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PubMedDate not supplied

Ibopamine: a new preoperative mydriatic for cataract surgery.

Ibopamine is a dopaminergic mydriatic of proven use for fundoscopy. This double-blind prospective trial assessed its efficacy and safety as a preoperative mydriatic agent. 105 patients undergoing extracapsular cataract surgery were randomly allocated to receive Ibopamine 1%, Ibopamine 1% with Cyclopentolate 1%, or the control Phenylephrine 10% with Cyclopentolate 1%. Ibopamine alone achieved good mydriasis prior to anaesthesia, but this was not maintained intraoperatively. Cyclopentolate combined with Ibopamine, produced consistently greater mydriasis than when combined with Phenylephrine, but the difference became less marked as surgery continued. Analysis in relation to the stage of surgery showed that the greatest stimulus to miosis occurred during expression of the nucleus. Pulse rate and blood pressure in the 51 local anaesthetic cases showed no significant difference between the treatment groups, and there was no significant variation from baseline. The incidence of local side effects was similar in the three groups, and there were no systemic symptoms attributable to the drops. In conclusion, Ibopamine is a safe and effective mydriatic agent for cataract surgery, when used in combination with Cyclopentolate.

Aged↗
PubMedDate not supplied

A mydriatic eye-drop combination without systemic effects for premature infants: a prospective double-blind study.

Eye drops used for diagnostic mydriasis may produce systemic side effects in preterm infants. Studies on the pupil dilating and systemic effect of various mydriatic agents yielded conflicting results. We conducted a prospective randomized double-blind study on the systemic effect of two mydriatic eye-drop combinations. Thirty-nine preterm infants were randomly assigned to two groups. An eye-drop combination of 2.5% phenylephrine and 0.5% tropicamide (group D) was compared with the combination of 0.5% cyclopentolate and 0.5% tropicamide (group F). Either eye-drop combination was followed by 0.5% tropicamide given 20 minutes later. Heart rate (HR) and the systolic, mean, and diastolic blood pressure (BP) were recorded before and after eye-drop instillation and after ophthalmoscopy. A control session with NaCl eye drops was added for each infant. A significant increase of BP and HR peak values was observed within 7 to 10 minutes after the cyclopentolate/tropicamide combination only. On the other hand, the mydriatic effect of the phenylephrine/tropicamide combination was significantly superior to that of the cyclopentolate/tropicamide combination. We recommend the combination of 2.5% phenylephrine and 0.5% tropicamide to achieve a sufficient diagnostic mydriasis without systemic side effects in preterm infants.

Blood Pressure↗
PubMed1986

Aqueous vs viscous phenylephrine. II. Mydriatic effects.

We performed four studies to determine whether there is a difference in the mydriatic effect of 2.5% aqueous vs 2.5% viscous phenylephrine hydrochloride solutions. The first study was performed under "room light" conditions, and the mean (+/- SD) dilation at one hour was 0.87 +/- 1.18 mm for the aqueous and 0.86 +/- 1.14 mm for the viscous solutions. The second study was performed in a darkened room, and the mean dilation at one hour was slightly greater than in room light but was still minimal (aqueous, 1.14 +/- 1.00 mm; viscous, 1.07 +/- 1.11 mm). In the third study, patients were pretreated with a topical anesthetic (0.5% proparacaine hydrochloride), and the mean one-hour dilation was approximately twice (aqueous, 2.30 +/- 0.81 mm; viscous, 2.41 +/- 0.88 mm) that found in patients who were not pretreated with proparacaine. In the fourth study, the two phenylephrine solutions were used in combination with 1% tropicamide, and the mean one-hour dilation was 3.8 +/- 0.82 mm for the aqueous and 3.8 +/- 0.98 mm for the viscous solutions. Our studies show that there is no difference in the mydriatic effect of 2.5% aqueous vs 2.5% viscous phenylephrine solutions when used alone or in combination with 0.5% proparacaine or 1% tropicamide.

Adult↗
PubMedDate not supplied

Modification of a Kowa RC-2 fundus camera for self-photography without the use of mydriatics.

Research on retinal circulation during space flight required the development of a simple technique to provide self monitoring of blood vessel changes in the fundus without the use of mydriatics. A Kowa RC-2 fundus camera was modified for self-photography by the use of a bite plate for positioning and cross hairs for focusing the subject's retina relative to the film plane. Dilation of the pupils without the use of mydriatics was accomplished by dark adaption of the subject. Pictures were obtained without pupil constriction by the use of a high speed strobe light. This method also has applications for clinical medicine.

