properties, packaging/storage solutions, and vary among different strains according to the level or type of adhesins expressed., METHODS: Adhesion of six clinical isolates of S. epidermidis to three different contact lens materials was tested. Adhesion assays were performed on lenses immediately after removal from their packages, and also after lenses were soaked in sterile phosphate buffered saline (PBS) for 7 days to dilute the packaging solution., RESULTS: For lenses tested immediately upon removal from their packaging, adhesion to polymacon (in PBS with 0.1% polyvinyl alcohol) was significantly greater than to etafilcon A (in borate buffered saline) and vifilcon A (in PBS). After soaking, adhesion to polymacon lenses was significantly less than to the other lens materials. This pattern was consistent for all strains, although major differences in baseline adhesion levels existed between strains, with exopolysaccharide (slime)-positive bacteria being more adherent to lenses., CONCLUSIONS: Properties of contact lens materials were not the sole determinant of viable S. epidermidis adhesion to lenses. Strain variability, including levels of exopolysaccharide expression, and the solution used for lens immersion also influenced adhesion.
Keywords: *Bacterial Adhesion/ph [Physiology]; *Contact Lenses, Hydrophilic; Humans; Staphylococcus epidermidis/ip [Isolation & Purification]; *Staphylococcus epidermidis/ph [Physiology]

Improving compliance with glaucoma eye-drop treatment. - Cooper, J (Nursing times, 1996)
Many older patients attending ophthalmic out-patient clinics have been prescribed eye drops for long-term use to treat glaucoma but do not continue with their treatment. This review looks at chronic simple glaucoma, the problems of compliance with long-term medical treatment in older people and the current and future treatment of glaucoma. Recommendations are made on the nurses' role in supporting these patients.
Keywords: Aged; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/nu [Nursing]; Humans; *Patient Compliance; *Patient Education as Topic

A controlled trial of oral acyclovir for iridocyclitis caused by herpes simplex virus. The Herpetic Eye Disease Study Group. - Anonymous (Archives of ophthalmology (Chicago, Ill. : 1960), 1996)
OBJECTIVE: To assess the benefit of adding oral acyclovir to a regimen of topical prednisolone phosphate and trifluridine for the treatment of iridocyclitis caused by herpes simplex virus (HSV)., METHODS: Patients with HSV iridocyclitis were enrolled in a multicenter controlled clinical trial supported by the National Eye Institute, Bethesda, Md, and randomly assigned to receive a 10-week course of either oral acyclovir, 400 mg, 5 times daily, or oral placebo in conjunction with regimens of topical trifluridine and a topical corticosteroid. Follow-up examinations were performed weekly during the 10-week treatment period, every 2 weeks for an additional 6 weeks, and at 26 weeks after enrollment in the trial. Treatment failure was defined as a persistence or worsening of ocular inflammation, withdrawal of medication because of toxicity, or a request by the patient to withdraw from the trial for any reason. The trial was stopped because of slow recruitment after only 50 of the originally planned 104 patients were enrolled in more than 4 years., RESULTS: A treatment failure occurred in 11 (50%) of the 22 patients in the acyclovir-treated group and in 19 (68%) of the 28 patients in the placebo group. Compared with the placebo group, the adjusted rate ratio for a treatment failure in the acyclovir-treated group during the 10-week treatment period was 0.43 (90% confidence interval, 0.18-1.02; P = .06, 1-tailed) and during the 16-week follow-up period (10-week treatment period plus 6-week observation period) was 0.60 (90% confidence interval, 0.29-1.25; P = .13, 1-tailed in a proportional hazards model). The treatment effect seemed slightly greater when only the patients with a persistence or worsening of ocular HSV disease were considered as treatment failures (ie, excludes terminations because of toxic effects of the drug and patients who requested to withdraw from the trial). By life-table analysis, similar results were obtained; the possible benefit of acyclovir became apparent after the first 3 weeks of follow-up., CONCLUSION: While the number of patients recruited in this trial was too small to achieve statistically conclusive results, the trend in the results suggests a benefit of oral acyclovir in the treatment of HSV iridocyclitis in patients receiving topical corticosteroids and trifluridine prophylaxis.
Keywords: Acyclovir/ad [Administration & Dosage]; *Acyclovir/tu [Therapeutic Use]; Administration, Oral; Administration, Topical; Anti-Inflammatory Agents/ad [Administration & Dosage]; Anti-Inflammatory Agents/tu [Therapeutic Use]; Antiviral Agents/ad [Administration & Dosage]; *Antiviral Agents/tu [Therapeutic Use]; Corneal Stroma/vi [Virology]; Female; Follow-Up Studies; Herpes Simplex/co [Complications]; *Herpes Simplex/dt [Drug Therapy]; Herpesvirus 1, Human/ip [Isolation & Purification]; Humans; *Iridocyclitis/dt [Drug Therapy]; *Iridocyclitis/vi [Virology]; Keratitis, Herpetic/co [Complications]; Keratitis, Herpetic/dt [Drug Therapy]; Male; Middle Aged; Ophthalmic Solutions; Patient Compliance; Prednisolone/ad [Administration & Dosage]; Prednisolone/tu [Therapeutic Use]; Treatment Failure; Treatment Outcome; Trifluridine/ad [Administration & Dosage]; Trifluridine/tu [Therapeutic Use]

Skillsharing. Joint statement from the Royal College of Physicians of London and the Royal College of Nursing. - Anonymous (Journal of the Royal College of Physicians of London, 1996)
For a number of years there has been a trend towards the sharing of skills, with their transfer from one group with which they have been traditionally associated to another within the health care professions. Examples in medicine include nurses delivering care to patients with diabetes mellitus, carrying out gastrointestinal endoscopy, administering intravenous chemotherapy to patients with cancer, and contributing to the management of patients with myocardial infarction and with asthma; opticians are employed in the screening of patients for glaucoma and diabetic retinopathy; and physiotherapy and radiography grew out of nursing. This movement is seen to be advantageous for patient care in that it extends the range and numbers of personnel. If this development is to be fostered and to continue to represent an advance in the delivery of health care, it is necessary to lay down guidelines to ensure that standards are maintained with safety and efficacy safeguarded. It was for this reason that representatives of the Royal Colleges of Nursing and of Physicians of London met to agree a set of principles that, while constructed for medicine and nursing, should be of general application to all the professions involved in providing health care.
Keywords: Delivery of Health Care; *Education, Medical/st [Standards]; Humans; Patient Satisfaction; *Professional Competence; United Kingdom

Investigation of microbial keratitis: an audit from 1988-1992. - Simcock, P R; Butcher, J M; Armstrong, M; Lloyd, I C; Tullo, A B (Acta ophthalmologica Scandinavica, 1996)
An audit was performed of the investigation of 263 cases of microbial keratitis severe enough to be admitted to the Manchester Royal Eye Hospital over the 5-year period, 1988-1992. A pathogen isolation rate of 37% was noted during the first year which increased to 79% (p < 0.05) by the final year of audit. In late 1991 a new method of inoculating enrichment broths was introduced, which also contributed by increasing the yield from corneal scrapes. The audit process resulted in the development of and adherence to our investigation protocol, improved communication between Manchester Royal Eye Hospital and the microbiology laboratory, the implementation of a new investigatory method, and a significantly improved microbial isolation rate.
Keywords: Adolescent; Adult; Age Distribution; Anti-Bacterial Agents/tu [Therapeutic Use]; Bacteria/ip [Isolation & Purification]; Child; Child, Preschool; Colony Count, Microbial; Cornea/mi [Microbiology]; England/ep [Epidemiology]; Eye Infections, Bacterial/dt [Drug Therapy]; *Eye Infections, Bacterial/ep [Epidemiology]; Eye Infections, Bacterial/mi [Microbiology]; Humans; Infant; Infant, Newborn; Keratitis/dt [Drug Therapy]; *Keratitis/ep [Epidemiology]; Keratitis/mi [Microbiology]; *Medical Audit; Middle Aged; Retrospective Studies

Extended wear soft contact lenses: to market or not to market. - Hostetter, T A (Journal of ophthalmic nursing & technology, 1996)
1. Today, cosmetic extended wear lenses have numerous aliases; continuous wear, provisional extended wear, and flexible wear, all referring to the same products, but on a relative scale of wearing time. Cosmetic extended wear lenses are elective and differ from the medical necessity of extended wear that few patients require. Refractive surgery has made significant advances in the cosmetic extended wear lens market. 2. Despite growing conservatism, positive marketing kept growing the EW philosophy for almost a decade until the FDA laid down some new rules, including a 1-week maximum for overnight wear. Coincidentally, this mandate came with the advent of the disposable lens in 1989. Since then, 1-week EW with disposable contacts has proved to be a safer modality for cosmetic EW; however, the concern of corneal complications continues to decline the market. 3. Patients risk a microbial ulcerative keratitis secondary to cosmetic EW. If daily wear contact lens options or occasional part-time EW is not amenable to the patient, refer the patient to an experienced refractive surgeon. Today, patients have more healthful vision choices than ever before.
Keywords: *Consumer Product Safety; Contact Lenses, Extended-Wear/ae [Adverse Effects]; Contact Lenses, Extended-Wear/ec [Economics]; *Contact Lenses, Extended-Wear/st [Standards]; Health Care Costs; Humans; Lasers, Excimer; *Marketing of Health Services; Photorefractive Keratectomy; United States; United States Food and Drug Administration

Effect of adhered bacteria on the binding of Acanthamoeba to hydrogel lenses. - Gorlin, A I; Gabriel, M M; Wilson, L A; Ahearn, D G (Archives of ophthalmology (Chicago, Ill. : 1960), 1996)
OBJECTIVES: To determine the effect of Pseudomonas aeruginosa and Staphylococcus epidermidis on the binding of Acanthamoeba species to hydrogel lenses., METHODS: Cells of amebae and bacteria were incubated with different types of hydrogel lenses. Densities of amebae that were bound to the lenses after rinsing were determined from direct counts with a cell detachment procedure and from scintillation counts of cells, which were radiolabeled with tritiated leucine., RESULTS: With both methods, amebae showed significantly increased binding to hydrogel lenses with attached P aeruginosa. The numbers of amebae that were retained on lenses with attached S epidermidis were not significantly different from those that were retained on lenses without bacteria. The binding of amebae to unworn hydrogel lenses, in contrast to the irreversible adherence of P aeruginosa, was tenuous., CONCLUSIONS: The binding of Acanthamoeba species to unworn hydrogel lenses was tenuous and appeared to be related to water content, surface tensions, and ionic charge. The presence of adhered P aeruginosa on the hydrogel lenses facilitated the binding of Acanthamoeba species. The cocontamination of lens systems with bacteria (eg, P aeruginosa) may be a prime factor in the development of amebic keratitis.
Keywords: Acanthamoeba/ip [Isolation & Purification]; *Acanthamoeba/me [Metabolism]; Animals; *Bacterial Adhesion/ph [Physiology]; Cell Adhesion; Colony Count, Microbial; *Contact Lenses; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; *Polyethylene Glycols; Pseudomonas aeruginosa/ip [Isolation & Purification]; *Pseudomonas aeruginosa/ph [Physiology]; Staphylococcus epidermidis/ip [Isolation & Purification]; *Staphylococcus epidermidis/ph [Physiology]

Herpetic eye disease study. You can help. - Dawson, C R; Beck, R; Wilhelmus, K R; Cohen, E J (Archives of ophthalmology (Chicago, Ill. : 1960), 1996)
Keywords: *Acyclovir/tu [Therapeutic Use]; Administration, Oral; Anti-Inflammatory Agents/tu [Therapeutic Use]; *Antiviral Agents/tu [Therapeutic Use]; Clinical Trials as Topic; Humans; Keratitis, Herpetic/dt [Drug Therapy]; *Keratitis, Herpetic/pc [Prevention & Control]; Multicenter Studies as Topic; Ophthalmic Solutions; Patient Participation; Prednisolone/tu [Therapeutic Use]; Randomized Controlled Trials as Topic; Recurrence

Adherence of Acanthamoeba to human corneal epithelial cells recovered from normal non-lens wearers and asymptomatic contact lens wearers. - Sharma, S; Sankaridurg, P R; Venkata, N; Potluri, S; Athmanathan, S; Reddy, S; Holden, B A; Rao, G N (Contact lens & anterior eye : the journal of the British Contact Lens Association, 1999)
To increase our knowledge of factors leading to Acanthamoeba keratitis in contact lens wearers, we determined the ability of this organism to adhere to corneal epithelial cells (EC) recovered from non-lens wearers (NL) and from subjects using hydrogel contact lenses on a daily (DW) and extended wear (EW) schedule. ECs were incubated with trophozoites of Acanthamoeba and, after 3 h, the median per cent of cells exhibiting adherence was 24, 23 and 23 for NL, DW and EW groups respectively (P=0.552, Kruskal-Wallis Test). There were no differences between the groups for the number of adherent amoebae and a significant majority had only one adherent trophozoite per EC. No difference in adherence was seen with increasing exposure time. Factors other than amoebic adherence to superficial corneal EC are responsible for the increased incidence of Acanthamoeba keratitis in lens wearers.

Acanthamoeba keratitis in Scotland: risk factors for contact lens wearers. - Seal, D V; Kirkness, C M; Bennett, H G; Peterson, M; Keratitis Study Group (Contact lens & anterior eye : the journal of the British Contact Lens Association, 1999)
OBJECTIVE: To investigate risk factors for Acanthamoeba keratitis amongst contact lens wearers in Scotland., DESIGN: Patients with Acanthamoeba keratitis in the Scottish study, all of whom wore contact lenses, were compared with 46 healthy asymptomatic contact lens-wearing controls. They were all visited at home for contact lens and environmental microbiological sampling. In addition, all 288 optical practices in the West of Scotland were polled for contact lens types and disinfecting solutions sold in 1995, and a sample, each of whom fitted more than 500 contact lenses per year, were polled for a second time. Independently, a poll was commissioned by the Eyecare Information Service in July/August 1995 to estimate the numbers of contact lens wearers in Scotland and the UK. Industry was polled for numbers of each contact lens disinfecting regimen sold in Scotland in 1995., SETTING: West of Scotland, UK., SUBJECTS: All contact lens wearers among the 3 million population of the West of Scotland Health Board Areas., MAIN OUTCOME MEASURES: Risk factors for Acanthamoeba infection and recommendations for its prevention., RESULTS: When Acanthamoeba infection occurred, patients' home water systems were frequently (54%) found to be colonised by this amoeba. Patients more frequently washed their storage cases in tap water than controls (P<0.05) with resulting contamination, kept storage cases wet rather than air drying them (P<0.05), and had coliform bacteria cultured from the storage case (P<0.05) and had viable Acanthamoeba within the storage case (P<0.0001). Overall, patients were found to have significantly more risk factors than controls (P<0.0001). The noncompliant use of chlorine tablet disinfection, or failure to disinfect contact lenses at all, was associated with increased risk (P<0.05). Ionic high water content contact lenses (FDA group 4 material), when used without disinfection or with non-compliant use of low chlorine (Soflab) tablet-based disinfection, were associated with increased risk of Acanthamoeba infection (P<0.05). In log-linear modelling of risky hygiene behaviours associated with contamination of storage cases with Acanthamoeba, the most significant behaviour was found to be use of the less effective disinfection methods (chlorine tablets or no disinfection). However further investigation showed that these methods were associated with an increased probability of rinsing the storage case in tap water, so that these two behaviours are confounded in the group studied., CONCLUSIONS: Failure to disinfect contact lenses, non-compliant use of chlorine tablets and/or introduction of tap water rinsing of storage cases were associated with increased risk of Acanthamoeba infection. New multipurpose solutions and hydrogen peroxide gave the lowest risk of Acanthamoeba infection, with no statistically significant difference between them. Ionic high-water content (FDA group 4) contact lenses were at increased risk of being associated with Acanthamoeba keratitis if used without effective disinfection (multipurpose solutions or hydrogen peroxide). The use of domestic tap water for contact lens and storage case hygiene must be avoided, as a chain-of-causation' was identified from the home water supply.

Potential utility of electronic drug compliance monitoring in measures of adverse outcomes associated with immunosuppressive agents. - Feldman, H I; Hackett, M; Bilker, W; Strom, B L (Pharmacoepidemiology and drug safety, 1999)
Poor compliance with prescribed medications limits the effectiveness of many pharmacologic therapies and enhances their potential toxicities. Traditional methods of measuring drug-taking behavior, including direct observation, patient self-report, pill counts, and therapeutic drug level monitoring, all have well-described limitations in validity and interpretability. Electronic medication event monitoring has been used to assess compliance with therapies for hypertension, glaucoma, anemia, and epilepsy, overcoming many problems of traditional approaches. However, no published reports describe the use of electronic monitoring with immunosuppressive agents, despite their increasing use for non-life-threatening conditions and their many dose-dependent toxicities. Transplant recipients are thought to be at particular risk from noncompliance. Therefore, we undertook this study to assess the feasibility of electronically monitoring compliance with immunosuppressive drugs among renal allograft recipients. Twenty-five kidney transplant patients receiving immunosuppressive medications from a single pharmacy were enrolled. Each subject received electronic monitors with their immunosuppressive serum drug refills for cyclosporine and azathioprine. Each subject returned their monitors after the first month of this 2-month study for downloading data. The frequency distribution of interdose intervals were described. Two measures of average non-compliance were calculated for both drugs: the proportion of monitored days that had missed doses, and the proportion of missed doses. Once daily and twice daily regimens of cyclosporine were compared. Concordance in drug compliance between the two drugs was calculated for each subject and averaged over the study population. Twenty-two of 25 subjects missed one or more doses of cyclosporine or azathioprine. Seventeen (68%) subjects never missed four or more consecutive doses. Subjects were non-compliant with cyclosporine on 8.7% of monitored days, and non-compliance with azathioprine on 9.8% of monitored days. Subjects were non-compliant with 6.8% of their cyclosporine doses and 9.8% of their azathioprine doses. Patients were compliant with both drugs on 86.6% of days and were non-compliant with both drugs on 5.1% of days. Subjects were non-compliant with cyclosporine during 5% and 13.2% of monitored days for once and twice daily dosing regimens, respectively. Concordance analysis demonstrated that for 91.7% of days of monitoring, compliance information was identical for both drugs. This study demonstrated the feasibility of electronic medication event monitoring among kidney transplant patients. This methodology represents an important tool for monitoring compliance of immunosuppressive agents essential to their safe and effective use, and should be considered for use in future studies of these drugs and others with substantial dose-dependent toxicity. Copyright 1999 John Wiley & Sons, Ltd.

Do glaucoma patients use eye drops correctly?. - Hosoda, M; Yamabayashi, S; Furuta, M; Tsukahara, S (Journal of glaucoma, 1995)
PURPOSE: To assess how glaucoma patients use their topical medications., METHODS: 142 subjects were tested before an examiner as to how they used their eyedrops., RESULTS: Fifty-six patients (39.4%) used one drop. The number of drops instilled increased with age. The tip of the bottle touched the ocular surface in 78 (54.9%). The proportion of patients whose bottle came into contact with the eye or periocular tissues increased with age. Only four patients (2.8%) closed the treated eye and compressed the medial angle after applying the medication., CONCLUSIONS: It is important that ophthalmologists instruct their patients on the correct manner of applying topical medication so that the patients can themselves administer the medicine precisely. Such instruction will improve the patients' compliance and quality of life during therapy for glaucoma.

Modulation of Pseudomonas aeruginosa adherence to the corneal surface by mucus. - Fleiszig, S M; Zaidi, T S; Ramphal, R; Pier, G B (Infection and immunity, 1994)
To gain access to the corneal epithelium and cause infections keratitis, bacterial pathogens must first interact with ocular surface factors that could affect bacterial adherence. In this study, we demonstrated that the mucus layer, and, in particular, the mucin fraction of mucus, modulated adherence to intact corneal epithelium of Pseudomonas aeruginosa but not that of Staphylococcus aureus or Streptococcus pyogenes. Removal of endogenous mucus from rat or rabbit eyes increased the adherence of P. aeruginosa by 3- to 10-fold. Ocular mucus obtained from rat eyes, porcine stomach mucin, or bovine submaxillary gland mucin inhibited adherence of P. aeruginosa to uninjured corneal epithelium. The mucin fraction of ocular mucus, purified by ultracentrifugation, was found to contain the inhibitory activity, and inhibition was demonstrated at concentrations of mucin as low as 35 micrograms/ml. Ocular mucin was the only material tested that inhibited adherence of P. aeruginosa to an injured cornea. However, the binding of P. aeruginosa to immobilized substrates in vitro did not predict which fraction would possess antiadherence activity: bacteria bound well to whole ocular mucus, mucin, the nonmucin fraction of ocular mucus, and dilute human tears as well as to porcine stomach mucin and bovine submaxillary gland mucin. The effectiveness of the mucin fraction of ocular mucus at inhibiting the binding of P. aeruginosa to the cornea implies that this material is a barrier that protects the surface of the eye from P. aeruginosa adherence.
Keywords: Animals; *Bacterial Adhesion; *Cornea/mi [Microbiology]; Female; Humans; Keratitis/et [Etiology]; Male; *Mucus/ph [Physiology]; *Pseudomonas aeruginosa/py [Pathogenicity]; Rabbits; Rats; Rats, Wistar

Pseudomonas aeruginosa invasion of and multiplication within corneal epithelial cells in vitro. - Fleiszig, S M; Zaidi, T S; Pier, G B (Infection and immunity, 1995)
Pseudomonas aeruginosa is usually considered an extracellular pathogen. Using assays to determine intracellular survival in the presence of gentamicin, we have previously demonstrated that P. aeruginosa is able to invade corneal cells during infectious keratitis in mice. In vitro, P. aeruginosa was found to enter the following cells: human corneal cells removed by irrigation; epithelial cells in the cornea of rats, mice, and rabbits; and primary corneal epithelial cells cultured from rat and rabbit eyes. The level of invasion was related to the level of adherent or associated bacteria. In general, invasion was more efficient with cultured epithelial cells than with cells tested in situ. Invasion did not occur when assays were performed at 4 degrees C. Cytochalasin D but not colchicine inhibited bacterial invasion, suggesting that bacterial entry was an endocytic process dependent on actin microfilaments but not microtubules. Bacteria that invaded cultured corneal epithelial cells were found to multiply within cells. The ability of P. aeruginosa to invade and multiply within corneal epithelial cells may contribute to the virulence of this organism during infectious keratitis, since intracellular bacteria can evade host immune effectors and antibiotics commonly used to treat infection.
Keywords: Animals; *Cornea/mi [Microbiology]; Cytochalasin D/pd [Pharmacology]; Epithelium/mi [Microbiology]; Gentamicins/pd [Pharmacology]; Humans; In Vitro Techniques; Mice; Mice, Inbred C57BL; *Pseudomonas aeruginosa/ph [Physiology]; Rats; Rats, Wistar; Temperature

Effects of protein, mucin, and human tears on adherence of Pseudomonas aeruginosa to hydrophilic contact lenses. - Miller, M J; Wilson, L A; Ahearn, D G (Journal of clinical microbiology, 1988)
Pseudomonas aeruginosa isolated from a corneal ulcer was examined for its ability to adhere to hydrophilic contact lenses with adsorbed organic films. Generally, adherence was enhanced by mucin, lactoferrin, lysozyme, immunoglobulin A, bovine serum albumin, and a mixture of these macromolecules. The water content of the lenses also influenced bacterial adherence and protein adsorption. Adherence to lenses coated with human tear films was more complex; both enhanced and inhibited adherence were observed on lenses obtained from different individuals.
Keywords: Bacterial Adhesion/de [Drug Effects]; *Contact Lenses, Hydrophilic; Humans; Immunoglobulin A, Secretory/me [Metabolism]; Lactoferrin/pd [Pharmacology]; Macromolecular Substances; *Mucins/pd [Pharmacology]; Muramidase/pd [Pharmacology]; *Proteins/pd [Pharmacology]; Pseudomonas aeruginosa/de [Drug Effects]; *Pseudomonas aeruginosa/ph [Physiology]; Serum Albumin, Bovine/pd [Pharmacology]; *Tears/ph [Physiology]

Branhamella catarrhalis: an organism gaining respect as a pathogen. - Catlin, B W (Clinical microbiology reviews, 1990)
Branhamella catarrhalis was formerly regarded as a common, essentially harmless inhabitant of the pharynx. This misapprehension was caused, in part, by confusion with another pharyngeal resident, Neisseria cinerea. The two organisms can now be differentiated by the positive reactions of B. catarrhalis in tests for nitrate reduction and hydrolysis of tributyrin and DNase. B. catarrhalis is currently recognized as the third most frequent cause of acute otitis media and acute sinusitis in young children. It often causes acute exacerbations of chronic bronchopulmonary disease in older or immunocompromised adults and is incriminated occasionally in meningitis, endocarditis, bacteremia, conjunctivitis, keratitis, and urogenital infections. Virulence-associated factors, such as pili, capsules, outer membrane vesicles, iron acquisition proteins, histamine-synthesizing ability, resistance to the bactericidal action of normal human serum, and binding to the C1q complement component, have been identified in some strains. beta-Lactamase producing strains, first detected in 1976, have risen to approximately 75% worldwide. Thus far, however, practically all American strains of B. catarrhalis remain susceptible to alternative antibiotics. A possible selective advantage of recent isolates is their reportedly heightened tendency for adherence to oropharyngeal cells from patients with chronic bronchopulmonary disease.
Keywords: *Bacterial Infections/mi [Microbiology]; Humans; Moraxella catarrhalis/cl [Classification]; Moraxella catarrhalis/de [Drug Effects]; *Moraxella catarrhalis/py [Pathogenicity]; Moraxella catarrhalis/ul [Ultrastructure]; Virulence

Acanthamoeba keratitis: synergy between amebic and bacterial cocontaminants in contact lens care systems as a prelude to infection. - Bottone, E J; Madayag, R M; Qureshi, M N (Journal of clinical microbiology, 1992)
We encountered a patient with Acanthamoeba keratitis whose contact lens care solution contained numerous trophozoites and cysts admixed with Xanthomonas maltophilia organisms, many of which were adherent to the trophozoite surface and internalized within endocytic vacuoles. Because of this finding, we investigated the role of bacterial cocontaminants in contact lens care systems as substrates for the growth of Acanthamoeba spp. Individual cocultivation of Acanthamoeba castellanii and A. polyphaga with X. maltophilia, Flavobacterium breve, and Pseudomonas paucimobilis showed better enhancement (1.5x) of ameba growth after 96 h than that obtained in the presence of Staphylococcus aureus, S. epidermidis, and Escherichia coli, the standard cocultivation species used for isolation of amebae from clinical specimens. Our data suggest that contamination of contact lens care systems with Acanthamoeba spp. and a bacterial species capable of supporting amebic growth may be the first step in the pathogenesis of ameba-induced keratitis by the provision of large inocula of amebae.
Keywords: *Acanthamoeba/gd [Growth & Development]; *Acanthamoeba Keratitis/et [Etiology]; Animals; Bacteria; *Contact Lenses/ae [Adverse Effects]; Culture Media; Humans

Office visits for glaucoma: United States, 1991-92. - Schappert, S M (Advance data, 1995)
Keywords: Adult; African Americans/sn [Statistics & Numerical Data]; Age Factors; Aged; Data Collection; European Continental Ancestry Group/sn [Statistics & Numerical Data]; Female; *Glaucoma/ep [Epidemiology]; Glaucoma/th [Therapy]; Health Surveys; Humans; Male; Middle Aged; *Office Visits/sn [Statistics & Numerical Data]; *Ophthalmology/sn [Statistics & Numerical Data]; *Personal Health Services/sn [Statistics & Numerical Data]; United States/ep [Epidemiology]

A cross-over trial comparing once daily levobunolol with once and twice daily timolol. - Akafo, S K; Thompson, J R; Rosenthal, A R (European journal of ophthalmology, 1995)
The intraocular pressure (IOP) lowering efficacy of once-daily levobunolol 0.5% was compared with timolol 0.5% twice-daily and timolol 0.5% once-daily in 20 chronic open angle glaucoma and 5 ocular hypertensive patients. The design used was a randomised double blind cross-over trial with three periods each of 8 weeks separated by 2 weeks of no treatment. We found that following levobunolol a two week washout was not sufficient for the IOP to return to its original baseline level suggesting that levobunolol is a longer acting drug than timolol. Adjusting for this carryover effect, we found on significant difference in the IOP lowering effect among the three regimes (p = 0.53). Reduced cost, less ocular discomfort and better compliance are the main potential advantages of the once daily treatments.
Keywords: Adrenergic beta-Antagonists/ad [Administration & Dosage]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; Adult; Aged; Aged, 80 and over; Cross-Over Studies; Double-Blind Method; Drug Administration Schedule; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Levobunolol/ad [Administration & Dosage]; *Levobunolol/tu [Therapeutic Use]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Ophthalmic Solutions; Timolol/ad [Administration & Dosage]; *Timolol/tu [Therapeutic Use]

