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At least 541 records · Page 30Linked to original sources
PubMed2000

Abuse potential of morphine/dextromethorphan combinations.

The potentiation of morphine analgesia by dextromethorphan raises the issue of whether dextromethorphan also potentiates those actions of morphine that lead to abuse. Clinical pharmacology experiments indicated that dextromethorphan does not potentiate the euphorigenic and miotic actions of morphine. Morphine suppresses the dysphoric action of dextromethorphan. A second set of experiments indicated that dextromethorphan does not alter the response to naloxone-precipitated withdrawal. In a third set of experiments, dextromethorphan did not alter the morphine-induced depression in the slope of the increase in minute volume in response to breathing increased CO2. In contrast to potentiation of analgesia, dextromethorphan does not enhance the euphorigenic, physical dependence, and respiratory depressant actions of morphine. These findings indicate that dextromethorphan does not enhance the abuse potential of morphine and that the potentiation of analgesia appeared to be selective.

Analgesics, Opioid↗
PubMed2000

Evaluation of giant-cell deposits on foldable intraocular lenses after combined cataract and glaucoma surgery.

PURPOSE: To compare the incidence of inflammatory giant-cell deposits (IGCDs) on various foldable intraocular lenses (IOLs) after combined cataract and glaucoma surgery. SETTING: The Phillips Eye Institute, Minneapolis, Minnesota, USA. METHODS: In this prospective randomized clinical trial, 128 patients were randomized to receive a single-piece, first-generation silicone lens (n = 36); a 3-piece acrylic lens (n = 40); or 3-piece, second-generation silicone lens (n = 52). All patients had combined phacoemulsification and trabeculectomy with mitomycin-C by 1 surgeon using a standardized technique. Dilated biomicroscopy was used to identify and quantitate IGCDs on the surface of the IOLs using a 6-point grading scale. RESULTS: Inflammatory giant-cell deposits were identified on 21 of 128 IOLs. Lens design was the most significant risk factor for deposit formation (P =.004). Inflammatory giant-cell deposits were most common in the first-generation silicone plate lens group (33%), less common in the acrylic lens group (15%), and least common in the 3-piece, second-generation silicone group (5.8%). Density of the deposits was significantly greater on the plate lens than the acrylic or the 3-piece silicone lenses (P <.0001). Although IOL design was the most significant risk factor for IGCD formation, other significant risk factors included intraoperative pupil stretch (P =.02) and preoperative miotic use (P =.04). CONCLUSION: Inflammatory giant-cell deposit formation was significantly greater on first-generation silicone plate IOLs than on acrylic or second-generation silicone IOLs. The deposits were somewhat more common on acrylic IOLs than on second-generation silicone IOLs. However, this difference was not clinically or statistically significant.

Anti-Inflammatory Agents↗
PubMed2000

Scleral fixation technique using 2 corneal tunnels for a dislocated intraocular lens.

Several techniques are used to reposition dislocated intraocular lenses (IOLs). Most place a suture loop around the end of the haptic. However, in cases of a dislocated capsular bag containing the IOL, a dislocated IOL with a large haptic, or a miotic pupil, it is not easy to see the haptic ends to place the suture loop. We describe a scleral fixation technique that uses 2 corneal tunnels. A double-armed 10-0 polypropylene suture loop can be introduced through 1 corneal tunnel and placed around any accessible part of the haptic with the help of a bent 26 gauge needle. This modified technique is an easy and effective way to reposition the IOL.

Biocompatible Materials↗
PubMed2001

Effect of brimonidine tartrate ophthalmic solution 0.2% on pupil size in normal eyes under different luminance conditions.

