• View in gallery
    Figure 1—

    Scatterplot of right eye anterior chamber fluorescein concentrations (ng/mL) over 5 days for each of 9 healthy dogs with ophthalmologically normal eyes.

  • View in gallery
    Figure 2—

    Scatterplot of left eye anterior chamber fluorescein concentrations (ng/mL) over 5 days for each of 9 healthy dogs with ophthalmologically normal eyes.

  • 1.

    Freddo TF. Shifting the paradigm of the blood-aqueous barrier. Exp Eye Res 2001; 73:581592.

  • 2.

    Smelser GKPei YF. Cytological basis of protein leakage into the eye following paracentesis. Invest Ophthalmol 1965; 4:249263.

  • 3.

    Knudsen LL. Ocular fluorophotometry in human subjects and in swine—with particular reference to long-term pharmacokinetics. Acta Ophthalmol Scand Suppl 2002; 80:624.

    • Search Google Scholar
    • Export Citation
  • 4.

    Freddo TE. Intercellular junctions of the ciliary epithelium in anterior uveitis. Invest Ophthalmol Vis Sci 1987; 28:320329.

  • 5.

    Butler JMUnger WGGrierson I. Recent experimental studies on the blood-aqueous barrier: the anatomical basis of the response to injury. Eye 1988; 2(suppl):S213S220.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Ward DAFerguson DCKaswan RL, et al. Fluorophotometric evaluation of experimental blood-aqueous barrier disruption in dogs. Am J Vet Res 1991; 52:14331437.

    • Search Google Scholar
    • Export Citation
  • 7.

    Mitchell PGBlair NPDeutsch TA. Prolonged monitoring of the blood-aqueous barrier with fluorescein-labeled albumin. Invest Ophthalmol Vis Sci 1986; 27:415418.

    • Search Google Scholar
    • Export Citation
  • 8.

    Fearnley IRSpalton DJSmith SE. Anterior segment fluorophotometry in acute anterior uveitis. Arch Ophthalmol 1987; 105:15501555.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Giuliano EA. Nonsteroidal anti-inflammatory drugs in veterinary ophthalmology. Vet Clin North Am Small Anim Pract 2004; 34:707723.

  • 10.

    Schalnus ROhrloff C. Quantification of blood-aqueous barrier function using laser flare measurement and fluorophotometry—a comparative study. Lens Eye Toxic Res 1992; 9:309320.

    • Search Google Scholar
    • Export Citation
  • 11.

    Shah SMSpalton DJAllen RJ, et al. A comparison of the laser flare cell meter and fluorophotometry in assessment of the blood-aqueous barrier. Invest Ophthalmol Vis Sci 1993; 34:31243130.

    • Search Google Scholar
    • Export Citation
  • 12.

    Johnstone McLean NSWard DAHendrix DV. The effect of a single dose of topical 0.005% latanoprost and 2% dorzolamide/0.5% timolol combination on the blood-aqueous barrier in dogs: a pilot study. Vet Ophthalmol 2008; 11:158161.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Dziezyc JMillichamp NJRohde BH, et al. Comparison of prednisolone and RMI-1068 in the ocular irritative response in dogs. Invest Ophthalmol Vis Sci 1992; 33:460465.

    • Search Google Scholar
    • Export Citation
  • 14.

    Dziezyc JMillichamp NJSmith WB. Effect of flurbiprofen and corticosteroids on the ocular irritative response in dogs. Vet Comp Ophthalmol 1995; 5:4245.

    • Search Google Scholar
    • Export Citation
  • 15.

    Ward DA. Comparative efficacy of topically applied flurbiprofen, diclofenac, tolmetin, and suprofen for the treatment of experimentally induced blood-aqueous barrier disruption in dogs. Am J Vet Res 1996; 57:875878.

    • Search Google Scholar
    • Export Citation
  • 16.

    Kraff MCSanders DRMcGuigan L, et al. Inhibition of blood-aqueous humor barrier breakdown with diclofenac. A fluorophotometric study. Arch Ophthalmol 1990; 108:380383.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Allbaugh RARoush JKRankin AJ, et al. Fluorophotometric and tonometric evaluation of ocular effects following aqueocentesis performed with needles of various sizes in dogs. Am J Vet Res 2011; 72:556561.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    AK-FLUOR [package insert]. Lake Forest, Ill: Akorn Inc, 2010.

