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PubMed1992

A comparison of the effects of fluvoxamine and amitriptyline on autonomic functions in healthy volunteers.

We have compared the effects of single oral doses of fluvoxamine (50 mg and 100 mg), amitriptyline (50 mg and 100 mg), and placebo on some autonomic functions in ten healthy volunteers, using a balanced, double-blind, crossover design. Amitriptyline significantly reduced salivation, the miosis evoked by locally applied pilocarpine, and the sweat secretion evoked by locally applied carbachol. Fluvoxamine also significantly attenuated carbachol-evoked sweat gland activity, although to a smaller degree than amitriptyline; fluvoxamine did not significantly alter salivation or pilocarpine-evoked miosis. Neither treatment significantly altered the miotic responses evoked by brief light stimuli. Heart rate and blood pressure were not greatly affected by either treatment, although the fall in heart rate (erect posture) with placebo was significantly reduced by amitriptyline (100 mg). The results suggest that fluvoxamine has some anti-muscarinic activity in man, but is considerably less potent in this respect than amitriptyline.

Administration, Oral↗

PubMed1996

Pseudoexfoliation syndrome with poorly dilating pupil: a light and electron microscopic study of the sphincter area.

BACKGROUND: The study was carried out to examine histological changes in the iris sphincter muscle and surrounding tissue in eyes with pseudoexfoliation syndrome (PXS). METHODS: Seventeen patients with PXS, 14 of them having capsular glaucoma, were enrolled into the study. Iris biopsies were obtained during extracapsular cataract extractions (ECCE) requiring sphincterotomies. Thirteen biopsy specimens underwent histological examination by light microscopy, and four were examined with the electron microscope. Three iris biopsies from cadaver eyes and one obtained during ECCE from a patient with a miotic pupil (no PXS) served as control specimens on light microscopy. Electron microscopic controls included three iris specimens from cadavers. RESULTS: In the light microscopic examination, blood vessel walls were stained with Congo Red in seven of the 13 PXS specimens. In three of these seven specimens the stromal tissue was extensively fibrotized, and in two specimens fibrosis was moderate. Distinct stromal fibrosis was also observed in one and moderate fibrosis in two PXS specimens negative for amyloid. The control specimens were not positive for Congo Red, but stromal tissue was moderately fibrotized in one specimen. Light microscopy did not reveal differences in muscle tissue between PXS and control specimens. Electron microscopically, however, the muscle tissue was fibrotic or disorganized in three PXS specimens and in one control specimen. Fibrils, similar to the fibrillar component of pseudoexfoliation material described in previous studies, were found in intimate association with the capillary basal lamina in all of the PXS specimens showing muscular fibrosis. CONCLUSIONS: These findings support the theory that PXS is associated with amyloid, and in some PXS eyes miosis is connected with degenerative changes both in the stromal tissue and in the muscular layer of the iris.

Adult↗

PubMed1980

Opiate receptors in the rabbit iris.

Evidence pointing to the presence of opiate receptors in the rabbit iris was obtained in an in vivo study of the effects on the pupil of the intraocular injection of morphine (10--100 micrograms) and D-Ala2-met-enkephalinamide (D-Ala-E) (5--50 micrograms). Both opiates induced a significant dose-dependent decrease in pupillary size and an appreciable fluctuation of pupillary size. I.v. administration of naloxone (0.5 mg/kg) before or after injection of opiates prevented the miotic effect and the fluctuation of pupil size. The parallelism of the dose-response curves of opiates in the presence and absence of naloxone indicated competitive reversible antagonism.

Animals↗

PubMed1997

Ascorbic acid and amino acid values in the aqueous humor of a patient with Lowe's syndrome.

BACKGROUND: Aminoaciduria is found in Lowe's syndrome. No studies of concentrations of ascorbic acid and amino acids in the aqueous humor of the syndrome have been performed. We examined these concentrations in a patient with Lowe's syndrome. METHODS: Ascorbic acid and amino acid levels in the aqueous humor and plasma of a male infant were measured by means of high-performance liquid chromatography. The patient, who had congenital cataract, miotic pupils, opaque corneas, glaucoma, aminoaciduria, normal levels of ascorbic acid and amino acid in the plasma, and renal tubular acidosis, underwent trabeculotomy, lensectomy, and anterior vitrectomy in both eyes. RESULTS: Intraocular pressure in both eyes decreased to within the normal range, but both corneas remained opaque. The amino acid levels in the aqueous humor were similar to those in the plasma, but intracameral ascorbic acid levels were decreased. After topical instillation of ascorbic acid, the corneas became transparent. The proband's mother had good visual acuity but paracentral lens opacities in both eyes. His maternal grandmother had scattered cortical opacities in both lenses. CONCLUSION: In this infant with Lowe's syndrome, we found intracameral levels of amino acids similar to those in the plasma. Levels of ascorbic acid in the aqueous humor were decreased.

