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Biomedical subjects

G K Krieglstein

Publications and source records attributed to G K Krieglstein.

At least 19 recordsLinked to original sources
PubMed1992

Effect of dexamethasone 0.1% and prednisolone acetate 1.0% eye drops on the blood-aqueous barrier after cataract surgery: a controlled randomized fluorophotometric study.

Using non-invasive anterior chamber fluorophotometry, we performed a double-blind, randomized clinical trial on the effects of dexamethasone 0.1% and prednisolone acetate 1.0% eye drops on the blood-aqueous barrier after phacoemulsification and posterior chamber lens implantation. Twenty patients received one of the preparations topically to the surgically treated eye 5 times daily for a period of 5 days, beginning the day after surgery. Patients chosen for the study had no history of eye disease other than senile cataract nor of systemic diseases influencing the eyes. No other steroids or non-steroidal anti-inflammatory drugs were given before or during the investigation. The fluorometric data measured 5 days after surgery show a lower mean concentration of fluorescein in the dexamethasone alcohol 0.1% treated group compared with the prednisolone acetate 1.0% treated group. The difference is statistically not significant. The clinical assessment of postoperative ocular inflammation did correlate with the fluorophotometric measurements. The results of the study indicate that although dexamethasone is the more potent anti-inflammatory agent, with a better binding affinity to glucocorticoid receptors, we are--with the number of cases measured--unable to demonstrate any difference in the efficacy in protecting the blood-aqueous barrier after cataract extraction and posterior chamber lens implantation to prednisolone acetate.

Administration, Topical↗
PubMed1992

[Effect of 0.1% dexamethasone and 1.0% prednisolone acetate eyedrops on the blood-aqueous humor barrier].

In a randomized, double-blind clinical trial we studied the protective effect of prednisolone-acetate 1.0% and dexamethasone 0.1% on the blood-aqueous barrier after cataract-extraction and posterior chamber lens implantation. Pre- and postoperative anterior chamber fluorophotometry was performed after i.v. administration of 10% fluorescein-sodium in 20 eyes of 20 patients of whom 16 finished the study (mean age 68.7 +/- 11.0; 13 female, 3 male). The topical application of either drug 5 times daily for 5 days did show a significant difference in surgery mediated disturbance of BAB in each group before and after phacoemulsification. However, when comparing the effect of the two drugs with each other, a difference could not be detected (p = 0.35). To attain a statistical 95% probability that there is no significant difference between the two treatment groups, a number of 690 patients would have had to be investigated. The results can be interpreted as to be due to a better cornea penetration of prednisolone-acetate which compensate the higher glucocorticoid-potency and receptor-affinity of dexamethasone. The untreated fellow-eyes did not reveal a significant difference between the pre- and postoperative anterior chamber fluorescein-concentrations in either treatment group. Anterior chamber fluorophotometry is able to demonstrate the potency and influence of both prednisolone-acetate 1.0% and dexamethasone 0.1% eye-drops on the BAB following phacoemulsification and IOL-implantation. The difference of both drugs does not seem to be of clinical importance in this context.

Aged↗
PubMed1992

Contact cw-Nd:YAG laser cyclophotocoagulation for treatment of refractory glaucoma.

Contact cw-Nd:YAG laser transscleral cyclophotocoagulation was performed on 42 patients (44 eyes) with glaucoma who were not responding to medical treatment or had failure of prior surgical procedures. No selection was made as to the type of glaucoma (congenital, primary, secondary due to trauma or inflammation). We applied between 16 and 60 exposures 0.5-2 mm posterior to the limbus. Prior to cyclophotocoagulation the mean intraocular pressure (IOP) was 40.4 mm Hg (+/- 8.0). As a result of the treatment, the mean IOP was lowered to 21.1 mm Hg (+/- 5.2). In eyes with congenital, neovascular, and inflammatory glaucoma, a therapeutic effect could only be achieved by repeated coagulations. The patients were followed for a mean of 4.8 months (3-7 months). One eye developed a transient choroidal detachment. In two eyes, iris hemorrhages were noted. Contact cyclophotocoagulation is generally well tolerated. Randomized studies are to be carried out to confirm whether cyclophotocoagulation is an effective tool in the treatment of glaucoma. Until then, cyclophotocoagulation should be restricted to cases not responding to conventional therapy.