  • 19.

    Miyake KAsakura MMaekubo K. Consensual reactions of human blood-aqueous barrier to implant operations. Arch Ophthalmol 1984; 102:558561.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Kottow MHSeligman LJ. Consensual reactions to anterior chamber paracentesis in the rabbit. Am J Ophthalmol 1978; 85:392399.

  • 21.

    Chiang TSThomas RP. Consensual ocular hypertensive response to prostaglandin E 2. Invest Ophthalmol 1972; 11:845849.

  • 22.

    Chiang TSThomas RP. Consensual ocular hypertensive response to prostaglandin. Invest Ophthalmol 1972; 11:169176.

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Repeated anterior chamber fluorophotometric evaluation of the eyes of ophthalmologically normal dogs

Victoria S. MillerDepartment of Veterinary Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506.

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Rachel A. AllbaughDepartment of Veterinary Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506.

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James K. RoushDepartment of Veterinary Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506.

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Amy J. RankinDepartment of Veterinary Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS 66506.

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Abstract

Objective—To perform repeated anterior chamber fluorophotometry on both eyes of ophthalmologically normal dogs to measure fluorescein concentrations over a 5-day period and identify any change in the degree of anterior chamber fluorescence over time or difference between eyes.

Animals—9 healthy adult dogs (18 eyes).

Procedures—Each dog received an IV injection of 10% fluorescein solution, and anterior chamber fluorophotometry was performed 1 hour later on both eyes. This procedure was repeated at the same time each day for 5 consecutive days.

Results—A significant increase in fluorescein concentration was evident in the anterior chamber on day 5 in the right eye and days 2, 3, 4, and 5 in the left eye. There was no significant difference in concentration between the left and the right eyes on any day.

Conclusions and Clinical Relevance—The increase in ocular fluorescein concentration in the study dogs was unlikely to be of clinical importance and is only pertinent for subsequent research studies. This is a limitation that should be considered when reporting fluorophotometry data as fluorescein concentration or as change in fluorescein concentration from baseline.

Abstract

Objective—To perform repeated anterior chamber fluorophotometry on both eyes of ophthalmologically normal dogs to measure fluorescein concentrations over a 5-day period and identify any change in the degree of anterior chamber fluorescence over time or difference between eyes.

Animals—9 healthy adult dogs (18 eyes).

Procedures—Each dog received an IV injection of 10% fluorescein solution, and anterior chamber fluorophotometry was performed 1 hour later on both eyes. This procedure was repeated at the same time each day for 5 consecutive days.

Results—A significant increase in fluorescein concentration was evident in the anterior chamber on day 5 in the right eye and days 2, 3, 4, and 5 in the left eye. There was no significant difference in concentration between the left and the right eyes on any day.

Conclusions and Clinical Relevance—The increase in ocular fluorescein concentration in the study dogs was unlikely to be of clinical importance and is only pertinent for subsequent research studies. This is a limitation that should be considered when reporting fluorophotometry data as fluorescein concentration or as change in fluorescein concentration from baseline.

The blood-aqueous barrier of an eye is formed by the endothelium of the iris blood vessels, the nonpigmented layer of the ciliary body epithelium, and the posterior pigmented epithelium of the iris.1–4 These structures usually prevent substances in the blood from entering the eye. When the barrier is disrupted, the blood vessels dilate and plasma proteins leak into the aqueous humor.4,5

Anterior chamber fluorophotometry is used in research as a noninvasive technique to objectively collect data on the blood-aqueous barrier and assess inflammation within the ocular anterior chamber following systemic administration of fluorescein.6 Fluorescein is a small molecule that can pass through the blood-aqueous barrier in the same manner that proteins leak into the eye during an inflammatory response.4,7 Because of this similarity, fluorescein is used to evaluate permeability of the blood-aqueous barrier and can objectively assess even subtle barrier compromise.8–10 Although a small amount of fluorescein will penetrate a healthy eye, the amount of fluorescein within the anterior chamber increases with increasing inflammation owing to an increase in blood-aqueous barrier disruption.