Relating spontaneous adverse experience reports to scores on a questionnaire querying tolerability. - Barber, B L; Santanello, N C (International journal of clinical pharmacology and therapeutics, 1995)
In this study, we examined the relation between spontaneously reported adverse experiences and responses given on the comparison of ophthalmic medications for tolerability (COMTOL) checklist questionnaire which queries the frequency and bother of specific side-effects known to be associated with topical ophthalmic agents used to treat ocular hypertension or open-angle glaucoma, and the impact that the side-effects have on health-related quality of life. The study was a 4-week, randomized, open-label, two-period cross-over clinical trial comparing dorzolamide and pilocarpine in 92 patients who were also receiving timolol for the treatment of ocular hypertension or open-angle glaucoma. Patients completed the COMTOL questionnaire at baseline and at the end of each period and spontaneous reports of adverse experiences (AEs) were collected throughout the study by the investigator. Since there were only 3 spontaneously reported AEs related to drug treatment while patients received dorzolamide and since COMTOL scores indicated a low level of side-effects, the analyses were limited to pilocarpine treatment periods. We discovered that during the pilocarpine treatment periods, a large percentage (94%) of the 47 patients, who failed to spontaneously report any adverse experiences, indicated on the COMTOL that they had experienced side-effects. These discrepancies between the methods of spontaneous reports and a checklist questionnaire are similar to those previously reported in the literature for other drugs. Unlike previous literature, we went beyond identifying discrepancies with the two reporting methods and we looked for possible explanations for why the discrepancies existed. We discovered that patients who spontaneously reported AEs expressed more bother from these specific side-effects on the questionnaire than patients who did not spontaneously report AEs. As well, patients who spontaneously reported AEs and discontinued drug as a result of the AEs expressed on the COMTOL the greatest bother from side-effects. This trend of increasing negative impact (as patients reported AEs and discontinued) was also observed with COMTOL global question scores on the impact of side-effects on health-related quality of life, the impact of activity limitations on quality of life, satisfaction with medication and compliance with medication. Therefore, spontaneous reporting of side-effects appears to be detecting the most clinically meaningful side-effects.
Keywords: Adult; *Adverse Drug Reaction Reporting Systems; Aged; Aged, 80 and over; Antihypertensive Agents/ae [Adverse Effects]; Cross-Over Studies; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; *Ophthalmic Solutions/ae [Adverse Effects]; Sulfonamides/ae [Adverse Effects]; *Surveys and Questionnaires; Thiophenes/ae [Adverse Effects]; Timolol/ae [Adverse Effects]

Principles and paradigms of pediatric cataract management. - Basti, S; Greenwald, M J (Indian journal of ophthalmology, 1995)
Propensity for increased postoperative inflammation and capsular opacification, a refractive state that is constantly in a state of flux due to growth of the eye, difficulty in documenting anatomic and refractive changes due to poor compliance, and a tendency to develop amblyopia, makes management of cataract in the child different from that in the adult. The recent past has unraveled several caveats of pediatric cataract management-the importance of atraumatic surgery and complete removal of lens matter, benefits of in-the-bag intraocular lens (IOL) implantation, role of titrating IOL power to counter refractive changes due to growth of the eye, prudery of continuously following these eyes for early detection of aphakic glaucoma and benefits of some surgical innovations. Although these promise to significantly improve our management of pediatric cataract, their long-term benefits are yet to be determined. We will also have to harness newer techniques, especially in the areas of wound construction and capsule management, and will have to develop effective strategies for the refractive management of infantile aphakia.
Keywords: Adult; *Cataract/cn [Congenital]; *Cataract Extraction/mt [Methods]; Child; Humans; Infant; Intraocular Pressure/ph [Physiology]; Lenses, Intraocular; Refraction, Ocular; Treatment Outcome; Visual Acuity/ph [Physiology]

Staged removal of acoustic tumors: techniques and lessons learned from a series of 83 patients. - Comey, C H; Jannetta, P J; Sheptak, P E; Joh, H D; Burkhart, L E (Neurosurgery, 1995)
The removal of large acoustic tumors is associated with increased mortality and cranial nerve injury. One method for treating these difficult lesions is staged resection. Between 1972 and 1992, more than 600 acoustic tumors were resected at our institution. Of these, 83 were removed in stages. This represents the largest series of staged acoustic tumor resections reported to date. A review of available films and patient records was performed for all acoustic tumors resected in stages between 1972 and early 1993 to analyze demographic information, tumor size, operative technique, outcome, and complications. The information was collected on standardized data sheets and entered into a computer database. Virtually all tumors were large, with the average size being 4 cm in greatest diameter. The average patient age was 41 years, and there was a slight preponderance of female patients. Ten patients had neurofibromatosis Type 2. The suboccipital approach was used in most patients. Anatomic preservation of the VIIth cranial nerve was achieved in > 72% of patients, with an average House-Brackmann score of Grade 3 at the longest follow-up (mean, 43 mo). Facial reanimation was performed in 19 of 23 patients with transected VIIth cranial nerves. Complications included cerebrospinal fluid fistulas in 11 patients, with 8 of 11 fistulas resolving after lumbar drainage. Six patients had meningitis (bacterial in three and aseptic in three). Two patients developed wound infections, and 10 patients developed exposure keratitis. There were two documented recurrences. There were no operative deaths. In most series, the incidence of cranial nerve deficits as well as morbidity and mortality is directly related to tumor size. Our operative strategy involved debulking the lateral aspect of large tumors during Stage I. Second stage removal is performed after the remaining tumor is shown to decompress out of the pons on computed tomographic or magnetic resonance images. During the second procedure, the residual tumor is less vascular and no longer densely adherent to the brain stem. Although staged removal is not without risk, there seems to be no apparent increase in morbidity when these results are compared with the results of series from the literature. Although there remain no absolute indications for staged resection of acoustic tumors, we think that it may represent the safest option for these difficult lesions.
Keywords: Adult; Female; Humans; Male; Middle Aged; Neoplasm Staging; Neurofibromatosis 2/mo [Mortality]; Neurofibromatosis 2/pa [Pathology]; Neurofibromatosis 2/su [Surgery]; Neuroma, Acoustic/mo [Mortality]; Neuroma, Acoustic/pa [Pathology]; *Neuroma, Acoustic/su [Surgery]; Postoperative Complications/et [Etiology]; Postoperative Complications/su [Surgery]; Reoperation; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome

The effects of short-term contact lens wear on adherence of Pseudomonas aeruginosa to human corneal cells. - Harding, A S; Lakkis, C; Brennan, N A (Journal of the American Optometric Association, 1995)
BACKGROUND: Ulcerative keratitis is the most serious complication of contact lens wear, with the majority of infections being attributed to Pseudomonas aeruginosa. The degree to which bacteria adhere to the cornea may indicate its susceptibility to infection. It has been found that long-term contact lens wear leads to increased adherence of Pseudomonas aeruginosa to corneal epithelial cells. This study examines the effect of short-term contact lens wear. MEANS: Cells were collected using a non-contact corneal irrigation system from a total of 16 subjects fitted with tight and loosely-fitted soft contact lenses. The control group consisted of 10 subjects with no recent contact-lens-wearing experience, eight of whom were later fitted with lenses to form a neophyte group. Six contact lens wearers formed the experienced group. After wearing lenses for a 30-hour period, including overnight, the collected corneal cells were incubated with Pseudomonas aeruginosa, differentially stained with Acridine orange and examined under fluorescence microscopy., RESULTS: The number of bacteria adhering to the cells was determined for the control group, neophyte and experienced groups. The frequency distribution profiles were similar for all groups and did not vary significantly between lens-wearing and non-wearing conditions, between neophyte and experienced wearers, or with lens fit., CONCLUSIONS: Using the technique reported, short-term extended contact lens wear produced minimal detectable changes in the potential of corneal epithelium cells to bind bacteria.
Keywords: Adult; Bacterial Adhesion; *Contact Lenses, Hydrophilic; Cornea/cy [Cytology]; *Cornea/mi [Microbiology]; Corneal Ulcer/mi [Microbiology]; Humans; *Pseudomonas aeruginosa/ph [Physiology]; Time Factors

Brisbane GPs' perceptions of screening for primary open-angle glaucoma. - Jackson, C; Hirst, L (Australian and New Zealand journal of ophthalmology, 1995)
BACKGROUND: Primary open-angle glaucoma (POAG) is one of the three leading causes of blindness in Australia, often causing considerable visual field loss before the patient becomes symptomatic. Recent years have seen a quickening of public health interest in primary open-angle glaucoma. Our study evaluates the attitudes and skills of Brisbane GPs with regard to screening for POAG., OBJECTIVES: To evaluate general practitioners' current use of possible screening modalities for POAG. To evaluate general practitioners' attitudes to screening for POAG. To evaluate general practitioner's levels of satisfaction with their knowledge and skills in the diagnosis of common ophthalmological conditions., METHOD: A questionnaire was distributed to 130 randomly selected GPs in the Brisbane metropolitan area. Response rate was 94%., RESULTS: Tonometry and funduscopy were infrequently used in Brisbane general practice. Only 15% of the sample were satisfied with their current knowledge and skills concerning the detection of POAG. 88% felt that patients > 50 years should be screened for POAG and nominated a variety of sources -75% advocating ophthalmology screeners, 65% GP screeners, and 41% optometrist screeners. Ninety-nine per cent believed ophthalmologists should be treating glaucoma patients, and 57% believed GPs should have a role in management. Only 1% supported a therapeutic role for optometrists. Major perceived barriers to glaucoma screening in the elderly were the inaccuracy of current general practice screening tools (65%) and paucity of information concerning the desirability of screening (32%)., CONCLUSION: Brisbane general practitioners believe patients > 50 years old should be screened for POAG. They advocated a role for screening by ophthalmologists, GPs and optometrists. Major perceived barriers to current screening in general practice are the inaccuracy of current general practice tools (65%) and paucity of information on the subject (32%). The majority (85%) requested further information and provision of skills in this area.
Comment in (CIN)
Keywords: *Attitude of Health Personnel; Australia; Clinical Competence; *Family Practice; *Glaucoma, Open-Angle/pc [Prevention & Control]; Humans; *Mass Screening; Middle Aged; Surveys and Questionnaires

The Bristol Shared Care Glaucoma Study: study design. - Spencer, I C; Spry, P G; Gray, S F; Baker, I A; Menage, M J; Easty, D L; Sparrow, J M (Ophthalmic & physiological optics : the journal of the British College of Ophthalmic Opticians (Optometrists), 1995)
The purpose of this study was the evaluation of community based optometric monitoring of stable glaucoma patients and glaucoma suspects compared to the routine Hospital Eye Services (HES) monitoring. Four hundred and five subjects were recruited from routine outpatient clinics at the Bristol Eye Hospital. All eligible participants were seen in the routine hospital clinic and then within two months were given a 'Gold Standard Assessment' (GSA) by an independent research team. Participants then visited one of 12 glaucoma-trained optometrists, for a standard battery of tests. Randomisation resulted in 204 subjects being allocated to community care, with reviews on a six monthly basis, with 201 who remained a control group within the hospital. Referral criteria were established to enable optometric detection of apparent glaucomatous progression. A questionnaire was used to assess patient satisfaction with both care types. Additionally a cost analysis exercise was performed.
Keywords: Community Health Services/ec [Economics]; *Community Health Services; *Glaucoma, Open-Angle/pc [Prevention & Control]; Humans; Intraocular Pressure; Middle Aged; Ocular Hypertension/pc [Prevention & Control]; Optometry/ec [Economics]; Optometry/ed [Education]; *Optometry; Patient Satisfaction; Referral and Consultation; Vision Tests; Visual Fields

Risk factors for acanthamoeba keratitis in contact lens users: a case-control study. - Radford, C F; Bacon, A S; Dart, J K; Minassian, D C (BMJ (Clinical research ed.), 1995)
OBJECTIVE: To investigate reasons for an increase in cases of Acanthamoeba keratitis related to contact lenses., DESIGN: Case-control study. Cases were contact lens related acanthamoeba keratitis patients treated between 1 September 1989 and 31 August 1992. Controls were lens users without lens related disease who presented as new patients to the casualty department from 1 March 1992 to 31 August 1992. All subjects completed a questionnaire detailing lens use and hygiene practices., SETTING: Eye hospital., SUBJECTS: 35 cases with acanthamoeba keratitis and 378 controls., MAIN OUTCOME MEASURES: Relative risks comparing different contact lens types, socioeconomic classification, age, sex, lens use, lens wearing experience, hygiene compliance, and hygiene systems., RESULTS: The crude relative risk for developing acanthamoeba keratitis with the use of daily wear disposable lenses was 49.45 (95% confidence interval 6.53 to 2227; P < 0.001) compared with conventional soft lenses (the referent). Multivariable analysis showed that this increased risk could be largely attributed to lack of disinfection (relative risk 55.86 (10 to 302); P < 0.001) and use of chlorine based disinfection (14.63 (2.8 to 76); P = 0.001) compared with other chemical systems (the referent). None of the other outcome measures showed a significant association., CONCLUSIONS: Both failure to disinfect daily wear soft contact lenses and the use of chlorine release lens disinfection systems, which have little protective effect against the organism, are major risk factors for acanthamoeba keratitis. These risks have been particularly common in disposable lens use. Over 80% of acanthamoeba keratitis could be avoided by the use of lens disinfection systems that are effective against the organism.
Comment in (CIN), Comment in (CIN)
Keywords: *Acanthamoeba Keratitis/et [Etiology]; Adolescent; Adult; Case-Control Studies; *Contact Lenses/ae [Adverse Effects]; Contact Lenses, Extended-Wear/ae [Adverse Effects]; Contact Lenses, Hydrophilic/ae [Adverse Effects]; Disinfection; Female; Humans; Hygiene; Male; Middle Aged; Multivariate Analysis; Retrospective Studies; Risk Factors

Predictors of outcome in patients who underwent cataract surgery. - Schein, O D; Steinberg, E P; Cassard, S D; Tielsch, J M; Javitt, J C; Sommer, A (Ophthalmology, 1995)
PURPOSE: To identify preoperative patient characteristics associated with a lack of improvement on one or more measures 4 months after cataract surgery., METHODS: The authors collected preoperative and 4-month postoperative information on 552 patients undergoing first-eye cataract surgery from the practices of 72 ophthalmologists in three cities. The principal outcomes assessed were (1) Snellen visual acuity, (2) a cataract-related symptom score (possible range: 0, 0 of 6 symptoms present or bothersome, to 18, all 6 symptoms very bothersome), and (3) a measure of functional impairment in patients with cataract--the VF-14 score (possible range: 0, inability to perform any of the applicable activities, to 100, no difficulty performing any of the applicable activities). Multiple logistic regression was used to assess the association between preoperative patient characteristics and failure to improve on one or more outcome measures. Multiple linear regression was used to estimate the adjusted rate of lack of improvement in one or more outcome measures for one group of patients compared with another., RESULTS: Although 91 patients (16.5%) failed to improve on one or more of the outcome measures assessed, only 2 (0.4%) failed to improve on all three measures. The 91 patients who did not improve on at least one measure were approximately one sixth as likely to be satisfied with their vision postoperatively as the 461 patients who improved on all three outcome measures. Preoperative age of 75 years of age or older, VF-14 score of 90 or higher, cataract symptom score of 3 or lower, and ocular comorbidity (glaucoma, diabetic retinopathy, or age-related macular degeneration) were associated independently with increased likelihood of not improving on one or more measure (odds ratio: 3.57, 2.10, 3.29, and 2.16, respectively). The mean adjusted rate of failure to improve on at least one of the outcome measures ranged from 20.5% to 26.5% for patients with these preoperative characteristics compared with 8.8% to 13.8% for those patients without them. The preoperative level of Snellen visual acuity was not associated with the likelihood of not improving on one or more of the outcomes assessed., CONCLUSIONS: The authors conclude that specific preoperative characteristics (age, comorbidity, cataract symptom score, and VF-14 score) are independent predictors of patient outcome after cataract surgery.
Keywords: Aged; Aged, 80 and over; *Cataract/pp [Physiopathology]; *Cataract Extraction; Cohort Studies; Female; Follow-Up Studies; Humans; Lenses, Intraocular; Male; Middle Aged; Odds Ratio; Patient Satisfaction; Postoperative Complications; Treatment Outcome; *Vision, Ocular/ph [Physiology]; *Visual Acuity/ph [Physiology]

Factors associated with having eye examinations in persons with diabetes. - Moss, S E; Klein, R; Klein, B E (Archives of family medicine, 1995)
OBJECTIVES: To estimate compliance with guidelines on ocular examinations for diabetic persons, to examine factors that affect compliance, and to determine reasons for noncompliance., DESIGN: Cross-sectional population study., SETTING: Primary care setting., PATIENTS: The population is 765 diabetic persons with younger onset and 533 with older onset who participated in the 1990 to 1992 follow-up examination of the Wisconsin Epidemiologic Study of Diabetic Retinopathy., MEASUREMENTS: A medical history was taken in which subjects were asked about eye examinations by ophthalmologists and optometrists., RESULTS: Sixty-four percent of the younger-onset group and 62% of the older-onset group had had a dilated eye examination in the previous year. Persons in both groups were more likely to have had a dilated examination if they had a longer duration of diabetes, more severe retinopathy, a history of glaucoma or cataract, and health insurance that covered eye examinations. Persons with younger-onset diabetes were more likely to have had an examination if they were older, were visually impaired, and had more education or higher income. Persons in the older-onset group were more likely to have had an examination if they were female or taking insulin. In those not having an eye examination, 79% and 71% of the younger- and older-onset groups, respectively, reported not having had one because they had no problems with their eyes, and 31% and 35% reported not having been told they needed one. Thirty-two percent and 11% said they were too busy, and 30% and 12% said they could not afford an examination., CONCLUSIONS: Diabetic persons should be educated as to the need for eye care; the results show that barriers to eye care exist in the form of affordability and lack of time.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Diabetic Retinopathy/di [Diagnosis]; *Diabetic Retinopathy/pc [Prevention & Control]; Female; Humans; Male; Middle Aged; Odds Ratio; *Vision Screening

Laser sclerostomy ab externo using two different infrared lasers: a clinical comparison. - Wetzel, W; Schmidt-Erfurth, U; Haring, G; Roider, J; Droge, G; Birngruber, R (German journal of ophthalmology, 1995)
This study was designed to compare the clinical results of an ab externo approach to laser sclerostomy using two different laser sources under identical conditions. A pulsed (200 microseconds) erbium-YAG laser (lambda = 2940 nm) and a pulsed (200 microseconds) holmium:YAG laser (lambda = 2120 nm) were used. The energy of each laser was transmitted via a fiber (300 microns in diameter) and applied near the limbus, with the fiber tip remaining in steady contact with the sclera. According to the higher tissue absorption coefficient, a shorter penetration depth and, therefore, fewer complications were expected for the Er:YAG laser. A total of 26 patients with advanced open-angle glaucoma were treated and followed for up to 6 months. In all cases a functioning fistula with a prominent filtering bleb and a marked reduction in the intraocular pressure (from up to 35 mm Hg to < 10 mm Hg) could be achieved primarily. The total energy required was about 4 times lower for erbium:YAG laser was compared with holmium:YAG laser sclerostomies. No complication occurred intraoperatively. Postoperatively, reversible adherence of the iris to the internal ostium was more frequently observed in Ho:YAG laser sclerostomies (60%) and small hyphemas were more often seen in Er:YAG laser sclerostomies (30%). After 6 months of follow-up, about 40% of the fistula remained patent in both groups. In principle, both lasers are suited to serve as energy sources for the described approach. Under the conditions of the present study, different levels of thermal effects did not cause any significant difference in the clinical success rate.(ABSTRACT TRUNCATED AT 250 WORDS)
Keywords: Adult; Chronic Disease; Follow-Up Studies; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; *Laser Therapy/mt [Methods]; Middle Aged; Ostomy; Postoperative Complications; Prognosis; Sclera/su [Surgery]; *Sclerostomy

Clinicians and patients with hypertension: unsettled issues about compliance. - Rudd, P (American heart journal, 1995)
Ambulatory treatment of hypertension depends largely on long-term oral medications to lower blood pressure and delay or prevent cardiovascular morbidity and mortality. Failure to achieve the therapeutic goal may reflect biologic, pharmacologic, or behavioral factors. Ignoring behavioral factors may result in unnecessary or even dangerous regimen escalation. More than half of patients with insufficient reductions in blood pressure display suboptimal medication compliance as assessed by pill count or bioassay. Once-daily dosing may be an important part of enhancing compliance, patient convenience, and regimen simplification; however, drug concentrations may be subtherapeutic when dosing delays or omissions occur. Electronic monitoring data in hypertension, glaucoma, seizure disorders, and other diseases indicate that 50% to 60% of patients adhere well to prescribed regiments, that 5% to 10% adhere poorly, and that the 30% to 45% adhere to an intermediate but markedly variable degree. A growing body of literature offers empirical support for focused and personalized interventions.
Keywords: Ambulatory Care; Antihypertensive Agents/ad [Administration & Dosage]; Female; Humans; *Hypertension/dt [Drug Therapy]; Hypertension/px [Psychology]; Male; Patient Compliance/px [Psychology]; *Patient Compliance; Treatment Outcome

Compliance in patients prescribed eyedrops for glaucoma. - Patel, S C; Spaeth, G L (Ophthalmic surgery, 1995)
We studied the rate of failure to use eyedrops as prescribed for glaucoma and some of the factors possibly associated with that noncompliance by interviewing 100 patients being followed in a setting emphasizing correct usage. Fifty-nine reported they had not used their eyedrops precisely as prescribed. Factors significantly influencing compliance included daily dose frequency, forgetfulness, inconvenience, and unaffordability. Gender and race were marginally significant factors, with men and blacks reporting somewhat higher rates of missed doses than women and whites. Side effects and age were not significant causes of noncompliance.
Keywords: Adult; Aged; Aged, 80 and over; Drug Administration Schedule; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance/px [Psychology]; Sex Factors; Surveys and Questionnaires; Treatment Refusal

[Critical thoughts on current laser surgery of the cornea]. - Gloor, B; Rol, P; Fankhauser, F; Hoppeler, T; Vrbka, E (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 1995)
OBJECTIVE: To analyze critically refractive surgery of the cornea by excimer laser and to compare laser surgery with other methods of treatment of refractive errors of the eye., MATERIAL AND METHODS: This analysis has to be restricted to a comparison of the treatment of myopia by keratotomy and photoablation with the ArF excimer laser. Correction of hypermetropia and of astigmatismus has to be left out, along with all the other methods to correct myopia, such as glasses, contact lenses, keratomileusis, epikeratoplasty, alloplastic implants, implantation of intraocular lenses with negative power, and replacement of the clear lens by an posterior chamber lens. The essential literature is screened. For intrastromal ablation with the picosecond Nd:YLF laser we relay on own experiences, also with the use of the ArF excimer laser we are not without own experiences. RESULTS AND STATEMENTS: For comparison of refractive surgery of the cornea not only the PERK study and the recommendations of the American Academy of Ophthalmology have to be considered, but also the newest developments in radial keratotomy such as two-step incision and reoperation with reopening of the keratotomy wounds. With these techniques the same precision can be reached as with the excimerlaser, and also higher myopias can be corrected. The dangers of the procedure, such as infection, perforation at surgery or laceration by contusion remain much larger. Intrastromal photoablation did not reach clinical maturity. Superficial photoablation is an almost safe procedure. A reduction of 3 D of myopia can be reached with satisfying precision, although higher myopias are still a problem. Pain following the ablation is considerable. Haze and disturbed vision at night can be present; infectious keratitis is rare, but possible., CONCLUSIONS: The critical fact of both procedures, keratotomy and photoablation with excimer laser, remains that healthy eyes are treated; therefore, even rare complications weigh much heavier than if sick eyes are treated. Because this is cosmetic surgery, the individuum asking for this type of procedure has to pay for on his own. Olson demands: "In determining when new technology is acceptable, we must consider the financial cost and the expected benefit to society. Is it an equitable tradeoff?" If we look at refractive surgery, especially laser photoablation, in the context of the needs for ophthalmic care of the whole world, then this type of surgery is out of proportion. The balance could be restored if, with every laser application, funds were given for third-world projects. Excimer-laser surgery may be justified insofar as the research with these lasers leads to useful therapeutic methods.
Keywords: Follow-Up Studies; Humans; Keratotomy, Radial/mt [Methods]; Lasers, Excimer; *Myopia/su [Surgery]; Patient Satisfaction; *Photorefractive Keratectomy/mt [Methods]; Postoperative Complications/et [Etiology]; Postoperative Complications/su [Surgery]; Refraction, Ocular; Reoperation; Treatment Outcome

[Current evaluation of myopia correction with the excimer laser]. - Seiler, T (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 1995)
Keratectomies with the excimer laser demonstrate extraordinarily smooth edges. Thermal and actinic side effects are negligible. Currently two techniques are in clinical use: the wide-field approach and the scanning-slit approach. A third one, the flying-spot approach is being tested in clinical studies. Postoperative refraction is mainly determined by the amount of correction. For corrections up to 6.0 D we found success rates of more than 90% and the refraction stabilizes during the first year after surgery. If the correction is higher, the success rate is decreased to 50% or less and the regression takes years. The complication rate is also dependent on the amount of correction: with corrections of more than 6.0 D it exceeds 1% and in corrections of 9.0 D and more, manifest corneal scars occur in more than 10% of the cases. Other complications are: eccentric ablation, IOP elevation due to steroid medication, and ptosis. Rheumatic diseases are absolutely contraindicated because of potential corneal melting ulcers, and subretinal neovascularization. In addition, corrections of more than 6.0 D are relatively contraindicated. More recent techniques like astigmatic PRK, LASIK, and hyperopic PRK are discussed.
Keywords: Follow-Up Studies; Humans; Lasers, Excimer; *Myopia/su [Surgery]; Patient Satisfaction; *Photorefractive Keratectomy; *Postoperative Complications/et [Etiology]; Refraction, Ocular; Treatment Outcome

Posterior chamber intraocular lenses: long-term results in pediatric cataract patients. - Crouch, E R Jr; Pressman, S H; Crouch, E R (Journal of pediatric ophthalmology and strabismus, 1995)
Major problems in pediatric cataract patients include noncompliance with contact lenses resulting in amblyopia. Advances in intraocular cataract surgery have provided a better environment to perform intraocular lens (IOL) implantation in children. We prospectively analyzed the results of 34 consecutive pediatric patients who underwent cataract removal and insertion of an IOL. Operative technique performed was posterior scleral beveled or frown incision and IOL endocapsular fixation. Subgroups included 10 eyes with traumatic cataract, and 24 eyes with developmental cataracts. Six patients had bilateral IOLs. Data presented in each subgroup included initial and final visual acuity, age, sex, type of cataract, A and B scan biometry, early and late postoperative complications, time of YAG capsulotomy, postoperative refractive correction, and state of binocular vision. Preoperative visual acuity ranged from 20/70 to light perception. The success rate for postoperative visual acuity of 20/40 or better occurred in 29 of 34 eyes, or 85.3%. In the traumatic cataracts, 8 of 10 eyes (80%) obtained 20/40 vision or better. In developmental cataracts, 21 of 24 eyes (88%) achieved visual acuity of 20/40 or better. Amblyopia (three patients) or macular scar (two patients) accounted for reduced visual acuity in the five eyes with vision less than 20/40. Early complications included posterior synechiae and lens deposits. The primary late complication was opacification of the posterior capsule in 18 of 34 eyes. The average time for YAG capsulotomy post-cataract removal was 17 months. None of the 28 patients (34 eyes) developed glaucoma, IOL dislocation, or other significant postoperative problems related to IOL insertion.(ABSTRACT TRUNCATED AT 250 WORDS)
Keywords: Adolescent; Cataract/cn [Congenital]; Cataract/et [Etiology]; *Cataract Extraction; Child; Child, Preschool; Eye Injuries/co [Complications]; Eye Injuries/su [Surgery]; Female; Humans; Lens, Crystalline/in [Injuries]; *Lenses, Intraocular; Longitudinal Studies; Male; Postoperative Complications; Prognosis; Prospective Studies; Refraction, Ocular; Sclera/su [Surgery]; Surgical Flaps; Vision, Binocular; Visual Acuity

Indications and efficacy of combined trabeculectomy and extracapsular cataract extraction with intraocular lens implantation in cataract patients with coexisting open angle glaucoma. - Storr-Paulsen, A; Perriard, A; Vangsted, P (Acta ophthalmologica Scandinavica, 1995)
In an observational study 19 eyes with cataract and coexisting primary open angle glaucoma were scheduled to undergo combined procedure with ECCE-IOL and trabeculectomy. The aim of the present study was to investigate the results and the efficacy of combined surgery, when we extended the indication for surgery. Thus the surgical decision making was not based solely upon IOP readings, but also involved social/psychological factors. Median decrease in IOP (IOPpost-IOPpre) was significant through a 12-month observation period, p < 0.001. The number of medications dropped from 1.74 to 0.21, p < 0.01. Complication rate during operation and in the postoperative follow-up period was low. We conclude that it seems justified to extend the indication for combined surgery in cataract patients with coexisting open angle glaucoma in case of uncontrolled IOP, poor compliance, inability of sufficient medical care, or unacceptable medication. We recommend careful monitoring of the early postoperative IOP, even if hypotensive agents are given prophylactically.
Keywords: Aged; Aged, 80 and over; *Cataract/co [Complications]; *Cataract Extraction; Female; Follow-Up Studies; *Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; Intraoperative Complications; *Lenses, Intraocular; Male; Postoperative Complications; Prognosis; *Trabeculectomy; Visual Acuity

