Comparison of a noninvasive measurement of optic nervehead mechanical compliance with an invasive method. - Zeimer, R C; Chen, K (Investigative ophthalmology & visual science, 1987)
We have postulated that abnormal mechanical support of the optic nervehead at the level of the lamina cribrosa could be the precursor of glaucomatous damage. Recent studies have shown deformations of the lamina cribrosa to be among the earliest changes in glaucoma. To evaluate the support of the nervehead, we have developed a noninvasive optical method to measure the optic nervehead compliance, namely, the displacement of the optic nervehead induced by an artificial increase in intraocular pressure. To test the validity of the method, we have compared noninvasive measurements obtained in post-mortem enucleated human eyes with those recorded using an invasive technique. Both methods had a reproducibility better than 6 microns and induced no damage capable of interfering with the results. The displacements measured by both methods were similar, thus indicating that our optical method is capable of measuring bulk motion of the optic nervehead. Our results were identical with those obtained by other authors using a third method. The data obtained also established the normal range of optic nervehead displacements induced by a range of intraocular pressure increments.
Keywords: Adult; Aged; Elasticity; Female; *Glaucoma/pp [Physiopathology]; Humans; Male; Methods; Middle Aged; *Optic Nerve/pp [Physiopathology]; Rheology

Management of open-angle glaucoma. - Stelmack, T R (Journal of the American Optometric Association, 1987)
Open-angle glaucoma is a non-curable, blinding disease which has its best prognosis when management begins at its earliest onset. Recent studies, such as those demonstrating axonal loss before functional or physical changes occur, will have an effect on the current standard of management. This includes indications for initiating treatment as well as what constitutes controlled intraocular pressure. Pharmacological management is often difficult due to drug tolerance and compliance problems. Some types of secondary open angle glaucomas respond very poorly to treatment. Hence, an accurate diagnosis is imperative to proper management. Principles underlying pharmacological management are discussed. When pharmacological management fails, laser and/or surgical intervention is required to prevent further vision loss.
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Glaucoma, Open-Angle/su [Surgery]; *Glaucoma, Open-Angle/th [Therapy]; Humans; Laser Therapy; Miotics/tu [Therapeutic Use]; Patient Compliance; Trabeculectomy

[A test of pressure tolerance of the optic nerve head in ocular hypertension]. - Pillunat, L E; Stodtmeister, R; Wilmanns, I; Christ, T (Klinische Monatsblatter fur Augenheilkunde, 1986)
VER was recorded in 7 patients with ocular hypertension while intraocular pressure was artificially elevated. Four of the patients manifested signs of vascular autoregulation, while in 3 no such signs were observed. This absence of autoregulation was also observed in primary open-angle glaucoma patients. On the basis of these first results it may be expected that the pressure compliance test will identify patients with ocular hypertension in whom damage to the optic disk is likely to occur at a later date.
Keywords: Adult; Evoked Potentials, Visual; Female; Glaucoma, Open-Angle/pp [Physiopathology]; Homeostasis; Humans; *Intraocular Pressure; Male; Middle Aged; *Ocular Hypertension/pp [Physiopathology]; Ophthalmodynamometry; *Optic Nerve/pp [Physiopathology]; Visual Fields

New drug therapy in open-angle glaucoma. - Patorgis, C J; Magnus, D (Journal of the American Optometric Association, 1986)
Keywords: Betaxolol; *Drug Therapy/td [Trends]; Drug-Related Side Effects and Adverse Reactions; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Nadolol/ae [Adverse Effects]; Nadolol/tu [Therapeutic Use]; Nadolol/to [Toxicity]; Patient Compliance; Propanolamines/ae [Adverse Effects]; Propanolamines/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]

Compliance with topical pilocarpine treatment. - Hansen, A C (American journal of ophthalmology, 1986)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; Ophthalmic Solutions; *Patient Compliance; *Pilocarpine/ad [Administration & Dosage]

The compliance factor. - Van Buskirk, E M (American journal of ophthalmology, 1986)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Ophthalmic Solutions/tu [Therapeutic Use]; *Patient Compliance

Can ophthalmologists correctly identify patients defaulting from pilocarpine therapy?. - Kass, M A; Gordon, M; Meltzer, D W (American journal of ophthalmology, 1986)
We determined whether clinical measurements and assessments available to ophthalmologists could be used to identify patients who default from pilocarpine treatment. The measurements and assessments included intraocular pressure, pupillary diameter, pupillary reactivity to light, the patient's report of compliance, the physician's prediction of compliance, the patient's log of pilocarpine administration, and the weight of pilocarpine eyedrops utilized. Compliance with the pilocarpine regimen was measured with an unobtrusive eyedrop medication monitor. Intraocular pressure and pupillary diameter did not correlate with compliance to the regimen as measured by the eyedrop monitor. Pupillary reaction to light, the physician's prediction of compliance, a daily log of pilocarpine administration, the weight of pilocarpine utilized, and the patient's report of compliance correlated modestly with compliance as measured by the monitor (range of correlations, 0.19 to 0.24). However, none of these measures taken by itself or combined in any manner adequately distinguished patients with lower rates of compliance from those with higher rates of compliance. At present, the eyedrop monitor is the only reliable method for detecting patients who default from treatment.
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; Ophthalmology; *Patient Compliance; Physician's Role; *Pilocarpine/ad [Administration & Dosage]; Pilocarpine/tu [Therapeutic Use]

Compliance with topical pilocarpine treatment. - Kass, M A; Meltzer, D W; Gordon, M; Cooper, D; Goldberg, J (American journal of ophthalmology, 1986)
Using an unobtrusive eyedrop medication monitor, we measured compliance with topical pilocarpine treatment in a sample of 184 patients. The eyedrop monitor recorded electronically the date and time of each pilocarpine administration over a four- to six-week period. The subjects administered a mean +/- S.D. of 76.0% +/- 24.3% of the prescribed pilocarpine doses. Eleven patients (6%) took less than one quarter and 28 patients (15.2%) took less than one half of the prescribed administrations. In contrast, when the subjects were interviewed they reported taking a mean +/- S.D. of 97.1% +/- 5.9% of the prescribed pilocarpine doses. As determined by the monitor, 45 patients (24.5%) had at least one day per month with no administrations of pilocarpine; 56 subjects (30.4%) compressed the doses during the daytime hours, leaving an interval between the night dose and the morning dose the next day of 12 hours or more. The rate of compliance was significantly higher (P less than .0001) in the 24-hour period preceding the return appointment than in the entire observation period.
Keywords: Aged; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Patient Compliance; Pilocarpine/ad [Administration & Dosage]; *Pilocarpine/tu [Therapeutic Use]

Effect of timolol on optic nerve head autoregulation. - Pillunat, L E; Stodtmeister, R; Wilmanns, I; Metzner, D (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 1986)
Healthy subjects show, in a special pressure compliance test of the optic nerve head, signs of autoregulation of optic nerve head circulation. In this test visual evoked response (VER) amplitudes were recorded during stepwise increased intraocular pressures. In the resulting VER amplitude/pressure curves glaucoma patients did not show the sign of autoregulation of optic nerve head circulation which is seen in healthy subjects. It is known that topically applied timolol maleate may affect optic nerve head circulation. Therefore the pressure compliance test was performed in 20 healthy eyes before and after 3 days of topically applied timolol maleate 0.5%. The aim of the study was to test the effect of topically applied timolol on optic nerve head autoregulation. In addition we determined the ocular perfusion pressures, heart rate and mean arterial blood pressure. While the ocular perfusion pressures show a slight, but statistically not significant, decrease under timolol, the systemic parameters and the autoregulation behavior did not change.
Keywords: Adult; Blood Pressure/de [Drug Effects]; Evoked Potentials, Visual; Female; Glaucoma/pp [Physiopathology]; Heart Rate/de [Drug Effects]; *Homeostasis; Humans; Intracranial Pressure/de [Drug Effects]; Male; Optic Nerve/bs [Blood Supply]; *Optic Nerve/de [Drug Effects]; Optic Nerve/ph [Physiology]; *Timolol/pd [Pharmacology]

Blocking Candida adherence to contact lenses. - Butrus, S I; Klotz, S A (Current eye research, 1986)
The adherence of microorganisms to contact lenses may be an important initial step in the pathogenesis of contact lens-associated infectious keratitis. Using a strain of Candida albicans whose interaction with various polymers has been well characterized we systematically investigated the adherence of this pathogen to hard hydrophobic and soft hydrophilic extended-wear contact lenses. Yeasts adhere to the hydrophobic lenses in direct proportion to the wetting angle of the lens whereas yeasts adhere to the hydrophilic lenses in direct proportion to the water content of the lens. Tear proteins such as albumin, lactoferrin, and lysozyme in addition to fibronectin enhance yeast adherence to both types of lenses (P less than 0.01). Concanavalin A reduces adherence of yeasts to both lens types (P less than 0.01). Among tear components however, only mucin (0.5%) consistently reduced yeast adherence to both lens types. Hydrophilic extended wear lenses worn for at least 28 days by normal patients consistently had greater adherence of yeasts than unworn lenses of the same type, often as much as ten-fold or greater yeasts/mm2 of lens surface area (P less than 0.05). These investigations indicate that tear components both in solution and adsorbed to the lens surface enhance microorganism adherence to contact lenses.
Keywords: *Candida albicans; Cell Adhesion; *Contact Lenses; Contact Lenses, Hydrophilic; Tears/ph [Physiology]

Glaucoma treatment with once-daily levobunolol. - Wandel, T; Charap, A D; Lewis, R A; Partamian, L; Cobb, S; Lue, J C; Novack, G D; Gaster, R; Smith, J; Duzman, E (American journal of ophthalmology, 1986)
Although twice-daily instillation of topical beta-blockers is the standard regimen for treatment of increased intraocular pressure, once-daily therapy might improve patient compliance and provide greater safety. In a three-month, double-masked clinical trial, 92 patients with open-angle glaucoma or ocular hypertension received levobunolol 0.5% or 1% or timolol 0.5% once daily, in both eyes. Overall mean decreases in intraocular pressure were significantly greater in the groups treated with levobunolol than in the group treated with timolol. Intraocular pressure decreases averaged 7.0 mm Hg with levobunolol 0.5%, 6.5 mm Hg with levobunolol 1%, and 4.5 mm Hg with timolol. The intraocular pressures of 72% (18 of 25 patients) of those treated with levobunolol 0.5%, 79% (22 of 28 patients) of those treated with levobunolol 1%, and 64% (16 of 25 patients) of those treated with timolol were successfully controlled during the study. Heart rate and blood pressure decreases were minimal with both levobunolol and timolol. Study results indicated that once-daily treatment with levobunolol and, to a lesser extent, timolol is sufficient to control intraocular pressure successfully and safely.
Keywords: Actuarial Analysis; Adolescent; Adult; Aged; Double-Blind Method; Drug Administration Schedule; Drug Evaluation; *Glaucoma/dt [Drug Therapy]; Heart Rate/de [Drug Effects]; Humans; Intraocular Pressure/de [Drug Effects]; *Levobunolol/ad [Administration & Dosage]; Levobunolol/ae [Adverse Effects]; Levobunolol/tu [Therapeutic Use]; Middle Aged

