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Biomedical subjects

A L Robin

Publications and source records attributed to A L Robin.

At least 19 recordsLinked to original sources
PubMed1995

The cardiovascular, pulmonary, and ocular hypotensive effects of 0.2% brimonidine.

OBJECTIVE: To compare the cardiovascular, pulmonary, and ocular hypotensive effects of 0.2% brimonidine tartrate with those of 0.5% timolol maleate, 0.25% betaxolol suspension, and brimonidine vehicle. DESIGN AND PATIENTS: A single-center, double-masked, randomized, crossover study of 24 young, healthy men. INTERVENTIONS: Baseline heart rate, blood pressure, respiratory rate, and intraocular pressure were recorded at hour 0. At hour 2, heart rate, blood pressure, respiratory rate, and forced expiratory volume in 1 second were measured and a 15-minute treadmill test performed. Hour 0 measurements were repeated at hour 4. On four subsequent visits, we instilled one drop of a study medication into each eye after the baseline measurements at hour 0. RESULTS: Timolol reduced resting (-5.3 to -6.5 beats/min, P < or = .004) and exercise-induced heart rate (-4.3 to -13.6 beats/min; P < or = .022) compared with brimonidine, betaxolol suspension, and brimonidine vehicle. At hour 4, brimonidine reduced resting systolic blood pressure compared with all other study medications (-5.2 to -7.3 mm Hg; P < or = .024). Timolol reduced systolic blood pressure during exercise and brimonidine reduced systolic blood pressure during recovery more than betaxolol suspension and brimonidine vehicle (-5.1 to -7.7 mm Hg; P < or = .033; and -5.4 to -6.0 mm Hg; P < or = .002, respectively). Mean respiratory rate and forced expiratory volume in 1 second were not significantly altered by any study medication. At hour 4, brimonidine lowered intraocular pressure as well as timolol and better than betaxolol suspension (-1.9 mm Hg; P < .001) or brimonidine vehicle (-1.8 mm Hg; P < .001). CONCLUSIONS: The cardiopulmonary effects of 0.2% brimonidine were limited to a slight reduction in systolic blood pressure during recovery from exercise and at 4 hours after instillation. The ocular hypotensive effect of brimonidine was comparable to that of timolol and greater than that of betaxolol suspension in this patient population.

Adrenergic alpha-Agonists↗
PubMed1995

Family versus individual therapy for anorexia: impact on family conflict.

This study evaluated the impact on family relations of behavioral family systems therapy (BFST) versus ego-oriented individual therapy (EOIT) as treatments for adolescents with anorexia nervosa. Twenty-two adolescents meeting DSM-III-R anorexia nervosa criteria were randomly assigned to receive approximately 16 months of either BFST or EOIT along with a common medical and dietary regimen. BFST emphasized parental control over eating, cognitive restructuring, and problem-solving communication training. EOIT emphasized building ego strength, adolescent autonomy, and insight. Measures including body mass index, self-reported general and eating-related conflict, and observed general and eating-related communication. Both treatments produced significant reductions in negative communication and parent-adolescent conflict, with some differences between condition and between eating and non-eating related measures; the improvements in eating-related conflict were maintained at a 1-year follow-up. The study demonstrated that structured therapies for adolescent anorexia do impact family relations, even when the family is never seen as a unit during the therapy.

Adolescent↗
PubMed1995

Short-term efficacy of apraclonidine hydrochloride added to maximum-tolerated medical therapy for glaucoma. Apraclonidine Maximum-Tolerated Medical Therapy Study Group.