Traumatic glaucoma. - Sihota, R; Sood, N N; Agarwal, H C (Acta ophthalmologica Scandinavica, 1995)
In the management of an ocular injury, traumatic glaucoma is often overlooked. Prospectively reviewing 100 consecutive patients of traumatic glaucoma we found a very high correlation of postconcussional glaucoma with traumatic cataracts, angle recession of more than 180 degrees, significant injuries to the iris and a displacement of the lens. Two of these four clinical features were present in all cases. Penetrating injuries were followed by a secondary glaucoma if an adherent leucoma and/or evidence of lenticular damage or displacement were seen. These clinical features all point to a damage to the lens-iris diaphragm. The trabecular meshwork being directly related to these structures would also be involved in such an injury, leading to significant impairment of function, and the eye would therefore be more prone to developing glaucoma. Our study has highlighted certain clinical findings which could act as 'markers' for the early diagnosis of traumatic glaucoma.
Keywords: Adolescent; Adult; Cataract/et [Etiology]; Child; *Eye Injuries/co [Complications]; *Eye Injuries, Penetrating/co [Complications]; Female; *Glaucoma/et [Etiology]; Glaucoma/th [Therapy]; Humans; *Iris/in [Injuries]; *Lens, Crystalline/in [Injuries]; Male; Ophthalmic Solutions; Prospective Studies; *Trabecular Meshwork/in [Injuries]; Trabeculectomy; Visual Acuity; *Wounds, Nonpenetrating/co [Complications]

Pseudomonas keratitis associated with biofilm formation on a disposable soft contact lens. - Stapleton, F; Dart, J (The British journal of ophthalmology, 1995)
Keywords: Adult; *Biofilms; *Contact Lenses, Extended-Wear/ae [Adverse Effects]; Female; Humans; *Keratitis/mi [Microbiology]; Patient Compliance; *Pseudomonas Infections

Laser sclerostomy ab externo using the erbium: YAG laser. First results of a clinical study. - Wetzel, W; Haring, G; Brinkmann, R; Birngruber, R (German journal of ophthalmology, 1994)
A new approach to fistulating glaucoma surgery, laser sclerostomy ab externo, was investigated in a clinical study. A pulsed (200 microseconds) erbium-YAG laser was used, as its wavelength (2940 nm) is very well absorbed by tissue water. The laser energy was transmitted via a fiber to an application probe with a cannula particularly designed to guide another fiber into the subconjunctival space. Nine patients with advanced open-angle or neovascular glaucoma were treated. In all cases a functioning fistula with a prominent filtering bleb and a reduction of the intraocular pressure (from up to 50 mmHg to 8-18 mmHg) could be achieved. The total energy was 60 mJ on average. No complication occurred intraoperatively. Postoperatively, all fistulas in patients with neovascular glaucoma (n = 6) were impatent after approx. 7 days due to iris adherence to the internal ostium and episcleral scarring. In cases of open-angle glaucoma (n = 3) a patent fistula persisted for several months. Variation of the exposure parameters, the use of antiproliferative drugs, and a less restrictive selection of patients could further improve the success rate.
Keywords: Fiber Optic Technology; Follow-Up Studies; *Glaucoma, Neovascular/su [Surgery]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; *Laser Therapy/mt [Methods]; Postoperative Complications; Prognosis; *Sclerostomy

[Argon laser trabeculoplasty. Results over 10 years]. - Moulin, F; Haut, J (Journal francais d'ophtalmologie, 1994)
To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. 159 eyes had a 5 year-follow-up, 147 eyes had a 8 year-follow-up and 127 eyes had a minimal 10 year-follow-up. These eyes corresponded to an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (< or = 3 mmHg), progression of visual field loss and need of filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to those criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. In the 147 eyes with a 8 year-follow-up 25 eyes (17%), and in the 127 eyes with a 10 year-follow-up 14 eyes (11%) were still controlled. At the 10 year-follow-up, the surgical failure rate was 35% (40 eyes in 113), quite similar to the rate at 5 years: 33% (27 in 82). Thirty eyes excluded in the study belonged to patients who died during the follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
Keywords: Adult; Aged; Aged, 80 and over; Argon; Evaluation Studies as Topic; Female; Follow-Up Studies; *Glaucoma, Open-Angle/su [Surgery]; Humans; Laser Coagulation/mt [Methods]; *Laser Coagulation; Male; Middle Aged; Trabeculectomy/mt [Methods]; *Trabeculectomy

The use of subconjunctivally administered tissue plasminogen activator after trabeculectomy. - Piltz, J R; Starita, R J (Ophthalmic surgery, 1994)
Blockage of aqueous flow in the early postoperative period can be devastating to the success of trabeculectomy. We used tissue plasminogen activator (tPA) subconjunctivally in an attempt to release a trabeculectomy flap that appeared to be adherent to its scleral bed. No change was noted 90 minutes after injection, but a highly elevated bleb was present on the first postoperative day. Subconjunctivally administered tPA may be useful in releasing the fibrin "glue" in cases with adherent trabeculectomy flaps.
Keywords: Aged; Aqueous Humor/me [Metabolism]; Conjunctiva/de [Drug Effects]; Female; Fibrinolysis/de [Drug Effects]; Glaucoma/dt [Drug Therapy]; *Glaucoma/su [Surgery]; Humans; Injections; Recombinant Proteins; Sclera; Surgical Flaps; Tissue Plasminogen Activator/ad [Administration & Dosage]; *Tissue Plasminogen Activator/tu [Therapeutic Use]; Trabeculectomy/ae [Adverse Effects]; *Trabeculectomy

Ocular amyloid deposition in familial amyloidosis, Finnish: an analysis of native and variant gelsolin in Meretoja's syndrome. - Kivela, T; Tarkkanen, A; Frangione, B; Ghiso, J; Haltia, M (Investigative ophthalmology & visual science, 1994)
PURPOSE: To analyze the deposition of amyloid and its precursors in eyes of patients with familial amyloidosis, Finnish (FAF; Meretoja's syndrome), a hereditary systemic amyloidosis., METHODS: Autopsy eyes from three patients with FAF and ten control eyes were studied by Congo red staining and with antibodies to the nonmutated part of gelsolin (GS-2C4), the mutated gelsolin Asn-187 fragment (AGel), and amyloid-P component (AP)., RESULTS: Congo red and antisera to AP and AGel bound to amyloid deposits in the cornea and conjunctiva, the sclera, the perineurium of ciliary nerves, the walls of ciliary vessels, the optic nerve sheaths, the stroma of the ciliary body, and along the choriocapillaris. mAb GS-2C4 bound weakly and focally to most deposits and strongly around the choriocapillaris. It labeled the corneal epithelium and endothelium, keratocytes, scleral fibroblasts, trabecular and lens epithelial cells, the ciliary muscle and epithelium, the iris sphincter and dilator, and stromal cells of the conjunctiva and uveal tract., CONCLUSIONS: Local production, especially in the cornea, conjunctiva, sclera, and ciliary muscle, and systemic deposition, particularly in blood vessles and in the sclera, may contribute to amyloid deposits in FAF. To explain the complex pattern of deposition, microenvironmental factors such as lamellar architecture of the cornea and sclera, altered processing of gelsolin, or blood-tissue barriers must be invoked. In addition to corneal lattice dystrophy type II, the observed deposits help to explain glaucoma in patients with FAF.
Keywords: Aged; Aged, 80 and over; *Amyloid/me [Metabolism]; Amyloidosis/ge [Genetics]; *Amyloidosis/me [Metabolism]; Amyloidosis/pa [Pathology]; Anterior Eye Segment/bs [Blood Supply]; Anterior Eye Segment/ir [Innervation]; Anterior Eye Segment/me [Metabolism]; Anterior Eye Segment/pa [Pathology]; Choroid/me [Metabolism]; Choroid/pa [Pathology]; Eye Diseases/ge [Genetics]; *Eye Diseases/me [Metabolism]; Eye Diseases/pa [Pathology]; Finland; *Gelsolin/me [Metabolism]; Humans; Immunoenzyme Techniques; Middle Aged; Optic Nerve/me [Metabolism]; Optic Nerve/pa [Pathology]; Retina/me [Metabolism]; Retina/pa [Pathology]; Syndrome

Age-related vision changes: a primary care guide. - Carter, T L (Geriatrics, 1994)
Visual impairment becomes more prevalent with age. A person has "low vision" when legally blind or partially sighted. In addition, many older patients have functional visual impairment that affects their ability to read, even with corrective lenses. Normal visual changes that occur with aging include presbyopia, decreased contrast sensitivity, decreased dark/light adaptation, and delayed glare recovery. The four most prevalent age-related ocular diseases are macular degeneration, open-angle glaucoma, cataract, and diabetic retinopathy. The primary care practitioner can identify patients with visual problems with a careful history and in-office tests of visual acuity. Patients with visual impairments should be referred to an eye care practitioner for a more comprehensive ocular evaluation.
Keywords: Age Factors; Aged; *Geriatrics/mt [Methods]; Humans; Medical History Taking; Office Visits; Prevalence; *Primary Health Care/mt [Methods]; Referral and Consultation; Vision Disorders/cl [Classification]; Vision Disorders/di [Diagnosis]; Vision Disorders/ep [Epidemiology]; *Vision Disorders/th [Therapy]; Vision Screening

Poloxamer 407 as a bacterial adhesive for hydrogel contact lenses. - Portoles, M; Refojo, M F; Leong, F L (Journal of biomedical materials research, 1994)
Bacterial adherence and colonization of biomedical prosthetic implants is one of the main causes for implant withdrawal. The abhesive (anti-adhesive) effect of poloxamer 407 on several Gram-positive and Gram-negative strains and the site of action of its effect have been investigated. Poloxamer 407 significantly inhibited 92-99% of Pseudomonas aeruginosa adherence to hydrophilic contact lenses (P < .05). This adherence inhibition was concentration-dependent. A reduction of about 50-60% was obtained for Staphylococcus strains, and 50-70% for Gram-negative strains other than Pseudomonas. The poloxamer seems to act on the bacteria surface, but not on the contact lens surface. Poloxamer 407 could potentially prevent implant-related infections and keratitis associated with contact lens wear, by inhibiting bacterial adherence onto the implant or contact lens surface.
Keywords: *Bacterial Adhesion/de [Drug Effects]; *Contact Lenses, Hydrophilic; *Disinfectants/pd [Pharmacology]; Equipment Contamination; *Gram-Negative Bacteria/de [Drug Effects]; *Gram-Positive Bacteria/de [Drug Effects]; *Poloxalene/pd [Pharmacology]

Comparative study of three non-contact tonometers and the Goldmann tonometer. - Moreno-Montanes, J; Gomez-Demmel, E; Lajara-Blesa, J; Aliseda-Perez de Madrid, D (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 1994)
The main objective of this study was to find out how well three non-contact tonometers (Pulsair, Xpert-NCT and CT-20) compare with the Goldmann tonometer (GT). Sensitivity, specificity, positive and negative predictive values were all evaluated for an intraocular pressure (IOP) > or = 21 mm Hg. We also calculated the mean IOP, the correlation and the dispersion of the results. The difficulty in using the instruments, the patient's attitude and subjective comfort of IOP measuring were also evaluated. We describe the advantages and shortcomings of non-contact tonometers as screening tools to detect elevated IOP in the general population.
Keywords: Adolescent; Adult; Aged; False Positive Reactions; Female; Humans; Intraocular Pressure; Male; Middle Aged; *Ocular Hypertension/di [Diagnosis]; Ocular Hypertension/pp [Physiopathology]; Patient Satisfaction; Predictive Value of Tests; Sensitivity and Specificity; *Tonometry, Ocular/is [Instrumentation]; Tonometry, Ocular/st [Standards]

Traditional eye medicines and corneal ulceration in Tanzania. - Yorston, D; Foster, A (The Journal of tropical medicine and hygiene, 1994)
A one-year prospective study into the aetiology of corneal ulceration in 103 patients attending Mvumi hospital, Tanzania, showed 25% (95% CL 16.5-33.5%) of ulcers to be associated with the use of traditional eye medicines (TEM) within the previous 7 days. There was no statistically significant difference between TEM users and non-users in terms of sex of the patients, season of presentation or age at presentation. Of 26 corneal ulcers in TEM users, 58% (n = 15) had no other identified cause of ulceration apart from TEM use. Of the remaining 11, eight showed the appearances of HSV keratitis, and three others had bacterial infection, two with Neisseria gonococcus. TEM use was associated with hypopyon at presentation (19.3 vs 2.6% in non-TEM users (P = 0.004)), and there was a trend to more central and dense corneal scarring in the TEM users group (42 vs 23%, P = 0.06). Secondary infection is an important cause of corneal scarring following TEM use, and all patients who have a TEM-associated corneal ulcer should have intensive antimicrobial treatment. TEM use will continue so long as primary eye care continues to be unavailable to the majority of the population of Africa.
Keywords: Adolescent; Adult; Anti-Bacterial Agents/tu [Therapeutic Use]; Child; Child, Preschool; Corneal Ulcer/dt [Drug Therapy]; *Corneal Ulcer/ep [Epidemiology]; *Corneal Ulcer/et [Etiology]; Female; Health Services Accessibility; Humans; Infant; Infant, Newborn; Male; *Medicine, African Traditional; Middle Aged; *Population Surveillance; Primary Health Care; Prospective Studies; Risk Factors; Severity of Illness Index; Tanzania/ep [Epidemiology]

Herpetic Eye Disease Study. A controlled trial of topical corticosteroids for herpes simplex stromal keratitis. - Wilhelmus, K R; Gee, L; Hauck, W W; Kurinij, N; Dawson, C R; Jones, D B; Barron, B A; Kaufman, H E; Sugar, J; Hyndiuk, R A (Ophthalmology, 1994)
PURPOSE: To evaluate the efficacy of topical corticosteroids in treating herpes simplex stromal keratitis., METHODS: The authors performed a randomized, double-masked, placebo-controlled, multicenter clinical trial of 106 patients with active herpes simplex stromal keratitis who had not received any corticosteroids for at least 10 days before study enrollment. Patients were assigned to the placebo group (n = 49) or the steroid group (topical prednisolone phosphate; n = 57); both regimens were tapered over 10 weeks. Both groups received topical trifluridine. Visual acuity assessment and slit-lamp biomicroscopy were performed weekly for 10 weeks, every other week for an additional 6 weeks or until removal from the trial, and at 6 months after randomization., RESULTS: The time to treatment failure (defined by specific criteria as persistent or progressive stromal keratouveitis or an adverse event) was significantly longer in the steroid group compared with the placebo group. Compared with placebo, corticosteroid therapy reduced the risk of persistent or progressive stromal keratouveitis by 68%. The time from randomization to resolution of stromal keratitis and uveitis was significantly shorter in the steroid group compared with the placebo group even though both groups included patients who were removed from the study and treated with topical corticosteroids according to best medical judgment. Nineteen (33%) of the steroid-treated patients and 11 (22%) of the placebo-treated patients completed the 10 weeks of protocol therapy and had stable, noninflamed corneas after 16 weeks. At 6 months after randomization, no clinically or statistically significant differences in visual outcome or recurrent herpetic eye disease were identified between the steroid and placebo groups., CONCLUSIONS: The topical corticosteroid regimen used in this study was significantly better than placebo in reducing persistence or progression of stromal inflammation and in shortening the duration of herpes simplex stromal keratitis. Postponing steroids during careful observation for a few weeks delayed resolution of stromal keratitis but had no detrimental effect as assessed by visual outcome at 6 months.
Keywords: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Chi-Square Distribution; Double-Blind Method; Female; Follow-Up Studies; Humans; *Keratitis, Herpetic/dt [Drug Therapy]; Keratitis, Herpetic/pp [Physiopathology]; Male; Middle Aged; Patient Compliance; Prednisolone/ad [Administration & Dosage]; Prednisolone/ae [Adverse Effects]; *Prednisolone/tu [Therapeutic Use]; Prospective Studies; Recurrence; Regression Analysis; Treatment Failure; Treatment Outcome; Trifluridine/ad [Administration & Dosage]; Trifluridine/tu [Therapeutic Use]; United States; Visual Acuity

Herpetic Eye Disease Study. A controlled trial of oral acyclovir for herpes simplex stromal keratitis. - Barron, B A; Gee, L; Hauck, W W; Kurinij, N; Dawson, C R; Jones, D B; Wilhelmus, K R; Kaufman, H E; Sugar, J; Hyndiuk, R A (Ophthalmology, 1994)
PURPOSE: To evaluate the efficacy of oral acyclovir in treating stromal keratitis caused by herpes simplex virus (HSV) in patients receiving concomitant topical corticosteroids and trifluridine., METHODS: The authors performed a randomized, double-masked, placebo-controlled, multicenter trial in 104 patients with HSV stromal keratitis without accompanying HSV epithelial keratitis. Sample size was chosen so that a 5%, one-tailed test would have an 80% chance of detecting a doubling of the median time to treatment failure. Patients were randomized to receive a 10-week course of either oral acyclovir (400 mg 5 times daily, n = 51) or placebo (n = 53). All patients also received a standard regimen of topical prednisolone phosphate and trifluridine. Ophthalmologic examinations were performed weekly during the 10-week treatment period, every 2 weeks for an additional 6 weeks, and at 6 months after entry into the trial., RESULTS: The median time to treatment failure (defined as worsening or no improvement of stromal keratitis or an adverse event) was 84 days (95% confidence interval, 69-93 days) for the acyclovir group and 62 days (95% confidence interval, 57-90 days) for the placebo group. By 16 weeks, 38 patients (75%) in the acyclovir group and 39 patients (74%) in the placebo group had failed treatment. Also by that time, the keratitis had resolved with trial medications, and there was no subsequent worsening in nine patients (18%) in the acyclovir group and ten (19%) in the placebo group. None of these results were significantly different between the two groups. However, visual acuity improved over 6 months in significantly more patients in the acyclovir group than in the placebo group., CONCLUSION: There was no statistically or clinically significant beneficial effect of oral acyclovir in treating HSV stromal keratitis in patients receiving concomitant topical corticosteroids and trifluridine with regard to time to treatment failure, proportion of patients who failed treatment, proportion of patients whose keratitis resolved, time to resolution, or 6-month best-corrected visual acuity. Visual acuity improved over 6 months in more patients in the acyclovir group than in the placebo group.
Keywords: Acyclovir/ad [Administration & Dosage]; Acyclovir/ae [Adverse Effects]; *Acyclovir/tu [Therapeutic Use]; Administration, Oral; Administration, Topical; Adolescent; Adult; Aged; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; *Keratitis, Herpetic/dt [Drug Therapy]; Keratitis, Herpetic/pp [Physiopathology]; Male; Middle Aged; Patient Compliance; Prednisolone/ad [Administration & Dosage]; Prednisolone/tu [Therapeutic Use]; Prospective Studies; Regression Analysis; Treatment Outcome; Trifluridine/ad [Administration & Dosage]; Trifluridine/tu [Therapeutic Use]; United States; Visual Acuity

RU 486: an alternative to surgical abortion. - Donaldson, K; Briggs, J; McMaster, D (Journal of obstetric, gynecologic, and neonatal nursing : JOGNN, 1994)
After 5 years of use in more than 100,000 European women, RU 486, an antiprogestin medication used as a medical abortifacient, has recently come under scrutiny in the United States. This article discusses the current and potential uses of RU 486. Also addressed are the history, advantages, and disadvantages of medical abortion (including the acceptability of the method from a woman-centered perspective); new clinical trials; and ethical issues.
Comment in (CIN), Comment in (CIN)
Keywords: *Abortion, Induced/mt [Methods]; Breast Neoplasms/dt [Drug Therapy]; Endometrium/de [Drug Effects]; Ethics, Professional; Female; Humans; Mifepristone/pd [Pharmacology]; Mifepristone/tu [Therapeutic Use]; *Mifepristone; Patient Education as Topic; Pregnancy

Effect of resisting tonometry on intraocular pressure. - Frantz, K A; Peters, R J; Maino, D M; Gunderson, G G (Journal of the American Optometric Association, 1994)
BACKGROUND: Children and patients with developmental delay frequently resist the procedure of tonometry. Intraocular pressure (IOP) readings, if obtained under stressful circumstances, may have questionable reliability because IOP is influenced by numerous factors characteristic of the uncooperative patient. These factors include possible increases in arterial blood pressure, intraocular vascular engorgement, and pressure on the globe. A study of the effect upon IOP of these factors occurring simultaneously has not been reported previously., METHODS: We measured IOP using the Tono-Pen on 40 cooperative adults under normal conditions and again under conditions simulating the resistant patient., RESULTS: Paired t-test revealed a statistically significant difference between IOP readings under the two conditions (p < 0.001), with IOP under "resistant" conditions showing more variability and averaging 6mmHg higher than under normal conditions., CONCLUSIONS: We conclude that IOP readings in resistant patients should be viewed with caution. The possibility of obtaining false high readings in these patients could lead to unnecessary glaucoma evaluations if based only on elevated IOP readings.
Keywords: Adult; Female; Humans; *Intraocular Pressure/ph [Physiology]; Male; *Patient Compliance; Reproducibility of Results; Tonometry, Ocular/st [Standards]; *Tonometry, Ocular; Valsalva Maneuver

The role of laser trabeculoplasty as primary therapy for open-angle glaucoma. - Smith, S D; Netland, P A (International ophthalmology clinics, 1994)
Keywords: Acetazolamide/ae [Adverse Effects]; Acetazolamide/tu [Therapeutic Use]; Adrenergic beta-Agonists/ae [Adverse Effects]; Adrenergic beta-Agonists/tu [Therapeutic Use]; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; *Laser Therapy; Patient Compliance; Sympatholytics/ae [Adverse Effects]; Sympatholytics/tu [Therapeutic Use]; *Trabeculectomy/mt [Methods]

Corneal abrasion associated with contact lens correction of keratoconus--a retrospective study. - Weissman, B; Chun, M W; Barnhart, L A (Optometry and vision science : official publication of the American Academy of Optometry, 1994)
BACKGROUND: Corneal abrasion is a frequently encountered complication of contact lens wear, but we are not aware of any previous study of relative frequency comparing keratoconic to nonkeratoconic patients., METHODS: We retrospectively studied the incidence of corneal abrasion during 2 months of contact lens practice., RESULTS: 784 contact lens-related patient visits (494 total patients); patients were assessed by 3 optometrists and 13 abrasions (11 patients) were diagnosed. Only the total number of individual patients and the first abrasion for each patient were statistically considered; the overall frequency of abrasion was therefore 11/494 (2.3%)/2 months. The frequency of abrasion was 5/68 (7.4%)/2 months for keratoconic patients and 6/426 (1.4%)/2 months for nonkeratoconic patients and this difference was significant (chi 2 test: p < 0.01). Among nonkeratoconic patients, the frequency of abrasion was 2/246 (0.8%)/2 months with hydrogel contact lens wear and 4/178 (2.2%)/2 months with rigid gas permeable (RGP) contact lens wear, but this difference did not achieve significance (chi 2 test: p = 0.10). IDENTIFIED RISK FACTORS INCLUDED: Contact lens wear; a torn lens and chemical keratitis for hydrogel lens wearers; an adherent "bound" lens and keratoconus for rigid lens wearers., CONCLUSION: Keratoconus appears to be a statistically significant risk factor for corneal abrasion among contact lens wearers.
Keywords: Adolescent; Adult; Aged; *Contact Lenses/ae [Adverse Effects]; Cornea/pa [Pathology]; *Corneal Injuries; Female; Humans; Incidence; *Keratoconus/th [Therapy]; Male; Middle Aged; Myopia/th [Therapy]; Retrospective Studies; Risk Factors

The sight test fee. Effectiveness of treatment for glaucoma remains unproved. - Clearkin, L (BMJ (Clinical research ed.), 1994)
Comment on (CON)
Keywords: Fees and Charges; *Glaucoma/di [Diagnosis]; Glaucoma/th [Therapy]; Humans; Patient Acceptance of Health Care; United Kingdom; *Vision Tests/ec [Economics]

Recurrent corneal infections in a patient with the acquired immunodeficiency syndrome. - Hemady, R K; Griffin, N; Aristimuno, B (Cornea, 1993)
A 29-year-old female intravenous drug abuser infected with the human immunodeficiency virus suffered recurrent, bilateral corneal infections over an 11-month period. Multiple infectious organisms were responsible, including capnocytophaga species, Candida albicans, Staphylococcus aureus, coagulase-negative staphylococcus, and a-streptococcus. One eye was eviscerated because of corneal perforation and loss of vision; the second eye has maintained good vision. Predisposing factors usually associated with corneal infections were absent. Treatment was complicated by extremely poor patient compliance, ongoing intravenous drug abuse, and concurrent multiple extraocular medical problems.
Keywords: *AIDS-Related Opportunistic Infections/mi [Microbiology]; Adult; Candidiasis; *Corneal Ulcer/mi [Microbiology]; *Eye Infections, Bacterial; *Eye Infections, Fungal; Female; Humans; Recurrence; Substance Abuse, Intravenous

Corneal endothelial involvement in pseudoexfoliation syndrome. - Schlotzer-Schrehardt, U M; Dorfler, S; Naumann, G O (Archives of ophthalmology (Chicago, Ill. : 1960), 1993)
Information on corneal manifestation in pseudoexfoliation syndrome is restricted to specular microscopic studies. We investigated morphologic changes of the posterior cornea of two corneal buttons with Fuchs' endothelial dystrophy obtained at penetrating keratoplasty and of one enucleated glaucomatous eye from three patients with ocular pseudoexfoliation syndrome. By transmission electron microscopy, large clumps of typical pseudoexfoliation material were found adhering to the corneal endothelium and masses of pseudoexfoliation material were incorporated into the posterior Descemet's membrane. In the affected areas, the endothelial layer appeared irregular and discontinuous, with loosely adherent, degenerating cells producing pseudoexfoliation fibers and fibroblastic cells spreading to cover denuded Descemet's membrane. The present findings indicate that the pseudoexfoliation material is initially formed by degenerative endothelial cells and that it becomes subsequently buried by overgrowing cells. The corneal endothelial involvement may potentiate complications of cataract surgery and open angle glaucoma in patients with pseudoexfoliation syndrome.
Comment in (CIN)
Keywords: Aged; Aged, 80 and over; *Anterior Eye Segment/ul [Ultrastructure]; Descemet Membrane/pa [Pathology]; *Endothelium, Corneal/ul [Ultrastructure]; Eye Diseases/pa [Pathology]; Eye Enucleation; Female; Fuchs' Endothelial Dystrophy/pa [Pathology]; Fuchs' Endothelial Dystrophy/su [Surgery]; Glaucoma/pa [Pathology]; Glaucoma/su [Surgery]; Humans; Keratoplasty, Penetrating; Male; Syndrome

Maintained intraocular pressure reduction with once-a-day application of a new prostaglandin F2 alpha analogue (PhXA41). An in-hospital, placebo-controlled study. - Racz, P; Ruzsonyi, M R; Nagy, Z T; Bito, L Z (Archives of ophthalmology (Chicago, Ill. : 1960), 1993)
To eliminate uncertainties about compliance, 15 patients with glaucoma (intraocular pressure [IOP] > 22 mm Hg and < 40 mm Hg) were hospitalized to participate in a clinical trial of the ocular hypotensive effectiveness of the new prostaglandin F2 alpha analogue prodrug, PhXA41 (13,14-dihydro-17-phenyl-18, 19, 20-trinor-PGF2a-isopropyl ester; latanoprost [World Health Organization generic name]). At 9 PM on each of five consecutive days, one of the investigators applied one drop of a 0.006% solution of PhXA41 (representing approximately 2 micrograms of PhXA41 per treatment) to one eye of nine patients and one drop of placebo to one eye of six patients. This was followed by an evaluation of potential local side effects at 9:30 PM. Complete examinations, including tonometry (Goldmann), were also performed at 8 AM and 8 PM on days 1 to 6, as well as at noon and 4 PM on days 1, 2, and 6. Except for mild conjunctival hyperemia in two PhXA41-treated eyes (once each at 8 AM), no side effects were observed or reported by any patient. Starting with the first IOP measurement after the first treatment (8 AM on day 2), IOP was reduced by 20% to 30% in the eyes treated with PhXA41. This reduction was highly significant (P < .01 at 12 time points and P < .05 at the remaining two measurements) throughout the study. The IOP reduction did not become attenuated during the 23 hours after treatments. At 11 hours after the last treatment, the mean (+/- SD) IOP difference between PhXA41-treated and contralateral control eyes was -5.5 +/- 2.8 mm Hg, as compared with -6.1 +/- 1.8 mm Hg 12 hours later. PhXA41 must, therefore, be regarded as an excellent candidate for use as a once-a-day glaucoma medication.
Keywords: Adult; Aged; Drug Administration Schedule; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Hospitalization; Humans; Intraocular Pressure/de [Drug Effects]; Latanoprost; Male; Middle Aged; Ocular Hypotension/ci [Chemically Induced]; Ophthalmic Solutions; Placebos; *Prodrugs/ad [Administration & Dosage]; Prodrugs/tu [Therapeutic Use]; *Prostaglandins F, Synthetic/ad [Administration & Dosage]; Prostaglandins F, Synthetic/tu [Therapeutic Use]; Tonometry, Ocular

