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PubMed1987

A modified technique of pupillary stretching.

In eyes undergoing vitreoretinal surgery up to now dilatation of a miotic pupil by the pupillary stretching technique could be performed only in aphakic eyes. Now a new needle with a tiny eye at its tip has been developed. With the help of this needle, 4 iris loop sutures can be led around the iris only passing the anterior chamber. This permits pupillary stretching also in phakic eyes. The modified technique was used on 3 phakic and 2 aphakic eyes.

Adult↗
PubMed1995

Thalamic hemorrhage. A prospective study of 100 patients.

BACKGROUND AND PURPOSE: The clinical features of thalamic hemorrhage in terms of localization are of great interest in many studies. To better understand the relationship between the localization of thalamic hemorrhage and clinical features. we evaluated the characteristics of patients with four different topographic types of thalamic hemorrhage. METHODS: We prospectively studied 100 patients with thalamic hemorrhage who were admitted consecutively to our primary care unit. We divided them into two groups according to large (> 2 cm in diameter and/or > 4 mL in volume) and small thalamic hemorrhage. Four topographic subgroups (large and small) were compared to identify clinical syndromes associated with distinct lesion locations. RESULTS: All patients with posterolateral thalamic hemorrhage had severe sensorimotor deficit. Neuropsychological disturbances in patients with posterolateral thalamic hemorrhage were prominent, with primarily transcortical aphasia in those with left-sided lesions and hemineglect and anosognosia in those with right-sided lesions. Several variants of vertical gaze dysfunction, skew ocular deviation, gaze preference toward the site of the lesion, and miotic pupils were frequent in posterolateral thalamic hemorrhage, particularly in the large type. Patients with small and large anterolateral thalamic hemorrhage were characterized by severe motor and sensory deficits; language and oculomotor disturbances were also observed, although less frequently than in posterolateral hemorrhage. Sensorimotor deficits were observed in patients with medial thalamic hemorrhage (moderate in small hemorrhages and severe in large hemorrhages because of involvement of the adjacent internal capsule). Language disturbances in patients with left-sided lesions and neglect in patients with right-sided lesions were seen only in large medial thalamic hemorrhage. Dorsal thalamic hemorrhage was rare and characterized by mild and transient sensorimotor disturbances. Among patients with dorsal thalamic hemorrhages, only those with large lesions had oculomotor and neuropsychological disturbances. CONCLUSIONS: We concluded that despite clinical similarity among the four types of thalamic hemorrhage, there was some discrepancy in the clinical features of small and large thalamic hemorrhages. The most important predictors of death were initial consciousness, nuchal rigidity, maximum size, volume and ventricular extension of hemorrhage, and occurrence of hydrocephalus.

Adolescent↗
PubMed1985

Pupillary and vascular effects of calcium antagonists in migraine.

In migraine patients the effect of calcium antagonists (flunarizine, verapamil and nifedipine) on both venous and pupillary neuromuscular functions, as well as on blood pressure have been evaluated. A single oral dose of flunarizine (10 mg) and verapamil infusion (50 micrograms/ml/min) increased venous compliance. Verapamil also counteracted dose-dependent dopamine induced venoconstriction. Nifedipine (10 mg orally) reduced mean arterial pressure in upright position in migraineurs but not in controls. In addition, chronic treatment with flunarizine (10 mg for 2 weeks) induced a transient miotic effect and a reduction of tyramine induced mydriasis. These findings demonstrated that calcium antagonists affect vascular and extravascular structures. It is postulated that, in migraine, calcium entry blockers may prevent exaggerated responses to catecholaminergic stimulation.

Blood Pressure↗
PubMed1990

Seizure-induced miosis and ptosis: association with temporal lobe magnetic resonance imaging abnormalities.

Two patients with seizure-associated miosis and ptosis are described. In both there are magnetic resonance imaging abnormalities of the temporal lobe. In one patient, increased magnetic resonance imaging signal intensity is present in the temporal lobe contralateral to ptosis and miosis. In the other, there is temporal lobe asymmetry with the smaller temporal lobe ipsilateral to the miotic pupil and ptotic lid. The relevant human and experimental literature related to cortical control of pupil size and lid movement is reviewed. Based on the available literature and the findings in these two patients, it is proposed that the increased signal intensity in the temporal lobe of one patient represents an irritative stimulus causing contralateral miosis and ptosis, whereas the temporal lobe hypoplasia in the second patient permitted impulses from the contralateral normal temporal lobe to predominate, resulting in miosis and ptosis homolateral to the hypoplastic temporal lobe.

