Amiodarone-induced lens opacities: an 8-year follow-up study.
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Amiodarone↗
Biomedical subjects
A J Flach
Publications and source records attributed to A J Flach.
Prophylaxis of aphakic cystoid macular edema without corticosteroids. A paired-comparison, placebo-controlled double-masked study.
Prior investigations have reported that topical nonsteroidal anti-inflammatory drug (NSAID) therapy prevents the development of postoperative angiographic signs of angiographic cystoid macular edema (CME). However, these studies include concurrent use of corticosteroids. The current study reports therapeutic efficacy for ketorolac ophthalmic solution (an NSAID) in the prophylaxis of angiographic aphakic CME (ACME) after cataract surgery without concurrent corticosteroids for the first time. Fifty patients with bilateral cataracts were enrolled in this placebo-controlled, paired-comparison, double-masked study. Eleven patients had evidence of angiographic ACME on postoperative day 40. Two of these patients demonstrated bilateral ACME, one patient had ACME in the NSAID-treated eye, and eight patients demonstrated ACME in the placebo-treated eye. This is a statistically significant difference favoring drug treatment. The signs of anterior ocular inflammation were greater in the eyes with ACME. This study suggests prophylactic treatment of ACME may be possible without the risks of concurrent corticosteroid toxicity. In addition, a higher incidence of ACME in black patients (22%) is observed in this study than has been recognized previously.
Adult↗
Episcleritis, conjunctivitis, and keratitis as ocular manifestations of Lyme disease.
A 35-year-old woman presented with a bilateral palpebral follicular conjunctivitis. Subsequently, she developed a bilateral keratitis and, on a separate occasion, an episcleritis that was associated with a recrudescence of Lyme disease and poor compliance with the antibiotic regimen. Both the keratitis and episcleritis cleared completely after topical corticosteroid therapy and reinstitution of appropriate antibiotic treatment. This report emphasizes the importance of collaboration between internal medicine and ophthalmologic specialists during the long-term management of Lyme disease.
Adrenal Cortex Hormones↗
Cystoid macular edema following cataract surgery.
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Adrenal Cortex Hormones↗
The effect of ketorolac tromethamine in reducing postoperative inflammation: double-mask parallel comparison with dexamethasone.
Anterior chamber fluorophotometry was done after the oral administration of fluorescein sodium in patients undergoing extracapsular cataract extraction and posterior chamber intraocular lens insertion before and after surgery. The administration of ketorolac solution 0.5% eye drops before and after surgery decreased the breakdown of the blood-aqueous barrier as much as did dexamethasone sodium phosphate solution 0.1% (dexamethasone solution) eye drops at each postoperative time period as measured by fluorophotometry. Slit-lamp observations of postoperative anterior ocular inflammation were not different between treatment groups. Both ketorolac and dexamethasone solutions were well tolerated by patients. No additional corticosteroids were given to any patients during the study. Therefore, ketorolac solution was as effective as dexamethasone solution in suppressing postoperative inflammation after cataract surgery as measured by fluorophotometry and as observed by slit-lamp examinations. This study confirms prior studies that suggest ketorolac ophthalmic solution 0.5% may be effective and safe as a nonsteroidal antiinflammatory agent for topical use after cataract surgery and intraocular lens implantation and as a substitute for topically applied corticosteroids.
Adult↗
Quantitative assessment of postsurgical breakdown of the blood-aqueous barrier following administration of 0.5% ketorolac tromethamine solution. A double-masked, paired comparison with vehicle-placebo solution study.
Preoperative and serial postoperative anterior chamber fluorophotometry were performed after oral administration of fluorescein sodium in patients undergoing extracapsular cataract extraction and posterior chamber intraocular lens insertion. The administration of topical 0.5% ketorolac tromethamine solution before and after surgery markedly decreased the breakdown of the blood-aqueous barrier compared with vehicle-placebo solution administration at each time period, as measured by fluorophotometry. Corticosteroids were not given to any patients throughout the duration of the study. These fluorophotometric results correlated well with slit-lamp observations of postoperative ocular inflammation. Both ketorolac and vehicle were well tolerated by patients. No effects on intraocular pressure were seen with ketorolac administration. This study suggests that ketorolac ophthalmic solution is effective and safe as a nonsteroidal anti-inflammatory agent for topical use following cataract surgery and intraocular lens implantation.
