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PubMed1994

Mucoadhesive ophthalmic vehicles: evaluation of polymeric low-viscosity formulations.

A series of polyanionic natural or semi-synthetic polymers (polygalacturonic acid, hyaluronic acid, carboxymethylamylose, carboxymethylchitin, chondroitin sulfate, heparan sulfate and mesoglycan) were evaluated as potential mucoadhesive carriers for ophthalmic drugs. Solutions containing cyclopentolate (CY) or pilocarpine (PI) as salts (or polyanionic complexes) with the acidic polymers, all showing a low viscosity, were tested for miotic (resp. mydriatic) activity in albino rabbits. In the case of some polymeric complexes, small but significant increases of the areas under the activity vs. time curves (AUC) over reference cyclopentolate hydrochloride (CYHC1) or pilocarpine nitrate (PINO3) vehicles, and significant AUC decreases after removal of precorneal mucin by treatment with N-acetylcysteine were observed. A correlation was found between these data, considered indicative of the occurrence of a mucoadhesive interaction "in vivo", and "in vitro" viscometric data expressing the polymers-mucin force of interaction. The advantages and limitations of the mucoadhesive non-viscous approach in the formulation of ophthalmic vehicles are presented and discussed.

Adhesiveness↗
PubMed1994

Comparison of cycloplegic and noncycloplegic retinoscopy in Chinese pre-school children.

Twenty-seven Hong Kong Chinese children, aged 3 to 5 1/2 years, were recruited in this study to evaluate the relation between refractive error as measured retinoscopically before and after cycloplegia using cyclopentolate 1%. The noncycloplegic spherical refractive error of these children ranged from -0.75 to +2.50 D and approximately 98% of the Hong Kong pre-school children have a manifest spherical error within this range. The cycloplegic refractive error can be approximated by multiplying the spherical component of the manifest error by 1.45 and adding +0.39 D to the product, while keeping the astigmatic power and axis unchanged. Cyclopentolate 1% requires more time to produce mydriasis and cycloplegia in eyes with heavily pigmented irides; however, its final effect on refractive error is apparently independent of iris pigmentation and depends on the amount of spherical refractive error present.

Accommodation, Ocular↗
PubMed1991

Automated refraction. A comparative study of automated refraction with the Nidek AR-1000 autorefractor and retinoscopy.

A prospective study was performed on 46 eyes to compare results of different methods of objective refraction, namely automated refraction with the Nidek AR-1000 autorefractometer and retinoscopy in cycloplegia. We found that automated refraction in cyclopentolate cycloplegia gave results that differed little from results of retinoscopy in atropine cycloplegia both with respect to sphere and cylinder. Axis determination was even better with automated refraction. Dry automated refraction gave inaccurate results for the spheric component presumably because of suboptimal control of accommodation in this group of young patients. We recommend automated refraction in cyclopentolate cycloplegia as an easy, rapid, accurate and convenient method for obtaining an objective refraction where accommodative disorders are suspected.

Accommodation, Ocular↗
PubMed1977

Dilating dangerous pupils.

Altogether 85 eyes from patients at risk to the development of closed-angle glaucoma were dilated with either parasympatholytic or sympathomimetic drugs. Of 21 eyes dilated with cyclopentolate 1/2%, 9 developed angle closure and a significantly raised pressure at some stage during dilatation and subsequent miosis. Of 58 eyes dilated with tropicamide 1/2%, 19 developed angle closure and a significantly raised pressure during dilatation. Treatment with intravenous acetazolamide and pilocarpine rapidly returned pressure to normal levels. Six eyes that had previously had a positive provocative test with simultaneous pilocarpine and phenylephrine were safely dilated with phenylephrine alone. Subsequent miosis with pilocarpine produced closed-angle glaucoma in all eyes. The significance of these observations is explained and discussed, and it is suggested that high-risk eyes should never be dilated with cyclopentolate. Tropicamide is safe if elementary precautions are observed. Safest of all, however, is phenylephrine-induced mydriasis and subsequent miosis with thymoxamine drops 1/2%.

Acetazolamide↗
PubMed1992

In vivo observation of the axial movement of intraocular lenses through an anterior eye segment analysis system.

