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PubMed1991

The effect of preoperative flurbiprofen on miosis produced by acetylcholine during cataract surgery.

Sustained pupillary dilation during cataract surgery may be achieved with preoperative noncorticosteroidal anti-inflammatory agents such as flurbiprofen. However, these agents may interfere with miosis after injection of acetylcholine. Thirty patients for extracapsular cataract extraction were randomly assigned in a double-masked fashion to receive either a placebo or preoperative 0.03% flurbiprofen every 30 minutes for four doses. All patients also received three doses of 2.5% phenylephrine and 2% cyclopentolate. Pupillary diameter was measured the day before surgery, immediately before the surgical incision, immediately before and five minutes after acetylcholine injection, and the morning after surgery. The flurbiprofen group had a larger mean pupillary diameter before injection of acetylcholine (P less than .001), five minutes after acetylcholine (P less than .001), and on the first postoperative day (P less than .005).

Acetylcholine↗

PubMedDate not supplied

Effect of decreased retinal illumination on frequency doubling technology.

PURPOSE: To investigate the effect of changes in retinal illumination on Frequency Doubling Technology (FDT). METHODS: Five eyes, of 5 adults who were free from identifiable ocular pathology, were examined using the Snellen chart and the Pelli-Robson chart, conventional automated perimetry, and the full threshold N-30 program of FDT. Each test was performed with and without a 0.9, 1.5, or 2.4 log unit neutral-density (ND) filter placed before the eye. Furthermore, the influence of pupil diameter on FDT test results was compared after treatment with pilocarpine or cyclopentolate with the influence of ND filters. RESULTS: All tests showed a decrease in sensitivity with decreasing retinal illumination. Frequency Doubling Technology showed an especially pronounced and significant decrease in sensitivity. The maximum mean threshold difference in FDT results with ND filter was 31.2 dB while that with the Humphrey Field Analyzer and the Pelli-Robson chart were 13.3 dB and 0.66 log contrast, respectively. The mydriatic state of the pupil increased the sensitivity of FDT and the miotic state decreased it to about the same extent as the the 0.9 ND filter. CONCLUSION: The change in retinal illumination has more impact on FDT than on spatial contrast tests and conventional automated perimetry. It is important to take this into account in evaluating FDT results.

Adaptation, Ocular↗

PubMed1982

The relation of myopia and astigmatism in developing eyes.

The relation of astigmatism and myopia was analyzed in 298 myopic children, ages birth to 10 years. The mean spherical equivalent, determined by cyclopentolate retinoscopy, for the entire group was--2.9 diopters and did not change significantly with age. However, in 3-year-old children and younger, myopia progressed in eyes with greater than or equal to 1 diopter of cylinder and tended to increase through age 8 years in those having greater than or equal to 3 diopters of cylinder. Also, astigmatic errors greater than or equal to 1 diopter, especially of oblique orientation, were associated with higher degrees of myopia than nonastigmatic errors. These data from myopic children suggest that uncorrected astigmatism during a period of visual immaturity influences the course of myopia. Thus, naturally occurring astigmatic errors, that are frequent among infants and young children, appear to have a role similar to the vision blurring perturbations that trigger the development of myopia in young animals. Ascertainment and full correction of these refractive errors in young children may be important in assuring the best possible vision.

Age Factors↗

PubMed1989

The effect of treatment with topical nonsteroidal anti-inflammatory drugs with and without intraoperative epinephrine on the maintenance of mydriasis during cataract surgery.

