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PubMed1975

The management of glaucoma in nanophthalmos.

Patients with nanophthalmos are prone to develop a chronic painless type of glaucoma in middle age, probably due to the natural increase in the size of the lens which is already relatively too large for the small eye. Although the underlying mechanism is obscure, a slowly progressive "creeping" chronic angle-closure is postulated, but gonioscopic evaluation is difficult due to the shallow anterior chamber, with grade I and slit angles. Response to medical treatment is poor and miotics may even make the condition worse by producing relative pupillary block and by relaxing the lens zonule. Ordinary glaucoma surgery is to be avoided in nanophthalmos because of the fear of postoperative ciliary-block malignant glaucoma. Periopheral iridectomy performed in five eyes at an advanced stage of the chronic angle-closure did not facilitate glaucoma control in three eyes, and in two eyes in which the operation was combined with posterior sclerotomy, the eyes became blind from vitreous hemorrhage. Lenx extraction in five eyes controlled the glaucoma but was followed by choroidal effusion and nonrhegmatogenous retinal detachements in two eyes and blindness in another eye when combined with a posterior sclerotomy. No firm therapeutic recommendations can be made on the basis of the author's experience in the six reported cases. Conventional medical therapy seems ineffectual even when begun early in the glaucoma. Conventional glaucoma surgery must be performed early, before permanent damage to the outflow mechanism occurs but removal of the lens must be anticipated. The surgeon must also remain aware of the high incidence of serious posterior-segment complications which inexplicably follow glaucoma or lens surgery in nanophthalmos, as described by Brockhurst.

Adult↗
PubMed2002

[Development of an automatic discrimination system for glaucomatous visual fields based on neuro-fuzzy nets].

PURPOSE: To provide a useful tool in the diagnosis of glaucoma by developing an automatic system for visual field classification based on neuro-fuzzy rules. METHOD: A total of 212 visual fields (OCTOPUS 123 program G1X), from 198 patients, were analysed: 61 normal (controls) and 151 with glaucomatous damage (49% with incipient damage, 29.1% with moderate damage, and 21.9% advanced). Inclusion criteria for glaucomatous patients were: Visual acuity >0.5, IOP < 20 mm Hg (with treatment), refraction <5 Dp and previous perimetric experience. EXCLUSION CRITERIA: miotics, other ocular pathologies which could interfere with visual field examination, and for control subjects: visual acuity >0.5, no ocular pathologies and refraction < 5 Dp. A neuro-fuzzy classifier (NEFCLASS) is a system consisting in a series of fuzzy rules, obtained after a learning process, which attempts to assign to each piece of data input its corresponding output. Initially, the characteristics of each data input are established (input units). Then, based on previous knowledge, a set of rules are defined, and finally, the learning process allows the optimisation of the classifier parameters to generate an output. RESULTS: Input units were defined by using the mean defects calculated at specific areas of the visual field; five rules were then created which generated sensitivity and specificity values of 96.0% and 93.4% respectively. CONCLUSIONS: The use of neuro-fuzzy rules for visual field classification in normal vs glaucomatous can provide results which can match the quality of those obtained with other techniques such as discriminatory analysis or neural networks.

Aged↗
PubMed2002

Pupil block glaucoma from traumatic vitreous prolapse in a patient with posterior chamber lens implantation.

BACKGROUND: Angle closure secondary to pupil block is an entity known to occur in aphakic and pseudophakic patients. In aphakic patients, typically the cause of the pupil block is vitreous prolapse (aphakic pupil block). In pseudophakic patients, the typical cause of the pupil block is an anterior chamber lens implant, often in the absence of an iridectomy (pseudophakic pupil block). Rarely, a hybrid of these two conditions can occur, in which vitreous prolapse causes a pupil block in a pseudophakic patient with a posterior chamber lens implant. METHODS: The case presented is that of an elderly pseudophakic man with a posterior chamber lens implant who experienced ocular trauma, and who subsequently also experienced a ruptured posterior capsule with resultant vitreous prolapse and pupil block angle closure. Key diagnostic features are presented, as well as patient-specific management for this uncommon condition. CONCLUSIONS: While diagnosis and management of acute primary angle closure are well-known and reported, acute secondary angle closure is not as well reported. It is imperative to understand the mechanism of angle closure, as this properly delineates the management plan. Use of management plans appropriate to acute primary angle closure with pupil block (the use of miotics) could potentially have disastrous consequences in cases of secondary angle closure from vitreous prolapse.

Aged↗
PubMed2002

Angle closure in younger patients.

