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At least 775 records · Page 43Linked to original sources
PubMed1995

Pupillary dilation and its effects on automated perimetry results.

BACKGROUND: The effects of miotic drugs on visual field sensitivity have been well documented, but few studies have reported the effects of active pupillary dilation on visual field sensitivity. Since visual field testing is sometimes performed when a patient is undergoing pupillary dilation for fundus examination, the effects of active pupillary dilation is of concern to today's optometrist. METHODS: The effects of active pupillary dilation on automated static threshold perimetry were studied in 23 normal subjects using the Humphrey Field Analyzer and the 30-2, StatPac, and FastPac programs. Baseline automated perimetry was performed on both eyes of each subject with the Humphrey Field Analyzer. On a separate visit, automated perimetry was performed on both eyes of all subjects while each eye was undergoing active pupillary dilation. Baseline and dilated visual field parameters were compared. RESULTS: A decrease in foveal threshold of 1.95 decibels (p = 0.0081), a mean deviation loss of 1.15 decibels (p = 0.0001), a decrease in short-term fluctuation (SF) of 0.19 decibels (p = 0.0423), and a decrease in the SF2 of 0.56 decibels (p = 0.0374) were found in the dilated fields as compared with the baseline visual fields in the first eye tested. A decrease in foveal threshold of 2.56 decibels (p = 0.0081) and a mean deviation loss of 1.43 decibels (p = 0.0001) were found in the dilated fields as compared with the baseline visual fields in the second eye tested. CONCLUSIONS: These findings indicate that active pupillary dilation in healthy subjects produces statistically significant differences, although these differences may not be clinically significant. To ensure repeatable visual fields, consistent pupil diameter should be controlled during serial visual field testing.

Adult↗
PubMed1977

Prophylactic cryotherapy of retinal breaks.

All 100 eyes treated with transconjunctival cryotherapy to seal peripheral retinal breaks had a final vision as good or better than when they were first seen. Three of the 100 eyes developed clinical retinal detachments subsequent to the initial cryotherapy, necessitating scleral buckling procedures; all 3 had a final vision of 6/6 in the involved eye. No other complications occurred. Indications for treating retinal breaks or for not treating, are presented. In general, all symptomatic retinal breaks and asymptomatic ones if in aphakic eyes, when crescentic or linear at the margin of lattice, or if horseshoe, are treated. Other instances in which asymptomatic retinal breaks are treated are the following: (1) eyes on long-term miotics: (2) cases in which a retinal detachment is present in the fellow eye: (3) the break(s) are in an only eye; (4) cataract extraction is being considered; (5) 4 diopters of myopia or greater are present; or (6) subretinal fluid of more than 1 but less than 2 disc diameters in size is noted. Other retinal breaks not associated with subclinical or clinical retinal detachments are placed under observation at periodic intervals.

Adolescent↗
PubMed1995

[Effect of local medications on intraocular pressure control following trabeculectomy].

Longterm administration of topical antiglaucoma therapies had been indicated to be a serious risk for failure of trabeculectomy through inducing a subclinical inflammation of conjunctival tissues and stimulating secondary fibroblastic proliferation. Our study had 3 main aims: (1) to check if this pejorative effect is present in our population of glaucomatous patients, (2) in order to improve the rate of surgical success in theoretically high risk patients (duration of topical treatment longer than 36 months), to determine the usefulness of the following actions: suppression of beta blocking agents 8 days before surgery, suppression of miotics and eventual topical administration of fluorometholone one month before surgery. (3) to correlate the observed clinical results to the cellular profile of preoperative conjunctival biopsies. We presented in a first step the results of a retrospective analysis including 88 trabeculectomies performed between January '93 and April '95 in 62 GCAO patients older than 40 years and without any previous ocular surgery. The mean age of patients was 66,8 years (41 to 87 years). Patients were classified into "complete success", "qualified success" and "failures" according to the "target" IOP was or was not reached in the last examination. Mean follow up was 5,8 months (1 to 26 months). The second prospective part of our study included 20 trabeculectomies performed in 16 patients we chose according to the nature, the duration of the preoperative topical therapy and the preoperative eventual preparation of the conjunctiva. This study also included a semiquantitative count of the different conjunctival cellular colonies in peroperative biopsies. Mean follow up of this study was 2,3 months (1 to 5 months). 31 "complete success", 52 "qualified success" and 5 "failure" were observed in the retrospective study. The reduction of IOP following trabeculectomy was statistically significant at all examinations (mean IOP in the last examination: 14,9 +/- 4,3 mmHg) but the level of success was not significantly different according to the nature, (mono against polytherapy), the duration of preoperative medical topical treatment, as well as the preoperative actions in order to improve the operative success in high risk patients. Preliminary results of our second prospective study did not yet show any failure and did not exhibit any clear correlation between the counts of the different cellular colonies and the level of operative success on one hand and the different topical therapies in the other hand. The results and limitations of this study were compared to those of the literature.