A review of the treatment of ocular herpes simplex infections in the neonate and immunocompromised host. - Binder, P S (Cornea, 1984)
Infection of newborns and immunocompromised hosts with herpes simplex virus appears to be no more common than in the normal adult. However, the disease tends to be more difficult to treat in the newborn because of poor patient compliance, delay in the diagnosis, and the tendency for retinal disease to occur. The disease is more difficult to treat in the immunocompromised host because of the necessity for maintenance of immunosuppression. Initial treatment is usually the same as used for adults unless intraocular infection occurs. Early diagnosis and treatment in the newborn can prevent corneal opacification and amblyopia, whereas ocular disease in the immunocompromised host may be an insignificant problem compared with infection elsewhere in the host's body.
Keywords: Antiviral Agents/tu [Therapeutic Use]; Combined Modality Therapy; Humans; Immunologic Deficiency Syndromes/di [Diagnosis]; *Immunologic Deficiency Syndromes/th [Therapy]; Infant, Newborn; Keratitis, Dendritic/di [Diagnosis]; *Keratitis, Dendritic/th [Therapy]; Prognosis; Recurrence; Uveitis/th [Therapy]

[Evaluation of the systemic effects of timolol maleate in eye drops]. - Hugues, F C; Le Jeunne, C; Munera, Y; Dufier, J L (Journal francais d'ophtalmologie, 1985)
The systemic effects of timolol eye drops were investigated in 35 patients divided into three groups: 1. (15 asthmatics); 2. (10 non-asthmatic patients suffering from glaucoma); 3. (10 elderly control subjects). A placebo eye drops was given at time 0, the timolol maleate drops were given at time 30 mn. The control parameters were checked every 15 minutes. They did not show variations under placebo. After administration of timolol, systolic and diastolic blood pressures as well as vital capacity remained unchanged. Heart rate decreased in 91% of subjects by a mean: 18.5% and, extreme 38%: Bradycardia was always sino-atrial and there was a dose effect relationship. Also F.E.V., decreased in 13 of the 15 asthmatics and in 2 patients with chronic bronchitis: in 4 patients the decrease in flow exceeded 20%. The importance of timolol in the treatment of open-angle chronic glaucoma is well-established, but the results reported here and else where emphazing frequent risks should induce prescribers to comply with the rules of good use: analysis of previous history, and compliance with general contra-indications to beta blockers. Routine E.C.G. and strict adjustment of dosage is recommended.
Keywords: *Asthma/ci [Chemically Induced]; Asthma/co [Complications]; Blood Pressure; *Bradycardia/ci [Chemically Induced]; Female; Glaucoma, Open-Angle/co [Complications]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Maximal Expiratory Flow Rate; Middle Aged; Ophthalmic Solutions; Timolol/ad [Administration & Dosage]; *Timolol/ae [Adverse Effects]; Vital Capacity

Tenckhoff catheter obstruction resulting from invasion by Curvularia lunata in the absence of peritonitis. - DeVault, G A Jr; Brown, S T 3rd; King, J W; Fowler, M; Oberle, A (American journal of kidney diseases : the official journal of the National Kidney Foundation, 1985)
A 60-year-old black woman on continuous ambulatory peritoneal dialysis (CAPD) presented with Tenckhoff catheter malfunction. She exhibited no signs or symptoms of acute peritonitis. Darkly pigmented plaques were adherent to the inner wall of the catheter and exchange tubing focally throughout its length. Similar material was adherent to the protein coagulum in the dialysis bag. The Tenckhoff catheter and tubing were removed, and hemodialysis was initiated. Cultures of the catheter and the dialysate protein coagulum grew the saprophytic soil fungus, Curvularia lunata. Histologic examination of the catheter and tubing demonstrated penetration of each by hyphae. Catheter removal alone was sufficient to eradicate the fungus since recurrence of colonization or peritonitis has not occurred following the resumption of CAPD. Peritonitis produced by opportunistic pathogens especially fungi is increasingly common. Although Curvularia species have been implicated in pulmonary and cerebral mycetomas, allergic bronchoalveolar disease, and keratitis, they have not been reported previously to cause peritonitis or catheter malfunction in CAPD patients. Fungal invasion of CAPD catheters can produce mechanical obstruction even in the absence of peritonitis. Such colonization does not preclude resumption of chronic peritoneal dialysis at a later date.
Keywords: Catheters, Indwelling; Female; Humans; Kidney Failure, Chronic/et [Etiology]; *Kidney Failure, Chronic/th [Therapy]; Middle Aged; Mitosporic Fungi/ip [Isolation & Purification]; Mycoses/mi [Microbiology]; *Mycoses; *Peritoneal Dialysis/ae [Adverse Effects]; *Peritoneal Dialysis, Continuous Ambulatory/ae [Adverse Effects]; *Peritonitis/et [Etiology]; Peritonitis/mi [Microbiology]; Polycystic Kidney Diseases/co [Complications]

Quantitative office perimetry. - Keltner, J L; Johnson, C A; Lewis, R A (Ophthalmology, 1985)
This study presents a preliminary comparison of six commercially-available automated threshold static parameters, consisting of three projection perimeters (Humphrey Field Analyzer, Squid, and Octopus 500) and three light-emitting diode (LED) perimeters (Dicon 2000, Fieldmaster 50, and Digilab 350). Eighteen individuals were included in the study: 6 normal observers (31-58 years old), six patients with glaucomatous field loss in both eyes (55-70 years old), and six patients with neuro-ophthalmologic or retinal visual field abnormalities in both eyes (12-61 years old). Three aspects of quantitative testing were evaluated: (1) the patients' and normal observers' acceptance and subjective impressions of the test procedure; (2) the technician's ease of operating the device and related tasks; and (3) practitioner-oriented considerations such as test-retest reliability, comparability of test results and testing time. Our results showed that no device was clearly superior to the others in all respects. Patients were most favorably impressed with the Octopus 500, Squid, and the Fieldmaster 50, while technician impressions were most favorable to the Humphrey Field Analyzer and the Squid. The projection perimeters (Humphrey Field Analyzer, Squid, and Octopus 500) were the easiest to perform cross-comparisons of test results, although there was considerable variation in the clarity of data interpretation from one case to another. Test-retest reliability and the time of testing varied among the six automated perimeters.
Keywords: Adolescent; Adult; Child; Computers; Female; *Glaucoma/di [Diagnosis]; Humans; Male; Middle Aged; Patient Acceptance of Health Care; Sensory Thresholds; *Visual Field Tests/is [Instrumentation]; Visual Fields

Iris sphincterotomy, iridotomy, and synechiotomy by linear incision with the argon laser. - Wise, J B (Ophthalmology, 1985)
Linear cuts can be made across the iris fibers by multiple 0.01- to 0.05-second duration argon laser burns delivered through an Abraham iridectomy lens. Intrinsic iris tension will then cause the linear cuts to spread apart. This allows enlargement, reshaping, or repositioning of the pupil and large laser iridotomies with minimal burn energies and a very high percentage of success. The technique minimizes risk to the retina and eliminates the need for stretch burns in laser iridotomy. It requires the use of the Abraham lens and an argon laser, which generates a small spot of high power density. Posterior synechiae can be incised by using a line of low-power 0.01- or 0.02-second burns applied to the adherent pigment epithelium along the iris margin.
Keywords: Adult; Aged; Argon; Female; *Glaucoma/su [Surgery]; Humans; *Iris/su [Surgery]; *Laser Therapy; Male; Methods; Middle Aged

Progression of visual field defects in glaucoma. Relation to compliance with pilocarpine therapy. - Granstrom, P A (Archives of ophthalmology (Chicago, Ill. : 1960), 1985)
In patients with primary open-angle glaucoma, compliance with pilocarpine therapy was studied with an electronic medication monitor. The visual fields and intraocular pressure (IOP) readings were followed up retrospectively during two years before and two years after the compliance measurements. Progression of visual field defects was significantly more common in patients with capsular glaucoma than in patients with simple glaucoma. Eyes with more extensive visual field defects showed progression more often than did eyes with smaller defects, and so did eyes with a high mean IOP as compared with those with a low mean IOP. Visual field defect progression was not significantly more common among patients with "poor" than among patients with "good" compliance, which indicates that noncompliance is less important for the outcome than are the type of glaucoma, the stage of visual field defects, and the mean IOP.
Keywords: *Glaucoma, Open-Angle/dt [Drug Therapy]; Glaucoma, Open-Angle/pp [Physiopathology]; Humans; *Patient Compliance; *Pilocarpine/tu [Therapeutic Use]; *Visual Fields

Compliance and prognosis in glaucoma. - Kass, M A (Archives of ophthalmology (Chicago, Ill. : 1960), 1985)
Keywords: *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance

Screening in health fairs. A critical review of benefits, risks, and costs. - Berwick, D M (JAMA, 1985)
Health fairs provide multiphasic screening to more than 2 million Americans each year, and the number is growing rapidly. Nearly 40 different tests are in use, commonly including the measurement of up to 30 different blood chemistry levels. This report reviews the activities in a sample of 940 health fair sites and examines the experience regarding six specific screening procedures (blood pressure, anemia, blood chemistries, glaucoma, hearing, and fecal occult blood testing). Widespread use of these and other tests raises complex issues of cost, risk, and benefit. Rates of false alarm of healthy people and false reassurance of those at risk may be high for some tests, and the benefits of detecting new disease are easily overestimated. Detailed data collection and evaluation could help health fair sponsors to identify more rational screening strategies.
Keywords: Anemia/ep [Epidemiology]; Blood Chemical Analysis; Cost-Benefit Analysis; Diagnostic Errors; Glaucoma/ep [Epidemiology]; Health Education/ec [Economics]; *Health Education; Health Fairs/ec [Economics]; *Health Fairs; Hearing Disorders/ep [Epidemiology]; Humans; Hypertension/ep [Epidemiology]; Mass Screening/ec [Economics]; *Mass Screening/mt [Methods]; Occult Blood; Patient Compliance; Risk

Keratoplasty for pseudophakic keratopathy. - Robertson, I F; Stasiuk, R M; Campbell, W G (Australian and New Zealand journal of ophthalmology, 1985)
Penetrating corneal grafts were performed on 15 eyes with keratopathy due to implantation of iris-supported intraocular lenses, on one eye with keratopathy due to an anterior chamber lens, and one eye with keratopathy due to a posterior chamber lens. A systematic meticulous surgical technique, with a softened eye, the use of a Flieringa ring, anterior vitrectomy and sodium hyaluronate (Healon) have resulted in clear grafts in all except in four eyes. Although most grafts have remained clear, the visual results are poor mainly due to glaucoma and/or maculopathy. Every effort was made to retain the implants and some were repositioned and sutured to the iris. Long-term postoperative follow-up, with good patient compliance and the judicious use of topical corticosteroids and timolol, is essential to maintain clear grafts.
Keywords: Adult; Aged; *Corneal Diseases/su [Surgery]; *Corneal Transplantation; *Edema/su [Surgery]; Female; Follow-Up Studies; Humans; *Lenses, Intraocular; Male; Middle Aged; *Postoperative Complications/su [Surgery]; Visual Acuity; Vitrectomy

