Analgesics in ophthalmic practice: a review of the oral non-narcotic agent tramadol.

This report reviews the causes of ocular pain and discusses the pharmacology, pharmacokinetics, efficacy, adverse effects, and dosage of tramadol, a novel non-narcotic oral analgesic. Tramadol is a synthetic analog of codeine with a dual mechanism of action that involves agonist activity at the mu opioid receptor, as well as inhibition of monoaminergic (norepinephrine and serotonin) re-uptake. Unlike opiate analgesics, tramadol has very low propensity toward physical dependence. Common dose-related adverse effects of tramadol include dizziness, nausea, vomiting, dry mouth, and/or drowsiness. Clinically, tramadol has been shown to be equivalent to acetaminophen (325 mg)-codeine (30 mg) combinations for the treatment of moderate or severe nonocular pain. Tramadol appears to be an effective analgesic agent for pain control due to postoperative surgical trauma, as well as in various chronic malignant and nonmalignant disease states. Tramadol has shown variable effectiveness in the control of pain related to dental procedures. The usefulness of tramadol in pain states from ophthalmic origin has yet to be clinically established.

Refractive astigmatism after oblique clear corneal phacoemulsification cataract incision.

PURPOSE: To determine the astigmatic effect of a supero-oblique clear corneal phacoemulsification cataract incision. SETTING: A university-based general ophthalmology practice. METHODS: All eyes having supero-oblique phacoemulsification cataract surgery using the right hand of a single surgeon between April 17, 1997, and July 24, 1997, were prospectively included. There were 52 eyes of 52 consecutive patients. Manifest refraction was performed preoperatively and 1, 3, and at least 6 months postoperatively. A Fourier method of vector analysis was used. RESULTS: Mean refractive error (Fourier corrected) for all eyes and all ages preoperatively was -1.422 + 0.085 x 35.85. At 6 months, it was -0.620 + 0.190 x 14.2. There was little difference between right and left eyes. Patients older than 80 years had greater induced astigmatism. CONCLUSION: This study provides evidence that making a supero-oblique clear corneal phacoemulsification incision while sitting in the more natural superior position does not induce a clinically important amount of oblique astigmatism.

Retinal dialysis in a patient on multiple seizure drugs and neuroleptic medication.

Retinal dialysis is often associated with trauma; however, as this report discusses, observation of a nontraumatic idiopathic form of retinal dialysis has been described. Idiopathic retinal dialyses may be caused by developmental or hereditary anomalies of the peripheral retina and may lead to occult retinal detachments which are often asymptomatic. Despite clinical observations suggesting the existence of a nontraumatic form of retinal dialysis, conclusive evidence establishing idiopathic retinal dialysis as a distinct pathologic entity is lacking. Complications of retinal dialysis, either idiopathic or traumatic, include retinal detachment and permanent vision loss. Comprehensive fundus examinations, which include scleral depression, are therefore critical in detecting silent retinal dialyses particularly when a history of trauma is reported. This report describes a case of retinal dialysis in a patient whose history is negative for antecedent trauma.

Biotransformation in review: applications in ocular disease and drug design.

The purpose of this paper is to review the biochemical processes of systemic biotransformation and describe their relevance to ocular disease and drug metabolism. The diverse nature of the biochemical pathways, commonly found in enzyme metabolism, is discussed. The occurrence of these processes in the eye has significance in that the products of metabolism may accumulate locally and exert deterimental effects, presumably by altering the cellular structure and/or function of crucial visual elements. The manipulation of these metabolic pathways within the eye has ramifications in the development of novel drug design for both ocular disease treatment and, perhaps more importantly, disease prevention.

Occult giant cell arteritis: a diagnosis of suspicion.

BACKGROUND: Giant cell arteritis (GCA), also known as temporal or cranial arteritis is an inflammatory disease of arterial vessels which often involves the short posterior ciliary vessels resulting in an ischemic optic neuropathy. If not recognized and treated appropriately devastating preventable blindness may result. RESULTS: This review will present a case of "occult" giant cell with a discussion of the histopathology, symptomatology, diagnosis and management of this intriguing disease entity. CONCLUSION: Giant cell arteritis may masquerade with subtle easily overlooked symptoms and camouflaged signs. By appropriate physical and laboratory examination loss of vision may be prevented.

Comparison of glucose, sorbitol and fructose accumulation in lens and liver of diabetic and insulin-treated rats and mice.

1. The accumulation of glucose, fructose and sorbitol was determined in the lens, liver, and blood from normal, streptozotocin-induced diabetic, and insulin-treated diabetic rats and mice. 2. Sorbitol concentration in rat lens was 10-100 times greater than that in mouse lens, with the highest concentrations in the diabetic animals. 3. Sorbitol levels in rat and mouse liver, and mouse lens were similar and increased only slightly under hyperglycemic conditions. 4. Fructose accumulation was similar in rat and mouse liver and was elevated in the diabetic mouse blood and diabetic rat lens. 5. Aldose reductase activity in rat lens was approximately 350 times that of mouse lens. 6. Lenticular sorbitol dehydrogenase activity in rats was approximately ten times that in mouse lens. 7. Administration of insulin tended to lower liver glucose and subsequent sorbitol formation in the diabetic rat and mouse.

Carbon tetrachloride and the sorbitol pathway in the diabetic mouse.

1. Sorbitol dehydrogenase activity and the hepatic and serum concentrations of sorbitol, glucose and fructose were quantified in diabetic mice. 2. Blood glucose concentrations were increased over 300% by diabetes and were decreased toward normal after insulin-treatment. 3. Hepatic sorbitol concentrations ranged from 7-15 mumol/g and were highest in uncontrolled diabetic mice. 4. Hepatic concentrations of fructose and sorbitol were not affected by insulin administration. 5. Challenge with carbon tetrachloride (25 microliters/kg i.p.) did not alter concentrations of glucose, sorbitol or fructose in blood or liver. 6. Sorbitol dehydrogenase activity in blood was increased similarly in normal, diabetic and insulin-treated diabetic mice after CCl4 administration. 7. The data indicate that sorbitol did not accumulate in diabetic mice, and that induction of diabetes did not increase the susceptibility of mice to CCl4 hepatotoxicity as occurs in rats.

Pseudophakic bullous keratopathy.

Although cataract surgery alone carries a risk of iatrogenic endothelial damage, IOL implantation will further increase the risk of endothelial compromise and resulting bullous keratopathy. PBK is an important consideration in the differential diagnosis of corneal disease in the pseudophakic eye and with proper treatment visual loss due to PBK is usually reversible. While seen most frequently with iris clip implants, all pseudophakes are susceptible to PBK and should be carefully observed for this disease entity.