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At least 235 records · Page 13Linked to original sources
PubMed1997

Ocular toxicology.

This review of recent articles on ocular toxicology concentrates on undesirable effects on the eye induced by systemically used xenobiotics. These include color vision deficiencies or visual field deterioration related to antiepileptic drugs, elevated intraocular pressure associated with inhaled corticosteroids, retinal detachments associated with systemic corticosteroids, rifabutin-induced uveitis, cocaine-related retinal hemorrhagic lesions in utero, deferoxamine-related decreases in vision, ocular allergy to bovine-derived collagen, and a large case study of hydroxychloroquine retinotoxicity. Other publications reviewed include a controlled study showing that glucose levels do not seem to alter color vision, a report that intravenous methotrexate can reach clinically meaningful levels in the aqueous humor, and a study showing the effect of systemic pentoxifylline on ocular blood flow and diabetes. With respect to systemic effects of topical ocular medications, there was a case report of apparent systemic exposure to pilocarpine from an Ocusert (Alza Corp., Palo Alto, CA), generalized urticaria after a single application of 1% cyclopentolate, and asthma induced with topical ketorolac. Readers are reminded that 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, that is, the ratio between efficacy and toxicity.

Eye↗
PubMed2006

Spontaneous wound dehiscence after removal of single continuous penetrating keratoplasty suture: conservative management.

PURPOSE: To describe a case of spontaneous wound dehiscence (WD) following removal of single continuous penetrating keratoplasty (PKP) suture, who was treated conservatively with a bandage contact lens. METHODS: A 36 year-old man who had penetrating keratoplasty for keratoconus 15 months earlier and removal of the single continues suture the previous week underwent ocular examination. He was treated with topical dexamethasone 0.3%, chloramphenicol 0.5% and cyclopentolate 1% 3 times a day and had a bandage contact lens (BCL) inserted. RESULTS: On presentation, he was complaining of reduced vision, tearing and pain following an attack of rhinitis-induced sneezing. His visual acuity (VA) in the affected eye was counting fingers, the anterior chamber was formed, the intraocular pressure (IOP) was low and there was a 2-clock-hour WD with a positive Seidel test but no iris incarceration. Two months later, his corrected VA was 6/5, his IOP was normal and the graft-host junction was good with no uplift. CONCLUSIONS: A 2-clock-hour WD after single continuous PKP suture removal may be conservatively treated with a BCL.

Adult↗
PubMed1997

Cataract surgery and pupil size in patients with diabetes mellitus.

PURPOSE: Constriction of the pupil during phacoemulsification and intraocular lens (IOL) implantation in patients with diabetes mellitus was studied. METHODS: Before surgery a combination of 0.75% cyclopentolate and 2.5% phenylephrine was applied topically to the eyes of 32 patients with diabetes mellitus and 25 age-matched controls. Epinephrine was mixed with buffered saline solution and used during the surgery. The surgical procedure included capsulorhexis, phacoemulsification in the posterior chamber and implantation into the capsular bag of a heparine surface-modified poly(methyl metacrylate) IOL with an optic diameter of 5.0 mm. The durations of phacoemulsification and the whole surgical procedure were recorded. Measurements of the horizontal pupillary diameter were taken before surgery, after phacoemulsification and at the end of the surgery. RESULTS: There was no significant difference in pupil size between controls and the diabetic group before the operation. Surgically induced miosis after phacoemulsification and at the end of operation were significantly more pronounced in the diabetic group than in controls (p < 0.05) (p < 0.05). Phacoemulsification and the entire surgical procedure took significantly longer time when performed in the diabetic eyes (p < 0.05) (p < 0.05). CONCLUSION: We conclude from these data that constriction of the pupil during cataract surgery is more pronounced in diabetic eyes as compared to controls.

Aged↗
PubMed1984

Toxic effect of scopolamine eye drops in children.

