Treatment of chalazia with injectable triamcinolone.

Twenty patients with a total of 22 chalazia unresponsive to conservative medical treatment were randomized for treatment with either intralesional triamcinolone acetonide or placebo. Eight of 12 lesions treated with triamcinolone acetonide resolved. In all ten of those treated with normal saline injection, treatment failed to achieve a clinical cure. Nine of the normal saline treatment failures were then injected with triamcinolone acetonide. Eight of nine in this group achieved clinical resolution. When the two treatment groups were combined, a total of 16 of 21 chalazia (76%) resolved with intralesional steroid therapy. Intralesional steroid therapy can be used successfully to treat chalazia, and its effect is not merely due to a mechanical disruption of the lesion. Pain and discomfort from intralesional injections is a common complaint.

Filtering valve implant for neovascular glaucoma in proliferative diabetic retinopathy.

The prevention and treatment of neovascular glaucoma in diabetic patients presents a difficult clinical challenge. This report presents the pathologic findings in a juvenile onset diabetic patient who underwent panretinal photocoagulation. She subsequently developed neovascular glaucoma, was treated with the the Krupin-Denver valve implant, and received cyclocryotherapy after the filtering surgery failed to maintain a normal intraocular pressure. The pathologic findings resulting from each treatment modality are presented with emphasis on the failed intraocular valve. A fibrous ingrowth surrounded the valve, and a foreign body granulomatous response was present.

The ocular manifestations and functional effects of occupational argyrosis.

Thirty employees of an industrial plant involved in the manufacture of silver nitrate and silver oxide underwent ophthalmologic evaluation in an effort to evaluate the frequency and extent of ocular argyrosis. The most frequently noted ocular abnormality was pigmentation of the conjunctiva, present in 20 workers; corneal pigmentation occurred in 15 workers. A direct relationship existed between the levels of pigmentation and duration of employment. Ocular pigmentation was seen more frequently than cutaneous pigmentation. Ten workers noted decreased night vision, but electrophysiologic and psychophysiologic studies of seven of these ten workers demonstrated no functional deficits.

Clinical comparison of dipivalyl epinephrine and epinephrine in the treatment of glaucoma.

Dipivalyl epinephrine, 0.1%, though slightly less effective in decreasing intraocular pressure, showed significantly fewer side effects than epinephrine hydrochloride, 2%. Seventeen patients with symmetrically increased intraocular pressures who completed a six-month double-masked crossover study showed a significant decrease in intraocular pressure averaging 23.7% for dipivalyl epinephrine over the entire study and 27.4% for epinephrine. In the first treatment period, dipivalyl epinephrine was slightly less effective than epinephrine. In the second treatment period, dipivalyl epinephrine was statistically less effective than epinephrine. Two of the original 25 patients were dropped from the study because of epinephrine allergy or intolerance, one had uncontrolled pressures with either drug, and five failed to maintain adequate follow-up. Complaints of side effects such as burning and irritation occurred much more frequently in eyes receiving epinephrine (24%) than dipivalyl epinephrine (3%). Mild mydriasis occurred with each drug, averaging +0.65 mm with dipivalyl epinephrine and +0.55 mm Hg with epinephrine. No effect on blood pressure or pulse rate was found for the two drugs.

A comparison of the effects of timolol and epinephrine on intraocular pressure.

We conducted a double-masked, six-week crossover study comparing bilateral twice-a-day therapy with timolol maleate (0.1%, 0.25%, and 0.5%) and epinephrine hydrochloride (0.5%, 1.0%, 2.0%) in 36 otherwise untreated patients. Increasing concentrations of each drug were administered until an arbitrary level of control was achieved before each of the six-week follow-up periods. Seventeen patients were controlled by both drugs and four patients were controlled by neither drug. Timolol, but not epinephrine, was effective in ten patients, whereas epinephrine, but not timolol, was effective in two patients. Three patients did not complete the study. The mean decrease in intraocular pressure from baseline was significantly greater with timolol than with epinephrine both before crossover and overall at both the lowest and highest concentrations of drug used. Significantly toxicity was produced in four patients during treatment with epinephrine, but in no patients during treatment with timolol.

The effect of 1.5% timolol maleate on intraocular pressure.

A controlled trial was instituted to compare the effect on intraocular pressure of topical administration of timolol maleate with epinephrine hydrochloride. A bottling error by the manufacturer resulted in the placebo bottles containing 1.5% timolol maleate. This drug given twice a day for two weeks significantly reduced intraocular pressure and produced no side effects.

Inadvertent substitution of acetohexamide for acetozolamide.

In three cases acetohexamide (Dymelor), an oral hypoglycemic agent, was mistakenly given to patients instead of acetazolamide (Diamox), which had been prescribed for their glaucoma. A number of similarities, including the fact that both medications are 250-mg white tablets, with similar generic and brand names which are generically repackaged medications juxtaposed on the pharmacist's shelf, predispose to the inadvertent substitution of one medication for the other. In one instance a systemic hypoglycemic reaction resulting in head trauma and confusion ended in an emegency hospital admission following the substitution of acetohexamide for acetazolamide.