https://deepblue.lib.umich.edu/bitstream/handle/2027.42/26516/0000054.pdf;sequence=1

Wound healing in glaucoma filtering surgery.

Our understanding of glaucoma has undergone dramatic changes in the past decade. The ferment has derived from new epidemiologic information, improved diagnostic methods, and developments in surgical and drug therapy. This review concentrates on primary open-angle glaucoma, the most prevalent form of the disorder in Western countries. Definition Primary open-angle glaucoma usually affects both eyes and combines a particular abnormal appearance of the optic disk (optic-nerve head) with a slowly progressive loss of visual sensitivity (Figure 1). The characteristic appearance of the glaucomatous optic disk is visible by ophthalmoscopy (Figure 2). The present standard for determining visual loss in glaucoma . . .

Open-Angle Glaucoma

Incubation of carbohydrate-free human serum albumin (HSA) with fructose in an aqueous buffer at pH 7.4 resulted in glycation of epsilon-amino groups of lysyl residues. A recently developed procedure, involving analysis of hexitol amino acids by high-performance liquid chromatography of phenylthiocarbamyl derivatives, was used to show that 85% of the bound hexose was attached to protein via carbon 2 (C-2). The remainder was attached to protein via carbon 1 (C-1). When incubations were conducted with glucose under identical conditions, all the hexose was attached via C-1. Examination of human ocular lens proteins showed that the majority of the covalently bound hexose was connected to epsilon-amino groups of lysyl residues via C-1; this was attributed mainly to nonenzymatic glucosylation in vivo, which has already been documented. A significant proportion (10-20%) of the bound hexose was connected via C-2. In view of the HSA-hexose incubation results (above), this indicated that the lens proteins had reacted with endogenous fructose; i.e., they had undergone nonenzymatic fructosylation in vivo. The model protein bovine pancreatic ribonuclease A reacted with fructose and glucose at similar rates under physiological conditions. However, covalent, non-disulfide cross-linking, which could be inhibited by D-penicillamine, was induced 10 times more rapidly by fructose than by glucose. It is postulated that some of the protein cross-linking that occurs in vivo is fructose-induced. The possible significance of these processes in diabetic subjects is discussed.

Role of fructose in glycation and cross-linking of proteins

The role of aldose reductase in the development of diabetic complications.

Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery.

Anterior chamber tube shunt to an encircling band in the treatment of neovascular glaucoma and other refractory glaucomas. A long-term study.

• Circulating glycosylated hemoglobin (Hb A 1 ) and/or fasting blood glucose (FBG) levels, measures of the extent to which diabetes is clinically controlled, were correlated with the contents of fructose, sorbitol, glucose, and inositol in 27 cataracts removed by intracapsular extraction. In the series of patients studied, Hb A 1 levels ranged from 6.0% to 15.5% of the total hemoglobin value. The levels of fructose and sorbitol (micromoles per gram of lens) in their cataracts ranged from 0 to 8.4 and 0 to 10.2 μmole/ g, respectively, with correlation coefficients greater than.8. Similar correlations were noted with FBG. The Hb A 1 correlated with lens glucose ( r =.58) and not with inositol. However, FBG had no correlation with either lens glucose or inositol. The observed correlation of the polyol pathway metabolites with both Hb A 1 and FBG suggests that the lens can synthesize substantial quantities of sorbitol and fructose in response to the excess glucose available to lenses of human diabetics. A synergistic role of the polyol pathway in the cause of senile cataracts is thus possible.

Polyol Pathway Metabolites in Human Cataracts: Correlation of Circulating Glycosylated Hemoglobin Content and Fasting Blood Glucose Levels

Transient Myopia and Accommodative Paresis Following Retinal Cryotherapy and Panretinal Photocoagulation

Collateral Circulation in Patients with Unstable Angina

To the Editor. —The article by Isernhagen et al1in the June issue of theArchivesattempted to establish prospectively the necessity for inpatient hospital care. Our experience during the past eight years suggests that the vast majority of patients do very well both medically and socially in an outpatient setting. Outpatient surgery was gradually adopted for use in most of our patients as a review of inpatient medical records disclosed an absence of a medical necessity for admission. The option of admission always has been available but less than 15% of patients have required admission after discharge from our outpatient area. We routinely ask all patients on the first postoperative day about their experiences after surgery and certainly would have modified our approach if we had received any substantial complaints. A retrospective telephone survey of our past 20 consecutive outpatients who underwent vitreoretinal surgery did not disclose any

Brian C. Lerner

Papers

Anterior chamber tube shunt to an encircling band in the treatment of neovascular glaucoma and other refractory glaucomas. A long-term study.

Polyol Pathway Metabolites in Human Cataracts: Correlation of Circulating Glycosylated Hemoglobin Content and Fasting Blood Glucose Levels

Transient Myopia and Accommodative Paresis Following Retinal Cryotherapy and Panretinal Photocoagulation

Collateral Circulation in Patients with Unstable Angina

To admit or not to admit, that is the question.