Fluorophotometry results have been analyzed in various ways. Methods used include calculation of a fluorescein diffusion coefficient, calculation of the percentage increase in fluorescein concentration in the treated eye versus the contralateral eye or before fluorescein administration (change from baseline), and analysis of actual fluorescein concentrations.6,11–14 A diffusion coefficient for fluorescein calculated by fluorophotometry provides a numeric value for the leakage of fluorescein molecules through the blood-aqueous barrier.11 This method involves multiple blood samples and numerous fluorophotometric measurements per eye. A diffusion coefficient for fluorescein is rarely used for investigations because the measurement of plasma fluorescence and calculation of a diffusion coefficient does not improve the clinical accuracy of anterior chamber fluorophotometry.11

Investigations6,15,16 in which fluorophotometry results are calculated as percentage increase in the treated versus the contralateral eye involve use of the following formula:

article image

where %INC FL is the percentage increase in fluorescein concentration, FLtx is the fluorescein concentration in the treated eye, and FLuntx is the fluorescein concentration in the untreated eye. This formula is used to calculate the relative difference between the treated and untreated eye because both eyes will equilibrate to the same serum concentration.6 However, a possible consensual ocular reaction in dogs has been identified following unilateral blood-aqueous barrier breakdown,17 suggesting that this ratio may be deceptive, given that an untreated eye may not truly be unaffected.

Results reported as a percentage increase in the posttreatment fluorescein concentration, compared with the pretreatment (baseline) concentration, are calculated with the following formula12:

article image

where FLpost is the posttreatment fluorescein concentration and FLbaseline is baseline fluorescein concentration in the same eye. Lastly, when results are reported as actual fluorescein concentrations, the mean degree of anterior chamber fluorescence is given in nanograms per milliliter.13,17

Although reporting of actual fluorescein concentration is the simplest of these 4 approaches, the possible cumulative effect of repeated daily fluorescein administration has not been investigated and could impact results obtained with that method as well as with percentage increase in posttreatment fluorescein concentration from baseline. Parentally administered fluorescein in dogs is minimally detectable in the ocular aqueous humor 5 to 6 hours after administration, leading to the assumption that repeated fluorescein injections and fluorophotometric evaluations are acceptable after that period.6 When comparing the effects of treatments, investigators in 1 study12 used a 72-hour washout period in which no fluorescein was detected by fluorophotometry prior to beginning the next treatment. Although this washout period was apparently sufficient, studies in which the degree of inflammation is compared with repeated fluorophotometry on a 24-hour basis have not involved assessment of a potential buildup of fluorescein over time.

The purpose of the study reported here was to perform repeated anterior chamber fluorophotometry on healthy eyes of clinically normal dogs to measure ocular fluorescein concentrations over a 5-day period and determine whether there would be any change over time in the degree of anterior chamber fluorescence or any difference between eyes in the same dog. The intention was that the results might provide guidance in analysis of future anterior chamber fluorophotometric findings in dogs.

Materials and Methods

Animals—Nine dogs (5 females and 4 males; 18 eyes) were used for this study. Six dogs were personal pets owned by faculty and students of Kansas State University, and 3 dogs were research Beagles used in a previous noninvasive study and awaiting adoption. All dogs had a full physical examination, including an ophthalmic assessment performed by a board-certified ophthalmologist (RAA). The ophthalmic portion included rebound tonometry,a slit-lamp biomicroscopy,b and indirect ophthalmoscopy.c All dogs were determined to be free of clinical disease.

Privately owned dogs were allowed to be taken home at night and returned the next day for participation in the study. Research dogs were housed individually in a temperature-controlled environment illuminated by fluorescent lights that were automatically turned on (from 8 am to 8 pm) and off. The Institutional Animal Care and Use Committee at Kansas State University approved the use of all dogs and procedures in the study.