Five children, admitted with acute psychotic reactions after use of Scopolamine eye drops 0.2%, are presented. The predominant symptoms were visual hallucinations, strange behaviour, and restlessness. In one case peripheral symptoms were observed. Recovery was complete in 24 h. Prescription of Scopolamine eye drops should be followed by information of possible adverse effects. Cyclopentolate might be used instead.

Acute Disease↗
PubMed1984

Screening for refractive errors in 6-9 month old infants by photorefraction.

The method of isotropic photorefraction has been used in a trial of refractive screening of 6-9 month old infants. Data are presented on the calibration of the method against retinoscopic measurements and its reliability. In photorefractive screening of 1096 infants under cyclopentolate cycloplegia 5% were found to be hypermetropic (over +3.5 D), 4.5% myopic, and 1.3% anisometropic (over 1 D). These refractive errors were confirmed on retinoscopic follow-up (with the exception of a few anisometropes). Follow-up of controls shows that one small refractive error was missed in 52 infants. We conclude that photorefraction is a valid and practical screening technique. Longitudinal study of infants with refractive errors will assess the value of early detection, in particular for prediction and prevention of strabismus.

Adult↗
PubMed1999

Transient acute myopia induced by antilymphocyte globulins.

Acute onset of transient myopia may be induced by several drugs, different mechanisms having been described. We report the occurrence of such an event after intravenous administration of equine antilymphocyte globulins in a patient treated for aplastic anemia. Clinical ocular examination revealed no other abnormality, and ultrasonography disclosed no swelling of the ciliary body. The drug-induced myopia resolved completely after instillation of topical cyclopentolate, suggesting that its mechanism was the occurrence of a ciliary spasm. Acute myopia is a rare event and, to the authors' knowledge, this represents the first case described as being induced by antilymphocyte globulins.

Acute Disease↗
PubMedDate not supplied

Effects of topical mydriatics and vasoconstrictors on prostaglandin-E2-induced aqueous flare elevation in pigmented rabbits.

We evaluated the effects of topical instillation of mydriatics and vasoconstrictors on prostaglandin E2 (PGE2) induced aqueous flare elevation in pigmented rabbits. Transcorneal diffusion of PGE2 (25 microg/ml) by means of a glass cylinder produced aqueous flare elevation. Mydriatics (atropine sulfate, tropicamide, tropicamide plus phenylephrine hydrochloride, phenylephrine hydrochloride, and cyclopentolate hydrochloride) or vasoconstrictors (naphazoline nitrate and tramazoline hydrochloride) were topically administered before PGE2 application. Aqueous flare was measured with a laser flare-cell meter. One or two instillations of atropine sulfate 1.0%, tropicamide 0.4%, tropicamide 0.5% plus phenylephrine hydrochloride 0.5%, phenylephrine hydrochloride 5.0%, cyclopentrate hydrochloride 1.0%, and naphazoline nitrate 0.05% did not inhibit PGE2-induced aqueous flare elevation. Tramazoline hydrochloride 0.118% inhibited significantly (p < 0.05) PGE2-induced aqueous flare elevation. It is possible that vasoconstriction may be involved partly in inhibition of PGE2-induced aqueous flare elevation by some drugs in pigmented rabbits.

Administration, Topical↗
PubMed2005

Axial growth and changes in lenticular and corneal power during emmetropization in infants.

