Secondary hemorrhage in traumatic hyphema.
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Aminocaproates↗
Biomedical subjects
E R Crouch
Publications and source records attributed to E R Crouch.
Factors affecting therapeutic concentration of topical aminocaproic acid in traumatic hyphema.
Epsilon-aminocaproic acid (EACA) decreases rebleeding in traumatic hyphema through antifibrinolytic activity. Therapeutic levels were achieved in aqueous humor of rabbits after topical application. Aqueous humor EACA levels were significantly higher after pretreatment with 0.5% proparacaine. Use of EACA (60%) in a carboxypolymethylene (CPM) vehicle (0.5%, 1%, 2%, 3%, and 4%) was examined. Aqueous humors levels at 4 hours ranged from 6.18-20.42 micrograms/ml. The 2% and 3% formulas achieved the highest concentrations in aqueous. Use of EACA (15%, 30%, 40%, and 60%) in 4% CPM was also studied. At 2 and 4 hours after treatment, the 30% EACA solution most effectively achieved therapeutic levels. Velcro closure devices were attached to the rabbit's eyelids, and 200 microliters of 30% EACA in 2% CPM was administered. After 3 hours the patched eyes had a mean aqueous EACA level of 60.09 micrograms/ml compared with 8.97 micrograms/ml in unpatched eyes. When dose size was studied in patched eyes, 200-microliters doses achieved aqueous levels of 60.09 micrograms/ml, and 100-microliters doses resulted in levels of 10.40 micrograms/ml. Since epithelial toxicity was observed in eyes that had been patched, the optimum topical regimen appeared to be 200 microliters of 30% EACA in 2% CPM every 6 hours in unpatched eyes.
Acrylic Resins↗
Topical aminocaproic acid significantly reduces the incidence of secondary hemorrhage in traumatic hyphema in the rabbit model.
Systemically administered aminocaproic acid has been shown to reduce the incidence of secondary hemorrhage after traumatic hyphema. To date, no topical treatment has been shown to be effective in reducing the incidence of rebleeding in a double-masked study. Experimentally induced traumatic hyphemas in the rabbit model were treated with topical placebo gel (4% carboxypolymethylene gel only) or carboxypolymethylene gel with amino-caproic acid (treated group) in a double-masked fashion and were compared with untreated controls (control group). In both the control and placebo groups, there was a 33% rebleed rate. The treated eyes had a 10% rebleed rate that is statistically significant. The topically applied aminocaproic acid gel appears to be well tolerated locally without evidence of systemic toxicity. This study indicates that topical aminocaproic acid may be an effective alternative to systemic treatment to reduce the incidence of secondary hemorrhage in traumatic hyphema.
Acrylic Resins↗
Systemic aminocaproic acid reduces fibrinolysis in aqueous humor.
Systemically administered aminocaproic acid has been demonstrated to reduce the incidence of secondary hemorrhage in traumatic hyphema. To directly determine the concentration of aminocaproic acid in the aqueous humor, four groups of rabbits were studied following administration of four different regimens of intravenously administered aminocaproic acid. Plasma and aqueous humor samples were assayed for drug content and antifibrinolytic activity. Peak aqueous humor concentrations of aminocaproic acid ranged from 2.5 to 33 mg/dL and varied according to the systemic dose administered. The antifibrinolytic activity paralleled the aminocaproic acid content, with a peak range from 310 to 683 s. These findings indicate a direct relationship between antifibrinolytic activity and the concentration of aminocaproic acid in aqueous humor.
Aminocaproates↗
Topically applied aminocaproic acid concentrates in the aqueous humor of the rabbit in therapeutic levels.
Systemically administered aminocaproic acid, used to reduce the incidence of secondary hemorrhage in traumatic hyphema, has been shown to accumulate in the aqueous humor of rabbits in a dose-dependent manner. Eight topical preparations of aminocaproic acid were studied to determine aqueous humor concentrations. The vehicles studied included the following: sodium chloride, 0.85 g/dL; polyvinyl alcohol, 1.4 g/dL; hydroxypropyl methylcellulose, 0.4 g/dL; benzalkonium chloride, 0.01 g/dL; ethylenediamine tetraacetic acid disodium, 0.01 g/dL; dimethyl sulfoxide, 11 and 39.6 g/dL; and carboxypolymethylene, 4 g/dL. All contained 735 g/L of aminocaproic acid except for dimethyl sulfoxide (39.6 g/dL) and carboxypolymethylene (4 g/dL), which contained 238 and 600 g/L of aminocaproic acid, respectively. Aqueous humor and plasma samples were assayed for aminocaproic acid content following topical administration. Aqueous humor concentrations of aminocaproic acid ranged from undetectable (less than 0.01 mg/dL) to 5.75 mg/dL. Plasma concentrations ranged from undetectable (less than 0.01 mg/dL) to 9.85 mg/dL. Polyvinyl alcohol (1.4 g/dL) and carboxy polymethylene (4 g/dL) provided the highest aqueous humor aminocaproic acid concentrations. The aqueous humor levels with topical aminocaproic acid administration were comparable with those achieved by systemic administration. Plasma drug levels with topical aminocaproic acid were between 5% and 33% of levels achieved by systemic aminocaproic acid. This study demonstrates that aminocaproic acid can be effectively delivered into the anterior chamber of rabbits by topical application.
Acrylic Resins↗
Management of posterior lenticonus complicated by unilateral cataract.
We studied 21 patients with 23 eyes with posterior lenticonus. Twenty-one of the eyes developed progressive cataractous changes that required lens aspiration in 19 eyes when vision reduction was 6/30 (20/100) or less. The inherent weakness of the diaphanous portion of the posterior lens capsule contributed to disruption of the normal lamellar arrangement of the lens fibers resulting in cataractous changes. Amblyopia was the most significant visual problem associated with posterior lenticonus. Fifteen of the 19 operated eyes in this study were amblyopic and nine of the 15 were improved to 6/15 (20/50) or better vision with occlusion therapy, after surgical aspiration of the cataractous lens and contact lens therapy.