Fluorophotometry—A computerized scanning ocular fluorophotometerd with an anterior chamber adapter was used to scan each eye 60 minutes after IV injection of 10% fluorescein solutione (20 mg/kg). Fluorescein concentrations are reportedly maximal and stable at 30 to 90 minutes, so 1 scan to record anterior chamber fluorescence was performed.6 The dogs were restrained in sternal recumbency with the head stabilized, eyelids held open, and eye of interest positioned in front of the scanner. The left eye was scanned first, followed immediately by the right eye, with ≤ 2 minutes elapsing between scans. Fluorescein administration and fluorophotometry were repeated every 24 hours for 5 days.

The 3 research dogs were sedated for each evaluation with ketaminef (8.8 mg/kg, IM) and xylazineg (0.88 mg/kg, IM) to facilitate positioning in front of the fluorophotometer. These drugs reportedly have no effect on the diffusion of fluorescein through the blood-aqueous barrier.6 No chemical restraint was necessary for the 6 pet dogs because they could be positioned with only minimal manual restraint.

Statistical analysis—Anterior chamber fluorescein values were compared over time in the left eye and, in a separate comparison, in the right eye by repeated-measures ANOVA followed by a Newman-Keuls post hoc multiple comparisons test to discern individual differences. Data for the right and left eyes for each dog at each measurement point were combined, and changes over time within dogs were analyzed with repeated-measures ANOVA, followed by a Newman-Keuls post hoc multiple comparisons test to discern individual differences. The anterior chamber fluorescein values of the right and left eye were compared on each day by paired t test. A commercial software programh was used for all statistical analyses. Post hoc power analysis was performed to determine sufficient sample sizes for 80% confidence in nonsignificant results of comparisons. Values of P < 0.05 were considered significant.

Results

Anterior chamber fluorescein concentrations in each eye of the 9 healthy dogs were displayed in scatterplots for the 5-day study period (Figures 1 and 2). When left and right eyes were considered as separate groups, the fluorescein concentration in the right eye was significantly (P < 0.001) higher on day 5 than on days 1, 2, 3, and 4 (Table 1). Fluorescein concentration in the left eye was significantly (P < 0.001) higher on days 2, 3, 4, and 5, compared with on day 1. When both left and right eyes were considered as independent measures, fluorescence was significantly lower on day 1, compared with days 2, 3, 4, and 5, and fluorescence was also significantly higher on day 5 than on days 1, 2, 3, and 4. Post hoc power analysis at α = 0.05 and β = 0.80 indicated that larger sample sizes of 66 to 170 dogs would have been required to find significant differences within each eye between days 1 to 4.

Table 1—

Mean ± SD fluorescein concentrations (ng/mL) in the anterior chamber of the right and left eyes of 9 healthy dogs with ophthalmologically normal eyes over 5 days of repeated fluorophotometry.

EyeDay 1Day 2Day 3Day 4Day 5
Right427.26 ± 135.58456.31 ± 147.67473.97 ± 145.84469.97 ± 166.38517.36 ± 164.02*
Left418.31 ± 149.24475.58 ± 167.01480.75 ± 149.28467.14 ± 155.54510.77 ± 130.00

Value is significantly (P < 0.05) greater than that on all other days.

Value is significantly (P < 0.05) lower than that on all other days.

When the left and right eyes were compared on each day, there were no significant differences between eyes on any day. The percentage differences were as follows: day 1, 2.09%; day 2, 4.22%; day 3, 1.43%; day 4, 0.60%; and day 5, 1.27%. Post hoc power analysis at α = 0.05 and β = 0.80 indicated that larger sample sizes of 1,780 to 23,545 dogs would have been required to find a significant difference between right and left eyes on a given treatment day.

Figure 1—
Figure 1—

Scatterplot of right eye anterior chamber fluorescein concentrations (ng/mL) over 5 days for each of 9 healthy dogs with ophthalmologically normal eyes.

Citation: American Journal of Veterinary Research 73, 10; 10.2460/ajvr.73.10.1503

Figure 2—
Figure 2—

Scatterplot of left eye anterior chamber fluorescein concentrations (ng/mL) over 5 days for each of 9 healthy dogs with ophthalmologically normal eyes.