[The vernal plaque, a complication of so-called spring conjunctivitis]. - Dhermy, P; Pouliquen, Y; Foels, M O; Savoldelli, M (Journal francais d'ophtalmologie, 1985)
The vernal ulcer is a peculiar corneal complication of vernal conjunctivitis. Clinically, the ulcer is oval, grey, and resistant to medical treatment. Histological study by light and electron microscopy reveal the lesion to be composed of fibrin deposits adherent to a well-preserved Bowman's membrane. These deposits impede lateral progression of the epithelium, thus, opposing spontaneous healing. Resolution of the ulcer can be obtained, however, by superficial keratectomy.
Keywords: Adolescent; Conjunctiva/pa [Pathology]; *Conjunctivitis, Allergic/co [Complications]; Conjunctivitis, Allergic/pa [Pathology]; Cornea/pa [Pathology]; Cornea/su [Surgery]; Cornea/ul [Ultrastructure]; Corneal Stroma/ul [Ultrastructure]; *Corneal Ulcer/et [Etiology]; Corneal Ulcer/pa [Pathology]; Corneal Ulcer/th [Therapy]; Epithelium/pa [Pathology]; Epithelium/ul [Ultrastructure]; Fibrin/an [Analysis]; Humans; Male; Microscopy, Electron

The office visit and the glaucoma patient. - Olander, K W; Zimmerman, T J (Annals of ophthalmology, 1984)
Keywords: *Glaucoma; Humans; *Office Visits

[Argon laser trabeculoplasty. Initial results of a prospective study]. - Zink, H; Kampik, A; Lund, O E (Klinische Monatsblatter fur Augenheilkunde, 1984)
This paper presents the results of a prospective study on argon laser trabeculoplasty with clinical application in 166 cases up to now. So far, patients have been followed up for between 2 and 12 months. Low-intensity coagulation was performed over 360 degrees of the trabecular meshwork. The coagulation site within the trabecular meshwork was chosen according to the outflow facility as measured by tonography. In eyes with high outflow facility (C greater than 0.08) the unpigmented, so-called nonfunctioning trabecular meshwork was coagulated. Where the outflow facility was lower (C less than 0.03), a pigmented area of the trabecular meshwork was aimed at. Where the facility was intermediate (0.08 greater than C greater than 0.03) the border area between pigmented and nonpigmented meshwork was coagulated. Three groups of patients were treated: (1) older patients with insufficient compliance; (2) patients whose intraocular pressure (IOP) was poorly controlled by drugs and was under 35 mm Hg; (3) patients suffering from glaucoma in aphakia or status post trabeculectomy and poor control of IOP. Applying these criteria , IOP was controlled in 26.8% without additional drugs and in 68% in combination with local medication after 6 weeks. Very few complications were seen (8 cases), and they did not lead to deterioration or loss of vision. In the light of theoretical considerations and initial histopathologic findings in human eyes, the authors assume that low-intensity coagulation causes a denaturation and shrinkage of the trabecular collagen, leading to stretching of the surrounding trabecular structures.(ABSTRACT TRUNCATED AT 250 WORDS)
Keywords: Humans; *Laser Therapy; Prospective Studies; Trabecular Meshwork/pa [Pathology]; *Trabecular Meshwork/su [Surgery]

The follow-up in patients with pseudoexfoliation of the lens capsule with and without glaucoma. 1. Factors influencing the patients attendance in eye-controls. - Slagsvold, J E (Acta ophthalmologica, 1984)
This study deals with the problem of attendances in patients with pseudoexfoliation of the lens capsule with and without glaucoma. While 640 patients attended the controls, 321 patients did not return for re-examination in 2 years. This represents 1/6 of the capsular glaucoma patients and 1/3 of the non-glaucoma patients. The analysis of influencing factors revealed that the glaucoma patients who failed to return had a higher mean age than the non-glaucoma group (P less than 0.001) or the group of glaucoma patients that attended the controls (P less than 0.001). Persons with pseudoexfoliation without glaucoma who did not meet for control were younger than those who met (P less than 0.001). The sex or travelling distance of the patients seemed to be of no influence. Interviewing the glaucoma patients disclosed a resigned attitude towards treatment among those who failed to come. More information and/or communication seem to be the most important factors to achieve better follow-up in persons with pseudoexfoliation without glaucoma.
Keywords: Age Factors; Aged; *Diagnostic Services/sn [Statistics & Numerical Data]; Female; Follow-Up Studies; *Glaucoma/co [Complications]; Health Services Accessibility; Humans; Lens Diseases/co [Complications]; *Lens Diseases/di [Diagnosis]; Male; Middle Aged; Norway; *Patient Dropouts; Sex Factors

Improper topical self-administration of ocular medication among patients with glaucoma. - Brown, M M; Brown, G C; Spaeth, G L (Canadian journal of ophthalmology. Journal canadien d'ophtalmologie, 1984)
Possible sequelae of improper administration of eyedrops include treatment failure, unnecessary use of additional medications and spread of infection. To determine the extent of improper topical self-application of ocular medications, 150 patients with glaucoma who were already using eyedrops were studied. Employing their customary methods of administration 19 (13%) of the patients were unable to place drops in both eyes after one or more attempts, and 120 (80%) of the patients failed to maintain the bottle's sterility during application. No significant relation was found between performance and age, sex, educational level, visual acuity or field, intraocular pressure, length of time the patient had been using eyedrops or, among the 100 clinic patients, whether the patient had received prior instruction in their use. The 50 private practice patients had all received prior instruction, by one physician, whereas only 62% of the clinic patients had, and there had been several instructors at the clinic. Significantly more (p less than 0.05) of the clinic patients than of the private practice patients failed to wash their hands before instilling the drops (97% v. 78%) and were unable to properly instil the drops in both eyes after one or more attempts (18% v. 2%). Therefore, uniform teaching probably improves the ability of patients to topically administer ocular medication.
Keywords: Administration, Topical; Adult; Aged; Ambulatory Care Facilities; Cross-Sectional Studies; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Compliance; Private Practice; Self Administration

Combined procedures for cataract and glaucoma. - Hunsaker, J; Kass, M A (International ophthalmology clinics, 1984)
Keywords: Aged; Anterior Chamber/su [Surgery]; Cataract/co [Complications]; *Cataract Extraction; Follow-Up Studies; Glaucoma, Open-Angle/co [Complications]; Glaucoma, Open-Angle/dt [Drug Therapy]; *Glaucoma, Open-Angle/su [Surgery]; Humans; Methods; Patient Compliance; Postoperative Complications; Time Factors; Trabecular Meshwork/su [Surgery]

Quantitative adherence of bacteria to human corneal epithelial cells. - Reichert, R; Stern, G (Archives of ophthalmology (Chicago, Ill. : 1960), 1984)
An in vitro assay was used to quantitatively determine the ability of a variety of bacteria to adhere to human corneal epithelial cells. Staphylococcus aureus, Streptococcus pneumoniae, and Pseudomonas aeruginosa were found to adhere to corneal epithelium significantly better than other species that were tested. However, there was considerable variability in the adherence of individual strains of these bacterial species. The results of this study support the hypothesis that the frequency with which certain species of bacteria cause bacterial corneal ulceration may be related to the ability of those organisms to adhere to corneal epithelium. In addition, differences in pathogenicity between strains of a given species may be related to the variability of adherence within a species.
Keywords: *Bacterial Physiological Phenomena; *Cornea/cy [Cytology]; Epithelial Cells; Humans; In Vitro Techniques; Pseudomonas aeruginosa/ph [Physiology]; Staphylococcus aureus/ph [Physiology]; Streptococcus pneumoniae/ph [Physiology]

Oral and topical adrenergic beta-receptor blockers in glaucoma treatment. A multicenter study. - Ohrstrom, A; Kattstrom, O; Polland, W; Mortensen, J; Stenstrom, B (Acta ophthalmologica, 1984)
In a long-term multicenter open randomized study of 103 patients with glaucoma or intraocular hypertension, oral propranolol combined with 2% pilocarpine was compared with 0.5% topical timolol also combined with 2% pilocarpine, with respect to the effects on intraocular pressure and other signs of glaucoma. The results showed that the hypotensive effects were highly significant and equal for both treatments. There were no significant differences between the 2 groups in the amount of cupping of the nerve head or the visual field defects developing during treatment. An additive hypotensive effect was recorded when both propranolol and timolol were combined with pilocarpine, which indicates the development of tolerance to both beta-blockers. Pulse rate and blood pressure were moderately reduced in both groups, both significantly more so in the propranolol group. The investigation indicates that when combined with pilocarpine the 2 adrenergic beta-receptor blockers are equally effective. We believe that oral propranolol can improve drug compliance in the treatment of glaucoma.
Keywords: Administration, Oral; Clinical Trials as Topic; *Glaucoma/dt [Drug Therapy]; *Glaucoma, Open-Angle/dt [Drug Therapy]; Hemodynamics/de [Drug Effects]; Humans; Ophthalmic Solutions; *Pilocarpine/ad [Administration & Dosage]; *Propranolol/ad [Administration & Dosage]; Propranolol/ae [Adverse Effects]; Random Allocation; *Timolol/ad [Administration & Dosage]; Timolol/ae [Adverse Effects]

A miniature compliance monitor for eyedrop medication. - Kass, M A; Meltzer, D W; Gordon, M (Archives of ophthalmology (Chicago, Ill. : 1960), 1984)
We developed an eyedrop medication monitor that electronically records the date and time of each medication administration over a six-week period. It records a medication usage in a 15-minute interval when the cap is removed from the bottle and the bottle is inverted. The electronic components housed inside the bottle weigh 7.5 g, including the batteries, and the total volume of the circuit is 7.5 cc. The monitor resembles commercially available 30-mL eyedrop bottles in size, shape, and weight. The monitor is accurate when tested against known patterns of usage. The electronic eyedrop monitor should be useful in assessing compliance with eyedrop medications.
Keywords: Aged; Clinical Trials as Topic; Electronics, Medical/is [Instrumentation]; Equipment Design; Female; Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Microcomputers; Middle Aged; *Monitoring, Physiologic/is [Instrumentation]; *Ophthalmic Solutions/ad [Administration & Dosage]; Pilocarpine/ad [Administration & Dosage]; Time Factors

Ocular history of James Joyce. - Sullivan, E (Survey of ophthalmology, 1984)
James Joyce , considered by many to be the greatest novelist of the 20th century, was plagued by severe eye problems for most of his adult life. The presence of iritis, glaucoma and cataracts was complicated by the complexity of his systemic medical conditions, his noncompliance with professional advice, and the state of the art of ophthalmology during his lifetime.
Keywords: *Eye Diseases/hi [History]; *Famous Persons; History, 20th Century; Humans; Ireland; *Literature, Modern/hi [History]; Male

A reevaluation of glaucoma management. - Quigley, H A (International ophthalmology clinics, 1984)
Keywords: Acetazolamide/tu [Therapeutic Use]; Cataract/et [Etiology]; Costs and Cost Analysis; Drug-Related Side Effects and Adverse Reactions; Endophthalmitis/et [Etiology]; Epinephrine/tu [Therapeutic Use]; Glaucoma/dt [Drug Therapy]; Glaucoma/su [Surgery]; *Glaucoma/th [Therapy]; Humans; Middle Aged; Patient Compliance; Pilocarpine/tu [Therapeutic Use]; Postoperative Complications; Tachyphylaxis; Time Factors; Timolol/tu [Therapeutic Use]; Trabecular Meshwork/de [Drug Effects]; Trabecular Meshwork/su [Surgery]; Visual Acuity

