Antidepressants for the virtually eviscerated patient: options instead of oral dosing.

OBJECTIVE: Alternate ways of administering antidepressants when oral intake is impossible are discussed. METHOD: Reviews of 1) the medical circumstances that preclude oral medication administration and 2) novel administration strategies for antidepressants were conducted. RESULTS: Consultation psychiatrists not infrequently encounter depressed patients who lack a functioning gastrointestinal tract and who thus cannot absorb oral antidepressant medication. Under these circumstances, antidepressants can be administered intravenously, by rectal suppository, or topically. CONCLUSION: There are options for administration of antidepressant medication when oral intake is impossible.

A comparison of experienced clinical observers and statistical tests in detection of progressive visual field loss in glaucoma using automated perimetry.

The visual fields of 30 patients (subjects) with glaucoma were sent to six experienced clinicians (observers). Each subject had at least four visual field examinations on the OCTOPUS 201 automated perimeter spanning at least one year. Each observer was asked to review the visual field data of each subject and determine whether the visual fields were stable, improved, or worse over time. The visual field data were then analyzed using six different statistical models. In only 15 of the 30 subjects did at least five of the six human observers agree on the behavior of the visual field. Agreement among the statistical models was better, with at least five of the six models agreeing on 22 of the 30 subjects. It was concluded that there is, at present, no validated technique for detecting progressive visual field loss in glaucoma using automated perimetry when relatively few visual fields are available for analysis.

Intraocular pressure and visual field defects after argon laser trabeculoplasty in chronic open-angle glaucoma.

Nineteen patients undergoing argon laser trabeculoplasty for open-angle glaucoma were studied prospectively. All patients had glaucomatous visual field defects with inadequate medical control of intraocular pressure (IOP) before laser treatment. All patients had two automated visual fields immediately before laser treatment. They also had follow-up automated perimetry at 1, 4, 8, and 12 months posttreatment. The serial visual fields were compared using a one-way analysis of variance and trend analysis. After the laser trabeculoplasty, six patients showed visual field improvement, eight showed no change, and five showed progressive visual field deterioration. Patients with little fluctuation of IOP measurements after laser treatment had a better prognosis for visual field retention. The mean IOP level, however, was a poor predictor of visual field progression. Patients with more extensive visual field damage before laser treatment did not do worse than patients with less extensive visual field loss.