Adolescent↗
PubMed1991

Hypotension and bradycardia possibly associated with intraocular injection of acetylcholine.

Topically applied drugs are an important part of the pharmacologic management of cataract extraction and lens implant surgery. Acetylcholine facilitates this procedure via its miotic effect on the ciliary body of the eye. Systemic effects can occur with topically administered ophthalmic medications. Acetylcholine has been implicated in several cases of systemic cholinergic effects, such as hypotension, bradycardia, and bronchospasm, following intraocular administration. The patients we present experienced profound hypotension and bradycardia occurring up to 45 minutes after intraocular injection of acetylcholine. Both patients were over 90 years of age and had a history of first-degree atrioventricular block. As cataract surgery and lens implantation become more prevalent in the older ambulatory segment of the geriatric population, healthcare professionals should be aware that these patients may be more sensitive to the pharmacologic effects of medication used during surgery. Monitoring for adverse effects must be performed intraoperatively and several hours postoperatively. Additionally, patients with known conduction abnormalities prior to surgery should be monitored closely and proper emergency equipment and personnel should be available. Pharmacists who investigate adverse drug reactions should consider ophthalmic medications as potential causes for unexplained or suspected adverse drug reactions.

Acetylcholine↗
PubMedDate not supplied

Intraocular pressure, safety and quality of life in glaucoma patients switching to latanoprost from adjunctive and monotherapy treatments.

PURPOSE: To evaluate efficacy, safety and quality of life in ocular hypertensive or open-angle glaucoma patients changed to latanoprost from previous therapy. METHODS: A prospective, multicenter, active-controlled design in which qualified patients had their previous therapy substituted for latanoprost and were followed for at least three months. RESULTS: In 1068 patients, latanoprost was continued 92% throughout the 36-month observation period. Latanoprost treatment reduced the intraocular pressure (1OP)(p < 0.001) when compared to previous monotherapies including: beta-blockers (-4.0 +/- 3.7 mmHg, 42%), alpha-antagonists (-3.9 +/- 3.0 mmHg, 14%), miotics (-3.8 +/- 3.5 mmHg, 2%), or carbonic anhydrase inhibitors (CAI) (-3.8 +/- 3.6 mmHg, n = 16%), and adjunctive therapy including: beta-blocker and CAI (-3.7 +/- 3.1 mmHg, n = 12%), alpha-agonist (-3.7 +/- 3.4 mmHg, n = 5%), or pilocarpine (-3.4 +/- 3.7 mmHg, n = 6%), or CAI and alpha-agonist (-4.6 +/- 6.4 mm Hg, n = 2%)(p < 0.0017). The most common adverse event with latanoprost was ocular allergy (1.5% incidence). Patients showed a preference for latanoprost for many systemic and ocular quality of life measures on a non-validated questionnaire (p < 0.05). CONCLUSIONS: In a clinical setting, patients who have their mono- and adjunctive therapy treatment substituted for latanoprost may on average experience reduced IOP, decreased side effects and increased quality of life measures.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

Night vision after excimer laser photorefractive keratectomy: haze and halos.

A series of 85 patients with myopia, up to -6.00D, was treated by photorefractive keratectomy (PRK), using a 5 mm diameter ablation zone. At six months, 38 patients (45%) reported slight disturbances of night vision, nine (11%) of whom had significant problems. Perturbations of night vision after PRK are seen as starbursts and halos around lights. Corneal haze produces the starbursts, which are usually transient. In contrast, halos are myopic blur circles and may be persistent. Using a computer program, halos after PRK were found to be significantly larger than those in emmetropes and myopes corrected with spectacles (p < 0.01). The halos were diminished by using either artificial pupils or negative lens over-correction. In patients with identical bilateral PRK corrections, except for the ablation zone size, the magnitude of the halo was less with 5 mm than 4 mm zones (p < 0.01). Patients treated with 5 mm reported fewer problems attributable to halo than with the 4 mm ablation diameters (p < 0.01). Halos and pupil diameters were measured in nine patients with significant impairment of night vision haze. Those with starbursts had small hyperopic shifts, minimal halos and high haze and light scatter measurements, whilst patients with halos had large hyperopic shifts, little haze and large pupil diameters. Patients with persistent halo problems benefited from either negative lens over-correction or miotics at night.

