Recovery from ocular ischemic syndrome after treatment with verapamil.

Vasospasm has been implicated as a cause of amaurosis fugax, which can be controlled by administration of the calcium channel blockers nifedipine or verapamil. However, vasospasm has not previously been thought to be involved in chronic ocular ischemia. We report a patient with ocular ischemic syndrome, which may have had vasospasm as a contributing cause, since the patient also developed amaurosis fugax despite daily aspirin therapy. An 80-year-old man with chronic open-angle glaucoma developed chronic ocular ischemia characterized by progressively decreased visual acuity, pain, rubeosis, and hypotony, as well as transient visual dimming. Medical evaluation revealed no evidence of carotid stenosis, thromboembolism, or vasculitis as the cause of ocular ischemia. When the calcium channel blocker verapamil was administered, the episodes of transient visual dimming ceased immediately. In addition, soon thereafter, visual acuity improved, the rubeosis partially regressed, and the hypotony reversed. This case indicates that the calcium channel blocker verapamil may be effective in treating cases of ocular ischemic syndrome, when vasospasm is a contributing cause.

Bandage contact lens augmentation of 5-fluorouracil treatment in glaucoma filtration surgery.

The use of 5-Fluorouracil (5-FU) to inhibit scarring following filtration surgery has been hampered by corneal epithelial defects and their accompanying inflammation. This toxicity, which occurs during the crucial period in which the risk of bleb failure is highest, has previously been a relative contraindication to further 5-FU use. We have found the early placement of a therapeutic bandage contact lens permits extended administration of 5-FU during this period, minimizing discomfort and inflammation as well as enhancing bleb survival.

Blood loss measured with indium-111-labeled red blood cells in dogs.

The authors describe a safe, simple, sensitive, and accurate technique of measuring moderate amounts of blood loss using erythrocytes labeled with indium-111. Donor red cells were labeled with indium-111 and tracer amounts infused into dogs. The magnitude of red cell loss was determined by the difference between two sequential volume measurements. The coefficient of variation of sequential measurements of the same red cell volume was 4.6 +/- 1%. The sensitivity of the technique, as determined by comparison of measured and estimated volumes, was 20.5 ml. The measured volume was related linearly to the calculated volume of red cells lost (r = 0.98). The authors recommend indium-111-labeled erythrocytes as a means of obtaining multiple measurements of small to moderate amounts of hemorrhage.