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Biomedical subjects

J Tauber

Publications and source records attributed to J Tauber.

At least 19 recordsLinked to original sources
PubMed2000

Efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate-to-severe dry eye disease: a dose-ranging, randomized trial. The Cyclosporin A Phase 2 Study Group.

OBJECTIVE: To investigate the efficacy, safety, formulation tolerability, and optimal dosing of a novel cyclosporin A oil-in-water emulsion formulation for the treatment of moderate-to-severe dry eye disease. DESIGN: Randomized, multicenter, double-masked, parallel-group, dose-response controlled trial. PARTICIPANTS: Total enrollment: 162 patients; cyclosporin A groups: 129 patients; vehicle group: 33 patients. INTERVENTION: Patients instilled study medication (cyclosporin A ophthalmic emulsion 0.05%, 0.1%, 0.2%, or 0.4%, or vehicle) twice daily into both eyes for 12 weeks, followed by a 4-week posttreatment observation period. MAIN OUTCOME MEASURES EFFICACY: rose bengal staining, superficial punctate keratitis, Schirmer tear test, symptoms of ocular discomfort, and the Ocular Surface Disease Index (OSDI; a measure of symptom frequency and impact on vision-related functioning). SAFETY: biomicroscopy, cyclosporin A blood levels, conjunctival microbiology, intraocular pressure, visual acuity, and monitoring of adverse events. RESULTS: In a subset of 90 patients with moderate-to-severe keratoconjunctivitis sicca, the most significant improvements with cyclosporin A treatment were in rose bengal staining, superficial punctate keratitis, sandy or gritty feeling, dryness, and itching, with improvements persisting into the posttreatment period in some treatment groups. There was also a decrease in OSDI scores, indicating a decrease in the effect of ocular symptoms on patients' daily lives. There was no clear dose-response relationship, but cyclosporin A 0.1% produced the most consistent improvement in objective and subjective end points and cyclosporin A 0.05% gave the most consistent improvement in patient symptoms. The vehicle also performed well, perhaps because of its long residence time on the ocular surface. There were no significant adverse effects, no microbial overgrowth, and no increased risk of ocular infection in any treatment group. The highest cyclosporin A blood concentration detected was 0.16 ng/ml. All treatments were well tolerated by patients. CONCLUSIONS: Cyclosporin A ophthalmic emulsions, 0.05%, 0.1%, 0.2%, and 0.4%, were safe and well tolerated, significantly improved the ocular signs and symptoms of moderate-to-severe dry eye disease, and decreased the effect of the disease on vision-related functioning. Cyclosporin A 0.05% and 0.1% were deemed the most appropriate formulations for future clinical studies because no additional benefits were observed with the higher concentrations.

Adult↗
PubMed1998

A multicenter comparison of the ocular efficacy and safety of diclofenac 0.1% solution with that of ketorolac 0.5% solution in patients with acute seasonal allergic conjunctivitis.

Only one of several available ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) is currently FDA approved for use in acute seasonal allergic conjunctivitis (SAC). Sixty patients with SAC and moderate itching and bulbar conjunctival injection were enrolled in a multicenter, randomized, double-masked, parallel-group trial comparing diclofenac sodium (DS) with ketorolac tromethamine (KT). Patients instilled 1 drop four times daily while awake for 14 days. Ocular signs and symptoms were evaluated at one and two weeks. The primary efficacy variables were itching and bulbar conjunctival injection. For both treatments, the ocular allergy sign and symptom scores were comparable at baseline. Both treatments evaluated in this study were well tolerated. Significant clinical and statistical reductions from baseline were observed in the primary efficacy variables. Treatment group differences were observed for the pain/soreness score with an advantage observed for the DS group at 30 minutes and at day 7. Our conclusion is that diclofenac sodium and ketorolac tromethamine acted similarly to reduce the ocular signs and symptoms associated with acute seasonal allergic conjunctivitis. There was a statistically significant advantage for the DS group to be free of symptoms at the day 7 visit as compared to the KT group (20.7% vs. 3.2%).

Acute Disease↗
PubMed1996

Excimer retreatment for myopic photorefractive keratectomy failures. Six- to 18-month follow-up.

