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PubMed1992

[Pathogenesis and treatment of primary closed-angle glaucoma].

With an incidence of about 1/1000, primary angle-closure glaucoma is 4 to 5 times less frequent than primary open-angle glaucoma. It occurs most frequently due to pupillary block, itself both due to anatomical configuration and to either physiological or pathological changes in the anterior chamber. Pupillary block causes an increase of pressure in the posterior chamber, which leads to anterior displacement of the iris and, finally, to angle closure. The treatment of choice - dictated by the pathogenesis - consists of diminishing the posterior chamber pressure by means of hyperosmotic agents such as glycerin per os or mannitol iv. After reduction of the posterior-chamber pressure has been attained, a mild miotic, i.e. one which causes neither a strong miosis nor a flattening of the anterior chamber, is administered. If it is an acute attack, the application of these principles will permit normalization of pressure within about one hour. Several therapeutic guidelines are proposed, adapted to certain classical situations as well as to some less classical.

Acute Disease↗

PubMed1991

[Synthetic lens implantation in cataract patients with glaucoma].

In 178 eyes (122 patients) with chronic glaucomas an extracapsular cataract extraction was performed in combination with an implantation of a posterior chamber lens. In 45 cases a filtrating glaucoma surgery had been performed before. A narrow pupil, caused by the miotic therapy, posterior synechias or changes after glaucoma surgery, made the cataract extraction difficult in most of the cases. The variations in the operation techniques which thereby became necessary are discussed. 0.5 to 4 years after the lens implantation visual acuity, visual field, ocular pressure and glaucoma medication were investigated. The postoperative results and the late results were very satisfying. Not only the increase of the visual acuity was essential especially for patients with defects of the visual field but also the therapeutic effect on the intraocular pressure. After the posterior chamber lens implantation significantly (p less than 0.001) more eyes had a well regulated intraocular pressure under 20 mmHg (87%) at the time of the late investigation than preoperatively (63%). 33% had to use the same medicaments as they had before, 2% had more, 64% less medicaments. Altogether 56% of the eyes did not need any topical therapy at the time of the late investigation. So even in the case of insufficiently regulated glaucomas we do no longer primarily perform an extracapsular cataract extraction together with the implantation of a posterior chamber lens combined with a goniotrephining surgery (Elliot-Fronimopoulos).

Ciliary Body↗

PubMed1991

[Secondary angle-block glaucoma in posterior scleritis].

Posterior scleritis is an often misdiagnosed disease of the eye. Mainly it appears in elderly women and tends to be recurrent. Symptoms leading to diagnosis are swelling of the eye lids, a red eye, disturbances of the motility and protrusio bulbi. In rare cases you find exudative choroidal or retinal detachment, edema of the macula, or the optic nerve head, and secondary angle closure glaucoma. Often posterior scleritis is associated with general illness as herpes zoster, mixed connective tissue diseases, or Boeck's disease. Differential diagnosis are choroidal tumors as for example, melanoma, hemangioma, and metastases. The typical uveal effusion can also be caused by an arterio-venous fistula, panretinal photocoagulation, buckling procedure for retinal detachment, and by intraocular surgery in general. Especially cyclitis anularis pseudotumorosa has to be considered and shut out. Most important diagnostical means are ultrasound, and CT-scan. The underlying case describes an 81 years old woman that presented with acute angle closure glaucoma, and exudative choroidal detachment of the right eye. The ultrasound and CT-scan investigations confirmed the diagnosis of scleritis posterior. The acute angle closure glaucoma, and the choroidal detachment regressed immediately under the treatment with steroids given locally and systemically. There was no impact of miotics and peripheral iridectomy which both could not avoid recurrence of angle closure glaucoma.

Aged↗

PubMed1989

[Sources of error in automated static perimetry].

Several sources of errors in interpreting computerized visual fields (learning effect, miotic pupil, sub-optimal refraction, dirty contact lenses, inadequate patient cooperation, anatomical obstacle, and choice of the wrong program) are described with the help of examples. Their identification should result in more reliable diagnoses.

Contact Lenses↗

PubMed1989

[Evaluation of glaucomas. Frequently misdiagnosed glaucoma conditions].