PURPOSE: We determined whether the addition of topical apraclonidine hydrochloride to eyes that are receiving maximal medical therapy but still have inadequate intraocular pressure control and that are scheduled to undergo surgery could adequately decrease intraocular pressure, postponing the need for further intervention. METHODS: We performed a prospective, 90-day, multicentered, placebo-controlled, double-masked parallel study. We enrolled one eye each of 174 glaucoma patients with inadequate intraocular pressure control who were on maximally tolerated medical therapy. We continued to administer maximum medical therapy for glaucoma. Study medications were either apraclonidine hydrochloride 0.5% or placebo (apraclonidine's vehicle). Patients were instructed to take the study medication every eight hours. We measured intraocular pressure, change in intraocular pressure from baseline, and the number of eyes requiring surgery after the addition of study medication. RESULTS: Fifty-two (60%) of 86 patients treated with apraclonidine maintained adequate intraocular pressure control throughout the study and avoided surgery, compared with 28 (32%) of 88 patients treated with placebo (P < .001). Apraclonidine treatment resulted in significantly more patients attaining an additional 20% reduction or more in intraocular pressure from baseline and an intraocular pressure less than or equal to 20 mm Hg (P < .05). The most common ocular complication was conjunctival hyperemia (11 of 86 patients, 12.8%). The most frequent nonocular problem was dry mouth (four patients, 4.7%). CONCLUSION: Apraclonidine appeared to be safe in all eyes and efficacious in some eyes. It significantly lowered intraocular pressure when used in combination with maximally tolerated medical therapy, which delayed or prevented further glaucoma surgery for at least 90 days in 52 (60%) of 86 treated patients.

Adrenergic alpha-Agonists↗
PubMed1994

Attacking the backlog of India's curable blind. The Aravind Eye Hospital model.

The number of individuals in developing nations with preventable blindness from cataract and other disorders is increasing. New programs incorporating local customs and efficiently using available resources must be created to prevent the escalation of blindness and to rehabilitate patients already disabled with cataracts. We describe a system of high-quality, high-volume, cost-effective cataract surgery, using screening eye camps and a resident hospital. This has enabled us to provide efficient low-cost cataract surgery and overcome barriers of adequate eye care in southern India. We have been successful in locating patients with treatable eye problems, educating them about the availability of ophthalmic care, and providing free eye care. Our structure stresses the following: community involvement, identification of individuals most likely to benefit from screening, efficient utilization of both medical and paramedical personnel, and a streamlined approach to screening patients. This system may be capable of modification for use in other developing areas to decrease the backlog of cataract blindness.

Blindness↗
PubMed1994

Family therapy versus individual therapy for adolescent females with anorexia nervosa.

Behavioral family systems therapy (BFST) was compared with ego-oriented individual therapy (EOIT) in a controlled, random-assignment investigation involving 22 young adolescents with anorexia nervosa. Each adolescent and her parents received approximately 16 months of outpatient therapy along with a common medical and dietary regimen. BFST emphasized parental control over eating and weight gain, coupled with cognitive restructuring and problem-solving communication training. EOIT emphasized building ego strength, adolescent autonomy, and insight into the emotional blocks to eating. BFST produced greater change on body-mass index than did EOIT, but both treatments produced comparable improvements on eating attitudes, body shape dissatisfaction, interoceptive awareness, depression/internalizing psychopathology, and eating-related family conflict. The implications of these results for the clinician who treats adolescents with anorexia nervosa are discussed.

Adolescent↗
PubMed1993

Posterior capsule tears during extracapsular cataract surgery in India.

We determined the incidence in a developing nation of posterior capsule rupture during planned extracapsular cataract surgery and insertion of a posterior chamber intraocular lens. The results, in part, determine whether this complication limits the widespread utility of this procedure in developing nations. We retrospectively reviewed charts of all patients undergoing planned extracapsular cataract surgery during a 6-month period; all patients received surgery as inpatients at the Aravind Eye Hospital, Madurai, India, and all were southern Indians. We tried to exclude most patients with prior ocular diseases associated with loss of zonular or posterior capsule integrity. One eye of all eligible patients was included. Extra-capsular cataract surgery was performed using manual irrigation and aspiration with the insertion of a posterior chamber intraocular lens. In this study, we evaluated the ability to maintain an intact posterior capsule with the insertion of a posterior chamber intraocular lens during surgery. Of 898 eyes operated on, 15 (1.7%) developed rents in the posterior capsule, and seven of these had vitreous in the anterior chamber. Nine of the 15 rents were in eyes with either traumatic or hypermature lenses. We conclude that even in a developing nation where many cataracts are mature, hypermature, or traumatic, extracapsular cataract surgery with the insertion of a posterior chamber intraocular lens is technically feasible if surgeons are skilled and experienced.

Adolescent↗
PubMed1993

Safety and efficacy of mitomycin C trabeculectomy in southern India. A short-term pilot study.

