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Biomedical subjects

F T Fraunfelder

Publications and source records attributed to F T Fraunfelder.

At least 55 records · Page 3Linked to original sources

A technique for removal of filariasis of the anterior chamber.

We describe a useful technique for removing filaria from the anterior chamber. In the case described, an immature female filaria approximately 15 mm in length was removed from the anterior chamber of a 32-year-old man in western Oregon and identified as a species of Dipetalonema. Features of four cases of filarial infection in the anterior chamber from the same geographic area are described. In three out of four cases, the worms were removed alive without difficulty by means of simple irrigation aspiration system.

Adult↗

Optic neuropathy and amiodarone therapy.

Optic neuropathy has been diagnosed in several amiodarone-treated patients, including the 13 patients described in this report. The clinical severity of this drug-related optic neuropathy is milder than that characteristically described in anterior ischemic optic neuropathy. The incidence of occurrence was significantly higher than that found in an age-matched general population sample. Whether this result was due solely to amiodarone therapy, to the underlying poor health of these patients, or to a combination of these two factors is uncertain. The findings in this study prompt us to recommend that all patients who receive amiodarone undergo complete ophthalmologic examinations, including careful evaluation of the ocular fundus regularly during such therapy. Appearance of optic neuropathy is probably a relative indication for discontinuing the use of the drug, in the hopes of avoiding bilateral involvement or perhaps recovering vision. The risks of complications of amiodarone treatment must be weighed against the benefit of therapy in patients whose lives are threatened by cardiac arrhythmias. On the basis of this study, the benefits of treatment seem to outweigh the small risk of optic neuropathy. No randomized study has been undertaken to determine the true incidence of complications associated with this medication and at this time could not be justified.

Aged↗

Systemic side effects from ophthalmic timolol and their prevention.

Topically applied ophthalmic drugs can occasionally produce adverse systemic effects due to systemic absorption of the drug or impediment of the drug's metabolism. Increasing evidence points to significant adverse systemic effects from topical ocular administration of timolol, a beta-adrenergic blocking agent marketed for the treatment of glaucoma. Various methods to decrease or avoid unwanted systemic effects from eyedrops are discussed, including avoidance of overdosage and how to apply eye medications.

Absorption↗

Psychiatric side effects from topical ocular timolol, a beta-adrenergic blocker.

Neuropsychiatric side effects have been reported with various systemic betablockers. Data submitted to the National Registry of Drug-Induced Ocular Side Effects appear to indicate similar adverse reactions secondary to topical ophthalmic timolol. One hundred sixty-three of 369 central nervous system cases (44%) reported depression, psychosis, confusion, and hallucinations following topical ophthalmic timolol administration. The psychiatric community should be aware that sudden changes in mental status or onset of common psychiatric conditions, such as depression, may be due to topical ocular timolol. Withdrawal of the drug usually results in disappearance of these effects in 1 to 7 days.

Aged↗

Adverse respiratory and cardiovascular events attributed to timolol ophthalmic solution, 1978-1985.

Between September 1978 and December 1985, 450 case reports of serious respiratory and cardiovascular events and 32 case reports of death attributed to ophthalmic timolol were received by the United States Food and Drug Administration and the National Registry of Drug-Induced Ocular Side Effects. Two hundred sixty-seven patients (55%) experienced a cardiac arrhythmia or a bronchospasm-related event. The median age was 68 years (n = 365). Fifty-five percent of the patients were women and 45% were men (n = 41). Of the 212 persons for whom medical history was provided, 129 (61%) had respiratory disease, 65 (31%) had cardiovascular disease, 13 (6%) had other illnesses, and five (2%) had no underlying illness. Of the 318 patients for whom data on duration of drug use were available 106 (33%) experienced their adverse event within one week of beginning timolol therapy: 73 (23%) had their events on the first day of therapy. Of 192 patients for whom information was available 177 (92%) improved after the drug was discontinued.

Heart Diseases↗

Adverse ocular reactions possibly associated with isotretinoin.