Epidemic keratoconjunctivitis: report of an outbreak in an ophthalmology practice and recommendations for prevention. - Buehler, J W; Finton, R J; Goodman, R A; Choi, K; Hierholzer, J C; Sikes, R K; Elsea, W R (Infection control : IC, 1984)
In Fall 1981, an outbreak of acute infectious conjunctivitis with keratitis (EKC) occurred in patients who had visited a private ophthalmology clinic just prior to onset of illness. Among an estimated 2,200 patient visits to the office from August 10 to October 15, 1981 for problems unrelated to infectious conjunctivitis, 39 (1.8%) persons subsequently developed EKC. The median incubation period was 6.5 days (range, 1 to 14 days). A case-control study was done to identify risk factors associated with contracting EKC; patients with EKC were more likely than control patients to have been examined by one or the other of two of the four ophthalmologists at the clinic and to have undergone procedures such as tonometry or foreign body removal. Adenovirus was isolated from conjunctival swabs from four of five persons with conjunctivitis; three were type 8 and one was type 7. Recognition of the problem and improved handwashing practices were associated with terminating the outbreak. This outbreak illustrates the potential for transmission of adenovirus infection during the provision of eye care. Infection control practitioners should be familiar with measures for the prevention of such infections among ophthalmology patients.
Keywords: *Adenoviridae Infections/ep [Epidemiology]; *Adenovirus Infections, Human/ep [Epidemiology]; Adenovirus Infections, Human/tm [Transmission]; Adolescent; Adult; Aged; Child; Child, Preschool; *Disease Outbreaks/ep [Epidemiology]; Female; Georgia; Hand Disinfection; Humans; *Keratoconjunctivitis/ep [Epidemiology]; Keratoconjunctivitis/tm [Transmission]; Male; Middle Aged; *Office Visits; *Ophthalmology; Risk; Tonometry, Ocular/is [Instrumentation]

Virus chemotherapy: antiviral drugs and interferon. - Kaufman, H E; Varnell, E D; Centifanto-Fitzgerald, Y M; Sanitato, J G (Antiviral research, 1984)
Early antiviral drugs, such as idoxuridine and vidarabine, are less effective than newer drugs, such as trifluorothymidine and acyclovir. However, trifluorothymidine is less subject to the development of drug-resistant strains and can be administered topically as a clear drop, which increases patient compliance. Acyclovir has low toxicity and is selective for virus-infected cells because it must be phosphorylated by the viral thymidine kinase to become active. However, drug-resistant strains are produced relatively easily in vitro and may also develop in man with long-term use. To date, no antiviral drug alone has been shown to be effective in the treatment of stromal disease, and no antiviral drug is able to eradicate virus latent in the ganglia and thereby prevent recurrent herpetic infections. Combinations of antiviral drugs and antiviral drugs and interferon are being tested for enhanced efficacy in the treatment of ocular herpetic disease, and for prophylactic effects. The development of recombinant interferons has reduced cost and increased availability, but the effects of the 'manufactured' interferon are not identical to those of natural human leukocyte interferon in all experimental situations.
Keywords: Acyclovir/tu [Therapeutic Use]; Animals; *Antiviral Agents/tu [Therapeutic Use]; Drug Therapy, Combination; *Herpes Simplex/dt [Drug Therapy]; Herpes Simplex/th [Therapy]; Humans; Idoxuridine/tu [Therapeutic Use]; *Interferons/tu [Therapeutic Use]; Keratitis, Dendritic/dt [Drug Therapy]; Keratitis, Dendritic/th [Therapy]; Rabbits; Trifluridine/tu [Therapeutic Use]; Vidarabine/tu [Therapeutic Use]

Visual ability and drug regimen: relation to compliance with glaucoma therapy. - Granstrom, P A; Norell, S (Acta ophthalmologica, 1983)
Compliance with pilocarpine eye drop therapy was studied in relation to different measures of visual ability and different features of the drug regimen. Neither visual ability, nor complexity of the drug regimen nor side effects were significantly related to the patients' compliance with their pilocarpine therapy. Nevertheless, non-compliance was significantly more common among patients who regarded the eye drops as very unpleasant than among patients who did not. This indicates that non-compliance is related to the patient's perception of side effects and/or negative attitudes to the treatment.
Keywords: Aged; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Middle Aged; Ophthalmic Solutions; *Patient Compliance; Pilocarpine/ae [Adverse Effects]; *Pilocarpine/tu [Therapeutic Use]; Visual Acuity

Compliance with treatment of patients with chronic open-angle glaucoma. - MacKean, J M; Elkington, A R (The British journal of ophthalmology, 1983)
Keywords: Adult; Aged; Drug Administration Schedule; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Male; Memory; Middle Aged; *Patient Compliance

The role of Schlemm's canal in aqueous outflow from the human eye. - Johnson, M C; Kamm, R D (Investigative ophthalmology & visual science, 1983)
A mathematical model of Schlemm's canal is developed to simulate collapse of the canal and its effect on resistance to flow through the aqueous outflow network. Schlemm's canal is modeled as a porous, compliant channel that is held open by the trabecular meshwork. The trabecular meshwork is modeled as a series of linear springs that allow the inner wall of Schlemm's canal to deform in proportion to the local pressure drop across it. Based on comparisons between the model and results in the literature, the following tentative conclusions are reached: (1) Most of the resistance in the aqueous outflow network occurs in the inner wall of Schlemm's canal. (2) Glaucoma is not caused by a weakening of the trabecular meshwork and a resultant collapse of Schlemm's canal alone. Instead, glaucoma probably results from an increased flow resistance of the inner wall of the canal.
Keywords: *Aqueous Humor/ph [Physiology]; Glaucoma/pp [Physiopathology]; Humans; Mathematics; Models, Biological; *Sclera/ph [Physiology]; Trabecular Meshwork/ph [Physiology]

[Cooperation of patients with chronic primary open-angle glaucoma]. - Rocheblave, A (Journal francais d'ophtalmologie, 1983)
A survey was conducted in the homes of patients in a rural area to assess the degree of cooperation of patients with chronic open-angle glaucoma treated in the ophthalmology department of Valence Hospital, Drome, France. Degree of cooperation was estimated as a function of compliance to examinations over a two-year period, and to observance of treatment over last six months. Ninety-seven medical records, covering a period of twelve and a half years, were selected and 70 of these patients were followed up. Cooperation of the patients was judged satisfactory in two out of three cases. Age and the distance from the medical center had little or no influence on the degree of cooperation of the patients. However, the influence of the socio-cultural level and of the family environment was important. Patients under treatment generally cooperated better than those who were not. Trabeculectomy seemed to have a positive effect on compliance of patients to control examinations, and a negative effect on observance of treatment. Although this could be expected in 10 per cent of the cases in our survey, we believe that a coherent attitude would encourage the majority of the patients to improve their cooperation.
Keywords: Age Factors; Aged; Chronic Disease; Female; France; *Glaucoma, Open-Angle/px [Psychology]; Humans; Male; Motivation; *Patient Compliance; Rural Population; Socioeconomic Factors

Facilitating patient compliance in glaucoma therapy. - Zimmerman, T J; Zalta, A H (Survey of ophthalmology, 1983)
Noncompliance is a major problem in glaucoma therapy. The causes, forms, and sociological variables associated with noncompliance are reviewed. A comprehensive strategy to facilitate the safe and effective use of glaucoma medications is presented and discussed. This strategy combines education about the disease and its treatment, "tailoring" of the therapeutic regimen, training and reinforcement in eyedrop application, cooperation with primary care physicians, alleviating side effects, and improving doctor-patient relationships.
Keywords: *Glaucoma/dt [Drug Therapy]; Glaucoma/px [Psychology]; Humans; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; *Patient Education as Topic; Self Administration

Metaphors of glaucoma. - Kugelmann, R; Bensinger, R E (Culture, medicine and psychiatry, 1983)
In a phenomenological study of glaucoma as an illness, 31 patients were interviewed. The goal of the study was an explication of the meanings of the experience of glaucoma, in a twofold sense: (1) the face, the role, or the self of the patient that responds to the illness; (2) the visage that the illness presents to the patient. This twofold explication was achieved by generating a classification of the interviews in terms of the dominant metaphor that emerged in each interview. The following basic metaphors are presented through case material: glaucoma as an accompaniment of aging, as blindness, as pressure, as an abstraction (and a weapon), and as fate. Variations on these themes demonstrate the necessity, in such work and for enhanced communication with patients, of paying attention to both the face that the illness presents and to the self that responds.
Keywords: Adaptation, Psychological; Adult; Aged; Blindness/px [Psychology]; Female; *Glaucoma/px [Psychology]; Glaucoma/th [Therapy]; Humans; Male; Middle Aged; Patient Compliance; Physician-Patient Relations; *Sick Role; Social Isolation

Therapeutic problems in ocular hypertension. - Sood, N N; Grover, A K; Agarwal, H C (Indian journal of ophthalmology, 1983)
Keywords: Antihypertensive Agents/ae [Adverse Effects]; Economics; Humans; *Ocular Hypertension/dt [Drug Therapy]; Ocular Hypertension/su [Surgery]; Patient Compliance; Psychology; Tachyphylaxis

[The socioeconomic cost of glaucoma]. - Wolmark (Revue internationale du trachome et de pathologie oculaire tropicale et subtropicale et de sante publique : organe de la Ligue contre le trachome avec la collaboration de l'International Organization against Trachoma et des organisation..., 1983)
Keywords: Adolescent; Adult; Aged; Blindness/et [Etiology]; Child; Child, Preschool; Costs and Cost Analysis; Female; France; Glaucoma/co [Complications]; Glaucoma/di [Diagnosis]; *Glaucoma/ec [Economics]; *Health Expenditures; Health Services/ec [Economics]; Hospitalization/ec [Economics]; Humans; Infant; Infant, Newborn; Male; Middle Aged; Office Visits; Vision Disorders/et [Etiology]