Adult↗
The quantitative effect of 0.5% ketorolac tromethamine solution and 0.1% dexamethasone sodium phosphate solution on postsurgical blood-aqueous barrier.
Anterior chamber fluorophotometry was performed after the oral administration of fluorescein sodium in patients undergoing extracapsular cataract extraction and posterior chamber intraocular lens insertion before and after surgery. The administration of 0.5% ketorolac tromethamine solution (ketorolac solution) eye drops before and after surgery decreased the breakdown of the blood-aqueous barrier as compared with 0.1% dexamethasone sodium phosphate solution (dexamethasone solution) eye drops at each period, as measured by fluorophotometry. A single injection below Tenon's capsule of a short-acting corticosteroid had been given to each patient at the end of each surgical procedure. Slit-lamp observations of postoperative ocular inflammation were not different between treatment groups. Both ketorolac and dexamethasone solutions were well tolerated by patients. Ketorolac solution was more effective than dexamethasone solution in facilitating reestablishment of the blood-aqueous barrier after surgery, as measured by fluorophotometry, and was equal to dexamethasone solution as observed by slit-lamp observations. This study suggests that ketorolac ophthalmic solution may be effective and safe as a nonsteroidal anti-inflammatory agent for topical use after cataract surgery and intraocular lens implantation in place of topically administered corticosteroids.
Adult↗
The effect of ketorolac tromethamine solution 0.5% in reducing postoperative inflammation after cataract extraction and intraocular lens implantation.
Ketorolac tromethamine solution 0.5% (1 drop 3 times daily) was more effective than the placebo vehicle solution in suppressing postoperative anterior ocular inflammation after extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation in this multicenter, double-masked, randomized study. Four of 60 ketorolac-treated patients compared with 25 of 58 placebo-treated patients required supplemental corticosteroid therapy to suppress inflammation in the postoperative period which was statistically significant (P less than 0.001). Even though these supplemental steroid-treated patients were kept in the analysis, the placebo-treated group showed more evidence of anterior ocular inflammation as measured by anterior segment fluorophotometry. This was consistent with slit-lamp observations of increased anterior ocular inflammation. This study supported previous studies that suggested ketorolac tromethamine ophthalmic solution 0.5% was effective and safe as a nonsteroidal anti-inflammatory agent for topical use after ECCE and IOL implantation.
Adult↗
Topical prostaglandin E2 effects on normal human intraocular pressure.
This was a double-masked, randomized, paired comparison with vehicle trial of a topically administered prostaglandin (PG)E2 in healthy human volunteers. A statistically significant decrease of the intraocular pressure in these non-glaucomatous volunteers occurred at six hours following one drop of 0.02% solution that persisted to the last measurement of IOP at the 24 hour examination. Significant elevation in the intraocular pressure was present at one and two hours following the eye drop instillation. All volunteers reported transient ocular side effects related to drug administration, including mild eye ache and intermittent photophobia for a duration of 2 to 4 hours. These symptoms were associated with a transient conjunctival vasodilation, but with no evidence of anterior chamber cells and flare or ciliary flush as determined by slit lamp examination. The results of this study suggest that PGE2, or a derivative, may offer a new class of topically effective ocular hypotensive agents useful in lowering the intraocular pressure of glaucoma patients.
Administration, Topical↗
Effectiveness of ketorolac tromethamine 0.5% ophthalmic solution for chronic aphakic and pseudophakic cystoid macular edema.
The effect of ketorolac tromethamine 0.5% ophthalmic solution (a new nonsteroidal anti-inflammatory agent) treatment was compared to placebo treatment in patients with chronic, angiographically proven aphakic or pseudophakic cystoid macular edema (visual acuity less than or equal to 20/40 for six months) during a three- to four-month double-masked, randomized study. Twenty-six patients completed this study without significant ocular or systemic toxicity. The improved distance visual acuity observed in the ketorolac treatment group (8/13 patients) was statistically different from the improved vision observed in the placebo treated group (1/13 patients) (P = .005). No patient on a regimen of ketorolac therapy had a significant decrease in Snellen distance visual acuity while on treatment, but two patients in the placebo group demonstrated a decrease in visual acuity of two lines or more. Fluorescein angiography was consistent with changes in visual acuity.