On the basis of a number of examples the authors describe specific glaucomas which have often reached their final stages by the time the patients are referred to the clinic. They include sub-acute and chronic angle-closure glaucoma, pseudoexfoliation syndrome, and pigmentary glaucoma. An unpleasant feature of these glaucomas is that, somehow or other, treatment comes too late: complete cupping of the optic disk when the ophthalmologist is first consulted, increased intraocular pressure in exfoliation syndrome detected too late, or a tardy decision to perform an iridotomy or a fistulizing operation. The following are some important points: gonioscopy should be performed not only at the initial examination but also at subsequent ones; subacute and chronic pupillary or angle-closure glaucomas are progressive diseases for which the sensible therapy is not miotics but laser iridotomy; because papillary changes usually precede visual field changes (automated perimetry notwithstanding), particular attention must be paid to the former. This can only be accomplished with exact documentation. Therefore, glaucoma follow-up means pressure measurement and gonioscopy and examination of the optic disk and visual field. In conclusion, aids for decision-making and a follow-up schedule are presented.

Aged↗

PubMed1989

[Gonioscopy of the shallow anterior chamber].

During gonioscopy the aqueous humor can be shifted by appropriate indentation with the goniolens (Forbes test). The iris root is affected in a variety of ways: it may sink in, troughlike, or be deformed to an S-shape, or remain unchanged. The different findings depend on the configuration of the ciliary processes and the position of the lens equator; they enable conclusions to be drawn concerning the risks of inverse reaction to miotics or of ciliary lens block (malignant) glaucoma.

Anterior Chamber↗

PubMed1987

[Timoptol in the after-care following argon laser trabeculoplasty].

In 17% of the author's 205 patients treated by argon laser trabeculoplasty, Timoptol was the sole local antiglaucoma medication given postoperatively. These patients benefited from a particularly advantageous situation. Intraocular pressure was once again reliably regulated. In addition, there were no visual disturbances, e.g., as caused by miotics. Local and general tolerance are excellent; the level of patient discomfort is very low, as the drops are only applied once or twice a day; and, finally, the patient remains in ophthalmological care. Postoperative treatment with Timoptol has also proved highly successful in another group of patients, i.e., glaucoma patients in whom an argon laser trabeculoplasty was performed prior to cataract extraction. In these patients the subsequent cataract extraction is greatly facilitated because the pupil can be readily dilated.

Combined Modality Therapy↗

PubMed1986

[Long-term results of Nd-YAG laser iridotomy and indications deriving from it].

Of 132 patients who had undergone Nd-YAG laser iridotomy, 70 were randomly selected for follow-up examinations. Nd-YAG laser iridotomies were subsequently performed on 124 eyes (of these 70 patients), 12 for acute angle-closure glaucoma, 19 fellow eyes of those which had angle-closure glaucoma, 70 for chronic angle-closure glaucoma, and 23 eyes with increasingly narrow chamber angle under miotic therapy. The follow-up period ranged from 1 to 25 months (median = 9 months). Eighty-seven percent of the iridotomies remained visibly open. Of 12 acute glaucomas, 10 were successfully treated, whereas only 2 required a basal iridectomy. In the large group of 106 eyes with a "narrow angle condition," a significant pressure reduction from 20.9 +/- 5.8 to 16.7 +/- 3.4 mm Hg and a significant enlargement of the chamber angle resulted. Since fistulizing procedures involve a risk of malignant glaucoma, Nd-YAG laser iridotomy, which this investigation showed to be risk-free, is the initial procedure of choice in narrow-angle conditions, especially subacute and chronic angle-closure glaucoma, in order to alleviate the angle-closure component in such angle-closure situations, to diagnose its contribution to peak IOP, and to facilitate argon laser trabeculoplasty when needed.

Aged↗

PubMed1986

[YAG laser iris hole at 6 o'clock in the periphery in the treatment or prevention of closed angle glaucoma and plateau iris and in pupillary block (posterior iris surface-blocking mechanism)].

A shunt between the anterior and the posterior chamber, achieved by shooting an iris hole with a YAG Laser, is presumed to prevent angle closure in eyes with narrow angle glaucoma. Because of their thickening effect on all types of eye tissue, it is advisable to reduce pilocarpine and other miotics once the peripheral iris hole has been created. This is best made at 6 o'clock, since any hemorrhaging caused beneath this point will cease of its own accord. The shunt brings about deepening of the peripheral chamber, and almost always widens the angle in narrow angle glaucoma.

Aged↗

PubMed1983

[Trials in pressure regulation with metipranolol eyedrops in special forms of glaucoma in ophthalmologic practice].

