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Biomedical subjects

W Leydhecker

Publications and source records attributed to W Leydhecker.

At least 37 records · Page 2Linked to original sources
PubMed1982

[Topography of early glaucomatous visual field defects in computerized perimetry].

A total of 301 visual fields of 215 glaucoma patients exhibiting early glaucomatous field loss up to Stage II according to Aulhorn were investigated to determine the frequency distribution of absolute and relative defects at the 73 test points of Program 31 of the Octopus computer perimeter. The following results were obtained: (1) The frequency of absolute and relative defects was higher in the upper half of the visual field; (2) The frequency of both absolute and relative defects increased from 6 to 30 degrees eccentricity in the upper visual field, predominantly in the upper nasal quadrant, whereas in the temporal lower quadrant there were less absolute defects but equally frequent relative defects; (3) Defects in the nasal quadrant and above the horizontal meridian are most frequent (between 18 and 30 degrees absolute, between 12 and 30 degrees relative), while temporally of the blind spot and below the horizontal meridian they are quite rare; (4) In the upper half of the field, defects are closer to the fixation point and blind spot; the area between blind spot and macula largely free of defects. --In 71 eyes of 69 patients a similar frequency distribution was found with the Competer computer perimeter (test field 15-20 degrees eccentricity) giving good correlation with the Octopus results. --In 301 eyes of 215 patients with early glaucomatous defects the four test points in the region of the blind spot were evaluated and compared with the results of 121 eyes of 71 patients with ocular hypertension and no field changes. It appears highly probable that an increase in the size of the blind spot is associated with the incidence of field defects. --The distribution of early glaucomatous field defects in 214 eyes revealed a combination of paracentral scotomata with peripheral defects in 75.2%, exclusively peripheral scotomata in 19.6% and exclusively paracentral scotomata in 5.1%. The significance of the results with regard to the pathophysiology of glaucomatous visual field loss is discussed.

Computers↗
PubMed1982

[The physician's obligation to educate patients - legal aspects - patients' expectations].

There is some uncertainty among doctors and lawyers about the form and content of presurgical medical enlightenment of the patient. Presurgical enlightenment is of increasing significance with respect to malpractice suits. Current jurisdiction has developed principles of enlightenment that are often difficult for the doctor to handle. For routine procedures in major hospitals a standardized, pragmatically designed consent form is therefore necessary. At Würzburg University Eye Hospital the results of glaucoma and cataract surgery have been documented for years by using computer-readable forms. On the basis of these large-scale results from many thousands of procedures a written consent form was developed and tested for its suitability. Two hundred and twenty-two patients were questioned on their expectations as to proper enlightenment. The results of these broadly scattered interviews are summed up and presented. Especially with glaucoma patients, the best method of enlightenment, satisfying both medical and legal requirements, is an information booklet designed for lay people together with verbal information furnished by the doctor. Nearly all of the patients interviewed found the preoperative enlightenment complete and sufficiently clear. The majority ot them could repeat the contents of the enlightenment form four to six days after the operation. This speaks well for the adequacy of the enlightenment. As a rule, the written consent form was supplemented by verbal enlightenment from the operating physician immediately before hospitalization of the patient. A psychological investigation of preoperative anxiety with enlightened and non-enlightened patients revealed that the enlightenment form did not increase preoperative anxiety. Surgical ophthalmology lends itself to a written consent form more readily then other surgical disciplines, because diseases with poor prognoses for life are fortunately rare.

Aged↗
PubMed1980

Cataract Surgery: types and frequencies of complications.

A total of 4,300 cataract extractions were evaluated with respect to operative complications and their effects on postoperative visual function. Severe vision-threatening complications such as vitreous or expulsive hemorrhage occurred in 6 of the 4,300 eyes; 726 eyes followed up over 1--3 years showed late complications in 0.44%--1.77%. The relevance of the date prior to surgery is discussed.

Cataract Extraction↗
PubMed1980

The ocular responses of oral administration of penbutolol in the glaucomatous patient.

A single oral dose of 20 mg or 40 mg Penbutolol was given to two groups of ten untreated glaucoma patients. The drug significantly decreased intraocular pressure and was dose-related. The IOP response was paralleled with a decrease in pulse rate without significant effect on blood pressure. In another group 27 glaucoma patients, which were under sufficient IOP control following topical treatment with different antiglaucomatous agents, the daily peroral treatment with 40 mg Penbutolol did not result in a further decrease of IOP. However, a significant drop in pulse rate could be noted over the four weeks period of treatment in this series of patients. Blood pressure was, similar to the single does study, not significantly affected. Penbutolol treatment did not significantly change pupillary diameter, quantitative tear flow or corneal sensitivity. The potential usefulness of the drug in glaucomas with systemic hypertension or as additive treatment when topical treatment is insufficient is outlined.

Administration, Oral↗
PubMed1980

Patient information before cataract surgery.

Patients have to be informed before cataract surgery about possible complications, about chances and risks. This should be done in a written manner with additional verbal explanations. We documented all details of 4,300 cataract operations on computer-readable forms and obtained statistics on type and frequency of complications as well as visual acuity 1 week after the operation. With these data we have a reliable base for the presurgical information of our patients. Detailed information about possible risks and chances of cataract extraction were given to each patient by means of a written form which was read to the patient and explained in details to him. Immediately afterwards we tested the reaction of the patient upon the full information. It was found that the reactions were surprisingly positive. Not one of the patients felt less inclined to undergo surgery and not one patient had less confidence toward the hospital. The vast majority (approximately 90%) of the patients said in contrary that their confidence was much increased after the information. A similar type of information can be recommended, therefore, for moral and legal reasons.

Aged↗
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

Simple glaucoma before the age of 30 years.

'Juvenile glaucoma' is a meaningless term which should not be used. Glaucoma in young subjects can be hydrophthalmus, secondary or simple glaucoma. In this paper, early simple glaucoma is described in 15 patients (8 males, 7 females) below the age of 30 years, starting in some subjects already at 8 years of age. Inheritance was dominant in 6 patients. Anticipation could be shown in 2 pedigrees through 4 and 5 generations, respectively. The course of the disease was severe in 8 patients, with intraocular pressures over 40 mm Hg and/or heavy functional loss. There were usually no subjective symptoms. The chamber angles were gonioscopically normal in all patients. Miotics were effective but did not normalize the intraocular pressure. Surgical treatment is 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↗
PubMed1978

[Molsidomin and intraocular pressure. No effect in healthy subjects and in glaucoma patients].

Molsidomine is a new agent in coronary therapy. It does not influence the intra-ocular pressure in healthy volunteers or in glaucoma patients. This was tested in double-blind studies in short trials and in a long term study of 3 months. The outflow facility or the visual fields were also unchanged. These results correspond closely to those obtained previously with other coronary therapeutics. Molsidomine is not dangerous for glaucoma patients.

Coronary Disease↗
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↗