PURPOSE: To evaluate the effect of brimonidine tartrate ophthalmic solution 0.2% (Alphagan) on pupil size in normal eyes. Three luminance conditions were used to assess the potential use of brimonidine in postoperative refractive patients who experience nighttime vision problems related to large pupil size. SETTING: McDonald Eye Associates, Fayetteville, Arkansas, USA. METHODS: Pupil size was measured in 16 eyes of 16 participants with the Colvard pupillometer under 3 luminance conditions. One drop of brimonidine 0.2% was administered to each patient. Pupil size was then measured using the same technique 30 minutes and 4 and 6 hours after drop administration. RESULTS: Under scotopic conditions, 100% of the pupils showed significant miosis at 30 minutes (P <.05). The effect continued in all eyes for 4 hours. At 6 hours, a miotic effect was still present in 81.3%. However, under photopic luminance, there was no significant effect on pupil size in all 16 eyes (P >.05). The pupil size in 5 eyes (31.2%) was not affected at 30 minutes or 4 or 6 hours. At 6 hours, 15 eyes (93.8%) had returned to their preinstillation size. CONCLUSION: Brimonidine tartrate 0.2% had a significant effect in decreasing pupil size under scotopic conditions. The results indicate that the drug can decrease night-vision difficulties such as halos, star bursts, glare, and monocular diplopia in postoperative refractive patients.

Adrenergic alpha-Agonists↗
PubMed1992

Relationship between postoperative pupil size and disability glare.

A group of 40 postoperative cataract patients had Miller-Nadler glare testing performed before and after midpupillary pharmacologic dilation. The results indicated that pupillary enlargement is associated with increased glare disability. For that reason it is essential to maintain normal pupil shape and function after cataract surgery, a difficult task in cases with miotic pupils.

Cataract Extraction↗
PubMed1991

Intraocular dapiprazole for the reversal of mydriasis after extracapsular cataract extraction with intraocular lens implantation. Part I: Dose-response correlation.

Dapiprazole, an alpha-blocking miotic drug, was used intracamerally at the end of extracapsular cataract extraction with posterior chamber intraocular lens (IOL) implantation. The double-blind study included 120 patients divided into four groups of 30 eyes; the groups received balanced salt solution, 0.125%, 0.25%, or 0.5% intraocular dapiprazole after IOL implantation and before suturing. Pupillary diameter recordings were performed immediately before and a few minutes after drug injection and two, four, and eight hours after surgery. The results showed a significant reversal of mydriasis by intraocular dapiprazole, especially with the 0.25% and 0.5% concentrations which did not differ significantly in effectiveness and safety.

Adrenergic alpha-Antagonists↗
PubMed1995

Atonic pupil after cataract surgery.

We report and describe the clinical findings of three patients who developed atonic pupil after uncomplicated extracapsular cataract extraction with posterior chamber intraocular lens implantation. All patients had normally reactive pupils one day postoperatively, but after two weeks, the pupils were dilated and nonreactive to light, accommodation, and miotics. To estimate the incidence of atonic pupil after cataract surgery, we sent a survey on the frequency, clinical features, and possible etiologies of this syndrome to members of the American Society of Cataract and Refractive Surgery. Of the 567 respondents, 60% had seen at least one case of atonic pupil in the past five years; they reported a total of 1543 cases during that time. This is probably a conservative figure since many cases undoubtedly go unnoticed because of a lack of visual disturbance. We believe this condition occurs more frequently than previously reported. The atonic pupil should be recognized as a possible complication of cataract surgery that should be included in the preoperative consent form.

Aged↗
PubMed1991

Effect of a resutured iridotomy on glare disability in glaucoma patients having cataract surgery.

Twenty-two glaucoma patients with fixed miotic pupils prior to cataract surgery were retrospectively divided into two groups: Group A in which the sector iridotomy was resutured after intraocular lens insertion; Group B in which the sector iridotomy was not resutured. The two groups were matched for average age, sex, average disease duration, glaucoma type, operation type, mean follow-up, and average intraocular pressure and cup/disc ratio. Glare disability was measured with the Miller-Nadler tester. A similar reduction in visual acuity under glare was found in the two groups: 0.55 + 1.2 and 0.45 + 0.9 Snellen lines for Groups A and B, respectively. These findings are explained by two additional observations: Reduction in visual acuity under glare was positively correlated to the degree of posterior capsule opacity (r=0.4) and not to the functional pupillary area (r=0.13). Functional pupillary area (upper lid in normal position) was 42% larger in the nonresutured group compared to 85% difference in the total pupillary area.