PURPOSE: Angle-closure glaucoma is rare in children and young adults. Only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients in our database aged 40 or younger with angle closure. METHODS: Our database was searched for patients with angle closure who were 40 years old or younger. Data recorded included age at initial consultation; age at the time of diagnosis; gender; results of slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (from 1993 onward); clinical diagnosis; and therapy. Patients with previous incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure. RESULTS: Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age (+/- SD) at the time of consultation was 34.4 +/- 9.4 years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients), iridociliary cysts (8 patients), retinopathy of prematurity (7 patients), uveitis (5 patients), isolated nanophthalmos (3 patients), relative pupillary block (2 patients), Weill-Marchesani syndrome (3 patients), and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation. CONCLUSION: The etiology of angle closure in young persons is different from that in the older population and is typically associated with structural or developmental ocular anomalies rather than relative pupillary block. Following laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention.

Adolescent↗
PubMed2002

[Consciousness disturbance caused by iodoform absorption in a patient with decubitus ulcer topically treated with iodoform-gauze].

A 76-year-old man with supranuclear palsy, developed consciousness disturbance followed by the treatment of decubitus ulcer in the sacral region using iodoform-gauze. He was semicoma and tachycardia. His pupils were miotic and light reflexes were absent. EEG demonstrated diffuse and random slow activities. Plasma concentration of free iodine was high (151 micrograms/dl), but the other laboratory findings including thyroid functions were normal. He was diagnosed as suffering from iodoform poisoning. The symptoms and laboratory abnormalities of the patient recovered soon after the removal of iodoform-gauze. Although iodoform has been widely used for the treatment of wounds, there are few case reports of its side effects, such as consciousness disturbance, delirium, headache and tachycardia.

Acute Disease↗
PubMed1954

Diagnosis and treatment of glaucoma; a review of recent developments.

Tonography is helpful in the diagnosis of doubtful cases of chronic simple glaucoma. If also gives a good indication of the status of the disease in a given eye. The most useful miotic in the treatment of glaucoma is still pilocarpine. Carbachol is more potent but must be used in an anhydrous base ointment or in a solution of a wetting agent. DFP (diisopropyl fluorophosphate) produces undesirable side effects because of the hyperreactivity of the ciliary body and iris sphincter which it causes. These can be partly overcome by using pilocarpine first. Diamox is a carbonic anhydrase inhibitor that is effective when given orally. In many cases it produces at least a temporary lowering of tension in glaucomatous eyes, apparently by reducing the secretion of intraocular fluid. Its ultimate value in glaucoma remains to be seen. The cyclodiathermy operation which has been modified somewhat by Weekers has had a recent increase in use but the long-term results have been somewhat disappointing. The importance of early operation in narrow angle glaucoma is becoming more and more apparent. Following iridectomy the wound should be tightly sutured to insure the prompt reformation of the anterior chamber.

Anterior Chamber↗
PubMedDate not supplied

[Closed angle glaucoma induced by phospholine iodide and epinephrine in a case of open angle glaucoma].

A patient suffering from open angle glaucoma was treated with topical phospholine iodide and epinephrine. Before treatment the anterior chamber was deep and the angle wide open in both eyes. Two weeks after beginning treatment there was an acute elevation of pressure to 52 mm hg in the right eye accompanied by myopia, shallowing of the anterior chamber and closure of the angle. These findings were dramatically reversed by the instillation of one drop of tropicamide and one drop of cyclopentolate. Simultaneous contraction of the dilator and sphincter muscles of the iris in this case probably caused pupillary block and closure of the anterior chamber angle, in spite of the initially wide open angle. Phospholine iodide may also have caused a spasm of the ciliary muscle and a forward movement of the lens, in a manner similar to that thought to occur in malignant glaucoma. Strong miotics together with epinephrine should be used cautiously in the treatment of glaucoma even when the initial examination shows a wide open angle.

Adult↗
PubMed1992

[Effects of pre-instilled mydriatics on the intraocular concentration and anti-inflammatory action of topical 0.1% pranoprofen (2)--Study on multiple dosing].

We studied the effects of multiple dosing and pre-instilled mydriatics (0.5% tropicamide and 0.5% phenylephrine) on the intraocular concentration and anti-inflammatory action of topical 0.1% pranoprofen (PPF) in rabbit eyes. PPF was applied in a single or multiple doses: 1 to 4 times consecutively at 5-minute intervals with or without pre-instilled mydriatics. PPF concentrations in the aqueous humor increased dose-dependently. The PPF concentrations also increased dose-dependently, and reached the maximal concentration by instillation 3 times in the presence of pre-instilled mydriatics, and the concentrations were 3.4 to 5.8 times higher than those without mydriatics. The PPF concentrations in the cornea, secondary aqueous, and iris-ciliary body increased in a dose-dependent manner, and the concentrations were higher in the presence of mydriatics. PPF reduced the protein rise in the secondary aqueous and miotic responses which were seen after paracentesis. The percent inhibitions ranged from 75 to 83, but the inhibitory actions were not enhanced by increases of intraocular PPF concentrations. These data indicate that the potent anti-inflammatory actions of PPF were obtainable by a single instillation, but it might be useful to instill the drug 3 times consecutively to ensure higher intraocular drug concentrations in combination with pre-instilled mydriatics.