Fluorescein Angiography↗
PubMed1999

Comparison of mydriatic efficacy of spray application and drop instillation of tropicamide 1%.

PURPOSE: To determine whether the mydriatic efficacy of spray application of tropicamide 1% is comparable to drop instillation of tropicamide 1%, and to compare the ocular discomfort caused by these methods. METHODS: Thirty-four healthy volunteers were randomly assigned to one of two groups, and received either a single drop of tropicamide 1% eye drops or a single puff of tropicamide 1% spray into open eyes. Pupil diameters were measured from anterior segment images taken using a Topcon Imagenet system at baseline and at the fifth, tenth and fifteenth minute after drug administration. Ocular discomfort experienced with each method was also compared. RESULTS: Repeated measures analysis of variance revealed that a statistically significant increase in pupil diameter was achieved with both application methods over time (p < 0.0001), and that there were no statistically significant differences in pupil diameter between the two groups at each time point (p = 0.409). The mean ocular discomfort score for tropicamide 1% spray was 1.45 +/- 0.56, and for tropicamide 1% eye drops was 2.71 +/- 0.67. This difference was statistically significant (p < 0.001). CONCLUSIONS: The mydriatic efficacy of tropicamide 1% spray is similar to that of conventional tropicamide 1% eye drops, and spray application causes less ocular discomfort.

Adult↗
PubMedDate not supplied

Effects of mydriatics on intraocular pressure and pupil size in the normal feline eye.

OBJECTIVE: To determine the effect of various mydriatics (1% atropine, 1% cyclopentolate, 0.5% tropicamide, 10% phenylephrine) on intraocular pressure (IOP) and pupil size (PS) in normal cats. ANIMALS STUDIED: The mydriatics were tested in 10 adult ophthalmoscopically normal European Domestic Short-haired cats. Procedure Single-dose drug studies were divided into placebo (vehicle of phenylephrine), 10% phenylephrine, 0.5% tropicamide, 1% cyclopentolate and 1% atropine. After measurement of IOP and pupil size (PS) at 8 a.m. on the first day, one drop of the tested drug was applied to one randomly selected eye. The IOP and PS were measured for a minimum of 36 h until the pupil returned to pretest size. RESULTS: Ten per cent phenylephrine had no significant effect on IOP, and the effect on the pupil size was minimal (<or= 1 mm difference). One per cent atropine showed a maximal mean difference of 4.3 mmHg +/- 4.1 mmHg in IOP compared to the untreated eye. These differences were statistically significant at 1, 3, 6, 12 and 16 h post-treatment. At 1, 1.5 and 2 h after unilateral application of 1% cyclopentolate, the IOP in the treated eye was significantly higher than the IOP in the untreated eye with a maximal mean difference of 4.1 mmHg +/- 4.5 mmHg. With 0.5% tropicamide, IOP of the treated eye was significantly higher than IOP of the untreated eye at 1 and 1.5 h after treatment with a maximal mean difference of 3.5 mmHg +/- 3.3 mmHg. One per cent atropine caused the greatest increase in IOP, followed by 1% cyclopentolate and 0.5% tropicamide. The dilating effect of atropine, cyclopentolate and tropicamide lasted longer than the effect on intraocular pressure. CONCLUSIONS: The parasympatholytics 1% atropine, 1% cyclopentolate and 0.5% tropicamide caused a statistically significant elevation of IOP and produced mydriasis in the treated eye in normal cats, while the sympathomimetic 10% phenylephrine had no significant effect on IOP or pupil size.

Administration, Topical↗
PubMed1990

Non-mydriatic retinal photography as a screening service for general practitioners.

Non-mydriatic retinal photography was offered as a screening service to 37 general practitioners providing diabetes care in their practices. Of 84 patients photographed, 22 had appearances of diabetic retinopathy and these were compared with 25 of the remainder without retinopathy. In only seven of 11 patients with maculopathy or proliferative retinopathy had this been detected by their GP and, likewise, only six of 11 cases of probable background retinopathy had been detected. The mean annual examination rate in general practice was 33 (95% Cl 18-47)%. Of the 18 cases in whom action in response to recommendations for follow-up or referral could be ascertained, 15 (83%) had had the recommendations implemented. Thus, despite the potential risks of false-negative screening using non-mydriatic retinal photography, the technique may improve the comprehensiveness of screening in patients under the care of their GPs.

Diabetic Retinopathy↗
PubMed2004

Diabetic retinopathy screening using digital non-mydriatic fundus photography and automated image analysis.