Treatment for glaucoma: adherence by the elderly. - Gurwitz, J H; Glynn, R J; Monane, M; Everitt, D E; Gilden, D; Smith, N; Avorn, J (American journal of public health, 1993)
OBJECTIVES: The purpose of this study was to determine the extent of nonadherence to treatment for glaucoma among elderly patients., METHODS: This was a retrospective cohort study of 2440 patients older than age 65 who were enrolled in the New Jersey Medicaid Program and who were newly initiated on a topical agent for the treatment of glaucoma. Two patient-specific measures of nonadherence were employed: (1) no filled prescription for any glaucoma medication over a 12-month period after the initiation of therapy and (2) number of days without therapy for glaucoma during this 12-month period., RESULTS: By the first measure, 569 patients (23%) were found to be nonadherent. The mean number of days without therapy during the study year was 112. Factors associated with nonadherence included the use of glaucoma medication requiring more than 2 administrations per day and the presence of multiple other medications in the patient's drug regimen. Patients started on multiple glaucoma medication were more adherent than those started on a single agent. Age and sex were not found to be predictors of nonadherence., CONCLUSIONS: Substantial nonadherence was found to be common in this population. More attention to the issue of nonadherence could result in important benefits in the preservation of sight.
Keywords: Aged; Aged, 80 and over; Chi-Square Distribution; Cohort Studies; Demography; Drug Administration Schedule; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Odds Ratio; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; Regression Analysis; Retrospective Studies; Self Administration

Regulation of mitogen-driven lymphoreticular cell activation by human corneal cells and interleukin-1. - Shams, N B; Huggins, E M Jr; Sigel, M M (Cornea, 1993)
Keratin-positive fibroblast-like epithelial cells (FLE), isolated from human corneo-scleral-conjunctival rims, were shown to inhibit mitogen-driven (concanavalin A) DNA synthesis by murine thymocytes and splenocytes [lymphoreticular cells (LRC)]. The effect exerted by live cells in culture and by their supernatants was caused by factors active across species barriers. Paraformaldehyde-fixed or irradiated cells also suppressed mitogen-induced thymocyte DNA synthesis, but their supernatants manifested no such activity. Interaction between FLE cells and LRC in the presence of the mitogen resulted in suppressed cellular activation as evidenced by significantly lowered tetrazolium salt (MTT) reduction in murine thymocytes and splenocytes, suggesting reduced mitochondrial activity. The suppressive effect was seen with live and paraformaldehyde-fixed FLE cells. There was a good correlation between MTT assays and [3H]thymidine uptake experiments. Suppression of MTT reduction in murine thymocytes and splenocytes by intact FLE cells could be reversed by the addition of interleukin-1 (IL-1). Indomethacin prevented FLE-conditioned medium-induced suppression but failed to relieve suppression by whole FLE cells. Thus, suppression of LRC function by FLE cells and their secretions appeared to operate by different mechanisms. One mechanism related to prostaglandins present in FLE cell-conditioned medium, whereas another mechanism appeared to involve cell-membrane-associated factor(s). The findings not only provide additional information on the capability of corneal cells to regulate lymphoreticular cells but suggest an important role for IL-1 in the regulation of LRC function and corneal inflammation and immunity.
Keywords: Animals; Cells, Cultured; Concanavalin A/im [Immunology]; *Cornea/im [Immunology]; DNA Replication; Epithelium/im [Immunology]; Humans; *Interleukin-1/im [Immunology]; *Lymphocyte Activation/im [Immunology]; *Lymphocytes/im [Immunology]; Male; Mice; Mice, Inbred C3H; Tetrazolium Salts; Thiazoles

[Therapeutic observance and life of patients with primary open-angle glaucoma. Apropos of 341 cases in the department of Marne]. - Bour, T; Blanchard, F; Segal, A (Journal francais d'ophtalmologie, 1993)
Patient compliance with treatment is an important factor in chronic diseases such as primary open-angle glaucoma (POAG). Among the 404 glaucoma patients included in our study in the department of Marne (France), 341 patients responded by completing an anonymous questionnaire at home in which the psychological effect of the illness, their knowledge about it, compliance with treatment and their relationships with the physician were explored. Sixty-eight per cent of these patients confirmed strict compliance with the treatment prescribed; this rate does not vary with respect to either the ophthalmologist (p = 0.57), or the duration of treatment (p = 0.42). Half of the remaining patients only alter the hours of their treatment and 6% forget to instill the eyedrops on certain days. According to our survey, the principal causes of poor compliance are forgetfulness, time constraints with other duties, poor doctor-patient relationship and lack of sufficient knowledge about the disease and its treatment. The majority of patients (59%) are minimally disturbed by the treatment; 2/3 of the subjects do not feel any change in their moral whereas 15% are more depressed or weakened since the time the illness was discovered. Fifty-six per cent of them observed little or no change in their vision; 32% believe to have a moderate or considerable repercussion and 6% claim a very severe visual deterioration. Generally, patients appear to have a positive attitude towards their illness and do not try to deny it. Thirty-eight per cent of them consider it as a handicap which they can overcome and 42% have either no particular opinion or take it as a minor event.
Keywords: Activities of Daily Living; France; Glaucoma, Open-Angle/ep [Epidemiology]; Glaucoma, Open-Angle/px [Psychology]; *Glaucoma, Open-Angle/th [Therapy]; Humans; *Patient Compliance; Physician-Patient Relations; Surveys and Questionnaires

Factors associated with visual loss in patients with advanced glaucomatous changes in the optic nerve head. - Stewart, W C; Chorak, R P; Hunt, H H; Sethuraman, G (American journal of ophthalmology, 1993)
We evaluated factors associated with decreased or stable visual function in 72 patients with primary open-angle glaucoma and complete cupping of the optic disk who were followed up five years or more. We found a significantly lower mean (15.4 +/- 2.7 mm Hg) and peak (24.5 +/- 6.9 mm Hg) intraocular pressure in those patients whose vision remained stable vs those whose vision decreased (21.3 +/- 3.2 and 39.2 +/- 11.0 mm Hg, respectively) (t-test, P < .001). Additionally, the variance of each patient's individual intraocular pressure readings measured during the follow-up period was lower in the group with stable vision (4.5 mm Hg) than in those in whom vision decreased (9.0 mm Hg) (F test, P < .001). Stepwise discriminant analysis disclosed that mean intraocular pressure, variance of an individual's intraocular pressure measurements over time, history of argon laser trabeculoplasty, and compliance with therapy discriminated 92.9% of patients (52 of 56) whose vision remained stable and 87.5% of patients (14 of 16) whose vision decreased. Reduction of intraocular pressure and compliance with therapy are important in patients with complete glaucomatous cupping of the optic disk.
Keywords: Aged; Female; Follow-Up Studies; *Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure; Laser Therapy; Male; Middle Aged; *Optic Disk/pp [Physiopathology]; Optic Nerve Diseases/et [Etiology]; Optic Nerve Diseases/pp [Physiopathology]; Risk Factors; Trabeculectomy; *Vision Disorders/et [Etiology]; Vision Disorders/pp [Physiopathology]; Visual Acuity/ph [Physiology]; Visual Fields/ph [Physiology]

Ethnic differences in the assessment and treatment of disease. - Gibaldi, M (Pharmacotherapy, 1993)
Keywords: Acquired Immunodeficiency Syndrome/dt [Drug Therapy]; African Americans; African Continental Ancestry Group; Cerebrovascular Disorders/ge [Genetics]; Coronary Artery Bypass/sn [Statistics & Numerical Data]; *Ethnic Groups; European Continental Ancestry Group; Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/su [Surgery]; *Health Services Accessibility; Humans; Hypertension/dt [Drug Therapy]; Hypertension/ge [Genetics]; Kidney Transplantation; Liver Transplantation; Pharmaceutical Preparations/me [Metabolism]; United States

The Glaucoma Laser Trial (GLT): 5. Subgroup differences at enrollment. Glaucoma Laser Trial Research Group. - Anonymous (Ophthalmic surgery, 1993)
Data collected at enrollment on the 271 patients (542 eyes) who participated in the Glaucoma Laser Trial (GLT) were analyzed for subgroup differences. The subgrouping variables included four patient characteristics (race, sex, age, and history of a vascular disease) and one ocular characteristic (myopia). The strongest differences observed were between blacks and whites. As compared with the eyes of the white patients, those of the black patients had lower mean decibels per test location in the visual field (P < .001), greater mean defect (P < .001), number of abnormal test locations (P < .001), and corrected loss variance (P = .009), as well as greater cup depth (P < .001), and larger mean horizontal (P = .002) and vertical (P < .001) cup/disc ratios.
Keywords: Adult; African Continental Ancestry Group; Aged; Aged, 80 and over; European Continental Ancestry Group; Female; Glaucoma, Open-Angle/eh [Ethnology]; *Glaucoma, Open-Angle/pa [Pathology]; Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; *Laser Therapy; Male; Middle Aged; Myopia/pa [Pathology]; Optic Nerve/pa [Pathology]; Patient Participation; Trabeculectomy; Vision Disorders/pa [Pathology]; Visual Acuity; Visual Fields

Acanthamoeba trophozoite and cyst adherence to four types of soft contact lens and removal by cleaning agents. - Kilvington, S (Eye (London, England), 1993)
Trophozoite and cyst adherence of two Acanthamoeba keratitis strains (PHL/530 and PHL/978) to four types of unworn soft contact lens and their removal by cleaning agents were studied. Greater adherence of the trophozoites compared with the cysts was recorded for both strains. Trophozoites of PHL/530 adhered in greater numbers to type I lenses (61.4% poly[2-hydroxyethyl methacrylate-38.6% water), with no differences between type II (30% lidofilcon A-70% water), III (55% bufilcon A-45% water) and IV lenses (42% etafilcon A-58% water). Adherence of PHL/978 trophozoites to type II lenses was decreased compared with their adherence to the other lenses. Cysts of both strains showed greater adherence to type I and III lenses. Interstrain differences in trophozoite adherence occurred, with PHL/530 showing greater adherence to type I and II lenses. Recommended cleaning procedures using three commercial solutions were effective in removing Acanthamoeba from the lenses. This study indicates the possible role of adherence to contact lenses in the acquisition of Acanthamoeba keratitis, but shows that correct use of commercial cleaning agents may be important in the prevention of infection.
Keywords: Acanthamoeba/de [Drug Effects]; *Acanthamoeba/ip [Isolation & Purification]; Animals; *Contact Lenses, Hydrophilic; Detergents/pd [Pharmacology]; Equipment Contamination; Humans

Acanthamoeba keratitis. A masquerade of presentation in six cases. - Tay-Kearney, M L; McGhee, C N; Crawford, G J; Trown, K (Australian and New Zealand journal of ophthalmology, 1993)
Acanthamoeba keratitis is an uncommon but devastating complication of contact lens wear causing significant ocular morbidity. Six consecutive cases occurring in Western Australia in an 18-month period are reported. In all cases either poor contact lens hygiene or an association with swimming pools and contact lens use is a feature. There is invariably a delay in making the diagnosis, with the appearance frequently mistaken for herpes simplex keratitis. In all cases corneal biopsy was required to confirm the diagnosis. Of the six patients, four responded to medical therapy alone, one required a corneal graft and one required enucleation. We suggest that earlier rather than later corneal biopsy is important in unresponsive cases of culture-negative keratitis, especially in contact lens wearers. We would agree that the treatment of choice is intensive topical propamidine and neosporin. Prevention by strict adherence to contact lens care and hygiene is urged.
Keywords: *Acanthamoeba Keratitis/et [Etiology]; *Acanthamoeba Keratitis/pa [Pathology]; Acanthamoeba Keratitis/th [Therapy]; Adult; Animals; Bacitracin/tu [Therapeutic Use]; Benzamidines/tu [Therapeutic Use]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Diagnosis, Differential; Disposable Equipment; Drug Combinations; Female; Humans; Keratitis, Herpetic/di [Diagnosis]; Keratoplasty, Penetrating; Male; Middle Aged; Neomycin/tu [Therapeutic Use]; Polymyxin B/tu [Therapeutic Use]; Risk Factors

Five-year results of vitrectomy and silicone oil in patients with proliferative vitreoretinopathy. - van Meurs, J C; Mertens, D A; Peperkamp, E; Post, J (Retina (Philadelphia, Pa.), 1993)
The purpose for this study was to evaluate the results of silicone oil use in patients who have undergone vitrectomy for proliferative vitreoretinopathy (PVR). The authors reviewed the 5-year results of 50 consecutive patients (52 eyes) with grade C1/D3 PVR operated on in 1987. Silicone oil has been removed in 42 eyes. The retina remained attached in 38 eyes. Visual acuities were finger counting in 12 eyes and 0.1 or greater in 19 eyes. Glaucoma was thought to be the major cause of loss of visual acuity after an initial improvement (9 eyes), as well as the most frequent complication of surgery (13 eyes). Silicone oil was deemed nonremovable in 10 operated eyes. A questionnaire was developed to determine the patients' perceptions of the use of silicone oil, and 46 patients responded to the questionnaire. Four patients indicated that they would not have elected to have surgery again. Six patients thought that surgery was not worthwhile, but would permit treatment again. Most patients thought that a modest amount of improvement had taken place and that vision was stable. Subjectively, most patients believed that surgery was worthwhile.
Keywords: Evaluation Studies as Topic; Eye Diseases/su [Surgery]; Follow-Up Studies; Humans; Longitudinal Studies; Patient Satisfaction; Postoperative Complications; Reoperation; Retinal Detachment/su [Surgery]; *Retinal Diseases/su [Surgery]; *Silicone Oils; Surveys and Questionnaires; Treatment Outcome; Visual Acuity; *Vitrectomy/mt [Methods]; *Vitreous Body/su [Surgery]

[Optical rehabilitation by tectonic anterior segment reconstruction]. - Bialasiewicz, A A; Forster, W; Busse, H (Klinische Monatsblatter fur Augenheilkunde, 1993)
BACKGROUND: The potential benefits of anterior segment surgery to achieve visual rehabilitation in severely compromised eyes subsequent to infectious complications in the anterior segment remain a subject of controversy., PATIENTS AND METHODS: Anterior segment reconstructive surgery was performed on twelve patients (12 eyes) with infectious adherent leukoma and extensively damaged intraocular structures. Nine patients (nine eyes) were followed up over a period of two years (20-26 months) and three over a period of nine months (8-11 months)., RESULTS: Simultaneous and consecutive surgical interventions including corneal grafting, anterior chamber reconstruction and posterior chamber lens implantation combined with antimicrobial and antiviral prophylaxis as well as corticosteroid treatment resulted in visual recovery in nine eyes, and in four in a visual acuity of 0.4 or better (reading VA)., CONCLUSIONS: Surgery for optic reasons due to infectious adherent leukoma does not seem to be completely unsuccessful with respect to the low complication rate despite proven retrocorneal membranes in this study.
Keywords: Adult; Aged; Anterior Eye Segment/pp [Physiopathology]; *Anterior Eye Segment/su [Surgery]; Combined Modality Therapy; Corneal Opacity/pp [Physiopathology]; Corneal Opacity/su [Surgery]; Female; Follow-Up Studies; Humans; Keratitis/pp [Physiopathology]; Keratitis/su [Surgery]; Keratitis, Herpetic/pp [Physiopathology]; Keratitis, Herpetic/su [Surgery]; Keratoplasty, Penetrating/mt [Methods]; Lenses, Intraocular; Male; Middle Aged; Postoperative Complications/pp [Physiopathology]; *Postoperative Complications/su [Surgery]; Refraction, Ocular; Reoperation; *Visual Acuity/ph [Physiology]

Systemic and local tolerability of ophthalmic drug formulations. An update. - Hugues, F C; Le Jeunne, C (Drug safety, 1993)
All eye drops raise problems of local tolerance, but with variable frequencies. They can induce pain on instillation, allergic reactions, delayed healing, punctate keratitis, disturbances of lacrimal secretion, disturbances of accommodation (especially the parasympathomimetics) and local pigmentation after prolonged use. Corticosteroids are associated with 2 major risks: chronic glaucoma and cataract, initially reversible if treatment is stopped. There is still a major risk of corneal herpes with corticosteroids. It is important to be aware of these local problems as they are responsible for poor patient compliance. The systemic effects essentially concern the agonists and antagonists of the autonomic nervous system. beta-Blocker eye drops can cause bronchospasm, heart failure, syncope and psychiatric disorders, especially at high doses and with nonselective beta-blockers. These consequences are usually related to failure to comply with the prescribing precautions. alpha-Adrenergic agonists, which exert dose-dependent effects, can induce hypertensive crises or angina attacks. Apart from patients at risk (children under the age of 30 months and the elderly), parasympathomimetics cause few systemic adverse effects; anticholinesterases, which have curare-like properties, are contraindicated for 6 weeks before general anesthesia. In the very young and the very old, atropinic eye drops carry a risk of cardiovascular collapse and neuropsychiatric disturbances. Problems may also occur with other classes of drugs such as anti-infectives, antispectics, anti-inflammatories and contact lens products. Nevertheless, it is clear that this form of treatment is generally very well tolerated in relation to the volume of eye drops prescribed by ophthalmologists each day.
Keywords: Adrenal Cortex Hormones/ae [Adverse Effects]; Adrenal Cortex Hormones/to [Toxicity]; Adrenergic alpha-Agonists/ae [Adverse Effects]; Adrenergic alpha-Agonists/to [Toxicity]; Adrenergic beta-Antagonists/ae [Adverse Effects]; Adrenergic beta-Antagonists/to [Toxicity]; Anesthetics, Local/ae [Adverse Effects]; Anesthetics, Local/to [Toxicity]; Animals; Anti-Infective Agents/ae [Adverse Effects]; Anti-Infective Agents/to [Toxicity]; *Eye Diseases/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/ae [Adverse Effects]; Ophthalmic Solutions/to [Toxicity]; Parasympatholytics/ae [Adverse Effects]; Parasympatholytics/to [Toxicity]; Parasympathomimetics/ae [Adverse Effects]; Parasympathomimetics/to [Toxicity]

Central vein occlusion study of photocoagulation. Manual of operations. Central Vein Occlusion Study Group. - Anonymous (The Online journal of current clinical trials, 1993)
This paper is the complete protocol (Manual of Operations) used in the Central Vein Occlusion Study (CVOS). The CVOS is a randomized clinical trial and natural history study of central retinal vein occlusion supported by the National Eye Institute. The administrative structure includes a Data and Safety Monitoring Board, 9 clinical centers, a coordinating center, and a photograph reading center. The Manual of Operations describes study design, organization, policies, and procedures. Procedures described in detail include measurement of visual acuity, fundus and iris photography, fluorescein angiography, and quality control.
Keywords: Adult; *Clinical Protocols; Glaucoma, Neovascular/et [Etiology]; Glaucoma, Neovascular/pc [Prevention & Control]; Humans; *Iris/bs [Blood Supply]; Ischemia; Laser Coagulation/mt [Methods]; *Laser Coagulation; Macular Edema/et [Etiology]; *Macular Edema/su [Surgery]; Multicenter Studies as Topic; Neovascularization, Pathologic/et [Etiology]; *Neovascularization, Pathologic/pc [Prevention & Control]; Patient Compliance; Prospective Studies; *Randomized Controlled Trials as Topic; *Research Design; Retinal Artery Occlusion/co [Complications]; *Retinal Artery Occlusion/su [Surgery]; Visual Acuity

Intraocular pressure-dependent dynamic changes of optic disc cupping in adult glaucoma patients. - Parrow, K A; Shin, D H; Tsai, C S; Hong, Y J; Juzych, M S; Shi, D X (Ophthalmology, 1992)
The authors performed a study of intraocular pressure-dependent changes in optic disc cupping in 17 adults with chronic open-angle glaucoma. Analyses with the Rodenstock Optic Nerve Head Analyzer were performed at baseline low intraocular pressure during therapy, after elevation of intraocular pressure (from therapeutic failure or noncompliance), and after reduction of intraocular pressure with successful therapy. Optic disc cupping increased significantly upon short-term increase of intraocular pressure from baseline of 20.4 +/- 2.5 mmHg to 31.1 +/- 5.9 mmHg. Optic disc cupping reverted to baseline after persistent intraocular pressure reduction to 19.3 +/- 4.8 mmHg. These data demonstrate intraocular pressure-dependent dynamic changes of optic disc cupping in patients with demonstrable glaucomatous optic nerve damage. They underscore the detrimental effect of elevated intraocular pressure and the beneficial effect of intraocular pressure reduction on optic disc cup changes.
Keywords: Adult; Aged; Analysis of Variance; Chronic Disease; Female; *Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/su [Surgery]; Humans; Image Processing, Computer-Assisted; *Intraocular Pressure; Male; Middle Aged; *Optic Disk/pp [Physiopathology]; Optic Nerve Diseases/pp [Physiopathology]; Tonometry, Ocular; Trabeculectomy

Statistics Notebook: entry III.E: statistical significance and significance level, and entry III.F: P value. - De Land, P N; Chase, W W (Optometry and vision science : official publication of the American Academy of Optometry, 1992)
Keywords: *Contact Lenses; Humans; *Ocular Hypertension/dt [Drug Therapy]; *Patient Satisfaction/sn [Statistics & Numerical Data]; Probability

[Sterile corneal ulcers in dry eye. Incidence and factors of occurrence]. - Petroutsos, G; Paschides, C A; Kitsos, G; Skopouli, F N; Psilas, K (Journal francais d'ophtalmologie, 1992)
Sterile corneal ulceration is a serious complication in patients with keratoconjunctivitis sicca. The records of 134 patients, 19 males and 115 females, who presented with dry eyes in the Ophthalmologic Clinic were reviewed. Over a period of 6 years, 33 eyes of 23 (17%) patients developed a sterile corneal ulcer. The etiologies of dry eyes in these patients were: Primary Sjogren's syndrome: 10 cases, rheumatoid arthritis: 5 cases, ocular pemphigoid 6 cases, atopy: 1 case, local irradiation: 1 case. Patient's age and sex were not significantly associated with ulcer development (p greater than 0.05). The presence of a major underlying disease was the major contributing factor. Appropriate local treatment and patient compliance were also contributing factors. Blepharitis was found in 90% of patients.
Keywords: Adult; Aged; Blepharitis/co [Complications]; Corneal Ulcer/ep [Epidemiology]; *Corneal Ulcer/et [Etiology]; Female; Humans; *Keratoconjunctivitis Sicca/co [Complications]; Male; Middle Aged; Risk Factors; Sex Factors

[Principles of the treatment of ocular infections]. - Bron, A (La Revue du praticien, 1992)
Ocular infections are still quite common and their clinical presentation is variable; some of them may lead to blindness. In this paper only severe infections like keratitis and endophthalmitis are considered. The rationale for treatment and prophylaxis is based upon bacteriological findings, understanding of ocular barriers and pharmacokinetics of antibacterial agents.
Keywords: Drug Administration Schedule; Endophthalmitis/dt [Drug Therapy]; *Eye Infections/dt [Drug Therapy]; Eye Infections/mi [Microbiology]; Humans; Keratitis/dt [Drug Therapy]

Side effects of topical treatment in pigmentary glaucoma. - Lehto, I (Acta ophthalmologica, 1992)
A series of 35 patients with pigmentary glaucoma were asked to report possible side effects of topical glaucoma medication using a multiple-choice questionnaire. Of the 31 patients (89%) returning the forms, 22 (71%) were men and 9 (29%) women with a mean age of 45.1 years, range 23 to 72 years. The mean follow-up time of their glaucoma was 10.7 years, range 2 to 30 years. A mild burning feeling (in 50% in all treatment groups) and redness of the eyes (in 42% treated with timolol alone and in 50% with timolol combined with dipivephrine, pilocarpine or both) were the main complaints, followed by a slight reduction of vision (in 17% in the timolol group and in 56% with combined treatment) and mild watering of the eyes (in 42% of the timolol and in 31% of the combined treatment groups). Twenty-three percent of the patients did not have any side effects from their topical medication. Patients who admitted defaulting their topical treatment once a month amounted to 43% and once a week to 17%. Patients who admitted to never having missed a drop amounted to 40% of the sample; forgetfulness and haste were the main reasons for not applying the drops.
Keywords: Administration, Topical; Adult; Aged; Drug Therapy, Combination; Epinephrine/ae [Adverse Effects]; *Epinephrine/aa [Analogs & Derivatives]; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; Patient Compliance; *Pilocarpine/ae [Adverse Effects]; Retrospective Studies; Surveys and Questionnaires; *Timolol/ae [Adverse Effects]

Compliance aids--do they work?. - Rivers, P H (Drugs & aging, 1992)
The decision to use a compliance aid will depend on the motivation of the patient, their specific medication regimen, and their physical and cognitive ability. The administration of oral medicines may be facilitated through the appropriate use of 'organisers' which act as aides memoire. 'Medidos' and 'Dosett' are the most frequently studied compliance aids and both have been shown to be beneficial to the elderly and to community-based psychiatric patients. Adherence to a medication regimen may be improved without the use of proprietary compliance aids by ensuring that the most appropriate traditional container is used and by paying attention to the highest standard of labelling on the medicine container. Gadgets that are designed to improve physical dexterity can be useful when applying topical preparations, administering insulin injections, operating pressurised inhalers or administering eyedrops. The accurate administration of eyedrops is particularly important when treating glaucoma and may be facilitated by using devices that are designed to help with aiming of the eyedrops ('Easidrop', 'Mumford Auto-drop,' 'Opticare'). If squeezing the eyedrop container is a problem the 'Opticare' device may be particularly suitable. There may be value in the use of the compliance aids to provide assistance to carers who become involved with preparing medication for patients. Selection of an appropriate compliance aid is not likely to be the total solution to inadequate adherence and most patients will require a combination of strategies to facilitate adherence to treatment with medicines.
Keywords: Administration, Oral; Adolescent; Adult; Aged; Drug Packaging; Female; Humans; Male; Middle Aged; Ophthalmic Solutions; *Patient Compliance; Patient Education as Topic; *Pharmaceutical Preparations/ad [Administration & Dosage]; *Self-Help Devices

Extended contact lens wear enhances Pseudomonas aeruginosa adherence to human corneal epithelium. - Fleiszig, S M; Efron, N; Pier, G B (Investigative ophthalmology & visual science, 1992)
Extended wear of soft contact lenses is associated with an increased risk of Pseudomonas aeruginosa infection of the cornea. To assess the role of bacterial adherence in the pathogenesis of these infections, superficial corneal epithelial cells and leukocytes from ten patients who use extended-wear soft lenses and ten control eyes were compared for their propensity to attach P. aeruginosa in vitro. Cells were washed from the cornea by saline irrigation, incubated with a 10-ml solution containing 10(7) colony-forming units/ml of bacteria at 35 degrees C for 30 min, collected on a filter, and prepared using a modified acridine orange staining method. Fluorescence microscopy showed bacterial adherence to corneal epithelial cells, leukocytes, and ocular mucus. The mean number of bacteria adhering to epithelial cells was 2.6 for control eyes and 6.6 for the lens-wearing eyes (P = 0.002). The percentage of epithelial cells attaching greater than or equal to four bacteria was higher for lens-wearing eyes than control eyes (57.4% versus 26.0%, P = 0.0005). There was no significant difference between contact lens-wearing eyes and control eyes in the number of leukocytes collected or in the number of bacteria attached to these cells. These results show that P. aeruginosa adherence to epithelial cells is enhanced in those who use extended-wear soft contact lenses, and this may contribute to the increased incidence of P. aeruginosa keratitis for this population.
Keywords: Acridine Orange; Adult; *Bacterial Adhesion; Colony Count, Microbial; *Contact Lenses, Extended-Wear/ae [Adverse Effects]; Contact Lenses, Hydrophilic/ae [Adverse Effects]; Cornea/cy [Cytology]; *Cornea/mi [Microbiology]; Epithelial Cells; Epithelium/mi [Microbiology]; Female; Humans; Leukocytes; Male; Microscopy, Fluorescence; *Pseudomonas aeruginosa/ph [Physiology]

