Biomedical subjects

G K Krieglstein

Publications and source records attributed to G K Krieglstein.

At least 19 recordsLinked to original sources

PubMed1992

Effect of dexamethasone 0.1% and prednisolone acetate 1.0% eye drops on the blood-aqueous barrier after cataract surgery: a controlled randomized fluorophotometric study.

Using non-invasive anterior chamber fluorophotometry, we performed a double-blind, randomized clinical trial on the effects of dexamethasone 0.1% and prednisolone acetate 1.0% eye drops on the blood-aqueous barrier after phacoemulsification and posterior chamber lens implantation. Twenty patients received one of the preparations topically to the surgically treated eye 5 times daily for a period of 5 days, beginning the day after surgery. Patients chosen for the study had no history of eye disease other than senile cataract nor of systemic diseases influencing the eyes. No other steroids or non-steroidal anti-inflammatory drugs were given before or during the investigation. The fluorometric data measured 5 days after surgery show a lower mean concentration of fluorescein in the dexamethasone alcohol 0.1% treated group compared with the prednisolone acetate 1.0% treated group. The difference is statistically not significant. The clinical assessment of postoperative ocular inflammation did correlate with the fluorophotometric measurements. The results of the study indicate that although dexamethasone is the more potent anti-inflammatory agent, with a better binding affinity to glucocorticoid receptors, we are--with the number of cases measured--unable to demonstrate any difference in the efficacy in protecting the blood-aqueous barrier after cataract extraction and posterior chamber lens implantation to prednisolone acetate.

Administration, Topical↗

PubMed1992

[Effect of 0.1% dexamethasone and 1.0% prednisolone acetate eyedrops on the blood-aqueous humor barrier].

In a randomized, double-blind clinical trial we studied the protective effect of prednisolone-acetate 1.0% and dexamethasone 0.1% on the blood-aqueous barrier after cataract-extraction and posterior chamber lens implantation. Pre- and postoperative anterior chamber fluorophotometry was performed after i.v. administration of 10% fluorescein-sodium in 20 eyes of 20 patients of whom 16 finished the study (mean age 68.7 +/- 11.0; 13 female, 3 male). The topical application of either drug 5 times daily for 5 days did show a significant difference in surgery mediated disturbance of BAB in each group before and after phacoemulsification. However, when comparing the effect of the two drugs with each other, a difference could not be detected (p = 0.35). To attain a statistical 95% probability that there is no significant difference between the two treatment groups, a number of 690 patients would have had to be investigated. The results can be interpreted as to be due to a better cornea penetration of prednisolone-acetate which compensate the higher glucocorticoid-potency and receptor-affinity of dexamethasone. The untreated fellow-eyes did not reveal a significant difference between the pre- and postoperative anterior chamber fluorescein-concentrations in either treatment group. Anterior chamber fluorophotometry is able to demonstrate the potency and influence of both prednisolone-acetate 1.0% and dexamethasone 0.1% eye-drops on the BAB following phacoemulsification and IOL-implantation. The difference of both drugs does not seem to be of clinical importance in this context.

Aged↗

PubMed1992

Contact cw-Nd:YAG laser cyclophotocoagulation for treatment of refractory glaucoma.

Contact cw-Nd:YAG laser transscleral cyclophotocoagulation was performed on 42 patients (44 eyes) with glaucoma who were not responding to medical treatment or had failure of prior surgical procedures. No selection was made as to the type of glaucoma (congenital, primary, secondary due to trauma or inflammation). We applied between 16 and 60 exposures 0.5-2 mm posterior to the limbus. Prior to cyclophotocoagulation the mean intraocular pressure (IOP) was 40.4 mm Hg (+/- 8.0). As a result of the treatment, the mean IOP was lowered to 21.1 mm Hg (+/- 5.2). In eyes with congenital, neovascular, and inflammatory glaucoma, a therapeutic effect could only be achieved by repeated coagulations. The patients were followed for a mean of 4.8 months (3-7 months). One eye developed a transient choroidal detachment. In two eyes, iris hemorrhages were noted. Contact cyclophotocoagulation is generally well tolerated. Randomized studies are to be carried out to confirm whether cyclophotocoagulation is an effective tool in the treatment of glaucoma. Until then, cyclophotocoagulation should be restricted to cases not responding to conventional therapy.

Adult↗

PubMed1991

The effect of isosorbide-mononitrate eye drops on the human intraocular pressure and aqueous humor dynamics.

