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Biomedical subjects

A J Flach

Publications and source records attributed to A J Flach.

At least 19 recordsLinked to original sources
PubMed2001

Corneal melts associated with topically applied nonsteroidal anti-inflammatory drugs.

PURPOSE: Topically applied nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used to prevent miosis during cataract surgery, to treat ocular allergies, to prevent excessive postoperative inflammation following cataract surgery, and to treat cystoid macular edema following cataract surgery. They have also been used to control pain and photophobia following radial keratotomy and excimer laser photorefractive keratectomy. During August of 1999, severe complications following topical NSAID use including corneal melting, were reported by members of the American Society of Cataract and Refractive Surgery (ASCRS) responding to a survey distributed in letters from ASCRS to its members. The purpose of this report is to review 11 cases of corneal melting in patients treated with topical NSAIDs, with special attention to the observed toxicity and its relationship to dose and duration of treatment, coexistent disease and therapies, and the indication for treatment. The goal of this study is to identify factors useful in minimizing the occurrence of corneal toxicity. METHODS: The medical records and/or histories of 11 patients with corneal melting associated with the use of topical NSAIDs are reviewed, with special attention to the indication for treatment, the dose and duration of treatment, and coexistent diseases and medical treatments. In addition, the relationship between NSAID treatment and surgery and between NSAID treatment and onset and extent of corneal toxicity are described. RESULTS: Each of the 11 patients appeared to suffer severe corneal toxicity following the topical use of 0.5% diclofenac ophthalmic solution. Generic diclofenac (Falcon) (Alcon Laboratories, Inc, Fort Worth, Texas) was associated with 7 and Voltaren (Ciba Vision, Atlanta, Georgia) with 4 of these cases. Duration of treatment prior to corneal melting varied from 6 days to 17 months. Associated ocular and systemic diseases and their respective treatments complicate the analysis of these cases. In addition, the indication for treatment with topical NSAIDs was frequently unclear. CONCLUSIONS: The inconsistent and variable dose-toxicity relationships suggest that coexistent factors other than a simple drug toxicity are implicated, if not causative, in NSAID-associated corneal melting. These cases demonstrate the importance of making a clinical diagnosis before treatment and of following the clinical course of patients carefully during treatment.

Administration, Topical↗
PubMed2000

Incidence of postoperative posterior capsular opacification following treatment with diclofenac 0.1% and ketorolac 0.5% ophthalmic solutions: 3-year randomized, double-masked, prospective clinical investigation.

PURPOSE: Laboratory studies in experimental animals suggest that use of nonsteroidal anti-inflammatory drugs decreases the incidence of posterior capsular opacification (PCO) following cataract surgery. Recently the incidence of PCO following cataract surgery and intraocular lens implantation was reported to be no different following postoperative treatment with diclofenac sodium 0.1% (Voltaren, Ciba Vision) or with dexamethasone 0.1% (Maxidex, Alcon). We studied the incidence of PCO in patients following treatment with diclofenac 0.1% and ketorolac tromethamine 0.5% (Acular, Allergan) ophthalmic solutions 3 years after cataract surgery and implantation of a foldable silicone intraocular lens. METHODS: A total of 120 patients underwent phacoemulsification and implantation of a foldable silicone intracular lens. Patients were treated with either diclofenac 0.1% ophthalmic solution or 0.5% ketorolac ophthalmic solution 4 times daily for 30 days in a double-masked, randomized fashion during the postoperative period. Patients were examined 3 years following surgery by a masked observer who determined which patients received YAG capsulotomies and graded any existing PCO. RESULTS: Each treatment group had 12% YAG capsulotomies 3 years following surgery. Although PCO was present more often with diclofenac treatment (25/62) than with ketorolac treatment (16/58), this difference is not statistically significant (P = .142). Patients tolerated both treatments well without a difference in toxic effects or tolerability. CONCLUSIONS: This study did not demonstrate a difference in the ability of diclofenac or ketorolac ophthalmic solutions to prevent PCO following cataract extraction and implantation of an intraocular lens. Both treatment regimens were equally well tolerated.

Aged↗
PubMed1998

Comparative effects of ketorolac 0.5% or diclofenac 0.1% ophthalmic solutions on inflammation after cataract surgery.

OBJECTIVE: Ketorolac tromethamine 0.5% and diclofenac sodium 0.1% ophthalmic solutions are approved for use by the U.S. Food and Drug Administration to avoid excessive postoperative inflammation after cataract surgery and implantation of an intraocular lens. This study compares the efficacy and toxicity of these nonsteroidal anti-inflammatory drugs for the first time. DESIGN: Randomized, double-masked, prospective clinical trial. PARTICIPANTS: A total of 120 patients assigned in equal numbers to 1 of the 2 treatment regimens. INTERVENTION: Treatment with either ketorolac 0.5% or diclofenac 0.1% ophthalmic solutions instilled four times daily for 30 days beginning the first postoperative day after surgery. MAIN OUTCOME MEASURES: Objective (Kowa FC 1000 laser cell and flare meter) and subjective (slit-lamp biomicroscope) measurements of inflammation and toxicity were made and compared at three separate post-operative visits. RESULTS: The anti-inflammatory effects of the two treatment regimens were not statistically different at any of the postoperative visits. Patients tolerated both treatments equally well. CONCLUSIONS: This study shows diclofenac sodium 0.1% and ketorolac tromethamine 0.5% ophthalmic solutions are equally effective and safe for the control of postoperative inflammation after uncomplicated cataract surgery performed by phacoemulsification followed by the implantation of a foldable intraocular lens.