Aged↗
PubMed1986

Fox shield treatment of the UGH syndrome.

The uveitis-glaucoma-hyphema (UGH) syndrome has been described with all types of intraocular lenses. The usual forms of therapy include miotics, mydriatics, steroids, antiglaucomatous medications, laser therapy, and surgical explanation. I describe five patients in whom the UGH syndrome resolved after long-term Fox shield treatment to prevent nocturnal hand-eye trauma.

Aged↗
PubMed1989

Clinical evaluation of the effect of acetylcholine on the corneal endothelium.

A transient corneal edema is often seen after the injection of acetylcholine solution in the anterior chamber during cataract surgery. Ninety eyes of 90 patients scheduled for extracapsular cataract extraction with posterior chamber intraocular lens implantation were randomly assigned to two groups: one which received acetylcholine solution in the anterior chamber and one, a control group, which received only external conjunctival pilocarpine drops as a miotic. At three days, endothelial folds (P = .04) and corneal edema (P = .01) were more pronounced in the acetylcholine group; at seven days, endothelial folds were more severe (P = .04) in the acetylcholine group. At 30 days, the acetylcholine group showed a 37.2% increase (P = .01) of the endothelial cell area, whereas the control group showed a 7.08% increase. The difference between the groups was statistically significant (P = .05). Anterior chamber fluorophotometry at 30 days showed an increase of the corneal transfer coefficient that was higher but not significant in the acetylcholine group. We suggest caution in the intraoperative use of acetylcholine solution, particularly in those eyes showing a preoperative compromise of the endothelium.

Acetylcholine↗
PubMed2003

Transient nonketotic hyperglycinemia: two case reports and literature review.

Transient nonketotic hyperglycinemia is characterized by clinical and biochemical findings similar to those seen in classic nonketotic hyperglycinemia. Abnormalities in amino acids are partially or completely resolved in a period ranging from days to months. Almost all patients with the classic form of nonketotic hyperglycinemia survive with severe neurologic sequela, whereas most of the patients with the transient form exhibit normal development. Therefore, distinguishing the transient form of nonketotic hyperglycinemia from classic nonketotic hyperglycinemia is important to predict outcome of the patients. Transient nonketotic hyperglycinemia has been reported in only seven neonates. This article adds two cases to the transient nonketotic hyperglycinemia and reviews the relevant literature. Common clinical features were determined, and presence of miotic pupils was stressed.

Fatal Outcome↗
PubMed2002

Eudragit RS100 nanosuspensions for the ophthalmic controlled delivery of ibuprofen.

Topical application of non-steroidal anti-inflammatory drugs on the eye is a common treatment used to contrast the miosis induced by surgical traumas, such as cataract extraction. With the aim of improving the availability of sodium ibuprofen (IBU) at the intraocular level, IBU-loaded polymeric nanoparticle suspensions were made from inert polymer resins (Eudragit RS100). The nanosuspensions were prepared by a modification of the quasi-emulsion solvent diffusion technique using variable formulation parameters (drug-to-polymer ratio, total drug and polymer amount, stirring speed). Nanosuspensions had mean sizes around 100 nm and a positive charge (zeta-potential of +40/+60 mV), this makes them suitable for ophthalmic applications. Stability tests (up to 24 months storage at 4 degrees C or at room temperature) or freeze-drying were carried out to optimize a suitable pharmaceutical preparation. In vitro dissolution tests indicated a controlled release profile of IBU from nanoparticles. In vivo efficacy was assessed on the rabbit eye after induction of an ocular trauma (paracentesis). An inhibition of the miotic response to the surgical trauma was achieved, comparable to a control aqueous eye-drop formulation, even though a lower concentration of free drug in the conjunctival sac was reached from the nanoparticle system. Drug levels in the aqueous humour were also higher after application of the nanosuspensions; moreover, IBU-loaded nanosuspensions did not show toxicity on ocular tissues.