The small axial movement of the anterior surface of implanted intraocular lenses (IOLs) were examined in pseudophakic eyes with one-piece and three-piece IOLs using an anterior eye segment analysis system. The movement was calculated as the distance between the posterior surface of the cornea and the anterior surface of an IOL under a normal pupil size, following the instillation of 1% pilocarpine and 1% cyclopentolate solutions, respectively. The axial movement including movement after instillation of pilocarpine and cyclopentolate was 0.17 +/- 0.06, 0.05 +/- 0.07 and 0.13 +/- 0.06 mm, in phakic eyes and eyes with one-piece and three-piece IOLs, respectively. Image analysis techniques using Scheimpflug images proved its usefulness in the research field of IOL implantation.

Adolescent↗
PubMedDate not supplied

The efficacy of 2.5% phenylephrine and flurbiprofen combined in inducing and maintaining pupillary dilatation during cataract surgery.

PURPOSE: To evaluate the effectiveness of phenylephrine 2.5% and flurbiprofen 0.03% combined in inducing and maintaining mydriasis during extracapsular cataract extraction (ECCE). METHODS: One hundred patients undergoing ECCE + intraocular lens (IOL) implantation were randomly divided into four groups. The first group was given phenylphrine 10%, the second group phenylephrine 10% + flurbiprofen, the third group phenylephrine 2.5% and fourth group phenylephrine 2.5% + flurbiprofen. Cyclopentolate 1% was used in all patients. Phenylephrine and cyclopentolate were instilled preoperatively four times during 1 hour and flurbiprofen was given four times the day before surgery and twice with an hour's interval before operation. Pre-operative and post-cortex aspiration horizontal pupil diameters were measured with callipers viewed through the operating microscope. RESULTS: Pupil diameters in pre-operative and post-cortex aspiration were no different in the 2.5% and 10% phenylephrine groups (p>0.05). Both diameters were larger and pupillary constriction was smaller in the flurbiprofen groups (p<0.05). CONCLUSIONS: 2.5% phenylephrine was as effective as 10% phenylephrine, with and without flurbiprofen, in inducing and maintaining pupil dilatation during ECCE surgery.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMedDate not supplied

Higher order ocular aberrations after cycloplegic and non-cycloplegic pupil dilation.

PURPOSE: Clinical aberrometry is commonly undertaken with the use of mydriatic agents, however there is no literature available on whether aberrometry results obtained under cycloplegia differ from those obtained without cycloplegia. METHODS: Higher order aberrations were measured over a 6-mm pupil with a Bausch and Lomb Technolas Zywave Aberrometer on the right eyes of 31 young subjects (average age 19.7 +/- 1.7 years; 5 females, 16 males). Two measurement conditions were used for each subject: 1) topical installation of 3 drops 1% cyclopentolate hydrochloride; and 2) topical installation of 1 drop 2.5% phenylephrine hydrochloride, prior to aberrometry measurements. RESULTS: For higher order aberrations (3rd to 5th order), average root mean square (RMS) after phenylephrine measurement (0.3852 microm) was significantly lower than after cyclopentolate (0.4259 microm). A small but statistically significant difference was found between the two conditions for average vertical and horizontal coma and, to a lesser extent, horizontal 5th order aberrations. Repeatability RMS, a measure of test-retest measurement repeatability, was similar for the two conditions at 0.15 microm, and significantly lower than the average RMS for the difference between the two conditions (residual RMS) of 0.22 microm. CONCLUSIONS: The difference between cycloplegic and non-cycloplegic aberration measurements has implications for surgical correction of higher order aberrations.

Administration, Topical↗
PubMed1993

Effects of cycloplegia and iris pigmentation on postoperative intraocular inflammation.

Using the Kowa laser flare cell meter, we investigated the relation between anterior chamber inflammation following phacoemulsification and posterior chamber intraocular lens implantation, and (1) iris color and (2) the use of 1% cyclopentolate hydrochloride for 1 week postoperatively. One hundred sixty eyes, randomized into either a cycloplegic or noncycloplegic group, and classified into four different iris color groups--blue, brown, green, and hazel--were studied. Eyes with brown irides had significantly more intense flare 2 weeks postoperatively than eyes with blue irides. Overall, postoperative flare tended to be related to the degree of iris pigmentation. Use of 1% cyclopentolate hydrochloride for 1 week postoperatively failed to decrease anterior chamber inflammation in any of the eyes.

