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Biomedical subjects

K W Olander

Publications and source records attributed to K W Olander.

16 recordsLinked to original sources

Prophylactic use of apraclonidine for intraocular pressure increase after Nd:YAG capsulotomies.

We evaluated the prophylactic effect of 1% apraclonidine HCl in controlling the increase in intraocular pressure after Nd:YAG posterior capsulotomy in a large, multicenter double-masked clinical trial. One hundred sixty-four patients were enrolled into the apraclonidine-treated group, and 165 into the vehicle-treated group. The incidence of increase in intraocular pressure (greater than 5 mm Hg) in the apraclonidine-treated group (7%, 11 of 163 patients) was significantly less than that in the vehicle-treated group (39%, 64 of 164 patients). Similarly, the mean maximal change in intraocular pressure in the apraclonidine-treated group (1.3-mm Hg decrease) was significantly different from the increase in the vehicle-treated group (5.3-mm Hg increase). Few adverse reactions were observed. The risk for significant loss of visual function after Nd:YAG laser posterior capsulotomy, combined with the efficacy and relative safety of prophylactic apraclonidine, suggest its addition to the treatment armamentarium.

Adrenergic alpha-Agonists

A disposable 8-mm "corneal cap" to reduce surgical light exposure.

I have devised an easily-fashioned disposable "corneal cap" that reduces light exposure to the retina from the operating microscope. The 8-mm plastic cap is the cut end of the test chamber included in all packages of disposable handpieces and tubing for automated irrigation and aspiration instruments.

Cataract Extraction

Evaluation of the Keeler Pulsair non-contact tonometer.

The recently-introduced Pulsair non-contact tonometer (Keeler Instruments, Inc, Broomall, PA) was evaluated against the Goldmann applanation tonometer in cannulated post mortem human eyes, and in living subjects at three clinical centers. Statistical analysis of the findings revealed strong linear relationships between Goldmann or manometric and Pulsair intraocular pressure readings, with correlation coefficients ranging from 0.79 to 0.97. However, with the Pulsair reading as the dependent variable, the slope of the relationship in each case was significantly less than 1.0 (range 0.65 to 0.83), while the intercept was positive (range 1.31 to 2.33 mmHg). Thus, the Pulsair tended to read low at intraocular pressure above the normal range. Conversion factors and a calibration table allowing intraocular pressure estimates more comparable to Goldmann tonometry using the current (J-series) Pulsair are provided herein. A calibration algorithm could be integrated into the circuitry of future production models of the Pulsair instrument.

Aged

The effect of ketorolac tromethamine solution 0.5% in reducing postoperative inflammation after cataract extraction and intraocular lens implantation.

Ketorolac tromethamine solution 0.5% (1 drop 3 times daily) was more effective than the placebo vehicle solution in suppressing postoperative anterior ocular inflammation after extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation in this multicenter, double-masked, randomized study. Four of 60 ketorolac-treated patients compared with 25 of 58 placebo-treated patients required supplemental corticosteroid therapy to suppress inflammation in the postoperative period which was statistically significant (P less than 0.001). Even though these supplemental steroid-treated patients were kept in the analysis, the placebo-treated group showed more evidence of anterior ocular inflammation as measured by anterior segment fluorophotometry. This was consistent with slit-lamp observations of increased anterior ocular inflammation. This study supported previous studies that suggested ketorolac tromethamine ophthalmic solution 0.5% was effective and safe as a nonsteroidal anti-inflammatory agent for topical use after ECCE and IOL implantation.

Adult

Evaluation of the Krupin-Denver valve implant in normotensive and glaucomatous beagles.

