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Miotics pupils are compatible with phacoemulsification. Several techniques have been proposed to enlarge the pupil. We present a multiple sphincterotomies technique which enlarges the pupil to a size compatible with phacoemulsification, and retains postoperatively the circular shape of the pupil as well as its functional role.
Starting with the ideas of Donders, a method has been developed of non-surgical treatment of the so-called accommodative esotropia (glasses, bifocals, prisms, miotics), surgery being only considered if insufficient results are obtained: these results are analyzed. The method of Gobin is in opposition with this method by not admitting the role of hypermetropia and by doing systematically a "four muscles surgery" (on two medial recti and on two oblique muscles).
A vegetative lytic enzyme (VLE) of Chlamydomonas reinhardtii mediates digestion of the cell walls of mother cells (sporangia) to allow release of daughter cells after miotic cell division in the vegetative cell cycle. This enzyme is secreted into the culture medium concurrently with the appearance of daughter cells in synchronized cultures. Using an assay that monitors digestion of the mother cell wall, we purified VLE by ion-exchange and gel-filtration chromatography from the medium of synchronized cultures. The purified enzyme was a basic glycoprotein with an apparent molecular mass of 120 kDa on gel filtration and 130 kDa on SDS-PAGE. Thus, VLE appeared to behave as a monomer. The enzyme acted specifically on the mother cell wall and was unable to digest the cell walls derived from single vegetative cells. The enzymatic activity was inhibited by PMSF, p-APMSF, TLCK, HgCl2, iodoacetate, EGTA, EDTA and 1, 10-phenanthroline. VLE cleaved several synthetic model peptides on the carboxyl side of a Lys or Arg residue, indicating that it is a protease that acts on protein in the mother cell wall in vivo to release the daughter cells.
Forty-three cases (86 eyes) of primary chronic angle-closure glaucoma were randomly selected. An additional 44 cases (77 eyes) of primary acute angle-closure glaucoma and 30 normal subjects (34 eyes) were also randomly enrolled as control groups for comparison in the clinical study. Ultrasonic biometric measurements of the anterior chamber depth, lens thickness and axial length of the eyeball were performed. Using an potic microgauge attached to the slit-lamp, the entrance of anterior chamber angle was also calculated. The clinical manifestations and the natural course, including the characteristic appearance of anterior chamber angle, the form of peripheral anterior synechia as well as the facility of outflow, were carefully investigated. There were significant differences in the biometric parameters of the anterior segment of eye among above three groups. The facts reveal that the anatomic features of eyeball, especially in the anterior segment differentiate from those of primary acute angle-closure glaucoma. Follow-up study for the early stage cases showed that topical administration of miotics and/or peripheral iridectomy can effectively prevent iris from forming peripheral anterior synechia and thus halt its development. The criteria of diagnosis and the principles of prevention and treatment at the early stage cases were presented. The pathogenesis was discussed. We emphasized that the progressive stage after intermittent attacks of primary acute angle-closure glaucoma should not be confused with primary chronic angle-closure glaucoma.
The experiences of the management of 20 cases (20 eyes) of intraocular lens (IOL) dislocation or subluxation were summarized in this report. All the patients underwent primary extracapsular cataract extraction with posterior chamber IOL implantation. The dislocation or subluxation occurred in 2 eyes intraoperatively and 18 eyes in 1 day to 3 years, post-operatively. The IOLs were captured at pupils in 12 eyes, dislocated into the vitreous in 4 eyes, represented as in westeast syndrome in 2 eyes and sunset and sunrise syndrome in 1 eye and 1 eye, respectively. Of the 20 eyes, 1 eye with mild sunset syndrome was treated with a miotic, 2 eyes with IOL pupillary capture were treated successfully by conservative therapy and the rest, by surgeries. In cases treated by operations, the IOLs were removed from original incisions in 3 eyes, by vitrectomies in 5 eyes and surgical reposition of IOLs were undertaken in 9 eyes with IOL pupillary capture of which 7 eyes were successful and in 2 eyes recurrence took place shortly after reposition. The causes and management of IOL dislocation or subluxation were discussed.