PURPOSE: To evaluate the contribution made by the ocular components to the emmetropization of spherical equivalent refractive error in human infants between 3 and 9 months of age. METHODS: Keratophakometry in two meridians was performed on 222 normal-birthweight infant subjects at 3 and 9 months of age. The spherical equivalent refractive error was measured by cycloplegic retinoscopy (cyclopentolate 1%). Anterior chamber depth, lens thickness, and vitreous chamber depth were measured by A-scan ultrasonography over the closed eyelid. RESULTS: Both the mean and SD for spherical equivalent refractive error decreased between 3 and 9 months of age (+2.16 +/- 1.30 D at 3 months; +1.36 +/- 1.06 D at 9 months; P < 0.0001, for the change in both mean and SD). Average ocular component change was characterized by increases in axial length, thinning, and flattening of the crystalline lens, increases in lens equivalent refractive index, and decreases in lens and corneal power. Initial refractive error was associated in a nonlinear manner with the change in refractive error (R(2) = 0.41; P < 0.0001) and with axial growth (R(2) = 0.082; P = 0.0005). Reduction in hyperopia correlated significantly with increases in axial length (R(2) = 0.16; P < 0.0001), but not with changes in corneal and lenticular power. Decreases in lenticular and corneal power were associated with axial elongation (R(2) = 0.40, R(2) = 0.12, respectively; both P < 0.0001). CONCLUSIONS: Modulation in the amount of axial growth in relation to initial refractive error appeared to be the most influential factor in emmetropization of spherical equivalent refractive error. The associations between initial refractive error, subsequent axial growth, and change in refractive error were consistent with a visual basis for emmetropization. The cornea and crystalline lens lost substantial amounts of dioptric power in this phase of growth, but neither appeared to play a significant role in emmetropization.

Accommodation, Ocular↗
PubMed2004

Parameters of drug antagonism: re-examination of two modes of functional competitive drug antagonism on intraocular muscles.

There are two distinct kinetic functional pharmacological procedures by which the equilibrium affinity constant, KB, of a competitive reversible blocker is obtained. The classical method on an organ system requires the study of the parallel displacement of the agonist concentration-response curve in the presence of the blocker. In the second method, the agonist-evoked functional mechanical response is reduced to half by the blocker IC50 (the concentration required for 50% inhibition). In relation to these parameters the role of the ionization constant pKa and liposolubility log Pc or log D of blockers was examined. On the ciliary muscle from human eye, IC50/KB ratios for (+/-)-atropine, its quaternary analogue (+/-)-methylatropine, (-)-scopolamine, (+/-)-cyclopentolate, (-)-tropicamide, (+/-)-oxybutynin and pirenzepine were 15, 23, 4.4, 2.6, 1.66, 1.46 and 1.71, respectively. The ratios on the iris sphincter were comparable with those of ciliary muscle. When compared with large proportions of ionized molecules with water soluble properties of (+/-)-atropine and (+/-)-methylatropine, relatively high amounts of un-ionized and/or with greater partitioning of all other blockers in the lipoid barrier correlated well to low IC50/KB ratios, as predicted by the classical theory of competitive drug antagonism. It was hypothesized that due to receptor biophase access, the reduction of the mechanical response of the agonist by the highly ionized water-soluble antagonist at IC50 represented time-distorted "pseudoequilibrium" estimation, where a higher concentration of the blocker was needed. On the other cholinergic effectors, like that of rat anococcygeus muscle or frog rectus abdominus muscle, IC50/KB ratios of respective blockers atropine or (+)-tubocurarine and hexamethonium were close to 1. Thus physicochemical properties, which affect the distribution coefficient log D and the tissue morphology (where asymmetric distribution of receptors may occur), appeared to be a critical factor in the analysis of the affinity parameters of the competitive reversible blocker. On the intraocular muscles, two functional pharmacological procedures for obtaining KB and IC50 values were not kinetically equivalent.

Abdominal Muscles↗
PubMed1999

Utility of pupillary dilation for detecting leukocoria in patients with retinoblastoma.

In the United States, 50% of all retinoblastoma cases are diagnosed after the observation of leukocoria by a family member or primary care physician. However, leukocoria produced by retinoblastoma lesions can often be missed by direct ophthalmoscopic examination through an undilated pupil. The purpose of this study is to demonstrate the utility of pupillary dilation for the detection of leukocoria in suspected cases. Seven patients (10 eyes), aged 2 days to 20 months, with retinoblastoma were examined for leukocoria using a direct ophthalmoscope with the pupils first undilated and then after pharmacologic dilation with 0.5% cyclopentolate and 2.5% phenylephrine. Leukocoria was detected by direct ophthalmoscopy on undilated examination in 3 of 10 eyes (30%). In contrast, leukocoria was observed after pupillary dilation in 10 of 10 eyes (100%). The retinoblastoma lesions, from 2 to 10 mm in diameter, were located within the posterior 45 degrees of the retina. Pupillary dilation is a safe and effective tool that can enhance the ability of the examiner to detect leukocoria. Dilation may afford early diagnosis and treatment, and therefore should be considered on patients in whom the diagnosis of retinoblastoma is entertained.