Adult↗
PubMed1979

The intraocular pressure responses of low-dose bupranolol (Ophtorenin) and methazolamide (Neptazane) in glaucomatous eyes. A controlled clinical study.

In a single-dose, double-blind study, the minimum effective doses of bupranolol and methazolamide were established. The beta-blocker bupranolol (Ophtorenin, Dr. Winzer, Konstanz) in an oily solution reduced IOP significantly in a concentration of 0.05%. The carboanhydrase inhibitor Methazolamide (Neptazane) did not change IOP in a peroral dose of 50 mg, while 100 mg p.o. gave a significant IOP decrease. Both drugs exhibited an additive effect in this low regimen. It is concluded that the combined application of both drugs will postpone or avoid side effects and prolong the time and the field of clinical usefulness. It appears possible that both have a different mechanism of action.

Bupranolol↗
PubMed1979

[Comparative measurements of the ophthalmic arterial pressure using the Mikuni dynamometer and the Stepanik-arteriotonograph (author's transl)].

Comparative measurements of the ophthalmic arterial pressure have been performed in 102 eyes using the Mikuni dynamometer and the Stepanik-Arteriotonograph. There was a linear correlation between the results obtained with both methods (P less than 0.001). Ophthalmic arterial blood pressures taken with the Stepanik-Arteriotonograph (SAT) were on the average 23 mmHg higher than with the Mikuni suction cup dynamometer. The mean ophthalmic blood pressure using the SAT was 88% of the mean brachial arterial pressure, whereas it was 70% with the Mikuni instrument. Differences between duplicate readings in the same eye were higher with the SAT than with the Mikuni dynamometer (P less than 0.001). Differences between both eyes in one individual were on the average greater using the SAT than the Mikuni instrument (P less than 0.001) and suction cup dynamometry was tolerated better subjectively than ophthalmic arteriotonography. A different reference point for taking arterial blood pressure with both methods is discussed. In arteriotonography the point of pressure measurement is more central than in suction cup dynamometry, because of the different method of increasing intraocular pressure in each procedure. The pros and cons of both methods are critically discussed.

Adolescent↗
PubMed1979

Infantile glaucoma in unilateral uveal ectropion.

Two case reports are presented where a unilateral uveal ectropion was associated with congenital and late infantile glaucoma. Ipsilateral to the anterior segment anomaly a dysgenetic angle was found to be the basis of the glaucomatous process. The clinical implication that when such an iris malformation is found in a young child the possibility of glaucoma must be considered is discussed in detail.

Child↗
PubMed1979

[The perimetry of the blind spot. A comparison of kinetic and static, computerized stratgies].

The reproducibility of perimetric results on the blind spot has been investigated under controllnt well-trained perimetrists on 178 eyes of 107 patients; the same eyes and patients were examined twice with the computer perimeter as well. Perimetric results obtained from 158 eyes were considered for statistics. There was qualitative agreement based on the alternative 'normal' or 'pathological' in kinetic perimetry in 74% of the double examinations and in 89% in computer perimetry. Identical size of the blind spot in repeated examinations was found in 34% with the Goldmann perimeter and in 78% with the computer perimeter. Observer variability of the static computer perimetry of the blind spot was compared with the variability of the results on the rest of the central visual field.

Computers↗
PubMed1979

[Measurement of arterial tension at the eye with the Stepanik arteriotonograph (author's transl)].