In a placebo-controlled prospective study, thymoxamine 0.02% or acetylcholine 1.0% or thymoxamine 0.01% plus acetylcholine 0.5% were used intraocularly to reverse mydriasis during cataract surgery. Prior to surgery, pupils were dilated with scopolamine 0.25%, tropicamide 1%, and phenylephrine 10%. At the end of surgery, 228 eyes were randomly assigned to 1 of 4 different treatments: 57 eyes each received intracamerally thymoxamine 0.02%, acetylcholine 1%, a combination of both drugs, or placebo. At 5 min posttreatment, there was a significant mean pupillary constriction of 1.86 +/- 0.67 mm following acetylcholine administration and 1.53 +/- 0.80 mm following thymoxamine application as compared with the placebo group, in which the pupillary diameter remained almost constant. For the combination of acetylcholine plus thymoxamine the effect was fully additive, with a pupillary constriction of 3.42 +/- 0.98 and 4.04 +/- 1.02 mm being observed at 5 and 10 min posttreatment, respectively. No drug-related side effect was detected. We conclude that thymoxamine can be useful during surgery as an intraocular miotic to reverse mydriasis and can considerably enhance miosis when given in combination with acetylcholine.
A large bulk of data link the use of unopposed estrogens to an increased risk of endometrial cancer. Cancers associated with estrogen use are often well differentiated and carry a good prognosis. Concomitant use of progestogens either cyclically or continuously substantially reduces the risk of promoting endometrial cancer. The development of endometrial cancers as a result of prolonged estrogen medication often occurs via hyperplasia (and atypical hyperplasia). The reason for this increase is not known in detail, but estrogens are believed to be promoter substances by increasing miotic activity and possibly also by down-regulating the defense system against abnormal cell clones. Estrogen receptor activity seems to be dependent on the degree of phosphorylation. Receptor interaction with the specific sites upstream of "regulatory genes" may regulate a variety of steps in gene expression from transcription and mRNA half-life to protein processing, permitting a rapid regulation of the nuclear protooncogenes. This may also explain why serum placental protein reflects endometrial status during hormone replacement therapy. Both 17 beta-estradiol and medroxyprogesterone acetate are capable of modulating DNA synthesis in the endometrial glandular epithelium. The endothelin receptor type A seems to be stimulated during the proliferative phase, whereas an increase in the endothelin B type receptor has been noted in secretory and menstrual phases. Furthermore, low doses of oral norethisterone and levonorgestrel induce morphological changes inclusive of breaks in the endothelial lining of veins with and without hemostatic plugs. Endometrial fibrinolytic enzymes seem to be modulated by estrogens and progestogens.(ABSTRACT TRUNCATED AT 250 WORDS)
The experiment has shown that the serum of rabbits with acute pancreatitis produces proliferative effect on pancreatic islets' B-cells in rats with the acute form of experimental diabetes. The stimulation of miotic activity of B-cells, processes of acino-insular transformation, compensation of the insular function in rats with alloxan diabetes proved to be lower than in rabbits under the same experimental conditions. This testities to relative species specificity of factors in the serum of rabbits with pancreatic gland trauma.
Synkinetic lid and ocular movements after traumatic or non-traumatic, acquired oculomotor palsy are well known. Less often misdirection in the intraocular muscles is observed. A 20-year-old female patient suffered from congenital palsy of the third nerve of the left dominant eye. She had residual small-angle exotropia after having extraocular muscle surgery four times during childhood, e.g., after high-dosage recess-resect procedures on the horizontal recti of her left eye. There was an anisocoria with a miotic pupil in the left eye when fixating in the primary position and when attempting right gaze. The patient complained of blurred vision at far fixation in the primary position. Her visual acuity was 0.8 in the primary position and 1.25 in 7 degrees left gaze. Retinoscopy of the left eye revealed a 1-1.25 myopic increase for the primary position. Surgical and non-surgical treatment (e.g., cycloplegia plus bifocal glasses, induced change of the leading eye) is discussed.