Administration, Topical↗
PubMed1992

Clinicolegal aspects of vitreous and retinal detachment.

Failure to diagnose retinal detachment is an important cause of professional liability claims involving optometrists. To comply with medical standards, dilation of the pupil and examination of the retinal periphery are required, both for patients who are at risk for retinal detachment and for patients who are symptomatic. Important risk factors include a history of previous detachment, myopia, lattice retinal degeneration, aphakia and pseudophakia, YAG capsulotomy, treatment of primary open-angle glaucoma with miotic drugs, blunt ocular trauma, and the proliferative retinopathies. Patients with the symptoms of acute posterior vitreous detachment must receive a dilated fundus examination, evaluation of the retinal periphery, and assessment of the vitreous. If examination results are negative, the patient should be warned of the symptoms of retinal detachment and scheduled for reevaluation in 4 to 8 weeks. Examination findings, warnings, recall appointments, and referral for treatment should be documented in the patient's record of care.

Diagnostic Errors↗
PubMed1976

[Effects of methyl O-(4-hydroxy-3-methoxycinnamoly)reserpate (CD-3400) on the peripheral nervous system: especially on the smooth muscle organs].

Effects of methyl O-(4-hydroxy-3-methoxycinnamoyl) reserpate (CD-3400), a new antihypertensive agent, on the peripheral nervous system in mice, rats and guinea pigs were investigated and compared with effects of reserpine and rescinnamine. Oral administration of CD-3400 in doses from 40 to 320 mg/kg revealed a miotic action and such was weaker than that seen with reserpine and rescinnamine. The intestinal propulsion in mice was accelerated by pretreatment with reserpine, but no so with CD-3400. In isolated guinea pig vas deferens, CD-3400 at a concentration of 1 X 10(-5) M inhibited on norepinephrine-induced contraction non-competitively. However, in insolated rat vas deferens pretreated with CD-3400 (1 mg/kg, i.p.) for 5 days, norepinephrine-induced contraction was potentiated and this effect was weaker than that seen with reserpine and rescinnamine. In isolated rat vas deferens pretreated with CD-3400 for 1, 2 and 5 days,, the contraction induced by tyramine (3 X 10(-5)M) was significantly inhibited. The effect was qualitively similar to those of reserpine and rescinnamine. The intravenous administration of these three rauwolfia alkaloids in doses of 1, 2 and 4 mg/kg had no effect on the spontaneous movement of rat uterus. In isolated rat uterus pretreated with CD-3400, no significant effect was observed on oxytocin- and isoproterenol-induced responses. The peripheral actions of CD-3400 are attributed to a deterioration in the function the sympathetic nerve resulting in depletion of catecholamine stores. Efect of CD-3400 were slightly weaker than those of reserpine and rescinnamine.

Animals↗
PubMed1992

Effects of prostaglandin F2 alpha and leukotriene D4 on pupil size, intraocular pressure, and blood-aqueous barrier in dogs.

In each of 5 groups of dogs, 0.05 ml of 1 of the following solutions was injected into the anterior chamber of both eyes: phosphate-buffered saline solution, 0.001 microgram of prostaglandin F2 alpha (PGF2 alpha), 0.01 microgram of PGF2 alpha, 0.1 microgram of leukotriene D4 (LTD4), and 1 microgram of LTD4. A 10% solution of sodium fluorescein was injected IV (14 mg/kg of body weight) at the same time, and pupil size, intraocular pressure, and anterior chamber fluorescence were measured for 1 hour after injections. In a dose-dependent manner, PGF2 alpha was a potent miotic. A significant effect on intraocular pressure was not detected when the groups given PGF2 alpha were compared with the control group. When compared with LTD4, PGF2 alpha significantly (P less than 0.05) increased the breakdown of the blood-aqueous barrier, as evidenced by increased fluorescein leakage into the anterior chamber. Leukotriene D4 caused a decrease in pupil size only at 5 minutes, compared with that of the control group. Intraocular pressure was greater (but not significantly) in the group given 1 microgram of LTD4.