PURPOSE: Glaucoma is a major cause of blindness in developing nations. Medical and laser therapy have limitations in this environment. Filtration surgery alone often fails in young, darkly pigmented, individuals. The authors, therefore, evaluated the safety and efficacy of filtration surgery, using topical mitomycin C, in patients undergoing trabeculectomy in India. METHODS: A short-term pilot study used mitomycin C at the time of trabeculectomy in a population of southern Indians with various forms of glaucoma. A single 5-minute intraoperative application of 0.4 mg/ml mitomycin C was given to 76 consecutive patients requiring filtration surgery for the control of intraocular pressure (IOP). All patients were admitted for 6 days and were seen at 6-week intervals for a minimum of 18 weeks. RESULTS: The mean preoperative IOP was 35.3 +/- 9.6 mmHg. Postoperative IOP control was attained in 93.4% of patients as defined by an IOP of 20 mmHg or less without additional glaucoma medications (or an IOP reduction > 25% if the preoperative IOP was < or = 20 mmHg). No corneal epithelial defects or wound leaks were seen. The major complications were cataract formation and a decreased visual acuity in ten (13%) eyes. CONCLUSION: Mitomycin C-aided trabeculectomy was highly successful in controlling IOP in this darkly pigmented population and may become an important adjunct in the treatment of glaucoma in developing countries.

Administration, Topical↗
PubMed1993

The efficacy of brimonidine in decreasing elevations in intraocular pressure after laser trabeculoplasty.

PURPOSE: The authors explored the empirical dosing requirement for administration of an alpha 2-adrenoceptor agonist, brimonidine, and determined its efficacy in decreasing elevations in intraocular pressure (IOP) after 360 degrees argon laser trabeculoplasty (ALT). METHODS: This vehicle-controlled, double-masked, multicenter trial evaluated three dosing regimens of brimonidine. Two hundred thirty-two patients for whom 360 degrees ALT was indicated were randomized into one of four treatment groups: 0.5% brimonidine both before and after ALT; brimonidine before but vehicle after ALT; vehicle before but brimonidine after ALT; or vehicle at both times. RESULTS: During the first 3 hours after 360 degrees ALT, the overall incidence of IOP elevations of 5 mmHg or greater was 38% (23 of 60 eyes) in the group receiving vehicle only, and it ranged from 3% to 9% (2 of 62 to 5 of 53 eyes) in the groups receiving any brimonidine treatment. There was little difference in efficacy between the three dosing regimens of brimonidine. Brimonidine was well tolerated by the patients. CONCLUSION: Based on this large, controlled, multicenter study, 0.5% brimonidine was an effective agent for reducing elevations in IOP after 360 degrees ALT. Only one dose, administered either before or after 360 degrees ALT, was required.

Adrenergic alpha-Agonists↗
PubMed1993

Effect of topical apraclonidine on the frequency of intraocular pressure elevations after combined extracapsular cataract extraction and trabeculectomy.

PURPOSE: A trabeculectomy is frequently combined with extracapsular cataract surgery to minimize the risks of further optic nerve damage associated with intraocular pressure (IOP) elevations after cataract surgery in eyes with glaucoma. Acute IOP elevations still occur after this combined surgery. The author evaluated the efficacy of 1% topical apraclonidine, a relatively selective alpha 2 agonist, in minimizing this complication. METHODS: A prospective, randomized, double-masked study compared topical 1% apraclonidine with placebo. All eyes underwent otherwise uncomplicated combined trabeculectomy and extracapsular cataract surgery. They received the appropriate study drug before, immediately after, and 12 hours after surgery. Intraocular pressures were measured 24 hours and 1, 2, and 4 weeks after surgery. RESULTS: One hundred nine eyes (of 109 patients) underwent combined surgery. Fifty-nine received placebo. Preoperative mean IOPs were 22.5 +/- 4.2 mmHg for eyes treated with placebo and 24.0 +/- 7.7 mmHg for eyes treated with apraclonidine. Twenty-four hours after surgery, mean IOPs were 23.1 +/- 17.4 mmHg for placebo-treated eyes and 11.6 +/- 11.3 mmHg for apraclonidine-treated eyes (P < 0.001). Twenty-four hours after surgery, 12 (20%) placebo-treated eyes and 1 (2%) apraclonidine-treated eye had IOPs greater than 40 mmHg (P < 0.005). CONCLUSION: Apraclonidine effectively decreased large IOP elevations in glaucomatous eyes undergoing trabeculectomy combined with extracapsular cataract surgery.