Adult↗
PubMed1998

Changes in intraocular pressure due to cycloplegia.

PURPOSE: We studied intraocular pressure (IOP) in a group of healthy myopic subjects before and after administration of chlorhydrate cyclopentolate 1%. METHODS: We measured the IOP before administration and at 15, 30, 45, 60, and 300 minutes and 24 hours after administration. RESULTS: The rise in IOP at 15 and 300 minutes was not significant (P > 0.05), while the rise at 30, 45, and 60 minutes was significant (P < 0.05). The increase reached its maximum at 45 minutes. At 300 minutes, the increase was almost completely overcome and was not significant. At 24 hours, the pressure had returned to initial values. CONCLUSIONS: Cyclopentolate represents a valuable aid in performing retinoscopy in healthy subjects who have an anterior chamber with adequate depth and an open angle.

Adolescent↗
PubMed2000

A comparison between laser interferometric measurement of fundus pulsation and pneumotonometric measurement of pulsatile ocular blood flow. 1. Baseline considerations.

PURPOSE: Several methods have been proposed for the investigation of the human choroidal circulation. The aim of the present study was to compare laser interferometric measurements of cardiac synchronous fundus pulsations with pneumotonometric measurements of intraocular pressure pulse and pulsatile ocular blood flow in humans. METHODS: The association between fundus pulsation amplitude as assessed with laser interferometry and pulse amplitude (PA) and pulsatile ocular blood flow (POBF) as assessed with pneumotonometry was investigated in 28 healthy subjects. Additionally, we investigated the distribution of fundus pulsation amplitude (FPA) in a region of -15 degrees to +15 degrees around the macula (n = 18) and the influence of accommodation paralysis with cyclopentolate on FPA (n = 10). RESULTS: There was a high association between FPA and PA (r = 0.86, p < 0.001) and FPA and POBF (r = 0.70, p < 0.001). Fundus pulsations in the macula were significantly smaller than in the optic disc, but significantly larger than those in peripheral regions of the retina. Administration of cyclopentolate did not influence FPA. CONCLUSIONS: On the basis of the strong correlation between laser interferometric measurements of FPA and pneumotonometric measurements of PA and POBF, we conclude that the FPA is a valid index of pulsatile choroidal perfusion in humans.

Adult↗
PubMed1990

Review: systemic absorption of topically applied ocular drugs in humans.

Literature on human plasma concentrations after instillation of ocular timolol, levobunolol, atropine, cyclopentolate, scopolamine, phenylephrine, betamethasone and technetium Tc 99m and theories of lacrimal drainage were reviewed. In all studies the eyedrops absorbed rapidly into the systemic circulation. Like the kinetics of the tracer substances in lacrimal scintigraphy, the plasma drug levels showed interindividual variations. Plasma levels of ocular drugs were lower when punctal occlusion was applied, the mechanism, however, could not be explained. Since an early and a late plasma peak was occasionally registered in some subjects in timolol and cyclopentolate studies, it is suggested that systemic absorption of ocular drugs is low during the nasolacrimal passage but occurs during conjunctival and nasal contact.

Absorption↗
PubMed1990

Pseudophakic accommodation? A study of the stability of capsular bag supported, one piece, rigid tripod, or soft flexible implants.

A group of pseudophakic patients was investigated to determine whether their implants shift along an anteroposterior axis under different conditions of ciliary muscle stimulation. There was no statistically significant change in refraction after either pilocarpine or cyclopentolate administration. A change in anterior chamber depth between the position after pilocarpine and that after cyclopentolate was found. It appears that rigid posterior chamber implants do move backwards on ciliary muscle relaxation, but by a maximum 0.25 mm. This is not thought to represent a mechanical threat to ocular health. It is also not enough to account for the apparent accommodative ability of some pseudophakic patients. The possible causes for this phenomenon are discussed.

Accommodation, Ocular↗
PubMed1991

The refractive status of Hong Kong Chinese infants.

