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Biomedical subjects

A E Kolker

Publications and source records attributed to A E Kolker.

At least 19 recordsLinked to original sources
PubMed1992

Gonioscopic ab interno laser sclerostomy. A pilot study in glaucoma patients.

PURPOSE: The purpose of this study is to evaluate the safety and efficacy of gonioscopic ab interno laser sclerostomy (GLS) in patients with glaucoma. METHODS: The technique of GLS involves iontophoresis of methylene blue dye (1%) at the limbus to focally dye the sclera and to provide subsequent delivery of 10-microsecond pulsed laser energy to the dyed area through a goniolens. The laser emits at 660 nm, a wavelength that is maximally absorbed by the methylene blue dye. Patients were evaluated for fistula formation, intraocular pressure (IOP) reduction, and adverse sequelae. Thirty-eight treatments were performed in 35 eyes. RESULTS: Successful complete sclerostomies were achieved in 21 eyes (55%), which was associated with an acute mean reduction in IOP of 23 mmHg. Mean preoperative IOP for all patients was 35 mmHg, and 1 hour after treatment it was reduced to 18.5 mmHg. In 4 of the 38 treatments, there was no acute IOP reduction, and these eyes were judged as failures. The mean follow-up time was 8.2 months with a maximum follow-up of 15 months. By 9 months, 50% of patients had an IOP of 22 mmHg or lower. The number of antiglaucoma medications decreased from 3.1 to 1.7 for all eyes over the 15-month follow-up period. Hyphemas (13%) were the only major complication, and these resolved spontaneously. In only one case did the IOP increase after the procedure. CONCLUSION: The results of this trial indicate that GLS is technically feasible, and preliminary results of IOP control are promising.

Adult↗
PubMed1990

Failure of apraclonidine to prevent delayed IOP elevation after Nd:YAG laser posterior capsulotomy.

An elderly pseudophakic man with advanced open-angle glaucoma underwent Nd:YAG laser posterior capsulotomy. Pigment deposits were also removed from the anterior lens surface with laser applications. In spite of pre- and post-laser treatment with topical apraclonidine (Iopidine) and normal IOP 1 hour postoperatively, the patient presented the next day with visual acuity of 20/300, corneal edema, pain, and IOP of 60 mm Hg. Prompt treatment reduced the pressure and normal visual acuity was achieved. While apraclonidine prevents early post-laser elevation of IOP in most cases, some pressure elevations may be delayed or persist longer than the duration of action of the drug. Examination of patients with advanced glaucomatous optic nerve damage is recommended the day after anterior segment laser surgery, even when apraclonidine is used at the time of laser surgery and IOP is normal 1 to 2 hours postoperatively.

Adrenergic alpha-Agonists↗
PubMed1990

Transscleral neodymium: YAG laser cyclocoagulation for uncontrolled glaucoma.

To determine the efficacy and safety of the procedure, we reviewed the records of 25 eyes of 25 patients who had received noncontact transscleral Nd:YAG laser cyclocoagulation for a variety of uncontrolled glaucomas. Thirteen to 35 pulses (mean, 22.7 pulses) had been placed 1 mm to 2 mm behind the limbus with an energy per pulse of 3.4 J to 8.2 J (mean 4.5 J). Follow-up ranged from 6 months to 23 months, with the exception of one eye, which had to be enucleated. Nine of the 25 eyes (36%) required one or two repeat treatments. Twelve (48%) had intraocular pressures at last follow-up of less than 21 mm Hg but greater than 4 mm Hg. Ten eyes (40%) developed moderate to severe pain transiently, and 10 (40%) developed substantial, but transient, inflammation. Transscleral Nd:YAG laser cyclocoagulation appears to be relatively effective and well tolerated.

Adolescent↗
PubMed1989

Topical timolol administration reduces the incidence of glaucomatous damage in ocular hypertensive individuals. A randomized, double-masked, long-term clinical trial.

We conducted a randomized, double-masked, long-term clinical trial to determine whether topical timolol therapy was effective in delaying or preventing the onset of glaucomatous damage in moderate-risk ocular hypertensive subjects. In 62 patients, one eye was chosen randomly to receive timolol therapy twice daily while the fellow eye received placebo. During the course of the study, the mean +/- SD difference in intraocular pressure between the timolol-treated and the placebo-treated eyes was 2.3 +/- 2.6 mm Hg. Reproducible visual field loss developed in 4 timolol-treated eyes and 10 placebo-treated eyes. Progressive optic disc cupping was noted in 4 timolol-treated and 8 placebo-treated eyes. Using a computerized image analysis system, the mean +/- SD increase in optic disc pallor during the course of the study was 0.86% +/- 2.4% in the timolol-treated eyes as opposed to 1.80% +/- 3.6% in the placebo-treated eyes. This study provides evidence that lowering intraocular pressure by medical treatment reduces the incidence of glaucomatous damage in ocular-hypertensive individuals.

