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Biomedical subjects

A I Mandell

Publications and source records attributed to A I Mandell.

17 recordsLinked to original sources
PubMed1997

Levobunolol 0.5% and timolol 0.5% to prevent intraocular pressure elevation after neodymium:YAG laser posterior capsulotomy.

PURPOSE: To evaluate the prophylactic effect of levobunolol 0.5%, timolol 0.5%, or vehicle in reducing the incidence of postoperative intraocular pressure (IOP) spikes of 5 and 10 mm Hg or more in patients having neodymium:YAG (Nd:YAG) laser posterior capsulotomy. SETTING: Miami Vision Center, Coral Gables, Florida; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; Cincinnati Eye Institute, Cincinnati, Ohio; South Texas Cataract and Glaucoma Center, San Antonio, Texas; Mid-South Eye Foundation, Memphis, Tennessee, USA. METHODS: This prospective, double-masked, randomized study comprised 144 patients having Nd:YAG laser posterior capsulotomy in one eye. One drop of the test medication was administered preoperatively and one drop on the evening after surgery; IOP was measured preoperatively and 1,2,3 and 24 hours postoperatively. RESULTS: Intraocular pressure elevations of 5 mm Hg or more were seen in 1 of 60 patients (2%) in the levobunolol group, 4 of 54 (7%) in the timolol group, and 10 of 28 (36%) in the vehicle group. These elevations occurred significantly more frequently in the vehicle group than in the levobunolol (P < .001) or timolol (P < .004) groups. Elevations of 10 mm Hg or more were found in 2 of 28 patients (7%) treated with vehicle but were not observed in the patients treated with levobunolol or timolol. CONCLUSIONS: Levobunolol 0.5% or timolol 0.5% administered preoperatively and again in the evening after Nd:YAG laser capsulotomy effectively blunted the IOP rise that frequently follows laser surgery.

Adrenergic beta-Antagonists↗
PubMed1996

Timolol hemihydrate vs timolol maleate to treat ocular hypertension and open-angle glaucoma.

PURPOSE: We compared the therapeutic efficacy and safety of timolol hemihydrate to timolol maleate in patients with ocular hypertension and chronic open-angle glaucoma. METHODS: We conducted this three-month study as a multicentered, masked, parallel group comparison. Both the 0.25% and 0.5% concentrations were evaluated against similar concentrations of timolol maleate. Dosing was twice daily. An open-label, nine-month study followed the masked portion of the protocol, in which all patients received either 0.25% or 0.5% timolol hemihydrate. A total of 371 patients were included in both the 0.25% and 0.5% studies. RESULTS: We found statistically similar intraocular pressures with both the 0.25% (18.3 and 18.6 mm Hg for the hemihydrate and maleate groups, respectively) and 0.5% (19.9 and 19.5 mm Hg for the hemihydrate and maleate groups, respectively) concentrations of timolol hemihydrate and timolol maleate after three months of masked treatment. Likewise, peak intraocular effect at two hours after taking the medication was statistically similar between medicines at both concentrations. Likewise, both ocular and systemic safety were similar between the maleate and hemihydrate preparations at both concentrations. In the nine-month open-label protocol, therapeutic efficacy (19.9 and 19.1 mm Hg for the 0.25% and 0.5% concentrations, respectively) and safety of timolol hemihydrate were similar to effect and safety of the three-month protocol. CONCLUSIONS: This study suggests that timolol hemihydrate had an ocular hypotensive efficacy and safety profile statistically equivalent to that of timolol maleate for up to three months of therapy. Timolol hemihydrate showed efficacy and safety similar to that observed within the first three months, for up to one year of therapy.

Adolescent↗
PubMed1989

Therapeutic ultrasound for refractory glaucoma: a three-center study.

We present the results of therapeutic ultrasound for refractory glaucoma in a three-center study over 1 year. One hundred fifty-eight eyes were treated, with a mean follow-up of 8.0 months. The mean fall in intraocular pressure was 38.4%. Life table analysis for three success criteria are presented. Success varied between 66% and 72% at the mean follow-up time. Complications occurred in 11.4%, including phthisis bulbi in 0.6% and persistent hypotony in 2.5%. There was a mean loss of less than one line of visual acuity. Therapeutic ultrasound appears to be safe and effective for treatment of refractory glaucoma.

Adult↗
PubMed1988

ALO 2145 reduces the intraocular pressure elevation after anterior segment laser surgery.