PURPOSE: To study the results of retreatment after myopic photorefractive keratectomy in 22 patients. Five patients showed regression and 17 showed undercorrection combined with regression. The follow-up was 6 to 18 months. METHODS: A laser was used with a fluence of 160 mJ/cm2 at a frequency of 5 Hz. The same nomogram used for the initial treatment was used for the retreatment. No nitrogen purge was used. Fluorometholone 0.1% four times daily tapered over 4 months was applied postoperatively except in five patients. RESULTS: There was no untoward effect in any patient who had retreatment. The mean preoperative spherical equivalent before retreatment was -2.61 +/- 1.62 diopters (D) (range, -1.00 to -6.63 D). After 1 year, the mean spherical equivalent was -0.84 +/- 1.22 D (range, 0.00 to -4.88 D) and at 18 months it was -1.31 +/-1.60 D (range, 0.00 to -5.13 D). Spherical equivalent was +/- D in 82% of patients at 1 year and in 67% at 18 months. Uncorrected visual acuity was 20/40 or better at 1 year in 77% of patients and 20/20 or better in 55%; at 18 months, it was 20/40 or better in 67%. CONCLUSION: Retreatment may be considered for undercorrection and/or regression in photorefractive keratectomy. No complications were observed, and there is appreciable improvement in the final results. The refraction 6 months after retreatment is stable with no statistically significant change from 6 to 12 months (Student's t=0.51; P=0.62) and 6 to 18 months (Student's t=1.0l; P=0.33).

Adult↗
PubMed1995

Two-zone excimer photorefractive keratectomy for moderate myopia. Six- to 18-month follow-up.

PURPOSE: To study the results of the two-zone photorefractive keratectomy (PRK) in 35 eyes of 27 patients with moderate myopia of 6 to 8 diopters (D) over 6 to 18 months. METHODS: An excimer laser was used with a fluence of 160 mJ/cm2 at a frequency of 5 Hz. The ablation was performed with two zones (6 and 5 mm). All patients received topical steroid (0.1 fluorometholone) tapered over 4 months. RESULTS: There were no significant untoward effects in any patient. There were minimal changes in contrast sensitivity, brightness acuity, and astigmatism. Uncorrected visual acuity of 20/40 or better was obtained in 77% of patients at 6 months, in 73% at 12 months, and in 71% at 18 months. A refraction of +/-1.0 diopter was obtained in 69% at 6 months, in 65% at 12 months, and in 71% at 18 months. There is no statistically significant difference at 6, 12, and 18 months in both visual acuity and refraction. CONCLUSIONS: Two-zone PRK in moderate myopia is safe and reasonably effective. The results are stable from 6 to 18 months.

Administration, Topical↗
PubMed1993

Excimer photorefractive keratectomy for myopia.

PURPOSE: To study the safety, effectiveness, predictability, and stability of excimer laser photorefractive keratectomy (PRK) in 133 normally sighted eyes. METHODS: An excimer laser was used with a fluence of 160 mJ/cm2 at a frequency of 5 Hz and an ablation zone of 5.0 mm. The effects of nitrogen purge at surgery and postoperative steroids were evaluated. RESULTS: No significant complications occurred in any patient. After an initial over-correction, the refraction stabilized. The average results obtained at 6 months were maintained on successive examinations to 36 months. Analysis of their visual acuity in groups IIA, IIB, and III indicates that results at 6 months are predictive of final results at 1 to 3 years (P < 0.0001; r > 0.9). In myopia (1.00-6.00 diopters [D]) treated with the excimer laser, there was a trend toward improvement in results over the course of the study. In 60% in group IIA, 58% in group IIB, 71% in group III, and 88% in group III no nitrogen (no N2), +/- 1 D was obtained. For 20/40 or better uncorrected visual acuity, the outcome was 70% for group IIA, 67% for group IIB, 75% for group III, and 100% for group III no N2. Significant improvement was noted without nitrogen purge. No significant improvement was observed from steroid treatment as used. CONCLUSION: In reducing myopia, PRK appears to be safe and effective. The results obtained are reasonably predictable and stable after 6 months. As more refinements are introduced, this procedure could become one of the most promising in refractive surgery.

Adult↗
PubMed1992

Long-term results of systemic chemotherapy for ocular cicatricial pemphigoid.

Ocular cicatricial pemphigoid (OCP) is a chronic, progressive, blinding, autoimmune disease that scars mucous membranes. We studied the long-term outcome in 104 consecutive patients (average follow-up: 4 years) to determine whether complete remission could be achieved following a course of treatment with immunosuppressive drugs. We found that prolonged periods of remission off therapy are maintained in about one third of OCP patients. Follow-up must be continued for life as relapse occurs in approximately one third of cases. Those who relapsed regained disease control readily upon reinstitution of therapy and did not deteriorate to more advanced cicatrization. Sex, age, initial degree of inflammation and the incidence of extraocular involvement did not bear a prognostic significance. The mechanism which underlies the differing responses to therapy is not yet known.

Adult↗
PubMed1992

Improved detection of disease progression in ocular cicatricial pemphigoid.

