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Biomedical subjects

J Flammer

Publications and source records attributed to J Flammer.

At least 163 records · Page 9Linked to original sources

Silent myocardial ischemia in glaucoma patients.

The pathophysiological mechanism involved in normal-tension glaucoma is still not fully understood. Besides intraocular pressure, vascular and rheological factors have been described. In the present study, the prevalence of silent myocardial ischemia in patients of the same age with normal-tension glaucoma, primary open-angle glaucoma and cataract was compared. Our findings indicate that in all three groups ischemic episodes occurred more frequently than described in normal people. The most striking observation, however, was the fact that in normal-tension glaucoma the frequency was twice that of the other two groups.

Electrocardiography↗

Endothelium-dependent regulation of the ophthalmic microcirculation in the perfused porcine eye: role of nitric oxide and endothelins.

PURPOSE: The endothelium produces nitric oxide and endothelin (ET). This study was designed to investigate the endothelium-dependent regulation of the porcine ophthalmic microcirculation. METHODS: Isolated porcine eyes were perfused with a modified Langendorff setup (Hugo Sachs Elektronik KG, Freiburg, Germany) at a perfusion pressure of 80 cm H2O with Krebs-Ringer bicarbonate solution (37 degrees C; 95% O2, 5% CO2). RESULTS: The inhibitor of nitric oxide formation, L-nitroarginine methylester (L-NAME; 10(-6) to 10(-4) M), evoked decreases in flow (maximal decrease, 39% +/- 6%; P < 0.005 versus control). The endothelium-dependent vasodilator bradykinin evoked increases in ophthalmic flow (maximal increase, 26% +/- 2%; P < 0.05 versus control) prevented by L-NAME. The effect of endothelin-1 (ET-1; 10(-12) to 10(-11) M) on flow was biphasic, with early vasodilation (1 to 2 minutes) and late vasoconstriction. At 10(-12) M, the increase in flow was most pronounced (24% +/- 5%; P < 0.05 versus control), whereas 10(-10) M caused only significant decreases in flow (59% +/- 5%; P < 0.001 versus control). Endothelin-3 (ET-3) evoked similar vasodilator effects as ET-1 but less vasoconstriction. The vasodilator effects of ET-3 were prevented by pretreatment of the eye with indomethacin (10(-5) M, to block the production of prostaglandins; P < 0.05 versus control). The endothelinA receptor antagonist FR-139317 significantly reduced vasoconstriction to ET-1 (10(-10) M; P < 0.001 versus control). The thromboxane analogue (U-46619) reduced flow in a concentration-dependent manner (P < 0.001 versus control). CONCLUSIONS: Endothelium-derived nitric oxide released under basal conditions or stimulated by bradykinin significantly regulated flow to the porcine ophthalmic microcirculation. This vasodilator system may play an important protective role against vasospasm. In contrast, ET-1 has vasodilator effects through the release of prostaglandins and potent vasoconstrictor properties mediated through ETA receptors.

Animals↗

[Influence of cataract on automated perimetry].

58 eyes of 58 patients underwent cataract surgery with IOL implantation. The density of cataract was quantified by the Opacity Lensmeter 701 before operation and the visual field by program G1 of Octopus 201 before and after operation. The visual fields showed that there was significant difference in the mean defect (MD) before and after operation, but not in the corrected loss variance (CLV), indicating that cataract only caused diffuse visual field damage. This was also confirmed by the parallel shift of the mean cumulative defect curve after surgery. The preoperative lens opacity reading and the visual acuity were correlated with the difference between the pre- and post-operative MD, showing that measurement of OLM 701 and visual acuity permitted assessment of the influence of cataract on the visual field.

Adult↗

Vasovagal heart block following cataract surgery under local anesthesia.

Hemodynamic alterations during eye surgery usually consist of sinus bradycardia and hypotension provoked by the oculocardiac reflex. We report a case in which severe sinus bradycardia occurring immediately after the end of surgery was complicated by second-degree atrioventricular block, hypotension, and symptomatic myocardial ischemia.

Aged↗

Local anesthetic drugs reduce endothelium-dependent relaxations of porcine ciliary arteries.