Animals↗
PubMed1992

Computerized analysis of pupillograms in studies of alertness.

When alert subjects sit in a quiet, darkened room for 10-15 min, their pupils remain dilated. If the subjects become sleepy or fatigued, their pupils become miotic and oscillate. Pupillometry, the recording of pupil diameter, has been used to study alertness. Pupillograms are typically graded by subjective assessment on the basis of oscillations of pupil diameter (hippus) and miosis. In this study, numeric parameters were calculated from pupillograms and were compared to subjective ratings by clinicians. Pupil diameters were recorded for 15 min at five samples per second with a custom built video pupillometer. Subjects sat in the dark and fixated a small red light. Digital filtering techniques and Fourier analysis were used to calculate several parameters designed to report hippus and miosis. The same set of pupillograms was graded by three physicians familiar with pupillometry. Grades were assigned on a scale of 1 to 4, 1 being most alert and 4 least alert. A linear combination of three of the numeric parameters had the highest correlation with the average subjective grade (r = 0.92). These techniques provide a quantitative way to evaluate pupillograms that will be used in the assessment of alertness.

Adolescent↗
PubMed2005

Choroidal detachment after filtering surgery.

BACKGROUND: The purpose of this study is to report the treatment and outcome of eight cases of choroidal detachment, which occurred several days to many years after trabeculectomy. METHODS: This is a retrospective study of eight cases of choroidal detachment after trabeculectomy with or without cataract extraction reviewed at CGMH, Keelung, from 2002 to 2004. One eye with idiopathic scleromalacia with chronic uveitis and secondary glaucoma, five eyes with primary open angle glaucoma and two eyes with chronic angle closure glaucoma after trabeculectomy were reported. Six of the eight cases developed acute onset choroidal detachment within two weeks after surgery. The other two cases suffered from choroidal detachment many years after trabeculectomy for different reasons. Regarding the types of operation, combined glaucoma and cataract surgery was performed in five cases and intraoperative application of adjunctive mitomycin C was used in two cases. Decrease in vision acuity and varying degrees of eye pain with a flat or shallow chamber were noted in all cases. Associated hypotony was found in six of the eight cases. The treatment included topical cycloplegic corticosteroid and oral corticosteroid. RESULTS: Choroidal detachments were improved or complete resolution obtained after medical treatment for about three weeks to one month in all cases. But persistent poor control of intraocular pressure was found in two cases. Ultrasonography was used as a reliable tool to confirm the diagnosis and resolution of choroidal etachment in cases of blurred fundus examination and synechiae miotic pupil. CONCLUSIONS: Choroidal detachment is one of the complications after trabeculectomy. The diagnosis of choroidal detachment can be confirmed most reliably by ultrasonography. Medical therapy is effective for resolution.

Adult↗
PubMed2005

[Intermediate medullary infarction: a case report].

A 68-year-old man presented with right eye pain and vertigo. Thereafter, he gradually leaned rightward, then laid down. He felt nausea and vomited. His right upper eyelid drooped and he felt dysethesia of the right hand. On neurological examination, ptosis of his right eye with slightly miotic right pupil, paresis of the right soft palate and hoarseness were noted. Arm deviation test demonstrated rightward deviation. He presented sensory ataxia of the right upper and lower extremities: finger nose test showed mild dysmetria of the right upper extremity, heel knee test demonstrated dysmetria of right lower extremity and these findings worsened when he closed his eyes. He showed mild bending of his bilateral ring and little fingers when he did rapid alternative movement. He leaned rightward when he sat and closed his eyes. Position sense of his right upper and lower extremities was decreased and sometimes he could not answer correctly when asked on which direction his finger pointed. Pinprick sensation was mildly decreased on the left side not including the face. Touch and vibration sense were normal. SEP findings on upper and lower extremity stimulation were normal. MRI of the brain showed T2 high intensity and partially T1 low intensity lesion at the right medulla (Figure). MR angiography showed no apparent lesion of major arteries such as dissection of the vertebral arteries. He complained and presented with hiccup initially. On MRI, the lesion was thought to involve the spinothalamic tract, medial lemniscus and inferior olivary nucleus. Ambiguus nucleus was in the lesion and solitary nucleus near the lesion. There is no report that seems to describe clinical features of a lesion like that in this case. Intermediate medullary infarction may present dissociated sensory disturbance like Brown-Sequard syndrome and position sensory disturbance without disturbance of vibration sense.

Aged↗
PubMed1992

[A pupillographical study on the effects of cataract surgery on the contralateral eye].