In a randomized, double-masked, single drop study the effect of topical isosorbid-mononitrate (ISMO) 0.5% eye drops, the main metabolite of isosorbid-dinitrate, widely used in the treatment of coronary heart diseases, was studied in patients suffering from open angle glaucoma or ocular hypertension. There was no statistically significant IOP change within 8 hours posttreatment after topical administration of ISMO 0.5%. There were no side effects after application of the ophthalmic solution of ISMO 0.5%. There were no significant changes in blood pressure and pulse rate either. A 2% ophthalmic solution of ISMO was investigated with respect to a response on the aqueous humor dynamics in 10 healthy volunteers. Anterior chamber fluorophotometry revealed a mean increase in aqueous flow of 39% within 3 hours after topical application (P less than 0.01). However, in comparison to the placebo treated fellow eyes there were no statistical significant difference in aqueous humor flow during the time of investigation. There was a statistical significant reduction of IOP during the same time period (p less than 0.03) in all treated eyes.

Aqueous Humor↗

PubMed1991

The effect of flurbiprofen 0.03% eye drops on the blood aqueous barrier in extracapsular cataract extraction with IOL implantation.

Preoperative and postoperative anterior chamber fluorophotometry were performed after intravenous administration of fluorescein sodium in patients undergoing extracapsular extraction and posterior chamber lens implantation. The topical application of aqueous flurbiprofen sodium 0.03% solution before and after surgery significantly decreased the surgery mediated disturbance of the blood aqueous barrier as compared to vehicle application (placebo controlled). In contrast to similar studies, cortical steroids were not given topically or systemically to either group of patients during the study. The present fluorophotometric results correlate well with slitlamp biomicroscopy of postoperative inflammation. The data of this study indicate that flurbiprofen ophthalmic solution is effective in protecting the blood aqueous barrier (BAB) in human eyes during cataract surgery and IOL implantation.

Administration, Topical↗

PubMed1991

[Effect of cataract extraction on aqueous humor dynamics in patients with senile cataract. A prospective fluorophotometric study].

The influence of posterior chamber lens implantation on the aqueous humor dynamics was investigated using anterior chamber fluorophotometry before and 9 weeks after cataract extraction and IOL implantation. Thirty-four patients finished the protocol. Patients with preexisting glaucoma or those having a history of ocular or systemic inflammation were excluded from the study, as were those taking topical or systemic drugs with potential influence on the aqueous humor dynamics. Nine weeks after IOL implantation a mean increase in aqueous humor flow was noted. This increase was highly significant (p less than 0.01, Student's paired t-test). There were no significant changes in aqueous humor dynamics in the unoperated fellow eyes which served as controls. The significant difference in aqueous humor flow 9 weeks after cataract extraction and IOL implantation indicates that the liberation of prostaglandins may cause an increase in the ease of outflow facility.

Aged↗

PubMed1991

[Influence of cataract and posterior chamber lens implantation on the dynamics of the aqueous humor. Prospective study in fluorophotometry].

The influence of posterior chamber lens implantation on the aqueous humor dynamics was investigated using anterior chamber fluorophotometry before and 9 weeks after cataract extraction and IOL implantation. 34 Patients finished the protocol. Patients with preexisting glaucoma or those having a history of ocular or systemic inflammation were excluded from the study, also those taking topical or systemic drugs with potential influence on the aqueous humor dynamics. 9 weeks after IOL implantation, a mean increase in aqueous humor flow was notified. This increase was highly significant (p less than 0.01, Students paired t-test). There were no significant changes in aqueous humor dynamics in the unoperated, fellow eyes which served as controls. The significant difference of aqueous humor flow 9 weeks after cataract extraction and IOL implantation indicates that the liberation of prostaglandins may cause an increase of outflow facility as well as pseudo-facility.

Aged↗

PubMed1990

[Biometry of the anterior chamber of the eye in Nd:YAG laser iridectomy].

In a prospective clinical study covering 41 eyes (28 patients) with narrow-angle glaucoma the central and peripheral anterior chamber depths were determined biomicroscopically before and after Nd:YAG laser iridectomy. In 29 eyes the central anterior chamber depth was also measured by ultrasonography. In contrast to the increase in central anterior chamber depth, which was only slight, the increase in the peripheral anterior chamber depth was statistically significant (P less than 0.01).

Anterior Chamber↗

PubMed1990

[Morphology of capsular sack retraction in relation to capsulotomy technique, lens design and sulcus-/saccus fixation].