PURPOSE: To investigate the use of automated image analysis for the detection of diabetic retinopathy (DR) in fundus photographs captured with and without pharmacological pupil dilation using a digital non-mydriatic camera. METHODS: A total of 83 patients (165 eyes) with type 1 or type 2 diabetes, representing the full spectrum of DR, were photographed with and without pharmacological pupil dilation using a digital non-mydriatic camera. Two sets of five overlapping, non-stereoscopic, 45-degree field images of each eye were obtained. All images were graded in a masked fashion by two readers according to ETDRS standards and disagreements were settled by an independent adjudicator. Automated detection of red lesions as well as image quality control was made: detection of a single red lesion or insufficient image quality was categorized as possible DR. RESULTS: At patient level, the automated red lesion detection and image quality control combined demonstrated a sensitivity of 89.9% and specificity of 85.7% in detecting DR when used on images captured without pupil dilation, and a sensitivity of 97.0% and specificity of 75.0% when used on images captured with pupil dilation. For moderate non-proliferative or more severe DR the sensitivity was 100% for images captured both with and without pupil dilation. CONCLUSION: Our results demonstrate that the described automated image analysis system, which detects the presence or absence of DR, can be used as a first-step screening tool in DR screening with considerable effectiveness.

Area Under Curve↗
PubMed2006

Redilatation with intracameral mydriatics in phacoemulsification surgery.

PURPOSE: To determine whether intracameral mydriatics can redilate pupils that contract during phacoemulsification cataract surgery. METHODS: A total of 80 patients were included in this prospective, randomized, double-blind study performed at Ornsköldsviks Hospital Eye Clinic. Of these, 60 patients had 0.6 microg/ml of epinephrine added to the balanced salt solution (BSS) used for irrigation and 20 patients did not. The patients in each group were randomized and given either an intracameral mydriatics (ICM) solution or placebo intracamerally after phacoemulsification and cortex cleaning. The pupil size was registered preoperatively, after cortex cleaning, 30 seconds after study injection, 2 mins after study injection and the day after surgery. RESULTS: No clinically relevant differences were found preoperatively. In the epinephrine material a significantly longer operation time (p = 0.023) and more procedures requiring Vision Blue and Kelman-type tip in the placebo group might indicate diversity in the grade of cataract. There was a greater degree of contraction in the absence of epinephrine in the irrigation solution (2.3 +/- 1.0 mm in the ICM group and 3.2 +/- 0.7 mm in the placebo group) compared to in the presence of epinephrine. With no epinephrine ICM significantly redilated the pupils at 30 seconds (p < or = 0.001) as well as at 2 mins (p = 0.015). CONCLUSION: We have shown that in cases with an intraoperative pupil contraction, ICM is effective in redilating the pupil. Insufficient adrenergic stimulation of the pupil dilator appears to be a major factor causing intraoperative pupil contraction during phacoemulsification cataract surgery.

Aged↗
PubMed1990

Comparison of non-mydriatic retinal photography with ophthalmoscopy in 2159 patients: mobile retinal camera study.

OBJECTIVE: To determine whether non-mydriatic Polaroid retinal photography was comparable to ophthalmoscopy with mydriasis in routine clinic screening for early, treatable diabetic retinopathy. DESIGN: Prospective study of ophthalmoscopic findings according to retinal camera screening and ophthalmoscopy and outcome of referral to ophthalmologist. SETTING: Outpatient diabetic clinics of three teaching hospitals and three district general hospitals. PATIENTS: 2159 Adults selected randomly from the diabetic clinics, excluding only those registered as blind or those in wheelchairs and unable to enter the screening vehicle. MAIN OUTCOME MEASURES: Numbers of patients and eyes correctly identified by each technique as requiring referral with potentially treatable retinopathy (new vessel formation and maculopathy) and congruence in numbers of microaneurysms, haemorrhages, and exudates reported. RESULTS: Camera screening missed two cases of new vessel formation and did not identify a further 12 but indicated a need for referral. Ophthalmoscopy missed five cases of new vessel formation and indicated a need for referral in another four for other reasons. Maculopathy was reported in 147 eyes with camera screening alone and 95 eyes by ophthalmoscopy only (chi 2 = 11.2; p less than 0.001), in 66 and 29 of which respectively maculopathy was subsequently confirmed. Overall, 38 eyes received laser treatment for maculopathy after detection by camera screening compared with 17 after ophthalmoscopic detection (chi 2 = 8.0; p less than 0.01). Camera screening underestimated numbers of microaneurysms (chi 2 = 12.9; p less than 0.001) and haemorrhages (chi 2 = 7.4; p less than 0.01) and ophthalmoscopy underestimated hard exudates (chi 2 = 48.2; p less than 0.001). CONCLUSIONS: Non-mydriatic Polaroid retinal photography is at least as good as ophthalmoscopy with mydriasis in routine diabetic clinics in identifying new vessel formation and absence of retinopathy and is significantly better in detecting exudative maculopathy.