Detection, quantification, and significance of basic fibroblast growth factor in the aqueous humor of man, cat, dog and pig. - Tripathi, R C; Borisuth, N S; Tripathi, B J (Experimental eye research, 1992)
By using a highly specific and sensitive heterologous radioimmunoassay, we determined the content of basic fibroblast growth factor (bFGF) in fresh samples of aqueous humor obtained from human (n = 18), feline (n = 8), canine (n = 12), and porcine (n = 10) eyes by paracentesis. The content of bFGF in human aqueous humor ranged from 0.480 to 1.44 ng ml-1 (mean +/- S.D. = 1.074 +/- 0.297 ng ml-1); in feline samples, from 0.672 to 1.152 ng ml-1 (1.016 +/- 0.158 ng ml-1); in canine samples, from 0.640 to 1.232 ng ml-1 (1.026 +/- 0.171 ng ml-1); and in porcine samples, from 0.627 to 0.957 ng ml-1 (0.728 +/- 0.115 ng ml-1). These values were confirmed by means of a dot/slot-blot technique. For all species, the aqueous samples had normal protein levels that ranged from 5 to 19 mg dl-1. There was no correlation of the content of bFGF with the level of protein or with age of the human subjects. The similarity in the concentrations of bFGF in the aqueous humor as well as the stability of the blood-aqueous barriers of all four species indicate that cats, dogs, and pigs can serve as suitable animal models for the study of the role of bFGF in health and disease. We suggest the possible involvement of bFGF in the pathogenesis of anterior-segment disorders, such as neovascular glaucoma, and in the wound-healing response of limbal tissues after glaucoma filtration surgery.
Keywords: Aged; Aged, 80 and over; Animals; *Aqueous Humor/ch [Chemistry]; Cats; Dogs; Electrophoresis, Polyacrylamide Gel; Eye Proteins/an [Analysis]; *Fibroblast Growth Factor 2/an [Analysis]; Fibroblast Growth Factor 2/ph [Physiology]; Humans; Immunoblotting; Middle Aged; Radioimmunoassay; Swine

Rigid gas permeable contact lens correction of aphakia following congenital cataract removal during infancy. - Amos, C F; Lambert, S R; Ward, M A (Journal of pediatric ophthalmology and strabismus, 1992)
Rigid gas permeable (RGP) contact lenses were prescribed and worn with little difficulty by 10 consecutive aphakic infants. Fluoroperm 92 lenses were used instead of silicone lenses (Bausch & Lomb) because of their lower cost, ease in handling, flexibility in design, and better neutralization of astigmatism. Lenses were worn on a daily wear basis (with occasional overnight wear) to reduce the risk of keratitis. Keratometry readings were taken at the time of surgery with the patient in a supine position. Trial lens fitting was performed 1 to 7 days later using a Burton Lamp. None of the patients developed keratitis, corneal neovascularization, or the sucked-on-lens syndrome. The lenses were well tolerated and the parents soon became adept at handling them. We now use RGP lenses as our lens of choice when treating aphakic infants.
Keywords: *Aphakia, Postcataract/th [Therapy]; *Cataract/cn [Congenital]; *Cataract Extraction; Child, Preschool; *Contact Lenses; Follow-Up Studies; Humans; Infant; Patient Satisfaction

A prospective multicenter clinical trial to assess safety and efficacy of Menicon SF-P RGP lenses for extended wear. - MacKeen, D L; Sachdev, M; Ballou, V; Cavanagh, H D (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1992)
A prospective, multicenter, national clinical trial was undertaken to assess the safety and efficacy of Menicon SF-P (melafocon A) rigid gas permeable (RGP) contact lenses for extended wear in healthy human eyes. Ten investigators enrolled 167 patients (334 eyes), of which 143 (286 eyes) were initially fit with lenses for the 12-month study. Most subjects were reexamined at 18 months or more, with findings essentially unchanged from those noted at 1 year. Two hundred-two eyes (71%) completed the study. Seventy-two eyes (25%) discontinued, and 12 (4%) elected to continue extended wear. During the study, no significant adverse clinical reaction attributable to the lens was observed. Surface irritation, occasional punctate staining, and lens binding were very rare. The average wearing time was 6.2 days, mandated partially by FDA restrictions as well as patient response. As expected, keratometric shifts were principally vertical: less than 0.99 D (69%), 1.00-1.99 D (28%), and 2.00-2.99 D (4%). The majority of changes observed were toward sphericity. Two hundred lens replacements were required, 24% for adjustments in power/base curve. Only 16 lenses were replaced for warpage, and none for discoloration or crazing. Of those completing the study, 76% rated overall lens comfort and satisfaction to be very good. These results suggest that RGP lens extended wear can be safe and effective and offer patients an acceptable alternative to extended wear of disposable hydrogel lenses.
Keywords: Adolescent; Adult; Aged; Child; Contact Lenses, Extended-Wear/ae [Adverse Effects]; *Contact Lenses, Extended-Wear; Corneal Ulcer/di [Diagnosis]; Corneal Ulcer/et [Etiology]; Female; Humans; Male; Middle Aged; Patient Satisfaction; Prospective Studies; Visual Acuity

[2 years self-tonometry. Acceptance and results]. - Deutsch, C; Draeger, J; Groenhoff, S (Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 1992)
For more than 2 years we have been trying out a microprocessor-controlled self-tonometer to determine its clinical usefulness. Most of the measurements were taken with two instruments (A and B). In vitro calibration series on human donor corneas gave good results over the whole pressure range. In a patient series both instruments were compared with the established hand-held applanation tonometer put out by Draeger (HAT). Each self-tonometer was applied three times, followed by a controlling measurement with the HAT. The correlation coefficient between instrument A and HAT was 0.85 with a standard deviation of +/- 1.9126 mmHg. Instrument B showed a better correlation (r = 0.904), the standard deviation was similar to tonometer A (SD = +/- 1.8598 mmHg). Most of the values obtained by the self-tonometers-about 50%-deviated from the corresponding HAT values by +/- 1 mmHg. The new measurement principle was accepted by 75% of all patients. Improvements in the details are planned in order to simplify tonometer handling and increase the accuracy and precision of the measurements.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; Female; Follow-Up Studies; *Glaucoma/di [Diagnosis]; Glaucoma/pp [Physiopathology]; Humans; *Intraocular Pressure/ph [Physiology]; Male; Middle Aged; Patient Acceptance of Health Care; *Self Care/is [Instrumentation]; *Signal Processing, Computer-Assisted/is [Instrumentation]; *Tonometry, Ocular/is [Instrumentation]

Risks of keratitis and patterns of use with disposable contact lenses. - Matthews, T D; Frazer, D G; Minassian, D C; Radford, C F; Dart, J K (Archives of ophthalmology (Chicago, Ill. : 1960), 1992)
Disposable soft contact lenses have been marketed as a safer alternative to conventional soft lenses. We undertook a case-control study of patients attending the casualty unit of an eye hospital to quantify the relative risk of keratitis in disposable lens wear and to establish associated patterns of use. All eligible contact lens users were identified and asked to complete a questionnaire (n=242). Keratitis, microbial or sterile, was the most common complication in disposable lens users, occurring in 16 of 41 subjects. The relative risks for all lens types were estimated by comparison with rigid lenses (the referent). Both extended- and daily-wear disposable lenses were associated with higher risks of keratitis than other lens types including conventional extended-wear lenses. Poor hygiene, disinfectant system failure, and lens type may all account for these statistically significant trends.
Keywords: Acanthamoeba Keratitis/et [Etiology]; Adolescent; Adult; Aged; Case-Control Studies; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Corneal Ulcer/et [Etiology]; Corneal Ulcer/mi [Microbiology]; Corneal Ulcer/ps [Parasitology]; *Disposable Equipment; Eye Infections, Bacterial/et [Etiology]; Female; Humans; Male; Middle Aged; Patient Compliance; Pseudomonas Infections/et [Etiology]; Risk Factors; Surveys and Questionnaires

Community care of corneal ulcers. - McDonnell, P J; Nobe, J; Gauderman, W J; Lee, P; Aiello, A; Trousdale, M (American journal of ophthalmology, 1992)
Because of increasing concern about the appropriate and cost-effective use of eye care services and procedures, several organizations have sought to arrive at practice guidelines or practice patterns from which physicians can draw guidance. To assess the potential effectiveness of such guidelines, we reviewed the care of patients with corneal ulcers. Corneal specialists recommend that cultures be obtained before initiation of treatment. We determined whether ophthalmologists implemented these guidelines by the following: (1) a review of records of 79 patients referred to a tertiary care corneal and external disease service for evaluation of keratitis, and (2) a survey by mail of practicing ophthalmologists. Antibiotic therapy without any cultures was observed in 38 of 79 referred patients with corneal ulcers (48.1%). Our survey of general ophthalmologists disclosed that 274 of 560 patients with corneal ulcers (48.7%) were treated with antibiotics without any cultures being obtained. Compliance with recommended practice in the care of corneal ulcers is poor, as measured with either method. This procedure provides insights into more effective implementation of future practice guidelines.
Comment in (CIN), Comment in (CIN)
Keywords: Anti-Bacterial Agents/tu [Therapeutic Use]; Bacteriological Techniques/st [Standards]; *Corneal Ulcer/dt [Drug Therapy]; Corneal Ulcer/mi [Microbiology]; Eye Infections, Bacterial/dt [Drug Therapy]; Humans; *Ophthalmology/st [Standards]; Ophthalmology/sn [Statistics & Numerical Data]; Practice Guidelines as Topic; *Practice Patterns, Physicians'/st [Standards]; Practice Patterns, Physicians'/sn [Statistics & Numerical Data]; Surveys and Questionnaires

Self-tonometry: technical aspects of calibration and clinical application. - Groenhoff, S; Draeger, J; Deutsch, C; Wiezorrek, R; Hock, B (International ophthalmology, 1992)
Self-tonometry could be established as an important diagnostic tool in the early diagnosis and follow-up of glaucoma provided that a self-tonometer is precise, safe and easy to use. Furthermore, it has to comply with the legal standards for tonometer calibration. A new software-controlled detection system for the self-tonometer permits the evaluation of external factors during the measurement which influence the precision of the tonometric readings. The updated version of the self-tonometer (ST) was compared to the Draeger hand-held applanation tonometer (HAT) in a clinical study with 82 patients (151 eyes). The results show a regression line characterized by a slope of 0.99, an y interception of 1.41, a correlation coefficient of 0.96 and a standard deviation for the ST readings of +/- 1.78 mmHg. Self-tonometry improves the IOP monitoring as well as patient compliance and therefore is a potential diagnostic tool in the management of glaucoma.
Keywords: Calibration; False Positive Reactions; *Glaucoma/di [Diagnosis]; Humans; Intraocular Pressure; Predictive Value of Tests; Reproducibility of Results; *Self Care; *Tonometry, Ocular/is [Instrumentation]

The current management of herpetic eye disease. - Collum, L M; Power, W J; Collum, A (Documenta ophthalmologica. Advances in ophthalmology, 1992)
Herpes simplex disciform keratitis is a difficult condition. The general feeling is that it is an immune disease, mediated by the virus, possibly located in the endothelial cells. It is frequently combined with inflammation in the trabecular meshwork and with uveitis. There is some controversy in relation to treatment and it has been suggested that anti-virals will control herpetic disciform keratitis, particularly if the patient has never had steroids previously. The authors of this paper have, in the past, published data which showed that Acyclovir, with corticosteroid, was necessary in the management of disciform keratitis. The data suggested that Acyclovir on its own was not effective. It remained to be answered whether Acyclovir on its own would be effective in patients who never had steroids for any reason previously. This paper demonstrates clearly that it is necessary, irrespective of whether patients have had steroids in the past or not, to combine corticosteroids with Acyclovir in the management of herpetic disciform keratitis. Acyclovir, on its own, is shown to be ineffective. It has also been suggested that Acyclovir is non-toxic. In a general way this is true, but the authors suggest that Acyclovir ointment does produce a punctate keratitis in patients with tear film disease, and that oral Acyclovir is preferable in such patients.
Keywords: *Acyclovir/tu [Therapeutic Use]; *Betamethasone/tu [Therapeutic Use]; Double-Blind Method; Humans; *Keratitis, Herpetic/dt [Drug Therapy]; Ointments; Patient Compliance; Placebos

Pseudomembranous and membranous conjunctivitis. Immunohistochemical features. - Kivela, T; Tervo, K; Ravila, E; Tarkkanen, A; Virtanen, I; Tervo, T (Acta ophthalmologica, 1992)
A 63-year-old man, who had for one month been on sulfasalazine therapy, developed general malaise, high fever, severe stomatitis, and bilateral necrotizing pseudomembranous conjunctivitis with corneal erosion, identical to that seen in the Stevens-Johnson syndrome. Topical therapy with antibiotics and aprotinin rapidly healed the corneal surfaces, while densely adherent true membranes developed on the conjunctiva, and were removed surgically several times during the next week. After the acute stage, subtle subepithelial conjunctival scarring, superficial punctate keratitis, dry eye syndrome and fluctuating irregular corneal astigmatism became evident, but good visual acuity, lid function and ocular motility were retained. Histopathologic study of conjunctival membranes from two cases of membranous conjunctivitis revealed polymorphonuclear leukocytes within a matrix composed of fibrin, tenascin and fibronectin. In older membranes, histiocytes were additionally found. Surgical debridement of such membranes removes a substratum of inflammatory debris that is likely to promote secondary infection, fibrosis and symblepharon formation, and may decrease rather than increase subsequent scarring of the necrotized conjunctiva.
Keywords: Adult; Cell Adhesion Molecules, Neuronal/me [Metabolism]; Conjunctivitis/me [Metabolism]; *Conjunctivitis/pa [Pathology]; Extracellular Matrix Proteins/me [Metabolism]; Female; Fibronectins/me [Metabolism]; Humans; Male; Middle Aged; Neutrophils/me [Metabolism]; Stevens-Johnson Syndrome/me [Metabolism]; *Stevens-Johnson Syndrome/pa [Pathology]; Tenascin; Vimentin/me [Metabolism]

The collagen shield as a collagenase inhibitor and clinical indicator of collagenase activity on the ocular surface. - Schiff, W M; Speaker, M G; McCormick, S A (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1992)
Collagen shields applied to the corneas of patients with bacterial keratitis degrade rapidly, often within a few hours. Once treatment brings the infection under control, subsequently applied collagen shields degrade more slowly. In vitro models were established to evaluate the significance of these observations. Twenty-four and 72-hour collagen shields were incubated with collagenase from Clostridium histolyticum. The in vitro rate of digestion of the shields was directly proportional to the concentration of collagenase, with the rate of digestion of the 24-hour shields being greater than that of the 72-hour shields. Therefore, the rate of collagen shield degradation may be a clinically useful index of collagenase activity on the ocular surface. Ultrastructural studies of collagen shields from patients with acute bacterial keratitis revealed irregular degradation of shield matrix with no evidence of adherence of microorganisms or inflammatory cells. Co-incubation of deepithelialized rabbit corneas and collagen shields resulted in inhibition of the digestion of the rabbit corneas when the weight:weight ratio of collagen shield:rabbit cornea was increased to greater than or equal to 2:1. Collagen shields may inhibit corneal collagen degradation in infectious ulceration and melting disorders by effectively competing for collagenase on the ocular surface.
Keywords: Animals; Biological Dressings; *Collagen/pd [Pharmacology]; Collagen/tu [Therapeutic Use]; Collagen/ul [Ultrastructure]; *Cornea/en [Enzymology]; Corneal Ulcer/mi [Microbiology]; Corneal Ulcer/th [Therapy]; Humans; *Microbial Collagenase/ai [Antagonists & Inhibitors]; Microbial Collagenase/me [Metabolism]; Rabbits

[Trabeculoretraction by argon laser. 5 and 8-year results]. - Moulin, F; Ameline, B; Redor, Y; Bey Boumerzag, A; Haut, J (Journal francais d'ophtalmologie, 1992)
To appreciate the current place of argon laser trabeculoplasty (ALT) in the therapeutic armamentarium of primary open-angle glaucoma (POAG), the first 211 photocoagulated phakic eyes were analysed. One hundred and fifty-nine eyes had a 5 year-follow-up and 147 eyes had a minimal 8 year-follow-up. These eyes came from an initial group of 151 patients: 76 women and 75 men with a mean age of 66 years. We decided, arbitrarily, to assess trabeculoplasty results according to three combined criteria of failure (insufficient or transient intraocular pressure drop (3 mmHg), progression in visual field loss and need for a filtrating surgery) and to various expected goals: prevent an increase of drugs with their subsequent side effects, taper a non tolerated medical treatment and, lastly, try to cease all medical treatment in non compliant patients. According to these criteria, during the first five years, the cumulative failure rate in the 159 eyes rose steadily from 19% (31 eyes) in the first year to 52% (82 eyes) in the fifth year. The initial mean intraocular pressure (27.22 mmHg) of 7 failures operated on during the first 2 months and that of all 27 operated on failures (24.41 mmHg) was higher than the initial mean intraocular pressure of the 77 successful cases (22.67 mmHg). In the 77 eyes still controlled at 5 years, the intraocular pressure drop was 6.57 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
Keywords: Adult; Aged; Aged, 80 and over; Argon; Female; Follow-Up Studies; Humans; Laser Therapy/ae [Adverse Effects]; *Laser Therapy; Male; Middle Aged; Trabeculectomy/ae [Adverse Effects]; *Trabeculectomy

Corneal response to different oxygen levels during extended wear. - Rivera, R K; Polse, K A (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1991)
In this study we explored the relationship between hypoxic exposure level and corneal response by assuming that the partial pressure of oxygen (PO2) under a contact lens during eye closure is directly related to oxygen transmissibility (Dk/L). To study this relationship, we monitored a group of subjects who wore RGP lenses of various Dk/L values on an extended wear basis. The results revealed that as Dk/L increases, there is a substantial decrease in overnight corneal edema and epithelial microcysts. However, other responses seemingly related to purely mechanical properties (e.g., lens adherence, corneal topographical changes, and 3-9 limbal superficial punctate keratitis) appear to be independent of Dk/L. Results also suggest that sufficient PO2 levels under a contact lens can minimize endothelial morphological changes associated with hypoxia. We conclude that metabolically driven complications accompanying RGP extended wear can be substantially eliminated with lenses having Dk/L values of 80 x 10(-9) (cm x mL O2)/(sec x mL x mm Hg) or greater.
Keywords: Adult; *Contact Lenses, Extended-Wear; *Cornea/me [Metabolism]; Cornea/pa [Pathology]; Corneal Edema/et [Etiology]; Cysts/et [Etiology]; Endothelium, Corneal/pa [Pathology]; Humans; Keratitis/et [Etiology]; Middle Aged; *Oxygen Consumption

Efficiency of referral for suspected glaucoma. - Tuck, M W; Crick, R P (BMJ (Clinical research ed.), 1991)
OBJECTIVE: To examine the efficiency of referral for suspected glaucoma to general practitioners and consultants by optometrists., DESIGN: A prospective survey covering 5% of all sight tests performed by optometrists in England and Wales over six months, with analysis of referred patients., SETTING: 241 optometrists' practices in areas representative of England and Wales in socioeconomic terms., SUBJECTS: Of 275,600 people attending for a sight test, 1505 were referred with suspected glaucoma (0.9% of those aged over 4%). Outcomes were recorded for 1228 patients, 1103 (90%) of whom attended for examination by a consultant ophthalmologist (8% on a private basis). The analysis was confined to the 704 cases in which the information on diagnosis was received directly from a consultant or general practitioner., MAIN OUTCOME MEASURES: Diagnoses reported by consultant ophthalmologists. Waiting times before an appointment for examination by a consultant ophthalmologist., RESULTS: Glaucoma was confirmed in 283 of the 704 referred patients, and another 222 patients were considered to require further monitoring. In all, 112 (41%) of 275 confirmed cases of glaucoma were in patients with intraocular pressures greater than or equal to 30 mm Hg. At all levels of intraocular pressure the accuracy of referral was greater when the optometrist also recorded the presence of suspicious optic discs or loss of visual field, or both; but only 331 (47%) out of the 704 referred patients had been tested with a field screener. The median waiting time for an NHS clinic appointment was nine weeks. Almost a 10th of confirmed cases of glaucoma were in people in a high risk category for glaucoma who had to wait at least 14 weeks for an appointment., CONCLUSIONS: Closer cooperation, especially at the local level, among consultants, general practitioners, and optometrists is needed to improve testing and referral for suspected glaucoma. Optometrists should be encouraged to perform all the three main tests--ophthalmoscopy, tonometry, and perimetry--in patients before referral and to report precisely on reasons for referral to help prioritisation. The optometrist's referral letter to the general practitioner should always be passed on to the consultant. Similarly, the diagnosis should always be reported back to the optometrist.
Comment in (CIN), Comment in (CIN)
Keywords: Aged; *Clinical Competence; England; Family Practice; *Glaucoma/di [Diagnosis]; Humans; Middle Aged; Ophthalmology; *Optometry/mt [Methods]; Optometry/st [Standards]; Prospective Studies; *Referral and Consultation/sn [Statistics & Numerical Data]; Time Factors; Waiting Lists; Wales

Automated perimetry in glaucoma. - Caprioli, J (American journal of ophthalmology, 1991)
Keywords: Automation; Differential Threshold; *Glaucoma/di [Diagnosis]; Humans; Patient Compliance; Psychophysics/mt [Methods]; Pupil; Sensory Thresholds; Vision Tests; *Visual Field Tests; Visual Fields

Effectiveness of the C Cap in promoting prescription refill compliance among patients with glaucoma. - Sclar, D A; Skaer, T L; Chin, A; Okamoto, M P; Nakahiro, R K; Gill, M A (Clinical therapeutics, 1991)
In an attempt to increase patient compliance with a dosing regimen, prescriptions for topical solutions of glaucoma medication were refilled using the C Cap, a memory aid designed to help patients to remember to instill the medication as prescribed. A comparison of the number of prescription refills requested by 121 patients with glaucoma showed that patients who received the C Cap requested significantly more refills in the six months after receiving the C Cap than before and requested significantly more refills than did patients who did not receive the C Cap.
Keywords: Aged; Drug Administration Schedule; *Drug Packaging; Drug Prescriptions; Epinephrine/aa [Analogs & Derivatives]; Epinephrine/tu [Therapeutic Use]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Levobunolol/tu [Therapeutic Use]; Male; Middle Aged; *Patient Compliance; Timolol/tu [Therapeutic Use]

Health fair glaucoma screening: follow-up evaluation. - Skorin, L Jr; Multack, R F; Holtzman, J N (The Journal of the American Osteopathic Association, 1991)
Glaucoma screening is a standard procedure at many health fairs. Information on correct screening techniques, instrumentation, and target populations has been available. However, a scarcity of information exists concerning the success of efforts to follow up on abnormal results. This study reports on the findings of a long-term (6-month) follow-up of all individuals with abnormal tonometric results screened at an inner-city osteopathic hospital. Of the 218 subjects screened, 15 were found to have abnormal tonometric results. Seven of the 15 subjects were actually reached at the 6-month follow-up interval. Four of the seven had not sought any further eye care; two had sought nonmedical evaluation; only one had sought medical ocular care, and that subject was later found to have glaucoma. The results presented in this article indicate that compliance by this population is inadequate. Inner-city participants require more education. We encourage physicians to promptly refer such patients for appropriate medical ocular care.
Keywords: Adolescent; Adult; Aged; Female; Follow-Up Studies; *Glaucoma/pc [Prevention & Control]; *Health Fairs; Humans; Male; *Mass Screening; Middle Aged; *Patient Compliance; Tonometry, Ocular; United States; Urban Population

Adherence of Pseudomonas aeruginosa to rigid gas-permeable contact lenses. - Miller, M J; Wilson, L A; Ahearn, D G (Archives of ophthalmology (Chicago, Ill. : 1960), 1991)
We examined the adherence of a human corneal isolate of Pseudomonas aeruginosa to unused rigid gas-permeable and hydrogel contact lenses. Adherence to rigid gas-permeable lenses was greater than the adherence to hydrogels. The lower incidence of microbial keratitis associated with rigid gas-permeable lenses, as compared with hydrogel lenses, may be attributed to the more rigorous cleaning and disinfection possible for rigid gas-permeable lenses and/or patient noncompliance with complicated disinfection systems used with hydrogel lenses.
Keywords: *Bacterial Adhesion; Colony Count, Microbial; *Contact Lenses; *Pseudomonas aeruginosa/ph [Physiology]

Myopic photorefractive keratectomy with the excimer laser. One-year follow-up. - Seiler, T; Wollensak, J (Ophthalmology, 1991)
To evaluate the efficacy, predictability, and stability of myopic photorefractive keratectomy (PRK), the authors completed a 1-year follow-up study on a consecutive series of 26 sighted eyes undergoing this procedure. The results of this follow-up are presented. In addition, side effects and complications in another 255 sighted eyes with a follow-up of 3 months to 1 year are reported to judge the safety of the procedure. Twenty-four of 26 eyes (92%) were within +/- 1.0 diopter (D) of the intended final refraction (baseline, -1.4 to -9.25 D). Fifty-eight percent of the eyes were stable within +/- 0.25 D between 6 and 12 months. One year after surgery, none of the patients lost or gained more than one line of best corrected (spectacle) visual acuity. Uncorrected visual acuity improved to 20/40 or better in 96% of the eyes and to 20/20 or better in 48% of the eyes (not including the eyes that were intentionally undercorrected). However, visual acuity with glare decreased from 20/27 preoperatively to 20/31 after 1 year. Scarring occurred in 2.8% of the treated corneas. Risk factors for scarring include noncompliance with postoperative steroid medication, high myopic corrections, and high steroid responders (3.1%). Collagen vascular and other autoimmune diseases are a contraindication for PRK.
Keywords: Adult; *Cornea/su [Surgery]; Female; Follow-Up Studies; Glaucoma/ci [Chemically Induced]; Humans; Intraocular Pressure/de [Drug Effects]; *Laser Therapy; Male; Middle Aged; *Myopia/su [Surgery]; Postoperative Complications; Refraction, Ocular; Steroids/ae [Adverse Effects]; Vision Disorders/et [Etiology]; Visual Acuity

The effect of a glaucoma medication reminder cap on patient compliance and intraocular pressure. - Chang, J S Jr; Lee, D A; Petursson, G; Spaeth, G; Zimmerman, T J; Hoskins, H D; Mills, R; Brown, R; Kass, M; Lue, J (Journal of ocular pharmacology, 1991)
A multi-site, open-labeled clinical trial was conducted to evaluate the ease of use and acceptance of a newly developed medication cap with a memory aid (C Cap Compliance Cap, Allergan, Inc.) and its effect on patient compliance and intraocular pressure. One-hundred-twenty-two patients with glaucoma or ocular hypertension received their prescribed eye drops in bottles with the compliance cap. Overall, 83% of the patients found the compliance cap very easy to use. By the end of the study, significantly more patients (67%) claimed 100% compliance than prior to using the compliance cap (41%). An overall drop in intraocular pressure of 0.8 mm Hg was seen. However, in a subset of patients who reported an increase in compliance, mean intraocular pressure decreased from baseline by 1.7 mm Hg. The results of this study suggest that the compliance cap helps patients with glaucoma or ocular hypertension remember to take their medication as prescribed.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Drug Labeling/mt [Methods]; Epinephrine/ad [Administration & Dosage]; Epinephrine/aa [Analogs & Derivatives]; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; *Patient Compliance; Patient Satisfaction; Pilocarpine/ad [Administration & Dosage]; Prospective Studies; *Reminder Systems; Surveys and Questionnaires

Alterations in elastin of the optic nerve head in human and experimental glaucoma. - Quigley, H A; Brown, A; Dorman-Pease, M E (The British journal of ophthalmology, 1991)
The optic nerve heads from normal and glaucomatous eyes of humans and monkeys were examined by light and electron microscopy for the presence and distribution of elastin. Elastin densely lined the insertion of the lamina cribrosa into the sclera and was prominent in the laminar beams. The long axis of elastin paralleled that of the collagen fibrils and corresponded to the directions of expected forces on the tissue. In glaucomatous eyes elastin molecules were curled instead of straight and seemed disconnected from the other elements of the connective tissue matrix. Laminar beams stretch and reorganise their substructure during glaucomatous atrophy, probably leading to changed compliance. Differences in elastin function may have a part in susceptibility to glaucomatous injury.
Keywords: Aged; Animals; Collagen/an [Analysis]; Collagen/ul [Ultrastructure]; Elastin/an [Analysis]; *Elastin/ul [Ultrastructure]; Female; *Glaucoma/pa [Pathology]; Histocytochemistry; Humans; Macaca fascicularis; Male; Microscopy, Electron; Optic Disk/ch [Chemistry]; *Optic Disk/ul [Ultrastructure]

Noncontact tonometry in children. - Buscemi, M; Capoferri, C; Garavaglia, A; Nassivera, C; Nucci, P (Optometry and vision science : official publication of the American Academy of Optometry, 1991)
A hand-held noncontact tonometer (Pulsair, Keeler Ltd., UK) was tested in 42 children, from 5 months to 12 years of age. At least 1 intraocular pressure (IOP) reading was obtained in all of the 84 eyes studied, whereas with a Goldman applanation tonometer measurements could be obtained in only 26 eyes (14 subjects). Time required for examination with the Pulsair was quite variable and related to age (p less than 0.0001). Compliance in children was reported as "good" in the majority of cases; it was also age-related (p less than 0.005). Although its reliability could not be definitely evaluated, the results of this study indicate that this instrument may be a valuable choice for screening and follow-up purposes in childhood.
Keywords: Child; Child, Preschool; Female; Glaucoma/di [Diagnosis]; Humans; Infant; *Intraocular Pressure; Male; Patient Compliance; *Tonometry, Ocular/is [Instrumentation]; Vision Tests/is [Instrumentation]

