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Biomedical subjects

A E Kolker

Publications and source records attributed to A E Kolker.

At least 19 recordsLinked to original sources
PubMed1992

Gonioscopic ab interno laser sclerostomy. A pilot study in glaucoma patients.

PURPOSE: The purpose of this study is to evaluate the safety and efficacy of gonioscopic ab interno laser sclerostomy (GLS) in patients with glaucoma. METHODS: The technique of GLS involves iontophoresis of methylene blue dye (1%) at the limbus to focally dye the sclera and to provide subsequent delivery of 10-microsecond pulsed laser energy to the dyed area through a goniolens. The laser emits at 660 nm, a wavelength that is maximally absorbed by the methylene blue dye. Patients were evaluated for fistula formation, intraocular pressure (IOP) reduction, and adverse sequelae. Thirty-eight treatments were performed in 35 eyes. RESULTS: Successful complete sclerostomies were achieved in 21 eyes (55%), which was associated with an acute mean reduction in IOP of 23 mmHg. Mean preoperative IOP for all patients was 35 mmHg, and 1 hour after treatment it was reduced to 18.5 mmHg. In 4 of the 38 treatments, there was no acute IOP reduction, and these eyes were judged as failures. The mean follow-up time was 8.2 months with a maximum follow-up of 15 months. By 9 months, 50% of patients had an IOP of 22 mmHg or lower. The number of antiglaucoma medications decreased from 3.1 to 1.7 for all eyes over the 15-month follow-up period. Hyphemas (13%) were the only major complication, and these resolved spontaneously. In only one case did the IOP increase after the procedure. CONCLUSION: The results of this trial indicate that GLS is technically feasible, and preliminary results of IOP control are promising.

Adult↗
PubMed1990

Failure of apraclonidine to prevent delayed IOP elevation after Nd:YAG laser posterior capsulotomy.

An elderly pseudophakic man with advanced open-angle glaucoma underwent Nd:YAG laser posterior capsulotomy. Pigment deposits were also removed from the anterior lens surface with laser applications. In spite of pre- and post-laser treatment with topical apraclonidine (Iopidine) and normal IOP 1 hour postoperatively, the patient presented the next day with visual acuity of 20/300, corneal edema, pain, and IOP of 60 mm Hg. Prompt treatment reduced the pressure and normal visual acuity was achieved. While apraclonidine prevents early post-laser elevation of IOP in most cases, some pressure elevations may be delayed or persist longer than the duration of action of the drug. Examination of patients with advanced glaucomatous optic nerve damage is recommended the day after anterior segment laser surgery, even when apraclonidine is used at the time of laser surgery and IOP is normal 1 to 2 hours postoperatively.

Adrenergic alpha-Agonists↗
PubMed1990

Transscleral neodymium: YAG laser cyclocoagulation for uncontrolled glaucoma.

To determine the efficacy and safety of the procedure, we reviewed the records of 25 eyes of 25 patients who had received noncontact transscleral Nd:YAG laser cyclocoagulation for a variety of uncontrolled glaucomas. Thirteen to 35 pulses (mean, 22.7 pulses) had been placed 1 mm to 2 mm behind the limbus with an energy per pulse of 3.4 J to 8.2 J (mean 4.5 J). Follow-up ranged from 6 months to 23 months, with the exception of one eye, which had to be enucleated. Nine of the 25 eyes (36%) required one or two repeat treatments. Twelve (48%) had intraocular pressures at last follow-up of less than 21 mm Hg but greater than 4 mm Hg. Ten eyes (40%) developed moderate to severe pain transiently, and 10 (40%) developed substantial, but transient, inflammation. Transscleral Nd:YAG laser cyclocoagulation appears to be relatively effective and well tolerated.

Adolescent↗
PubMed1989

Topical timolol administration reduces the incidence of glaucomatous damage in ocular hypertensive individuals. A randomized, double-masked, long-term clinical trial.