This paper presents the results of a study on the effect of Metipranolol eye drops (Betamann) in 10 patients. The drops were tested with the following forms of glaucoma: glaucoma associated with alpha-kia, neovascular glaucoma, exfoliative glaucoma, pigmentary glaucoma, juvenile glaucoma. Some patients required treatment in combination with miotics. Metipranolol eye drops reduced intraocular pressure by about 15 percent for a prolonged period of time. The pressure-lowering effect was maintained during an observation period of twelve months. Visual acuity and visual fields were constant. The drug was tolerated well subjectively by almost all the patients.

Adrenergic beta-Antagonists↗

PubMed1983

[The alpha-adrenergic effect of thymoxamine on the vessels of the ciliary body].

The effects of epinephrine on the permeability of the blood-aqueous barrier, stimulated by paracentesis of the anterior chamber, were studied in rabbits following alpha-adrenergic blocking by means of topical or systemic thymoxamine. The alpha-adrenergic block was tested by continuous recording of the systemic arterial blood pressure. The reversal of the vascular effects of epinephrine after administration of thymoxamine was demonstrated at the bloodaqueous barrier. The miotic property of thymoxamine is believed to have had no influence on our results.

Animals↗

PubMed1980

[Surgical treatment of glaucoma].

Normalization of intraocular pressure in primary open-angle glaucoma and narrow-angle glaucoma by single iridencleisis was demonstrated in 551 eyes between six months and seven years postoperatively. Of the eyes followed up in our clinic, 80% were normalized by operation, another 18.8% by operation and additional miotics and 1.2% after a second operation. On the other hand, of the eyes followed up externally, the corresponding figures were 69.3%, 25.2% and 4.5%, respectively. Because of the low complication rate in respect of secondary cataract, visual field defects and late infections, we maintain the view that single iridencleisis is an excellent intervention for the treatment of glaucoma.

Follow-Up Studies↗

PubMed1980

[Pressure-lowering effect of timolol in various forms of glaucoma (author's transl)].

The action of Timolol, which lowers IOP in open-angle glaucoma, was investigated in patients with aphakic glaucoma and, with simultaneous administration of a miotic, in patients with narrow-angle glaucoma. Follow-ups, in some cases over periods of up to one year, showed that Timolol lowers IOP in almost all cases. Timolol alone reduced the pressure in 46% of the patients. Additional administration of other glaucoma drugs enabled IOP to be lowered to 22 mmHg or less in 82%. In five patients the pressure-lowering effect was unsatisfactory or, respectively, treatment with the drug had to be discontinued. All the patients had previously taken numerous pressure-lowering drugs without achieving adequate stabilization. In view of its minor side-effects and convenient mode of application (drops twice a day), Timolol should always be used in younger patients with wide chamber angles before surgery is contemplated.

Glaucoma↗

PubMed1998

Tachykinins as enhancers of prostaglandin E2-induced intraocular inflammation.

The effects of tachykinins on prostaglandin E2 (PGE2)-induced intraocular inflammation were investigated. PGE2 (0.01% or 0.1%) instillation induced iridal hyperemia and protein leakage into the aqueous humor in rabbits, but caused minimal miosis. Intravitreally injected substance P (SP) or neurokinin A (NKA), on the other hand, did not induce protein leakage into the aqueous humor in normal rabbits, but they (SP 10 micrograms/eye or NKA 50 micrograms/eye) did induce long-lasting miosis. The miotic activity of SP was about fivefold stronger than that of NKA. Intravitreally injected SP (10 micrograms/eye) but not NKA (50 micrograms/eye) increased PGE2 concentration in the aqueous humor in normal rabbits. In addition, SP (10 micrograms/eye) or NKA (50 micrograms/eye) markedly enhanced protein leakage into the aqueous humor induced by PGE2 instillation. Pretreatment with indomethacin partially blocked the enhancing effect of SP on protein leakage, while it did not block that of NKA. These results suggest that SP or NKA may enhance intraocular inflammation in vivo. However, the mechanisms of these effects of SP and NKA may be different. The enhancing effect of SP in eye inflammation may be partially due to an increased turnover of arachidonic acid into PGE2 caused by activation of the enzyme cyclooxygenase.

Animals↗

PubMed2003

Influence of hydroxypropyl beta-cyclodextrin on the corneal permeation of pilocarpine.