Glaucoma screening. A cost-effectiveness analysis. - Gottlieb, L K; Schwartz, B; Pauker, S G (Survey of ophthalmology, 1983)
We designed an intricate model of the process of glaucoma screening, diagnosis, and treatment in order to evaluate the medical care costs of such efforts in relation to the benefits in terms of quality-adjusted years of vision saved, utilizing the economic principles of cost-effectiveness analysis. Although a relatively limited data base and numerous assumptions concerning the accuracy of diagnostic tests, the natural history of ocular hypertension and glaucoma, and the effectiveness of available treatment modalities, limit our ability to draw definitive conclusions concerning the cost-effectiveness of various glaucoma screening options, our analysis indicates that glaucoma screening is probably cost-effective when targeted at certain subgroups of the population. Our analysis suggests that changes in several aspects of existing screening policies may be appropriate if cost-effectiveness is to be used as one of the criteria for the efficient allocation of resources to and within screening programs. Specifically, combinations of screening tests and screening targeted at high risk populations such as blacks, diabetics, and relatives of glaucoma patients are probably more cost-effective than screening of the general population with a single test. In younger populations, the importance of detecting ocular hypertension argues for the use of tonometry. Ophthalmoscopy may be more cost-effective in older age groups in whom the higher prevalence of glaucoma outweighs the need for identifying ocular hypertensives. In the very elderly, automated perimetry becomes cost-effective since the detection of established field loss will have greater yield. In addition, it is evident that diversion of resources away from actual screening efforts and towards efforts aimed at improving follow-up and compliance would be an additional cost-effective strategy.
Keywords: Adult; Aged; Cost-Benefit Analysis; Glaucoma, Open-Angle/di [Diagnosis]; *Glaucoma, Open-Angle/pc [Prevention & Control]; Humans; *Mass Screening/ec [Economics]; Massachusetts; Middle Aged; Ocular Hypertension/di [Diagnosis]; Ophthalmoscopy/ec [Economics]; Population Surveillance; Risk; *Tonometry, Ocular/ec [Economics]; *Visual Field Tests/ec [Economics]

Importance of asking about glaucoma. - Price, N C (British medical journal (Clinical research ed.), 1983)
Keywords: Aged; Chronic Disease; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; *Medical History Taking; Middle Aged; Patient Admission; Patient Compliance

Implantable controlled release systems. - Langer, R (Pharmacology & therapeutics, 1983)
Keywords: Administration, Oral; Animals; Anticoagulants/ad [Administration & Dosage]; Contraceptive Agents, Female/ad [Administration & Dosage]; *Delayed-Action Preparations; *Drug Implants; Female; Glaucoma/dt [Drug Therapy]; Humans; Immunization/mt [Methods]; Insulin Infusion Systems; Mouth Diseases/dt [Drug Therapy]; Narcotic Antagonists/ad [Administration & Dosage]; Neoplasms/dt [Drug Therapy]; Skin Absorption

Timolol and dipivalyl epinephrine combination therapy. - McGuinness, R; Frumar, K D (Australian journal of ophthalmology, 1982)
Combination therapy with timolol 0.25% eye drops and dipivalyl epinephrine (DPE) 0.1% eye drops twice daily is an acceptable form of medication for both chronic simple glaucoma and ocular hypertension. A group of eighteen patients using this combination therapy have been followed up for a period of two years with satisfactory control of intraocular pressure in the majority of cases. An additive effect in lowering intraocular pressure when the two drugs were used in combination was confirmed. Two patients developed a sensitivity reaction to DPE and were able to continue on timolol alone. There was a slight rise in the intraocular pressure between the sixth and ninth months of therapy, but following this the mean intraocular pressure was remarkably stable. Patient acceptance of this twice daily regime was excellent and compliance with the drug therapy was also good.
Keywords: Aged; Chronic Disease; Drug Synergism; Drug Therapy, Combination; Epinephrine/ad [Administration & Dosage]; *Epinephrine/aa [Analogs & Derivatives]; Epinephrine/pd [Pharmacology]; Epinephrine/tu [Therapeutic Use]; Female; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; *Ocular Hypertension/dt [Drug Therapy]; *Propanolamines/ad [Administration & Dosage]; *Timolol/ad [Administration & Dosage]; Timolol/pd [Pharmacology]; Timolol/tu [Therapeutic Use]

[Monitoring of patients with primary chronic open-angle glaucoma]. - Demailly, P; Pittman, S; Abadie, P (Journal francais d'ophtalmologie, 1982)
Compliance to examinations performed in a specialised department was studied in patients with chronic open-angle glaucoma. A total of 429 case reports from patients treated from 1974 to 1977 were analyzed, follow up being for a period of up to 7 years. Examinations were performed two or three times a year and any patient who didn't return for two consecutive years was considered as lost. The number of lost patients was very few, about 10 percent a year, and this did not increase during the whole follow-up period. Overall, compliance was not related to sex. However, a higher proportion of women were lost between the second and third year of follow up. The distance between patient's homes and the medical center, near or far away, was not significant. As expected, a higher proportion of patients over sixty were lost after one year of follow up.
Keywords: Adult; Age Factors; Aged; Female; *Glaucoma, Open-Angle/th [Therapy]; Humans; Male; Middle Aged; *Patient Compliance; Residence Characteristics; Sex Factors; Time Factors

Glaucoma patients not compliant with their drug therapy: clinical and behavioural aspects. - Granstrom, P A (The British journal of ophthalmology, 1982)
The pattern of drug self-administration among 15 patients not compliant with their pilocarpine therapy was studied with an electronic medication monitor. Recording the date and the hour every time the medication bottle was opened, the monitor gives detailed information on the medication behaviour. The results indicate different types of medication errors; inadequate spacing of doses during the day with long intervals during the night, frequently missed doses at noon, and long interruptions in the medication, sometimes lasting for several days. Improvement in their compliance was seen in patients who were given instruction and taught to relate their medication to specified events in the day.
Keywords: Aged; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Medication Errors; *Patient Compliance; Patient Education as Topic; *Pilocarpine/tu [Therapeutic Use]; Self Administration

Corneal xerophthalmia and keratomalacia. - Sommer, A; Sugana, T (Archives of ophthalmology (Chicago, Ill. : 1960), 1982)
Detailed examinations were conducted on 162 consecutive children with nutritional keratopathy. Surface changes ranged from mild haziness through generalized xerosis and formation of thickened keratinized plaques. Diffuse stromal edema occured early in the disease. Stromal loss took two forms: relatively small, sharply demarcated, eccentric, noninfiltrated cylindrical ulcers of varying depth; and localized or generalized, usually full-thickness necrosis. All forms of involvement were sometimes present in the same individual or even the same eye. Traumatic separation of a keratinized plaque, or decompensation of a dellen, accounted for some instances of stromal baring. In other cases, stromal melting appeared to progress below an intact epithelium. Focal areas of necrosis healed rapidly, as adherent leukomas; larger lesions sloughed, forming extensive descemetoceles. With therapy, the vast majority of children retained central corneal clarity.
Keywords: Child; Child, Preschool; Corneal Ulcer/co [Complications]; Edema/co [Complications]; Humans; Infant; Necrosis; Vitamin A/bl [Blood]; Vitamin A/tu [Therapeutic Use]; Xerophthalmia/co [Complications]; Xerophthalmia/dt [Drug Therapy]; *Xerophthalmia/pa [Pathology]

Protein glaucoma--overtaxing of flow mechanisms? Preliminary report. - Zirm, M (Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift fur Augenheilkunde, 1982)
A possible reason for secondary glaucoma may be an unphysiological accumulation of proteins or blood in the aqueous humor. A positive Tyndall phenomenon shows an increase in the proteins of the aqueous humor, although a negative Tyndall does not exclude this. This study shows that disruption of blood vessel membrane barriers in the retina and uvea leads to an increase in low molecular weight proteins in the aqueous humor. Contrary to current knowledge, it is discussed that overtaxing of flow mechanisms by these additional proteins can cause so-called protein glaucoma.
Keywords: *Aqueous Humor/an [Analysis]; Eye Proteins/an [Analysis]; *Eye Proteins/ph [Physiology]; *Glaucoma/et [Etiology]; Humans; Intraocular Pressure

Lensectomy-vitrectomy for stage V cicatricial retrolental fibroplasia. - Merritt, J C; Lawson, E E; Sprague, D H; Eifrig, D E (Ophthalmic surgery, 1982)
Ten infants (18 eyes) blind from stage V cicatricial retrolental fibroplasia were examined from January 1978 to January 1981 at North Carolina Memorial Hospital. The early perinatal factors which may have predisposed to the binding end-stage cicatrix are identified. To increase their visual potential and to prevent secondary angle closure glaucoma, 12 lensectomy-vitrectomies were performed on 12 eyes (eight infants). One eye (one infant) had a pars plana vitrectomy without lensectomy. Seven eyes (seven infants) were not operated. Five of these eyes (five infants) had stage VRLF while two eyes (two infants) remained stable at stage II RLF. All retinas remained detached immediately after surgery. Secondary vitrectomies with air injections (three eyes, two infants) similarly failed to attach any retinas. Adherence of ciliary epithelium to clear lens and retrolental membrane as visualized within the dilated pupil (Eifrig-Merritt sign) was an intra-operative indicator of imminent surgical failure. Two eyes (two infants) developed early vitreous hemorrhages, hyphemas, secondary glaucoma, and phthisis bulbi within 12 months. Follow-up data were unavailable on two infants. Blindness secondary to cicatricial retrolental fibroplasia is increasing due to increased survival of low birthweight premature infants. Since surgical visual rehabilitation is not possible after the retrolental cicatrix has formed, the risk factors common to this high risk population should prompt preventive therapies.
Keywords: Cicatrix/co [Complications]; Female; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; *Lens, Crystalline/su [Surgery]; Male; Retinal Detachment/co [Complications]; Retinopathy of Prematurity/co [Complications]; *Retinopathy of Prematurity/su [Surgery]; Scleral Buckling; *Vitreous Body/su [Surgery]

Studies on human corneal ulcers treated with histoacrylic glue. Morphological studies of a successful and unsuccessful membrane. - Prause, J U; Jensen, O A (Acta ophthalmologica, 1982)
Artificial epithelial corneal barriers of histoacrylic glue have been used since 1968. Experimental and clinical studies have since then indicated that the barrier protects the cornea from repopulation by polymorphonuclear leukocytes from the tears and thereby from tissue-destroying enzymes. Using light-, scanning electron- and transmission electron-microscopical techniques, the differences between a successful and an unsuccessful treatment of a corneal ulcer with histoacrylic glue have been investigated. The successful glue barrier is a continuous membrane tightly bound to the corneal stroma and preventing population of the stroma by polymorphonuclear leukocytes from the tear fluid.
Keywords: Collagen/me [Metabolism]; Cornea/me [Metabolism]; Cornea/ul [Ultrastructure]; Corneal Ulcer/pa [Pathology]; *Corneal Ulcer/th [Therapy]; *Enbucrilate/tu [Therapeutic Use]; Glycosaminoglycans/me [Metabolism]; Humans; Lipid Metabolism; Microscopy, Electron; Microscopy, Electron, Scanning; Neutrophils/ul [Ultrastructure]; *Tissue Adhesives/tu [Therapeutic Use]

Referral routes to hospital of patients with chronic open-angle glaucoma. - MacKean, J M; Elkington, A R (British medical journal (Clinical research ed.), 1982)
An analysis of the referral routes of Southampton Eye Hospital of 191 patients who had been diagnosed as having chronic open-angle glaucoma showed that 121 patients (63.4%) were diagnosed as a result of the patient seeking advice for ocular symptoms (118) or because they had a family history of glaucoma (3). Advice had been sought from general practitioners (48), ophthalmic medical practitioners (19), and ophthalmic opticians (46). The remaining eight patients had gone directly to the casualty department. Seventy patients had been identified by chance, the majority of ophthalmic medical practitioners (26) or ophthalmic opticians (32).
Keywords: Adult; Age Factors; Aged; England; Family Practice; Female; *Glaucoma, Open-Angle/di [Diagnosis]; Glaucoma, Open-Angle/ge [Genetics]; Humans; Male; Middle Aged; Ophthalmology; Optometry; Patient Acceptance of Health Care; *Referral and Consultation/sn [Statistics & Numerical Data]