Adult↗
PubMedDate not supplied

Effect of flurbiprofen on acetylcholine-induced pupillary contraction.

Preoperative treatment with topical nonsteroidal anti-inflammatory agents such as flurbiprofen (Ocufen) is used to maintain pupil dilation during cataract surgery. Flurbiprofen maintains pupil dilatation by inhibiting release of prostaglandins and other modulators of surgical miosis. Some reports suggest that these agents may reduce the miotic effect of intra-operative acetylcholine (Miochol). It is hard to explain this effect unless there is a pharmacological interaction between the two drugs. This study aimed to investigate the possibility of a direct interface by flurbiprofen with the action of acetylcholine on the pupil sphincter. Iris tissue of seven cadaver eyes were isolated and maintained in an organ bath containing Kreb's solution. Pupil contraction force induced by acetylcholine was measured in the presence and absence of flurbiprofen. Acetylcholine produced a mean pupillary contraction force of 52.4 x 10(-3) N. When it was added to the organ bath in the presence of flurbiprofen the mean contraction force was 50.5 x 10(-3) N (paired t-test P = 0.68). This study does not find any evidence to suggest that flurbiprofen reduces the pupil sphincter contraction that is induced by acetylcholine. It is likely that the apparent reduction in miosis is due to factors other than the mechanism of action of acetylcholine on the sphincter pupillae.

Acetylcholine↗
PubMed2006

Bilateral acute angle closure glaucoma as a presentation of isolated microspherophakia in an adult: case report.

BACKGROUND: Bilateral simultaneous angle closure glaucoma is a rare entity. To our knowledge this is the first reported case of bilateral acute angle-closure glaucoma secondary to isolated microspherophakia in an adult. CASE PRESENTATION: A 45-year-old woman presented with bilateral acute angle closure glaucoma, with a patent iridotomy in one eye. Prolonged miotic use prior to presentation had worsened the pupillary block. The diagnosis was not initially suspected, and the patient was subjected to pars-plana lensectomy and anterior vitrectomy for a presumed ciliary block glaucoma. The small spherical lens was detected intraoperatively, and spherophakia was diagnosed in retrospect. She had no systemic features of any of the known conditions associated with spherophakia. Pars-plana lensectomy both eyes controlled the intraocular pressure successfully. CONCLUSION: This case demonstrates the importance of considering the diagnosis of isolated microspherophakia in any case of bilateral acute angle closure glaucoma. Lensectomy appears to be an effective first-line strategy for managing these patients.

Diagnosis, Differential↗
PubMed1980

Ophthalmoplegia, ptosis, and miosis in temporal arteritis.

Ophthalmoplegia occurred in 7 of 14 patients with biopsy proved temporal arteritis. Only one patient had diplopia. In six of the seven patients, the pattern of ophthalmoplegia did not conform to the distribution of one of the ocular motor nerves. Impairment of upward gaze was most common. In five patients the ophthalmoplegia was accompanied by ptosis, and in five it was accompanied by a miotic pupil. Ophthalmoplegia and ptosis were the major manifestations of temporal arteritis in one patient. Oculomotor signs and symptoms responded to corticosteroid therapy in all seven patients, but in two patients prolonged therapy was necessary. Ophthalmoplegia or ptosis may be early manifestations and may precede visual loss, so that frequent examination is recommended in patients suspected of temporal arteritis, with prompt administration of adequate doses of corticosteroid as soon as any ocular manifestations of temporal arteritis are noted.

Aged↗
PubMed1986

Tonic pupils in neurosyphilis.

Of 60 patients with tonic pupils, 29 had serologic tests for syphilis. Five patients had positive blood serology and confirmatory tests; four had other manifestations of neurosyphilis and positive CSF serology. All seropositive patients had bilateral tonic pupils with light-near dissociation and denervation hypersensitivity. Of the 10 tonic pupils, only 1 was miotic and 1 dilated. Although tonic pupils tend to become small and bilateral, they should be distinguished readily from Argyll Robertson pupils, which react briskly, not tonically, to near stimuli. Patients with bilateral tonic pupils should have serologic tests for syphilis.

Diagnosis, Differential↗
PubMedDate not supplied

The role of eye accommodation in the depth perception of common toads.

