An ophthalmologist's health-care proposal.
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Delivery of Health Care↗
Biomedical subjects
J Herschler
Publications and source records attributed to J Herschler.
Long-term results of trabeculectomy with collagen sponge implant containing low-dose antimetabolite.
Eighteen eyes of 15 patients with uncontrolled glaucoma (neovascular, intracapsular aphakia, uveitic, previous filtration failure) at high risk for failure of standard filtration underwent trabeculectomy with implantation of a purified collagen sponge containing 100 micrograms of antimetabolite (5-fluorouracil or bleomycin). Follow-up ranged from 3 months to 5 years. At the end of follow-up, 14 eyes (78%) had intraocular pressure below 21 mmHg and functional filtration blebs. No corneal toxicity was encountered at any time. Two patients (both successes) had partial or complete erosion of the collagen sponge. Although the differences were not statistically significant, patients receiving bleomycin had better success rates (8 of 9 versus 6 of 9) and lower intraocular pressure levels (11.88 mmHg versus 14.63 mmHg) than those receiving 5-fluorouracil. The collagen sponge implant demonstrates the clear advantages of drug delivery devices for the administration of antimetabolites after filtration surgery.
Adult↗
Primate trabeculectomies with 5-fluorouracil collagen implants.
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Animals↗
Biochemical abnormalities in the aqueous in chronic open-angle glaucoma.
We studied gel electrophoretic patterns of proteins in the aqueous humor of patients undergoing cataract or glaucoma surgery. Of special interest was a protein doublet present in the range of 130,000 to 135,000 daltons. Analysis of the relative concentration of these two proteins in a given sample revealed statistically significant differences in aqueous humor obtained from patients with chronic open-angle glaucoma compared with that obtained from patients with non-chronic open-angle glaucoma or those with cataract. These differences could not be accounted for by other factors, such as preoperative medicines or age. It is possible that the outflow obstruction in chronic open-angle glaucoma somehow may be related to abnormalities in the protein distribution in the aqueous humor of susceptible individuals.
Aged↗
Delivery of antifibroblast agents as adjuncts to filtration surgery. Part I--Periocular clearance of cobalt-57 bleomycin in experimental drug delivery: pilot study in the rabbit.
Antitumor and antifibroblast agents show promise as adjuncts after glaucoma filtration surgery in reducing postoperative scarring and failure. We used nuclear imaging in rabbits to investigate periocular clearance of one such agent (57Co-bleomycin). Sub-Tenon injection was compared to other delivery techniques. Our results showed that a collagen sponge and a silastic disc implant with a microhole prolonged drug delivery when compared to sub-Tenon injection alone or injection with a viscosity enhancing agent (0.5% sodium hyaluronate). We theorize that if an antifibroblast agent can be delivered in small and sustained amounts after filtration surgery, this may prolong bleb longevity and avoid unnecessary drug toxicity.
Animals↗
Delivery of antifibroblast agents as adjuncts to filtration surgery--Part II: Delivery of 5-fluorouracil and bleomycin in a collagen implant: pilot study in the rabbit.
A pilot study was performed in order to determine if filtration bleb longevity could be enhanced in rabbits by delivery of 5-fluorouracil or bleomycin in a collagen sponge implant. Results showed that both agents prolonged bleb longevity and lowered intraocular pressure when compared to controls. Bleomycin treated animals had the best bleb appearance and function at the longest postoperative intervals.
Animals↗
Heat and protease treatment of aqueous humor: effect on cell DNA synthesis and growth.
Rabbit skin and Tenon's capsule fibroblasts were cultured in media containing 20% rabbit aqueous humor as a stimulatory agent. Cell stimulation was quantitated by 3H-thymidine uptake. The aqueous humor was either: (1) untreated; (2) heated at 37 degrees C for 60 min; (3) boiled for 2 min; or (4) heated at 37 degrees C for 60 min with 0.025% trypsin, followed by boiling. The effects of the various treatments of aqueous humor on cell stimulation were compared among themselves and to 10% fetal bovine serum. It was found that: (1) heating of aqueous humor at 37 degrees C for up to 60 min had no apparent effect on its ability to stimulate DNA synthesis in culture; (2) boiling and trypsin plus boiling reduced the ability of 20% aqueous humor to promote thymidine uptake to varying degrees; (3) 20% untreated aqueous humor was more effective than 10% fetal bovine serum in stimulating DNA synthesis in Tenon's capsule fibroblasts; skin fibroblasts responded similarly to both media.
Animals↗
Aqueous humor-stimulated protein biosynthesis in ocular tissue fibroblast culture.
Dilute concentrations of aqueous humor stimulate DNA synthesis and cell division in monolayer fibroblast culture of rabbit skin and human and rabbit Tenon's capsule. We used [35S]-methionine to study 20% aqueous humor's effect on protein biosynthesis. A non-specific stimulator, 10% fetal bovine serum, was also used for comparison. Incorporation of radioactivity into acid-precipitable material was measured in both the fibroblasts and the media containing extracellular labeled proteins. The extracellular and intracellular labeled proteins were resolved by gel electrophoresis. Both 20% aqueous humor and 10% fetal bovine serum stimulated increased incorporation of [35S]-methionine into intracellular proteins relative to control values (from fibroblasts maintained in 0.5% fetal bovine serum-supplemented medium). However, 20% aqueous humor caused only a slight increase in labeling of proteins exported into the medium, whereas 10% fetal bovine serum stimulated a several-fold increase in extracellular labeled proteins relative to control values. Gel electrophoresis of labeled proteins showed that the quantitative distribution of extracellular proteins varied depending on the growth stimulator present. We conclude that the protein biosynthesis modulation by aqueous humor differs from that by fetal bovine serum. Aqueous humor may selectively stimulate the synthesis of discrete proteins while a general stimulation occurs with fetal bovine serum.