Monitoring compliance with pilocarpine therapy. - Norell, S E (American journal of ophthalmology, 1981)
I used a recording medication monitor to obtain objective information on self-medication by date and hour from a group of 82 patients using pilocarpine three times daily to prevent visual loss from glaucoma. Doses meant to be taken during the day were missed more than twice as often as morning or evening doses. Of the missed doses, 272 (54%) were noon doses, but only 98 (19%) were morning doses. Medication compliance may be substantially improved by choosing a drug that needs to be taken less often than three times daily. The number of missed doses per day increases significantly during a 20-day period between clinic visits. This suggested that shorter intervals between clinic visits may improve adherence to the drug regimen prescribed.
Keywords: Aged; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Methods; Middle Aged; *Patient Compliance; *Pilocarpine/ad [Administration & Dosage]; *Self Administration; Time Factors

Comparative study of aqueous and oily pilocarpine in the production of ocular hypotension. - Bhojwani, S C; Jones, D K (The British journal of ophthalmology, 1981)
The effective use of aqueous and oily pilocarpine was studied in 19 glaucomatous eyes. The aqueous drops were used 4 times a day while the oily drops were used only twice. It was found that the oily drops were better than the aqueous drops in lowering the mean intraocular pressure and the maximum pressure reached during the day. no statistically significant difference was found between the 2 pilocarpine treatments in the reduction of daily variation of intraocular pressure. It is felt that oily drops used only twice a day would lead to better patient compliance and better control of chronic simple glaucoma.
Keywords: Aged; Drug Administration Schedule; *Glaucoma, Open-Angle/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Middle Aged; Ophthalmic Solutions; *Pilocarpine/ad [Administration & Dosage]; Pilocarpine/pd [Pharmacology]

Accuracy of patient interviews and estimates by clinical staff in determining medication compliance. - Norell, S E (Social science & medicine. Part E, Medical psychology, 1981)
Keywords: Aged; Female; *Glaucoma/dt [Drug Therapy]; Humans; *Interviews as Topic; *Judgment; Male; *Medical Staff, Hospital; Middle Aged; *Patient Compliance; *Pilocarpine/ad [Administration & Dosage]; Sweden

Hypnosis in high risk ophthalmic surgery. - Lewenstein, L N; Iwamoto, K; Schwartz, H (Ophthalmic surgery, 1981)
Hypnosis is an effective tool in many areas of medicine and surgery. The exacting demands of ophthalmic surgery require good patient cooperation and strict adherence to treatment regimens. Multisystemic diseases compounded by the physiological stress of surgery make it essential that already strained homeostatic mechanisms are interfered with minimally. The cases presented in this report illustrate the beneficial use of hypnosis in the treatment of several high risk patients in unusual situations.
Keywords: Adult; Aged; Analgesics; Cataract Extraction; Child; Diabetes Complications; Eye Diseases/co [Complications]; *Eye Diseases/su [Surgery]; *Eye Injuries/su [Surgery]; Female; Glaucoma/su [Surgery]; Humans; *Hypnosis, Anesthetic/mt [Methods]; Male; Myocardial Infarction/co [Complications]; Strabismus/su [Surgery]

Cyclocryotherapy for glaucoma. - Bellows, A R (International ophthalmology clinics, 1981)
CCT is a simple, noninvasive, short, ablative surgical procedure that has been effectively used to treat advanced uncontrolled glaucoma. A specific protocol is recommended and the rationale for strict adherence is presented. The long-term benefits of CCT in patients with open-angle glaucoma following cataract extraction have been well established. However, although patients with neovascular glaucoma may have adequate pressure control following CCT, the serious complications of progression to no light perception and phthisis bulbi have discouraged its use. CCT can be effective for neovascular glaucoma when other methods of surgical management prove unsuccessful and visual prognosis is very poor. The loss of functional vision occurred in fewer than 10 percent of eyes treated with CCT, and it is important to emphasize that only eyes with greatest risk and poorest prognosis were treated with this modality. CCT has become an important addition to the surgical armamentarium for the treatment of some specific types of glaucoma.
Keywords: *Ciliary Body/su [Surgery]; Cryosurgery/ae [Adverse Effects]; *Cryosurgery/mt [Methods]; *Glaucoma/su [Surgery]; Humans

Noninvasive measurement of optic nerve-head compliance by laser Doppler velocimetry. - Zeimer, R; Wilensky, J T; Goldberg, M F; Solin, S A (Journal of the Optical Society of America, 1981)
It is proposed that individuals who are susceptible to glaucomatous damage are those with relatively weak mechanical support at the optic nerve head. A noninvasive method of measuring tissue compliance is described. Preliminary results, obtained in vitro and in vivo, demonstrate the feasibility of the method.
Keywords: Animals; Doppler Effect; *Glaucoma/et [Etiology]; Humans; Intraocular Pressure; Lasers; *Optic Nerve/ah [Anatomy & Histology]; Rabbits

Glycerol: a review of its pharmacology, pharmacokinetics, adverse reactions, and clinical use. - Frank, M S; Nahata, M C; Hilty, M D (Pharmacotherapy, 1981)
Glycerol is a potent osmotic dehydrating agent with additional effects on brain metabolism. In doses of 0.25-2.0 g/kg glycerol decreases intracranial pressure in numerous disease states, including Reye's syndrome, stroke, encephalitis, meningitis, pseudotumor cerebri, central nervous system tumor, and space occupying lesions. It is also effective in lowering intraocular pressure in glaucoma and shrinking the brain during neurosurgical procedures. Hyperosmolality with rebound cerebral overhydration is of concern, especially in patients with altered blood brain barriers. They may be avoided if glycerol is administered on an intermittent rather than a continuous basis. Intravascular hemolysis does not occur with oral use. When administered intravenously, hemolysis can be minimized by using glycerol 10% in dextrose 5% with normal saline at rates of 6 mg/kg/min or less. However, intravenous doses of 1-2 g/kg every 2 hr can be administered safely in severe cases of elevated ICP. In such patients, glycerol serum concentration, serum osmolality and ICP monitoring are required to optimize glycerol therapy.
Keywords: Animals; Brain Injuries/dt [Drug Therapy]; Brain Neoplasms/dt [Drug Therapy]; Cerebrovascular Disorders/dt [Drug Therapy]; Dehydration/ci [Chemically Induced]; Encephalitis/dt [Drug Therapy]; Glycerol/ae [Adverse Effects]; Glycerol/me [Metabolism]; Glycerol/pd [Pharmacology]; *Glycerol/tu [Therapeutic Use]; Humans; Kinetics; Meningitis/dt [Drug Therapy]; Pseudotumor Cerebri/dt [Drug Therapy]; Reye Syndrome/dt [Drug Therapy]; Water-Electrolyte Balance/de [Drug Effects]

Determination of acetazolamide compliance in patients with glaucoma. - Alward, P D; Wilensky, J T (Archives of ophthalmology (Chicago, Ill. : 1960), 1981)
In an objective test to determine compliance with acetazolamide regimens by patients with glaucoma, treated inpatients had lower carbon dioxide levels (less than or equal to mEq/L) than untreated patients (greater than or equal to 25 mEq/L). The test results may be inaccurate in some obese diabetic patients with hyperglycemia and in some patients with obstructive lung disease, such as asthma and emphysema. In an outpatient clinic population, the test showed that 35% (30/87) of the patients did not seem to be taking acetazolamide and 22% (19/87) seemed to be taking it less frequently.
Keywords: Acetazolamide/ad [Administration & Dosage]; *Acetazolamide/tu [Therapeutic Use]; *Carbon Dioxide/bl [Blood]; Glaucoma/bl [Blood]; *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance

A medication monitor and fluorescein technique designed to study medication behaviour. - Norell, S E; Granstrom, P A; Wassen, R (Acta ophthalmologica, 1980)
Methods were developed to study medication behaviour, in order to obtain accurate and detailed information on the patterns of drug-taking in medication with eye drops. A medication monitor was designed, which recorded the date and hour each time the medication bottle was opened. A fluorescein technique was designed to study the ability of patients to administer the eye drops into the conjunctival sac. Some problems in the measurement of medication behaviour are discussed. In a group of patients with open-angle glaucoma, for whom pilocarpine eye drops three times daily had been prescribed, 18% of dose intervals had a duration of 12 h or more and 11% had a duration of 4 h or less. Fluorescein tests indicated that the patients were usually able to administer the eye drops correctly.
Keywords: *Fluoresceins; Glaucoma/dt [Drug Therapy]; Humans; Medical Laboratory Science; *Ophthalmic Solutions/ad [Administration & Dosage]; *Patient Compliance; Pilocarpine/tu [Therapeutic Use]; *Self Administration/is [Instrumentation]; Time Factors

Self-medication with pilocarpine among outpatients in a glaucoma clinic. - Norell, S E; Granstrom, P A (The British journal of ophthalmology, 1980)
A recording medication monitor and fluorescein technique were used to study self-medication by 82 patients with primary open-angle glaucoma for whom pilocarpine eye drops 3 times a day had been prescribed. Of these patients 34 (41%) missed 6 or more doses during a 20-day period, and for 35 (43%) an 8-hour dose interval was exceeded at least 20% of the time. Consequences may include lack of effectiveness in preventing visual loss and unnecessary prescription of more potent, and more toxic, drugs.
Keywords: Aged; Female; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; Patient Compliance; *Pilocarpine/tu [Therapeutic Use]; Self Administration

A multicentre study of the effect and tolerance of Ocusert-P-40. - Akerblom, T; Aurell, E; Cristiansson, J; Kriisa-Kunnos, V; Wiebert, O (Acta ophthalmologica, 1980)
The suitability of treatment with Ocusert-P-40, a lamellar system inserted in the eye and allowing the constant release of pilocarpine, was studied in a group of patients (age range 43-83 years) with wide-angle glaucoma. Those patients completing a 3-week trial were included in an 8 month follow-up study in which the long-term efficacy and tolerance of Ocusert were studied. Treatment was discontinued in 13 of the 42 patients in the 3-week trial owing to initial irritation and retention problems (n = 11) or unsatisfactory control of the intraocular pressure (I.O.P.) (n = 2). Of the 29 patients entering the long-term study, two were withdrawn because of tolerance problems and two as a result of unsatisfactory control of I.O.P. The 25 patients completing the study considered the Ocusert system more convenient and less liable to produce troublesome side-effects than their previous therapy. Ocusert was best tolerated by the younger patients.
Keywords: Adult; Aged; Clinical Trials as Topic; Drug Implants; Follow-Up Studies; *Glaucoma/dt [Drug Therapy]; Humans; Interinstitutional Relations; *Intraocular Pressure/de [Drug Effects]; Middle Aged; Patient Dropouts; *Pilocarpine/ad [Administration & Dosage]; Pilocarpine/ae [Adverse Effects]; Sweden; Time Factors