Over a period of several months the dynamics and morphology of capsular retraction were analyzed with various capsulotomy techniques and IOL types implanted into the capsular bag or the sulcus. The techniques compared were peripheral and intermediate canopener capsulotomy, intermediate and small letter-box capsulotomy, intermediate and small capsulorrhexis with and without superior incisions. The posterior chamber IOLs implanted were one-piece and three-piece C-loop lenses and, in a limited pilot study, one-piece disk lenses. The authors' results indicate that capsular retraction and the stable position of the implant depend on the type, form, and size of the capsulotomy, the type of IOL and its fixation in the bag or sulcus. Any irregularity of the anterior capsule induces irregular capsular retraction with the risk of IOL decentration. Free-floating anterior capsular flaps may induce formation of iridocapsular synechiae. Contact between the anterior capsular rim and the posterior capsule results in capsulocapsular adhesions, capsular wrinkling, and capsular opacification of the contact zone. In order to avoid these capsulocapsular adhesions the diameter of the IOL optics should exceed that of the capsular opening in endocapsular implantation. However, peripheral capsulocapsular adhesions are necessary to stabilize IOL haptics, which for this reason must be of open design. Capsulocapsular adhesions may inhibit migration of lens epithelial cells in secondary capsular opacification. The ideal anterior capsulotomy technique seems to be the symmetrical, small, circular, continuous capsulorrhexis, if endocapsular implantation is desired. However, the technique is mainly designed for phacoemulsification, as a small capsulorrhexis inhibits nuclear expression in extracapsular cataract extraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrophy↗

PubMed1990

[Drug therapy of glaucoma].

In the present review an update on the medical therapy of open-angle glaucoma is given. Antiglaucomatous drugs that are rarely or no longer indicated are briefly discussed, as are the current medical therapy and perspectives of the medical management of glaucoma. In light of the pharmacological profiles of current antiglaucomatous agents, irreversible cholinesterase inhibitors, are out of date, and higher concentrations of clonidine eye drops and aqueous preparations of epinephrine-hydrocloride are also old-fashioned. The spectrum of current antiglaucomatous drugs is outlined and perspectives are indicated that will enrich our antiglaucomatous drug armamentarium in the near future. In this respect the development of pro-drugs and, new designs in the pharmaceutical preparation of traditional drugs are emphasized. In the field of new agents special emphasis is placed on topically applicable carbonic anhydrase inhibitors, the selective alpha-2-agonist apraclonidine and IOP-lowering prostaglandin derivatives. A series of agents is presented that are still experimental.

Glaucoma↗

PubMed1990

[Use of graphic analysis of topographic trends in perimetry].

A new graphical procedure for topographical trend analysis (graphical analysis of topographical trends: GATT) is able to distinguish several possibilities of evolution of a visual field. Analysis of 100 cases with GATT made it possible to classified them into 10 types of development. This signifies an improvement over global statistical analysis, which distinguishes only 3 different types of evolution. In addition, the individual evaluation of visual field development with GATT is enhanced by quantitative and topographical differentiation within an evolutional type.

Computer Graphics↗

PubMed1990

[Stereospecificity of lowering intraocular pressure using a locally administered carbonic anhydrase inhibitor].

As MK-417, the S-enantiomer of the racemic compound MK-927, is the more active enantiomer in vitro, the potential differential ocular hypotensive activity was investigated in patients. The 1% concentration was chosen as the basis for comparison, as preliminary data indicated that the concentration would fall relatively steeply on the dose-response curve. This was a two-center crossover study of 1% MK-417, 1% MK-927, and placebo (common vehicle) in 27 patients with bilateral, relatively symmetric primary open-angle glaucoma or ocular hypertension. Following a washout period for ocular hypertensive therapy, IOP had to be greater than or equal to 23 mmHg at 10:00 o'clock with IOP difference between eyes less than or equal to 6 mmHg. Treatment days were separated by a 1-2 week washout period. IOP was measured at 9:30. At 10:00 patients received the test drug in one designated eye and placebo in the other eye. IOP was measured at 1, 2, 4, 6, and 8 h after the dose. IOP and the percentage of change in IOP from 30 min before the dose in the active drug-treated eye shows that MK-417 is slightly more potent than MK-927 in this patient model.

Adult↗

PubMed1989

The effect of betablockers with and without ISA on tonographic outflow facility.

