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Biomedical subjects

M A Kass

Publications and source records attributed to M A Kass.

At least 55 records · Page 3Linked to original sources
PubMed1985

Acute intraocular pressure response to argon laser iridotomy.

Argon laser iridotomy (ALI) was performed in 50 eyes for prophylactic treatment of anatomically narrow iridocorneal angles and in 50 eyes for therapy of chronic angle-closure glaucoma. Intraocular pressure was increased 6 mmHg or more 1 to 2 hours after ALI in 19 of 50 eyes with anatomical narrow iridocorneal angles and in 23 of 50 eyes with chronic angle-closure glaucoma. Increases greater than 20 mmHg over baseline value occurred in 5 of 50 eyes with narrow iridocorneal angles and in 7 of 50 eyes with chronic angle-closure glaucoma. A clinically significant increase in intraocular pressure (defined as a pressure 30 mmHg or greater and 40% or more increased over the pre-laser value) occurred 1 to 2 hours after ALI in 11 of 50 eyes with narrow iridocorneal angles and in 17 of 50 eyes with chronic angle-closure glaucoma. There was no statistical difference (chi square P greater than 0.3) in the incidence of this complication in the two groups. Additional medical therapy was effective in lowering the acute laser-induced elevation in intraocular pressure. Patient diagnosis, patient demographics, preoperative glaucoma medication and laser treatment parameters did not predict which eyes would develop this complication. Eyes which did not have a clinically significant elevation in intraocular pressure 1 to 2 hours after ALI did not show a later increase at 24 hours.

Female↗
PubMed1984

A miniature compliance monitor for eyedrop medication.

We developed an eyedrop medication monitor that electronically records the date and time of each medication administration over a six-week period. It records a medication usage in a 15-minute interval when the cap is removed from the bottle and the bottle is inverted. The electronic components housed inside the bottle weigh 7.5 g, including the batteries, and the total volume of the circuit is 7.5 cc. The monitor resembles commercially available 30-mL eyedrop bottles in size, shape, and weight. The monitor is accurate when tested against known patterns of usage. The electronic eyedrop monitor should be useful in assessing compliance with eyedrop medications.

Aged↗
PubMed1984

Intraocular pressure the day of argon laser trabeculoplasty in primary open-angle glaucoma.

Argon laser trabeculoplasty was performed in one eye of 57 phakic patients with primary open-angle glaucoma. The eyes received a mean of 78 +/- 7 treatments over 360 degrees to the anterior trabecular meshwork. The power was titrated to produce blanching without bubble formation. Increased intraocular pressure (range +1 to +22 mmHg) occurred in 30 of the 57 (53%) eyes 1 hour after treatment. Eight (14%) of these eyes had a clinically significant elevation defined by all of three criteria: (1) an intraocular pressure greater than 30 mmHg, (2) greater than a 30% increase over the mean prelaser intraocular pressure, and (3) greater than a 10 mmHg increase over the peak prelaser diurnal intraocular pressure curve. These eight patients received either oral glycerine or acetazolamide. A rebound increase in intraocular pressure requiring repeat medical treatment occurred in four of the eight eyes. Two additional eyes without a pressure elevation 1 hour after treatment showed a later elevation. This was first detected 4 hours postoperatively in one eye and 7 hours after treatment in another eye. The 1-hour postoperative measurement detected most patients with clinically significant increased intraocular pressure (8 of 10 eyes) but these required continued observation for rebound increases. Patients with advanced glaucomatous visual field loss should also be followed closely to detect late increases in intraocular pressure (2 of 10 eyes).

Adult↗
PubMed1983

A dose-response study of the effect of levobunolol on ocular hypertension.

We conducted a randomized, double-masked, dose-response study of the ocular hypotensive effect of the beta-adrenergic blocker, levobunolol. A single drop of placebo or levobunolol (at concentrations of 0.03%, 0.3%, 0.6%, 1%, and 2%) was administered to one eye of each of 48 patients with ocular hypertension. The 0.3% and 0.6% concentrations decreased intraocular pressure significantly from baseline levels compared to placebo at one, two, and four hours after treatment. The 1% and 2% concentrations decreased intraocular pressure significantly from baseline compared to placebo at one, two, four, six, eight, and 12 hours after administration. No objective or subjective side effects were noted, and no substantial changes in visual acuity, pupil diameter, pulse rate, or blood pressure were recorded during the study. These results appear to justify long-term studies of levobunolol for the treatment of increased intraocular pressure.

Adolescent↗
PubMed1983

When to treat ocular hypertension.

Ocular hypertension (intraocular pressure greater than or equal to 21 mm Hg, normal visual fields, normal optic discs, open angles, and the absence of any contributing ocular disease) occurs in 4-10% of the population over age 40. The question of whether to treat ocular hypertensive patients remains controversial. The author recommends prophylactic treatment for selected ocular hypertensive individuals who are at high risk of developing primary open angle glaucoma. The primary risk factors are high intraocular pressure, optic disc abnormality, increasing age, a family history of glaucoma, and systemic vascular disease. In addition, certain features of the patient's personality or medical condition favor treatment; for instance, treatment would probably be indicated in (1) a young patient, (2) a one-eyed patient, (3) an unreliable patient, (4) a patient who cannot do reliable visual fields or in whom the optic disc cannot be visualized, (5) a patient who prefers to be treated, and (6) a patient who has suffered a retinal vascular occlusion.

Age Factors↗
PubMed1983

Efficacy of combining timolol with other antiglaucoma medications.