PURPOSE: To examine whether blockade of chemosensitivity of corneal nociceptors by Ca2+ antagonists decreases pain and irritation induced by capsaicin. METHODS: In adult rabbits, the number of lid-squeezing movements and the degree of palpebral opening, miotic response, and conjunctival vasodilation evoked by a bilateral instillation of 30 microliters of capsaicin (33 mM) were measured at different times (up to 5 hours) after the drug. Irritative responses to capsaicin in eyes pretreated with diltiazem, verapamil, or nifedipine were compared with those that received only the vehicle. Protein content in aqueous humor was also measured at the end of the experiment. RESULTS: Diltiazem at doses of 1 to 28 mM, administered 15 minutes before the application of capsaicin, significantly decreased scratching movements, conjunctival hyperemia, closure of the eye, and elevated aqueous protein concentration induced by capsaicin; however, it did not significantly reduce miosis. Nifedipine (2.8 and 10 mM) diminished the number of scratching movements but not other inflammatory parameters, whereas verapamil (2.8 and 10 mM) was totally ineffective in attenuating ocular signs of irritation produced by capsaicin. CONCLUSIONS: These results suggest that by lowering capsaicin-induced neural activity in nociceptive terminals, diltiazem decreases pain and neurogenic inflammation and may be useful as both an analgesic and an antiinflammatory agent in the eye.
An ab-interno goniotomy-like operation for disinserting the ciliary muscle from the scleral spur in cynomolgus monkeys is described. Following postoperative miotic and corticosteroid treatment, the eyes did well clinically and the muscle reattached to the sclera posterior to the spur. Outflow facility and intraocular pressure were mildly reduced. There was drainage of aqueous humor via the conventional outflow routes, and blood flow to the ciliary body. The outflow facility increasing effect of intravenous and intracameral pilocarpine was nearly completely eliminated. These and other data suggest that: (1) the ciliary muscle was permanently disconnected, anatomically and functionally, from the trabecular meshwork; (2) the trabecular meshwork and Schlemm's canal remained relatively normal structurally and functionally; (3) monkey eyes with retrodisplaced ciliary muscles may prove valuable for testing the functional effects of drugs directly on the conventional outflow channels, independent of drug actions on the ciliary muscle.
A case of Russell-Silver dwarfism is described with intrauterine dwarfism, craniofacial disproportion, congenital asymmetry of the body, triangular face, retro- and micrognathia and short incurved fifth fingers. This child has numerous ocular abnormalities including microphthalmia, tunica vasculosa lentis, chronic angle closure glaucoma and retinal degeneration with detachment. The glaucoma was controlled with miotic therapy following an iridectomy.
Angle recession is a relatively common result of ocular injury, which, if extensive, creates a noteworthy risk of elevated intraocular pressure (IOP) and glaucoma. The unilateral elevation in IOP is usually seen long after the injury has occurred. The diagnosis is often made based on clinical suspicion, either because of information obtained during the history-taking or from signs of ocular trauma observed during the examination. The treatment of angle-recession glaucoma is in many ways similar to that of primary open-angle glaucoma, although miotic drugs and argon laser trabeculoplasty are controversial therapies for this condition.
A descriptive cross-sectional epidemiological survey of primary open-angle glaucoma (POAG) was carried out in the department of Marne, France, between October 1990 and May 1991. The aim of the study was to obtain socio-medico-demographic data on glaucoma patients who were treated for a period of one year or more. Fifty per cent of the ophthalmologists in the department of Marne participated in the study by having their patients complete an anonymous questionnaire at home. Eighty-five per cent of the 407 patients replied. This response rate to the investigation did not vary significantly (p > 0.90) with respect to the ophthalmologist. However, forgetting to distribute the questionnaires to the patients was variable from one physician to the other. The prevalence of POAG cases undergoing treatment was between 0.15 and 0.36% for the whole population; between 0.37 and 0.89% for patients over the age of 40 years; 0.67 and 1.67% after the age of 60. The same number of women and men are affected, but the risk is 1.33 times greater for men after the age of 60. The geographical distribution of the patients is identical to that of the general population. Sixty-two per cent of the patients take other drugs as well and this proportion increases with age (p < 0.0001); 24% of the subjects have hypertension and 10.6% are diabetic. Half of the patients have received anti-glaucoma therapy for 6 years or less; 94% take beta-blockers, 18% take miotics and 12% use adrenergic drugs. More women instil their eyedrops on their own (79% vs 57%; p < 0.0001). Ten per cent of patients have had glaucoma operations and this proportion increases with age (p < 0.03). The frequency of laser treatment is 20%. Glaucoma patients seem to be faithful to their ophthalmologist as 65% of them go to the same one for follow-up. Our study shows that this type of investigation is well received by the patients.