We conducted a randomized, double-masked, long-term clinical trial to determine whether topical timolol therapy was effective in delaying or preventing the onset of glaucomatous damage in moderate-risk ocular hypertensive subjects. In 62 patients, one eye was chosen randomly to receive timolol therapy twice daily while the fellow eye received placebo. During the course of the study, the mean +/- SD difference in intraocular pressure between the timolol-treated and the placebo-treated eyes was 2.3 +/- 2.6 mm Hg. Reproducible visual field loss developed in 4 timolol-treated eyes and 10 placebo-treated eyes. Progressive optic disc cupping was noted in 4 timolol-treated and 8 placebo-treated eyes. Using a computerized image analysis system, the mean +/- SD increase in optic disc pallor during the course of the study was 0.86% +/- 2.4% in the timolol-treated eyes as opposed to 1.80% +/- 3.6% in the placebo-treated eyes. This study provides evidence that lowering intraocular pressure by medical treatment reduces the incidence of glaucomatous damage in ocular-hypertensive individuals.

Administration, Topical↗
PubMed1989

Assessing the utility of reliability indices for automated visual fields. Testing ocular hypertensives.

Monocular (right eye) visual fields were recorded with the Humphrey Visual Field Analyzer (30-2 Program) at baseline as well as 6 and 12 months later in 120 patients with established ocular hypertension. Indices of field reliability (fixation loss, less than 20%; false-positives and false-negatives, less than 33%) and field sensitivity (mean deviation [MD] and pattern standard deviation [PSD]) were examined. At baseline, 35% of patients exhibited low reliability (LR) fields, a figure which decreased to approximately 25% at 6 and 12 months, respectively. During this period, over 50% of patients produced at least one LR field, whereas 8.3% were unable to produce even one reliable field. Exhibition of a LR field appeared to be independent of patient age. Fixation errors, the major cause of LR fields, decreased by approximately 10% over the 12-month period; most patients had between 20 and 32% fixation errors. The incidence of significant defects identified by PSD was greater than that for MD; this was true for both reliable and LR fields. It is suggested that increasing the fixation loss criteria for assessing patient reliability to a 33% cutoff might substantially increase the percentage of fields graded reliable with minimal effect on the sensitivity or specificity of the test.

Adult↗
PubMed1988

Intraocular pressure response to topical dexamethasone as a predictor for the development of primary open-angle glaucoma.

In a retrospective study we reviewed the records of 788 subjects who had been corticosteroid tested with 0.1% dexamethasone four times daily to one eye for six weeks. All subjects had normal kinetic visual fields and optic nerve heads in both eyes at the time of testing and were followed up for a minimum of five years. Some subjects had normal baseline intraocular pressures whereas others were considered to have ocular hypertension. Of 276 individuals who were high corticosteroid responders (intraocular pressure greater than 31 mm Hg during dexamethasone administration), 36 (13.0%) developed glaucomatous visual field loss during the follow-up period. Only nine of 261 individuals (3.4%) who were intermediate responders (intraocular pressure 20 to 31 mm Hg during dexamethasone administration) and none of 251 individuals who were low responders (intraocular pressure less than 20 mm Hg during dexamethasone administration) developed glaucomatous visual field loss. However, the ability of the intraocular pressure response to dexamethasone to predict the development of glaucomatous visual field loss was not as good as the predictive power of a multivariate model that included patient age, race, baseline intraocular pressure, baseline outflow facility, baseline cup/disk ratio, and systemic hypertension.

Adult↗
PubMed1988

Pattern reversal electroretinogram (PRERG) abnormalities in ocular hypertension: correlation with glaucoma risk factors.