Dilatation↗
PubMed1990

Effects of various anesthetic and autonomic drugs on refraction in monkeys.

Resting refractive correction in ketamine-, pentobarbital-, or halothane-anesthetized rhesus and cynomolgus monkeys was approximately 1-3 diopters myopic, with little difference under the various anesthetic regimens. Topical cyclopentolate or atropine, or systemic hexamethonium eliminated much of the myopia, while epinephrine, phenylephrine and thymoxamine had little effect. Anesthesia-induced myopia in monkeys thus seems comparable to tonic accommodation ("night myopia") in the human. Accommodation induced by electrical stimulation of the Edinger-Westphal nucleus averaged approximately 50% less under halothane than under pentobarbital, possibly due to halothane-induced systemic arterial hypotension.

Accommodation, Ocular↗
PubMedDate not supplied

Weill-Marchesani syndrome with bilateral angle-closure glaucoma.

To our knowledge this is the first reported case of cyclopentolate induced bilateral acute angle-closure glaucoma associated with the Weill-Marchesani syndrome without lens subluxation. The diagnosis of Weill-Marchesani syndrome was not initially suspected, and Pilocarpine was used in an attempt to break the acute attack. Treatment with Pilocarpine-induced myosis only worsened the glaucoma by causing a severe pupillary block. This case is important because it demonstrates that mid-dilatation and cycloplegia can induce acute glaucoma in patients with the Weill-Marchesani syndrome and points out the importance for considering the diagnosis of Weill-Marchesani syndrome in any case of acute glaucoma in childhood.

Abnormalities, Multiple↗
PubMedDate not supplied

A comparison of the pupillary and cardiovascular effects of various mydriatic agents in preterm infants.

We conducted a randomized, masked study of pupillary dilating capabilities and associated cardiovascular effects of three solutions. Thirty-four babies less than 1500 grams at birth were studied at six to eight weeks. Group A (n = 10) received phenylephrine (PE) 2.5% and tropicamide 1.0%; Group B (n = 10) PE 2.5%, tropicamide 0.5%, and cyclopentolate 0.5%, Group C (n = 10) PE 1.0% and tropicamide 1.0%; Group D (n = 4) saline 0.9%. One drop was placed in each eye and repeated five minutes later. Pupillary dilation was measured with a metric ruler by direct observation at one hour. Blood pressure (BP) and heart rate (HR) were monitored, using an oscillometer, immediately prior to the instillation of the drops and at five-minute intervals, for 60 minutes. BP and HR increased transiently in all groups receiving mydriatics but returned to baseline values in 25 minutes. This increase was significant in Groups A and B (2.5% PE: p less than 0.02). Group D (saline) showed no change in BP or HR. Postdrop pupillary size was largest in Group A but the differences were not significant. On exposure to bright light, the pupillary size in Group C was significantly smaller than Groups A or B (7.35 +/- 0.59 mm, 7.23 +/- 0.38 mm and 6.75 +/- 0.57 mm in Groups A, B and C, p less than .01). Nevertheless, dilation was sufficient to allow appropriate examination in all infants (pupillary diameter greater than 6.0 mm). Solutions containing 2.5% PE are most effective for use in LBW infants, but produce cardiovascular effects. Solutions containing 1% PE provide adequate dilation with minimum cardiovascular effects.

Cardiovascular System↗
PubMedDate not supplied

Glaucoma following childhood cataract surgery.