Administration, Topical↗
PubMed1989

Assessing the utility of reliability indices for automated visual fields. Testing ocular hypertensives.

Monocular (right eye) visual fields were recorded with the Humphrey Visual Field Analyzer (30-2 Program) at baseline as well as 6 and 12 months later in 120 patients with established ocular hypertension. Indices of field reliability (fixation loss, less than 20%; false-positives and false-negatives, less than 33%) and field sensitivity (mean deviation [MD] and pattern standard deviation [PSD]) were examined. At baseline, 35% of patients exhibited low reliability (LR) fields, a figure which decreased to approximately 25% at 6 and 12 months, respectively. During this period, over 50% of patients produced at least one LR field, whereas 8.3% were unable to produce even one reliable field. Exhibition of a LR field appeared to be independent of patient age. Fixation errors, the major cause of LR fields, decreased by approximately 10% over the 12-month period; most patients had between 20 and 32% fixation errors. The incidence of significant defects identified by PSD was greater than that for MD; this was true for both reliable and LR fields. It is suggested that increasing the fixation loss criteria for assessing patient reliability to a 33% cutoff might substantially increase the percentage of fields graded reliable with minimal effect on the sensitivity or specificity of the test.

Adult↗
PubMed1988

Intraocular pressure response to topical dexamethasone as a predictor for the development of primary open-angle glaucoma.

In a retrospective study we reviewed the records of 788 subjects who had been corticosteroid tested with 0.1% dexamethasone four times daily to one eye for six weeks. All subjects had normal kinetic visual fields and optic nerve heads in both eyes at the time of testing and were followed up for a minimum of five years. Some subjects had normal baseline intraocular pressures whereas others were considered to have ocular hypertension. Of 276 individuals who were high corticosteroid responders (intraocular pressure greater than 31 mm Hg during dexamethasone administration), 36 (13.0%) developed glaucomatous visual field loss during the follow-up period. Only nine of 261 individuals (3.4%) who were intermediate responders (intraocular pressure 20 to 31 mm Hg during dexamethasone administration) and none of 251 individuals who were low responders (intraocular pressure less than 20 mm Hg during dexamethasone administration) developed glaucomatous visual field loss. However, the ability of the intraocular pressure response to dexamethasone to predict the development of glaucomatous visual field loss was not as good as the predictive power of a multivariate model that included patient age, race, baseline intraocular pressure, baseline outflow facility, baseline cup/disk ratio, and systemic hypertension.

Adult↗
PubMed1988

Pattern reversal electroretinogram (PRERG) abnormalities in ocular hypertension: correlation with glaucoma risk factors.

The indices employed commonly for the diagnosis of glaucoma (tonometry, ophthalmoscopy and perimetry) do not always identify which patients with ocular hypertension (OHT) will develop primary open-angle glaucoma (POAG) before irreversible visual field loss is manifest (1). The human pattern reversal electroretinogram (PRERG) is a bioelectric response reflecting neural activity of the proximal retina. PRERG amplitude reductions have been observed in POAG and other diseases affecting the optic nerve and retinal ganglion cells. This study was designed to determine whether OHT patients exhibit PRERG amplitude reductions and whether PRERG results are correlated with routinely evaluated clinical parameters. Steady-state PRERG (16 rps) were elicited by high contrast (76%), phase alternating checkerboard patterns (15-20 min checks) from one eye of 130 patients with ocular hypertension and 47 age matched visual normals (AMVNs). A significant (p less than 0.05) reduction in PRERG amplitude was noted for the OHT patients and 11.5% of those patients exhibited PRERG amplitudes more than 2.0 standard deviations below the AMVN mean. PRERG amplitude was found to be positively correlated with diastolic blood pressure (DBP) and negatively correlated with age, but no correlation between PRERG amplitude and either IOP, C/D ratio, or systolic blood pressure was evident. The lack of correlation between PRERG amplitude and the commonly used clinical indices may suggest a complementary role for this neurophysiologic test in determining which OHT patients will develop glaucoma.

Analysis of Variance↗
PubMed1988

Dissociation of visual deficits in ocular hypertension.

