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At least 271 records · Page 15Linked to original sources
PubMed1979

Management of acute closed-angle glaucoma with miotics and timolol.

The hypotensive effect of intramuscular or intravenous acetazolamide with frequent instillation of 2% or 4% pilocarpine in polyvinyl alcohol, or with single drops of pilocarpine in polyvinyl alcohol or oily vehicles, and the hypotensive effect of topical timolol alone and together with pilocarpine was investigated in the treatment of acute closed-angle glaucoma in 75 patients (81 eyes). The results showed that there was no marked difference in the hypotensive effect whether pilocarpine was used frequently or in a single dose, in different concentrations, or in different vehicles after acetazolamide. Topical timolol alone was not effective enough to control the intraocular pressure in acute closed-angle glaucoma, but a good hypotensive effect was seen when topical timolol was followed by pilocarpine. It is concluded that 1 drop of pilocarpine 3 hours after intravenous or intramuscular acetazolamide or after topical timolol may be sufficient to terminate an acute attack. Topical timolol may serve as a valuable alternative when systemic medication is contraindicated.

Acetazolamide↗
PubMed2006

Miotic action of tramadol is determined by CYP2D6 genotype.

Polymorphic CYP2D6 is the enzyme that activates the opioid analgesic tramadol by O-demethylation to its active metabolite O-demethyltramadol (M1). Our objective was to determine the opioid effects measured by pupillary response to tramadol of CYP2D6 genotyped volunteers in relation to the disposition of tramadol and M1 in plasma. Tramadol displayed phenotypic pharmacokinetics and it was possible to identify poor metabolizers (PM) with >99% confidence from the metabolic ratio (MR) in a single blood sample taken between 2.5 and 24 h post-dose. Homozygous extensive metabolizers (EM) differed from PM subjects by an almost threefold greater (P=0.0014) maximal pupillary constriction (Emax). Significant correlations between the AUC and Cmax values of M1 versus pupillary constriction were found. The corresponding correlations of pharmacokinetic parameters for tramadol itself were weaker and negative. The strongest correlations were for the single-point metabolic ratios at all sampling intervals versus the effects, with rs ranging from 0.85 to 0.89 (p<0.01). It is concluded that the concept of dual opioid/non-opioid action of the drug, though considerably stronger in EMs, is valid for both EM and PM subjects. This is the theoretical basis for the frequent use and satisfactory efficacy of tramadol in clinical practice when given to genetically non-selected population.

Adult↗
PubMed1976

Effects of mydriatics and a miotic on ocular discomfort and pupil responses.

Mydriatics produced two different effects on the discomfort threshold following administration of the drugs depending upon whether the mydriasis was produced by paralysis of the sphincter muscle or by activation of the dilator. When the sphincter was paralyzed by tropicamide, the discomfort threshold was elevated during the period of time that the pupillary light reflex was significantly reduced to the flashing stimulus. Initially, phenylephrine-induced mydriasis had no effect on the discomfort threshold, but as the pupil responses returned to normal the threshold rapidly increased and then gradually returned to a pre-drug level. The return of the threshold back to normal seemed to parallel the decline of action of phenylphrine on the dilator muscle. Significant impairment of the light reflex by pilocarpine-produced miosis was also related to an increase of the discomfort threshold.

Humans↗
PubMed1989

The effect of chronic miotic therapy on the results of posterior chamber intraocular lens implantation and trabeculectomy in patients with glaucoma.

We reviewed the charts of 18 patients (20 glaucomatous eyes) who had not used pilocarpine prior to undergoing trabeculectomy combined with or performed later with posterior chamber lens implantation. We then compared postoperative results and complications in these patients with those in 35 other patients (40 glaucomatous eyes) in two age- and stage-matched groups who had used pilocarpine prior to undergoing the same procedures. All patients had a minimum follow-up of 6 months. There was no significant difference between these groups in terms of postoperative intraocular pressure and required glaucoma medications. However, in the pilocarpine-treated groups, there was a significantly higher incidence of complications, especially intraocular lens capture (P less than 0.05), and of worse visual outcomes (P less than 0.01).

Aged↗