In vitro penetration of human corneal epithelium by Acanthamoeba castellanii: a scanning and transmission electron microscopy study. - Moore, M B; Ubelaker, J E; Martin, J H; Silvany, R; Dougherty, J M; Meyer, D R; McCulley, J P (Cornea, 1991)
Human corneal buttons were exposed to Acanthamoeba castellanii trophozoites and cysts for 12 hours at 35 degrees C. The buttons examined by light microscopy and scanning and transmission electron microscopy had severe epithelial ulceration and penetration by trophozoites. Observations on trophozoites below the surface suggest that penetration is accomplished by both secreted cytolytic enzymes and phagocytosis. It is likely that the secretion of one or more enzymes constitutes the initial step in preparing the host tissue for endocytosis or that the secretory mechanism is used by the amebas to move through the outer squamous layer to the basement epithelium where phagocytosis occurs. Based on this study and a previous study, it appears that entry into the cornea is a two-step process involving adherence and penetration by trophozoites.
Keywords: *Acanthamoeba/ul [Ultrastructure]; Acanthamoeba Keratitis/ps [Parasitology]; *Acanthamoeba Keratitis/pa [Pathology]; Animals; *Cornea/ps [Parasitology]; Cornea/ul [Ultrastructure]; Epithelium/ps [Parasitology]; Epithelium/ul [Ultrastructure]; Humans; Microscopy, Electron, Scanning

Topical beta blockers and serum lipoproteins. - Joyce, P W; Raj, P S (The British journal of ophthalmology, 1991)
Comment on (CON)
Keywords: Administration, Topical; Adult; Aged; Glaucoma/bl [Blood]; *Glaucoma/dt [Drug Therapy]; Humans; *Lipoproteins/bl [Blood]; Patient Compliance; *Timolol/tu [Therapeutic Use]

Efficiency of referral for suspected glaucoma. - Bruce, D W (BMJ (Clinical research ed.), 1991)
Comment on (CON)
Keywords: Aged; Efficiency; *Glaucoma/di [Diagnosis]; Humans; Patient Acceptance of Health Care; Referral and Consultation

Patient drug schedules and compliance. - Fingeret, M; Schuettenberg, S P (Journal of the American Optometric Association, 1991)
Open-angle glaucoma is a chronic disease usually requiring a patient to take medications for the rest of his or her life. Because of the expense and side effects of the medications and due to a lack of understanding of the condition, many patients do not take their medications properly, often leading to progressive damage. A written instruction sheet completed for each patient covering their medication dosage schedule is an aid that may subtly remind individuals to use their medications, reducing the problems associated with noncompliance.
Keywords: Drug Administration Schedule; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Patient Compliance; Sympatholytics/tu [Therapeutic Use]

Diagnosis and management of primary open-angle glaucoma. - Alexander, L J (Optometry clinics : the official publication of the Prentice Society, 1991)
Primary open-angle glaucoma offers a significant diagnostic and management challenge for primary care providers. Uncertainty clouds the definition of the disease, its prevalence, the sensitivity and accuracy of the clinical tests used for its diagnosis, the efficacy of antiglaucoma medications, the compliance of patients with these drug regimens, the appropriate use of follow-up examinations, and the use of surgical techniques in lieu of medical management. This discussion addresses these many vexing issues for the purpose of assisting primary care providers to better diagnose and manage glaucoma patients.
Keywords: Fundus Oculi; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/et [Etiology]; Humans; Optic Atrophy/pa [Pathology]; Optic Disk/pa [Pathology]; Optometry; United States/ep [Epidemiology]; Visual Field Tests; Visual Fields

Liability for extended-wear contact lenses. - Classe, J G (Optometry clinics : the official publication of the Prentice Society, 1991)
Because of the risk of serious complication that accompanies the extended wear of contact lenses, clinical management should emphasize adequate communication with the patient and a systematic program of examination and follow-up. Management should be in compliance with informed consent requirements, which obligate practitioners to document instructions, findings, warnings, and recall examinations. The most likely legal claim is one of negligence, and the most common causes of liability are inappropriate patient selection, improper wearing schedules, improper management of contact lens-related complications (especially corneal abrasions), and inadequate monitoring of ocular health. In determining the liability of optometrists, a medical standard of care may be applied.
Keywords: *Contact Lenses, Extended-Wear/ae [Adverse Effects]; Corneal Ulcer/et [Etiology]; Disposable Equipment; Humans; Liability, Legal; *Malpractice; *Optometry/lj [Legislation & Jurisprudence]; Patient Compliance; Risk Factors

Ceasing of epithelisation and deposit formation of unknown origin on the cornea. - Szeghy, G (Acta physiologica Hungarica, 1991)
The author presents a so far unknown pathological process interrupting permanently the regeneration of the superficially damaged cornea, and its consequences and therapy of the condition as well. The process occurs only in 5.6% of the injured individuals. The occurrence is in no correlation with the quality or extent of the damage. Also it is independent of the form and duration of therapy. The essence of the pathological changes is the slowing of corneal epithelisation within 2-4 days, followed by a complete cessation. After that a thin membrane-like layer develops simultaneously and evenly within 12 days on the area without epithelium, the surface of which is dull, transparent and whitish in colour. Within weeks or months an individually varying thickening of the membrane occurs, but the area does not grow. The surface becomes whitish-grey and is without any epithelium and with no adherence to tear. The deposits are closely and inseparably adherent to their base, their substance is rigid, being brittle only at the margins. The lesion is staining greenish-yellow with Na-fluorescein, and lively blue with toluidine blue. It is staining in small reddish-brown with rose bengal. In vivo the deposits are not measurably influenced by hyaluronidase, trypsin, alpha-chymotrypsin and papain. The microbes play no role in the process. Histological and electron-microscopical examinations suggest the corneal deposit are the product of the necrobiotic process occurring on the corneal surface during regeneration. The specific treatment consists of local application of corticoid-heparin. On the basis of the results of the examinations and literary data the author suggests that the corneal deposition and the similarly rare KCV (keratoconjunctivitis vernalis) plaque formation is the same specific process, i.e. the peculiar manifestation of the atopic state of the organism occurring independently of age.
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Child; *Cornea/pa [Pathology]; *Corneal Diseases/pa [Pathology]; Epithelium/pa [Pathology]; Female; Fluorescent Dyes; Humans; Keratitis, Herpetic/pa [Pathology]; Male; Microscopy; Middle Aged; Staining and Labeling

Intercellular adhesion molecule-1 in human corneal endothelium. Modulation and function. - Elner, V M; Elner, S G; Pavilack, M A; Todd, R F 3rd; Yue, B Y; Huber, A R (The American journal of pathology, 1991)
The endothelium lining the posterior corneal surface performs physiologic pump functions essential to corneal clarity and integrity. A hallmark of keratitis, anterior ocular inflammation, and corneal allograft rejection is leukocyte adherence to the corneal endothelium (CE) forming keratitic precipitates. To elucidate mechanisms governing cornea-leukocyte interactions, cultured human CE cells and intact corneas were examined for expression of intercellular adhesion molecule-1 (ICAM-1), which binds the lymphocyte function-associated antigen-1 (LFA-1) on all leukocytes and enhances delayed-type hypersensitivity mediated by class II major histocompatibility complex antigens. Immunohistochemistry on culture CE cells using monoclonal anti-ICAM-1 antibody yield positive staining that increased after exposure to interleukin-1-beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (gamma-IFN). Standard leukocyte adherence assays demonstrated ICAM-1-mediated CE-neutrophil binding, which was specifically blocked by antibody to ICAM-1 or antibodies to LFA-1 on neutrophils. In whole human corneas, gamma-IFN increased CE and stromal keratocyte ICAM-1 immunoreactivity and enhanced CE-neutrophil adherence. As in CE cell cultures, antibody to ICAM-1 effectively blocked neutrophil binding to the CE cells of whole corneas. These results are the first to demonstrate ICAM-1 in ocular tissue. They indicate that CE cells express functional ICAM-1, which may be modulated by inflammatory cytokines, ICAM-1 provides mechanisms for keratitic precipitate formation, regulation of corneal leukocyte trafficking and the generation of immune responses that may be crucial to allograft rejection.
Keywords: *Cell Adhesion Molecules/me [Metabolism]; Child, Preschool; Endothelium, Corneal/cy [Cytology]; *Endothelium, Corneal/me [Metabolism]; Humans; Immunohistochemistry/mt [Methods]; Intercellular Adhesion Molecule-1; Interleukin-1/pd [Pharmacology]; Neutrophils/me [Metabolism]; Staining and Labeling; Tumor Necrosis Factor-alpha/pd [Pharmacology]

Recruitment of patients to a glaucoma drug trial in a district general hospital. - Sunderraj, P; Peiris, C S (Eye (London, England), 1991)
We report the difficulties experienced in identifying and recruiting 21 patients with ocular hypertension or primary open-angle glaucoma to participate in a clinical trial of two topical beta-blockers. The case-notes of 374 consecutive patients expected to attend routine glaucoma clinics were reviewed to recruit 21 eligible patients who were willing to undergo the drug trial. Recruitment of patients to prospective drug trials may be complicated by a high proportion of exclusions due to ineligibility and also by refusal of otherwise eligible patients.
Keywords: *Adrenergic beta-Antagonists/tu [Therapeutic Use]; *Clinical Trials as Topic; *Glaucoma, Open-Angle/dt [Drug Therapy]; Hospitals, District; Hospitals, General; Humans; Informed Consent; Medical Records; Ocular Hypertension/dt [Drug Therapy]; Patient Compliance; *Patients; Prospective Studies; United Kingdom

Contact lenses and keratitis. - Guillon, M; Benjamin, W J (Lancet (London, England), 1991)
Comment on (CON)
Keywords: *Contact Lenses/ae [Adverse Effects]; *Corneal Ulcer/mi [Microbiology]; Humans; Patient Compliance; Risk Factors

Combination therapy. - Brown, R H (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1991)
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Drug Therapy, Combination; Epinephrine/aa [Analogs & Derivatives]; Epinephrine/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance

Beta blockers. - Katz, L J (The CLAO journal : official publication of the Contact Lens Association of Ophthalmologists, Inc, 1991)
Keywords: Adrenergic beta-Antagonists/ae [Adverse Effects]; *Adrenergic beta-Antagonists/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Patient Compliance

The Glaucoma Laser Trial (GLT): 3. Design and methods. Glaucoma Laser Trial Research Group. - Anonymous (Controlled clinical trials, 1991)
The Glaucoma Laser Trial (GLT) was an investigator-initiated, grant-supported, multicenter, randomized, controlled clinical trial designed to investigate the efficacy and safety of argon laser trabeculoplasty (ALT) as an alternative to medical treatment for newly diagnosed primary open-angle glaucoma (POAG). One eye of each patient was randomly assigned to ALT followed by medical treatment if needed to control intraocular pressure (IOP). The patient's other eye was assigned to medical treatment. Medical treatment for either eye was prescribed according to a stepped sequence. Patients were followed for a minimum of 2 years. Monitoring for control of IOP and for adherence to the protocol continued throughout the followup period. This article describes the design and methods of the trial and provides a discussion of the underlying rationale for key design decisions.
Keywords: Double-Blind Method; Female; *Glaucoma, Open-Angle/su [Surgery]; Humans; Intraocular Pressure; *Laser Therapy; Male; *Multicenter Studies as Topic/mt [Methods]; *Randomized Controlled Trials as Topic/mt [Methods]; *Trabeculectomy

Maintaining a healthy eye. - Rakow, P L (Journal of ophthalmic nursing & technology, 1990)
Keywords: Acanthamoeba Keratitis/pc [Prevention & Control]; Conjunctivitis, Allergic/pc [Prevention & Control]; Contact Lenses/ae [Adverse Effects]; *Contact Lenses; Humans; *Patient Compliance

Prevalence of undiagnosed eye disease in high-risk diabetic individuals. - Sprafka, J M; Fritsche, T L; Baker, R; Kurth, D; Whipple, D (Archives of internal medicine, 1990)
A total of 533 diabetic individuals using the Marshall, Minn, medical care system were identified as potential subjects for a study of unrecognized eye disease. Of these, 172 (32%) stated they had never had an ophthalmologic eye examination and subsequently were defined as being at high risk for unrecognized diabetic eye disease. Ophthalmic examination was performed on 145 (84%) of these high-risk individuals and revealed that 61% had clinical characteristics consistent with diabetic retinopathy, glaucoma, cataract, or other eye abnormalities. Twenty-five (17%) of these subjects presented with eye disease that required immediate treatment, referral, or accelerated follow-up. Of those indicating they had an ophthalmologist, approximately 35% reported a time since last visit of 2 years or greater. These findings indicate a high prevalence of ocular morbidity among diabetic individuals who are not under routine ophthalmic surveillance and suggest that improvements in patient and professional compliance with recommended guidelines for eye care are warranted.
Keywords: Adult; *Cataract/ep [Epidemiology]; Diabetes Mellitus, Type 1/co [Complications]; Diabetes Mellitus, Type 2/co [Complications]; *Diabetic Retinopathy/ep [Epidemiology]; Female; Follow-Up Studies; *Glaucoma/ep [Epidemiology]; Humans; Male; Middle Aged; Minnesota/ep [Epidemiology]; Prevalence; Risk Factors

Chronic glaucoma in northern Ghana--a retrospective study of 397 patients. - Verrey, J D; Foster, A; Wormald, R; Akuamoa, C (Eye (London, England), 1990)
A retrospective study of 397 patients with chronic glaucoma in North-East Ghana seen in 1986/87 showed 71% of the patients to be male and 26% to be aged under 40 years. Fifty two per cent of eyes were already blind (V/A less than 3/60) at presentation. Blindness was associated with younger age at presentation, and greater distance of residence from the hospital. Only 19% of patients undergoing treatment were attending for follow-up at six months. Of those patients treated medically who returned for follow-up at six months only 17% had an intraocular pressure less than 22 mmHg. While of the patients treated surgically 84% of those seen at six months had an IOP below 22 mmHg.
Keywords: Adolescent; Adult; Age Factors; Aged; Blindness/et [Etiology]; Chronic Disease; Female; Ghana/ep [Epidemiology]; Glaucoma/co [Complications]; *Glaucoma/ep [Epidemiology]; Glaucoma/th [Therapy]; Health Services Accessibility; Humans; Male; Middle Aged; Patient Compliance; Retrospective Studies; Risk Factors; Trabeculectomy; Visual Acuity

Acanthamoeba adherence to contact lenses and removal by cleaning agents. - Kilvington, S; Larkin, D F (Eye (London, England), 1990)
The quantitative adherence of a keratitis isolate of Acanthamoeba polyphaga to low- and high-water content non-ionic soft contact lenses and one type of rigid gas-permeable lens was investigated. Adherence of trophozoite and cyst forms of the organism was observed in vitro, and adherent amoebae counted by a plaque assay method following detachment. Trophozoites adhered to all lens types with adherence being statistically significantly greater to high water content soft lenses. Cyst attachment occurred only to the soft lenses but not to gas-permeable lenses, and was significantly higher for the high water content lenses. Attachment of cysts was significantly lower than that of trophozoites to each lens tested. Recommended cleaning procedures using two commercial solutions removed all adherent trophozoites and cysts from lenses. These studies demonstrate (i) that lenses may act as a vector in Acanthamoeba keratitis, particularly for high-water content lenses and trophozoite amoebae, (ii) that lens cleaning agents may prevent keratitis by removing adherent Acanthamoeba.
Keywords: *Acanthamoeba/ph [Physiology]; Acanthamoeba Keratitis/ps [Parasitology]; Acanthamoeba Keratitis/pc [Prevention & Control]; Acanthamoeba Keratitis/tm [Transmission]; Adhesiveness; Animals; *Contact Lenses, Hydrophilic; Detergents; Humans

Episcleritis, conjunctivitis, and keratitis as ocular manifestations of Lyme disease. - Flach, A J; Lavoie, P E (Ophthalmology, 1990)
A 35-year-old woman presented with a bilateral palpebral follicular conjunctivitis. Subsequently, she developed a bilateral keratitis and, on a separate occasion, an episcleritis that was associated with a recrudescence of Lyme disease and poor compliance with the antibiotic regimen. Both the keratitis and episcleritis cleared completely after topical corticosteroid therapy and reinstitution of appropriate antibiotic treatment. This report emphasizes the importance of collaboration between internal medicine and ophthalmologic specialists during the long-term management of Lyme disease.
Keywords: Adrenal Cortex Hormones/tu [Therapeutic Use]; Adult; Borrelia burgdorferi Group/de [Drug Effects]; Borrelia burgdorferi Group/im [Immunology]; *Conjunctivitis/et [Etiology]; Female; Fluorescent Antibody Technique; Humans; Keratitis/dt [Drug Therapy]; *Keratitis/et [Etiology]; *Lyme Disease/co [Complications]; Lyme Disease/di [Diagnosis]; Lyme Disease/dt [Drug Therapy]; Minocycline/tu [Therapeutic Use]; Scleritis/dt [Drug Therapy]; *Scleritis/et [Etiology]

The ophthalmic rod--a new drug-delivery system II. - Alani, S D; Hammerstein, W (Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 1990)
The ophthalmic rod (OR) is a new ophthalmic drug-delivery system. The rod is made of nontoxic plastic. The active substance is deposited as a thin film on the end of the rod. To deliver the drug, the tip of the rod is introduced into the conjunctival sac and rubbed against the palpebral conjunctiva of the lower lid. The OR is a single-dose sterile applicator. By using the OR the problems of preservation and sterility of eyedrops are eliminated, and the risk of cross-infection is avoided. This was an open uncontrolled study. Clonidine ORs were used by 15 patients with glaucoma for 12 days. Fluorescein ORs were used for tonometry and to check the safetness of using the ORs. Patients with dry eyes or scotoma were excluded from the study. The clonidine film remaining on the ORs after delivery was quantitatively analyzed. A dose of 20 micrograms clonidine rod, three ORs/day, was sufficient to keep the ocular pressure under control. The fluorescin ORs, 30 micrograms/rod, were satisfactory for coloring the cornea. On the last day (12th) no clinically apparent side effects were observed. Subjectively, the patients were satisfied with the OR method of application, as an alternative to eyedrops.
Keywords: Adult; Aged; Aged, 80 and over; Clinical Trials as Topic; *Clonidine/ad [Administration & Dosage]; Clonidine/tu [Therapeutic Use]; Conjunctiva/de [Drug Effects]; Female; Fluorescein; Fluoresceins/ad [Administration & Dosage]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Plastics; Safety; Tonometry, Ocular

Pseudomonas keratitis and contact lens wear: the lens/eye is at fault. - Stern, G A (Cornea, 1990)
Microbial keratitis with Pseudomonas aeruginosa is the most common corneal infection associated with contact lenses (CLs). Pseudomonas organisms are ubiquitous in nature, and can colonize CLs without a prior breach in lens care or hygiene. Although poor lens care is often found in affected patients, lens contamination and traumatic epithelial defects are more relevant. Hydrophilic lenses, particularly extended wear lenses, have been associated with a greater frequency of Pseudomonas keratitis. The polymer matrix of these lenses is apparently suited to the avid adherence of Pseudomonas organisms. Adherence is promoted by the presence of lens coatings, which begin to accumulate upon lens insertion and whose level mounts over time. Evidence suggests that infection is more common with mucin-coated contaminated CLs than with noncoated contaminated CLs. In general, lens wear can promote bacterial adherence to the ocular surface by shielding the cornea from the wiping action of the eyelids and immune components in tears. Still, experimental models have shown that keratitis develops regularly (84%) only in corneas that have been traumatized. Trauma may arise through lens insertion or removal, deposits or debris entrapment, hypoxia, or toxic reactions to solution preservatives. Extended wear is believed to facilitate the infectious process because of the chronic accumulation of coatings, the chronic exposure of CLs to potentially adherent bacteria, the continuous presence of irritating lens deposits, the prolonged entrapment of debris beneath the lens, and the relative infrequency of lens cleaning and disinfection.
Keywords: Bacterial Adhesion; *Contact Lenses/ae [Adverse Effects]; Contact Lenses, Extended-Wear/ae [Adverse Effects]; Corneal Ulcer/et [Etiology]; Equipment Contamination; *Eye Infections, Bacterial/et [Etiology]; Eye Injuries/co [Complications]; Eye Injuries/et [Etiology]; Humans; *Keratitis/et [Etiology]; Keratitis/mi [Microbiology]; *Pseudomonas Infections/et [Etiology]

Bacterial adherence to extended wear soft contact lenses. - Aswad, M I; John, T; Barza, M; Kenyon, K; Baum, J (Ophthalmology, 1990)
The authors studied the adherence of Pseudomonas aeruginosa and Staphylococcus aureus to extended wear soft contact lenses (EWSCLs) with and without focal deposits using both a radiolabeling technique and electron microscopy. P. aeruginosa showed significant adherence to contact lenses in vitro. In contrast, S. aureus failed to show significant adherence to contact lenses in vitro (i.e., the radioactive uptake was not significantly above background). The extent of adherence of Pseudomonas was proportional to the number of focal deposits on the lenses. Results of electron microscopic examination showed the bacteria to be adherent primarily to large focal deposits (greater than or equal to 150 microns). There was no pseudomonal adherence to the small focal deposits (less than or equal to 50 microns) and little adherence to the areas in between the focal deposits. The authors hypothesize that worn lenses, especially those with large focal deposits, serve as a vehicle for the transport of P. aeruginosa to the cornea. This hypothesis could be a partial explanation for the high incidence of keratitis caused by P. aeruginosa in EWSCL patients.
Keywords: *Bacterial Adhesion; Colony Count, Microbial; *Contact Lenses, Extended-Wear; Humans; Microscopy, Electron, Scanning; *Pseudomonas aeruginosa/gd [Growth & Development]; Pseudomonas aeruginosa/ul [Ultrastructure]; *Staphylococcus aureus/gd [Growth & Development]; Staphylococcus aureus/ul [Ultrastructure]; Thymidine; Tritium

Outcome of referrals by optometrists to general practitioners: an 18 month study in one practice. - Perkins, P (The British journal of general practice : the journal of the Royal College of General Practitioners, 1990)
All general ophthalmic services forms (GOS18) received by one practice over an 18 month period were analysed and the patient outcome after two years noted from the practice records. Sixty one forms were collected. Fifty patients (82%) were referred by the general practitioners to the local eye hospital. Among the 45 patients that have so far been seen by an ophthalmologist, 22 (49%) were diagnosed as having cataracts, eight (18%) macular degeneration and two (4%) glaucoma. Thirteen patients (29%) were found to have normal eyes. Nine of the 61 patients (15%) were not referred to an ophthalmologist and two patients (3%) were already under review at the eye hospital. It is concluded that some referrals to ophthalmologists might be avoided if general practitioners received improved training in ophthalmology, However, general practitioners remain an effective filter in the referral system between optometrists and ophthalmologists.
Comment in (CIN)
Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Child; Child, Preschool; England; *Eye Diseases/th [Therapy]; *Family Practice; Female; Humans; Infant; Male; Middle Aged; *Optometry; Patient Acceptance of Health Care; Prognosis; *Referral and Consultation

Retinal detachment adherent to posterior chamber IOL after Molteno implant surgery. - Huna, R; Melamed, S; Hirsh, A; Treister, G (Ophthalmic surgery, 1990)
A patient with refractory glaucoma 1 year after cataract extraction and trabeculectomy had Molteno implant surgery. Three days after surgery a kissing choroidal effusion and retinal detachment adherent to the posterior chamber IOL were detected. Repeated choroidal taps were unsuccessful. Removal of the Molteno implant, vitrectomy, and silicone oil injection were required to reattach the retina.
Keywords: Cataract Extraction; Female; *Glaucoma/su [Surgery]; Humans; Intraocular Pressure; *Lenses, Intraocular; Middle Aged; Postoperative Complications; *Prostheses and Implants; Reoperation; *Retinal Detachment/et [Etiology]; Retinal Detachment/su [Surgery]; *Silicone Elastomers; Silicone Oils/tu [Therapeutic Use]; Tissue Adhesions; Visual Acuity; Vitrectomy

[Self-tonometry--technical possibilities and clinical significance]. - Draeger, J; Groenhoff, S (Fortschritte der Ophthalmologie : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft, 1990)
Since 1975, four selected glaucoma patients and their relatives have attended the Department of Ophthalmology at Hamburg University, for instruction in home tonometry using the Draeger motor-driven hand applanation tonometer. Two glaucoma patients whose intraocular pressure (IOP) was measured by their physicians were also included, in order to analyse long-term monitoring of the IOP by medical staff. Home tonometry has been performed over several years and has proved to be a reliable and precise diagnostic tool allowing valuable treatment and close follow-up of glaucoma, especially in severe forms of glaucoma. The benefits of patient's participation in their own disease monitoring, e.g., self-measurement of blood pressure in patients with arterial hypertension, show that such involvement can lead to more diagnostic security and better compliance. On the basis of applanation tonometry calibrated by Goldmann, new concepts of microprocessor-controlled assessment of the applanation area are outlined. These sensor tonometers will allow automatic, precise and fast self-measurement of the intraocular pressure, opening up new perspectives in the management of glaucoma.
Keywords: Adult; Child; Female; Glaucoma/cn [Congenital]; *Glaucoma/di [Diagnosis]; *Home Nursing; Humans; Male; *Ocular Hypertension/di [Diagnosis]; *Self Care/is [Instrumentation]; *Tonometry, Ocular/is [Instrumentation]

Pharmacological and clinical aspects of glaucoma therapy. - Berggren, L (Acta ophthalmologica, 1990)
Keywords: Administration, Topical; Adrenergic Agonists/pd [Pharmacology]; Adrenergic beta-Antagonists/pd [Pharmacology]; Animals; Biological Availability; Carbonic Anhydrase Inhibitors/pd [Pharmacology]; *Glaucoma/dt [Drug Therapy]; Humans; Parasympathomimetics/pd [Pharmacology]; Patient Compliance

Ocular disease from wearing contact lenses. A potentially devastating complication. - Grutzmacher, R D (Postgraduate medicine, 1989)
Because of the continued popularity of contact lenses in the United States, ocular inflammatory diseases are being encountered with increasing frequency by both ophthalmologists and primary care physicians. Distinction between minor noninfectious inflammation and serious, sight-threatening infection is crucial to the proper management of these patients. Symptoms of infectious keratitis are pain and loss of vision. Signs include infiltration or loss of clarity of the cornea, eyelid swelling, and purulent discharge. If an infectious process is suspected, the patient should be referred to an ophthalmologist immediately. If this is not possible, the contact lens should be removed and a culture performed, if possible. Aminoglycoside antibiotic drops should be applied frequently until ophthalmologic consultation is obtained. Patients should be reminded of the need for strict adherence to disinfection techniques and avoidance of homemade saline preparations. They should also be told to discontinue use of contact lenses at the first sign of ocular irritation or inflammation and to report to their physician if inflammation persists.
Keywords: Amebiasis/co [Complications]; Amebiasis/et [Etiology]; Aminoglycosides; Anti-Bacterial Agents/tu [Therapeutic Use]; *Contact Lenses/ae [Adverse Effects]; Corneal Diseases/di [Diagnosis]; *Corneal Diseases/et [Etiology]; Corneal Diseases/th [Therapy]; Corneal Ulcer/et [Etiology]; Corneal Ulcer/mi [Microbiology]; Humans

Diabetic microangiopathy in patients with cystic fibrosis. - Sullivan, M M; Denning, C R (Pediatrics, 1989)
Individuals with cystic fibrosis have a 1% to 7% incidence of insulin-dependent diabetes mellitus. The occurrence of diabetic microangiopathy in patients with cystic fibrosis has been reported recently. From 1978 to 1987, 19 patients with cystic fibrosis and diabetes mellitus were followed up. Four patients (21%) had evidence of diabetic microangiopathy. In one, peripheral neuropathy developed 5 years after the onset of diabetes mellitus, and the other 3 patients each had complications of retinopathy, nephropathy, and neuropathy which developed 10 years after the onset of diabetes mellitus. All were poorly compliant in their medical care. Significant morbidity was seen in the 3 patients with multisystem involvement--blindness, glaucoma, hypertension, and renal failure. The combination of long-standing diabetes mellitus, poor glycemic control, plus pathophysiologic features associated with cystic fibrosis may have contributed to the development of microangiopathy. The use of steroids in 4 other patients and dextrose infusions (as part of hyperalimentation) in another 4 patients precipitated or exacerbated diabetes. The data indicate that diabetic microangiopathy can occur in the individual with cystic fibrosis. Routine screening for diabetes and its complications in the population with cystic fibrosis, as well as optimal control of hyperglycemia, is warranted.
Keywords: Adolescent; Adult; Blood Glucose/an [Analysis]; Child; *Cystic Fibrosis/co [Complications]; Cystic Fibrosis/dt [Drug Therapy]; Diabetes Mellitus, Type 1/bl [Blood]; Diabetes Mellitus, Type 1/co [Complications]; *Diabetic Angiopathies/co [Complications]; Diabetic Angiopathies/pa [Pathology]; Diabetic Nephropathies/co [Complications]; Diabetic Nephropathies/pa [Pathology]; Diabetic Neuropathies/co [Complications]; Diabetic Neuropathies/pa [Pathology]; Diabetic Retinopathy/co [Complications]; Diabetic Retinopathy/pa [Pathology]; Female; Humans; Male; Retrospective Studies