One hundred and fifty-eight full-term Hong Kong Chinese infants were examined, at the age of approximately 10 weeks, using retinoscopy. Fifty of the subjects were re-examined at the ages of 20, 30 and 40 weeks. Cyclopentolate 1% was used to produce cycloplegia. Photographic methods were used to assess the straightness of the eyes of 122 infants. While the mean spherical equivalent of the refractive error at 10 weeks was within the limits reported in studies of Caucasian infants, a rapid decrease, not previously reported, occurred between the ages of 10 and 40 weeks. The amounts of astigmatism found were in line with results from Caucasian eyes but the direction was overwhelmingly with-the-rule. The prevalence of anisometropia decreased with age and anisometropia was not prevalent at the age of 37 weeks. Two exotropes (1.6%) and no esotropes were identified although this may have been confounded by the use of cyclopentolate.

Astigmatism↗
PubMed1989

Topical phenylephrine for mydriasis affects rabbit retinal pigment epithelial transport.

Rabbit retinal pigment epithelium (RPE) has an alpha-1 adrenoreceptor that substantially reduces RPE short circuit current (Isc) when stimulated. Since phenylephrine is a potent alpha adrenergic agonist frequently used to obtain pupil dilation, we examined the effect of topically applied phenylephrine for pupil dilation on RPE transport. Naive black dutch-belted rabbits received either one drop of 10% phenylephrine applied at t = 0 and t = 30 min or one drop of 1% cyclopentolate applied at t = 30 min. At t = 50 min, RPE-choroid-sclera explants from these animals were sealed in an Ussing chamber. At t = 60-70 min, 1.4 X 10(-4) M epinephrine was introduced into both sides of the Ussing chamber. The change in Isc produced by epinephrine was measured. The Isc reduction in rabbits receiving phenylephrine was 26% (+/- 5% SD, n = 6). The Isc reduction in rabbits receiving cyclopentolate was 39% (+/- 6% SD, n = 5). These values are significantly different (P less than 0.02, student two-tail t-test). These results indicate that topical phenylephrine reached the RPE in vivo and prestimulated the alpha-1 adrenoreceptors.

Administration, Topical↗
PubMed1978

Evaluation of drugs in ointment for mydriasis and cycloplegia.

Ointment preparations of cyclopentolate hydrochloride and tropicamide were compared with aqueous drops of these medications for the production of mydriasis and/or cycloplegia in clinic patients. Mydriasis and/or cycloplegia could be accomplished by the single application of a minute volume (around 0.005 ml) of ointment containing these drugs. With the use of ointment preparation, ocular irritation was minimal, and there was no interference with subsequent ocular examination. A delivery system was devised with a piece of silicone-rubber tubing that was filled with an ointment preparation. By squeezing the tubing, a minute volume (about 0.005 ml) of ointment preparation was expressed.

Accommodation, Ocular↗
PubMed1985

Feeding intolerance following ophthalmologic examination.

Reports of isolated cases of necrotizing enterocolitis following administration of mydriatric medication and ophthalmologic examination prompted a comparison of the incidence of feeding difficulties 24 hours before and 24 hours after the ophthalmologic examination of 50 newborns. All infants had received cyclopentolate hydrochloride and phenylephrine hydrochloride before the examination. A critical review of the nursing notes showed more abdominal distention and gastric aspirates in the period following the examination than in the period preceding the examination. One infant developed necrotizing enterocolitis during the 24-hour postexamination period. This study demonstrates the risk of feeding intolerance following the ophthalmologic examination of neonates. These risks may be due to the known side effects of the mydriatics, to the physical stress of the examination, or to a combination of both factors.

Animals↗
PubMed1993

Simultaneous bilateral malignant glaucoma following laser iridotomy.

A case of bilateral malignant glaucoma is described in a 50-year-old white woman 4 weeks after successful bilateral laser iridotomy for angle-closure glaucoma. The malignant glaucoma may have been precipitated by systemic hydrochlorothiazide therapy. The condition was worsened by pilocarpine; however, atropine and cyclopentolate opened the angle and deepened the anterior chamber, resulting in resolution of the malignant glaucoma. The clinician must be alert to the possibility of malignant glaucoma following laser iridotomy for angle-closure glaucoma.

Atropine↗