Distance estimation in prey catching was as exact in monocular toads (Bufo bufo (L.)) as in binocular ones. Application of Atropine or Miotic had no significant effect on binocular animals, whereas in monocular toads it made accurate distance estimation impossible. The accommodative state of the eye is decisive for depth estimation of monocular, but not of binocular toads.

Accommodation, Ocular↗
PubMed1998

Ultrastructural changes of the myoepithelium of the dilator pupillae during miosis and mydriasis in the rat iris.

Changes in the three-dimensional structures of the myoepithelium of the dilator pupillae (MDP) during mydriasis and miosis were investigated in the rat by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Following fixation, SEM specimens were treated with sodium hydroxide to expose the muscle surface. Significant morphological differences were noted in the anterior surface of the MDP between mydriasis and miosis. In the mydriatic eye, a highly rugged structure with numerous linear folds was oriented circularly or obliquely together with spherical bulges. These structures, presumably corresponding to the highly contractile portion of the myoepithelial cells, were more prominent near the pupillary margin than near the ciliary margin, indicating that the MDP may contract much more strongly in the pupillary margin. In the miotic eye, the anterior surface of the MDP showed less conspicuous linear folds in the pupillary area, and was almost flat in the ciliary area. Radially oriented ridges were observed only in the pupillary area. These findings suggest that the contraction of the sphincter pupillae in miosis induces a stretching of the MDP toward the pupil and a circular shrinkage of the MDP. Ultrastructural changes of the MDP particularly near the pupillary margin may play an important role in regulation of the pupil diameter as a diaphragm of the eye because morphological changes such as the linear folds, spherical bulges, and ridges were more prominent near the pupillary margin than those near the ciliary margin.

Animals↗
PubMed2000

Topical dorzolamide 2%/timolol 0.5%: a review of its use in the treatment of open-angle glaucoma.

UNLABELLED: The nonselective beta-blocker timolol and the carbonic anhydrase inhibitor dorzolamide both lower intraocular pressure (IOP). Timolol and dorzolamide have different mechanisms of action and their effects are additive when administered together. Therefore, the 2 drugs are frequently used concomitantly to treat patients with open-angle glaucoma who have not adequately responded to first-line therapy. A barrier to good compliance with concomitant therapy is the need to administer 5 or 6 drops of medication on 2 or 4 occasions during the day. Timolol 0.5% and dorzolamide 2.0% have therefore been combined in a single formulation, reducing the number of administrations required to 2 per day. Clinical trials in patients with glaucoma have demonstrated that dorzolamide 2%/timolol 0.5% (dorzolamide/timolol) is superior to monotherapy with the individual components. When dorzolamide/timolol administered twice daily was compared with concomitant treatment with dorzolamide 2% and timolol 0.5%, each administered twice daily for 90 days, both regimens resulted in marked lowering of trough IOP (measured just before the morning dose) compared with baseline (reduction in IOP = 4.2mm Hg). The effect of the 2 regimens on IOP at all time points, both before treatment and at peak effect (2 hours after treatment), were virtually indistinguishable. When the combined formulation was compared with a concomitant regimen that included dorzolamide 2% 3 times daily and timolol 0.5% twice daily the concomitant regimen was slightly more efficacious than the combined regimen at trough after 90 days: IOP was lowered by 3.6mm Hg in the combined group versus 4.1 mm Hg in the concomitant group. Dorzolamide/timolol has been compared with concomitant administration of timolol 0.5% and the IOP lowering miotic drug, pilocarpine 2.0%. This non-blind patient-preference study found that both regimens reduced IOP. However, the dorzolamide/timolol combination was preferred by the patients because of reduced frequency and severity of adverse effects and less frequent administration. Dorzolamide/timolol was well tolerated in clinical trials, the adverse effects reflected those of the individual components, and no additional tolerability issues were identified. However, the potential for timolol to cause cardiorespiratory effects must be considered when prescribing this combination. Furthermore, dorzolamide is a sulfonamide and can cause allergic reactions in those who are hypersensitive to this class of drug. CONCLUSIONS: Dorzolamide/timolol is a well tolerated and effective fixed combination for lowering IOP in the treatment of open-angle glaucoma and is likely to be useful in those patients who do not respond adequately to first-line monotherapy. Compared with concomitant therapy with the same 2 drugs the primary advantage is convenience, which may lead to improved compliance. Studies of compliance and comparisons with other currently available combination therapies would be useful to fully define the value of the formulation. Nonetheless, dorzolamide combined with timolol in a single applicator system will be a useful addition to the treatment options for glaucoma, a leading cause of preventable blindness.