Comparative measurements of the ophthalmic artery pressure (using the Stepanik-ArteriotonographTM) and the brachial arterial pressure (sphygmomanometry according to Riva-Rocci) in 110 eyes are presented. There was a significant correlation (p less than 0,01) between both parameters. The mean systolic ophthalmic artery pressure was 114,5 mmHg, the diastolic pressure was 81,2 mmHg. The ipsilateral mean systolic brachial arterial pressure was 134,5 mmHg, the mean diastolic pressure 88,2 mmHg. In 7 eyes the ophthalmic pressure was exceeding the systolic brachial pressure, in 26 eyes the diastolic brachial pressure. 78% of the differences of paired measurements were within 0 and 10 mmHg (on the average 4,97 mmHg in the systolic readings and 4,30 mmHg in the diastolic readings). After repeated measurements with the arteriotonograph a significant increase of the ophthalmic arterial pressure was noted. The explanation of this phenomenon might be a ocular-vascular reflex produced by the compression of the globe into the orbit. The methodological limits of the arteriotonograph and the clinical significances of the present results are discussed.

Adolescent↗
PubMed1979

[The pressure reducing effects of pilocarpin in combination with Dipivalyl-epinephrine in glaucoma simplex (author's transl)].

We compared in two controlled studies the effect of pilocarpine 1% with the effect of pilocarpine 1% combined with 0,05% or 0,1% dipivalyl-epinephrine in patients with open-angle glaucoma. The pressure reducing effect of pilocarpine 1% was significantly increased and prolonged by the combination with dipivalyl-epinephrine. 0,1% dipivalyl-epinephrine + pilocarpine 1% did not have a more significant pressure reducing effect in our patients than 0,05% dipivalyl-epinephrine + pilocarpine 1%, but the reduction of pressure persisted longer. It is a considerable advantage in glaucoma therapy to diminish or to avoid systemic and local side effects of epinephrine due to very low concentrations of dipivalyl-epinephrine.

Double-Blind Method↗
PubMed1979

[First experiences with a written consent form for patients prior to cataract surgery (author's transl)].

The first experiences with a written consent form signed by patients prior to cataract surgery are presented. Details of possible surgical complications were discussed with the patient. The average time for this type of discussion was 15,6 min (7--30 min). The positive outcome of this study appeared to be that the confidence of the patient towards the surgeon or the hospital did not suffer nor did any patient change his decision to undergo surgery. This was tasted in a questionnaire showed to the patients after the discussion on possible complications. Some patients stated that they preferred enlightment on the day before surgery, whereas others would have preferred to have the written consent form sent home some days before surgery to have chance to discuss the problems with their relatives.

Cataract Extraction↗
PubMed1979

[A follow-up study on the intraocular pressure response of timolol eye drops (author's transl)].

In 22 open-angle glaucoma patients a total of 39 eyes were treated with Timolol 0.25% twice daily for an average period of 12.6 months. The relative intraocular pressure decrease at the beginning of the study was 47% of the untreated pressure level. This initial response declined to a 23% pressure decrease at the end of the study. In 8 eyes treatment had to be discontinued because of insufficient pressure control and in one patient because of subjective intolerance. In two patients (4 eyes) a complete loss of response of Timolol therapy was observed. The phenomenon of slowly diminishing drug effectiveness was not related to the untreated pressure levels in the patients covered by this study. In 5 eyes there was evidence of a rebound effect after discontinuation of Timolol therapy.

Adult↗
PubMed1978

The response of ophthalmic arterial pressure to topically applied clonidine.

The effect of topically applied clonidine on aphthalmic arterial pressure was tested in three groups of open-angle glaucoma patients. In this test, 0.125% clonidine eye drops did not cause a statistically significant change in ophthalmic arterial pressure, but 0.25% and 0.5% clonidine caused a statistically significant, dose-dependent decrease in the diastolic and the systolic arterial pressure in the orbit. The clinical relevance of the results is discussed.

Blood Pressure↗
PubMed1978

The vascular basis of the positional influence of the intraocular pressure.