Adrenergic beta-Antagonists↗
PubMed1997

A review of the outcome of trabeculectomy in open-angle glaucoma.

BACKGROUND AND OBJECTIVE: The outcome of trabeculectomy in the treatment of primary open-angle glaucoma and exfoliative glaucoma was reviewed. PATIENTS AND METHODS: The study included 87 consecutive eyes of 87 patients with open-angle glaucoma. The outcome of trabeculectomy was correlated with a biomicroscopic appearance of the filtering bleb. Visual acuity, myopic shift in refraction, and lens opacity measurements were used as indicators for cataract progression. The effect of viscoelastics on complications and short-term outcome was studied in a randomized series of 107 eyes. RESULTS: In a series of 87 eyes, 61% had intraocular pressure (IOP) of less than 22 mm Hg without glaucoma medication 1 year after surgery. After 3 years, the corresponding success rate was 74% in a series of 85 eyes that had preoperative pupillary dilation of 4 mm or more. CONCLUSION: The diffuse filtering bleb type was associated with the greatest decrease in IOP. Unfavorable flap-sized blebs and bleb failures were associated with preoperative treatment with miotics, anterior fistulation, and postoperative hypotony. These patients also tended to be younger. In a randomized, prospective study of 107 eyes, the use of sodium hyaluronate had no significant effect on the incidence of complications or on the short-term outcome. Age 61 years or older, exfoliative glaucoma, postoperative hypotony, and IOP peaks were identified as risk factors for accelerated cataract progression after trabeculectomy.

Aged↗
PubMed1997

[Idiopathic hypertrophic cranial pachymeningitis associated with Horner's syndrome. A case report].

A 64-year-old man was admitted to our hospital for recurrence of visual disturbance and double vision experienced 1 year previously. He was alert and oriented. Bilateral light perception in a vision test, the third to the sixth cranial nerve palsies on the left side, and neck stiffness were observed. The patient exhibited left blepharoptosis, anisocoria and a left miotic pupil. After a pupillary drug test, a diagnosis of Horner's syndrome was made. Laboratory tests revealed hypoalbuminemia, elevated erythrocyte sedimentation rate, positive rheumatoid factor, and elevated p-ANCA. Examination of the cerebrospinal fluid showed increased initial pressure and pleocytosis, but its bacterial and fungal cultures were negative. Cranial magnetic resonance imaging after intravenous administration of gadolinium revealed mild brain edema and marked hypertrophy of the left tentorium cerebelli, bilateral frontal dura and falx. Marked hypertrophy of the dura accompanied by cellular infiltration was observed in biopsied dura specimens. The patient was given a diagnosis as idiopathic hypertrophic cranial pachymeningitis (IHCP). His ocular symptoms gradually improved with methylprednisolone pulse therapy and oral prednisolone. This is the first reported case of IHCP associated with Horner's syndrome. Previous anatomical findings of the cavernous sinus suggest that Horner syndrome in this patient might be due to a mechanism other than constrictive compression of the cranial nerves by the hypertrophic dura mater.

Anisocoria↗
PubMedDate not supplied

Angel-closure glaucoma following scleral buckling operations.

We have observed 22 patients with angle-closure glaucoma following scleral buckling operations. These patients did not have narrow anterior chamber angles preoperatively, and several were aphakix with surgical iris colobomas. The angle-closure glaucoma was manifest by a hazy cornea, elevated intraocular pressure, closed angle, absence or iris bombé, and presence of choroidal detachments. Treatment with cycloplegics and corticosteroids was more effective than treatment with miotics. A likely pathogenic mechanism is congestion and swelling of the ciliary body due to a temporary interference by the scleral buckle with venous drainage. Episcleral implants accounted for a statistically significant higher incidence of angle-closure glaucoma as compared to intrascleral implants.

