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Biomedical subjects

M H Friedlaender

Publications and source records attributed to M H Friedlaender.

At least 19 recordsLinked to original sources
PubMed1997

A double-masked, placebo-controlled evaluation of the efficacy and safety of loteprednol etabonate in the treatment of giant papillary conjunctivitis. The Loteprednol Etabonate Giant Papillary Conjunctivitis Study Group I.

PURPOSE: To evaluate the safety and effectiveness of loteprednol etabonate 0.5% ophthalmic suspension in reducing the ocular signs and symptoms accompanying contact lens-associated giant papillary conjunctivitis. METHODS: In a randomized, double-masked, placebo-controlled, parallel-group study conducted at 14 academic or private practice clinics, 223 adults with contact lens-associated giant papillary conjunctivitis received either loteprednol or the loteprednol vehicle (placebo), one drop, four times daily for 6 weeks. Papillae, itching, contact lens intolerance, other signs and symptoms of giant papillary conjunctivitis (O-to-3 or O-to-4 grade scales), and intraocular pressure were measured. RESULTS: The proportion of patients treated with loteprednol who at final visit demonstrated an improvement in papillae of at least one grade (78%, 85/109) was significantly greater than the proportion of those treated with placebo (51%, 56/110; P = .001). A treatment difference favoring loteprednol was seen with improvement in itching (95% vs 81%, 104/109 vs 89/110; P < .001) and lens intolerance (87% vs 77%, 95/109 vs 85/110; P = .053). Eight of 109 patients (7%, all taking loteprednol) had an intraocular pressure increase of 10 mm Hg or more on at least one visit during treatment. After discontinuation of loteprednol, intraocular pressure returned to normal levels. Both treatments were well tolerated, and no serious unexpected treatment-related medical events were reported. CONCLUSIONS: The rapid therapeutic response combined with the low incidence and transient nature of any intraocular pressure increase suggests that loteprednol is an appropriate treatment for giant papillary conjunctivitis.

Adolescent↗
PubMed1996

Efficacy and safety of rimexolone 1% ophthalmic suspension vs 1% prednisolone acetate in the treatment of uveitis.

PURPOSE: Two multicenter studies compared the efficacy and safety of rimexolone 1% ophthalmic suspension (Vexol 1%, Alcon) and 1% prednisolone acetate (Pred Forte, Allergan). METHODS: Patients with acute uveitis, recurrent iridocyclitis, or chronic uveitis treatable by topical corticosteroid were enrolled. Treatment regimen was one or two drops every hour during Week 1, every two hours during Week 2, four times a day during Week 3, and once a day for the last three days. Efficacy and safety were determined on Days 3, 4, 7 to 10, 14, 21, and 28. A poststudy evaluation was conducted 36 to 72 hours after treatment was stopped. RESULTS: When anterior chamber cell and flare were measured, rimexolone 1% was found to be as effective as 1% prednisolone. The largest difference observed between treatments was 0.5 score unit, not clinically significant. There were no statistically significant differences in cell scores in either study (P > .05). No statistically significant differences in flare scores were found except at Day 28 in Study One (P = .04). Also, prednisolone was found to be more likely than rimexolone to cause a clinically significant increase (10 mm Hg or more) in intraocular pressure (1.7 times more likely in Study One, eight times more likely in Study Two). CONCLUSION: Rimexolone 1% ophthalmic suspension is safe and effective for the treatment of uveitis.

Acute Disease↗
PubMed1996

Contact lens induced conjunctivitis: a model of human ocular inflammation.

PURPOSE: To demonstrate the usefulness of contact lens induced conjunctivitis as a model of human ocular inflammation and to evaluate the effect of antiallergic eyedrops on this model. METHODS: We recruited 40 subjects with contact lens induced conjunctivitis. Half were treated with ketorolac tromethamine (KT), and half with iodoxamide tromethamine (LT). Signs, symptoms, contact lens wearing time, and wearing time until discomfort developed were evaluated at baseline, day 7, and day 14. RESULTS: The group receiving LT showed improvement of symptoms 7 days after beginning the study (P = 0.016), and both the LT and KT groups showed improvement from baseline on day 14 (P = 0.001 and P = 0.004, respectively). Signs improved for both the KT group (P = 0.011) and the LT group (P = 0.043) on day 7 and day 14 (P = 0.033 and P = 0.007, respectively). Mean contact lens wearing time improved on day 14 for the group treated with KT (P = 0.001). CONCLUSIONS: Contact lens induced conjunctivitis appears to be a useful model of human ocular inflammation. Both antiallergics KT and LT improve contact lens tolerance in subjects with contact lens induced conjunctivitis. Two weeks of treatment may be required to demonstrate therapeutic benefits of antiallergic drops.

Administration, Topical↗
PubMed1996

Characterization of receptor subtypes involved in prostanoid-induced conjunctival pruritus and their role in mediating allergic conjunctival itching.