The response of two ophthalmic betablockers, Timolol (without ISA) and Pindolol (with marked ISA), on IOP and tonographic outflow facility was investigated in a single-blind clinical study on 20 patients with glaucoma or ocular hypertension. In two treatment groups, ten patients each, in a randomized order IOP and tonographic outflow facility measurements were performed before and 2 hrs after drug application. Timolol reduced IOP by 6.8 mm Hg and Pindolol eye drops by 4.5 mm Hg. Both topically applied betablockers did not influence tonographic facility of outflow. It is concluded that the intrinsic sympathomimetic activity of an ophthalmic betablocker has no effect on outflow facility of aqueous humor.

Aqueous Humor↗

PubMed1989

The intraocular pressure response of human atrial natriuretic factor in glaucoma.

In an open label, single dose study on ten glaucoma patients with bilateral untreated IOP levels exceeding 30 mmHg the effects of 100 micrograms human atrial natriuretic factor (HANF) on IOP, systolic blood pressure, pulse rate and serum electrolytes were investigated. The intravenous application of HANF decreased IOP over more than 8 hrs. The magnitude of IOP reduction in this study was in the range of 4-7 mmHg. There was no significant change in blood pressure, pulse rate or serum electrolytes. The verified, yet still limited efficacy of HANF on IOP in glaucoma warrants further investigations.

Atrial Natriuretic Factor↗

PubMed1989

Graphical analysis of topographical trends (GATT) in automated perimetry.

The assessment of change in analysis of visual fields is one of the most difficult tasks in automated perimetry. A new, computerized method shows the original fields and the topographic trends in one easy graphic display. This new way of analysis the 'GATT' superimposes the grayscale maps of two fields with a simple logic, producing the following patterns: all stable, unchanged areas are displayed normally; in changed areas, the grayscale of the first and the second field are mixed in the form of stripes. The contrast between the stripes indicates the amount of change. The orientation of the stripes depends on the direction of change: horizontal stripes mean deterioration, vertical stripes mean improvement. The GATT is also able to compare 4 fields, using the same patterns. In addition, a scatterboard without stripes indicates areas of high fluctuation, but without a significant change in the course of the 4 fields. The GATT enables a quick, quantitative judgement of the trends of visual fields.

Computer Graphics↗

PubMed1989

[Graphic analysis of topographic trends in perimetry follow-up of glaucoma].

GATT is a new, graphic method of showing the development of visual fields in glaucoma and other diseases. The grayscale maps of a series of two or four fields are superimposed with a simple logic, producing the following pattern: all stable areas are displayed in the usual way, thus giving defects a typical appearance. Changed areas appear as stripes, alternately showing the grayscale of the two fields. The orientation of the stripes is vertical in zones of improvement and horizontal in areas of deterioration. The level of contrast indicates the amount of change. The authors examined the development of the visual fields in 30 glaucomatous eyes. With the help of GATT it was established that areas of change were close to existing defects. Second, most of the changes were at the periphery. GATT is not only proving to be a method for perimetric follow-up in glaucoma cases that furnishes much useful information, but is also raising hopes of new findings concerning the course of glaucoma.

Computer Graphics↗

PubMed1989

[The intraocular pressure lowering effect of human atrial peptide].

The human atrial natriuretic factor (hANF) is a cardiovascular hormone, which promotes renal sodium secretion in response to increases in extracellular fluid volume and atrial pressure. It regulates sodium and volume homeostasis. Specific receptors for hANF have been identified in the ciliary processes of rats and rabbits, which mediated a long-lasting reduction in intraocular pressure (IOP) after intra-atrial injection. In a series of 10 glaucoma patients with bilateral IOP elevations above 33 mmHg an i.v. bolus injection of hANF was administered and IOP was recorded before and over an 8-h period after injection. The human atrial natriuretic factor lowered IOP significantly. The potential of hANF as an antiglaucoma agent is discussed.

Atrial Natriuretic Factor↗

PubMed1979

The intraocular pressure responses of low-dose bupranolol (Ophtorenin) and methazolamide (Neptazane) in glaucomatous eyes. A controlled clinical study.

In a single-dose, double-blind study, the minimum effective doses of bupranolol and methazolamide were established. The beta-blocker bupranolol (Ophtorenin, Dr. Winzer, Konstanz) in an oily solution reduced IOP significantly in a concentration of 0.05%. The carboanhydrase inhibitor Methazolamide (Neptazane) did not change IOP in a peroral dose of 50 mg, while 100 mg p.o. gave a significant IOP decrease. Both drugs exhibited an additive effect in this low regimen. It is concluded that the combined application of both drugs will postpone or avoid side effects and prolong the time and the field of clinical usefulness. It appears possible that both have a different mechanism of action.

Bupranolol↗