PURPOSE: During retrobulbar anesthesia ocular hemodynamics are altered. The purpose of this study is to investigate the effects of local anesthetics in isolated porcine ciliary arteries (diameter between 200 and 400 microns). METHODS: Isolated porcine ciliary arteries were suspended in myograph systems filled with modified Krebs-Ringer solution for isometric tension recording. RESULTS: In quiescent or serotonin-precontracted arteries, lidocaine, bupivacaine, or mepivacaine (10(-9)-10(-5)M) evoked no change in vascular tone. However, all local anesthetics (10(-5)M) and bupivacaine (10(-5)-10(-6)M) reduced endothelium-dependent relaxations to bradykinin (10(-9)-10(-6)M), whereas the endothelium-independent relaxations to the nitric oxide-donor 3-morpholino-sydnonimine (SIN-1; 10(-9)-10(-5)M) were unaffected by local anesthetics. The addition of L-arginine (10(-4)M) markedly reduced the inhibitory effects of bupivacaine on endothelial vasodilatation function. CONCLUSION: These findings demonstrate that in porcine ciliary arteries, local anesthetics impair endothelial formation of nitric oxide from L-arginine after stimulation with bradykinin, which may contribute importantly to the reduction in blood flow to the eye during retrobulbar anesthesia.

Anesthetics, Local↗

Heterogeneity of endothelium-dependent regulation in ophthalmic and ciliary arteries.

PURPOSE: Endothelial cells modulate vascular tone by releasing the vasodilator nitric oxide (NO) or the vasoconstrictor endothelin-1. From one vascular bed to another and between vessels of different diameter, heterogeneities of endothelium-dependent regulatory mechanisms exist. Hence, the current study compared the effects of NO and endothelin-1 in the porcine ophthalmic artery and one of its branches, the ciliary artery. METHODS: Porcine eyes were obtained at the slaughterhouse. The ophthalmic and ciliary arteries were dissected free under a microscope and suspended in myograph systems (95% O2 and 5% CO2, 37 degrees C) for isometric tension recording. RESULTS: In both vessels, bradykinin stimulated the release of NO, but the sensitivity to bradykinin increased with decreasing vascular diameter. By contrast, the basal release of NO became less efficient in inhibiting contractions to serotonin and endothelin-1 in ciliary versus ophthalmic artery. Endothelin-1 induced potent contractions that were more pronounced in ciliary than in ophthalmic artery. Serotonin-induced contractions also were more efficient in ciliary artery but less than to those to endothelin-1. Contractions to serotonin were inhibited in both blood vessels by the 5-HT2 serotonergic antagonist ketanserin. CONCLUSIONS: Thus endothelium-derived vasoactive substances are potent regulators of porcine extraocular ophthalmic circulation. Their effects increase with decreasing vascular diameter, suggesting an important role of NO and endothelin-1 in the regulation of ophthalmic circulation. A dysfunction of these regulatory mechanisms could have implications about the pathogenesis of ophthalmic complications seen in diabetes, hypertension, and in certain forms of glaucoma associated with ocular vasospasms.

Animals↗

A comparison of five methods for estimating general glaucomatous visual field depression.

The separation of local and diffuse visual field loss is important for evaluating the nature and extent of glaucomatous visual field damage. Here, five automated methods for estimating diffuse loss in glaucomatous visual fields (as measured with the Octopus G1 program) are compared. Four are taken from the published literature, and one is introduced in this investigation. It is shown that the new index (here called diffuse loss) provides the best agreement with a value determined using a more empirical approach.

Glaucoma↗

Lens opacity: a population study.

Age-corrected normal values for the Opacity Lens Meter (OLM) 701 were established by measuring 1598 eyes of 799 healthy volunteers. This study revealed a remarkable age-relation for the normal values. The average readings of the OLM of the 30-year-old subjects were around 10 units whereas the average for the 65-year-olds was close to 20 units. The best fit of the opacity vs. age was a quadratic function. The interindividual variation was small in the young and quite large in the older population. The correlation between contralateral eyes was high (R = 0.93).

Adolescent↗

[Significance of the peripheral visual field for diagnosis of glaucoma].