Adolescent↗

PubMed1995

Secondary exposure of medical staff to sarin vapor in the emergency room.

OBJECTIVE: To clarify the risk of secondary exposure of medical staff to sarin vapor in the emergency room, and to warn emergency room staffs of the hazard. DESIGN: Retrospective observational survey. SETTING: Emergency department of a university hospital in a metropolitan area of Japan. PARTICIPANTS: Fifteen doctors treating victims of a terrorist attack with sarin in the Tokyo subways on the day of the attack. MEASUREMENTS AND RESULTS: Of the 15 doctors who worked in the emergency room treating the victims, 13 became simultaneously aware of symptoms during the resuscitation of two victims who were exposed to sarin. Among 11 doctors (73%) who complained of dim vision, the pupils were severely miotic (<2 mm) in 8 (73%). Other symptoms included rhinorrhea in eight (53%), dyspnea or tightness of the chest in four (27%), and cough in two (13%). Atropine sulfate was given to six, and pralidoxime was given to one of these six doctors. To decontaminate the emergency room of sarin vapor, ventilation was facilitated and all belongings of the patients were sealed up. None of the doctors noticed worsening of their symptoms thereafter. CONCLUSIONS: Careful attention to the risks of secondary exposure to toxic gas in the emergency room and prompt decontamination if such exposure should occur are necessary in the case of large-scale disasters caused by sarin.

Adult↗

PubMed1989

Quantitative assessment of the optic nerve head with the laser tomographic scanner.

We describe the use of a laser tomographic scanner to objectively measure optic nerve head topography. A laser beam is focused on the optic disc using confocal imaging. Reflected light is detected only if it originates from a small region around the focal place of the special optics. Optic disc parameters are calculated from the measured values of confocal reflected light. In five glaucomatous eyes, maximum cup depth was between 0.33 mm and 0.58 mm. Cup volume was between 0.10 mm3 and 0.65 mm3; it correlated well with ophthalmoscopy. Compared with conventional imaging systems, the laser tomographic scanner has certain advantages: 1) images can be obtained with miotic pupils; 2) clarity of media is not important; 3) low light intensity is employed; and 4) a real time image is obtained.

Eye↗

PubMed1989

Fine structural defects in a case of congenital microcoria.

A case of congenital miosis associated with myopia and cataract is described. Tissue obtained at iridectomy was examined with the electron microscope and compared with a specimen of normal iris. The miotic iris was found to be hypoplastic and to display differences in the cellular density of the stroma. The contractile processes of the dilator myoepithelium were conspicuously absent from the underlying stroma, and the existing myofibrils were much disarranged.

Adult↗

PubMed1990

Naloxone induces miosis in normal subjects.

In a placebo-controlled trial, pupillary constriction was measured in healthy non-addicted subjects and in opiate addicts by using static computer-assisted pupillometry. In contrast to earlier reports, a clear-cut pupillary constriction was observed in healthy persons after a single intravenous injection of 0.4 mg naloxone. No significant changes of pupillary size were recorded in the same subjects after the administration of a placebo. In methadone-maintained subjects, the IV administration of 0.4 mg naloxone caused a significant pupillary dilatation. From these data it can be concluded that naloxone seems to have a central pharmacological action not only in opiate addicts, but also in healthy persons. This is demonstrable by studying the miotic response.

Adult↗

PubMed1996

Dapiprazole for patients with night haloes after excimer keratectomy.