Cicatricial pemphigoid is an autoimmune systemic disease characterized by chronic conjunctival cicatrization. The natural history is one of variable degrees of progressive scarring of the ocular surface and visual loss. Previous reports have shown systemic chemotherapy to be efficacious in halting cicatrization in progressive cases. This observation makes it of critical importance to be able to detect progression of the disease as early as possible so as to allow for earlier institution of treatment. Our experience in previous studies has led us to believe that disease staging systems currently in use are relatively insensitive in detecting disease progression. We present a revised staging system that combines the strengths of the staging systems in use today and extends their sensitivity.

Humans↗
PubMed1991

Remission and recurrence after withdrawal of therapy for ocular cicatricial pemphigoid.

Ocular cicatricial pemphigoid (OCP) is a chronic, progressive, autoimmune disease that scars mucus membranes and may lead to blindness. The authors studied the long-term effects of OCP in 104 consecutive patients (average follow-up, 4 years) to determine whether complete remission could be achieved after a course of treatment with immunosuppressive drugs. Prolonged periods of remission while not undergoing therapy were maintained in approximately one third of patients with OCP. Follow-up must be continued for life, as relapse occurred in 22% of those who were in remission and not undergoing therapy. Those who relapsed regained disease control readily upon reinstitution of therapy and did not deteriorate to more advanced cicatrization. Sex, age, initial degree of inflammation, and the incidence of extraocular involvement did not have a prognostic significance on outcome. Mechanisms that underlie the differing responses to therapy are not yet known.

Adult↗
PubMed1991

Systemic chemotherapy for ocular cicatricial pemphigoid.

The records of 105 patients treated with three different chemotherapeutic agents for ocular cicatricial pemphigoid (OCP) were reviewed to compare long-term efficacies, side effects, and tolerance of different regimens. For the entire group, OCP progressed in 6% of eyes in 10% of patients (follow-up 35 months). More than half of the treatment failures occurred in patients intolerant of chemotherapy. Diaminodiphenylsulfone (DAP), as initial agent, failed to control disease in 2% of patients, compared with 8% after cyclophosphamide (CYC) and 9% after azathioprine (AZA) (p less than 0.05). Stratification of results revealed that DAP was the most effective initial agent for modestly active OCP, whereas CYC was the most effective initial choice for highly active cases. In patients treated with a single agent exclusively for 10 months or more, failure to control disease occurred in 4% of DAP, 4% of CYC, and 15% of AZA patients (p less than 0.01). Recommendations for a sequential approach to chemotherapy for OCP are presented.

Adult↗
PubMed1991

Romberg's progressive hemifacial atrophy: an association with scleral melting.

We report the unusual case of a 43-year-old woman who presented with Romberg's progressive facial hemiatrophy and spontaneous scleral perforation in the ipsilateral eye, for which scleral grafting was performed. Histologic and ultrastructural examination of the scleral specimen revealed a noninflammatory lytic process. The location of the scleral loss, exactly on the line of the "en coup de sabre" atrophy, as well as the light microscopy and ultrastructural histopathologic findings suggest that the scleral destruction was a late manifestation of Romberg's disease.

Adult↗
PubMed1990

Viral isolation and systemic immune responses after intracameral inoculation of herpes simplex virus type 1 in Igh-1-disparate congenic murine strains.

Igh-1-disparate congenic murine strains differ in their susceptibility to develop contralateral chorioretinitis after intracameral (AC) inoculation with Herpes simplex virus type 1 (HSV-1): 75% of BALB/cByJ (Igh-1a) and 5% of C.B-17 (Igh-1b) develop necrotizing chorioretinitis. To determine the mechanism of influence of host genetics on development of contralateral chorioretinitis, the authors did viral isolation studies in contralateral eyes, determined in vivo and in vitro T-cell responses, and HSV-antibody levels at various times after AC inoculation of BALB/cByJ and C.B-17 mice with HSV-1. Viral isolation was similar in both mouse strains (P less than 0.2). Similarities in systemic immune responses included suppressed delayed-type hypersensitivity responses 5 days, cytotoxic T-lymphocyte and lymphocyte proliferation responses 8 days, and viral neutralizing antibody titers 5 days postinoculation (PI). Differences in systemic immune responses included: (1) delayed-type hypersensitivity responses were not suppressed in C.B-17 mice (P greater than 0.1) and were hyperactive in BALB/cByJ mice (P less than 0.025) 10 days PI and (2) HSV-neutralizing antibody production was higher in C.B-17 mice 10 days PI. These data suggest that the mere presence of HSV-1 in the uninoculated eye is insufficient for the development of chorioretinitis. Virus-specific delayed-type hypersensitivity reactions might be involved in the pathogenesis of retinitis in BALB/cByJ mice; and virus-neutralizing antibodies and suppressed HSV-specific delayed-type hypersensitivity reactions might be instrumental in the protection enjoyed by C.B-17 mice.