Citation: American Journal of Veterinary Research 73, 10; 10.2460/ajvr.73.10.1503

Discussion

Use of anterior chamber fluorophotometry in research allows noninvasive and objective determination of the breakdown and reestablishment of the blood-aqueous barrier. Proper assessment of the data is imperative to report accurate study findings, in particular when various treatments for uveitis are evaluated. The results of the present study demonstrated that there was a slight cumulative effect (mean, 92 ng/mL) of repeated daily fluorescein injections over 5 days as measured by anterior chamber fluorophotometry in clinically normal dogs. Although this increase was significant over time, it has been reported that a difference over time as high as 30% is typical in healthy eyes.6 In the present study, there was a mean increase of 22% over the 5-day study period, which was similar to the aforementioned typical variation. This finding is important to consider when comparing absolute fluorescein concentrations or increases from baseline in which a significant difference is found that is < 30%. Although such a difference may be significant, it should not be considered clinically important because it may be due to typical variation or fluorescein accumulation within the plasma or anterior chamber.

Proposed mechanisms for the increase in fluorescein concentration within the anterior chamber in ophthalmologically normal canine eyes are persistence within the eyes or equilibration with gradually increasing plasma fluorescein concentrations. The first explanation is unlikely given that fluorescein concentrations are minimally detectable within an eye 6 hours after IV administration in dogs.6 The second explanation is more likely given that parentally administered fluorescein is not completely excreted in humans for 48 to 72 hours.18

In humans, the elimination rate constant of fluorescein in the anterior chamber is not significantly different than the plasma terminal half-life.3 Excretion times are not known for dogs, and a small amount of fluorescein may still be present within the blood or other tissues > 24 hours and a small amount may accumulate as repeated daily IV fluorescein injections are performed. As a result, the anterior chamber equilibrates to increasing plasma concentrations that accrue over time. Plasma fluorescein could be measured prior to daily fluorescein injection to document an increasing plasma concentration; however, this was not performed in the present study. Regardless of plasma fluorescein concentration, there appears to be an increase in anterior chamber fluorescence over time with repeated daily fluorophotometry, which should be considered in future studies assessing blood-aqueous barrier breakdown. A significant finding of an increase > 30% should be the minimum increase considered relevant for study results. Anything less may be no different than typical variation or an increase over time, as was observed in the present study.

Although findings suggest that results are slightly affected when fluorophotometry values are evaluated as gross numbers or as a percentage increase compared with baseline, results from the other common method of reporting (increase in fluorescein concentration as a percentage increase in the treated vs contralateral eye) should not be affected because both eyes will equilibrate to the same plasma concentration. Indeed, the typical percentage variation between right and left eyes was < 5% on each day the dogs were evaluated. The problem with comparing treated with contralateral eyes for data reporting is that this method does not take into account a potential consensual response in which the contralateral eye is indeed affected by a treatment performed on the opposite eye. This type of response has been reported for numerous species and most recently was observed in dogs.17,19–22

a.

TonoVet, Tiolat Ltd, Helsinki, Finland.

b.

SL-14 Biomicroscope, Kowa Co Ltd, Tokyo, Japan.

c.

HEINE Omega 180 Ophthalmoscope, HEINE Optotechnik, Herrsching, Germany.

d.

FM-2 Fluorotron Master, OcuMetrics Inc, Mountain View, Calif.

e.

AK-FLUOR, Akorn Inc, Buffalo Grove, Ill.

f.

VetaKet, IVX Animal Health Inc, St Joseph, Mo.

g.

AnaSed, Ben Venue Laboratories, Bedford, Ohio.

h.

WINKS, version 4.8, 5th ed, Statistical Analysis System, TexaSoft, Cedar Hill, Tex.

References

  • 1.

    Freddo TF. Shifting the paradigm of the blood-aqueous barrier. Exp Eye Res 2001; 73:581592.

  • 2.

    Smelser GKPei YF. Cytological basis of protein leakage into the eye following paracentesis. Invest Ophthalmol 1965; 4:249263.

  • 3.

    Knudsen LL. Ocular fluorophotometry in human subjects and in swine—with particular reference to long-term pharmacokinetics. Acta Ophthalmol Scand Suppl 2002; 80:624.

    • Search Google Scholar
    • Export Citation
  • 4.