A total of 261 adverse ocular reactions occurred in 237 patients who received isotretinoin, a commonly used drug in the treatment of severe cystic acne. Blepharoconjunctivitis, subjective complaints of dry eyes, blurred vision, contact lens intolerance, and photodermatitis are reversible side effects. More serious ocular adverse reactions include papilledema, pseudotumor cerebri, and white or gray subepithelial corneal opacities; all of these are reversible if the drug is discontinued. Reported cases of decreased dark adaptation are under investigation. Isotretinoin is contraindicated in pregnancy because of the many reported congenital abnormalities after maternal use (including microphthalmos, orbital hypertelorism, and optic nerve hypoplasia).

Acne Vulgaris↗

Hematologic reactions to carbonic anhydrase inhibitors.

The National Registry of Drug-Induced Ocular Side Effects has received 79 case reports of suspected hematopoietic toxicity caused by carbonic anhydrase inhibitors. Twenty-six of these suspected cases (32%) resulted in death secondary to aplastic anemia, thrombocytopenia, or agranulocytosis. In 54 of these 79, adverse reactions (68%) occurred during the first six months of therapy.

Acetazolamide↗

Results of cryotherapy for eyelid malignancies.

A total of 164 nodular and infiltrative eyelid basal cell carcinomas were treated with liquid nitrogen spray cryotherapy and followed up for a minimum of five years. For lesions less than 10 mm in diameter, nodular basal cell carcinomas had a 97% cure rate with cryotherapy and infiltrative basal cell carcinomas had a 94% cure rate. However, nodular of infiltrative basal cell carcinoma lesions larger than 10 mm in diameter had 85% and 82% cure rates with cryotherapy, respectively. After a minimum four-year follow-up period, 25 recurrent basal cell carcinomas previously treated by various methods had a 93% cure rate when re-treated with cryotherapy. Data for other malignant eyelid lesions treated with cryotherapy were insufficient for statistical analysis.

Basal Cell Carcinoma↗

Further studies on allopurinol therapy and human cataractogenesis.

We examined 11 cataractous lenses (or aspirated lens matter from extracapsular extractions) from patients ranging in age from 55 to 84 years who used allopurinol on a long-term basis (more than two years). Phosphorescence analyses demonstrated the characteristic allopurinol triplet in these lenses. When we analyzed normal lenses from patients taking allopurinol in a similar manner we found no evidence of allopurinol photobinding. These data indicated that allopurinol has a cataractogenic action only in patients in whom the drug has become photobound within the lens. Long-term allopurinol therapy does not necessarily cause or enhance cataracts in all patients. There may be a relationship between ultraviolet radiation exposure and circulating allopurinol levels (and perhaps renal function) in the genesis of photosensitized allopurinol cataracts.

Aged↗

Ocular toxicology update.

The National Registry of Drug-induced Ocular Side Effects has accumulated 13 cases of possible major haemopoietic responses from topical ocular chloramphenicol. Over 75 cases of major haemopoietic events from carbonic anhydrase inhibitors are also reviewed. While numerous reports of local ocular effects secondary to timolol have been received by the Registry, the more significant adverse effects are the same systemic side effects seen with any beta-receptor blocking agent. Data in the Registry have shown that allopurinol may be possibly associated with cataract formation. Severe cardiovascular effects with elevated blood pressure and stroke are uncommon systemic adverse reactions following topical ophthalmic 10% phenylephrine, but these systemic effects have also been seen secondary to concentrations of 2.5%. Other drugs, such as adrenaline (epinephrine), ecothiopate (echothiophate), practolol, thiabendazole, and penicillamine are suspected of causing ocular pseudopemphigoid.

Adult↗

The national registry of drug-induced ocular side effects.

The National Registry of Drug-induced Ocular Side Effects is an international information centre for ocular toxicology. The Registry collects case reports of drug-induced ocular side effects from physicians and other national registries, and surveys the world literature for drug-related ocular events. Possible adverse drug associations can be identified in this system, and cause-and-effect relationships may on occasion be proven. Functions of this Registry include increasing ophthalmic awareness of human ocular toxicology, and promoting continuation of contributions to decrease the delay between recognition of a possible adverse drug reaction and the actual reporting of it in the literature.

Drug-Related Side Effects and Adverse Reactions↗