Maintained reduction of intraocular pressure by prostaglandin F2 alpha-1-isopropyl ester applied in multiple doses in ocular hypertensive and glaucoma patients. - Camras, C B; Siebold, E C; Lustgarten, J S; Serle, J B; Frisch, S C; Podos, S M; Bito, L Z (Ophthalmology, 1989)
In a randomized, double-masked, placebo-controlled study, 0.25 microgram (n = 11) or 0.5 microgram (n = 13) of prostaglandin F2 alpha-1-isopropyl ester (PGF2 alpha-IE) was applied topically twice daily for 8 days to one eye of ocular hypertensive or chronic open-angle glaucoma patients. Compared with contralateral, vehicle-treated eyes, PGF2 alpha-IE significantly (P less than 0.05) reduced intraocular pressure (IOP), beginning 4 hours after the first 0.5-microgram dose and lasting at least 12 hours after the fourteenth dose, with a significant (P less than 0.005) mean reduction of 4 to 6 mmHg maintained throughout the last day of therapy with either dose. A contralateral effect was not observed. Mean tonographic outflow facility was significantly (P less than 0.05) higher in PG-treated compared with vehicle-treated eyes (0.17 +/- 0.02 versus 0.12 +/- 0.01 microliter/minute/mmHg, respectively; +/- standard error of the mean) for the 0.5 microgram dose. Conjunctival hyperemia reached a maximum at 30 to 60 minutes after PGF2 alpha-IE application. Some patients reported mild irritation lasting several minutes after some doses. Visual acuity, accommodative amplitude, pupillary diameter, aqueous humor flare, anterior chamber cellular response, Schirmer's test, pulse rate, and blood pressure were not significantly altered. Our findings show that PGF2 alpha-IE is a potent ocular hypotensive agent and a promising drug for glaucoma therapy.
Keywords: Aged; Conjunctiva/de [Drug Effects]; Dinoprost/ae [Adverse Effects]; *Dinoprost/aa [Analogs & Derivatives]; Dinoprost/pd [Pharmacology]; Dose-Response Relationship, Drug; Double-Blind Method; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Hyperemia/ci [Chemically Induced]; *Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; *Ocular Hypertension/dt [Drug Therapy]; Patient Compliance; Random Allocation; Tonometry, Ocular

Reasons for enucleation after plaque radiotherapy for posterior uveal melanoma. Clinical findings. - Shields, C L; Shields, J A; Karlsson, U; Markoe, A M; Brady, L W (Ophthalmology, 1989)
A review of 1019 patients with posterior uveal melanomas who were treated with episcleral plaque radiotherapy showed that 59 (6%) required enucleation of the affected eye. Seventeen of the enucleations were done within 1 year, 30 within 2 years, and 55 within 5 years. The enucleated eyes had been treated with a cobalt-60 plaque in 39 cases, a ruthenium-106 plaque in 13 cases, an iodine-125 plaque in four cases, and an iridium-192 plaque in three cases. The primary reasons for enucleation included tumor regrowth in 30 cases (51%), neovascular glaucoma in 18 (31%), patient request in five (8%), scleral melting in four (7%), painful bullous keratopathy in one (2%), and hemolytic glaucoma in one (2%). The time interval from plaque treatment to eventual enucleation averaged 29 months. Tumor regrowth requiring enucleation was detected clinically an average of 28 months after treatment. In these cases the average radiation dose to the tumor apex was 7700 cGy and to the tumor base 36,000 cGy. Uncontrollable neovascular glaucoma occurred an average of 38 months after plaque radiotherapy and, most commonly, after cobalt-60 plaques were used. Eyes with plaque-induced scleral melting eventually required enucleation after an average of 10 months. In all cases of scleral melting, the tumor was ciliochoroidal.
Keywords: Adult; Aged; Brachytherapy; Corneal Diseases/et [Etiology]; *Eye Enucleation; Female; Glaucoma/et [Etiology]; Glaucoma, Neovascular/et [Etiology]; Humans; Male; *Melanoma/rt [Radiotherapy]; Middle Aged; *Neoplasm Recurrence, Local/et [Etiology]; Patient Compliance; Scleral Diseases/et [Etiology]; Time Factors; *Uveal Neoplasms/rt [Radiotherapy]; Visual Acuity

[Correlation of changes of the optic nerve disc and the field of vision in initial open-angle glaucoma]. - Listopadova, N A; Romanova, T B (Vestnik oftalmologii, 1989)
Compliance of the optic disc with the visual field has been examined with the Peritest in 137 eyes (90 patients) with initial open-angle glaucoma. Coincidence of the two states has been observed in 54% of cases, no coincidence in the rest. The authors' findings evidence that changes in the visual field have anticipated the optic disc changes in 48% of cases, whereas optic disc shifts have developed before the visual field defects in 52% of cases. An important factor contributing to the compliance of the optic disc with the visual field is, besides the excavation area, the neuroglial ring status, that has been changed in 58% of cases. The authors come to the conclusion that combined changes in the visual field and optic disc are a more reliable criterion confirming the diagnosis of glaucoma.
Keywords: *Glaucoma, Open-Angle/pa [Pathology]; Humans; *Optic Disk/pa [Pathology]; *Visual Fields

[Lasers in ophthalmology]. - Gloor, B (Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis, 1989)
The optical accessibility of almost all its structures predestines the eye for the application of lasers for diagnostic and therapeutic purposes. The lasers presently used in ophthalmology are listed in the table. We can distinguish among five different kinds of tissue change caused by lasers: photocoagulation, photovaporization, photodisruption, photodynamic effect, and photo-ablation. Photocoagulation therapy is used in vascular diseases of the retina, particularly diabetic retinopathy, in macular disease, especially senile macular degeneration, in retinal surgery as a prophylaxis for retinal detachment, as well as in glaucoma surgery. Completely new surgical dimensions have been made possible by photodisruptive therapy, including very specific, microsurgical tearing and shredding, even of transparent structures such as the posterior lens capsule after extracapsular cataract operation and posterior lens implantation, or of vitreal strands. Photodynamic therapy is applied together with hematoporphyrins in the treatment of malignant melanoma. At present, we are fascinated with the development of the excimer laser, which promises to provide photoablative corneal surgery without mechanical deformation of the eye.
Keywords: *Eye Diseases/di [Diagnosis]; Eye Diseases/su [Surgery]; Glaucoma/su [Surgery]; Humans; Laser Therapy/mt [Methods]; *Laser Therapy; Ophthalmoscopes; Retinal Diseases/su [Surgery]

Non-contact tonometry in the postoperative eye. - Vernon, S A (The British journal of ophthalmology, 1989)
The Keeler Pulsair non-contact tonometer was compared with the Goldmann applanation tonometer in a series of 48 eyes after operation. A correlation coefficient of 0.92 (p less than 0.001) was found between the two instruments, with the Pulsair having a statistically significant tendency to overread the Goldmann slightly in this situation. The Pulsair was, however, shown to be effective in the identification of postoperative ocular hypertension with a high degree of sensitivity and specificity and good patient compliance, while reducing the risk of cross infection.
Keywords: Air; Humans; Ocular Hypertension/di [Diagnosis]; *Ophthalmologic Surgical Procedures; *Postoperative Complications/di [Diagnosis]; Tonometry, Ocular/is [Instrumentation]; *Tonometry, Ocular/mt [Methods]

"Outlier" intraocular pressure readings: valid or invalid for statistical analysis?. - Dandona, L; Morrison, J C; Robin, A L; Quigley, H A (Ophthalmic surgery, 1989)
Wide variations in the response to intraocular (IOP)-lowering medications may be due to the normal response of the subjects or to variables unrelated to the effect of medication, eg, noncompliance or recording errors. We used data from a previous study of medications designed to lower IOP to investigate the influence of readings showing an unusually large increase in IOP from baseline on the statistical analysis and conclusions. These readings, which could have been due to variables unrelated to the effect of medication, were defined as "outliers" by a statistical method. A statistically insignificant difference between two IOP-lowering medications became significant on excluding two subjects with outlier IOP readings. We explain how reporting results obtained with and without including outliers in the analysis may provide clinicians with more complete information.
Keywords: Analysis of Variance; Clinical Trials as Topic; Clonidine/ad [Administration & Dosage]; Clonidine/aa [Analogs & Derivatives]; Clonidine/tu [Therapeutic Use]; *Data Interpretation, Statistical; Double-Blind Method; Drug Therapy, Combination; Epinephrine/ad [Administration & Dosage]; Epinephrine/aa [Analogs & Derivatives]; Epinephrine/tu [Therapeutic Use]; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Ocular Hypertension/dt [Drug Therapy]; Random Allocation; Timolol/ad [Administration & Dosage]; Timolol/tu [Therapeutic Use]

The place of trabeculectomy in the management of primary open-angle glaucoma and factors favouring success. - Thomas, R; Billson, F (Australian and New Zealand journal of ophthalmology, 1989)
Medical treatment has always been the mainstay in the management of primary open-angle glaucoma (POAG). Surgical intervention has been reserved for cases with intraocular pressures uncontrolled on medical therapy and/or progression of visual field loss. Following the introduction of trabeculectomy, there was a move toward earlier surgery in POAG with some advocating it as a primary procedure. However, others have emphasised the complications and unpredictability of trabeculectomy and use it only as a last resort. In this article the literature is reviewed and the factors that prevent complications and help ensure a successful result in trabeculectomy are considered. While the role of trabeculectomy as a primary procedure in POAG is debatable, the authors favour earlier surgical intervention rather than using surgery as a last resort.
Keywords: *Glaucoma, Open-Angle/su [Surgery]; Humans; Laser Therapy; Patient Compliance; Prognosis; *Trabeculectomy

Disposable soft contact lenses. - Driebe, W T Jr (Survey of ophthalmology, 1989)
Disposable soft lenses are now available for extended wear. These lenses were designed to provide a more acceptable margin of safety than conventional extended wear soft lenses. Disposable lenses, which are intended to be discarded after 1-2 weeks of continuous wearing time, do offer a number of theoretical advantages. The short wearing schedule minimizes deposit formation which has been implicated in the development of giant papillary conjunctivitis and infectious keratitis. Lens disinfection systems, which are expensive and time consuming, and may become contaminated, are rarely needed if the manufacturer's guidelines are followed. Careful longterm follow-up of disposable soft lens patients will be needed to establish actual patient compliance and the safety of these lenses.
Keywords: *Contact Lenses, Hydrophilic; Corneal Diseases/co [Complications]; *Disposable Equipment; Humans; Keratitis/co [Complications]

Antibacterial agents in the treatment of ocular infections. - Barza, M (Infectious disease clinics of North America, 1989)
There are a number of barriers to the ocular transport of poorly lipid-soluble antibiotics such as beta-lactams and aminoglycosides. Knowledge of these barriers can help the physician in the choice of agent and the route of administration for specific ocular infections. Because of the corneal epithelial barrier, topically applied drugs should be administered frequently; "fortified" drops afford higher corneal concentrations than commercially available drops. Periocular injections may occasionally be of benefit in the treatment of refractory corneal ulcers. The mainstay of treatment of bacterial endophthalmitis should be intravitreal injection of antimicrobial agents; ancillary treatments include the periocular and systemic administration of antimicrobial agents, the systemic administration of probenecid, the administration of corticosteroids, and the use of vitrectomy.
Keywords: Animals; Anti-Bacterial Agents/ad [Administration & Dosage]; Anti-Bacterial Agents/pk [Pharmacokinetics]; *Anti-Bacterial Agents/tu [Therapeutic Use]; *Bacterial Infections/dt [Drug Therapy]; Bacterial Infections/mi [Microbiology]; Biological Transport; Eye Diseases/dt [Drug Therapy]; *Eye Diseases/et [Etiology]; Half-Life; Humans; Rabbits

Reactive membrane on a foldable silicone lens implant in the posterior chamber of a human eye. - Wolter, J R; Sugar, A (Ophthalmic surgery, 1989)
A foldable silicone posterior chamber intraocular lens implant caused irritation and glaucoma postoperatively in the eye of a diabetic patient who subsequently was treated with steroids and a laser capsulotomy. Because the lens implant was loose in the capsular bag and caused considerable glare, it was removed about 4 months after placement. Pathologic study revealed the entire surface of the implant to be covered by a continuous and firmly adherent protein membrane with excrescences and of irregular thickness. Sessile macrophages found on the membrane were not firmly attached.
Keywords: Cataract Extraction; Female; *Foreign-Body Reaction/et [Etiology]; Foreign-Body Reaction/pa [Pathology]; Glaucoma/et [Etiology]; Humans; Laser Therapy; Lens Capsule, Crystalline/su [Surgery]; *Lenses, Intraocular/ae [Adverse Effects]; *Macrophages/im [Immunology]; Membranes; Middle Aged; Silicone Elastomers/ae [Adverse Effects]; Visual Acuity

Update on epikeratophakia in children. - Morgan, K S; Somers, M (International ophthalmology clinics, 1989)
Epikeratophakia continues to be an extremely attractive option for younger children with unilateral aphakia who are noncompliant users of contact lenses but who are young enough to benefit from amblyopia therapy. The epikeratophakia procedure is much safer than IOL implantation. The epikeratophakia tissue lens is especially useful for children with traumatic aphakia and corneal lacerations because the lens can strengthen and smooth the cornea as well as correct the aphakia. This allows much quicker rehabilitation than could be accomplished with contact lenses. The epikeratophakia procedure may be combined with a cataract extraction and should be in those children with acquired cataracts who demonstrate contact lens noncompliance in an office trial of contact lens insertion before operation. Epikeratophakia should be used with caution in neonates and young infants because of the rapid growth of the eye. Extended-wear contact lenses are a safer option for these children, and epikeratophakia can be performed as a secondary procedure if and when problems with contact lens compliance arise. Surface ocular problems such as uncontrolled dry eyes or severe blepharitis will continue to be incompatible with the survival of epikeratophakia tissue lenses. Children who are treated with high doses of radiation for orbital tumors such as rhabdomyosarcomas invariably develop radiation cataracts, which can occur before the onset of radiation keratitis. These children do not do well with epikeratophakia tissue lenses. Likewise, children with severe metabolic disturbances who are not healthy or gaining weight have a diminished chance of graft healing, as do children with poor vision in whom oculodigital autostimulation produces persistent epithelial defects, which prevent survival of the tissue lens.(ABSTRACT TRUNCATED AT 250 WORDS)
Keywords: Adolescent; *Aphakia, Postcataract/su [Surgery]; Aphakia, Postcataract/th [Therapy]; Cataract Extraction; Child; Contact Lenses; *Corneal Transplantation; Humans; Methods; Visual Acuity

[5-Fluorouracil in trabeculectomy: preliminary report]. - Jeng, S; Ku, W C; Fan, D (Taiwan yi xue hui za zhi. Journal of the Formosan Medical Association, 1989)
Subconjunctival 5-FU injections were used as an adjunctive therapy in trabeculectomy for high risk glaucoma patients. We injected 5 mg once a day for five to seven days as a routine treatment. For the first 10 eyes, the injections were started immediately after the operation. However, for the remaining 9 eyes, the injections began 24 to 48 hours postoperative. If the appearance of the bleb was not prominent or enriched in vascularity, the duration of the injections should be extended to 10 to 14 days. At least 8 months of follow-up were available for 19 eyes, including aphakic glaucoma, 8 eyes; neovascular glaucoma, 2 eyes; previous failed filter, 6 eyes; total collapse of the anterior chamber with leucoma adherence, 1 eye; glaucoma due to mesodermal dysgenesis, 1 eye; and juvenile glaucoma, 1 eye (whose fellow eye had received twice failed filtering procedures). The results revealed a success rate of 79% (intraocular pressure below 22mmHg with or without topical medication). The success rate for aphakic glaucoma was 63% (5/8), for neovascular glaucoma 100% (2/2) and for the failed filters 83% (5/6). We also presume that 5-FU injections would be effective in the treatment of to abnormally marked fibrous proliferations caused by age factors. The complications related to the use of 5-FU include corneal epithelial defect 4/9 (21%), conjunctival leak 3/9 (16%), subconjunctival hematoma 1/19 (5%), and conjunctival sterile ulcer 1/19 (5%).
Keywords: Adolescent; Adult; Aged; Child; Combined Modality Therapy; Female; *Fluorouracil/tu [Therapeutic Use]; *Glaucoma/th [Therapy]; Humans; Male; Middle Aged; *Trabeculectomy/mt [Methods]

[Personalities and chronic glaucoma]. - Demailly, P; Zoute, C; Castro, D (Journal francais d'ophtalmologie, 1989)
This survey has investigated the occurence of psychopathological affections and their relationship with compliance in open angle glaucomatous patients. Three groups have been considered: 48 severe glaucomas, 37 early glaucomas and 48 control patients, under treatment for other ophthalmological affections. These groups have taken a psychiatric interview, compliance evaluating scale and psychological assessment (inducling: Vocabulaire Binois Pichot, Cattel's 16 Personality Factors and Autoanalyse, Thematic Aperception Test and the Rorschach Test analysed through Exner's Synthetic System). Anxiety personality and disoders are more frequent in the glaucomatous group than the control or early (P = 0.0156). Patients in the early group appeared to be most compliant. Personality structure play a role in the acceptance of the disease and in the degree of cooperation with treatment. Maximal compliance is observed at the beginning of the disease. Personality scales show that glaucomatous patients have difficulties in coping with aggressive pulsions and tend to react to affect loaded situations by a defensive or avoiding attitude.
Keywords: Adult; Chronic Disease; Female; Glaucoma, Open-Angle/co [Complications]; *Glaucoma, Open-Angle/px [Psychology]; Glaucoma, Open-Angle/th [Therapy]; Humans; Male; Mental Disorders/et [Etiology]; Middle Aged; Patient Compliance; *Personality; Psychological Tests; Psychometrics

[Rotational corneal auto-grafting]. - Zhu, Z Z ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 1989)
Fifteen (15) cases of rotational corneal autografting were performed in patients with adherent leukoma, sequelae of anterior segment burns, corneal ulcer, and corneal fistula. The optical and cosmetic effects were good in 14 of the 15 eyes in which the grafts were clear in the pupil area. The indications, technique, advantages and shortcomings of this operation were discussed.
Keywords: Adolescent; Adult; Child; Child, Preschool; *Corneal Diseases/su [Surgery]; Corneal Opacity/su [Surgery]; *Corneal Transplantation/mt [Methods]; Eye Neoplasms/su [Surgery]; Female; Humans; Infant; Male; Transplantation, Autologous

Adherence of Acanthamoeba castellanii cysts and trophozoites to unworn soft contact lenses. - John, T; Desai, D; Sahm, D (American journal of ophthalmology, 1989)
Contact lens-related Acanthamoeba keratitis has been associated with the use of soft contact lenses and homemade saline solutions. We studied the adherence of Acanthamoeba to unworn extended-wear soft contact lenses on a human corneal isolate of Acanthamoeba castellanii suspended in normal saline (cysts, 6.3 x 10(5)/ml; trophozoites, 3.6 x 10(5)/ml). Unworn hydrogel contact lenses (polymacon, water content 38.6%; 50 lenses, 400 lens segments) were exposed to A. castellanii cysts or trophozoites with or without stirring. After exposure for zero to seven hours, soft contact lenses were or were not washed, and the A. castellanii adherence was determined with a standardized light-microscopy technique (40 fields, ten lens segments for each count) and with scanning electron microscopy. Both cysts and trophozoites adhered to the unworn soft contact lenses. Trophozoites showed acanthopodia, lobopodia, and filopodia. This study indicates that both A. castellanii cysts and trophozoites can firmly adhere to unworn soft contact lens. Such adherence may play a role in the pathogenesis of soft contact lens-related Acanthamoeba keratitis.
Keywords: *Acanthamoeba/ip [Isolation & Purification]; Acanthamoeba/ul [Ultrastructure]; Acanthamoeba Keratitis/et [Etiology]; Animals; *Bacterial Adhesion; *Contact Lenses, Hydrophilic; Humans; Time Factors

Dosage cost analysis in glaucoma management. - Gelvin, J B; Goen, T M (Journal of the American Optometric Association, 1989)
After the diagnosis of chronic open-angle glaucoma has been made, and the indications vs. contraindications of each of the potential first-line topical medications have been weighed, what medical therapy should be initiated if the most cost effective form of management is desired? We surveyed 40 pharmacies in four cities and found no statistical difference between the mean annual cost of therapy with timolol maleate (Timoptic), betaxolol (Betoptic), and pilocarpine. Statistically, both dipivefrin (Propine) and levobunolol (Betagan) were found to be more expensive. We also discovered that there are large variations in medication prices between various pharmacies. In order to enhance compliance, optometrists may want to know the pharmacies in their communities that offer antiglaucoma medications at reasonable prices.
Keywords: Analysis of Variance; Costs and Cost Analysis; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/ec [Economics]; Humans; Patient Compliance; Pharmacies; Random Allocation

Pressure compliance test of the optic nerve head: influence of different antiglaucoma drugs. - Pillunat, L E; Stodtmeister, R (Survey of ophthalmology, 1989)
Keywords: Acetazolamide/pd [Pharmacology]; *Adrenergic beta-Antagonists/pd [Pharmacology]; Betaxolol; Carteolol/pd [Pharmacology]; Glaucoma/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; *Optic Disk/de [Drug Effects]; Pilocarpine/pd [Pharmacology]; Propanolamines/pd [Pharmacology]; Timolol/pd [Pharmacology]

The relation between glaucomatous damage and optic nerve head mechanical compliance. - Zeimer, R C; Ogura, Y (Archives of ophthalmology (Chicago, Ill. : 1960), 1989)
Histologic studies seem to imply that the mechanical compliance of the optic nerve head, namely, its displacement under a given pressure, may be altered in glaucoma. We have developed a method to noninvasively measure the optic nerve head displacement. In postmortem human glaucomatous eyes, the optic nerve head compliance decreased as the visual field worsened (n = 15, r = -.34). The mean difference between the optic nerve head displacement of the two eyes in subjects with symmetric clinical findings differed significantly from the mean in subjects with asymmetry. In the latter group, the lower value was always measured in the more affected eye. No significant correlation was found between age and the optic nerve head compliance. Overall, the results indicate that, in glaucoma, there is a stiffening of the mechanical support of the optic nerve head.
Keywords: Adult; Aged; Aged, 80 and over; Biomechanical Phenomena; *Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure; Lasers; Middle Aged; *Optic Disk/pp [Physiopathology]; Rheology; Sclera/pp [Physiopathology]; Visual Fields

Flow of aqueous humor in the canal of Schlemm. - Tandon, P N; Autar, R (Mathematical biosciences, 1989)
A mathematical model is presented for the flow of aqueous humor in Schlemm's canal in the eye. The model introduces a canal segment between two collector channels as a rectangular channel with porous upper wall. Two cases have been considered in the model: (I) the inner porous wall of the canal is rigid; (II) the inner wall is collapsible. Analytical solution of the governing equation in case I is straightforward, whereas the nonlinear equation in case II is solved by an iterative procedure. Aqueous fluid pressure and flow profiles in the proposed model are drawn, and the effects of important parameters on these profiles are brought out and discussed. It is concluded that for case I, resistance to aqueous flow is influenced by the filtration constant of the trabecular and endothelial meshwork and that narrowing of the canal reduces outflow. In case II, an increase in intraocular pressure (IOP) or compliance coefficient of the canal inner wall increases the collapse of the canal, which offers increased resistance to flow resulting in the decreased flow whereas increasing filtration constant facilitates aqueous outflow. These theoretical results suggest that increased IOP or decreased rigidity of the inner wall may contribute to the development of increased resistance as observed in some cases of glaucoma and that increasing values of filtration constant may contribute to the facility of outflow increase.
Keywords: Animals; *Aqueous Humor/ph [Physiology]; Ciliary Body/ph [Physiology]; Humans; *Intraocular Pressure/ph [Physiology]; Mathematics; Models, Biological; Sclera/ah [Anatomy & Histology]; *Sclera/ph [Physiology]

[Selection of treatment modality for developmental glaucoma]. - Yang, G H ([Zhonghua yan ke za zhi] Chinese journal of ophthalmology, 1989)
53 cases of developmental glaucoma were analyzed with regard to results of treatment and factors involved. Poor compliance was found a major problem, and a number of patients did not respond well to medical treatment. Surgical intervention was indicated for patients with (1) unsatisfactory medical control of IOP, (2) inadequate recognition of the severity of their case, (3) inaccessibility to prompt treatment when needed, (4) occurrence of progressive visual field defects and optic disk damages, and (5) the other eye already in the terminal stage of glaucoma.
Keywords: Adolescent; Adult; Blindness/et [Etiology]; Blindness/pc [Prevention & Control]; Child; Female; Glaucoma/cn [Congenital]; Glaucoma/dt [Drug Therapy]; *Glaucoma/su [Surgery]; Humans; Male

The contribution of bacterial surface hydrophobicity to the process of adherence of Pseudomonas aeruginosa to hydrophilic contact lenses. - Klotz, S A; Butrus, S I; Misra, R P; Osato, M S (Current eye research, 1989)
Ten isolates of Pseudomonas aeruginosa obtained from the corneas of patients with Pseudomonas keratitis adhered to soft contact lenses in significantly greater numbers than did six isolates from other body sites (P less than .05). However, there was no predominant serotype among the 10 corneal isolates tested. Isolates grown statically in broth at 37 degrees C formed a pellicle and adhered two times as much to contact lenses as did isolates grown in broth while shaking which did not form a pellicle (P less than .01). The more adherent isolates (grown at 37 degrees C) were shown to be more hydrophobic than the less adherent bacteria (grown at 26 degrees C) by their propensity to accumulate at the interface between hexadecane and saline and their movement into polyethylene glycol from dextran. These corneal isolates agglutinated erythrocytes, a process that was inhibited by dilute solutions (as low as 0.01%) of three commonly used surfactants. These same surfactants inhibited the adherence of Pseudomonas aeruginosa to soft contact lens surfaces by as much as 52%. It is concluded that hydrophobic interactions may significantly contribute to the ability of Pseudomonas aeruginosa to adhere to contact lenses.
Keywords: *Bacterial Adhesion; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Hemagglutination Tests; *Pseudomonas aeruginosa/ph [Physiology]; Serotyping; Surface Properties

Moraxella corneal ulcer. - Parker, P (Journal of ophthalmic nursing & technology, 1988)
Keywords: Aged; *Bacterial Infections/nu [Nursing]; Bacterial Infections/pa [Pathology]; *Corneal Ulcer/nu [Nursing]; Corneal Ulcer/pa [Pathology]; Humans; Male; Middle Aged; Moraxella; Patient Compliance

Treatment versus no treatment in chronic open angle glaucoma. - Holmin, C; Thorburn, W; Krakau, C E (Acta ophthalmologica, 1988)
In a controlled randomized study 15 patients (20 eyes) with chronic open angle glaucoma and visual field defects were followed by greater than 1 year, 12 of them were followed for 3 years. Half of the group were untreated controls, the other half treated with pressure reducing medical therapy. At least 5 consecutive computerized visual fields were recorded (COMPETER) on each eye, and the linear regression coefficient was calculated. With the reservation for uncontrolled compliance no significant difference in the line of favourable effect of pressure reduction could be spotted, in spite of an average pressure reduction in the treated group of 4 mmHg. More important than this result, which is open to criticism for the smallness of the material, uncontrolled compliance etc, is the lesson that a randomized experiment with treated and non-treated glaucoma cases carried out in accordance with the Helsingfors convention is hardly feasible.
Keywords: Aged; Clinical Trials as Topic; Female; Follow-Up Studies; *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Random Allocation; Visual Fields

Effect of changing medication regimens in glaucoma patients. - Novack, G D; David, R; Lee, P F; Freeman, M I; Duzman, E; Batoosingh, A L (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 1988)
When glaucoma medication fails to adequately control intraocular pressure (IOP), a second medication is frequently added. Before adding a second drug to patients whose IOP was no longer controlled by 0.5% timolol, we tested the effect of switching to another beta blocker, levobunolol (0.5 or 1%). We also evaluated the effect of study participation on compliance in the control group continuing to receive 0.5% timolol. In each treatment group, the IOP of approximately 30-40% of the patients was successfully controlled for the 3-month study period. The remaining patients did not exhibit significant pressure reductions and were dropped from the study within 2 weeks. We concluded that (1) the results of 'switch' studies without a control group must be interpreted carefully, and (2) the initiation of a 'new regimen' with an equieffective beta blocker may be sufficient to increase compliance and thereby control IOP.
Keywords: Aged; Clinical Trials as Topic; Double-Blind Method; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Levobunolol/ad [Administration & Dosage]; *Levobunolol/tu [Therapeutic Use]; Male; Middle Aged; Ocular Hypertension/dt [Drug Therapy]; Patient Compliance; Timolol/ad [Administration & Dosage]; *Timolol/tu [Therapeutic Use]