The author conducted a six-group, randomized, clinical trial to compare the relative efficacies of use of preoperative topical Ocufen (flurbiprofen), or Indocid (indomethacin, Indocin), with and without concurrent intraoperative epinephrine treatment; epinephrine treatment alone; and placebo in maintaining surgical mydriasis produced by preoperative administration of phenylephrine and cyclopentolate before cataract intraocular lens (IOL) surgery. Two hundred sixteen cases were randomized to receive one of the six treatment combinations. The treatment groups not receiving epinephrine (placebo, Indocid, Ocufen) had average percent decreases in pupil diameter of 19 to 24%, whereas groups receiving epinephrine (with or without Ocufen or Indocid), had decreases of only 0.8 to 2.6%. The effect of epinephrine treatment was significant (P less than 0.0001), regardless of nonsteroidal anti-inflammatory drug (NSAID) treatment. Indocin patients (without epinephrine) had less miosis than placebo patients; the proportion of cases with large decreases in pupil diameter (greater than or equal to 2 mm) was reduced by approximately 50%. Ocufen had an additive effect with epinephrine; the group with Ocufen + epinephrine treatment had a smaller proportion of cases with pupil size decreases than the group with epinephrine alone.

Administration, Topical↗

PubMed1991

Effects of topical suprofen and flurbiprofen on the miosis produced by anterior chamber irrigation with cholinergic agonists.

Pretreatment with topical nonsteroidal anti-inflammatory drugs is common practice to maintain maximal pupil dilation for cataract surgery. Most surgeons also inject a cholinergic agent intracamerally for miosis after intraocular lens insertion. We evaluated the effects of topical suprofen and flurbiprofen on the miosis induced by anterior chamber irrigation with either acetylcholine or carbachol. One eye of 30 pigmented rabbits was dilated with cyclopentolate HCl and phenylephrine HCl. Three groups, each composed of ten eyes, received flurbiprofen, suprofen, or a control. In each group, five eyes received acetylcholine by anterior chamber irrigation and five received carbachol. Pupil diameters were measured with calipers before and five minutes after irrigation by an observer unaware of the treatment regimen. Irides irrigated with carbachol constricted less than those irrigated with acetylcholine (P = .016). In anterior chambers irrigated with carbachol, suprofen was associated with less miosis than either tears (P = .005) or flurbiprofen (P = .009); however, if the infusion was performed with acetylcholine, no differences between the three groups were noted (P = .44).

Acetylcholine↗

PubMed1990

Evaluation of flurbiprofen-exposed irises to acetylcholine anterior chamber irrigation.

Flurbiprofen (Ocufen), an antiprostaglandin, has been introduced into cataract surgery. It is used to prevent intraoperative miosis by blocking inflammatory mediator formation. Ocufen has been noted to diminish the controlled miosis produced by using acetylcholine in the operative period. This study evaluated the pupillary response to acetylcholine after it had been exposed to Ocufen. This was done using a control versus a study eye in 16 rabbits dilated with phenylephrine hydrochloride and cyclopentolate hydrochloride. The pupil diameters were measured at baseline, then the rabbits' anterior chambers were irrigated with an acetylcholine solution. The resultant pupillary diameters were measured at one and five minutes. At five minutes post-irrigation there was a statistically significant greater constriction in the control group than in the Ocufen group. This implies that Ocufen dampens the iris musculature's response to acetylcholine.

Acetylcholine↗

PubMed1999

Posterior capsule opacification after phacoemulsification in patients with diabetes mellitus.

PURPOSE: To compare posterior capsule opacification (PCO) after phacoemulsification and implantation of heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) in the capsular bag in patients with diabetes mellitus with that in a control group. SETTING: St. Erik's Eye Hospital, Stockholm, Sweden. METHODS: This prospective study comprised 26 patients with diabetes mellitus and 26 control patients without diabetes. Those with glaucoma, exfoliation syndrome, uveitis, and pupil size smaller than 6.0 mm after dilation were excluded. All patients received the same standardized phacoemulsification procedure with implantation of an HSM PMMA IOL in the capsular bag. Posterior capsule opacification was scored 1 and 2 years after surgery by evaluating retroillumination images taken with a Scheimpflug camera (Nidek Anterior Eye Segment Analysis System) after pupil dilation with phenylephrine 10% and cyclopentolate 1%. The PCO density behind the IOL optic was graded clinically from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, 4 = severe) and scored using the Evaluation of Posterior Capsule Opacification medical software developing system. RESULTS: No differences in PCO were found between the diabetic and control groups 1 year after surgery. The total PCO score was significantly less in diabetic than in control eyes 2 years after surgery (P < .05, Mann-Whitney). In addition, progression of PCO from 1 year to 2 years after surgery was significantly less in diabetic groups with different stages of diabetic retinopathy than in the control group (P < or = .05, Kruskal-Wallis analysis of variance and multiple comparisons). CONCLUSION: The rate of PCO after phacoemulsification was statistically significantly lower in patients with diabetes mellitus than in those without diabetes.