Glaucoma has been recognized as an infrequent but serious complication following surgery for congenital and acquired cataracts in childhood. Little is known concerning the influence of factors on the risk of glaucoma such as age at surgery, type of cataract, associated ocular abnormalities, and type of surgery. We reviewed records of 240 eyes of 155 patients on whom cataract surgery had been performed between January 1965 and July 1990 at Children's Hospital, Boston. After excluding those patients who had been followed up less than 5 years after surgery, and those who had had surgery after the age of 10 years, 125 eyes of 82 patients were included in the study group. We identified 14 eyes of 9 patients that had developed open-angle glaucoma 5.3 to 13.1 years following surgery (average 7.4 years). An additional 4 eyes of 3 patients developed angle closure glaucoma, which was diagnosed at 146, 177, 2911, and 2939 days following surgery. A fifth patient developed acute angle closure 1.7 years following primary cataract surgery and 53 days following secondary discission. All but one of the patients who developed glaucoma had cataract surgery at less than 1 year of age. Age at surgery for the entire study group averaged 1.9 years, and ranged from 25 days to 9.6 years. We conclude that patients having cataract surgery before 1 year of age are at the greatest risk of developing postoperative open-angle glaucoma. Additional increased relative risk was found in eyes with microcornea, congenital rubella syndrome, and poor pupillary dilation with 1% cyclopentolate (Cyclogyl). No significant difference was seen among the various surgical methods of cataract removal.

Aphakia, Postcataract↗
PubMed1998

[Developmental mechanism of low myopia and therapeutic possibilities. A review].

We studied the developmental mechanism of low myopia and the possibility of its drug treatment. I. Prevalence of myopia. According to surveys by the Japanese Ministry of Education, Science, Sports and Culture, the frequency of myopia in school children has gradually increased. We examined office workers from 20 to 60 years of age over a 3-year period. Myopia progression was observed in the thirties and fourties. Late-onset myopia is an important problem around the world. II. Developmental mechanism of low myopia. 1. Reduction of refraction after cycloplegia was statistically significant in adults after their twenties. We measured accommodative hysteresis after a close visual task. Accommodative hysteresis persisted for a long time in late-onset and adult-onset myopia. Continuous ciliary contraction seems to be related to late-onset myopia. 2. Bovine ciliary muscle strips were suspended in a Magnus double tube. The changes in isometric tension of the strips, when chemicals were added, were measured with a force-displacement transducer. After the addition of the cholinergic agonist carbachol, the strips of ciliary muscle produced a tonic contraction. When the muscarinic receptor antagonist cyclopentolate was added, relaxation was produced. After the addition of ET-1, a dual response occurred which consisted of a moderate relaxation and a long-lasting contraction. The mean contraction caused by ET-1 was weak but continuous compared to carbachol. The contractile response was inhibited by an ETA receptor antagonist. Also, when takusha, one component of gorei-san, a Chinese drug, was added to the ciliary muscle strips, contraction with ET-1 was attenuated. Contraction of the ciliary muscle with ET-1 was attenuated after addition of sodium nitroprusside (SNP), an NO donor. This reaction suggests that NO causes relaxation of the bovine ciliary muscle through the activation of guanylyl cyclase and an increase in cyclic GMP. Currently, at least 5 muscarinic receptor subtypes are recognized; they are named M1 to M5. The effects of M1, M2, and M3 on the contractile response to transmural electrical stimulation of the bovine ciliary muscle were studied. The contractions produced by transmural electrical stimulation were greatly attenuated by 4-DAMP as an M3 antagonist. 3. We measured autofluorescence of the lens by fluorophotometry. A statistically significant relation was found between autofluorescence of the lens and refraction. 4. Possibility of axial elongation: The anterior and posterior suprachoroidal spaces are different anatomically and physiologically. When the choroid is stretched forward by accommodation, the intraocular pressure may exert more influence on the posterior part of the sclera, than on the anterior part. Using a fluorophotometer, fluorescence leakage at a site 3 mm in front of the retina was examined. Intensity of fluorescence 3 mm in front of the retina was strong in late-onset myopia. This may indicate disturbance of the barrier of the retinal pigment epithelium. When cultured fibroblasts of the sclera of the chick embryo was stretched by a stretching apparatus, proliferation of the cultured cells was inhibited. Therefore, some influence may involve the posterior part of the eyeball. III. Possibility of drug treatment of low myopia: From these results, muscarinic receptor antagonists (especially M3), ET receptor agtagonists, and NO donors are possible drugs for low myopia treatment. As there are many causative factors of low myopia, there are several treatment methods to be evaluated.