Both acquired color vision deficiencies and abnormal pattern electroretinograms (PERGs) are observed in patients with ocular hypertension (OHT) as well as in patients with glaucoma. In the present study we determined the prevalence of both of these functional deficits in a large group of OHT patients (N = 130). Color vision was tested with the desaturated D-15 and a color confusion score was used to quantitatively assess the magnitude of the color vision deficiency. Steady-state PERGs were evoked with rapidly alternating high contrast checkerboard patterns. Color vision deficits were detected in 23% of OHTs while 11.5% of the patients exhibited significant PERG amplitude reductions. Only 2.3% exhibited both abnormalities. The results suggest that although color vision deficiencies and PERG abnormalities are both evident in OHT, they are often dissociated findings.

Adult↗
PubMed1985

Neovascular glaucoma after intracapsular and extracapsular cataract extraction in diabetic patients.

A retrospective study of the rate of development of neovascular glaucoma after cataract extraction in 242 eyes of 186 diabetic patients identified neovascular glaucoma in 13 of 146 eyes (8.9%) after intracapsular extraction, in two of 17 eyes (11.8%) after extracapsular extraction with primary capsulotomy, and in zero of 53 eyes after extracapsular extraction without capsulotomy. The incidence of neovascular glaucoma was significantly lower in patients who underwent extracapsular extraction with preservation of an intact posterior capsule than in those undergoing intracapsular cataract extraction (P less than .01) or extracapsular cataract extraction with primary capsulotomy (P less than .05).

Aged↗
PubMed1978

Cataracts induced by topical dexamethasone in diabetics.

Eleven diabetic patients were treated with unilateral topical dexamethasone for 14 to 36 months in an attempt to control their retinopathy. Cataracts developed in the treated eye of nine patients, compared with only one cataract in an untreated eye.

Administration, Topical↗
PubMed1977

Family history in primary open-angle glaucoma.

A family history of glaucoma was found in 50% of patients with primary open-angle glaucoma (POAG) and 43% of patients with ocular hypertension (OH). Positive family history was twice as prevalent in those with OH and either HLA-B7 or B12 antigens than in OH with neither antigen (P less than .01). Although POAG occurred equally in men and women, the prevalence of a positive family history of glaucoma on the maternal side of the family in POAG patients was six to seven times greater than on the paternal side (P less than .0005). However, in patients with OH, but no glaucomatous field loss, there was no difference in prevalence of maternal and paternal family history. Even in OH with HLA-B7 or B12 antigens, there was no predominance of maternal family history. The implication that offspring were more likely to develop POAG when their mother's side of the family rather than their father's side had the disease has provided an additional potentially useful risk factor in patients with OH. In addition, it has raised interesting questions as to possible maternal cytoplasmic factors in the transmission and pathogenesis of POAG.

Black or African American↗
PubMed1977

Dipivefrin use in patients with intolerance to topically applied epinephrine.

Twelve patients who had previously demonstrated an intolerance to topically applied epinephrine received dipivefrin 0.1% in one eye and epinephrine 2% in the other eye. An adverse reaction occurred in only one eye (8%) receiving dipivefrin, but in ten (83%) on epinephrine. Topical dipivefrin 0.1% proved useful for lowering intraocular pressure in patients intolerant to topically applied epinephrine.

Administration, Topical↗
PubMed1977

Topical corticosteroid therapy complicating congenital glaucoma.

A 4-month-old infant with congenital glaucoma had been treated with a topical antibiotic-corticosteroid for three months. This fact complicated initial management, delaying definitive diagnosis and therapy. Topical steroid therapy in infants can produce a condition simulating congenital glaucoma. Since there is little rationale for using topical steroids to treat most infantile external disease processes, they are best avoided. When steroids are used for a prolonged period, some strategy for detecting glaucoma should be adopted.

Administration, Topical↗
PubMed1977

Topical corticosteroid response and retinopathy in juvenile-onset diabetes mellitus.

In a prospective study, 64 patients with insulin-dependent juvenile-onset diabetes mellitus were followed for eight to 12 years to determine if those with higher spontaneous intraocular pressures (IOPs) would be protected from the development of retinopathy. The patients were also classified initially as high (GG), intermediate (NG), or low (NN), responders on the basis of their IOP response to corticosteroid eyedrops. High responders were found to be considerably in excess (25 per cent) of the proportion found in the general population (6 per cent). Retinopathy developed significantly less often and was less severe in the high (GG) corticosteroid responders. Although the GG diabetics had significantly higher mean baseline IOPs than the less responsive NN and NG groups in each corticosteroid response category, the mean IOP of the group with retinopathy was not significantly different from that without retinopathy. This suggested that factors associated with the GG response other than increased IOP might be important in the relative resistance to diabetic retinopathy.

Administration, Topical↗