Aged↗

PubMed1999

Pseudoaccommodation: BioComFold versus a foldable silicone intraocular lens.

PURPOSE: To assess the degree of pseudoaccommodation amplitude correlated with shifts along the anteroposterior axis of the BioComFold foldable intraocular lens (IOL). SETTING: Department of Ophthalmology, Hôtel-Dieu Hospital, Paris, France. METHODS: This prospective study comprised 30 eyes of 30 patients operated on consecutively for cataract by phacoemulsification and in-the-bag implantation of a BioComFold (15 patients) or a foldable control (15 patients) IOL. The BioComFold IOL has a peripheral bulging ring that pushes the optic forward during the effort to accommodate, creating a zoom effect. Pseudoaccommodation amplitude was evaluated using the blurring of controlled vision by adding spheres, with the best correction for distance vision in place. Pupil diameter was measured with a Goldmann campimeter under constant illumination. Anterior chamber depth was determined by A-scan (Paxial, Biophysic Medical) 30 minutes after cyclopentolate 1% was instilled and again 30 minutes after pilocarpine 2% was instilled. RESULTS: The difference in pseudoaccommodation amplitude and pupil diameter between the 2 groups was not statistically significant (P = .6737 and P = .4014, respectively). The IOL's forward shifts from maximal ciliary relaxation to maximal ciliary contraction were significantly greater in the BioComFold group (P = .0215). CONCLUSION: The design of the BioComFold IOL allowed greater forward optic shifts along the anteroposterior axis during the effort to accommodate. Nevertheless, this shift was not correlated with a significantly greater pseudoaccommodation amplitude.

Accommodation, Ocular↗

PubMed2001

Randomised controlled trial of ketorolac in the management of corneal abrasions.

PURPOSE: To evaluate the role of topical non-steroidal anti-inflammatory agents (NSAIDs) in the management of corneal abrasions with respect to symptoms and healing. METHODS: The study was designed as a prospective, single center, randomised, placebo controlled, double-blinded trial. Eighty-eight consecutive patients with non-infective, non-contact lens related traumatic or foreign body removal related corneal abrasions were recruited to this study. They were randomised into two groups. Both groups were given a single instillation of Gutt. cyclopentolate 0.5% followed by chloramphenicol eye ointment four times a day until the following day. In addition, the treatment group received topical Ketorolac trometamol 0.5% ophthalmic solution while the control group received placebo Liquifilm tears. Patients were assessed at presentation and about twenty-four hours later for subjective symptoms, abrasion size and any associated complications. RESULTS: There was no statistical difference in the two groups at base line and twenty-four hour follow-up when assessed for five subjective symptoms of pain, photophobia, grittiness, watering and blurring of vision. However, those receiving topical ketorolac required significantly less additional oral analgesics (p=0.001). There was no difference in the rate of healing. CONCLUSION: Use of topical ketorolac may be a useful adjunct in the management of corneal abrasions.

Administration, Topical↗

PubMed2003

Surgically induced miosis during phacoemulsification in patients with diabetes mellitus.