Acrylic Resins↗
PubMed2001

Marked miosis caused by deafferenting the oculomotor nuclear complex in the cat.

Animals show highly constricted pupils in certain conditions (e.g., coma). To know the anatomical basis for this miosis, mechanical separation of the oculomotor nuclear complex was done using four transections of the brain. Two frontal transections were placed rostral and caudal to the oculomotor nuclear complex. Two bilateral oblique transections were performed by aiming through the dorsal edge of the Edinger-Westphal nucleus at an angle of 50 degrees from the horizontal plane and vertical to the frontal plane. After the transections, we examined pupillary size for up to 2 weeks to exclude acute effects of deafferentiation. The transections were histologically examined. If the bilateral pupils were highly constricted after the transections, those pupils remained in the miotic state during the survival periods (4-14 days). The deafferented midbrain of the animals, which showed marked miosis, contained the intact oculomotor nuclear complex and nerves with the whole part of the midbrain ventral to them, but with only a small region dorsolateral to them. Given the previous finding that electrical microstimulation of the area ventral to the oculomotor nuclear complex and nerves has failed to elicit pupil constriction, our results suggest that the oculomotor nuclear complex itself could work as a generator for the strong activity of preganglionic pupilloconstrictor neurons.

Afferent Pathways↗
PubMed2003

Inhalational induction of anaesthesia with 8% sevoflurane in children: conditions for endotracheal intubation and side-effects.

BACKGROUND AND OBJECTIVE: This study was designed to assess the conditions for endotracheal intubation or insertion of a laryngeal mask airway following an inhalational induction using 8% sevoflurane and nitrous oxide without the use of muscle relaxants or opioids. METHODS: There were two groups: 30 children had endotracheal intubation and 30 children had a laryngeal mask airway inserted. Induction of anaesthesia was accomplished using an inspiratory concentration of sevoflurane 8% in a nitrous oxide and oxygen mixture. After an end-expiratory concentration of sevoflurane of at least 4% had been reached, when the pupils were miotic and centred, the trachea was intubated or a laryngeal mask inserted. The time to loss of consciousness and successful airway management was recorded. Jaw relaxation, movements, visibility, and position of the vocal cords and vital parameters were monitored. RESULTS: Jaw relaxation was complete in all children. The vocal cords were completely visible in all patients of the tracheal intubation group, whereas vocal cord relaxation was incomplete in five children. Nevertheless, all children had an atraumatic intubation or insertion of the laryngeal mask without the use of a muscle relaxant. Vital signs were stable in both groups. There were no cases of restlessness and/or postoperative shivering. Four patients in the endotracheal group (13.3%) were nauseous and three (10%) vomited, while two children (6.6%) in the laryngeal mask group experienced nausea and vomiting. CONCLUSIONS: Induction with sevoflurane in nitrous oxide and oxygen leads to fast loss of consciousness and provides ideal conditions for managing the airway without supplemental opioids or muscle relaxants. Furthermore, sevoflurane using this technique was very well tolerated, indicated by high haemodynamic stability and a reduced rate of postoperative restlessness, shivering, nausea and vomiting.

Anesthesia, Inhalation↗
PubMed2006

Organometallic enantiomeric scaffolding: organometallic chirons. Total synthesis of (-)-Bao Gong Teng A by a molybdenum-mediated [5 + 2] cycloaddition.

Bao Gong Teng A, an optically active tropane alkaloid with hypotensive and miotic activity isolated from the Chinese herb Erycibe obtusifolia Benth, was synthesized by an "organometallic chiron" strategy in which single enantiomers of TpMo(CO)(2)(eta(3)-pyridinyl) complexes are produced in quantity and then elaborated easily and efficiently to generate, after demetalation, highly enantiopure advanced synthetic intermediates possessing the tropane core.