Prevalence and causes of blindness in the northern Transvaal. - Bucher, P J; Ijsselmuiden, C B (The British journal of ophthalmology, 1988)
During November 1985 a survey was carried out to determine the prevalence and causes of blindness in the Elim Hospital district of Gazankulu in the Northern Transvaal, South Africa, and to assess the Eye Department's effectiveness in preventing blindness. Using a random cluster sample technique, we screened 18,962 of the estimated 71,200 inhabitants of the district (26.6%). We found 109 blind people. The prevalence of blindness was 0.57% (95% confidence interval 0.46%-0.68%). The main causes of blindness were senile cataract (55%), corneal scarring due to trachoma (10%), uncorrected aphakia (9%), and open-angle glaucoma (6%). There were 14 aphakic blind persons who did not have aphakia glasses (43% of all persons operated on for cataract). Women had a significantly higher prevalence of blindness than men. After the age of 60 years the prevalence of blindness increased sharply. Women were 1.6 times less likely to have undergone cataract surgery than men. The two most effective steps to reduce the prevalence of blindness in the Elim district further are to provide aphakia glasses to all aphakic patients and to improve the accessibility of the Eye Department's surgical services.
Keywords: Adolescent; Adult; Aged; Aphakia/co [Complications]; *Blindness/ep [Epidemiology]; Blindness/et [Etiology]; Cataract/co [Complications]; Child; Child, Preschool; Cross-Sectional Studies; Female; Glaucoma, Open-Angle/co [Complications]; Humans; Infant; Infant, Newborn; Male; Middle Aged; South Africa; Trachoma/co [Complications]

Corneal complications of herpes zoster ophthalmicus. Prevention and treatment. - Cobo, L M (Cornea, 1988)
Corneal complications of herpes zoster ophthalmicus include pseudodendritic keratitis, late mucous adherent keratopathy, varied forms of stromal keratitis, and exposure/neurotrophic keratopathy. Prophylactic therapy of acute herpes zoster ophthalmicus with oral acyclovir is of proven benefit in reducing the incidence of early pseudodendritic keratopathy and stromal keratitis but has no evident effect on exposure/neurotrophic keratopathy. Although early pseudodendritic keratitis is due to virus infection of epithelial cells, it is self-limited and does not require topical antiviral therapy. Stromal keratitis and associated epithelial mucous adherent keratopathy are responsive to topical corticosteroids but chronic therapy is often required and may prolong the duration of keratitis and result in cataract or secondary glaucoma. Exposure and neurotrophic keratopathy may respond to topical lubricants and correction of lid abnormalities but severely affected corneas may require tarsorrhaphy or conjunctival flap to maintain corneal integrity.
Keywords: Acyclovir/tu [Therapeutic Use]; Administration, Oral; Administration, Topical; Adrenal Cortex Hormones/tu [Therapeutic Use]; Antiviral Agents/tu [Therapeutic Use]; Cornea/pa [Pathology]; Corneal Diseases/cl [Classification]; Corneal Diseases/dt [Drug Therapy]; *Corneal Diseases/et [Etiology]; Corneal Diseases/pc [Prevention & Control]; Corneal Stroma; *Herpes Zoster Ophthalmicus/co [Complications]; Humans; Keratitis/dt [Drug Therapy]; Keratitis/et [Etiology]; Lubrication

The effects of oral or intravenous citrate on the activation of neutrophils in vitro. - Pfister, R R; Haddox, J L; Pfister, D R; Lank, K M; Snyder, T L (Cornea, 1988)
Topical citrate has been shown to significantly reduce the severity and incidence of corneal ulceration in alkali-burned rabbit eyes. Subcutaneous injection of citrate significantly reduced the severity of ulceration. This study was performed to determine the plasma citrate and ionized calcium levels after systemic administration of citrate. Repeated ingestion of citric acid capsules showed a small increase in the plasma citrate level, but no significant change in the level of ionized serum calcium 30 min after the last ingestion. A single dose of Polycitra-LC (6.672 g of citrate) more than doubled the baseline citrate concentration but only induced a 5% decrease in the level of ionized serum calcium 30 min after ingestion. Neither regimen of orally administered citrate produced any significant effect on the respiratory burst or adherence of in vitro polymorphonuclear leukocytes (PMNs) resuspended in their respective plasma. In comparison studies, higher levels of plasma citrate and lower levels of ionized serum calcium were achieved through plateletpheresis. The respiratory burst and adherence of PMNs were not statistically different from baseline PMNs. However, there was an inverse correlation between the micromolar increase in citrate or the micromolar decrease in calcium and the respiratory burst. These results suggest that the use of oral citrate alone may not be practical, but does not preclude the use of oral citrate as a supplement to topical citrate.
Keywords: Administration, Oral; Adult; Alkalies; Burns, Chemical/th [Therapy]; Calcium/bl [Blood]; Cell Adhesion/de [Drug Effects]; Citrates/ad [Administration & Dosage]; Citrates/bl [Blood]; *Citrates/pd [Pharmacology]; Citric Acid; Humans; In Vitro Techniques; Middle Aged; *Neutrophils/de [Drug Effects]; Oxygen Consumption/de [Drug Effects]; Plateletpheresis

Does lacrimal duct occlusion decrease intraocular pressure in patients refractory to medical treatment for glaucoma? A randomized, sham-controlled, crossover trial. - Simel, D L; Simel, P J (Journal of clinical epidemiology, 1988)
We temporarily occluded lacrimal ducts with dissolvable collagen inserts in a randomized, double masked, sham-controlled crossover trial to test whether longer ocular contact of eye drops lowers intraocular pressure in patients with refractory glaucoma. Patients were randomized to the sequence temporary lacrimal duct occlusion----21 day washout----sham occlusion (6 patients), or the reverse order (5 patients); all maintained their usual medication. Compliance was greater than 90% for every patient as assessed by medication diaries kept by each patient's medication partner. There was no treatment effect (bivariate Wilcoxon chi 2 = 0.10, p = 0.95) or treatment-period interaction (chi 2 = 2.87, p = 0.24). However, whichever treatment was received first significantly lowered intraocular pressure (left eye first period X:[ipr50] = 3.0: [-6.0, -1.0] mmHg, right eye = -3.0:[-6.0, -1.0] mmHg, bivariate response chi 2 = 5.92, p = 0.05). Although lacrimal duct occlusion appears to have no clinical benefit, more careful supervision of eye drop administration may be efficacious for treating some patients with medically refractory glaucoma.
Keywords: Collagen; Double-Blind Method; *Glaucoma/th [Therapy]; Humans; *Intraocular Pressure; *Lacrimal Apparatus; *Nasolacrimal Duct; Ophthalmic Solutions/pk [Pharmacokinetics]; *Prostheses and Implants; Random Allocation

Glaucoma therapy: the pharmacist's role in compliance. - O'Dea, P (American pharmacy, 1988)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance; Patient Education as Topic; *Pharmacists

Ocular effects of hard gas-permeable-lens extended wear. - Polse, K A; Rivera, R K; Bonanno, J (American journal of optometry and physiological optics, 1988)
Thirty-five myopic subjects were fitted with rigid gas-permeable lenses for 6 months of extended wear (EW). These lenses had an average oxygen transmissibility of 37 x 10(-9) (cm x ml x O2)/(s x ml x mm Hg). For six monthly morning visits subjects reported with one eye patched; corneal thickness, corneal curvature, refractive error, endothelial photomicroscopy, and slitlamp examinations were done on both eyes. The average morning corneal swelling was 5.9 +/- 3.3%. Corneal curvature showed 0.24 +/- 0.44 D flattening in the steep meridian and 0.20 D steepening in the flat meridian. Spectacle refraction and corrected visual acuity changes were small in the spherical and cylindrical components. Complications that were important clinically included 10% lens adherence syndrome, 20% superficial limbal keratitis, 6.5% epithelial microcysts, and some increase in endothelial polymegathism. No infections, red eye responses, or infiltrative keratitis were observed during the 6-month follow-up period. These results suggest that hard-lens EW is feasible and that lenses with this Dk/L value will meet oxygen requirements for many patients; however, some patients will require lenses of higher oxygen transmissibility to avoid undesirable complications.
Keywords: Cell Count; *Contact Lenses, Extended-Wear; *Contact Lenses, Hydrophilic; *Cornea/ph [Physiology]; Endothelium, Corneal/pa [Pathology]; Gases; Humans; Permeability; Refractive Errors/pp [Physiopathology]; Refractive Errors/th [Therapy]

Eye pain with nifedipine and disturbance of taste with captopril: a mutually controlled study showing a method of postmarketing surveillance. - Coulter, D M (British medical journal (Clinical research ed.), 1988)
Several notifications of eye pain and blurred vision associated with treatment with nifedipine were received by New Zealand's Intensive Medicines Monitoring Programme. A questionnaire survey of patients taking nifedipine was undertaken to test the importance of these associations, with disturbance of taste associated with captopril taken as a methodological control. Altogether 961 patients taking nifedipine and 368 taking captopril were sent a questionnaire that asked whether any eye problems and changes in the sense of taste had occurred while they were taking the drug and whether these had resolved after treatment was stopped. Compliance was high: of 922 and 343 questionnaires that were assumed to have been delivered to patients taking nifedipine and captopril, respectively, 770 (84%) and 295 (86%) were returned satisfactorily completed. The distribution of sex was comparable in the two groups; patients taking captopril were slightly younger. Eye symptoms were reported in both groups, but eye pain was significantly more common in patients taking nifedipine (107 (14%) compared with 26 (9%) patients taking captopril). This is a new finding and may be related to ocular vasodilatation. Theoretically, glaucoma is a possible adverse reaction. Loss of taste was significantly associated with captopril, but no other disturbances of taste showed significant associations. Loss of taste persisted in 27 out of 35 patients who continued to take captopril and in three out of eight patients when the drug was withdrawn. This study showed a method of assessing early signs of adverse drug reactions, which has been used once before and identified previously unrecognised reactions.
Keywords: Adolescent; Adult; Aged; Captopril/ae [Adverse Effects]; Child; *Evaluation Studies as Topic/mt [Methods]; *Eye Diseases/ci [Chemically Induced]; Eye Diseases/pp [Physiopathology]; Female; Humans; Male; Middle Aged; *Nifedipine/ae [Adverse Effects]; *Pain/ci [Chemically Induced]; *Product Surveillance, Postmarketing/mt [Methods]; Taste Disorders/ci [Chemically Induced]; Vision Disorders/ci [Chemically Induced]

An organ culture system for study of adherence of Pseudomonas aeruginosa to normal and wounded corneas. - Spurr-Michaud, S J; Barza, M; Gipson, I K (Investigative ophthalmology & visual science, 1988)
An organ culture system has been developed to study the adherence of Pseudomonas aeruginosa to unwounded corneas and to corneas healing after a 3 mm central epithelial debridement. The Pseudomonas strain was isolated from a human corneal ulcer; suspensions containing 1 X 10(8) colony-forming units/ml (CFU/ml) of bacteria were incubated with the corneas for the last 30 min of the 18 hr culture period. The distribution pattern and number of adherent bacteria on the ocular surface were determined by morphometric analysis of scanning electron micrographs. Few bacteria (25 +/- 15/mm2) adhered to the apical cells of unwounded corneas. There was a definite region-specific distribution of adherent bacteria on healing corneas. There was a definite region-specific distribution of adherent bacteria on healing corneas. Most bacteria were found on the denuded basal lamina in front of the leading edge of the migrating epithelium (360,700 +/- 49,000/mm2). Appreciable but lower numbers adhered to the apical membrane of leading-edge cells (37,700 +/- 6,100/mm2) and to the central portion of the denuded basal lamina (28,800 +/- 10,700/mm2). No bacteria were found adherent to the apical cells of the stratified epithelium behind the leading edge of the epithelium migrating to cover the wound. A similar region-specific distribution of adherent bacteria was found when corneas were inverted in the bacterial suspension and when corneas were incubated in the bacterial suspension for 15 rather than 30 min. Corneas preincubated with the lectin, succinyl-concanavalin A, showed significantly decreased bacterial adherence, indicating a possible role for mannose moieties of wound surface glycoconjugates in bacterial adherence.
Keywords: Animals; *Bacterial Adhesion; *Cornea/ph [Physiology]; Cornea/ul [Ultrastructure]; *Corneal Diseases/pp [Physiopathology]; Humans; Organ Culture Techniques; *Pseudomonas Infections/pp [Physiopathology]; Pseudomonas aeruginosa/ph [Physiology]; Rats; Rats, Inbred Strains

Argon laser trabeculoplasty five years on. - Brooks, A M; West, R H; Gillies, W E (Australian and New Zealand journal of ophthalmology, 1988)
The results of argon laser trabeculoplasty (ALT) in a series of 252 patients are presented with follow-up of up to five years. The procedure is effective in chronic open-angle glaucoma (COAG), ocular hypertension and pseudoexfoliative (PXF) glaucoma. Most cases were treated initially over 180 degrees of the angle and repeat treatment of the remaining 180 degrees usually resulted in an additional fall in IOP which was maintained at two, three and four year follow-up with only a small number of these retreated cases having no fall on later follow-up. ALT was not very effective in further lowering IOP in eyes with IOP controlled to a low level before treatment or in low tension glaucoma. It was effective in most of a number of miscellaneous glaucomas including pigmentary glaucoma. Apart from the immediate high rise in IOP the main complication was a late high rise in IOP which was serious in degree and appeared mainly in PXF but also in two cases of ocular hypertension. The presence of a concomitant fall in IOP in the fellow untreated eye is important and probably due to better compliance with treatment. Almost all cases required medical treatment for glaucoma which could not be ceased after ALT. ALT should be seen as an adjunct to, but not a substitute for, medical treatment.
Keywords: Adult; Aged; Female; Follow-Up Studies; *Glaucoma/su [Surgery]; Glaucoma, Open-Angle/su [Surgery]; Humans; *Laser Therapy/mt [Methods]; Male; Middle Aged; *Trabeculectomy/mt [Methods]

Trigeminal schwannoma. Surgical series of 14 cases with review of the literature. - McCormick, P C; Bello, J A; Post, K D (Journal of neurosurgery, 1988)
A consecutive series of 14 patients with trigeminal schwannoma managed surgically at the Neurological Institute of New York since 1970 is reported. Nine women and five men (mean age 40 years) were diagnosed following a mean symptom duration of 33 months. Abnormalities of trigeminal nerve function were present in 11 patients on admission examination. Facial pain was a prominent feature in eight patients. Two patients, both with schwannomas arising from the trigeminal root, presented initially with typical trigeminal neuralgia. Additional cranial nerve palsies or cerebellar or pyramidal tract signs were noted in eight patients. The surgical approach to these tumors depends on their anatomical location. Four patients had tumors confined to the middle fossa, three patients had tumors limited to the posterior fossa, and seven patients had both supratentorial and infratentorial components of their tumors. Twenty operative procedures were performed on these patients, resulting in complete extirpation in six patients, nearly complete removal in seven patients, and partial removal in one patient. Adherence of the tumor to the lateral wall of the cavernous sinus or the brain stem precluded total removal. There was one postoperative death. In the immediate postoperative period, abnormalities of cranial nerves controlling the extraocular muscles were common. In general, these deficits were transient; however, some permanent loss of trigeminal nerve function occurred in nine patients. Two patients required tarsorrhaphy for neurotropic keratitis, and two patients underwent cerebrospinal fluid (CSF) shunting procedures for hydrocephalus or for a persistent CSF leak. The follow-up period ranged from 4 to 177 months (mean 47 months). The clinical features, anatomical considerations, and surgical approach to these rare tumors are discussed. A clinical review of 106 additional cases of trigeminal schwannoma, reported in the English literature since 1935, is also presented.
Keywords: Adolescent; Adult; Aged; Cerebral Angiography; Cranial Nerve Neoplasms/pa [Pathology]; Cranial Nerve Neoplasms/pp [Physiopathology]; *Cranial Nerve Neoplasms/su [Surgery]; Cranial Nerves/pp [Physiopathology]; Female; Follow-Up Studies; Humans; Male; Masticatory Muscles/pp [Physiopathology]; Middle Aged; Neurilemmoma/pa [Pathology]; Neurilemmoma/pp [Physiopathology]; *Neurilemmoma/su [Surgery]; Postoperative Period; Sensation; Time Factors; Tomography, X-Ray Computed; Trigeminal Nerve/pp [Physiopathology]; *Trigeminal Nerve

Hydrogel contact lens cleaning with or without multi-enzymes. A prospective study. - Nilsson, S E; Lindh, H (Acta ophthalmologica, 1988)
In a group of 66 daily hydrogel contact lens wearers, all lenses were cleaned and disinfected daily using a regular daily cleaner and a 3% hydrogen peroxide system. In addition, one of the lenses for each subject was subjected to weekly enzymatic cleaning with a multi-enzyme pancreatin preparation. After 6 months there were highly significant differences (P less than 0.001) between the lenses, the enzymatically cleaned ones showing less deposits and longer break-up time (BUT) on the lens. Also, comfort was significantly (P less than 0.05) better for these latter lenses. No adverse reactions that could be attributed with certainty to the preparations used were observed. The effectiveness of the pancreatin preparation employed in this study is of interest, since it has been demonstrated that enzymatic removal of deposits from hydrogel lenses reduces complications such as acute red eye reaction, contact lens-induced papillary conjunctivitis, and presumably also corneal ulceration because of decreased bacterial adherence to the lenses.
Keywords: Amylases/ad [Administration & Dosage]; *Contact Lenses, Hydrophilic; *Disinfection/mt [Methods]; Lipase/ad [Administration & Dosage]; Peptide Hydrolases/ad [Administration & Dosage]; Prospective Studies; *Sterilization/mt [Methods]

Adherence of Pseudomonas aeruginosa to hydrophilic contact lenses and other substrata. - Miller, M J; Ahearn, D G (Journal of clinical microbiology, 1987)
Nonmucoid Pseudomonas aeruginosa isolated from corneal ulcers and contact lens cases and solutions were examined for their ability to adhere to polystyrene, glass, and hydrophilic contact lenses of varying water content and polymer composition. Adherence to the various substrates was strain specific. Adherence also was influenced by hydrophobicity and chemical composition of the substratum, as well as pH and electrolyte concentration. An extracellular polymeric adhesive appeared to be involved in the firm attachment of cells to soft contact lenses.
Keywords: *Bacterial Adhesion; *Contact Lenses, Hydrophilic; Electrolytes; Glass; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Hydrogen-Ion Concentration; Microscopy, Electron; Polyethylene Glycols/me [Metabolism]; Polystyrenes/me [Metabolism]; *Pseudomonas aeruginosa/ph [Physiology]; Pseudomonas aeruginosa/ul [Ultrastructure]; Species Specificity

Pressure compliance of the optic nerve head in low tension glaucoma. - Pillunat, L E; Stodtmeister, R; Wilmanns, I (The British journal of ophthalmology, 1987)
Twenty eyes of 10 healthy subjects, 11 eyes of seven patients with low tension glaucoma, and three eyes of three patients with ischaemic optic neuropathy were investigated. Visual evoked responses were recorded under stepwise artificially increased intraocular pressures. The results of the visual evoked response recording (pressure compliance test) allow a clear distinction to be made between healthy subjects, patients with low tension glaucoma, and patients with ischaemic optic neuropathy. In the groups investigated a lack of autoregulation of the optic nerve head circulation was found in patients with low tension glaucoma only. Patients with anterior ischaemic optic neuropathy showed the same pressure compliance behaviour as healthy subjects. The methods used here seem to provide a practicable clinical tool in the differential diagnosis of low tension glaucoma.
Keywords: *Evoked Potentials, Visual; Female; Glaucoma/di [Diagnosis]; *Glaucoma/pp [Physiopathology]; Humans; Intraocular Pressure; Ischemia/di [Diagnosis]; *Ischemia/pp [Physiopathology]; Male; Middle Aged; Optic Disk/pp [Physiopathology]; *Optic Nerve/bs [Blood Supply]

Cell adherence to microfilariae of Onchocerca volvulus: a comparative study. - Williams, J F; Ghalib, H W; Mackenzie, C D; Elkhalifa, M Y; Ayuya, J M; Kron, M A (Ciba Foundation symposium, 1987)
The conditions were examined for in vitro antibody-mediated adherence of granulocytes to microfilariae of Onchocera volvulus and Dirofilaria immitis. Reactivity in human sera from patients in endemic foci in Sudan was specific for O. volvulus and no reactions were observed with heterologous Onchocerca species or with Mansonella perstans. Microfilariae from skin, nodules or adult female worms were satisfactory targets for cell adherence, and the cells involved were almost exclusively eosinophils. The reaction was inhibited by indomethacin but not by nordihydroguaiaretic acid, an inhibitor of leukotriene production. Agents that slowed or stopped microfilarial motility (e.g. nifedipine, lidocaine, chloroquine) inhibited the reaction, probably by reducing target/cell contact. Ivermectin did not enhance the reaction, and in the absence of cells exerted only slight effects on the movement of microfilariae at higher concentrations (greater than 10 micrograms/ml). Antibody activity was labile, and did not persist well through freeze-thaw cycles. Some differences between homologous and heterologous mixtures (microfilariae/cells/serum) were seen but they could not be resolved satisfactorily. There were no apparent geographical differences between microfilariae from different foci in Sudan. In the D. immitis system neutrophils were the dominant cell type adhering to microfilariae, and the activity was stable to storage and freeze-thaw. No enhancement was detectable with diethylcarbamazine. Antibody activity was absorbable with microfilarial antigens and was reduced by agents that inhibited microfilarial motility. In dogs, adherence-mediating antibody was seen only in amicrofilaraemic animals with occult infection, and in only a minority of these sera. In humans the relationship to clinical findings was less clear, but patients with punctate keratitis were the most likely to have positive serum and were the most reactive in the assay. This system may therefore offer some insights into disease mechanisms in vivo, and its molecular mechanisms deserve further characterization.
Keywords: Animals; Antibodies/im [Immunology]; Cell Adhesion; Dirofilaria immitis/im [Immunology]; Dirofilariasis/im [Immunology]; Dirofilariasis/ve [Veterinary]; Dog Diseases/im [Immunology]; Dogs; *Eosinophils/im [Immunology]; Female; *Granulocytes/im [Immunology]; Humans; Keratitis/im [Immunology]; Mansonella/im [Immunology]; Mansonelliasis/im [Immunology]; Microfilariae/im [Immunology]; *Onchocerca/im [Immunology]; *Onchocerciasis/im [Immunology]; Skin Diseases, Parasitic/im [Immunology]

Acanthamoeba keratitis in soft contact lens wearers. A case-control study. - Stehr-Green, J K; Bailey, T M; Brandt, F H; Carr, J H; Bond, W W; Visvesvara, G S (JAMA, 1987)
Acanthamoeba keratitis is a rare, serious protozoal infection of the cornea associated with wearing contact lenses. To identify risk factors in soft contact lens wearers, we interviewed 27 patients with Acanthamoeba keratitis and 81 uninfected matched controls to compare contact lens care practices, brands of contact lenses and associated solutions, and behavioral activities. Patients were significantly more likely than controls to use homemade saline instead of commercially prepared saline (21/27 [78%] vs 14/81 [17%]; odds ratio [OR], infinity), and wear their lenses while swimming (17/27 [63%] vs 24/81 [30%]; OR, 6.2). Contact lens disinfection schedules could be determined for 25 of the patients and all of the controls. Patients were significantly more likely than controls to disinfect their lenses less frequently than recommended by lens manufacturers (18/25 [72%] vs 26/81 [32%]; OR, 5.8). Microbiologic assay of contact lens solutions from controls showed frequent contamination with high levels of bacteria. Acanthamoeba species were isolated from homemade saline solutions from two controls. These findings emphasize adherence to recommended methods of soft contact lens care, especially when using nonsterile lens care solutions.
Keywords: Amebiasis/ep [Epidemiology]; *Amebiasis/et [Etiology]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Humans; Keratitis/ep [Epidemiology]; *Keratitis/et [Etiology]; Keratitis/ps [Parasitology]; United States

A glaucoma medication time-table card. - Kooner, K S; Zimmerman, T J (Annals of ophthalmology, 1987)
Keywords: Drug Administration Schedule; *Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; *Patient Education as Topic/mt [Methods]

Why optometrists should treat glaucoma. - Bartlett, J D (Journal of the American Optometric Association, 1987)
Keywords: Blindness/et [Etiology]; Blindness/pc [Prevention & Control]; Costs and Cost Analysis; Glaucoma/co [Complications]; *Glaucoma/th [Therapy]; Health Services Accessibility; Humans; Optometry/ec [Economics]; *Optometry/mt [Methods]; Social Security

Immunological complications of soft contact lenses. - Mondino, B J; Brawman-Mintzer, O; Boothe, W A (Journal of the American Optometric Association, 1987)
Immunologic reactions may be the basis of some complications associated with the use of soft contact lenses. In the case of giant papillary conjunctivitis, the antigen causing the problem is not known but is presumed to be protein adherent to the lenses. Superior limbic keratoconjunctivitis and dendritic corneal lesions related to soft contact lenses are associated with thimerosal, but occlusive patch tests do not demonstrate consistent delayed hypersensitivity responses to this preservative in these patients, suggesting that a toxic response may be involved. The association of corneal infiltrates and conjunctival hyperemia with delayed hypersensitivity to thimerosal probably represents the strongest immunologic association to date. These patients consistently show delayed hypersensitivity reactions to thimerosal in occlusive patch tests and intradermal tests.
Keywords: *Conjunctival Diseases/et [Etiology]; Conjunctival Diseases/im [Immunology]; Conjunctivitis, Allergic/et [Etiology]; Conjunctivitis, Allergic/im [Immunology]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; *Corneal Diseases/et [Etiology]; Corneal Diseases/im [Immunology]; Humans; *Hypersensitivity, Delayed/im [Immunology]; Keratitis, Dendritic/et [Etiology]; Keratitis, Dendritic/im [Immunology]; Keratoconjunctivitis/et [Etiology]; Keratoconjunctivitis/im [Immunology]; Thimerosal/ae [Adverse Effects]

The adherence of Pseudomonas aeruginosa to soft contact lenses. - Butrus, S I; Klotz, S A; Misra, R P (Ophthalmology, 1987)
The adherence of Pseudomonas aeruginosa to extended-wear soft contact lenses (EWSCLs) may be an important initial step in the pathogenesis of EWSCL-associated infectious keratitis. P. aeruginosa tend to adhere more to worn EWSCLs than unworn EWSCLs (P less than 0.05). Normal tear components such as aqueous solutions of albumin, lysozyme, and lactoferrin all significantly enhance adherence of P. aeruginosa to unworn EWSCLs often by as much as 300%. The presence of a 1% solution of sialic acid in the bathing medium significantly reduces the adherence of P. aeruginosa to both unworn and worn lenses. Inhibition of bacterial adherence could also be achieved with the addition of mucin (which contains terminal sialic acid residues in its major sugar chains). Therefore, selective adherence by P. aeruginosa to a specific sugar (sialic acid) may be important in the initial attachment of the bacterium to soft contact lenses.
Keywords: *Bacterial Adhesion; *Contact Lenses, Extended-Wear/ae [Adverse Effects]; *Contact Lenses, Hydrophilic/ae [Adverse Effects]; Eye Proteins/ph [Physiology]; Humans; *Keratitis/mi [Microbiology]; *Pseudomonas Infections/mi [Microbiology]; Pseudomonas aeruginosa/py [Pathogenicity]

The effect of enzymatic contact lens cleaning on adherence of Pseudomonas aeruginosa to soft contact lenses. - Stern, G A; Zam, Z S (Ophthalmology, 1987)
Previous studies have demonstrated that Pseudomonas aeruginosa adheres more readily to soft contact lenses with a mucin coating than to unworn contact lenses. The mucin coatings that develop on soft contact lenses may, therefore, play a significant role in the pathogenesis of contact lens-associated Pseudomonas corneal ulceration. We tested the ability of a variety of enzymatic contact lens cleaners and other enzyme solutions to decrease the adherence of Pseudomonas to mucin-coated soft contact lenses. Of the commercially available solutions that were tested, cleaning with Optizyme and Extenzyme significantly reduced the adherence of Pseudomonas to the lenses, whereas cleaning with the Softmate Weekly Cleaning System had no effect. Optizyme and Extenzyme were as effective as a 10% solution of acetylcysteine and more effective than a 0.25% trypsin solution. Neuraminidase at pH 5 was the most effective solution at reducing the adherence of Pseudomonas to the lenses, supporting the finding that sialic acid is a specific receptor for Pseudomonas aeruginosa. Soft contact lenses should be cleaned frequently with an effective enzymatic cleaner to reduce the likelihood of Pseudomonas adhering to the lens and thereby reduce the incidence of Pseudomonas corneal ulceration in soft contact lens wearers.
Keywords: Acetylcysteine/pd [Pharmacology]; *Bacterial Adhesion/de [Drug Effects]; *Contact Lenses, Extended-Wear; *Contact Lenses, Hydrophilic; *Detergents/pd [Pharmacology]; *Enzymes/pd [Pharmacology]; Hydrogen-Ion Concentration; Neuraminidase/pd [Pharmacology]; Pancreatin/pd [Pharmacology]; Papain/pd [Pharmacology]; Pseudomonas aeruginosa/de [Drug Effects]; *Pseudomonas aeruginosa/ph [Physiology]; *Surface-Active Agents/pd [Pharmacology]; Trypsin/pd [Pharmacology]