BACKGROUND: Haloes causing difficulties during the night driving are one of the common complications of photorefractive keratectomy (PRK). The presumed reason for this phenomenon is the different refraction of light through the treated and untreated areas of the cornea. Its magnitude is proportional to the ratio between the treated area and pupil size. At nighttime, when the pupil dilates, rays from treated and untreated areas of the cornea reach the retina at different foci and produce haloes. We investigated whether dapiprazole, a miotic alpha-blocker drug, would be helpful in reducing night haloes in patients after PRK. METHODS: Twenty-four patients who complained of night haloes after PRK participated in our study. All were given dapiprazole 0.5% before night driving. Change in pupil size was recorded, and all patients completed a questionnaire on changes in the severity of haloes after instillation of dapiprazole. RESULTS: Improvement was described as very significant in five patients, moderate in ten and slight in seven. There was no improvement in two patients. The only side effect was slight irritation, which resolved within 1 h. CONCLUSION: Our results demonstrate that dapiprazole improves the subjective discomfort caused by night haloes in post-PRK patients.

Adrenergic alpha-Antagonists↗

PubMed1979

Morphometric analysis of B2cAMP induced reverse transformation in synchronized CHO cells.

Synchronized tranformed and reverse-transformed (by 10(-3) M B2cAMP) CHO-K1 cells, growing adherent to plastic, are characterized by means of geometric and densitometric parameters at the level of both the entire cell and of the nuclei at various time intervals after selective miotic detachment. Transformed and reverse-transformed cells triple-stained with Feulgen, Napthol Yellow S, and periodic acid-Schiff appeared very similar in terms of integrated optical density (IOD), related to either polysaccharides, protein, or DNA amount. On the other hand, a shift from a polygonal to a spindle-shaped morphology is a accompanied by a significant decrease in both form factor and average optical density (AOD) of intact cell and nuclei, which are the most conspicuous measured changes caused by B2cAMP, in addition to a lengthening of the cell cycle duration. In both control and treated cells, important and parallel cell-cycle-dependent modulations of geometric and densitometric parameters are also observed, for both the cytoplasmic (i.e., cell morphometry) and DNA space (i e., nuclear morphometry). Specifically, the modulation in nulear morphometry during G1, S, G2, and M phases confirms previous findings on synchronized HeLa cells. The optical density threshold-dependence of geometric parameters shows that, while becoming fusiform, the cytoplasm of reverse-transformed cells had a particularly low optical density precisely in the polar area. Utilization of such an approach in the development of an objective morphological classification of all cell lines grown as monolayers "in vitro" is also discussed.

Animals↗

PubMed2002

[Opioid intoxication following transdermal administration of fentanyl].

The case of a 77-year-old woman is described, who was found unconscious, with decreased respiration and miotic pupils, having previously experienced dizziness, nausea and drowsiness before. In the emergency room a fentanyl patch was detected, which had obviously been mistakenly applied by the patient the day before. Opioid intoxication was assumed and successfully treated with naloxon. The patient was supervised in an ICU for 24 h and sent home the next day without serious sequelae. The consequences following inappropriate use of transdermal fentanyl are discussed.

Administration, Cutaneous↗

PubMed2006

In vivo studies on the effects of alpha1-adrenoceptor antagonists on pupil diameter and urethral tone in rabbits.

Alpha1-adrenoceptors mediate contraction of iris dilator smooth muscle and hence pupil dilatation. We compared the ability of i.v. bolus injections of alfuzosin, doxazosin, naftopidil, prazosin, tamsulosin and terazosin to antagonise phenylephrine-induced mydriasis relative to their potency for inhibiting phenylephrine-induced elevations of intraurethral pressure (IUP) in rabbits. Moreover, we compared the ability of these drugs to induce miosis in conscious rabbits in the absence of phenylephrine. All antagonists inhibited the effects of phenylephrine on pupil size and IUP, and the ratio of the respective ED50 values was close to unity in all cases. The doses required to induce statistically significant miosis in the absence of phenylephrine were 30- to 100-fold higher than those inhibiting phenylephrine-induced mydriasis for all antagonists, except for naftopidil. Moreover, the miotic effects of all alpha1-adrenoceptor antagonists were fully reversible within 8 h. We conclude that alfuzosin, doxazosin, naftopidil, prazosin, tamsulosin and terazosin inhibit phenylephrine-induced mydriasis in the same dose range as they inhibit elevations in IUP. Higher doses of all antagonists are required to induce miosis in the absence of an exogenous agonist, and such miosis is always reversible within hours.

Adrenergic alpha-1 Receptor Antagonists↗

PubMed2003

The effects of different intraocular irrigating solutions on the apoptosis of cultured RPE cells.