Bridged Bicyclo Compounds, Heterocyclic↗
PubMed1991

Evaluation of mucoadhesive polymers in ocular drug delivery. I. Viscous solutions.

The potential of a mucoadhesive polymer as an ophthalmic vehicle is evaluated within the rabbit. Precorneal clearance of a mucoadhesive polymer solution (Carbopol 934P) is compared to that of an equiviscous nonmucoadhesive poly(vinyl alcohol) solution (PVA) and buffer (PBS). The precorneal retention of the Carbopol 934P, as studied by lacrimal dacryoscintigraphy, is shown to be significantly greater (P less than 0.05) than that of PVA, which, in turn, is significantly greater than that of PBS. The effect of the polymer solution on the bioavailability of pilocarpine is subsequently assessed by measuring the relative miotic response intensities produced by a 1% solution of the drug. Carbopol 934P solution produces a significant increase (P less than 0.05) in bioavailability as compared to PVA and PBS. The bioavailability from PVA is significantly greater (P less than 0.05) than that from PBS. Studies evaluating vehicle-drug association indicated no binding of the drug to the polymer.

Acrylic Resins↗
PubMed1992

New water-soluble pilocarpine derivatives with enhanced and sustained muscarinic activity.

The synthesis of an homologous series of new water-soluble derivatives of pilocarpine is described. The new compounds, referred to as soft quaternary salts, are water soluble by virtue of a cationic ammonium head and their lipophilicity can be modulated by manipulating the size and the nature of the substituent in the inactive portion of the molecule. The miotic activity of the compounds was evaluated after administration to normotensive New Zealand White rabbits. Changes in pupil size indicated a substantial cholinergic effect on the iridal sphincter musculature. The best candidate, compound 20, which has a 16-carbon side chain, was evaluated for reduction of the intraocular pressure in genetically glaucomatous Beagles. Compound 20 is superior to pilocarpine in both tests, with a potency 10 to 20 times that of the parent compound and a longer duration of action. It is suggested that the new compounds are prodrug forms of pilocarpine which greatly enhance the corneal bioavailability of the parent compound.

Animals↗
PubMed1995

Ocular absorption and irritation of pilocarpine prodrug is modified with buffer, polymer, and cyclodextrin in the eyedrop.

The influence of buffer, viscosity and cyclodextrin on the ocular absorption and irritation of a pilocarpine prodrug, O,O'-dipropionyl-(1,4-xylylene) bispilocarpic acid diester, was studied in albino rabbits. The prodrug solutions, equivalent to 0.5% pilocarpine, were prepared in 0, 10, 20, 50, or 75 mM citrate buffer at pH 5.0. Viscosity of the solutions (20, 50 or 115 cP) was modified with hydroxypropyl methylcellulose. 2-hydroxypropyl-beta-cyclodextrin (HPCD) was included at concentrations 5, 10 and 15% (w/v). The formulations were compared to a commercial pilocarpine eyedrop (1.7%). Ocular irritation was graded in a double-masked experiment and miosis was used as a bioassay for pilocarpine delivery to the iris. The prodrug showed decreased peak and prolonged duration of miosis compared to pilocarpine, but it caused ocular irritation. Increasing buffer strength decreased and elevated viscosity intensified the miotic response and irritation by the pilocarpine prodrug. HPCD decreased both the ocular delivery of pilocarpine and the irritation by the prodrug, but the net effect was positive. Thus, administering 1.0% of pilocarpine as a prodrug with 15% (w/v) HPCD, the irritation was at the same level with the commercial pilocarpine eyedrop, but the ocular delivery was substantially improved. In conclusion, the ocular delivery of the pilocarpine prodrug may be enhanced in relation to its local irritation by properly combining buffer, viscosity and HPCD.

2-Hydroxypropyl-beta-cyclodextrin↗