Biomedical subjects
F T Fraunfelder
Publications and source records attributed to F T Fraunfelder.
Safe use of ocular drugs in the elderly.
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Ocular chloramphenicol and aplastic anemia.
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Ocular effects following the volcanic eruptions of Mount St Helens.
Three hundred thirty-two ophthalmologists examined 1,523 patients with immediate ocular complaints following the 1980 eruptions of Mount St Helens. Loggers working up to 18 months in environments with high concentrations of volcanic ash were compared with a control group of loggers without volcanic ash contact. Although the ash particles acted as ocular foreign bodies, the small particles were apparently well tolerated for the most part, except for acute irritation. Patients with contact lenses or sicca syndrome had the most frequent ocular complaints. To date, no long-term ocular effects have been noted secondary to volcanic ash exposure.
Management of intraepithelial conjunctival tumors and squamous cell carcinomas.
We compared the effects of excision, extensive freezing with a liquid nitrogen spray, and combined therapy with excision and superficial freezing with a liquid nitrogen probe on intraepithelial conjunctival tumors. After follow-up periods of at least 36 months, excision and extensive freezing produced recurrence rates similar to those previously reported (two of six lesions treated with excision alone recurred and three of nine treated with extensive freezing recurred), but excision combined with superficial freezing produced a recurrence rate of only 8% (two of 23 lesions recurred), almost three times better than any previously reported. Both lesions recurred in patients who had undergone previous therapy.
Ocular toxicity of antineoplastic agents.
The increased use of chemotherapeutic agents has resulted in longer patient survival; consequently, the ophthalmologist is seeing more patients with adverse ocular side effects secondary to these antineoplastic agents. Many of these drugs cause aggravating ocular irritation (fluorouracil, methotrexate), canalicular fibrosis with epiphora (fluorouracil), retinopathy (mitotane, tamoxifen), corneal opacities (tamoxifen), cataracts (busulfan, methotrexate), and optic or ocular motor abnormalities (carmustine, vinblastine, vincristine). Based on the data in the National Registry of Drug-Induced Ocular Side Effects and the literature, adverse ocular reactions of the more commonly used chemotherapeutic agents are reviewed.
Transdermal scopolamine precipitating narrow-angle glaucoma.
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Fatal aplastic anemia.
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Cataracts associated with allopurinol therapy.
The National Registry of Drug-Induced Ocular Side Effects has accumulated 30 cases of suspected allopurinol-induced lens changes. The cataracts associated with this antihyperuricemic agent are initially anterior and posterior lens capsule changes with anterior subcapsular vacuoles. With time, wedge-shaped anterior and posterior cortical haze occurs, along with dense posterior subcapsular cataracts. Histologic studies of these cataracts showed no unique or identifying features. These cases do not prove a cause-and-effect relationship, but raise the suspicion that allopurinol may be cataractogenic in some patients. Additional case reports and lens material should be sent to the National Registry of Drug-Induced Ocular Side Effects, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97201.
Fatal aplastic anemia following topical administration of ophthalmic chloramphenicol.
A 73-year-old woman died of aplastic anemia less than two months after undergoing cataract extraction and beginning topical therapy with chloramphenicol. The first signs of pancytopenia began within one month of the surgery. The pattern of the aplastic anemia was associated with an idiosyncratic response to chloramphenicol. This was the second report of fatal aplastic anemia after topical treatment with chloramphenicol for ocular conditions, although two cases of reversible bone marrow hypoplasia have also been reported. Any other suspected cases of ocular toxicity associated with topically applied chloramphenicol should be reported to the National Registry of Drug-Induced Ocular Side Effects, Oregon Health Sciences University, Portland, OR 97201.
6. Oral contraceptives.
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Proparacaine drug alert.
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3. Phenylephrine hydrochloride.
Phenylephrine hydrochloride is a potent, effective, relatively safe drug with few ocular side effects. Side effects from topical instillation are uncommon but include severe systemic cardiovascular effects with elevated blood pressure and stroke. Ten percent phenylephrine should be used with caution in patients with known cardiac disease, hypertension, aneurysms, long-standing insulin-dependent diabetes, or advanced arteriosclerosis. A 2.5% concentration is generally indicated for ophthalmic examination as well as for use in infants and in the elderly. Phenylephrine should not be used in patients with narrow-angle glaucoma, and it is also contraindicated in patients taking monoamine oxidase inhibitors or tricyclic antidepressants.
Cryosurgery for malignancies of the eyelid.
The results of liquid nitrogen spray technique for 310 biopsy-proven eyelid malignancies are reviewed. The raw recurrence rate for basal cell carcinomas of the eyelids with a mean follow-up of almost three years is 4.2%, while the recurrence rate is 6% in 49 cases followed for five years. For all lid malignancies 10 mm or less in diameter, a 2.0% raw recurrence rate was obtained; however, in those lesions larger than 10 mm, this rose to 9.5%. With this form of therapy, basal cell carcinomas with infiltrative, nonelevated, indistinct borders had twice the recurrence rate than those tumors with elevated distinct borders. Twenty-one squamous cell carcinomas treated with cryosurgery with an average follow-up 21.6 months have yet to show a recurrence. Complications with cryosurgery include permanent loss of eyelashes and depigmentation lasting from six months to over six years. Depending on the extent and location of the tumor, eyelid defects occurred. To date, five plastic reconstructive procedures have been required for ectropion or lid defects; however, no lacrimal outflow surgery has as yet been required.
Interim report: National Registry of possible Drug-induced Ocular Side Effects.
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Therapy of intraepithelial epitheliomas and squamous cell carcinoma of the limbus.
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Repair of an inadvertent buttonhole or leaking filtering bleb.
Buttonholing of conjunctival flaps at the time of filtering glaucoma surgery or a leak in the flap postoperatively can cause serious problems and may be most difficult to repair. A new delicate atraumatic needle has been used successfully in five cases to close conjunctiva to conjunctiva or conjunctiva to cornea defects.