Adolescent↗
Elephantiasis of eyelids following repeated craniotomy. Case report.
A case is reported in which craniectomy for removal of right frontal meningioma was complicated by porencephaly. A peculiar granulomatous area was found over the brain at reoperation for cranioplasty. Iodine solution was used to paint the reactive material under the scalp flap. Giant swelling of the isilateral eyelids gradually developed, ascribed to interference with lymphatic drainage from the eyelids. There was no communication between eyelids and cerebrospinal fluid spaces. The enlarged eyelids were removed by ophthalmic plastic surgery.
Brain Neoplasms↗
Aminocaproic acid in the treatment of traumatic hyphema.
Of 59 patients with traumatic hyphema studied prospectively, 32 received aminocaproic acid, an antifibrinolytic agent, to prevent secondary hemorrhage. The remaining 27 patients received placebo in an identical manner. Of the aminocaproic acid-treated patients, only one (3%) rebled, while nine patients (33%) receiving placebo suffered secondary hemorrhage. The results of this study indicate a statistically significant reduction (P less than .01) in the incidence of rebleeding in patients treated with this drug.
Adolescent↗
Retinal periarteritis secondary to syphilis.
A 43-year-old black woman showed ophthalmoscopic evidence of retinal arteriolitis two weeks after being treated for uniocular panuveitis. Angiographic examination suggested that these deposits were not intraluminal or endothelial atherosclerotic emboli or plaques, but were deposits in the outer walls of retinal arterioles. Sequential ophthalmoscopic and angiographic examinations at one-month intervals for 12 months showed no progression or change in location of these deposits. Results of clinical and laboratory investigations suggested the diagnosis of syphilis. We believe it is rare for syphilitic infection to be implicated in the diagnosis of isolated retinal arteriolitis without periphlebitis.
Adult↗
Prevention of corneal opacification in open sky vitrectomy: Part I. An in vitro study.
We tested the effects of various physiologic solutions with known osmotic pressures on maintenance of corneal transparency in vitro and compared them with the effects of other solutions that exert both oncotic and osmotic pressures. Normal saline solution, 5% glucose and normal saline solution, tissue culture 199, and plasma were bathing solutions tested. Increases in hydration and endothelial cell damage for the various media were compared. We found that plasma preserved corneal dehydration and endothelial viability better than other physiologic solutions.
Animals↗
Surgical treatment of exotropia after surgically produced pseudoparalysis of the medial rectus muscle.
The characteristic clinical findings of pseudoparalysis of the medial rectus muscle include exotropia in primary position, widened medial fissure on the affected side, limitation of adduction on the affected side, an A-pattern exotropia, and a paradoxical forced-traction test. We have devised a surgical technique to restore good movement of the eye in adduction. The priniciple behind the technique is that all adhesions between Tenon's capsule covering the muscle and conjunctiva, and between muscle and sclera must be found and cut posterior to the fornix. This will allow the muscle to be brought forward easily so that it can be resected and advanced for restoration of function.
Adolescent↗
Working with the Cherokees and Creeks.
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Adolescent↗
Traumatic hyphema.
Multiple modalities of treatment for traumatic hyphema have been advocated in the past. Therapy should be directed at reducing the risk of secondary hemorrhage and the potentially devastating complications of corneal blood staining and optic atrophy. Therapeutic regimens proven successful include: a patch and shield to the traumatized eye; daily visual acuity and slit-lamp biomicroscopy, including intraocular pressure, evaluation of corneal clarity, and size of hyphema; topical atropine; the systemic administration of aminocaproic acid; and topical and systemic antiglaucomatous medications with elevated intraocular pressure. Surgical intervention should generally be avoided in hyphemas of less than 50%. In larger hyphemas, there are definite indications for surgical intervention. Preferred surgical methods include: irrigation and aspiration, and hyphema evacuation by vitrectomy instrumentation.
Aminocaproic Acid↗
Acute orbital pseudotumor with iatrogenic intraorbital air: a diagnostic dilemma.
A 13-year-old black female was referred with unilateral granulomatous uveitis and orbital inflammation of sudden onset. Hematologic, serologic, bacteriologic, and ultrasonographic studies along with high resolution CT scans of the orbits were employed to determine the diagnosis and appropriate treatment. Subconjunctival corticosteroid injection containing air prior to referral obfuscated the ultimate diagnosis of pseudotumor. The Pediatric Infectious Disease service delayed definitive treatment with systemic steroids. Differential diagnosis of granulomatous uveitis with orbital inflammation are discussed. CT scan has significantly advanced the diagnosis and management of orbital pseudotumor.
Acute Disease↗
Bilateral hypermetropic amblyopia.
A retrospective analysis was performed on the records of 184 children who had hyperopia of at least 4.0 diopters in each eye to see if bilateral amblyopia was more than just a rare occurrence and to evaluate how well it responded to treatment. Twelve patients were found to have bilateral amblyopia of 20/50 or worse. The mean age at diagnosis was four and a half years (two and a half to six and a half) and mean follow-up was 22 months (five months to seven years, four months). Ten of 12 patients showed improvement of vision to 20/40 or better in both eyes. Treatment consisted of full cycloplegic correction in all cases. Six patients had accommodative esotropia but this did not account for the bilateral nature of the amblyopia. Bilateral amblyopia should be considered in patients with large amounts of hyperopia. It responds well to treatment with standard amblyopia therapy.
Accommodation, Ocular↗