Clinical trials in diabetic retinopathy.
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Biomedical subjects
Publications and source records attributed to C Kupfer.
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Bilateral progressive essential iris atrophy, more advanced in one eye than in the other, occurred in a 24-year-old white man. Histopathologic examination of the iris from the eye with the more advanced iris atrophy disclosed no vascular abnormalities in that the vessels were patent and appeared normal except for accumulated perivascular connective tissue. Fluorescein angiographic examination of the fellow eye that was undergoing the earliest changes of iris atrophy failed to reveal any vascular abnormalities. However, tonographic examination indicated a markedly decreased outflow facility. There does not appear to be any vascular abnormality involved in the pathogenesis.
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Young and old volunteers received acetazolamide systemically or isoproterenol topically. Although the responses of the two groups of volunteers were quite similar for acetazolamide, they differed significantly for isoproterenol. It is suggested that a normal aging change is altered responsiveness of the site of aqueous production and of the outflow pathways to topical isoproterenol. The site of aqueous production becomes less responsive; the outflow pathways become more responsive.
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A case of bilateral progressive essential iris atrophy, more advanced in one eye than the other, has been studied. Histopathologic examination of the iris from the eye with the more advanced iris atrophy failed to find any vascular abnormalities in that the vessels were patent and appeared normal except for accumulated perivascular connective tissue. Fluorescein angiographic examination of the right eye which was undergoing the earliest changes of iris atrophy failed to show any vascular abnormalities. However, tonographic examination indicated a markedly decreased outflow facility. There does not appear to be any vascular abnormality involved in the pathogenesis of this case.
Iris tissue and trabecular meshwork, obtained at time of trabeculectomy, was studied using the light and electron microscope in a 54-year-old woman with pigmentary dispersion syndrome with glaucoma. The specific defect was a loss of the outer epithelial cells of the iris with marked thinning of the remaining outer layers so that the two-cell architecture of the iris epithelium was maintained. In addition, the radial muscle layer was increased in both number and size of muscle fiber. It would appear that the pigmentary dispersion syndrome may represent a congenital or developmental abnormality of the iris epithelium, or both, and that the glaucoma which occasionally occurs in conjunction with this syndrome is of the usual open-angle type.
As exemplified by the collaborative Diabetic Retinopathy Study, all the appropriate techniques involved in a clinical trial-random assignment of treatment, appropriate controls, and avoidance of investigator bias-should be incorporated during the earliest testing of a new therapy for a chronic disease, for the sake of the patient and for the progress of medical science. This approach to clinical trials in the testing of new ocular therapies can provide the most scientifically sound and rational therapy to the patient.
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The acute effects of topical pilocarpine 4 per cent, administered to one eye, have been studied in replicate experiments in young volunteers. One hour after medication administration the intraocular pressure was significantly lower. The magnitude of the reduction exceeded that predicated from the significant increase of true facility of outflow. This is explained by the observation of a significant reduction of calculated aqueous humor flow. Pilocarpine caused a significant increase of pseudofacility, a clinically useful drug effect not previously reported. One hour after medication administration, measured episcleral venous pressure was not different from the pretreatment level.
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