Compliance in ophthalmology. - Davidson, S I; Akingbehin, T (Transactions of the ophthalmological societies of the United Kingdom, 1980)
Keywords: Acetazolamide/ad [Administration & Dosage]; Acetazolamide/tu [Therapeutic Use]; Drug Packaging; *Glaucoma/dt [Drug Therapy]; Humans; Middle Aged; *Patient Dropouts; Tablets

Maintenance therapy of glaucoma patients with guanethidine (3%) and adrenaline (0.5%) once daily. - Hoyng, P F; Dake, C L (Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie. Albrecht von Graefe's archive for clinical and experimental ophthalmology, 1980)
Over a period of 4 months, 16 of 24 patients (30 of 46 eyes) with either primary open angle glaucoma (POAG) or suspected glaucoma were treated successfully with a maintenance dose of guanethidine (3%) and adrenaline (0.5%) combined in one eyedrop (GA) once daily. In the previous month the medication was given twice daily and at the end of 4 months the decrease in intraocular pressure (IOP) was 8.9 mm Hg (33%) compared to 9.9 mm Hg (37%) with twice-daily application; three of four eyes responded just as well to single-daily application as to twice daily application of GA. Once-daily treatment with GA was not successful when the average IOP in the absence of treatment was over 32 mm Hg. The advantages of once-daily application were less conjunctival hyperemia, less dilation of the pupils, less ptosis and difficulty reading, plus the advantage that the drops needed only to be applied once a day (patient compliance). The recommended regime for GA therapy in patients with an IOP of less than 32 mm Hg is application of GA twice daily for 1 month followed by a decrease in the dosage to once a day. GA can best be applied in the evening before retiring.
Keywords: Drug Combinations; Epinephrine/pd [Pharmacology]; *Epinephrine/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Guanethidine/pd [Pharmacology]; *Guanethidine/tu [Therapeutic Use]; Humans; Intraocular Pressure/de [Drug Effects]

Medication behaviour. A study of outpatients treated with pilocarpine eye drops for primary open-angle glaucoma. - Norell, S (Acta ophthalmologica. Supplementum, 1980)
Keywords: Data Collection/mt [Methods]; Ethics, Medical; Fluoresceins; *Glaucoma/dt [Drug Therapy]; Humans; *Medication Errors; Ophthalmic Solutions; Patient Compliance; Patient Education as Topic; Patient Participation; *Pilocarpine/tu [Therapeutic Use]; Self Administration/px [Psychology]; *Self Medication/px [Psychology]

Improving medication compliance: a randomised clinical trial. - Norell, S E (British medical journal, 1979)
A medical monitor which recorded the date and hour each time a medicine bottle was opened was used to evaluate a programme for improving patients' compliance with their treatment. Eighty-two patients with glaucoma who had been prescribed pilocarpine eye drops three times daily to prevent visual loss were randomised into two groups. Both groups used the medication monitor during two 20-day periods, but before the second period the experimental group were given an education and tailoring programme in an attempt to improve their compliance. Nine patients missed the second treatment period and were excluded from the analysis. The patients in the experimental group showed significantly improved compliance when compared with the control group. The numbers of missed doses were reduced by about half, as was the proportion of time that exceeded the eight-hour dose intervals. Follow-up studies are needed to determine how long the improved compliance persists, but anyone considering setting up an education and tailoring programme should recognise the extent to which therapeutic efforts are wasted because of non-compliance.
Keywords: Aged; Chronic Disease; Drug Administration Schedule; Female; Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Patient Compliance; Patient Education as Topic; Pilocarpine/ad [Administration & Dosage]; Pilocarpine/tu [Therapeutic Use]; Random Allocation; Self Administration

Apneic spells associated with timolol therapy in a neonate. - Olson, R J; Bromberg, B B; Zimmerman, T J (American journal of ophthalmology, 1979)
A 2-week-old premature child with congenital glaucoma secondary to anterior cleavage syndrome was treated with timolol maleate and cyclocryotherapy. The patient had apneic spells of up to 30 seconds that stopped soon after timolol maleate therapy was discontinued. No apnea was seen before timolol maleate administration, and no further spells were noted after subsequent cyclocryotherapy without timolol maleate treatment. Possible central nervous system toxicity of timol maleate or its metabolic by-products in neonates with immature blood-brain barriers was noted.
Keywords: Acetazolamide/ad [Administration & Dosage]; Acetazolamide/tu [Therapeutic Use]; *Apnea/ci [Chemically Induced]; *Asphyxia Neonatorum/ci [Chemically Induced]; *Cheyne-Stokes Respiration/ci [Chemically Induced]; Cryosurgery; *Glaucoma/cn [Congenital]; Glaucoma/dt [Drug Therapy]; Glaucoma/th [Therapy]; Humans; Infant, Newborn; Infant, Premature, Diseases/ci [Chemically Induced]; *Infant, Premature, Diseases/dt [Drug Therapy]; Intraocular Pressure/de [Drug Effects]; *Propanolamines/ae [Adverse Effects]; *Respiration Disorders/ci [Chemically Induced]; Timolol/ad [Administration & Dosage]; *Timolol/ae [Adverse Effects]; Timolol/tu [Therapeutic Use]

Patient compliance and the "usefulness product" of timolol. - Worthen, D M (Survey of ophthalmology, 1979)
The practical value of any therapy depends upon a combination of effectiveness of the agent (or procedure) and the extent to which the patient complies in its proper administration. Thus, it might be said that the multiple of effectiveness times compliance equals the "usefulness product." Among the various glaucoma therapies, this product seems to range from about 30%--90%. Timolol's effectiveness in lowering intraocular pressure combined with its low incidence of side effects yields a high usefulness product, and this may decrease the incidence of surgery required for the treatment of the open-angle glaucomas.
Keywords: Evaluation Studies as Topic; *Glaucoma/dt [Drug Therapy]; Humans; *Patient Compliance; *Propanolamines/tu [Therapeutic Use]; Timolol/ae [Adverse Effects]; *Timolol/tu [Therapeutic Use]

Filtering surgery in children: barriers to success. - Beauchamp, G R; Parks, M M (Ophthalmology, 1979)
The use of trabeculectomy in advanced pediatric glaucoma is reviewed. Intraocular pressure was controlled in only 50% of the patients, and the best visual results was 20/200. Complications of vitreous loss, scleral collapse, ectasia, retinal detachment, and endophthalmitis were encountered. No evidence was found to support the claim that in the seriously compromised buphthalmic eyes, trabeculectomy is safer than other filtering operations since it filters under a scleral flap.
Keywords: Adolescent; Adult; Child; Child, Preschool; Endophthalmitis/co [Complications]; Female; *Glaucoma/su [Surgery]; Humans; Infant; *Intraocular Pressure; Intraoperative Complications; Male; Postoperative Complications; Retinal Detachment/co [Complications]; *Trabecular Meshwork/su [Surgery]; Visual Acuity

Methods for rapid detection of human ocular viral infections. - Rodrigues, M R; Lennette, D A; Arentsen, J J; Thompson, C (Ophthalmology, 1979)
Recent methods for detection of viruses in clinical specimens include immunofluorescence, immunoperoxidase, immune adherence hemagglutination, radioimmunoassay, enzyme-linked immunosorbent assay (ELISA), and immunoelectron microscopy. Some are useful for the detection of traces of viral antigens but are more complicated and time-consuming than others. Simple techniques of immunofluorescence and negative stain electron microscopy are used for the rapid detection of viruses in human adenoviral, herpetic, rubella, molluscum contagiosum, and vaccinial infections.
Keywords: *Adenoviridae Infections/di [Diagnosis]; Conjunctiva/ul [Ultrastructure]; Cornea/ul [Ultrastructure]; Enzyme-Linked Immunosorbent Assay; Evaluation Studies as Topic; Fluorescent Antibody Technique; Hemagglutination Tests/mt [Methods]; Humans; Immune Adherence Reaction/mt [Methods]; Immunoenzyme Techniques; *Keratitis, Dendritic/di [Diagnosis]; *Keratoconjunctivitis/di [Diagnosis]; Microscopy, Electron; *Molluscum Contagiosum/di [Diagnosis]; Radioimmunoassay/mt [Methods]; *Rubella/di [Diagnosis]; *Vaccinia/di [Diagnosis]

The ultrastructure of the deep layer of the lens capsule in fibrillopathia epitheliocapsularis (FEC), so-called senile exfoliation or pseudoexfoliation. A scanning electron microscopic study. - Seland, J H (Acta ophthalmologica, 1978)
The epithelial surface of the lens capsule and the capsular surface of the epithelium have been studied in six cataractous lenses from persons with fibrillopathia epitheliocapsularis (FEC) or so-called senile exfoliation or pseudoexfoliation by scanning electron microscopy. Five of the lenses came from eyes with capsular glaucoma. Three senile cataractous lenses have been used as controls and two of the control lenses came from eyes with simple glaucoma. The investigation revealed round discoid plaques closely adherent to the capsule. The plaque surfaces had numerous smooth tentacle-like projections and matching pits in the underlying epithelium. These plaques were only found in FEC lenses and corresponded both in size and location to the structure known as the deep or amorphous layer of the lens capsule. The findings indicate that the epithelial cells are the source of origin.
Keywords: Adult; Aged; Cataract/pa [Pathology]; Cell Membrane/ul [Ultrastructure]; Epithelial Cells; Epithelium/ul [Ultrastructure]; Eye Diseases/pa [Pathology]; Female; Glaucoma/pa [Pathology]; Humans; *Lens, Crystalline/ul [Ultrastructure]; Male; Microscopy, Electron, Scanning; Middle Aged

Iridectomy technique in trabeculectomy. - Freedman, J (Ophthalmic surgery, 1978)
Peripheral iridectomy in trabeculectomy surgery should be larger than the scleral opening to prevent adherence of iris to the edges of the scleral opening. A method for the fashioning of such an iridectomy is described.
Keywords: *Glaucoma/su [Surgery]; Humans; *Iris/su [Surgery]; Scleral Buckling; *Trabecular Meshwork/su [Surgery]

The "usefulness" product: concern for cupping, control, and compliance. - Worthen, D M (Annals of ophthalmology, 1978)
Keywords: Adrenergic beta-Antagonists/tu [Therapeutic Use]; Carbonic Anhydrase Inhibitors/tu [Therapeutic Use]; Epinephrine/tu [Therapeutic Use]; *Glaucoma/dt [Drug Therapy]; Humans; *Intraocular Pressure/de [Drug Effects]; Ophthalmic Solutions/ae [Adverse Effects]; Ophthalmic Solutions/pd [Pharmacology]; *Ophthalmic Solutions/tu [Therapeutic Use]; Patient Compliance; Pilocarpine/tu [Therapeutic Use]

Patient compliance in glaucoma. - Bloch, S; Rosenthal, A R; Friedman, L; Caldarolla, P (The British journal of ophthalmology, 1977)
Of a randomly selected sample of 40 patients with chronic simple glaucoma 11 were identified as having failed to comply adequately with medical advice. Noncompliers were more likely: to be men, to have had no other medical disorder but glaucoma, not to rank glaucoma as most troubling if they had another illness, to have experienced side effects from the treatment, and not to have appreciated the association between glaucoma and blindness. Detailed clinical study revealed that several interrelated psychosocial factors contributed to noncompliance.
Keywords: Adult; Aged; Blindness/et [Etiology]; Drug-Related Side Effects and Adverse Reactions; Female; Glaucoma/co [Complications]; *Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; *Patient Compliance