By measuring intraocular pressure in different body positions from 60 degrees semiupright to 30 degrees head down, a nonlinear relationship between IOP increase and body position was confirmed. IOP postural response in individual subjects was roughly correlated to ophthalmic arterial pressure and to the episcleral venous pressure postural response. In one series of subjects, the episcleral venous pressure increments due to posture wa; parallel to the applanation-indentation disparity in the same individual eyes. Differential tonometry with applanation or indentation procedures under blind conditions gave significantly low indentation readings. It is concluded that IOP postural response depends on arterial and venous vascular changes when subjects move from an erect to a horizontal body position. Blood expulsion from the choroid by indentation tonometry might be the reason that this tonometric procedure does not measure IOP changes based on vascular changes.

Adult↗
PubMed1978

The dose-response relationships of dipivalyl epinephrine in open-angle glaucoma.

The intraocular pressure responses of topically applied dipivalyl epinephrine (DPE: 0.025, 0.1, and 0.25%) were investigated in three series of open angle glaucoma patients in a double blind study. IOP responses were compared intra-individually with the effects of 1% epinephrine hydrochloride. 0.1% DPE gave an IOP reduction similar to that of 1% epinephrine-HCl. The change in IOP was less with 0.025% DPE and statistically significantly greater with 0.25% DPE when compared with the conventional epinephrine preparation. The clinical advantages of the 'pro drug' DPE are pointed out.

Dose-Response Relationship, Drug↗
PubMed1978

The peripheral and central neural actions of clonidine in normal and glaucomatous eyes.

The peripheral and central neural actions of clonidine on normal and glaucomatous eyes have been investigated. Threshold doses of clonidine applied topically induced a monotonic decrease of intraocular pressure in the treated eye and had no effect on the contralateral eye. With increased clonidine dose, a decrease of intraocular pressure occurred in the untreated eye, and there was a concomitant decrease of systemic arterial blood pressure. Analysis of aqueous humor dynamics showed that the ocular response to the peripheral and the central neural actions of clonidine were without effect on the tonographic coefficient of outflow facility. The episcleral venous pressure decreased in both the treated and the untreated eyes, but the changes were too small to account for the observed decrease of intraocular pressure. The results are consistent with the concept that both the peripheral and central ocular hypotensive actions of clonidine are mediated by an inhibition of adrenergic neurogenic vasoconstriction in the eye.

Adrenergic alpha-Antagonists↗
PubMed1978

[The effect of low concentrations of pilocarpine with phenylephrine on intraocular pressure in glaucoma (author's transl)].

Orientating preliminary trials showed that the reducing action of pilocarpine on intraocular pressure is considerably enhanced by adding the alpha-receptor stimulant phenylephrine. Pilocarpine eyedrops 1% and pilocarpine drops 1% with phenylephrine 0.25% were compared in two double-blind crossover studies. Pressure reduction was more pronounced after administering the combination, the width of the pupil remaining unchanged. Attention is drawn to the advantages of pressure reduction without narrowing of the pupils in the treatment of all types of open-angle glaucoma. Miosis is of therapeutical advantage only in angle-closure glaucoma; hence, for reasons of safety, administration of phenylephrine should be avoided.

Clinical Trials as Topic↗
PubMed1978

The effect of metoprolol on IOP (author's transl).

The beta1-selective beta-blocking agent Metoprolol gave a significant intraocular pressure decrease in different groups of open angle glaucoma patients in a concentration of 1% and 3%. The magnitude of effect corresponded to 33% of the untreated pressure level. The maximum of the therapeutic response occured within 4 hrs after local application of the drug. A significant IOP decrease could be observed over 8 hrs after single application. There was no more effect after 24 hrs. Metoprolol eye drops did not affect pupillary diameter, pulse rate or blood pressure. The drug was tolerated well in all patients tested both subjectively and objectively after a single topical application.

Chronic Disease↗