Prostaglandin E2 in side effects of ocular surgery in man: preventive action of indomethacin.
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Biomedical subjects
Publications and source records attributed to G Baikoff.
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Endothelial cell density of 70 penetrating grafts and 11 lamellar keratoplasties was studied by specular microscopy. In perforating transplants, mean cell density was 1150 cells/mm2. No correlation could be established between cell counts and diagnosis or associated surgical procedures. Minimal cell density for a clear transplant appears to be of the order of 450 cells/mm2. In lamellar keratoplasties cell loss is reduced, and this may be one way to increase the proportion of clear grafts when endothelium is healthy.
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Inflammatory reaction to ocular trauma is known to be related to prostaglandins. To further evaluate this phenomenon in human, PGE1 and E2 were measured by R.I.A. after silicic acid chromatography in aqueous humour of 26 patients before and 3 days after surgery for unilateral senile cataract (posterior chamber implant after extracapsular surgery). 13 out of these patients were treated with indomethacin by enteral route and 13 were not treated. PGE2 levels increased in all non-treated patients from: m less than 214 pg/ml before surgery, to 2666 +/- 869 pg/ml (range: 257 - 8728) p less than 0.001 after surgery. PGE2 levels did not increase in indomethacin-treated patients. PGE1 levels did not increase significantly in non-treated as in treated patients. 1) Intra-ocular surgery is followed in human by a constant increase of the only PGE2 in the aqueous humour. 2) Indomethacin inhibits this increase. 3) The post-surgical increase in the permeability of blood-aqueous barrier appears to be related to a release of PGE2.
The authors relate their experience with five types of I.O.L. A retrospective study had been done with a specular microscope in order to determine which way provokes the lowest endothelial cell loss. The less traumatic technique is E.C.C.E. with posterior chamber lens: cell loss is 10%. There is no difference between this method and conventional E.C.C.E. without implantation.
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Clinical resistance of herpetic keratitis to antiviral agents constitutes one of the reasons for failure of treatment after their administration. A retrospective study of 42 cases of superficial herpetic keratitis resistant to IDU, IDU and IDC, and Ara-A demonstrated that in 2 out of 3 cases this resistance appeared in patients previously treated locally with antiviral compounds for anterior ocular lesions. Patients resistant to IDU were then treated with Ara-A, and those not responding to Ara-A, with TFT. Resistance may be observed following this new treatment during the subsequent relapses.
Posterior chamber seems to be the best theoretical place in the eye for the I.O.L. But surgical techniques are often difficult and may be dangerous for the ciliary body. A safer way is described to Simcoe lens implantation. The anterior capsule of the crystalline bag is respected and acts as a Sheet's glide. Two cases prove the capsular fixation of the lens without any touch of the ciliary body.
Aqueous humor of 26 patients was collected just before surgery and on the 5th postoperative day. PGE2 levels increase if there is no specific treatment, but if indomethacin is systematically given before and after surgery there is no significant increase in PGE2 levels. The effect of indomethacin is exactly the same in human eyes as in rabbit eyes.
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The authors relate the specular microscopy study of 19 penetrating keratoplasties. Seven of them were associated with an intra-ocular lens. The mean cell density is 1 100 cells/SQ. MM. The endothelial cell density does not differ in the two series. One graft remains clear with 330 cells/SQ. MM.
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This is a double blind study on the eventual effect a single dose administration of an indomethacin collyrium given prior to surgery of cataract without implantation. The goal is to decrease post-operative reactions. Twenty patients were treated with indomethacin and then operated. Twenty witnesses were operated without prior administration of the collyrium. The control parameters were the following: the cell tyndall of the anterior chamber, the protein tyndall of the anterior chamber and the intra-ocular pressure. The parameters were studied from the first to the fifth post-operative day and on the fourteenth day. In some cases, structures of the anterior segment were explored by means of prolonged fluoroangiography. The goal was to study the permeability of the blood aqueous barrier. No significant difference was found between the two groups for any of the studied parameters. The result shows the ineffectiveness of a single dose administration of indomethacin in reducing postoperative reactions that result from lens extraction.
The authors compare two series of I.O.L. The first group of patients was treated with oral indometacin: 75 mg per os during six weeks. The second group did not receive indometacin. Anterior segment fluorographic study proves the effectiveness of the therapy. Dye leakage is minimised with indometacin, prostaglandin synthesis is inhibited and decreases the rupture of the blood aqueous barrier.