Acute Disease↗
PubMed1997

Risk of acute angle-closure glaucoma after diagnostic mydriasis in nonselected subjects: the Rotterdam Study.

PURPOSE: To report the prevalence of narrow anterior chamber angles on slit-lamp examination and the incidence of acute angle-closure glaucoma (AACG) after diagnostic mydriasis in nonselected white subjects aged 55 years and over. METHODS: Of all subjects in the population-based Rotterdam Study (n = 7983), 6760 participated in the ophthalmologic examination and received both tropicamide 0.5% and phenylephrine 5% eye drops for diagnostic mydriasis. No exclusion criteria (e.g., level of intraocular pressure, presence of narrow anterior chamber angles, history of or treatment for glaucoma) were used. After the ophthalmologic examination, all participants received thymoxamine 0.5% drops in both eyes and were warned about the symptoms of AACG. RESULTS: The prevalence of narrow angles was 2.2% and was twice as high in women. In two subjects (0.03%), an attack of AACG developed in one eye after diagnostic mydriasis. After medical therapy, peripheral iridotomies were made with a Nd:YAG laser, and both eyes healed without loss of visual acuity or visual field. CONCLUSIONS: In nonselected white subjects of 55 years of age or older, the 2% prevalence of narrow anterior chamber angles is similar to that in a mixed black and white population in the United States. According to our protocol, 3 in 10,000 subjects are likely to develop AACG after diagnostic mydriasis followed by miotic drops.

Acute Disease↗
PubMed1998

The use of the consensual light reflex as an aid to performing laser peripheral iridectomy in patients with pigment dispersion syndrome and pigmentary glaucoma.

PURPOSE: The authors explore an alternative method of performing laser peripheral iridectomy (LPI) in patients with pigment dispersion syndrome and pigmentary glaucoma (PDS/PG) who are high myopes and therefore at increased risk of developing retinal detachment. METHODS: Four myopic patients with PDS/PG had LPI performed in one eye. A transilluminator was held up to the opposite eye to provide pupillary constriction via the consensual light reflex. No miotics were used. RESULTS: All LPIs were easily performed without complications. CONCLUSION: The authors present an alternative method to the standard use of pilocarpine for LPI theoretically to decrease further the incidence of retinal detachment in populations predisposed to it.

Accommodation, Ocular↗
PubMed1976

Comparative study of 1-cyclohexyl-4-(1,2-diphenylethyl)-piperazine and its enantiomorphs on analgesic and othe pharmacological activities in experimental animals.

The analgesic activity of (+/-)-1-cycylohexyl-4-(1,2-diphenylethyl)-piperazine (MT-45) was comparable to that of morphine. The activity of the S(+)-isomer was 1.14 to 1.97 times in mice and 1.00 and 1.23 times in rats as potent as MT-45, and 18.3 to 61.6 times as potent as the R(--)isomer, which was approximately comparable to that of Spa. The hyperglycemic and miotic activities of MT-45 and its S(+)-isomer in rabbits were negligible or very low, though they showed potent morphine-like activites. On the other hand, the R(--)-isomer showed no or very weak effects on those, while Spa showed definite effects. These results suggest that the modes of action of MT-45 and its enantiomorphs are partly different from those of morphine and Spa, and it may be concluded that MT-45 belongs to a new series of compounds having a potent analgesic activity.

Analgesics↗
PubMed1997

[Treatment of glaucoma with carbonic anhydrase inhibitors in eyewash: medium term retrospective experience with dorzolamide].