PURPOSE: To assess the incidence of surgically induced miosis during phacoemulsification in diabetic patients. METHODS: A total of 76 patients with diabetes mellitus were compared to 76 age- and race-matched controls. A combination of cyclopentolate 1%, phenylephrine 2.5% and diclofenac sodium 0.1% was applied topically 60, 45 and 30 min before surgery. Adrenaline mixed with buffered saline solution was used for irrigation during surgery. The procedure included phacoemulsification and implantation into the bag of a foldable acrylic implant. Measurements of the horizontal pupillary diameter were taken at three stages: before corneal incision, after phacoemulsification, and at the end of surgery. The duration of phacoemulsification was also recorded. RESULTS: Surgically induced miosis or dilation of the pupil was defined as constriction or dilation noted at any interval during surgery. The pairs of diabetic-control were grouped into three groups: those in which constriction was noted, those in which dilation was noted, and those in which there was no change in pupil size during the procedure. Surgically induced miosis was noted more often in the diabetics (McNemar's test, chi(2), P=0.016). The mean pupil size at the beginning of surgery was 7.38 (+/-0.95) mm in the diabetics as compared to 7.65 (+/-0.89) mm in the control group. No statistically significant difference was noted between the two groups (paired t-test, P=0.07). The mean (+/-SD) duration of phacoemulsification in the diabetic group was 2.31 (+/-1) min as compared to 2.05 (+/-0.82) min in the control group. No statistically significant difference was found between the two groups (paired t-test, P=0.08). CONCLUSION: Surgically induced miosis occurred more often in the diabetics. Therefore, it is advisable that phacoemulsification in this group of patients is undertaken by an experienced surgeon.

Aged↗

PubMed2001

[Biochemical stress monitoring during cataract surgery; phenylephrine 10% shows no changes in serum-catecholamines in comparison with phenylephrine 5%].

BACKGROUND: There is a controversy about the concentration of topical phenylephrine recommended for diagnostic or therapeutic mydriasis. Phenylephrine 10% leads to a faster and more pronounced mydriasis but cardio-vascular side-effects like hypertension and arrhythmia have been reported. A maximal pupillary dilatation is a prerequisite for successful cataract surgery. The aim of this study was to evaluate the risk-benefit ratio of phenylephrine 10% in comparison to 5% in the daily practice of the cataract-surgery unit in our clinic by clinical assessment and monitoring of biochemical stress parameters. PATIENTS AND METHODS: 30 informed and consenting patients were randomly allocated to 2 groups of equal size. After a single application of 2 drops of phenylephrine 5% in group 1 and 10% in group 2 respectively and 1 drops of cyclopentolate 1% with neutral pupil (time 0), an ECG was recorded and blood pressure, pulse, oxygen-saturation and pupil size were measured. Simultaneously a blood-sample was taken and the serum-catecholamines adrenaline and noradrenaline were determined by HPLC (High Pressure Liquid Chromatography). These measurements were repeated after 5, 10 and 30 minutes. RESULTS: The mean pupil area after 30 minutes in group 1 was 31.97 (+/- 0.43) mm2 compared to 45.72 (+/- 0.39) mm2 in group 2. Our data showed no other significant variation between the groups: neither clinical monitoring nor catecholamine measurements showed concentration-dependent patterns in blood pressure development or serum levels. No systemic cardiovascular effects were observed. CONCLUSION: These results demonstrate that a controlled application of phenylephrine 10%--under observation of contraindications--yields no increased risk for the occurrence of cardio-vascular side-effects in comparison with phenylephrine 5%. Therefore, we recommend the use of phenylephrine 10% in the described dosage as routine medication for cataract surgery.

Aged↗

PubMed1999

[Perioperative circulatory side effects of topical 5% phenylephrine for mydriasis].

PURPOSE: To study the systemic effects of topically applied 5% phenylephrine. To investigate intraoperative injection of epinephrine in the anterior chamber as an alternative. METHOD: 75 patients undergoing cataract surgery were randomized into three groups. In group 1, the pupil was dilated using topically 5% phenylephrine and 1% cyclopentolate, the patients blocked the lacrimal drainage system themselves by digital compression. Group 2 received the same drops, digital compression was performed by one of the investigators. In Group 3, no preoperative phenylephrine was used--instead, epinephrine 1:25,000 was injected in the anterior chamber at the beginning of surgery. Retrobulbar anesthesia was performed in a short narcosis with ketamine and propofol. RESULTS: Mean preoperative blood pressure values were higher than the day before. They fell during narcosis, to increase significantly after the injection of the local anesthetics. At the beginning of surgery they were back to prenarcotic values. Intraoperative blood pressure remained stable. Preoperative day values were found two hours postop. There was no significant difference in the circulatory behavior between the three groups. For mydriasis, intraoperative intracameral epinephrine was not as effective as preoperative phenylephrine. CONCLUSION: In normotonic or medically treated arterial hypertensive patients, preoperative mydriasis using 5% phenylephrine is safe--proceeding the way described above. Compression of the lacrimal drainage system can be performed by the patients effectively. Intraoperative intracameral epinephrine does not replace preoperative phenylephrine.