    Freddo TE. Intercellular junctions of the ciliary epithelium in anterior uveitis. Invest Ophthalmol Vis Sci 1987; 28:320329.

  • 5.

    Butler JMUnger WGGrierson I. Recent experimental studies on the blood-aqueous barrier: the anatomical basis of the response to injury. Eye 1988; 2(suppl):S213S220.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Ward DAFerguson DCKaswan RL, et al. Fluorophotometric evaluation of experimental blood-aqueous barrier disruption in dogs. Am J Vet Res 1991; 52:14331437.

    • Search Google Scholar
    • Export Citation
  • 7.

    Mitchell PGBlair NPDeutsch TA. Prolonged monitoring of the blood-aqueous barrier with fluorescein-labeled albumin. Invest Ophthalmol Vis Sci 1986; 27:415418.

    • Search Google Scholar
    • Export Citation
  • 8.

    Fearnley IRSpalton DJSmith SE. Anterior segment fluorophotometry in acute anterior uveitis. Arch Ophthalmol 1987; 105:15501555.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Giuliano EA. Nonsteroidal anti-inflammatory drugs in veterinary ophthalmology. Vet Clin North Am Small Anim Pract 2004; 34:707723.

  • 10.

    Schalnus ROhrloff C. Quantification of blood-aqueous barrier function using laser flare measurement and fluorophotometry—a comparative study. Lens Eye Toxic Res 1992; 9:309320.

    • Search Google Scholar
    • Export Citation
  • 11.

    Shah SMSpalton DJAllen RJ, et al. A comparison of the laser flare cell meter and fluorophotometry in assessment of the blood-aqueous barrier. Invest Ophthalmol Vis Sci 1993; 34:31243130.

    • Search Google Scholar
    • Export Citation
  • 12.

    Johnstone McLean NSWard DAHendrix DV. The effect of a single dose of topical 0.005% latanoprost and 2% dorzolamide/0.5% timolol combination on the blood-aqueous barrier in dogs: a pilot study. Vet Ophthalmol 2008; 11:158161.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Dziezyc JMillichamp NJRohde BH, et al. Comparison of prednisolone and RMI-1068 in the ocular irritative response in dogs. Invest Ophthalmol Vis Sci 1992; 33:460465.

    • Search Google Scholar
    • Export Citation
  • 14.

    Dziezyc JMillichamp NJSmith WB. Effect of flurbiprofen and corticosteroids on the ocular irritative response in dogs. Vet Comp Ophthalmol 1995; 5:4245.

    • Search Google Scholar
    • Export Citation
  • 15.

    Ward DA. Comparative efficacy of topically applied flurbiprofen, diclofenac, tolmetin, and suprofen for the treatment of experimentally induced blood-aqueous barrier disruption in dogs. Am J Vet Res 1996; 57:875878.

    • Search Google Scholar
    • Export Citation
  • 16.

    Kraff MCSanders DRMcGuigan L, et al. Inhibition of blood-aqueous humor barrier breakdown with diclofenac. A fluorophotometric study. Arch Ophthalmol 1990; 108:380383.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Allbaugh RARoush JKRankin AJ, et al. Fluorophotometric and tonometric evaluation of ocular effects following aqueocentesis performed with needles of various sizes in dogs. Am J Vet Res 2011; 72:556561.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    AK-FLUOR [package insert]. Lake Forest, Ill: Akorn Inc, 2010.

  • 19.

    Miyake KAsakura MMaekubo K. Consensual reactions of human blood-aqueous barrier to implant operations. Arch Ophthalmol 1984; 102:558561.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Kottow MHSeligman LJ. Consensual reactions to anterior chamber paracentesis in the rabbit. Am J Ophthalmol 1978; 85:392399.

  • 21.

    Chiang TSThomas RP. Consensual ocular hypertensive response to prostaglandin E 2. Invest Ophthalmol 1972; 11:845849.

  • 22.

    Chiang TSThomas RP. Consensual ocular hypertensive response to prostaglandin. Invest Ophthalmol 1972; 11:169176.

Contributor Notes

Dr. Allbaugh's present address is Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA 50011.

Address correspondence to Dr. Allbaugh (rachelallbaugh@yahoo.com).