Anti-Inflammatory Agents, Non-Steroidal↗
Ocular hypertensive responses in pigmented rabbits following different methods of waterloading.
Waterloading tests are used in rabbits to screen potentially useful ocular hypotensive drugs. The present study examines the ocular hypertensive response following oral, intravenous and intraperitoneal administration of water in conscious Dutch belt pigmented rabbits. All methods of waterloading were well tolerated by rabbits. However, intraperitoneal waterloading provided an ocular hypertensive effect of longer duration than either oral or intravenous waterloading.
Animals↗
The therapy of Adie's syndrome with dilute pilocarpine hydrochloride solutions.
Impressed by the benefit two patients with Adie's Syndrome derived from topical 0.1% pilocarpine therapy, we performed the present study to examine the measurable effects of 0.1% pilocarpine in several patients with this syndrome. Our study suggests those patients with Adie's Syndrome who lack stereoacuity may benefit from long term therapy with dilute pilocarpine if their stereoacuity may benefit from long term therapy with dilute pilocarpine if their stereoacuity improves following a single drop of 0.1% pilocarpine. Therefore, we recommend measuring stereoacuity during pupil diagnostic testing with 0.1% pilocarpine hydrochloride. Potential problems concerning medical therapy of Adie's Syndrome with parasympathomimetics are discussed.
Adie Syndrome↗
Anterior subcapsular cataracts: a review of potential etiologies.
Photographs of amiodarone-induced anterior subcapsular lens opacities and axial punctate lens opacities are presented and compared for the first time. The similarities and differences between these lens opacities and phenothiazine-induced lens opacities are discussed. Potential etiologies for anterior subcapsular cataracts are reviewed. The biomicroscopic techniques required to appreciate subtle lens opacities are mentioned. The importance of recognizing and recording subtle lens opacities is discussed.
Adult↗
Amiodarone keratopathy and lens opacities.
Amiodarone hydrochloride is an antiarrhythmic drug which produces a keratopathy and anterior subcapsular lens opacities that are usually asymptomatic. Serial observations for eye findings were made in 21 patients on a daily dosage of 200-600 mg for periods ranging from six months to three years. Corneal deposits developed in all 21 patients and anterior lens opacities developed in 12 of 20 phakic patients. Resolving keratopathy was present in three patients for periods of at least seven to 20 months after amiodarone was discontinued.
Adult↗
Dangers of ocular instillation of medications.
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Drug-Related Side Effects and Adverse Reactions↗
Local ocular hypotensive effect of topically applied acetazolamide.
Acetazolamide's usefulness in the treatment of the glaucomas is limited by the systemic side effects that often accompany its oral administration, and topical administration was initially thought to have no effect upon the intraocular pressures of human and rabbit eyes. Recent studies, however, have shown the usefulness of water-loading tests for screening drugs with potential antiglaucomatous activity. We found evidence that topical acetazolamide has the ability to lessen the increase in intraocular pressure after water-loading in pigmented rabbits and correlated this observation with low levels (0.0 to 0.7 microgram/ml) of plasma acetazolamide. Further, a separate study showed that 10% topical acetazolamide can enhance the ocular hypotensive effects of systemically administered acetazolamide in normal pigmented rabbits, suggesting that topically applied acetazolamide can have a local effect on intraocular pressure.
Acetazolamide↗
The use of amiodarone in children.
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Adolescent↗
Adie's syndrome: a medical treatment for symptomatic patients.
A symptomatic patient with Adie's syndrome is described as successfully managed with pilocarpine 0.125% applied topically to the involved eye three times daily. This is the first report of such a patient responding to direct parasympathomimetic therapy. Alternate approaches to the therapy of Adie's syndrome are mentioned. An approach to the management of Adie's syndrome is proposed.
Accommodation, Ocular↗