Administration, Topical↗

PubMed1998

Selectivity of muscarinic agonists including (+/-)-aceclidine and antimuscarinics on the human intraocular muscles.

The average EC50 value and the maximum response of carbachol on the human circular ciliary muscle obtained within 24 h of postmortem hypoxia was 517 nmol/l and 135 mg, respectively. These values for carbachol did not differ significantly from that of the longitudinal ciliary muscle. However, when tested at 1 mumol/l of carbachol, the peak response of the longitudinal muscle occurred at 59 sec vs 173 sec for that of the circular muscle of 70 year old donors. The relative potency of the muscarinic agonists on the circular muscle was oxotremorine-M, 1 > carbachol, 1/4 > pilocarpine, 1/19 > aceclidine, 1/132. The relative order of potency of agonists was similar for the longitudinal muscle. Only pilocarpine and aceclidine were partial agonists which produced 80-85% of the maximum response. When compared with the EC50 values of aceclidine on the iris sphincter and the longitudinal ciliary muscles, the agonist potency was only 1/28 for the latter tissue. Implications of these findings in relation to the use of these agonists in glaucoma are discussed. The pKB values of muscarinic antagonists on the circular ciliary muscle were: atropine, 8.8; cyclopentolate, 7.8; tropicamide, 7.4; P.F. HHSiD, 7.0; pirenzepine, 6.4; and methoctramine, 5.7. Nearly equal pKB values of each antagonist were obtained for the longitudinal ciliary muscle and iris sphincter. Based on the affinity constants of various competitive antagonists, the human iris as well as ciliary muscles may contain M3, M2 or M4 subtypes of muscarinic receptors.

Adult↗

PubMed1985

Comparison of refraction obtained by "near retinoscopy" and retinoscopy under cycloplegia.

This study compared refractive error obtained by the "near retinoscopy" method as described by Mohindra and static retinoscopy under cycloplegic conditions. Twenty-two patients between the age of 3.6 and 10.0 years were objectively refracted. The examiner performed a near retinoscopy on each patient. Immediately after this procedure, 2 drops of 1% Cyclogyl (cyclopentolate) were administered to each eye, 5 min apart. Cycloplegic retinoscopy was performed 35 to 40 min after the 2nd drop was administered. In order to reduce examiner bias, the specific powers of the neutralizing lenses were unknown to the examiner throughout the entire procedure. On average, retinoscopy under cycloplegic conditions revealed +0.50 to +0.75 D more plus than near retinoscopy. Although the Student's t-test indicated the values were significantly different on an absolute basis, a Pearson's r of +0.85 was found when all meridians were compared. In addition, if a "cut" factor is introduced to adjust for normal accommodative tonus eliminated under cycloplegic conditions, the two procedures produce essentially the same results.

Child↗

PubMed1993

Dark focus of accommodation and uncorrected visual acuity.

We compared the dark focus of accommodation in 33 healthy children, 19 eyes with good uncorrected visual acuity (1.0 or more) vs. 14 with poor uncorrected visual acuity (below 1.0). The two groups were matched for age and cycloplegic refractive error. Cycloplegic refractive error ranged from +0.15 to +1.75 D in the good visual acuity group and from +0.25 to +1.87 D in the poor visual acuity group. The dark focus was defined as the difference between the refractive error in the dark and the refractive error under cycloplegia. Initially, visual acuity was measured subjectively. Next, refractive error in the dark was measured using the Nidek Autorefractometer AR1600 with its optical target light off. Refractive error under cycloplegia was measured 40 min after the instillation of cyclopentolate hydrochloride using the same autorefractometer. There was a significant correlation between the dark focus and the cycloplegic refractive error (r = -0.53, p < 0.01). Despite an equal refractive error under cycloplegia the dark focus was significantly larger in the eyes with good uncorrected visual acuity than in those with poor uncorrected visual acuity (p < 0.01). Tonic accommodation may influence uncorrected visual acuity.