The ocular hypotensive effects of timolol and a carbonic anhydrase inhibitor (acetazolamide or methazolamide) are partially additive; that is, concurrent administration of these drugs produces a clinically useful reduction in intraocular pressure which is greater than the effect of either medication alone, but less than the arithmetic sum of the effects of the individual drugs. Similarly, concurrent administration of timolol and a miotic agent (pilocarpine, carbachol, or echothiophate iodide) produces a clinically useful response in most glaucoma patients. In contrast, the ocular hypotensive effects of timolol and epinephrine are poorly additive. Only a minority of patients maintain a substantial, longterm reduction in intraocular pressure when timolol is added to a regimen of epinephrine or vice versa. Ophthalmologists prescribing timolol or epinephrine for patients receiving the other drug are urged to use a therapeutic trial to one eye for several weeks to determine the efficacy of concurrent treatment. The addition of timolol to the medical regimen of patients uncontrolled on maximum tolerated antiglaucoma therapy (a miotic agent, epinephrine and a carbonic anhydrase inhibitor) reduces intraocular pressure substantially in one-third to one-half of the cases.

Acetazolamide↗
PubMed1982

Timolol and epinephrine: long-term evaluation of concurrent administration.

Thirty-two ocular hypertensive subjects were treated for 90 days with either 0.5% timolol maleate or 2% epinephrine hydrochloride twice daily to one eye and both drugs to the fellow eye. The ocular hypotensive effects of timolol and epinephrine were partially additive throughout the course of this study. On the 91st day, eyes treated with epinephrine had a 25.8% mean reduction of intraocular pressure from baseline, whereas their fellow eyes treated with epinephrine and timolol had a 33.9% reduction. Eyes treated with timolol had a 27.2% mean reduction of IOP, whereas fellow eyes treated with timolol and epinephrine had a 29% reduction. These results suggest that the majority of patients being treated with either drug are unlikely to have a substantial long-term reduction in IOP when the other drug is added to their therapeutic regimen.

Administration, Topical↗
PubMed1982

Timolol and acetazolamide. A study of concurrent administration.

A five-week clinical trial of the concurrent administration of topical timolol maleate and oral acetazolamide was conducted to determine the additivity of the ocular hypotensive effects of the two drugs. One drop of 0.5% timolol maleate, every 12 hours, produced a mean reduction in outflow pressure from baseline of 36.0%. When added to an eye pretreated with oral acetazolamide, timolol caused an additional mean decrease in outflow pressure of 27.6%. Acetazolamide, 500 mg orally every 12 hours, produced a mean reduction in outflow pressure from baseline of 48.6%. When added to an eye receiving topical timolol, oral acetazolamide caused an additional mean decrease in outflow pressure of 43.2%. Concurrent administration of oral acetazolamide and topical timolol reduced outflow pressure only slightly less than the predicted reduction assuming full additivity of the drugs. This study supported the clinical usefulness of concurrent administration of acetazolamide and timolol to lower intraocular pressure.

Acetazolamide↗
PubMed1982

Central corneal endothelial cell density and central corneal thickness in ocular hypertension and primary open-angle glaucoma.

In order to assess the effect of increased intraocular pressure on the corneal endothelium, we classified 254 patients into four groups: Group 1, those with normal intraocular pressures; Group 2, those with untreated ocular hypertension; Group 3, those with treated ocular hypertension; and Group 4, those with primary open-angle glaucoma. One eye of each patient underwent specular microscopy and pachymetry. The eyes in the four groups did not differ significantly as to central corneal endothelial cell density or central corneal thickness. These measurements were not related to sex, race, or intraocular pressure (P greater than .12 in all cases). Increasing age was associated with a decrease in central corneal endothelial cell density (P = .0001), but was not associated with a change in central corneal thickness (P = .22). There was no significant relationship between the use of topical ocular hypotensive medications and central corneal endothelial cell density (P = .38) or central corneal thickness (P = .07) in patients with ocular hypertension or primary open-angle glaucoma. Neither uncomplicated peripheral iridectomy nor trabeculectomy produced significant changes when preoperative measurements were compared to measurements made 12 weeks postoperatively (P greater than .30 in all cases). Two eyes with flat anterior chambers following trabeculectomy had substantial decreases in central corneal endothelial cell density.

Adult↗
PubMed1982

Cataract extraction in an eye with filtering bleb.

Seventy-two ophthalmologists with a major interest in glaucoma (glaucoma surgeons) responded to a questionnaire as to how they would remove a cataract from a hypothetical 60-year-old patient with a functioning filtering bleb in the superior nasal quadrant. The majority recommended an intracapsular cataract extraction through a lateral or inferolateral limbal incision or a superior corneal incision anterior to the bleb. Most of the glaucoma surgeons preferred to close the wound with five to nine interrupted 10-0 nylon sutures. Estimates of the percentage of blebs failing after cataract extraction ranged from zero to more than 50%, with a median of 30%. The majority of the glaucoma surgeons stated that they would never, or only under exceptional circumstances, implant an intraocular lens in an eye with a filtering bleb. Twelve ophthalmologists with a major interest in intraocular lens implantation (implant surgeons) responded to the same questionnaire. They were more likely than the glaucoma surgeons to recommend extracapsular cataract extraction and to implant an intraocular lens in an eye with a filtering bleb.

Cataract↗
PubMed1982

Part I. Patient administration of eyedrops: interview.

Interviews of 141 patients were conducted to determine their use of eyedrops. This study indicates a need to improve patient instruction concerning drug compliance and proper time scheduling of eyedrop treatments.

Adult↗