The effect of an alpha adrenergic agonist, ALO 2145 (para-amino-clonidine [PAC]), was examined in a double-masked, multicenter study on the postoperative intraocular pressure (IOP) elevation after laser surgery in 165 patients (83 trabeculoplasty, 36 iridotomy, and 46 capsulotomy). One drop of 1.0% ALO 2145 or vehicle was instilled 1 hour before and immediately after laser surgery. The mean IOP increase in the ALO 2145-treated group was lower (P less than 0.05) than in the placebo group at each of the first three postoperative hours. Overall, 18% of placebo-treated eyes experienced IOP increases greater than or equal to 10 mmHg as compared with 4% of ALO 2145-treated eyes (P less than 0.003). Ocular and systemic side effects were minimal and did not differ between the treatment groups. ALO 2145 safely and effectively reduced the incidence and magnitude of potentially harmful IOP elevations after anterior segment laser surgery.

Aged↗
PubMed1988

A comparison of betaxolol and timolol in open angle glaucoma and ocular hypertension.

In a randomized, double-masked study, 41 patients with primary open-angle glaucoma or ocular hypertension were treated with betaxolol 0.5% or timolol 0.5% drops for 26 weeks. The average decrease in intraocular pressure (IOP) over the total study period was significant with both betaxolol (-6.3 mmHg) and timolol (-7.2 mmHg) in patients receiving no adjunctive therapy. There was no difference between betaxolol and timolol with respect to changes from baseline IOP. Significantly decreased mean brachial arterial pressure (MAP) was seen only with timolol, although the difference between the two groups was not significant. Pulse, pupil size, and basal tear secretion were unchanged in both groups. Burning upon instillation of the drops was more frequent with betaxolol.

Adrenergic beta-Antagonists↗
PubMed1988

Reduced cyclic myopia with pilocarpine gel.

Pilocarpine 4% gel and pilocarpine 4% solution were compared in young normal subjects for their effects on induced myopia. The pilocarpine 4% solution produced marked myopia lasting one to two hours which indicates that a qid therapeutic regimen produces about three to six hours of blurred vision during waking hours. The gel-induced myopic effects returned to normal in most subjects nine hours after a single instillation. Thus, pilocarpine-gel-induced myopic effects occur principally while asleep and are reduced substantially upon awakening. This allows patients to carry on normal activities throughout the day.

Adult↗
PubMed1984

Gel tears. A new medication for the treatment of dry eyes.

Gel Tears, a clear, semisolid formulation of synthetic, high molecular weight, cross-linked polymers of acrylic acid, persists in the conjunctival sac for hours after topical instillation, slowly melting while absorbing fluid and retaining it locally. In the present study of 55 patients (106 eyes) with severe dry eyes, who were unable to obtain ocular comfort with frequent administration of a wide variety of commercially available artificial tear preparations, 78% were improved by Gel Tear therapy. Subjective symptoms such as burning, stinging, foreign body sensation, dryness, and photophobia were significantly (P less than 0.001) alleviated, while objective signs concurrently improved but to a lesser degree. No patient required Gel Tears more often than four times daily. Most maintained optimal comfort on a dose of twice daily or less, and several patients previously unable to obtain ocular comfort with hourly administered conventional artificial tears required Gel Tears less than once a day.

Acrylic Resins↗
PubMed1983

Long-term results of valve implants in filtering surgery for eyes with neovascular glaucoma.

Filtration surgery was performed with a pressure-sensitive, unidirectional valve implant in 79 eyes with neovascular glaucoma. The device consisted of an open Supramid tube (outside diameter 0.58 mm) sealed to a Silastic tube with a slit valve. The Supramid tube was inserted at the corneoscleral limbus 1 to 4 mm into the anterior chamber. The Silastic portion was located under a scleral flap. Of the 79 eyes, 53 had postoperative intraocular pressures less than or equal to 24 mm Hg after a mean follow-up period of 23.7 +/- 10.9 months. Bleb revision for external scarring was required in ten of these 53 eyes and postoperative medical therapy was required in 26. The valve implant failed to control intraocular pressure in 26 of the 79 eyes. Failure was secondary to scarring of the external bleb in 18 eyes and to closure of the internal Supramid tube in five eyes. Mortality during the follow-up period was high: 12 of the 53 successfully treated patients and five of the unsuccessfully treated patients died.