In order to estimate the effect of cataract surgery on the contralateral eye, we examined pupillary light reflex and performed laser flare-cell measurement. The subjects were nine patients who underwent extracapsular cataract extraction (ECCE) and fourteen patients who underwent ECCE with intraocular lens implantation. Pupillary light reflexes of the contralateral eyes were examined using a computerized videopupillogram (HTV C-301). Aqueous cells and flare of both eyes were measured by a laser flare-cell meter (KOWA FC 100). The author performed five successive measurements before and 1, 3 days, 1, 2 weeks and 1, 2, 3 months after surgery and statistically estimated the consensual effect of cataract surgery. As a result of contralateral cataract surgery, pupils became significantly miotic from the first postoperative day for more than 3 months without any alteration of other parameters of light reflex. On the contrary aqueous cells and flare significantly raised from the first postoperative day and disappeared within 3 months. Consensual miosis was considered to be sensitive indicator of postoperative inflammation of cataract surgery as well as contralateral increase of aqueous cells and flare.

Adult↗
PubMed2006

[Near triad measurement--accommodative pupillometry with horizontal eye tracking and its qualitative analysis].

PURPOSE: Recording of "near triad responses" was done by static accommodative stimulation to reveal the qualitative analysis of asthenopia. METHOD: Twelve healthy subjects in agegroups of 20, 30, and 40 years were examined before and after several hours of visual display terminal (VDT) work after informed consent. Three trials of forward <-> backward movement of focusing on a target were carried out. Response curves of horizontal eye tracking and pupillary diameter, that is, convergence with miosis and divergence with mydriasis, were recorded continuously, bilaterally and simultaneously by TriIRIS. RESULTS: 1) Normal patterns of vergence and pupillary responses with constant amplitudes were recorded in five subjects and were stable. 2 ) Gradual decline of the mydriatic peak was observed in two subjects, suggesting spastic accommodation. Increasing mydriatic peak or notching of mydriatic phase was seen in one eye each, suggesting tonic disaccommodation. These abnormal patterns were reversed by adequate refractive correction, and classified as an eye-fatigue group. 3) Abruption of miotic phase was observed in two cases of exophoria. 4) Low and declining amplitudes despite normal light response were observed in two subjects, suggesting debilitated accommodation, and they were classified as an eye-strain group. 5) Post-traumatic mydriatic anisocoria responded in parallel, suggesting paretic accommodation. CONCLUSIONS: Coordinated dynamics of near triad responses revealed remarkable characteristics of accommodative iris movements with vergence. These objective findings revealed the different patterns of functional disorder of accommodation.

Accommodation, Ocular↗
PubMed2006

[Mydriasis--areflexia syndrome in eye with posterior chamber intraocular lens].

PURPOSE: To describe a rare complication of classical EEC technique with posterior chamber IOL implantation in the sulcus. PATIENTS AND METHODS: This is a retrospective study of 296 eyes which underwent EEC and CP implantation. None was operated with phacoemulsification. The posterior chamber IOL originated from 4 renowned manufacturers. RESULTS: In 25 eyes, at 2 to 7 month after surgery, we noticed a mydriasis with pupillary areflexia, though the majority (20 eyes) presented a miotic pupil in the days following surgery. CONCLUSION: The authors discuss possible causes of such a delayed complication: direct trauma of the iris, difficult haptic introduction in the sulcus, toxic material on the i., o.l. More probably the interaction of more than a cause is necessary for this delayed complication.

Cataract Extraction↗
PubMed1991

[The effects on accommodative and pupillary responses by topical application of cyclopentolate hydrochloride].

Accommodative and pupillary responses, refractive change, and visual acuity after 30 microliters instillation of cyclopentolate hydrochloride of various concentrations (0.00625-0.1%) in 6 young normal males (27.0 +/- 0.6 yrs) were investigated. Both accommodative and pupillary responses were measured by an infrared optometer, at pre-instillation and 1, 3, 6, 9 and 24 hours post-instillation. No significant effects were induced by concentrations of cyclopentolate hydrochloride 0.0125% or less. Reduced amplitude of accommodation and enlarged pupil were, however, observed by 0.025% and 0.05% of cyclopentolate hydrochloride from 1 through 9 hours post-instillation. Miotic response in accommodation was also reduced from 1-6 hours at the same concentrations. A concentration of 0.1% cyclopentolate hydrochloride showed both reduction of accommodation amplitude and enlarged pupil for 24 hours after instillation. However, neither refraction nor visual acuity was affected by any concentration of cyclopentolate hydrochloride. The results suggest that cyclopentolate hydrochloride at concentrations up to 0.05% applied before sleep would not be accompanied by inhibitory effects on accommodation during the day.

Accommodation, Ocular↗