The indices employed commonly for the diagnosis of glaucoma (tonometry, ophthalmoscopy and perimetry) do not always identify which patients with ocular hypertension (OHT) will develop primary open-angle glaucoma (POAG) before irreversible visual field loss is manifest (1). The human pattern reversal electroretinogram (PRERG) is a bioelectric response reflecting neural activity of the proximal retina. PRERG amplitude reductions have been observed in POAG and other diseases affecting the optic nerve and retinal ganglion cells. This study was designed to determine whether OHT patients exhibit PRERG amplitude reductions and whether PRERG results are correlated with routinely evaluated clinical parameters. Steady-state PRERG (16 rps) were elicited by high contrast (76%), phase alternating checkerboard patterns (15-20 min checks) from one eye of 130 patients with ocular hypertension and 47 age matched visual normals (AMVNs). A significant (p less than 0.05) reduction in PRERG amplitude was noted for the OHT patients and 11.5% of those patients exhibited PRERG amplitudes more than 2.0 standard deviations below the AMVN mean. PRERG amplitude was found to be positively correlated with diastolic blood pressure (DBP) and negatively correlated with age, but no correlation between PRERG amplitude and either IOP, C/D ratio, or systolic blood pressure was evident. The lack of correlation between PRERG amplitude and the commonly used clinical indices may suggest a complementary role for this neurophysiologic test in determining which OHT patients will develop glaucoma.

Analysis of Variance↗
PubMed1988

Dissociation of visual deficits in ocular hypertension.

Both acquired color vision deficiencies and abnormal pattern electroretinograms (PERGs) are observed in patients with ocular hypertension (OHT) as well as in patients with glaucoma. In the present study we determined the prevalence of both of these functional deficits in a large group of OHT patients (N = 130). Color vision was tested with the desaturated D-15 and a color confusion score was used to quantitatively assess the magnitude of the color vision deficiency. Steady-state PERGs were evoked with rapidly alternating high contrast checkerboard patterns. Color vision deficits were detected in 23% of OHTs while 11.5% of the patients exhibited significant PERG amplitude reductions. Only 2.3% exhibited both abnormalities. The results suggest that although color vision deficiencies and PERG abnormalities are both evident in OHT, they are often dissociated findings.

Adult↗
PubMed1985

Neovascular glaucoma after intracapsular and extracapsular cataract extraction in diabetic patients.

A retrospective study of the rate of development of neovascular glaucoma after cataract extraction in 242 eyes of 186 diabetic patients identified neovascular glaucoma in 13 of 146 eyes (8.9%) after intracapsular extraction, in two of 17 eyes (11.8%) after extracapsular extraction with primary capsulotomy, and in zero of 53 eyes after extracapsular extraction without capsulotomy. The incidence of neovascular glaucoma was significantly lower in patients who underwent extracapsular extraction with preservation of an intact posterior capsule than in those undergoing intracapsular cataract extraction (P less than .01) or extracapsular cataract extraction with primary capsulotomy (P less than .05).

Aged↗
PubMed1985

Acute intraocular pressure response to argon laser iridotomy.

Argon laser iridotomy (ALI) was performed in 50 eyes for prophylactic treatment of anatomically narrow iridocorneal angles and in 50 eyes for therapy of chronic angle-closure glaucoma. Intraocular pressure was increased 6 mmHg or more 1 to 2 hours after ALI in 19 of 50 eyes with anatomical narrow iridocorneal angles and in 23 of 50 eyes with chronic angle-closure glaucoma. Increases greater than 20 mmHg over baseline value occurred in 5 of 50 eyes with narrow iridocorneal angles and in 7 of 50 eyes with chronic angle-closure glaucoma. A clinically significant increase in intraocular pressure (defined as a pressure 30 mmHg or greater and 40% or more increased over the pre-laser value) occurred 1 to 2 hours after ALI in 11 of 50 eyes with narrow iridocorneal angles and in 17 of 50 eyes with chronic angle-closure glaucoma. There was no statistical difference (chi square P greater than 0.3) in the incidence of this complication in the two groups. Additional medical therapy was effective in lowering the acute laser-induced elevation in intraocular pressure. Patient diagnosis, patient demographics, preoperative glaucoma medication and laser treatment parameters did not predict which eyes would develop this complication. Eyes which did not have a clinically significant elevation in intraocular pressure 1 to 2 hours after ALI did not show a later increase at 24 hours.