Animals↗
Effect of antineoplastic drugs on cell proliferation--individually and in combination.
Three antineoplastic agents, bleomycin, cytosine arabinoside and 5-fluorouracil, were studied individually and in combination to determine their effectiveness in controlling cell growth in the presence of fetal bovine serum. All three drugs were effective individually in specifically controlling proliferation (as measured by 3H-thymidine uptake) of human Tenon's capsule fibroblasts while bleomycin is effective at the lowest concentration. However, bleomycin alone rather than in combination with cytosine arabinoside or 5-fluorouracil was most effective in preventing division by these fibroblasts.
Animals↗
Silver staining of human aqueous humor proteins resolved by gel electrophoresis.
The detection of aqueous humor proteins resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis was achieved using an ultrasensitive silver staining technique. This procedure permitted the detection of more than 35 different protein bands in human aqueous humor on a one-dimensional gel. Most of the stained proteins had an apparent molecular weight greater than 45,000 daltons.
Aqueous Humor↗
Effect of antineoplastic drugs on fibroblast proliferation in rabbit aqueous humor.
An assay is described to test the ability of antineoplastic agents to slow fibroblast growth. The effect of bleomycin sulfate, cytosine arabinoside (cytarabine), and 5-fluorouracil on suppression of fibroblast proliferation in 20% rabbit aqueous humor was studied in vitro. All of the drugs exhibited some suppression of fibroblast proliferation at differing doses. The choice of target cell, however, was an important factor in the dose responses obtained.
Animals↗
Management of glaucoma in the aphakic eye.
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Anterior Chamber↗
Eyes with end-stage neovascular glaucoma. Natural history following successful modified filtering operation.
A modified filtering operation for neovascular glaucoma provided control of intraocular pressure after 12 to 23 months in ten of 13 eyes. After long-term follow-up, 23 to 54 months, seven of ten eyes still had controlled IOP. Two eyes were receiving no medication, two required miotics, and three required maximal medical therapy, including carbonic anhydrase inhibitors. One eye had undergone cyclocryotherapy four years after trabeculectomy. Four of seven eyes with diabetic neovascular glaucoma retained ambulatory vision. The eye with neovascular glaucoma from central retinal vein occlusion lost useful vision. The underlying disease process is an important determinant of surviving visual function.
Adult↗
Orbital haemorrhage and prolonged blindness: a treatable posterior optic neuropathy.
Two patients developed traumatic orbital haemorrhage resulting in prolonged blindness. Orbital decompression successfully reversed the visual loss, though both eyes had no light perception for at least 3 1/2 hours. The clinical findings suggest damage to the posterior optic nerve as cause of the visual loss. The optic nerve tolerance time to ischaemic injury may be longer than previously thought.
Adult↗
Reversal of glaucomatous cupping in adults.
Six cases of reversal of cupping have been collected in 28- to 62-year-old patients with open angle glaucoma. Reversal of cupping occurred after filtration surgery in five of the cases and after resolution of a glaucomatocyclitic crisis in one. The average intraocular pressure reduction was 27.5 mm Hg (a 68% fall). Reversal of cupping preponderantly consisted of a reduction in saucerization and undermining of the cup wall. An omnidirectional decrease in cup size resulted. A slight improvement in the visual field occurred in one eye after reversal of cupping. The most likely mechanism to explain reversal of cupping is a reduction in the posterior bowing of the lamina cribrosa and a reduction of scleral canal diameter after normalization of IOP. A distinction between true reversal of cupping and pseudoreversal (caused by disc edema from hypotony) could be made from studying the caliber of the large retinal veins. Treatment of early glaucoma, at which stage reversal of cupping is possible, is suggested.
Adult↗
The significance of baring of the circumlinear vessel. A prospective study.
Twenty-seven consecutive patients whose diagnoses were previously unestablished and who demonstrated baring of the circumlinear vessel underwent thorough ophthalmologic examinations. Evidence supporting optic nerve damage was found in 24 of these 27 patients. The majority of patients had either primary or secondary glaucoma, although neurologic, ischemic, and retinal causes of optic atrophy were also found. In the three patients in whom no cause was established, either unusual asymmetry or size of cupping was noted. Baring of the circumlinear vessel should alert the examiner to look for causes of optic nerve damage.
Adult↗
The inhibitory factor in aqueous humor.
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Animals↗
The effect of total vitrectomy on filtration surgery in the aphakic eye.
The influence of total vitrectomy on the success rate of filtration surgery was investigated, with 47 operations (6 reoperations) being performed on 41 patients. At six months postoperatively, successful control (IOP less than 21 mm Hg) was achieved in 32 of 41 patients (78%). Twenty-four patients had filtration blebs present. Total vitrectomy favorably influences the result of filtration surgery. However, the morbidity rate (two retinal detachments and two cases of cystoid macular edema) is higher than in standard filtration procedures.
Adult↗