ABSTRACT
Refractory glaucoma remains a challenging problem for the ophthalmologist. Drainage implant surgery is a valuable and effective option for its treatment. Recent developments in implant design and surgical technique have decreased the incidence and severity of postoperative complications while increasing the efficacy of glaucoma drainage implant devices.
Subject(s)
Glaucoma Drainage Implants/trends , Glaucoma/surgery , Filtering Surgery , Humans , Intraocular Pressure , Postoperative Complications , Treatment OutcomeABSTRACT
In this study we examined the relative effects of reducing eyedrop size (from 30 microliters to 10 microliters) and eyelid closure on the ocular efficacy and systemic absorption of 10% phenylephrine. Thirteen subjects participated in a quadruple crossover study that involved dilation with a 10-microliters and a 30-microliters drop of phenylephrine with and without eyelid closure. The 10-microliters drop was just as effective for pupillary dilation as the 30-microliters drop. Eyelid closure improved dilation for both drop sizes. Both eyelid closure and reducing the drug volume decreased systemic absorption of phenylephrine as measured by plasma concentration. When used together, eyelid closure and the smaller drop size reduced plasma concentration by 45%. The therapeutic index for 10% phenylephrine appears to be improved by using a 10-microliters drop followed by eyelid closure.
Subject(s)
Eyelids/physiology , Ophthalmic Solutions , Phenylephrine/administration & dosage , Pupil/drug effects , Absorption , Adult , Female , Humans , Male , Middle Aged , Phenylephrine/pharmacokinetics , Therapeutic EquivalencyABSTRACT
Potent opiate analgesics, administered either epidurally, intrathecally, or intravenously, are a common adjunct to pain control in the perioperative period. Little is known, however, of the effects of opiate agonists on cerebral blood flow (CBF) and metabolism. Current studies are complicated by the hypotensive effects of these compounds and their route of administration. To circumvent these difficulties we studied the effects of intraventricular and intracarotid morphine sulfate, in doses that do not affect arterial blood pressure, on regional CBF and total cerebral oxygen consumption (CMRO2) in pentobarbital-anesthetized dogs. Five dogs received 0.04 mg/kg morphine via intracarotid injection. Five additional dogs received 0.2 mg/kg morphine via ventricular cisternal infusion over 5 min, and five control dogs received mock cerebrospinal fluid at the same infusion rate. CBF was measured using the radiolabeled microsphere technique. Intracarotid morphine decreased neurohypophyseal blood flow to 58% of control, but it did not alter blood flow to any other brain region, except caudate nucleus, or cause a change in CMRO2. Infusion of mock cerebrospinal fluid in the cerebral ventricles did not alter CBF or CMRO2. Ventricular-cisternal perfusion of morphine caused a transient increase in CBF (24 +/- 2 to 37 +/- 6 mL min-1 100 kg-1) but had no effect on spinal cord blood flow or CMRO2. Neurohypophyseal blood flow, however, decreased to 40% of control levels (480 +/- 76 to 176 +/- 42 mL min-1 100 kg-1) after 2 min and gradually returned to control levels at 60 min.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Brain/metabolism , Cerebrovascular Circulation/drug effects , Morphine/administration & dosage , Oxygen Consumption/drug effects , Anesthesia, Intravenous , Animals , Brain/drug effects , Carbon Dioxide/blood , Carotid Arteries , Cerebrovascular Circulation/physiology , Dogs , Female , Hemodynamics/drug effects , Hemodynamics/physiology , Injections , Injections, Intraventricular , Male , Oxygen/blood , Oxygen Consumption/physiology , PentobarbitalABSTRACT
Topical beta-blocking agents have been associated with adverse central nervous system (CNS) effects, including depression, emotional lability, and sexual dysfunction. Two studies were done to determine if patients who develop CNS effects while using timolol maleate would improve with betaxolol hydrochloride. In one study, 18 patients with CNS symptoms during timolol therapy were switched to betaxolol. Sixteen of the 18 patients noted symptomatic improvement with betaxolol. The second study involved seven patients with CNS symptoms during timolol therapy who were entered into a double-masked cross-over study. In two patients CNS symptoms resolved with betaxolol; in three patients symptoms improved; and in one patient symptoms worsened with betaxolol. Although factors influencing beta-blocker activity in the CNS are not well understood, there may be some advantage to a selective agent.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Central Nervous System/drug effects , Glaucoma/drug therapy , Propanolamines/therapeutic use , Timolol/therapeutic use , Administration, Topical , Adrenergic beta-Antagonists/adverse effects , Adult , Aged , Betaxolol , Depression/chemically induced , Double-Blind Method , Emotions/drug effects , Female , Humans , Male , Middle Aged , Propanolamines/adverse effects , Sexual Dysfunction, Physiological/chemically induced , Sleep Stages , Timolol/adverse effectsABSTRACT
We report clinicopathologic features of a case of von Hippel-Lindau disease in a patient who had been clinically followed for bilateral retinal and cerebellar involvement. Two of the patient's retinal hemangiomas appeared to show evidence of spontaneous regression.