Adrenergic alpha-Agonists↗
PubMed1993

Confocal laser scanning ophthalmoscope. Reproducibility of optic nerve head topographic measurements with the confocal laser scanning ophthalmoscope.

BACKGROUND: Glaucoma is an optic neuropathy in which changes in the appearance of both the optic nerve head and the surrounding tissues are important in both diagnosing its presence and progression. Accurate methods to objectively document the appearance of the optic nerve are necessary. The confocal laser scanning ophthalmoscope (Zeiss) is a new prototype instrument that may have the capability to accurately perform this function. METHODS: The authors performed a prospective pilot study evaluating the ability of the confocal laser scanning ophthalmoscope to reproduce three-dimensional optic nerve images. Each retinal image contained 600,000 bytes of information. Thirty discrete images of the right optic nerves of 19 visually normal volunteers were obtained. Depth measurements were compared from the same 100 x 100 micron areas (neighborhoods). RESULTS: Image comparisons found the variability of depth measurements for the entire image were within 102 microns (95% confidence interval). Sixty percent of the depth measurements were reproducible within 100 microns. Variability of the depth measurements was greatest where the neuroretinal rim sloped at the edge of the optic cup and lowest in the peripapillary area. CONCLUSION: The confocal laser scanning ophthalmoscope has the potential to be a safe, rapid, and reproducible method of imaging ocular structures.

Adult↗
PubMed1992

Reformulation and drop size of apraclonidine hydrochloride.

We performed a prospective, double-masked, placebo-controlled, six-period, cross-over study in which normal subjects were randomly assigned to treatment and compared three different formulations of apraclonidine hydrochloride (the present commercially available formulation, and formulations with hydroxypropylmethylcellulose or lysolecithin). We also evaluated the efficacy of a 16-microliters and 30-microliters drop size. The magnitude and duration of decrease in intraocular pressure was comparable for all formulations. Most subjects tolerated all formulations well with only a few reporting any side effects. The best-tolerated formulation was 0.5% apraclonidine hydrochloride delivered with a 16-microliters drop size. Dry mouth developed frequently with the commercially available 1% apraclonidine solution. Blurred vision complicated the use of the formulation containing hydroxypropylmethylcellulose. Both dry mouth (P less than .05) and blurred vision (P = .004) were statistically significant side effects.

Adrenergic alpha-Agonists↗
PubMed1992

Once-daily versus twice-daily levobunolol (0.5%) therapy. A crossover study.

The authors executed a two-period, randomized, double-masked, crossover study comparing once-daily to twice-daily levobunolol hydrochloride (0.5%) in 20 patients with elevated intraocular pressure (IOP). Modified diurnal curves were performed at four times for each study arm: baseline, day 1, day 14, and day 28. The mean diurnal corrected decrease in IOP from baseline ranged from 16% +/- 11% to 22% +/- 9% when the subjects were treated twice daily, and from 14% +/- 10% to 18% +/- 8% when the same subjects were treated once daily. At day 1, patients had a significantly greater IOP lowering after twice-daily therapy than after once-daily therapy (P less than 0.05). At 14 and 28 days, there was no clinically significant difference between the two treatment regimens. The results of our crossover study suggest that once-daily treatment with levobunolol (0.5%) is as effective as twice-daily treatment.

Adult↗
PubMed1991

The influence of iris pigmentation on the miotic effect of thymoxamine.

We performed a randomly assigned, double-masked, placebo-controlled study in 78 patients with varied iris pigmentation to evaluate the influence of iris pigmentation on the ability of 0.1% thymoxamine to reverse mydriasis produced by 2.5% phenylephrine. Patients were chosen so that a 1.6:1 ratio of dark to light irides was obtained. Within one-half hour after medication, thymoxamine-treated nonbrown irides constricted significantly compared to their fellow placebo-treated irides (P less than .001). Thymoxamine-treated pupils of nonbrown irides were 1.0 to 3.1 mm smaller than placebo-treated fellow eyes. Thymoxamine-treated light brown irides constricted less (0.6 to 2.0 mm) and more slowly compared to fellow placebo-treated irides. Thymoxamine did not reverse the mydriasis in eyes of patients with dark brown irides. Thymoxamine appears similar to other adrenergic agents that bind to melanin, delaying onset and strength of action. Its efficacy as presently formulated may be limited, in part, by iris color.

Adolescent↗