Topically administered ketorolac (Acular), a cyclooxygenase inhibitor, has recently been reported as clinically beneficial for treating allergic conjunctivitis. The ability of ketorolac to relieve the itching associated with allergic conjunctivitis is intriguing because cyclooxygenase inhibitors are not regarded as useful in treating allergic dermatoses and prostaglandins (PG) do not elicit an itch response in human skin. To gain further insight into the mechanisms involved in the antipruritic activity of ketorolac, we used a method of reproducibly assessing ocular surface itch responses in the guinea pig. The measurement of conjunctival pruritus involved a recently developed behavioral model whereby hind limb scratching episodes directed toward the afflicted area were quantified. Itch-scratch episodes have previously been delineated from foreign body and pain sensations, which do not evoke such a behavioral response. Ketorolac significantly inhibited the itching associated with experimental allergic conjunctivitis. The basis of this antipruritic activity may be ascribed to preventing the biosynthesis of itch-producing PGs because ketorolac inhibited arachidonic acid-induced pruritus. In contrast to skin studies, PGE2 and PGI2 were found to be potent pruritogens at the guinea pig ocular surface. PGD2 was a weak pruritogen, and PGF2 alpha and the thromboxane-mimetic U-46619 produced no meaningful response. Further studies involving selective agonists and antagonists suggested that EP1 receptors, IP receptors and PGD2-sensitive receptors may mediate prostanoid-induced conjunctival itching. No evidence for the involvement of other prostanoid receptor subtypes was obtained. Although the EP1 receptor antagonist AH 6809 and the DP receptor antagonist BW A868C inhibited PGE2- and PGD2-induced itching, respectively, neither antagonist alone significantly affected the itching associated with experimental allergic conjunctivitis. A combination of AH 6809 and BW A868C, however, did exhibit antipruritic activity. It appears that for effective relief of itching in allergic conjunctivitis, it is not sufficient to block the effects of a single pruritogenic PG. It is preferable to reduce the participation of all pruritogenic PGs by either using combined receptor antagonists or by using a cyclooxygenase inhibitor such as ketorolac to block their biosynthesis.

Animals↗
PubMed1995

Management of ocular allergy.

OBJECTIVE: Ocular allergy is a frequent accompaniment of systemic allergy and in some situations ocular signs and symptoms are the most prominent features of allergic disease. This paper will describe an approach to ocular allergy intended to aid in the recognition, differentiation from other ocular conditions, and management of ocular allergic disease. DATA SOURCES: Ophthalmologists and allergists have contributed to the body of knowledge concerning ocular allergy during the last several decades. Recent investigations have provided better and more specific treatments for the safe and effective management of ocular allergy. STUDY SELECTION: The results of several review articles, investigation of certain aspects of ocular allergy, and clinical trials have contributed to the approach that ophthalmologists and allergists take in the diagnosis and management of ocular allergy. RESULTS: In most cases, it is not difficult to recognize ocular allergy because of its association with systemic allergy. On the other hand, numerous inflammatory ocular conditions can be confused with ocular allergy. It is important to recognize infectious ocular disease and severe ocular inflammatory disease, such as uveitis, to ensure appropriate treatment. CONCLUSIONS: Allergists and ophthalmologists should be able to recognize ocular allergy and distinguish it from other ocular inflammatory conditions. Most ocular allergy is mild and easily managed. Currently available medications allow for the safe and effective management of most cases of ocular allergy. Many situations can be managed with avoidance of allergens, supportive treatment such as cold compresses, or no treatment at all. It is rare that ocular allergy requires treatment with topical corticosteroids. When such severe circumstances occur, an ophthalmologist should monitor the intraocular pressure and the overall course of the ocular disease.

Allergens↗
PubMed1995

Controlled comparison of two fluorometholone formulations in the antigen challenge model of allergic conjunctivitis.

We compared the safety and efficacy of MethaSite, a gel-forming suspension (0.1% fluorometholone), to a commercially available 0.1% fluorometholone ointment, FML S.O.P., using an antigen challenge model. Subjects with known allergic histories were exposed to increasing concentrations of cat dander, ragweed, or grass at visits 1 and 2. Allergic responses of conjunctival injection, chemosis, and subjective itching were quantified on a scale from zero to 3; the sum of these ratings constituted the total allergic score. At visit 3, 105 subjects with total scores of > or = 5 received a drop of MethaSite in one eye and a 0.5 inch ribbon of FML ointment in the other eye. Three and 6 hours postdose, the eyes were challenged with the antigen concentration that provoked significant allergic response at visit 2. We determined safety by evaluating changes in visual acuity, intraocular pressure, and biomicroscopy that occurred between visits 1 and 3. Eyes treated with MethaSite and FML responded similarly to the antigen challenges. Both groups demonstrated suppression of allergic response 3 and 6 hours postdose through equivalent and significant reductions in total allergy scores and individual ratings of injection, chemosis, and itching. In this population, MethaSite was equivalent to FML ointment in safety and efficacy.

Adult↗
PubMed1994

The eye in immunologic disease.

The eye may be affected in a wide variety of systemic immunologic diseases. In many of these conditions, the eye examination may provide an important clue to the diagnosis and treatment of the systemic condition. It is important for the treating physician to work with the ophthalmologist to expedite the management of the patient with ocular manifestations of systemic disease.