Investigated was the significance of semiquantitative tests of the peripheral visual field in glaucoma. For that purpose 793 visual fields of 793 glaucoma patients or glaucoma suspects and 338 visual fields of 338 normal controls (normal central 26 degrees--area) were analysed. Perimetry was performed with an Octopus 201 with the help of program G1, which tests 14 peripheral test locations. In the majority of the 455 glaucoma patients (pathological findings in the central visual field) the periphery was also disturbed. Much to our surprise however, the 338 glaucoma suspects (having normal central visual fields) showed the same frequency of peripheral visual field disturbance as the normals. This holds true for the total peripheral visual field, as well as for the individual test locations. Therefore it makes sense to limit perimetry in glaucoma patients to the central area, provided that the central area is quantitatively measured with an adequate testgrid.

Diagnosis, Differential↗

Lupus anticoagulants/anticardiolipin antibodies in patients with normal tension glaucoma.

Ocular vascular occlusive disease resulting in severe retinopathy and/or post-thrombotic glaucoma has been extensively discussed in patients with lupus anticoagulant and/or anticardiolipin antibodies (LA/aCL). Inadequate circulation plays an important role in the pathogenesis of another ophthalmic entity--the normal tension glaucoma. We studied 22 patients with normal tension glaucoma (group I) and 23 with chronic open-angle glaucoma (group II) and compared them with a control group (n = 25, group III). LA, aCL, the aCL cofactor beta 2-Glycoprotein I, and other haemostatic parameters including factor VIII:C, von Willebrand factor, factors II, V, VII and plasminogen activator inhibitor were measured. Five out of 22 (22.7%) in group I, five out of 23 (21.7%) in group II and three out of 25 (12.0%) in group III had positive LA and/or aCL. These prevalences were not statistically significantly different. beta 2-Glycoprotein I was normal in all groups. No other parameters were significantly different between groups. These findings do not support the contribution of ocular microvascular occlusive disease, due to elevated aCL, in the pathogenesis of glaucomatous damage.

Aged↗

Psychophysical mechanisms and treatment of vasospastic disorders in normal-tension glaucoma.

Vasospasms are inappropriate constrictions of small vessels leading to a variety of clinical pictures depending on the location of such spasms. Although the pathophysiological mechanism is not yet well understood, we know some factors able to provoke spasm in patients with appropriate predisposition like hemorrhage, coldness, emotional stress and others. Such vasoconstrictions provoke normally relative mild symptoms like cold fingers, or pain as in variant angina and in only very rare cases, to irreversible structural damage such as myocardial infarction. There is not much known about the involvement of the eye in vasospastic disorders. Retinal migraine is a known entity but occurs quite seldom. If one looks for it, one can often find (mostly reversible) visual field damage in patients with vasospastic disorders. This might be a sign of a reversible functional damage most probably due to a decreased circulation in the optic nerve head or the surrounding choroid. In most of these patients the optic nerve head looks normal, sometimes slightly pale. In patients with the so-called normal-tension glaucoma however, the prevalence of vasospastic disorders, is very clearly increased. This leads to the hypothesis that recurrent vasospasm in the eye may, in some cases, finally lead to structural damage, presenting itself phenomenologically as normal-tension glaucoma. Therefore treatment or selected normal tension glaucoma patients with calcium-channel-blockers is helpful, as has been proven in prospective studies.

Calcium Channel Blockers↗

Nitric oxide and endothelin-1 are important regulators of human ophthalmic artery.

The vascular endothelial cells have the ability to modulate local vascular tone by releasing relaxing factors such as nitric oxide or the vasoconstrictor peptide endothelin-1. Although this regulatory system is found in all vertebrates, there is a great heterogeneity in the release of these endothelium-derived substances, from one organ to an other, between large and small vessels, and between different species. Therefore, observations made in certain vascular beds or animals do not necessarily apply to human ophthalmic circulation. The present study was designed to investigate endothelial mediators in the human ophthalmic artery. The results show that in the human ophthalmic artery, nitric oxide is released under basal conditions and that its production can be markedly stimulated by bradykinin, acetylcholine, and particularly histamine, which cause profound vascular relaxation. In contrast, endothelin-1 evoked potent contractions, which were unaffected by the calcium antagonist nifedipine. However, upon re-exposure of the blood vessels to the peptide, marked tachyphylaxis occurred. These findings demonstrate that in the human ophthalmic artery, endothelium-derived nitric oxide and endothelin are very potent modulators of vascular tone, suggesting that they play an important role in the regulation of local blood flow in the eye. Hence, endothelium dysfunction may represent a new pathogenetic mechanism in disease states associated with altered blood flow to the eye, such as diabetes, hypertension, and some forms of low-tension glaucoma.