Social and emotional factors in glaucoma care. - Shipsey, M (The Sight-saving review, 1977)
Keywords: Adaptation, Psychological; Glaucoma/px [Psychology]; *Glaucoma/th [Therapy]; Health Education; Humans; Patient Dropouts

Ocusert in Christchurch. - Holmes, W R (Transactions of the Ophthalmological Society of New Zealand, 1977)
Keywords: Attitude of Health Personnel; *Glaucoma/dt [Drug Therapy]; Humans; Patient Acceptance of Health Care; *Pilocarpine/ad [Administration & Dosage]; Pilocarpine/tu [Therapeutic Use]

The Ocusert pilocarpine system: advantages and disadvantages. - Pollack, I P; Quigley, H A; Harbin, T S (Southern medical journal, 1976)
Thirty-four patients with glaucoma were treated with the Ocusert pilocarpine system, a unique method of providing round-the-clock delivery of pilocarpine in the eye for seven-day periods. Advantages of the device include therapeutic effectiveness and continuous release rate, less effect on accommodation, less miosis, convenience for the patient, and reliability in patients who must rely on others for treatment (eg, children and the elderly). Some disadvantages encountered were need for instruction and encouragement of patients; retention difficulties, with some patients unaware when the device was lost; occasional side effects of a cutting sensation (as when the Ocusert sometimes doubles over), movement in the eye, and transient blurring of vision and miosis; and high cost. Overall, when compared to pilocarpine eyedrops, the Ocusert pilocarpine system presents many definite advantages and is a highly desirable method of therapy in selected cases of glaucoma.
Keywords: Drug Evaluation; Drug Implants; Female; Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Middle Aged; Myopia/ci [Chemically Induced]; Patient Acceptance of Health Care; *Pilocarpine/ad [Administration & Dosage]; Pilocarpine/ae [Adverse Effects]; Visual Acuity/de [Drug Effects]

The prognosis of penetrating keratoplasty based upon corneal morphology. - Paton, D (Ophthalmic surgery, 1976)
In this paper, the author has attempted to express the prognosis for successful penetrating keratoplasty based upon a morphological classification of corneal disease. Four groups have been designated with their basic prognosis ranging from excellent to poor. The importance of appraising the diseased cornea in the area of its optimal recipient zone has been stressed. Ancillary factors adversely affecting the estimated final prognosis of keratoplasty have been considered, with emphasis upon the importance of glaucoma, lid function, tear film, ocular inflammation and patient compliance. Not only is it important for the surgeon to appraise the chance of successful surgery, but it is essential for the patient to be informed in advance regarding the probability for successful surgery and the need to comply with sometimes demanding requirements of postoperative care.
Keywords: Cornea/pa [Pathology]; *Cornea/su [Surgery]; Corneal Diseases/pa [Pathology]; Humans; Prognosis

A comparison of patient compliance in treated vs untreated ocular hypertension. - Bigger, J F (Transactions. Section on Ophthalmology. American Academy of Ophthalmology and Otolaryngology, 1976)
Eighty-nine patients with newly diagnosed asymptomatic elevations of intraocular pressure were followed up over a 12- to 20-month interval. During this period 33 (37%) of the patients were lost to ophthalmic follow-up evaluation. The majority of these patients dropped out within one month following the initial diagnosis. While institution of medical therapy for the elevated ocular pressure improved patient compliance when compared to the nontreated group, the rates of noncompliance in both groups were unacceptably high in view of the disease risk. Management of the noncompliant patient requires good physician-patient communication, emphasis on patient education activities, and the use of selective reminder and recall systems within the ophthalmologist's office.
Keywords: Adult; Aged; Female; Follow-Up Studies; *Glaucoma/th [Therapy]; Humans; *Intraocular Pressure; Male; Middle Aged; *Patient Compliance

[Genetics of diabetes mellitus (author's transl)]. - Feingold, J (Diabete & metabolisme, 1976)
Since Pincus and White's claim in 1933 that diabetes mellitus is an inherited disease, the precise mode of inheritance remains a matter of dispute. The reason for the controversy is that the geneticist is confronted with a number of impediments to genetic analysis. As pointed by Neel, "diabetes mellitus is in many respects a geneticists nightmare". The obstacles are : 1) a precise definition of diabetes is difficult to establish, 2) the frequency of the disease which is sex and age dependent is not well known, 3) the probability of genetic heterogeneity is great but whether early onset and late onset diabetes are different genetic diseases or the same one remains controversial, 4) the basic defect (s) is unknown, 5) environmental factors (e.g. nutritional status) influence the frequency of the disease. Despite these problems many studies have been devoted to the mode of inheritance of diabetes mellitus. Many authors favour an autosomal recessive mechanism. However, low penetrance (25 %) is necessary to support this mode of inheritance. Simple autosomal dominant mode of inheritance has also been suggested, but this pattern fits only few families. The majority of geneticists think, at the present time, that diabetes has a multifactorial mode of inhritance. The heritability which express the extent to which the phenotypes exhibited by parents are transmitted to their offspring is in the neighbourhood of 50%. Many arguments favour this mode of inheritance: 1) low penetrance is necessary to aistinct genetic diseases, and especially in chronic glaucoma, which also have a multifactorial mode of inheritance; in particular, one must note the association between glucose intolerance and ocular hypertension induced by dexamethasone, 3) the association between diabetes and antigen A of the ABO system and antigens HL-A8 and W 15 of the HL-A system.
Keywords: *Diabetes Mellitus/ge [Genetics]; Female; Genes; Humans; Male; Models, Biological; Nutritional Physiological Phenomena

Herpetic corneal epithelial disease. - Marsh, R J; Fraunfelder, F T; McGill, J I (Archives of ophthalmology (Chicago, Ill. : 1960), 1976)
The clinical differentiation of corneal epithelial lesions due to herpes simplex or herpes zoster may be confusing. Practical clinical tests, including the use of topical ocular stains, are useful to differentiate corneal epithelial lesions caused by these two viruses. Two distinctive types of zoster corneal epithelial disease may be seen; an early dendritic form, and a delayed form characterized by corneal mucus plaques that may take a dendriform pattern. These plaques are composed of mucus that is adherent to swollen, degenerating epithelial cells. The clinical differentiation between these two viruses is essential since topically applied corticosteroids are contraindicated in epithelial herpes simplex and often are indicated in the management of epithelial herpes zoster.
Keywords: Adrenal Cortex Hormones/tu [Therapeutic Use]; Alcian Blue; Cornea/pa [Pathology]; Diagnosis, Differential; Fluoresceins; *Herpes Zoster Ophthalmicus/di [Diagnosis]; Herpes Zoster Ophthalmicus/dt [Drug Therapy]; Herpes Zoster Ophthalmicus/pa [Pathology]; Humans; *Keratitis, Dendritic/di [Diagnosis]; Keratitis, Dendritic/pa [Pathology]; Rose Bengal; Staining and Labeling

Drug delivery systems for topical ophthalmic medication. - Halberg, G P; Kelly, S E; Morrone, M (Annals of ophthalmology, 1975)
Two new topical ophthalmic delivery systems are described. The modes of delivery were compared with conventionally administered eyedrops on the basis of intraocular pressure lowering effect, dependability in delivery of prescribed dosage, and patient acceptance of the system. Pilocarpine delivered by each of the systems was found to control IOP as well as conventional pilocarpine drops. Although some patients took a longer time than others to adjust to a new mode of delivery, patient acceptance of the systems was high.
Keywords: Administration, Topical; Adult; Aerosols; Aged; Delayed-Action Preparations; Evaluation Studies as Topic; Female; *Glaucoma/dt [Drug Therapy]; Humans; Intraocular Pressure/de [Drug Effects]; Male; Membranes, Artificial; Middle Aged; *Ophthalmic Solutions/ad [Administration & Dosage]; Patient Acceptance of Health Care; *Pilocarpine/ad [Administration & Dosage]

Recent advances in antiviral therapy. - Pavan-Langston, D; Langston, R H (International ophthalmology clinics, 1975)
It has been demonstrated in clinical trials that (1) the antimetabolites Ara A and F3T are both significantly better than IDU in the treatment of many forms of ocular herpes, and (2) they are not significantly different from each other. In preclinical trials, the IDU ocular insert also has shown itself to be significantly better than IDU drop-ointment therapy, while exposing the eye to 40 percent less drug and adding tremendous convenience and ease of compliance by patients to an otherwise difficult medication schedule. Both photodynamic inactivation and cryotherapy have been shown in clinical trials to have notable therapeutic efficacy against herpes, but undesirable and occasionally severe side-effects have slowed down and possibly stopped the further development of these techniques.
Keywords: *Antiviral Agents/tu [Therapeutic Use]; Cryosurgery; Humans; Idoxuridine/ad [Administration & Dosage]; Idoxuridine/tu [Therapeutic Use]; Keratitis, Dendritic/dt [Drug Therapy]; *Keratitis, Dendritic/th [Therapy]; Phototherapy; Trifluridine/tu [Therapeutic Use]; Vidarabine/tu [Therapeutic Use]

Design and planning of a specialized glaucoma unit. - Cowan, E C; Linton, D; Bryars, J H (Transactions of the ophthalmological societies of the United Kingdom, 1974)
Keywords: Appointments and Schedules; Equipment and Supplies, Hospital; Glaucoma/di [Diagnosis]; *Glaucoma; *Hospital Design and Construction; *Hospital Units; Medical Records; Ophthalmology/is [Instrumentation]; Punched-Card Systems; Research

Noncompliance--a dilemma. - Glogow, E (The Sight-saving review, 1973)
Keywords: Adult; *Appointments and Schedules; *Attitude to Health; *Cooperative Behavior; Female; *Glaucoma/di [Diagnosis]; Humans; Male; Middle Aged; Physician-Patient Relations

Why people fail appointments. - Glogow, E (The Sight-saving review, 1970)
Keywords: Adult; Aged; *Appointments and Schedules; Attitude to Health; Fear; Female; *Glaucoma/di [Diagnosis]; Humans; Male; Middle Aged

Factors influencing patient noncompliance: a theoretical approach. - Vincent, P (Nursing research, 1971)
Keywords: Adolescent; Adult; Aged; *Attitude to Health; *Behavior; Cooperative Behavior; Female; Glaucoma/dt [Drug Therapy]; Humans; Male; Middle Aged; Physician-Patient Relations; Socioeconomic Factors; United States

Effects of health education methods on appointment breaking. - Glogow, E (Public health reports (Washington, D.C. : 1896), 1970)
Keywords: *Appointments and Schedules; *Behavior; California; Ethnic Groups; Glaucoma/di [Diagnosis]; *Health Education; Humans; Methods; Nurse-Patient Relations; Problem Solving; Prospective Studies; Referral and Consultation; Socioeconomic Factors; Statistics as Topic

[Round table conference. Study on non-adherent material, gelfilm]. - Anonymous (Ganka. Ophthalmology, 1967)
Keywords: *Gelatin; *Glaucoma/su [Surgery]; Humans; *Retinal Detachment/su [Surgery]; *Surgical Equipment