A 48-year-old male was admitted to our hospital because of fever, headache and vomiting. At admission, the level of consciousness was depressed (drowsy) with slight confusion. Extremely miotic pupils, nuchal stiffness, ataxia and myoclonic movements of both upper limbs were observed. The eye movements were almost normal and there was no definite limb weakness or sensory impairment. A few days after admission, his level of consciousness further decreased, and opsoclonus, ataxic breathing and intestinal paralysis appeared. The body temperature fluctuated remarkably ranging from 33.0 degrees C to 39.0 degrees C. The cerebrospinal fluid (CSF) examination revealed lymphocytic dominant pleocytosis, increase of protein and decrease of glucose. Enzyme-linked immunosorbent assay (ELISA) showed increased antibody (IgG) to herpes simplex virus (HSV) in both serum and CSF. The antibody in CSF further elevated at the later examination. Magnetic resonance imaging (MRI) demonstrated high signal intensity areas mainly in the cerebellum and sporadically in the supratentorial subcortical white matter on T2-weighted images. Administration of Gadolinium-DTPA also revealed an additional lesion in the pons. From these findings, he was diagnosed as herpetic encephalitis involving the brainstem and the cerebellum, and acyclovir was administered. Although his initial symptoms and signs started to recover three weeks after admission, he newly developed complete flaccid paraplegia, dysuria and sensory disturbance with the spinal cord level of the 4th thoracic segment. The oligoclonal IgG bands were detected in the cerebrospinal fluid of the convalescent stage.(ABSTRACT TRUNCATED AT 250 WORDS)
43 cases (86 eyes) of primary chronic angle-closure glaucoma (PCACG) and 44 cases (77 eyes) of primary acute angle-closure glaucoma (PAACG) randomly selected, and 30 normal subjects (34 eyes) were performed ultrasonic biometry of anterior chamber depth, lens thickness and axial length of the globe. By a micrometer attached to the slip-lamp, the width of the anterior chamber angle entrance was also calculated. The clinical manifestations and the natural course of PCACG, including the morphology of the anterior chamber angle and the peripheral anterior synechiae (PAS) as well as the dynamic changes in aqueous outflow were investigated. It was found that there were significant differences in the biometric parameters of the anterior segment between PCACG and PAACG or normal eyes. Follow-up study of the early stage PCACG cases showed that topical miotics and/or peripheral iridectomy effectively prevented the formation of PAS and the progressive development of PCACG. The criteria for diagnosis and the principles for treatment of PCACG were stipulated. The pathogenesis of PCACG was discussed, and it was emphasized that minor attacks of PAACG and its progressive stage should not be confused with PCACG.
Recurrent late hyphema following cataract surgery and implantation of a posterior chamber intraocular lens (PC-IOL) is a rare complication, since there is usually no contact between the IOL and the anterior iris. If treatment with miotics or mydriatics fails, surgical removal of the IOL is often necessary. We report a patient with recurrent hyphema in his only myopic eye who had undergone two retinal detachment operations. A loop of the PC-IOL dislocated anteriorly through a peripheral iridectomy and caused localized pressure and recurrent bleeding. Conservative treatment with argon laser photocoagulation obviated more complex surgery in a high-risk patient.
Visual-training methods in management of myopia are suggested as possibly leading to normal vision or an improvement in the refractive state. The purpose of this work was to investigate the hypothesis that a Qi-Qong ocular exercise improves visual function by training the accommodation bias. Variations of pupil size, accommodative amplitude, latency and speed of accommodative response and accommodative adaptation were evaluated objectively. The accommodative state was monitored with an objective infrared refractometer (Nidek AA-2000). Subjects were divided into two groups: experimental (n = 9), and control (n = 8). Subjects of the experimental group undertook the Qi-Qong ocular exercise for at least three years, and were able to perform the exercise smoothly and gently. Subjects of the control group had no knowledge of the Qi-Qong ocular exercise, but were given the same testing procedures as the experimental group. Results showed that Qi-Qong ocular exercise can improve the accommodative amplitude and accelerate the accommodative response slightly, but there was no effect on the latency of accommodative response. Furthermore, the level of accommodative adaptation was elevated, and the pupil became slight miotic. Therefore, the mechanism of visual improvement may undergo a great accommodative adaptation and produce a pinhole effect by miosis of the pupil. Methods of visual training can produce a false image of visual improvement from an enhanced parasympathetic response to a task, but this effect may be a factor that induces progression of myopia.