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Biomedical subjects

U Ticho

Publications and source records attributed to U Ticho.

At least 19 recordsLinked to original sources

[Treatment of anterior uveitis with 5-fluorouracil].

Filtering surgery with use of 5-fluorouracil (5FU) was performed in 5 eyes (4 patients) with inflammatory glaucoma to prevent filtering bleb scarring. Postoperative injections of 5FU were given once or twice a day, according to the degree of anterior chamber inflammation. Complete remission of the uveitis was achieved in all 5 eyes after 7-14 days of postoperative injections of 5FU. There were no recurrences of uveitis during a minimum of 8 months of follow-up.

Fluorouracil

A randomized study of trabeculectomy and subconjunctival administration of fluorouracil in primary glaucomas.

Forty-one adult patients with primary open angle glaucoma and nine adult patients with chronic angle closure glaucoma underwent trabeculectomy in one eye each. Twenty-one eyes with primary open angle glaucoma and four with chronic angle closure glaucoma were randomly assigned to receive four to six subconjunctival injections of fluorouracil for 10 days after surgery. Twenty-five control eyes did not receive fluorouracil. Intraocular pressure was 20 mm Hg or lower in 24 eyes (96%) in the treatment group after mean follow-up of 17.8 months and in 19 control eyes (76%) after mean follow-up of 17.5 months (P less than .05). Encapsulated bleb developed in three (12%) of the fluorouracil-treated eyes vs two (8%) of the control eyes. A few injections of fluorouracil adequately inhibited scarring. This might be explained by its toxic effect on existing fibroblasts. Overall, trabeculectomy with injection of fluorouracil was found to be efficacious and relatively safe. Further studies regarding late complications are required.

Aged

Toxic effects of 5-fluorouracil on fibroblasts following trabeculectomy.

The inhibitory effect of 5-fluorouracil (5-FU) on fibroblast proliferation is well established. In addition, toxic effects of 5-FU on existing fibroblasts, in rabbits and in vitro, were demonstrated. We examined human subconjunctival scar tissue which was removed during Molteno tube implantation. Surgery was performed 9 weeks after filtering surgery with 5-FU that resulted in bleb scarring. In the tissue, intracytoplasmic vacuoles were detected in some myofibroblasts, with no visible collagen in their vicinity. This presumed toxic effect of 5-FU may be one explanation for the adequacy of fewer than twice 5-FU injections daily following filtering surgery, and for less than 14 days, as originally recommended for inhibiting bleb scarring.

Adult

Trabeculectomy with 5-fluorouracil subsequent to circular buckling operation and cataract extraction.

Six patients, each with one eye that had previously undergone circular buckling surgery for the repair of retinal detachment before or followed by cataract extraction with or without intraocular lens implantation, underwent trabeculectomy with 5-fluorouracil (5-FU) for intractable glaucoma. Surgery was done through scarred subconjunctival tissues that were excised partially. The total doses of 5-FU ranged from 65 to 100mg (mean +/- standard deviation, 84.2 +/- 13.2mg) Eight to 47 months later, intraocular pressures were 18mmHg in five eyes, two of which were not receiving hypotensive medications. In the sixth eye, the intraocular pressure was 26mmHg with maximum hypotensive treatment. Intraocular pressures in the six eyes were significantly lower postoperatively than preoperatively (P < .05). This preliminary study suggests that filtering surgery with 5-FU may be beneficial after intraocular operations even in eyes where it is done through postoperative scarred subconjunctival tissues.

Adult

Delayed filtering bleb encapsulation.

Encapsulated filtering blebs concomitant with increased intraocular pressure (IOP) developed 47 and 6 months, respectively, after surgery in two women, 46 and 60 years old, respectively, who had undergone trabeculectomy operations in one eye. Both blebs were associated with mild anterior uveitis. Following treatment with topical steroids, cyclopentolate, hypotensive medications, and digital massage, the uveitis resolved and the IOP fell. The likely cause of these late-appearing encapsulated blebs was anterior uveitis.

Epinephrine

Encapsulated filtering bleb and subconjunctival 5-fluorouracil.