Female↗
PubMed1984

Reopening filtration fistulas with transconjunctival argon laser photocoagulation.

Three patients (a 15-year-old girl, a 45-year-old woman, and a 61-year-old woman) with previously successful full-thickness filtering procedures developed pigmented tissue in the fistula sites and uncontrolled intraocular pressures despite maximum tolerable medical therapy. The filtering procedures in the first and second patients spontaneously failed two and four years after surgery. The filtration bleb of the third patient, after successfully controlling intraocular pressure for six years, failed two months after cataract extraction. Argon laser therapy was applied through the conjunctiva to treat visible subconjunctival pigmented tissue within the sites of the previous surgical filtration blebs. In all three cases, there was an immediate and significant decrease in intraocular pressure associated with reestablishment of the filtration bleb (from 44 to 16 mm Hg in Case 1, from 40 to 15 mm Hg in Case 2, and from 25 to 12 mm Hg in Case 3). Long-term follow-up showed well controlled intraocular pressures without glaucoma medications (Case 1, 5 mm Hg after 18 months; Case 2, 17 mm Hg after one year; and Case 3, 9 mm Hg after five months).

Adolescent↗
PubMed1984

Limbus- v fornix-based conjunctival flap in trabeculectomy. A long-term randomized study.

The safety and success rates of trabeculectomy using fornix-based or limbus-based conjunctival flaps were investigated in a randomized, prospective study. Patients with phakic eyes and uncontrolled primary open-angle glaucoma had a trabeculectomy with either a standard limbus-based conjunctival flap (18 eyes) or a fornix-based conjunctival flap (19 eyes). Filtration surgery was equally successful (intraocular pressure, less than or equal to 21 mm Hg) in both groups independent of the type of conjunctival flap: 17 (94%) of 18 eyes with a limbus-based flap (three eyes with additional medical therapy) and 17 (89%) of 19 eyes with a fornix-based flap (three eyes with additional medical therapy). Four eyes in the fornix-based group showed positive Seidel tests in the early postoperative period. Aqueous leakage was from the suture sites at the lateral margins of the flap and resolved spontaneously without surgical intervention. The fornix-based conjunctival flap was easier to perform, provided better surgical exposure, and was easier to close than the limbus-based flap.

Adult↗
PubMed1984

Intraocular pressure the day of argon laser trabeculoplasty in primary open-angle glaucoma.

Argon laser trabeculoplasty was performed in one eye of 57 phakic patients with primary open-angle glaucoma. The eyes received a mean of 78 +/- 7 treatments over 360 degrees to the anterior trabecular meshwork. The power was titrated to produce blanching without bubble formation. Increased intraocular pressure (range +1 to +22 mmHg) occurred in 30 of the 57 (53%) eyes 1 hour after treatment. Eight (14%) of these eyes had a clinically significant elevation defined by all of three criteria: (1) an intraocular pressure greater than 30 mmHg, (2) greater than a 30% increase over the mean prelaser intraocular pressure, and (3) greater than a 10 mmHg increase over the peak prelaser diurnal intraocular pressure curve. These eight patients received either oral glycerine or acetazolamide. A rebound increase in intraocular pressure requiring repeat medical treatment occurred in four of the eight eyes. Two additional eyes without a pressure elevation 1 hour after treatment showed a later elevation. This was first detected 4 hours postoperatively in one eye and 7 hours after treatment in another eye. The 1-hour postoperative measurement detected most patients with clinically significant increased intraocular pressure (8 of 10 eyes) but these required continued observation for rebound increases. Patients with advanced glaucomatous visual field loss should also be followed closely to detect late increases in intraocular pressure (2 of 10 eyes).

Adult↗
PubMed1982

Part I. Patient administration of eyedrops: interview.

Interviews of 141 patients were conducted to determine their use of eyedrops. This study indicates a need to improve patient instruction concerning drug compliance and proper time scheduling of eyedrop treatments.

Adult↗