Adolescent↗
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↗
PubMed2006

Randomised controlled single-blind study of conventional versus depot mydriatic drug delivery prior to cataract surgery.

BACKGROUND: A prerequisite for safe cataract surgery is an adequately dilated pupil. The authors conducted a trial to assess the efficacy (in terms of pupil diameter) of a depot method of pre-operative pupil dilatation, as compared with repeated instillations of drops (which is time-consuming for the nursing staff and uncomfortable for the patient). METHODS: A prospective randomised masked trial was conducted comprising 130 patients with no significant ocular history undergoing elective clear corneal phacoemulsification. 65 patients had mydriatic drops (Tropicamide 1%, Phenylephrine 2.5%, Diclofenac sodium 0.1%) instilled prior to surgery, 65 had a wick soaked in the same drop mixture placed in the inferior fornix. Horizontal pupil diameters were recorded on a millimetre scale immediately prior to surgery. RESULTS: There was no significant difference in pupil size between the two groups (p = 0.255, Student's t-test). CONCLUSION: There was no significant difference between the mydriasis obtained with the depot system compared with conventional drop application. Use of a depot mydriatic delivery system appears to be a safe and efficient method of drug delivery. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number Register ISRCTN78047760.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1994

[Siebold's mydriatic eyedrops].

I discovered two prescriptions of mydriatic eye drops that seemed to be written by Von Siebold. One prescription (prescription 1) belongs to the Siebold Memorial Hall in Nagasaki City, and the other (prescription 2) to the Municipal Museum in Ohzu City in Ehime Prefecture. Prescription 2 does not bear Siebold's signature but can be considered to have been written by him based on handwriting analysis. The major drugs in these prescriptions are Ex Belladonna and Ex Hyoscyamus. However, both prescriptions seem to have been written not only for mydriasis but also for antiphlogistic, analgesic and anticonvulsant effects in patients with eye disease. Based on the notes of the JP III and JP V, the mydriatics used by Siebold in operations such as for cataract were Ex Belladonna and Ex Hyoscyamus at a concentration of about 1%. Prescription 1. For a male with eye disease. Ex Belladonna 0.65 g; Laudanum 20 drops; Barium chloride 1.3 g; Rose water or chamomile water 124.4 g. Administer 3 times/day. Von Siebold (signature). Prescription 2. For Soya's daughter in Narutaki. Ex Hyoscyamus 0.39 g; Rose water 62.2 g. Administer some drops twice/day.

Eye Diseases↗
PubMed2005

Effective and accurate screening for diabetic retinopathy using a 60 degree mydriatic fundus camera.

UNLABELLED: OBJECTIVES. To establish whether an experienced endocrinologist could screen accurately for diabetic retinopathy using mydriatic 60 degree fundus photographs compared with a reference standard, viz. the combined highest scores of two experienced ophthalmologists. DESIGN: Retrospective review of 60 degree colour transparency photographs taken over a 6-year period. Retinopathy was graded in a standardised way. SETTING: Patients attending the diabetic clinic at Johannesburg Hospital, South Africa. SUBJECTS: Fifteen hundred and seventeen patients (2446 eyes) formed the basis for the study. Patients were included if there was more than 50% readability of the fundus photographs. OUTCOME MEASURES: Outcome measures were prevalence of any retinopathy and presence of referable (severe) retinopathy. Interobserver agreement was measured using the kappa statistic, and sensitivity and specificity of the screener were evaluated. RESULTS: The prevalence of retinopathy at the clinic was approximately 30%, but only about 12% was severe enough to warrant referral to the ophthalmology outpatient department. The endocrinologist was very accurate in determining cases requiring referral; there was 97% agreement with the reference standard, viz. the combined highest score of two experienced ophthalmologists (gold standard). Correlation on the determination of any retinopathy was less accurate (80% agreement), mostly owing to the endocrinologist reporting more isolated microaneurysms than the ophthalmologists. The screening method used gave a sensitivity of 83% and specificity of 99% which are within recommended standards. CONCLUSIONS: The screening strategy using a mydriatic fundus camera at the diabetic clinic was found to be effective and accurate and greatly reduced the number of possible referrals to the ophthalmology outpatient department.