AIM: Clinical evaluation of the efficacy and innocuity of dorzolamide, the first new born topical carbonic anhydrase inhibitor. MATERIALS AND METHODS: Our retrospective analysis included 162 patients (76 men, 86 women) who were exclusively followed in our department and treated between June 96 and August 97 with dorzolamide (Trusopt 2%) administered in a minority of patients (n = 13) as the only hypotensive medication and in combination with other hypotensive drugs and/or as a substitute for acetazolamide or for miotics in the others (add on, n = 149). The mean age of the patients was 65.2 +/- 15.6 and the average follow up was 9.8 +/- 5.4 months. Dorzolamide was prescribed in various forms of glaucoma and ocular hypertension, mostly in POAG (n = 137). In bilateral treatments (n = 116/162), the eye with the most severe defect and/or the highest IOP was considered. IOP was checked along the other criteria generally followed in glaucoma patients at 1 and 3 months following the instauration of dorzolamide and then trimestrially. We considered as the initial IOP a mean value of the 2 most recent successive IOP values before instauration of dorzolamide realized at the same daytime. Patients with laser trabeculoplasty or cataract surgery during the dorzolamide treatment were disguarded. RESULTS: All patients considered, the mean IOP reduction was from 21.5 mm Hg before to 19.3 mm Hg with dorzolamide at the last control. The mean IOP decrease was statistically significant and stable at all controls. The mean IOP reduction was 18.4% (4.2 mm Hg) in the monotherapy group and 12.5% (3 mm Hg) in the add on group. There were 15.3% non responders (mean IOP reduction < half of the average IOP decrease observed all patients confounded) in the monotherapy group and 26% in the add on group. Local tolerance of dorzolamide was excellent in 84%. About 15% of patients (25/162) complained of systemic side effects mostly comparable to the side effects of oral IAC. Treatment was stopped in 57 patients (35.2%) primarily due to allergic blepharoconjunctivitis (n = 12 or 7.4%), general intolerance (n = 14 or 8.6%) and insufficient IOP reduction (n = 26 or 16%). CONCLUSIONS: Dorzolamide represents in our experience an effective ocular hypotensive drug but its systemic tolerance profile seems less promising than described in the literature.

Adolescent↗
PubMed1998

[Four new drugs for glaucoma: apraclonidine, brimonidine, dorzolamide and latanoprost].

Glaucoma is in most of cases initially treated with drugs, viz. beta-blocking agents, miotics, sympathicomimetics and carbonic anhydrase inhibitors. The therapy of first choice is a beta-blocking agent, but in approximately 50% of the patients treated the effect becomes inadequate with time and combination therapy is necessary. Recently, four new antiglaucomatous agents have become available: apraclonidine, brimonidine, dorzolamide and latanoprost. Apraclonidine, an alpha 2-adrenergic agonist, is indicated for brief episodes of postlaser rise of the intraocular pressure. Longer treatment may lead to tolerance. Brimonidine, another alpha 2-adrenergic agonist, is indicated for long-term treatment of glaucoma; tolerance does not often occur. Dorzolamide is a local carbonic anhydrase inhibitor which lacks the systemic side effects seen after oral administration of carbonic anhydrase inhibitors. Latanoprost, a prostaglandin F2 alpha-derivative induces an effective decrease of the intraocular pressure if administered as monotherapy and has a good efficacy when combined with other drugs lowering the intraocular pressure. The new antiglaucomatous agents are a welcome addition to the pharmacotherapy, since in many cases they make it possible to postpone or avoid surgery.

Administration, Oral↗
PubMed1998

Early dysfunction of iris sensory fibres in diabetic patients.

BACKGROUND: The present study was designed to propose transcutaneous electrical nerve stimulation (TENS) of the infratrochlear nerve as a noninvasive test useful in the detection of early iris small nerve fibre dysfunction in patients with diabetes mellitus. METHODS: A total of 32 diabetic patients with no symptoms or signs of diabetic neuropathy were enrolled from a clinical practice. Sixteen of them, 6 women and 10 men, ranging in age from 19 to 53 years, had been affected by IDDM for 13 +/- 2 years. The remainder, 6 women and 10 men, age range 32 to 58 years, were suffering from NIDDM (duration of manifestation 5 +/- 1 years). Twenty-six healthy individuals, 11 women and 15 men, ranging in age from 21 to 47 years, served as controls. Pupil area changes induced by TENS of the infratrochlear nerve were investigated. The electrical stimulus was not painful and consisted of a single square wave pulse of 40 mA intensity and 0.8 ms duration. Measurements were carried out by means of a TV monocular electronic pupillometer. RESULTS: A clear-cut miosis was provoked in controls (p < 0.01 versus basal values 100 sec to 220 sec from stimulation). NIDDM patients also showed a miotic response, but it was slower in onset (p < 0.05 versus basal values 140 sec after stimulation) and shorter (p < 0.01 at 180 sec from stimulation) in duration. No pupillary changes were registered in IDDM patients. CONCLUSIONS: An abnormality of iris sensory nerve fibres in inducing pupillary constriction was detected in both diabetic groups. The differences in the severity of the dysfunction could be related to the differences in duration of the disease among the diabetic patients in the two groups. In conclusion, TENS of the infratrochlear nerve could represent an original noninvasive method in detecting early iris sensory alterations in diabetic patients.

Adult↗