The Krupin-Denver valve was implanted unilaterally in 2 normotensive and in 6 glaucomatous Beagles. The fellow eye of each dog had an external trabeculectomy. Before and after surgery, all dogs were evaluated serially by gonioscopy, biomicroscopy, tonometry, and tonography. The valve implant remained patent in 2 normotensive and in 2 glaucomatous Beagles throughout the 12 months of observation. Valve function was lost in 4 glaucomatous Beagles 4 to 6 weeks (3 dogs) and 6 months (1 dog) after implantation. Light microscopic and scanning electron microscopic evaluations of early loss of implant function revealed occlusion of the lumen and/or valve mechanism by inflammatory debris and cells. The late loss of valve function was related to chronic inflammatory response and fibrosis about the valve mechanism and tubing within the sclera.

Animals

Inheritance and the pigmentary dispersion syndrome.

The authors studied 33 patients in five families and have found that 14 of these patients fulfill criteria for the pigmentary dispersion syndrome. Affected patients had characteristics associated with the pigmentary dispersion syndrome, which are: peripheral slit-like iris transillumination defects, increased trabecular meshwork pigmentation, Krukenberg spindle, myopia, and elevated intraocular pressure. The authors observed this syndrome to be transmitted in a direct linear manner from parent to sibling in three of the four families. The transmission of this syndrome was found to be independent of refractive error, iris color, and sexual predilection, all of which are presented.

Female

Trabeculectomy vs. nonpenetrating trabeculectomy: a retrospective study of two procedures in phakic patients with glaucoma.

In a retrospective study we compared the efficacy and safety of trabeculectomy and nonpenetrating trabeculectomy (NPT). In the latter procedure under a thin scleral flap, juxtacanalicular trabecular meshwork with Schlemm's canal is excised leaving the innermost trabecular meshwork behind. Trabeculectomy was performed on 86 eyes (66 blacks, 20 whites), whereas 71 eyes underwent NPT (44 blacks, 27 whites). The mean follow-up period was 1.7 years. Postoperatively at one year, trabeculectomy controlled 70.3% of patients with no or topical antiglaucoma medication, whereas 83.7% of NPT patients were similarly controlled. There was a difference in the number and severity of complications between trabeculectomy and NPT. Postoperative flat anterior chamber, uveitis, hyphema, vitreous loss, and choroidal detachment occurred more frequently after trabeculectomy.

Adult

Effectiveness of nonpenetrating trabeculectomy in aphakic patients with glaucoma.

Nonpenetrating trabeculectomy was performed on 28 aphakic eyes consisting of 18 with chronic open-angle glaucoma and 10 with secondary and/or complicated glaucoma. The canal of Schlemm and the juxtacanalicular trabecular meshwork were excised for a length of 4 mm beneath a 6 mm x 6 mm scleral flap. At one year postoperatively, 72.0% of all patients were controlled, 24% required no antiglaucoma medications. However, 88% of chronic simple glaucoma patients were satisfactorily controlled. The mean follow-up period was 1.4 years. Minimal complications have been encountered to date. Nonpenetrating trabeculectomy may be valuable as an initial procedure in aphakic patients who require glaucoma filtration surgery.

Adult

Inheritance and the pigmentary dispersion syndrome.

We studied 23 patients in four families and have found that ten of these patients fulfill criteria for the pigmentary dispersion syndrome. Affected patients had characteristics associated with the pigmentary dispersion syndrome, which are: peripheral slit-like iris transillumination defects, increased trabecular meshwork pigmentation, Krukenberg spindle, myopia, and elevated intraocular pressure. We observed this syndrome to be transmitted in a direct linear manner from parent to sibling in three of the four families. The transmission of this syndrome was found to be independent of refractive error, iris color, and sexual predilection; all of which will be presented.

Adult

Short exposure times in argon laser iridotomy.

Currently employed techniques utilizing a continuous wave argon laser for the production of peripheral iridotomies in the treatment of angle-closure glaucoma are successful in producing patient iridotomies; however, complications such as corneal, lenticular, and retinal burns have been experienced. We found that a combination of low energy, much shorter exposures and an overlapping stretch pattern also gave a high success ratio in terms of formation of a patent iridotomy while reducing the number of complications for both black and white patients. Highly encouraging was the absence of corneal edema of a severity sufficient to cause an interruption in the treatment.

Argon