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Use of a wick to deliver preoperative mydriatics for cataract surgery.

Before cataract surgery at our institution, we traditionally dilated the pupils with 5 drops: proparacaine 0.5%, cyclopentolate 1%, phenylephrine 2.5%, flurbiprofen sodium 0.03% (Ocufen), and ofloxacin 0.3% (Ocuflox) at 15-minute intervals given 3 times. This was work intensive for the nursing staff. Since September 2000, we have used a wick soaked in a dilating mixture containing cyclopentolate 1%, phenylephrine 2.5%, diclofenac sodium 0.1% (Voltaren), and Ocuflox. Use of the wick has been beneficial and time saving to hospital staff.

Anti-Infective Agents↗

Permeability characteristics of novel mydriatic agents using an in vitro cell culture model that utilizes SIRC rabbit corneal cells.

The purpose of this study was to evaluate the permeability characteristics of a previously reported in vitro corneal model that utilizes SIRC rabbbit corneal cells and to investigate the permeability of three novel esters of phenylephrone chemical delivery systems (CDS) under different pH conditions using this in vitro model. The SIRC rabbit corneal cell line was grown on transwell polycarbonate membranes, and the barrier properties were assessed by measuring transepithelial electrical resistance (TEER) using a voltohmmeter. The permeabilities of esters of phenylephrone CDS across the SIRC cell layers were measured over a pH range 4.0-7. 4. The esters tested include phenylacetyl (1), isovaleryl (2), and pivalyl (3). The SIRC rabbit corneal cell line, when grown on permeable filters, formed tight monolayers of high electrical resistance with TEER values increasing from 71.6 +/- 20.8 Omega.cm2 at day 3 in culture to 2233.42 +/- 15.2 Omega.cm2 at day 8 in culture and remained constant through day 14 in culture. The transepithelial permeability coefficients (Papp) at pH 7.4 ranged from 0.58 x 10(-6) cm/s for the hydrophilic marker, mannitol, to 43. 5 x 10(-6) cm/s for the most lipophilic molecule, testosterone. The Papp at pH 7.4 for phenylephrine was 4.21 x 10(-6) cm/s. The Papp values and the lag times of the three esters of phenylephrone were pH dependent. The Papp for 1, 2, and 3 at pH 7.4 were 14.76 x 10(-6), 13.19 x 10(-6), and 12.86 x 10(-6) cm/s, respectively and the permeabilities decreased at conditions below pH 7.4. The lag times at pH 7.4 were 0.10, 0.17, and 0.12 h for 1, 2, and 3, respectively, and the values increased at lower pH conditions. The TEER values of SIRC cell line observed at day 8 to day 14 in the present investigation are similar to the resistance value reported for rabbit cornea (2 kOmega.cm2). All the esters showed significantly (p < 0.05) higher permeabilities than phenylephrine at pH 7.4. The rate and extent of transport of the drugs across the cell layers were influenced by the fraction of ionized and un-ionized species and the intrinsic partition coefficient of the drug. The results indicate that the permeability of ophthalmic drugs through ocular membranes may be predicted by measuring the permeability through the new in vitro cell culture model.

Adrenergic alpha-Agonists↗

The mydriatic effect of multiple doses of tropicamide.

PURPOSE: We investigated whether two drops of 0.5% tropicamide produced a wider pupillary dilation when compared with a single drop and saline control in subjects with dark-colored irides. METHODS: Twelve young adult subjects with dark irides and who were free from ocular disease participated in the study. One eye of each subject, selected at random, was designated as experimental and the fellow eye as control. A single drop of 0.5% tropicamide was instilled in the lower cul-de-sac of each eye in turn. Immediately after, a second drop of 0.5% tropicamide was instilled in the experimental eye and a single drop of unpreserved saline into the control eye. A double-masked experimental protocol was followed. Digital images of both pupils of each subject were taken at baseline (predrug instillation) and then every 5 minutes up to 30 minutes postdrug instillation and at 40, 50, and 60 minutes. The images were subsequently viewed on a PC monitor, and pupil size was measured using a calibrated millimeter scale. RESULTS: Pupil diameter increased as a function of time for both conditions reaching a maximum between 20 and 30 minutes after drop instillation. Pupil diameter was greater under the experimental condition compared with the control (analysis of variance p < 0.001). Pupil diameter reached at least 6 mm under both the experimental and control conditions. CONCLUSION: In young healthy subjects, compared with a single drop of tropicamide, two drops were associated with a greater degree of pupillary dilation on average over the 60-minute study period. However, the magnitude of the difference was small and not clinically significant. A single drop of tropicamide produced a pupillary diameter of at least 6 mm, which should be sufficient for the conduct of a thorough dilated fundus examination.

Adult↗

Alpha 1- and alpha 2-adrenoreceptor antagonists produce opposing mydriatic effects by a central action.

1. In anaesthetized rats, intravenous administration of alpha 2-adrenoreceptor antagonists yohimbine (0.3-3.0 mg kg-1), idazoxan (0.03-0.3 mg kg-1) and raulwolscine (0.3-3.0 mg kg-1) produced a dose-related inhibition of sciatic nerve-(ScN) mediated reflex pupillary dilation (parasympatho-inhibition). The rank order of potency was idazoxan greater than yohimbine greater than rauwolscine. 2. Under similar experimental conditions, intravenous administration of alpha 1-adrenoreceptor antagonists prazosin (0.03-1.0 mg kg-1), phenoxybenzamine (0.3-3.0 mg kg-1) and corynanthine (0.03-1.0 mg kg-1) produced a dose-dependent potentiation of the reflex mydriasis with the potency order being prazosin greater than corynanthine greater than phenoxybenzamine. Intravenous yohimbine (1.5 mg kg-1) reversed the potentiation caused by the alpha 1-adrenoreceptor antagonists and blocked the reflex mydriasis. 3. Parasympatho-inhibition and mydriasis elicited by hypothalamic stimulation was not affected by the alpha 2-adrenoreceptor antagonists yohimbine (0.3-3.0 mg kg-1), idazoxan (0.03-0.3 mg kg-1) or the alpha 1-adrenoreceptor antagonist prazosin (0.3-1.0 mg kg-1). 4. Microinjection of prazosin (3-30 ng) into the oculomotor nuclear complex (IIIn), produced a dose-related potentiation, whereas microinjection of yohimbine (0.3-3.0 micrograms) produced a dose-related blockade of reflex mydriasis. 5. The above findings support the hypothesis that ascending mechanisms (e.g. afferent ScN) produce inhibition of parasympathetic oculomotor tone to the iris by activation of central postsynaptic alpha 2-adrenoreceptors. Furthermore, these studies demonstrate that alpha 2-adrenoreceptor antagonists block and alpha 1-adrenoreceptor antagonists potentiate the reflex mydriasis. These actions appear to be localized within the pupilloconstrictor regions of the brain (oculomotor nuclear complex).

Adrenergic alpha-Antagonists↗

Mydriatics.

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Eye Diseases↗