Aged↗
PubMed1995

Stevens-Johnson syndrome associated with methazolamide treatment reported in two Japanese-American women.

BACKGROUND: Systemic acetazolamide treatment has been reported in association with Stevens-Johnson syndrome (SJS). This is the first report of this syndrome associated with methazolamide treatment. The association is reported in two Japanese-American women. METHOD AND RESULTS: Two patients with SJS, which developed during treatment with methazolamide, are described. Other potential associations are discussed. CONCLUSIONS: Systemically administered carbonic anhydrase inhibitors, including both acetazolamide and methazolamide can be associated with SJS.

Adult↗
PubMed1994

Systemic toxicity. Associated with topical ophthalmic medications.

Topically administered ophthalmic preparations can be associated with systemic adverse events if excessive absorption occurs. The nasolacrimal system can deliver eyedrops and ointments to the vascular nasal mucosae where the drugs are absorbed avoiding the first-pass effect and reaching sites of action with increased bioavailability. Topical ophthalmic eye-drop preparations most often involved include glaucoma medications, and diagnostic, antimicrobial and anti-inflammatory drugs. This article reviews reported systemic reactions and summarizes methods useful in preventing excessive absorption.

Absorption↗
PubMed1993

Progression of amiodarone induced cataracts.

Amiodarone hydrochloride is a potent antiarrhythmic agent recently approved for use by the Food and Drug Administration. Anterior subcapsular lens opacities were observed in seven of fourteen patients treated with moderate to high doses of amiodarone at the Veterans Administration Medical Center in San Francisco in 1982. The present report summarizes the present status of these same fourteen patients ten years later. Anterior subcapsular lens opacities developed or progressed in all patients continuing treatment with this antiarrhythmic agent during the following ten year interval. Although Snellen visual acuities are not decreased, subtle visual impairment is present as measured by contrast sensitivity measurements with and without glare. This decrease in visual acuity is not a contraindication for therapy with this potentially life saving drug.

Aged↗
PubMed1992

Nerve terminal degeneration in the rat iris observed following chronic topical 2% epinephrine and 0.1% dipivalyl epinephrine: a quantitative comparison of electron microscopic observations and tissue norepinephrine levels.

This is the first report of nerve terminal degeneration within the iris following topical dipivalyl epinephrine 0.1% treatment. A quantitative comparison of the effects of topically applied epinephrine 2%, dipivalyl epinephrine 0.1%, and placebo vehicle on the nerve terminals within the iris of a rat was made using electron microscopy and a catecholamine radioenzyme assay. Thirty-nine rats were divided into these 3 treatment groups and treated for 10 weeks, after which they were killed and studied. Both the epinephrine 2%- and dipivalyl epinephrine 0.1%-treated groups showed greater nerve terminal degeneration compared with the placebo-treated group (P < 0.05). The epinephrine-treated group showed greater nerve terminal degeneration than the dipivalyl epinephrine-treated group. The clinical significance of these observations is unknown. It is impossible to decide whether these degenerative changes are related unavoidably to a desired therapeutic effect or to an undesirable, potentially avoidable, toxic side effect.

Animals↗
PubMed1992

Effects of topically applied 2% epinephrine and 0.1% dipivalyl epinephrine on the adrenergic nerves as revealed by histofluorescence.

Commercially available epinephrine (EPI) 2% and dipivalyl epinephrine (DPE) 0.1% ophthalmic solutions were instilled twice daily in the eyes of rats over a 12-week period and compared to placebo-vehicle-treated controls. Fluorescence photomicrographs of stretch preparations from the dilator muscle of the rat irises showed a weaker fluorescence in the eyes treated with EPI and DPE as compared with controls treated with a placebo vehicle. This study provides further evidence that EPI and DPE treatment can result in a chemical sympathectomy as has been described following topical application of 6-hydroxydopamine.

Animals↗
PubMed1991

Improvement in visual acuity in chronic aphakic and pseudophakic cystoid macular edema after treatment with topical 0.5% ketorolac tromethamine.

Ketorolac tromethamine 0.5% ophthalmic solution treatment was compared to placebo treatment in 120 patients with chronic aphakic or pseudophakic cystoid macular edema (six-month or more duration of distance visual acuity of 20/40 or less and angiographic evidence of cystoid changes) during a four- to five-month double-masked, multicenter study in which patients were randomly assigned. A statistically significant improvement in distance visual acuity (two lines or more) was observed in the ketorolac-treated group as compared to the placebo-treated group after 30 days (P = .038), 60 days (P = .017), and 90 days (P = .008) of treatment. This improvement in visual acuity remained statistically significant one month after cessation of treatment (P = .001). Nine ketorolac-treated patients and two placebo-treated patients demonstrated a decrease in visual acuity one month after treatment was discontinued. Seven of the nine ketorolac-treated patients experienced an improvement in visual acuity after retreatment as compared to none of the placebo-treated patients. This study offers evidence for a more optimistic outlook in the medical treatment of chronic aphakic and pseudophakic cystoid macular edema.

Administration, Topical↗