Filtering bleb encapsulation (BE) involves fibroblast proliferation and collagen synthesis. We analyzed the effect of 5-fluorouracil (5-FU) on the inhibition of BE. Forty-one patients with primary open-angle glaucoma underwent trabeculectomy in one eye as an initial surgery. Twenty-one of these eyes, randomly chosen, were treated postoperatively with four to six 5-FU subconjunctival injections over 10 days to inhibit bleb scarring; the remaining 20 eyes did not receive 5-FU. After 12 to 24 months, the surgical success rate was significantly higher in the treated eyes (P less than .05). However, the incidence of BE was similar: two eyes (9.5% and 10%, respectively) in each group. The difference between the effect of 5-FU in the inhibition of BE and bleb scarring suggests that the characteristics of the two fibroblast populations are heterogeneous.

Aged

Regulating the dose of 5-fluorouracil to prevent filtering bleb scarring.

Repeated doses of 5mg of 5-fluorouracil (5-FU) were injected subconjunctivally in 25 poor-prognosis glaucomatous eyes after filtering surgery to prevent filtering bleb scarring. The frequency (1-2 times a day) and duration (minimum, 7 days) of injections were determined by the degree of the anterior chamber reaction and/or conjunctival hyperemia at the filtering bleb site. Punctate corneal erosions or filaments were not considered a contraindication to continuation of 5-FU treatment. After 12 months, intraocular pressure (IOP) of 16 mmHg or less without medical treatment was found in 19 (76%) eyes. In 16 of these (64%), the IOP was 12 mmHg or less. In two (8%) other eyes, it was 20 mmHg or less with medication. We believe that the comparatively low IOP levels achieved without medical treatment in 76% of the eyes in our study can be attributed in part to our therapeutic approach with 5-FU.

Adolescent

Subconjunctival 5-fluorouracil and herpes simplex keratitis.

We present a case of herpes simplex keratitis that appeared during a period following filtering surgery in which subconjunctival 5-FU was being administered. Although the 5-FU treatment was not halted, 4 days later the keratitis healed. The typical practice of discontinuing 5-FU treatment when these kinds of inflammation occur following filtering surgery may be unwarranted.

Eye Diseases

[Prevention of scarring of filtering bleb by 5-fluorouracil].

Scarring of the filtering bleb is the most common cause of failure of surgery for glaucoma. It is much more common when the surgery is for certain types of glaucoma, such as aphakic glaucoma, cases of previously failed filtering surgery and neovascular and uveitic glaucoma. In 31 such high-risk cases we injected 5-fluorouracil subconjunctivally for 7-16 days after operation to prevent scarring of the filtering bleb. The success rate was 83%. After a follow-up of 3-12 months, there was statistically significant improvement in each group as compared to cases in which the drug was not administered. Further indications should be considered for the use of 5-fluorouracil in glaucoma.

Conjunctiva

Filtering surgery with 5-fluorouracil: a second course.

In five glaucoma patients, a previous filtering surgery that was followed by sub-conjunctival injections of 5-Fluorouracil (5-FU) failed, due to filtering bleb scarring. A repetition of the filtering surgery with subsequent sub-conjunctival injections of 5 mg of 5-FU, administered once daily for 8-14 days, was undertaken. At the end of 6-19 months of follow-up, IOP levels in all five eyes were 20 mmHg or less with medication. A repeated course of filtering surgery plus 5-FU treatment seems to be a favourable surgical option in refractory glaucoma.

Adult

A functional vagotomy induced by unilateral forced right nostril breathing decreases intraocular pressure in open and closed angle glaucoma.

There is evidence of the central regulation of intraocular pressure, and it has been suggested that vagal tone might be increased in glaucoma simplex. The nasal cycle, the simultaneous congestion-decongestion response in the nasal cavities, reflects the dynamic lateralisation of the autonomic nervous system. Since this lateralisation presents with sympathetic activity induced by left brain hemisphere stimulation and parasympathetic activity induced by right hemisphere stimulation, it was subsequently demonstrated that forced unilateral nostril breathing induces selective contralateral hemispheric stimulation as measured by relative increases in the electroencephalographic amplitude in the contralateral hemisphere as well as alternating lateralisation of plasma catecholamines. Using this functional vagotomy, we report that left hemispheric stimulation by 20 minutes of forced unilateral right nostril breathing led to a significant bilateral decrease of 4.6 mmHg (25%) in intraocular pressure in 46 patients with open and closed angle glaucoma. However, it significantly increased the IOP in three patients with neovascular, one with juvenile onset, and one with closed angle glaucoma.

Adolescent

Laser trabeculoplasty in glaucoma. Ten-year evaluation.