Adult↗
PubMed1991

Allergic contact sensitivity to mydriatic agents on a nurse's fingers.

We report a case of contact sensitivity to a cycloplegic mydriatic agent (Mydrin-P) on the fingers of a nurse whose work included the instillation of eyedrops into patients undergoing routine funduscopic examination in a hospital ophthalmology department. The lesion showed well-demarcated brownish erythema with scaling on the second and third fingers of her left hand, which are used for opening the eyes of patients and are subjected routinely to contact with leaking mydriatic eyedrops. The results of a patch test to Mydrin-P and to its pharmacologic components tropicamide and phenylephrine hydrochloride were positive. These chemicals seem to be weak antigens since reports of allergic reactions to them are rare. This case exemplifies a unique occupational contact dermatitis.

Adult↗
PubMed1983

A clinical comparison of mydriatics.

Clinicians use various topical agents for mydriasis in evaluation of the retina and its periphery. This paper shows the use of two mydriatic methods for this procedure--a combination of one drop 1% tropicamide (Mydriacyl) and the drop 1% hydroxyamphetamine hydrobromide (Paredrine) in comparison with the regimen of two drops 1% tropicamide (Mydriacyl) separated by five minutes. The degree of dilation, the resistance to intense comparable binocular indirect ophthalmoscope (BIO) illumination and the time recovery from these agents were evaluated in an optometric clinical setting. The same degree of mydriasis was demonstrated at the p greater than 0.01 level with these two regimens. The two regimens appear to be clinically similar for cycloplegic and mydriatic recovery time.

Adult↗
PubMed1982

Mydriatic and cycloplegic drugs: a review of ocular and systemic complications.

Complications from mydriatic and cycloplegic drugs are rare compared with their extensive use. Adverse effects are often related to dosage or other factors. The ocular complications include increased intraocular pressure, pigmentation of the conjunctiva and cornea, pigment in the anterior chamber, lacrimal duct blockage, macular edema, corneal endothelium damage, hyperemia, allergy, discomfort, and blurred vision. The systemic complications are those common to sympathomimetic and parasympatholytic drugs and include tachycardia, hypertension, headache, faintness. pallor, trembling, excessive sweating, palpitations, arrhythmias, confusion, hallucinations, drowsiness, ataxia, flushed skin, high fever, dysarthria, thirst, dry mouth, convulsions, disorientation, nervousness, coma, and death. An understanding of all possible side effects is of paramount importance to those using these drugs in the treatment of anticholinesterase poisoning. This review is intended as a ready reference to the adverse effects of mydriatic and cycloplegic drugs.

Adolescent↗
PubMed1996

Effects of mydriatic agents in cockatoos, African gray parrots, and Blue-fronted Amazon parrots.

OBJECTIVE: To compare, in psittacines, the mydriatic effects of several topically applied curariform, sympathomimetic, and parasympatholytic drugs with and without the addition of surface-acting penetrating agents. DESIGN: Prospective, randomized controlled trial. ANIMALS: 10 adult cockatoos (Cacatua sulphurea subspecies), 2 adult African gray parrots (Psittacus erithacus), and 3 adult Blue-fronted Amazon parrots (Amazona aestiva). PROCEDURE: Three curariform drugs (d-tubocurarine, pancuronium, and vecuronium bromide) and 2 autonomic drugs (atropine and phenylephrine hydrochloride) were evaluated. Drugs were tested with and without the addition of a surface-acting penetrating agent, either saponin or benzalkonium chloride. The agent that resulted in the most significant change in pupillary diameter with the fewest systemic side effects in the cockatoos then was evaluated for its effects in the African gray parrots and the Blue-fronted Amazon parrots. During each drug trial, 1 eye was randomly selected to receive the control drug (0.9% NaCl), and the opposite eye was selected to receive the test drug. Each pupil was videotaped 5 (cockatoos only), 15, 30, 45, 60, and 75 minutes after treatment. Pupil diameters were measured by use of a computerized image analysis system. Data for pupil size were analyzed by means of repeated measures ANOVA. RESULTS: Vecuronium without the addition of a surface-acting penetrating agent produced the most consistent and greatest pupillary dilatation in all 3 species with the fewest systemic side effects. CLINICAL IMPLICATIONS: Vecuronium is potentially a clinically useful, topical mydriatic agent for use in avian species. Documented differences in the prevalence of systemic side effects between species suggests that caution should be applied when applying this drug bilaterally.

Animals↗