Adrenergic beta-Antagonists↗
PubMed1979

Timolol: a review of its therapeutic efficacy in the topical treatment of glaucoma.

Timolol maleate is a nonselective beta-blocking drug used for the topical treatment of increased intraocular pressure in patients with chronic open angle glaucoma. In comparative studies it has had a somewhat greater ocular hypotensive effect than the sympathomimetic agent adrenaline (epinephrine), or lower to medium concentrations (up to 4%) of the miotic drug pilocarpine, usually lowering intraocular pressure by about 30 to 35% (absolute pressure reduction). Timolol has been well tolerated by most patients, producing fewer subjective complaints than the comparison drugs, and objective measurements of ophthalmic status have not revealed any marked changes. Although some patients have been treated for extended periods without serious adverse effects or loss of effectiveness, further published reports in larger numbers of patients treated over several years are needed to confirm the drug's apparent long term safety and continued efficacy. Nevertheless, on the basis of present evidence, timolol appears to represent an important advance in the topical treatment of glaucoma.

Glaucoma↗
PubMed1986

Ocular effects of a relatively selective alpha 2 agonist (UK-14, 304-18) in cats, rabbits and monkeys.

UK-14, 304-18 (UK), a relatively selective alpha 2-agonist, was examined for its effects on intraocular pressure (IOP) and pupil diameter (PD) in rabbits, cats and monkeys and on noradrenergic function in the cat nictitating membrane (CNM) preparation. Topical, unilateral administration of UK (0.0005-0.5 mg) produced dose-dependent decreases in IOP and pupil size in normal, unanesthetized rabbits, cats and monkeys. The ocular hypotensive effect of UK in the ipsilateral eye was delayed relative to the contralateral eye in all three species; UK produced an initial transient ocular hypertension in rabbits which was abolished by surgical transection of three major extraocular muscles. Mean arterial blood pressure in rabbits was not affected by 0.005 mg UK topically. The ocular hypotensive and miotic effects of UK were attenuated in superior cervical ganglionectomized (SX) cats and rabbits. Intra-arterially administered UK (0.33, 1.0, 3.3 and 10 micrograms) produced dose-related systemic hypotension and inhibition of contractions of the CNM elicited by electrically stimulating the pre- and postganglionic sympathetic trunks in the urethane/chloralose anesthetized cat. This inhibition was reversed and prevented by 300 micrograms rauwolscine but not by 300 micrograms domperidone. UK also enhanced the contractile response of the CNM to injected norepinephrine (10 micrograms). UK suppressed ocular hypertension induced by water loading and IOP recovery rate following hypertonic saline infusion in rabbits suggesting that aqueous flow was inhibited. These results indicate that UK lowers IOP, in part, by suppressing sympathetic neuronal function which causes a reduction in aqueous flow.

Adrenergic alpha-Agonists↗
PubMed1987

Effects of topical PGF2 alpha on aqueous humor dynamics in cynomolgus monkeys.

Single topical applications of prostaglandin F2 alpha (PGF2 alpha) tromethamine salt to living cynomolgus monkey eyes reduced intraocular pressure (IOP). Twice daily topical application was far more effective, so that after the 7th 50 micrograms or 100 micrograms dose on day 4, IOP fell 40-50%, to 8-10 mm Hg. Following twice daily application of 50 or 100 micrograms for greater than 3 days: (1) no increase in total outflow facility could be demonstrated by 2-level constant pressure perfusion or Schiotz tonography; (2) no decrease in aqueous humor formation rate could be demonstrated by fluorophotometry--rather, aqueous flow may have increased; (3) anterior chamber aqueous humor protein concentration was unaltered, but entry of intravenously injected fluorescein into the cornea and anterior chamber tended to increase; (4) there was a weak but sometimes statistically significant miosis of up to approximately 0.5 mm. We conclude that in the cynomolgus monkey: (1) PGF2 alpha is a potent ocular hypotensive agent with only very weak miotic and blood-aqueous barrier-disrupting effects; (2) the ocular hypotensive action of PGF2 alpha is definitely not due to increased conventional outflow facility or decreased aqueous production, but probably to increased uveoscleral drainage of aqueous humor.

Administration, Topical↗