Animals↗
PubMed1990

An analysis of therapeutic decision making regarding immunosuppressive chemotherapy for peripheral ulcerative keratitis.

We reviewed our experience in the management of 47 patients (61 eyes) with peripheral ulcerative keratitis (PUK) to establish guidelines for appropriate indications to consider institution of systemic chemotherapy. Fifty-three percent of patients had a systemic disease as the etiology of PUK; one fourth of these were newly diagnosed as a result of meticulous history taking. The histologic demonstration of vasculitis in ocular tissue was the crucial step in deciding on chemotherapy in more than half of our patients. The presence of scleritis was highly associated with active vasculitis. Twelve of 14 patients with bilateral PUK required chemotherapy. Recommendations for an approach to therapy of PUK are presented.

Adult↗
PubMed1989

Scleral grafting for necrotizing scleritis.

Although systemic immunosuppressive chemotherapy is effective in halting progressive necrotizing scleritis, the onset of its action may be too slow to prevent profound scleral thinning and/or traumatic or spontaneous perforation. Scleral homografts may be used to maintain the integrity of the globe until immunosuppressive drugs can take effect. The authors reviewed their experience with scleral homografts in 12 patients with progressive necrotizing scleritis; eight (all with autoimmune disease) had concomitant chemotherapy and four (two with autoimmune disease) did not. Grafts remained stable in patients receiving both surgical and drug therapy over a mean follow-up of 12 months. One graft melted after discontinuation of chemotherapy, but regrafting and renewed immunosuppression salvaged the eye. Grafts in two of the patients not initially given chemotherapy melted rapidly (within 14 and 45 days, respectively). Both eyes were salvaged by regrafting and/or addition of chemotherapy. Though rarely successful by itself against necrotizing scleritis, scleral grafting is a useful adjunct to chemotherapy.

Aged↗
PubMed1989

Glaucoma in patients with ocular cicatricial pemphigoid.

This retrospective review of 111 patients with ocular cicatricial pemphigoid (CP) identifies 29 patients (26%) with glaucoma. Twenty-seven of these patients had a history of glaucoma for a mean of 11.3 years before the diagnosis of CP was made. Most had advanced glaucoma, with a long history of medication use, optic nerve damage, and visual field loss. Patients with CP and glaucoma were more likely to manifest continued high-grade conjunctival inflammation than those with CP alone despite treatment for CP (P less than 0.05). Possible mechanisms including genetic susceptibility to both diseases, drug-induced conjunctival cicatrization, and CP-induced alterations in aqueous outflow are discussed. Physicians who care for patients with CP should remain mindful of the possible coexistence or development of glaucoma in this group of patients. Patients with glaucoma and chronic conjunctivitis of uncertain etiology should be referred for evaluation by physicians experienced in the detection and management of CP.

Age Factors↗
PubMed1988

Plasmapheresis treatment in patients with severe atopic keratoconjunctivitis.

A 19-year-old woman with hyperimmunoglobulinemia E (the hyper-IgE syndrome [HIE]) and a 62-year-old man with atopic dermatitis experienced dramatic improvement in their chronic ocular symptoms and signs of atopic keratoconjunctivitis after plasmapheresis was instituted. Both patients had previously received topical and oral corticosteroids as well as topical cromolyn sodium without significant beneficial effect. The authors recommend a trial of plasmapheresis in selected patients with recalcitrant and debilitating atopic keratoconjunctivitis when standard therapy proves unsuccessful.

Adult↗
PubMed1988

Cataract surgery in ocular cicatricial pemphigoid.

The authors report the results of their experience with cataract surgery in 20 patients (26 eyes) with biopsy-proven cicatricial pemphigoid. All patients were on systemic immunosuppression at the time of surgery (dapsone, azathioprine, cyclophosphamide, or combinations) and were treated with perioperative oral corticosteroids. Patients were evaluated pre- and postoperatively for conjunctival inflammation, conjunctival cicatrization, degree of keratopathy, and disease stage. No patient progressed in disease stage. Vision improved an average of 3.5 Snellen lines (-3 to +8). Worse outcome was associated with chemotherapy intolerance or the presence of any preoperative conjunctival inflammation. Thirteen patients remained on immunosuppressives for the entire study. Corneal ulcers developed postoperatively in three patients in whom continued immunosuppression was not tolerated. Possible mechanisms for inflammatory exacerbation after surgery are discussed. Results indicate that after successful abolition of all conjunctival inflammation through chemotherapy, cataract surgery may be safely performed in patients with cicatricial pemphigoid.

Aged↗