Argon laser trabeculoplasty was evaluated in 134 eyes of 94 patients with glaucoma, over a follow-up period of three to ten years. Success was defined by the patient having intraocular pressures (IOPs) below 20 mm Hg under the prelaser medical regimen, or taking less medication, and having no evidence of progressive field loss. The overall success rate by three years was 70%; it decreased to 55% after six years and remained at this level thereafter. Altogether, there were 26 eyes that had controlled glaucoma for six to ten years. The favorable factors for success were age over 60 years (82%), pseudoexfoliation glaucoma (75%), and lower baseline IOPs (69.3%). Argon laser trabeculoplasty was found to be a useful means of treatment in low tension glaucoma.

Adult

Changes in intraocular pressure induced by differential forced unilateral nostril breathing, a technique that affects both brain hemisphericity and autonomic activity. A pilot study.

There is evidence of the central regulation of intraocular pressure, and it has been suggested that vagal tone might be elevated in glaucoma simplex. The nasal cycle, the simultaneous congestion-decongestion response in the nasal cavities, reflects the dynamic lateralization of the autonomic nervous system. Since this lateralization presents with sympathetic activity induced by left brain hemisphere stimulation and parasympathetic activity induced by right hemisphere stimulation, forced unilateral nostril breathing (FUNB) has recently been demonstrated to induce selective contralateral hemispheric stimulation as measured by relative increases in EEG amplitude in the contralateral hemisphere as well as alternating lateralization of plasma catecholamines. Using this functional vagotomy/sympathectomy, we report the novel finding that right hemispheric activation via left FUNB increases intraocular pressure (IOP) by an average of 4.5%, whereas left hemispheric stimulation via right FUNB leads to a significant (25%) decrease in IOP.

Adult

Oculographic automatic perimetry in glaucoma visual field screening: a clinical study--preliminary results in glaucoma patients.

An automatic method for visual field screening using oculographic potentials have been evaluated on 12 eyes of 65 glaucoma patients. The oculographic perimeter records, plotting the central 22 degrees of the visual field, have been compared with Armaly's manual selective perimetry performed by the Goldman Perimeter. In spite of different testing standards of both methods, equivalent pathological field defects were demonstrated in 72% of the eyes following the first examination. Successive plottings with the automatic method improved the results considerably. The method has proved to be a reliable objective automatic test. Further development is suggested through which the procedure might be useful for glaucoma screening in the future.

Adolescent

Piloplex, a new long-acting pilocarpine polymer salt. A: Long-term study.

Thirty eyes of 15 patients with open-angle glaucoma were followed up for a period of up to 1 year while being treated with Piloplex eye drops containg a new long-acting pilocarpine polymer salt. Average morning intraocular pressure (IOP) values during treatment with pilocarpine hydrochloride administered 4 times daily was 20.5 mmHg. Average morning IOP values during Piloplex medication administered only twice daily were 19.8 to 18.2 mmHg (range of averages on 14 sessions). These findings indicate the lower average pressure during Piloplex medication and show its prolonged hypotensive effect. Both medications contained an equivalent total daily amount of pilocarpine. Throughout the 1-year study period no adverse side effects were reported, and only 1 patient complained of local sensitivity reaction. Visual disturbances characteristic of pilocarpine eye drops were reduced from 3 times a day on pilocarpine hydrochloride 4 times daily to once a day on Piloplex twice daily.

Aged

Piloplex, a new long-acting pilocarpine polymer salt. B: Comparative study of the visual effects of pilocarpine and Piloplex eye drops.

Induced accommodation and changes in vision (distance and near) were measured monocularly and binocularly in 9 young healthy volunteers in a double blind study after administering to them pilocarpine hydrochloride 4%, Piloplex 3.4, and saline eye drop instillations. Piloplex 3.4, a new long-acting pilocarpine polymer salt, and pilocarpine hydrochloride 4% (both contain equal amounts of pilocarpine-3.4%) induced changes in vision and accommodation. These changes were greater with pilocarpine hydrochloride than with Piloplex. The maximum changes occurred half an hour after instillation and the effect vanished after an additional period up to 3 hours. The changes were greater when measured monocularly than binocularly. Piloplex initiates a prolonged hypotensive effect which lasts for 12 hours. Patients with glaucoma are thus able to use Piloplex on a twice-daily schedule. Consequently, visual disturbances occur only once a day in contrast to pilocarpine hydrochloride given 4 times a day, which induces 3 visual disturbances during the day.

Accommodation, Ocular