The influence of hydroxypropyl beta-cyclodextrin (HPbetaCD) on the corneal permeation of pilocarpine nitrate was investigated by an in vitro permeability study using isolated rabbit cornea. Pupillary-response pattern to pilocarpine nitrate with and without HPbetaCD was examined in rabbit eye. Corneal permeation of pilocarpine nitrate was found to be four times higher after adding HPbetaCD into the formulation. The reduction of pupil diameter (miosis) by pilocarpine nitrate was significantly increased as a result of HPbetaCD addition into the simple aqueous solution of the active substance. The highest miotic response was obtained with the formulation prepared in a vehicle of Carbopol 940. It is suggested that ocular bioavailability of pilocarpine nitrate could be improved by the addition of HPbetaCD.

2-Hydroxypropyl-beta-cyclodextrin↗

PubMed2001

Preclinical efficacy of travoprost, a potent and selective FP prostaglandin receptor agonist.

Travoprost is the isopropyl ester prodrug of a high affinity, selective FP prostaglandin full receptor agonist. In contrast to travoprost acid's high affinity and efficacy at the FP receptor, there is only sub-micromolar affinity for the DP, EP1, EP3, EP4, IP, and TP receptors. Travoprost produced a lower incidence of ocular irritation than PGF20 isopropyl ester at a dose of 1 microg in the New Zealand albino (NZA) rabbit. Topical ocular application of travoprost produced a marked miotic effect in cats following doses of 0.01, 0.03 and 0.1 microg. In the ocular hypertensive monkey, b.i.d. application of 0.1 and 0.3 microg of travoprost afforded peak reduction in intraocular pressure (IOP) of 22.7% and 28.6%, respectively. Topical application of travoprost was well tolerated in rabbits, cats and monkeys, causing no ocular irritation or discomfort at doses up to 1 microg. Travoprost is a promising ocular hypotensive prostaglandin FP derivative that has the ocular hypotensive efficacy of PGF2alpha isopropyl ester but with less severe ocular side effects.

Adenylyl Cyclases↗

PubMed2003

Intraocular pressure, safety, and quality of life in glaucoma patients switching to latanoprost from monotherapy treatments.

PURPOSE: To evaluate the efficacy, safety and quality of life in ocular hypertensive or open-angle glaucoma patients who required alteration in previous therapy and were changed to latanoprost. METHODS: A prospective, multicenter, active, historical controlled trial in which qualified patients had previous therapy substituted with latanoprost 0.005% and were followed for up to 6 months. RESULTS: 3179 patients were included in the intent-to-treat analysis. In all patients latanoprost reduced the intraocular pressure (IOP) from 20.1 +/- 3.9 to 17.1 +/- 3.5 mm Hg (p< 0.0001) and when compared to previous monotherapies: beta-blockers (-3.0 +/- 3.5, n = 1976), alpha-agonists (-3.6 +/- 3.7, n = 581), miotics (-2.8 +/- 3.0, n = 21), carbonic anhydrase inhibitors (-3.2 +/- 3.5, n = 198), and other prostaglandin analogs (-1.6 +/- 3.7, n = 402). The most common ocular adverse event with latanoprost was conjunctival hyperemia (n = 66, 2.0% incidence) and the most common systemic adverse event was headache (n = 9, 0.2%). Over the 6-month treatment interval 89.8% of patients were maintained on latanoprost. On the solicited symptom survey patients showed a preference for latanoprost compared to previous therapy for several reasons: (depending on the product) dryness, blurred vision, tearing, stinging on instillation, crusting, itching, fatigue, dizziness, despondency and dry mouth (p < 0.005). CONCLUSION: Latanoprost generally provides reduced IOP, limited side-effects, improvement in many quality of life measures and is maintained in patients who required a substitution from previous monotherapy.

Adult↗

PubMed1985

Calcitonin gene-related polypeptide as a mediator of the neurogenic ocular injury response.

Calcitonin gene-related polypeptide (CGRP) has been localised immunochemically within the rat and guinea pig anterior uvea to nerve fibres of trigeminal origin. As with substance P (1-3) the level of CGRP in the iris-ciliary body is depleted after thermal damage to the Gasserian ganglion and elevated in chronically sympathectically denervated eyes. Unlike substance P, a potent pupillary constrictor (4,5), CGRP has no notable miotic action, but does, however, cause an elevation of the intraocular pressure (IOP) accompanied by disruption of the blood-aqueous barrier. It is proposed that the diverse actions of these two sensory neuropeptides conjointly mediate the antidromic ocular injury response.

Afferent Pathways↗