Adolescent↗
PubMed1983

Combined timolol and epinephrine therapy for open angle glaucoma.

A survey of the literature concerning the interaction of timolol and epinephrine in lowering intraocular pressure, and a study comparing the efficacy of timolol and dipivefrin (a prodrug of epinephrine) to that of timolol and pilocarpine are presented. These observations suggest that timolol-epinephrine therapy is less effective than timolol-pilocarpine treatment, although the former combination has clinical value in some patients, and it is possible that this can be enhanced when special schedules for drug administration are used.

Drug Therapy, Combination↗
PubMed1982

Duration of effect of pilocarpine gel.

Thirty-five patients participated in a clinical trial of pilocarpine hydrochloride gel applied once daily at 10 PM. Patients tolerated the medication well and there were no untoward side effects. Significant lowering of intraocular pressure was found for 24 hours after administration. The effect 12 hours after administration was greater than 24 hours after administration. Therefore, pilocarpine gel can be endorsed as an effective medication for 24 hours in the vast majority of patients. However, it is incumbent on the prescribing ophthalmologist to measure the IOP at 10 PM at least once after prescribing pilocarpine gel to ensure adequate control of IOP at that time.

Aged↗
PubMed1981

6-hydroxydopamine in the treatment of open-angle glaucoma.

We evaluated the effectiveness of subconjunctival injections of 6-hydroxydopamine in conjunction with epinephrine in lowering ocular tension in 63 eyes of 61 patients with open-angle glaucoma. A single injection caused a peak median reduction in ocular tension of 6 mm Hg four weeks after the injection. Ten eyes (16%) showed no significant decrease in ocular tension. A single injection significantly decreased the ocular tension for 12 weeks in 40 (63%) and for 20 weeks in 21 (33%) of the eyes. The fellow control eyes showed a slight but not significant decrease in ocular tension.

Adult↗
PubMed1979

Dipivefrin and epinephrine treatment of elevated intraocular pressure: a comparative study.

Every 12 hours 0.1% dipivefrin was administered to one eye and 2% epinephrine hydrochloride was administered to the fellow eye of 42 patients with primary open-angle glaucoma or ocular hypertension in a randomized, double-masked study lasting three months. Dipivefrin produced similar percent reductions in intraocular pressure (18.6%) to epinephrine (21.0%), as well as similar increases in outflow facility and pupil diameter. A significantly lower incidence of burning and stinging after drug instillation was noted with dipivefrin therapy. This study supported the contention that dipivefrin is an effective and safe alternative to epinephrine therapy for the reduction of elevated intraocular pressure.

Adult↗
PubMed1978

Dipivalyl epinephrine: a new pro-drug in the treatment of glaucoma.

The dansyl chloride technique in conjunction with thin layer chromatography and autoradiography has shown that dipivalyl epinephrine is a pro-drug in the human eye. Dipivalyl epinephrine appears to be a more effective epinephrine compound, in that it penetrates the cornea approximately 17 times greater than epinephrine.

Aqueous Humor↗
PubMed1976

Topical corticosteroid therapy and pituitary-adrenal function.

Systemic absorption has been reported after the use of corticosteroid eye drops. Prolonged use could result in adrenocortical insufficiency and an associated adrenal crisis under stressful situations. For that reason, we studied the hypothalamic-pituitary-adrenal axis of patients receiving corticosteroid eye drope. Fifteen patients were given 0.1% dexamethasone sodium phosphate eye drops, one drop (approximately 1/30 ml) to each eye four times a day for six weeks. This dosage resulted in partial adrenal suppression, manifested by reduced levels of plasma cortisol. However, in each case, the hypothalamic-pituitary-adrenal axis, as evaluated with the use of the oral metyrapone tartrate test, was intact.

Administration, Topical↗
PubMed1976

Platelet function, blood coagulability, and fibrinolysis in patients with low tension glaucoma.

Platelet function in vitro and in vivo and certain measurements of blood coagulability and fibrinolysis were examined in 12 patients with low tension glaucoma and the results were compared with those obtained in 12 normal subjects matched for age, race, and sex. The data obtained seem to indicate that patients with low tension glaucoma cannot be readily distinguished from individuals of similar age and sex not afflicted with this disorder by measuring these variables. Thus, a "hypercoagulable state," ie, a thrombotic tendency, does not appear to be of major importance in the pathogenesis of this disorder.

Aged↗