Adolescent↗
PubMed1998

Could a cycloplegic agent be replaced by a fogging or a corrective lens in the biometric measurement of the crystalline lens?

This study investigated whether a fogging or a corrective lens could be used to replace a cycloplegic agent in the ultrasonic measurement of crystalline lens thickness in myopia. A group of 28 Hong Kong Chinese adults with myopia was recruited. The crystalline lens thickness of the examined eye was measured by A-scan ultrasonography while the fixating eye was in one of three conditions: fog (+2.00 D fogging lens), full corrective lens, or cycloplegia (50 minutes after instillation of 1% cyclopentolate HCl). We found that the mean lens thickness was significantly different between the three conditions in our myopic subjects. The mean crystalline lens thickness under fogging and corrective lens conditions was significantly greater than the cycloplegic condition by 0.09 mm and 0.11 mm, respectively. The 95% limits of agreement compared to cycloplegia (fogging: -0.32 to +0.14; corrective: -0.35 to +0.13) showed marked intersubject variability, indicating that there is a risk of overestimating the lens thickness when substituting cycloplegia with either a fogging or a corrective lens.

Accommodation, Ocular↗
PubMedDate not supplied

Open drops in ophthalmology offices: expiration and contamination.

OBJECTIVE: To determine the relationship between eye drop use and contamination rate in ophthalmology offices. DESIGN: Following permission request, open bottles were examined and the nozzle tip and one drop of content was cultured on solid media. OUTCOME MEASURES: Drug category, volume, weight compared to full, clean legible label, expiration date; 2 or more bacterial colonies along the inoculation site. RESULTS: In 18 offices, of 1,485 open bottles (mean 12.2, range 4 to 23 per lane) on average 19.8% (range 0% to 88%) were expired (16.2 of 82.5 bottles per office). The frequency of occurrence (%) and expiration (%E) were 40.3% cycloplegics (19.4%E); 16.4% glaucoma (33.7%E); 10.8% anesthetics (8.8%E); and 4% steroids (8.8%E; or 42.2%E including one outlier). Most likely expired were glaucoma (P < 0.001); small 2-3 ml (P < 0.02), nearly empty (P < 0.05), or dirty (P < 0.001) bottles. Only one (5 ml cyclopentolate, not expired) grew a Micrococcus (0.07%). CONCLUSIONS: Drops in ophthalmology offices may be expired but are not contaminated.

Drug Contamination↗
PubMed2000

The use of cycloplegic agents. Results of a 1999 survey of German-speaking centers for pediatric ophthalmology and strabology.

INTRODUCTION: Because of its advantages, topical cyclopentolate is often preferred over the gold standard, atropine. The purpose of this study was to obtain an overview over current cycloplegia protocols and to estimate the likelihood of severe complications due to the use of cycloplegics. METHODS: A questionnaire was sent to 107 German-speaking centers with a supposed high frequency of cycloplegias. RESULTS: 57 centers answered, whereby 1,112 cumulated years of experience with cycloplegia were available for analysis. The frequency of cycloplegias varied between 2 and 180/week/center, median 25/week/center. A cumulated total of 1.7 million cycloplegias was computed. The extrapolated average experience with cycloplegia was 49,000 cycloplegias/30 years. Complications which would warrant a medical follow-up of several hours (severe complications) or which led to a follow-up in a ward (very severe complications) were named 47 times and 2 times, respectively. DISCUSSION: During 30 years of a cycloplegia career with an average of 34 cycloplegias/week, one may expect 2-10 severe or very severe complications. In current practice, the patient risk of severe complications is very small. Health care professionals and parents should be informed about the frequent occurrence of harmless side effects in order to achieve a good compliance with cycloplegia.

Child↗