Acetylcholine↗

Influence of betaxolol and timolol on the visual fields of patients with glaucoma.

In a double-masked study, 40 patients with primary open-angle glaucoma were randomly assigned to treatment with betaxolol 0.5% or timolol 0.5% in both eyes twice daily. Visual fields and intraocular pressures were studied. Perimetry was performed with the Octopus G1 program two weeks after a washout period and three, six, 12, and 18 months after initiation of treatment. Both drugs reduced intraocular pressure. The reduction in intraocular pressure in the timolol-treated group was more pronounced than that in the betaxolol-treated group; the difference, however, was not statistically significant. In both treatment groups, the visual fields tended to improve during the first six months of treatment and remained stable or tended to deteriorate thereafter. The treatment effect on the visual field was better in the betaxolol-treated group than it was in the timolol-treated group (P = .041).

Aged↗

Blood-cell velocity in the nailfold capillaries of patients with normal-tension and high-tension glaucoma.

We compared the capillary blood-cell velocity in the fingertips of 30 patients with high-tension glaucoma, 30 patients with normal-tension glaucoma, and 30 control subjects by nailfold capillaroscopy. There were no measurable differences in the morphologic findings. The blood-flow velocity, however, was reduced significantly in the patients with normal-tension glaucoma compared with the control subjects (P less than .05). This difference was especially pronounced after cold provocation (P less than .0005). After cooling, 25 of 30 patients with normal-tension glaucoma had a blood standstill of 12 seconds or more, whereas only three of 30 control subjects and four of 30 patients with high-tension glaucoma had a measurable blood standstill.

Adult↗

The learning and fatigue effect in automated perimetry.

A visual field test was performed on 100 volunteers to study learning or fatigue effects during one session. The test was carried out with the help of the Octopus program J1, which measures the threshold 12 times at 3 test locations. In the majority of cases the sensitivity was quite stable during the session. We noted no difference between trained and untrained subjects or between normal and pathological eyes. However, patients with refractive errors, especially myopes, revealed a larger learning effect than did emmetropes.

Adolescent↗

Fluctuation of the differential light threshold at the border of absolute scotomas. Comparison between glaucomatous visual field defects and blind spots.

The outcome of repeated measurements of the differential light sensitivity fluctuates slightly. This fluctuation can be markedly increased in glaucoma patients but has also been described at the border of the blind spot of healthy subjects. The question arises, therefore, whether in glaucoma this increase may be due to the fact that many test locations may touch the border of (detected or undetected) scotomas. This study compares the behavior of the threshold at the border of glaucomatous defects and blind spots. The threshold was measured with program F8 of the Octopus 201 (Interzeag, Inc, Schlieren, Switzerland) automated static perimeter. The results revealed that the borders of glaucomatous defects are less steep than those of blind spots, the fluctuation is largest just at the border of the scotomas in both groups, and that the fluctuation is significantly larger at the edge of glaucomatous defects than at the edge of blind spots of normal subjects.

Glaucoma, Open-Angle↗

[Effect of betaxolol and timolol on visual fields in glaucoma patients].

In a prospective, randomized, double-masked study, primary open-angle glaucoma patients were treated twice daily with either betaxolol 0.5% or timolol 0.5%. Patients received a pretreatment baseline examination following a 2 week washout period; they were then examined after 3 and 6 months of treatment. Each examination included visual field measurements with an Octopus automated perimeter and intraocular pressure measurement. The visual fields of the betaxolol group showed on the average a pronounced tendency toward improvement (MD decrease of 2.05 dB); visual fields in the timolol group showed a slight tendency toward improvement (MD decrease of 1.56 dB). The difference between these 2 trends after 6 months was statistically not significant (p greater than or equal to 0.05, U-test). Both drugs lowered intraocular pressure, there was no significant difference between the two drugs (p greater than or equal to 0.05, U-test).

Betaxolol↗