Accommodation, Ocular↗

PubMed1995

Ocular dimensions and refraction in Tibetan children.

A cross-sectional study of 404 Tibetan children (212 males, 192 females) aged 6 to 16 years was conducted in the Bouda region of Kathmandu, Napal in April, 1992. Examination procedures included retinoscopy (1% cyclopentolate HCl), keratometry A-scan ultrasonography, and video ophthalmophakometry. The mean refractive error was +1.11 D (SD: 0.56 D) at age 6 years decreasing to +0.63 D (SD: 0.34 D) at age 16 years with a prevalence of myopia in this group of 3.9%. Most children examined had low refractive errors, with 95.5% having errors in the range -0.50 to +1.50 D. Crystalline lens power decreased by 2.59 D, with an associated increase in its anterior radius of curvature of 1.98 mm and 0.49 mm in its posterior radius of curvature over the age range studied. Vitreous chamber depth increased by 0.69 mm, but no significant changes were recorded in anterior chamber depth, lens thickness, or corneal curvature. We conclude that the balance between the decrease in crystalline lens power and the increase in vitreous length is the major factor in maintaining the tendency to emmetropia in these children.

Adolescent↗

PubMed2000

The role of preoperative subconjunctival mydricaine and topical diclofenac sodium 0.1% in maintaining mydriasis during vitrectomy.

PURPOSE: To establish the role of preoperative subconjunctival mydricaine and diclofenac 0.1% in maintaining mydriasis during vitrectomy. METHODS: Fifty-seven patients were entered into the study. All were given cyclopentolate 1% and phenylephrine 2.5% preoperatively. Each patient was randomly allocated to one of three groups. In Group 1, patients received mydricaine by subconjunctival injection and diclofenac 0.1% topically preoperatively. In Group 2, patients received only subconjunctival mydricaine. Group 3 patients received only topical diclofenac preoperatively. Pupil diameter was measured with calipers before and at the end of the operation. RESULTS: There was no statistically significant difference in the change in pupil size between Groups 2 and 3. In all patients in Group 1 (who received both subconjunctival mydricaine and diclofenac preoperatively), pupil size was either maintained or increased after vitrectomy. This result was statistically significant when compared with the other groups (for Group 1 versus Group 2, P<0.005; for Group 1 versus Group 3, P<4.7x10(-06)). CONCLUSION: Topical diclofenac is useful for maintaining pupil size during vitrectomy only when used in conjunction with subconjunctival mydricaine, especially in patients in whom prolonged surgery is anticipated.

Adolescent↗

PubMed1995

Ocular toxicology.

In this review of recent articles on ocular toxicology, the author concentrates on undesirable effects on the eye induced by systemically used xenobiotics. These effects include increased tear flow elicited by systemic cyclosporine; uveitis associated with inactivated influenza vaccine, intravenous immunoglobulins, or skin tattoos; iritis associated with intravenous streptokinase; corneal epithelial erosion associated with the use of an alcohol-based antimisting spray; decreased color vision associated with workplace exposure to perchloroethylene, or to digoxin; myocardial ischemia induced by topical atropine; and systemic exposure to cyclopentolate after topical instillation. Ocular irritation associated with systemic use of 5-fluorouracil may be attenuated with prophylactic ice packs. At doses evaluated for treatment of choroidal neovascularization, systemic alpha interferon leads to toxicity in multiple organ systems. Promethazine precipitates when injected into intravenous lines with fluorescein. No drug achieves ultimate efficacy or ultimate safety. Thus, the decision to employ a given therapy involves a physician's evaluation of its therapeutic index-the ratio between efficacy and toxicity.

Drug-Related Side Effects and Adverse Reactions↗