Eye↗
PubMed1992

Ocular manifestations of Sjögren's syndrome: keratoconjunctivitis sicca.

As part of the triad of Sjögren's syndrome (SS), keratoconjunctivitis sicca (KCS) can be found in virtually all SS patients. This term emphasizes not only the reduced tear production but also the pathologic changes in the epithelial cells of the ocular surface. The symptoms of dry eye may vary from one patient to another depending on the severity of dryness, the ability of the diminished tear film to moisten the ocular surface, and the patient's tolerance for ocular discomfort. Treatment of the dry eyes is remarkably effective, and most patients benefit from moisturizing eyedrops to replace their own deficient tears. Major issues include the pathogenesis of decreased tear flow and ocular surface disturbances, as well as the roles of wound healing agents and anti-inflammatory medications in KCS therapy.

Humans↗
PubMed1991

Current concepts in ocular allergy.

Ocular allergy is commonly encountered by the allergist, general physician, and ophthalmologist. Diagnosis can usually be made by history, especially a history of itching and an allergic background. The diagnosis can be confirmed by skin testing, in vitro testing, and conjunctival scrapings to look for eosinophils. Once the diagnosis is made, a decision can be reached as to whether treatment is necessary. Often, supportive treatment, or removal of the allergen is preferred. When pharmacologic treatment is necessary, it is advisable to choose a benign form of therapy such as topical vasoconstrictor-antihistamine eyedrops or cromolyn sodium. Topical steroids are rarely necessary and should be used with great caution since they can induce serious sight threatening complications. If topical steroids are required, the patient should be monitored by an ophthalmologist.

Eye Diseases↗
PubMed1990

Inflammatory mediator release on conjunctival provocation of allergic subjects with allergen.

To evaluate the role of inflammatory mediators in the pathogenesis of the ocular allergic response, 23 subjects with positive histories of allergies to either cat dander or ragweed pollen and positive skin tests to the appropriate allergen extract were recruited and were subjected to conjunctival provocation. The tear duct of the left eye of each subject was blocked with a collagen plug while the right eye was left unplugged. In all cases, the eye was initially provoked with saline and subsequently with the appropriate allergen extract. Nonallergic subjects, or allergic subjects provoked with nonrelevant allergen, were used as control subjects. After each provocation, symptoms were recorded, and tears were collected with preweighed strips of filter paper (Schirmer strip). Each strip was placed into a tared tube containing fluid appropriate for the optimal preservation of the mediator to be measured. It was therefore possible to calculate the weight of tears collected and to express mediator levels per milliliter of tears. All allergic subjects demonstrated a positive symptomatic response to allergen challenge, whereas the control subjects remained asymptomatic. Blockage of the tear duct did not significantly alter the response. For allergic subjects, the levels of histamine, kinins, prostaglandin D2, albumin, and TAME-esterase activity were all significantly (p less than 0.005 in each case) greater after allergen challenge than after saline challenge. Furthermore, levels of each of these mediators after allergen challenge (expressed as increases above levels after saline provocation) were significantly greater for allergic subjects than for control subjects (p less than 0.005 in each case). Thus, the clinical response to conjunctival provocation with allergen is associated with increases in the levels of inflammatory mediators in tears.

Adolescent↗
PubMed1990

Lens implant surgery in pars planitis.

Intraocular lens (IOL) implantation is usually contraindicated in eyes with active inflammation, but patients with "burned-out" pars planitis also may be considered as candidates. Fifteen of 16 eyes in eight patients underwent extracapsular cataract extraction (ECCE) with posterior chamber IOL (PC IOL) implantation combined with pars plana vitrectomy for both cataracts and chronic cystoid macular edema (CME); 60% achieved visual acuity of 20/40 or better. Even with "low-grade" inflammation in these patients, however, a persistent veil of debris accumulated over the posterior and anterior surface of the IOL. One patient (patient 2) required 27 YAG procedures for two eyes, and another required 11 YAG procedures and eventual removal of the IOL. Another patient required surgical "brushing-off" of the IOL and vitrectomy. Even in eyes with "burned-out" uveitis, a continual low-grade inflammation may complicate the use of IOL implantation.

Adult↗
PubMed1990

Behçet's disease.

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Behcet Syndrome↗
PubMed1989

Effect of minimal antibiotic treatment on bacterial keratitis.

We studied the effect of minimal antibiotic therapy on pseudomonas keratitis in rabbits. Both corneas of 12 rabbits were infected with Pseudomonas aeruginosa and treated 24 and 48 h later with two drops of tobramycin or placebo. Corneal infections in antibiotic- and placebo-treated groups were comparable in appearance 24 and 48 h after inoculation. However, bacterial recovery was significantly less in eyes treated with minimal antibiotic therapy (p = 0.009). Although negative cultures were obtained from 11 of 12 antibiotic-treated eyes, bacteria could be recovered from eight of these culture negative corneas when corneas were ground and cultured. These studies suggest that minimal antibiotic therapy may impair bacterial recovery without completely eradicating live organisms.

Animals↗