PURPOSE: To investigate the effect on porcine retinal pigment epithelial (RPE) cells of modified intraocular irrigating solutions compared with BSS and BSS plus. METHODS: Confluent cultures of RPE cells were incubated in experimental intraocular irrigating solutions. The cells were then examined for breakdown of DNA by the TUNEL procedure. Fragmentation of the DNA from cells was also confirmed by flow cytometry. RESULTS: Most of the experimentally, treated cells exhibited a shrunken appearance for up to 72 h. There was a steady increase in the number of cells labeled by the TUNEL method in three solutions with time. The data demonstrated that the influence of solutions on the percentage of RPE cell nuclei that gave a clear positive TUNEL stain was, in ascending order: modified solution>BSS>BSS plus. Of the three solutions tested, BSS plus showed least apoptosis. CONCLUSIONS: It is suggested that BSS plus is less harmful to RPE cells than the other solutions tested. Introduction of other adjunctive solutions of antibiotics, mydriatics, miotics, and steroid, resulting in an altered electrolyte balance, pH, or osmolality in the solution, may compromise the safety and efficacy of a properly formulated and packaged solution.

Acetates↗

PubMed1989

Significance of the Argyll Robertson pupil in clinical medicine.

The Argyll Robertson pupil, a miotic pupil that fails to react to direct light, has been described for more than a century. Originally associated with tabes dorsalis, the sign has now been found in a number of conditions with lesions in the area of the nucleus of Edinger-Westphal. Magnetic resonance imaging studies have localized the lesion in patients with sarcoidosis and multiple sclerosis. With the declining incidence of neurosyphilis, the sign is increasingly likely to indicate another cause, although an assiduous search for lues should also be undertaken.

Brain Diseases↗

PubMed1976

Argon laser photomydriasis.

Argon laser photomydriasis was used to enlarge 20 miotic pupils in 18 open-angle glaucoma patients, with beneficial visual results in patients properly selected before treatment. During eight months of observation, significant complications such as persistent iritis and lens changes did not occur. An increase in intraocular pressure occasionally occurred shortly after treatment, but chronic exacerbation of underlying glaucoma was not observed. Argon laser iris photocoagulation in rabbit eyes showed localized atrophy of the iris sphincter and stroma within the treatment zones. Discrete, anterior lens opacities occurred only at high-power levels, and these appeared to be nonprogressive during the eight-week observation period.

Animals↗

PubMed1979

Lens implantation, miosis, and glaucoma.

In a series of 1,079 patients, average age 76.3 years, 48 eyes required an iridoplasty for chronic miosis and, of these, visual acuity was 6/12 (20/40) or better postoperatively in 89.6% (43). In those patients with glaucoma, the control of intraocular pressure was the same or better than post-operative levels in 83.3% (15) of patients. Lens implantation was not contraindicated in the miotic patient if adequate iris surgery was performed before both cataract extraction and implant insertion. When there was concomitant glaucoma, lens implantation was likewise not contraindicated if the glaucoma was well controlled.

Aged↗

PubMed1979

Mydriatic effect of anticholinergic drugs used during reversal of nondepolarizing muscle relaxants.

Large doses of anticholinergic drugs (atropine, glycopyrrolate) produced mydriasis in a group of adults with no eye abnormalities except strabismus, though the usual intramuscular and intravenous doses of these drugs do not have this tendency. Such large doses are often given intravenously during general anesthesia to prevent the side effects of neostigmine methylsulfate, which is used to reverse the effect of nondepolarizing muscle relaxants. Neostigmine methylsulfate (Prostigmin) reduced the mydriatic effect when given intravenously in conjunction with atropine or glycopyrrolate. Mydriasis was more likely to occur in lightly pigmented eyes than in eyes with dark irides. Pilocarpine eyedrops instilled at the beginning of anesthesia caused miosis that persisted after the large intravenous doses of atropine or glycopyrrolate were given. To prevent an attack of acute angle-closure glaucoma in any patient who is to receive large doses of anticholinergic drugs during general anesthesia, miotic drug therapy should be continued before, during, and after anesthesia at the same frequency as when awake.

Adolescent↗

PubMed1980

Central anterior chamber depth after laser iridectomy.

We found the true anterior chamber depth to be unaffected by successful laser iridectomy in ten eyes treated by this modality for chronic angle-closure glaucoma. The apparent general deepening seemed to be the result of peripheral chamber deepening combined with the common use of strong cycloplegic agents, reversing the shallowing effect of preoperative miotic medications.

Anterior Chamber↗