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The cyclopentolate provocative test in suspected or untreated open-angle glaucoma. IV. Fluorescein angiography of the vessels of the iris in open-angle glaucoma eyes with a positive cyclopentolate response.

Fluorescein angiography of the iris (IFAG) was performed on 15 patients with a positive cyclopentolate response (IOP elevation greater than or equal to 8 mmHg) in 17 eyes to the cyclopentolate provocative test. The chamber angles were open in all the eyes. Seven of the responder eyes had capsular glaucoma undergoing treatment, six had simple glaucoma, two had pigmentary glaucoma and two suspicion of open-angle glaucoma. The object was to study with IFAG whether vascular changes can be established in the iris of the responder eyes such as could have a role in the elevation of IOP. All the eyes with capsular glaucoma displayed vascular changes, vasoproliferation and fluorescein leakage from the iris vessles. No other vascular changes were seen in the irises of the responder eyes. IFAG revealed no differences in the iris vasculature between responder and non-responder eyes. A vascular aetiology for the IOP elevation in responders is improbable.

Cyclopentolate

Comparison of 0.5% cyclopentolate plus 0.5% tropicamide and 1% cyclopentolate alone for mydriasis of dark irides.

We studied the mydriatic and cycloplegic effect of a single dose of a combination of 0.5% cyclopentolate hydrochloride and 0.5% tropicamide in 20 healthy subjects with dark brown irides. The mean change in dilatation with the combination drop was 3.5 mm, compared with 0.6 mm with 1% cyclopentolate alone (p less than 0.001). In 92% of 26 eyes studied the difference in refraction between the combination drop and 1% atropine was +1.00 dioptre or less. The combination drop safely provided satisfactory mydriasis and cycloplegia in 20 minutes, allowing for rapid and accurate examination of these patients.

Atropine

The cyclopentolate provocative test in suspected or untreated open-angle glaucoma. III. The significane of pigment for the result of the cyclopentolate provocative test in suspected or untreated open-angle glaucoma.

Significant elevations of IOP, i. e. responses, occurred in eyes with suspected or untreated open-angle glaucoma during the mydriasis test with 1% cyclopentolate (CPT). The possible role of pigment in the IOP elevations seen in the responders was studied. Pigment was liberated in the aqueous, sometimes very profusely, in 88 (31.9%) of 276 eyes during CPT. The maximal IOP elevations, ad 20 mmHg, were seen in just these eyes. They were eyes with capsular or pigmentary glaucoma or eyes in which exceptionally heavy pigment was demonstrated in the chamber angle for other reasons. There was a statistically significant correlation between pigment liberation and IOP elevation during CPT. Evidently profuse pigment liberation may have caused transient blocking of the trabecular meshwork, obstruction of aqueous outflow and elevation of IOP. Liberation of pigment in the aqueous during CPT was statistically highly significantly more profuse in eyes with pseudoexfoliation than in eyes without pseudoexfoliation. An equally significant correlation with demonstrated between the grade of chamber angle pigmentation and the degree of pigment liberation during CPT. The significance of pigment for IOP elevation was seen also in the statistically highly significantly more profuse pigmentation of the chamber angle in the responder than in the non-responder eyes.

Aqueous Humor

The effects of thymoxamine, phenylephrine and cyclopentolate on the accommodative process in man.

Accommodation of the eye was measured in a cross-over study in 11 healthy volunteers (20-35 years). In 5 subjects the near point was determined before and after topical instillation of 5 microliter of 0.1% and 0.5%, and 5 x 5 microliter 0.5% thymoxamine, 5 microliter of 2% and 10%, and 5 x 5 microliter 10% phenylephrine and 5 microliter of 0.04%, 0.2%, and 1% cyclopentolate. All concentrations of thymoxamine increased the accommodative amplitude by about 1.5 dioptres. Accommodation decreased by about 0.5 dioptre after instillation of 5 x 5 microliter 10% phenylephrine. The cycloplegic effects of 0.2% and 1% cyclopentolate were similar. Accommodation was also determined after application of 5 microliter 1% cyclopentolate followed by either 5 x 5 microliter 0.5% thymoxamine or 10% phenylephrine. Addition of thymoxamine did not alter the cycloplegic response of cyclopentolate alone. Addition of phenylephrine caused a more prolonged but similar maximum response compared to that of cyclopentolate alone. In the 6 other test subjects, the accommodation was compared before and after topical instillation of 5 microliter of 0.2% and 1% and 40 microliter (one standard eye-drop) of 1% cyclopentolate and followed during 6 h. There was no difference between the maximum value of 5 microliter and 40 microliter 1% cyclopentolate. We conclude from these data that alpha-stimulation by phenylephrine decreases and alpha-inhibition by thymoxamine increases the accommodative amplitude in man.(ABSTRACT TRUNCATED AT 250 WORDS)

Accommodation, Ocular

Effects of cyclopentolate eyedrops on gastric secretory function in pre-term infants.

Because of a report of necrotizing enterocolitis and death of a neonate from cyclopentolate eyedrops, we prospectively studied the effects of cyclopentolate 0.5% and 0.25% ophthalmic solutions and of a placebo on gastric volume and acid secretions in 20 pre-term infants. Placebo and cyclopentolate 0.25% eyedrops had no significant effect on the tested gastric functions. However, cyclopentolate 0.5% eyedrops significantly decreased gastric acid secretion and volume. Since this effect may predispose to the development of gastroenteritis, we recommend that cyclopentolate 0.5% be avoided in preterm infants; a weaker concentration of cyclopentolate eyedrops, however, can be used for mydriasis.

Achlorhydria

The effect of some macromolecular ionic complexes on the pharmacokinetics and -dynamics of ocular cyclopentolate in rabbits.

The effect of mucoadhesive polymeric vehicles on the mydriatic efficacy, and on the systemic and ocular absorption of cyclopentolate from eyedrops was studied in albino rabbits. Combining cyclopentolate base to polygalacturonic (CY-PGA) or hyaluronic (CY-HA) acid resulted in an increased mydriatic effect when compared with cyclopentolate hydrochloride (CY-HCl). During the first half an hour, the systemic absorption of cyclopentolate was lower after CY-PGA than after CY-HCl. The ocular penetration of cyclopentolate, based on drug concentrations in aqueous humor 30 minutes after the eyedrop instillation, was increased 3 fold when the polygalacturonate complex was used. CY-PGA, as well as other polymeric salts, might offer a possibility to increase the therapeutic index of cyclopentolate.

Absorption

Status of cyclopentolate as a cycloplegic in children: a comparison with atropine and homatropine.

We compared the cycloplegic effects of cyclopentolate, homatropine and atropine by the retinoscopy findings and residual accommodation left following their use in the same individual. The mean residual accommodation measured after the use of cyclopentolate, homatropine and atropine was 1.48 +/- 0.33 D, 2.32 +/- 0.37 D and 1.10 D +/- 0.28 D, respectively, and the mean difference in retinoscopy readings between cyclopentolate and homatropine, homatropine and atropine, and atropine and cyclopentolate was 0.46 +/- 0.21, 0.71 +/- 0.23 and 0.26 +/- 0.14, respectively. We further observed that a tonus allowance of about +0.75 D would suffice for cyclopentolate. The merits for recommending cyclopentolate as a routine cycloplegic in children are discussed.

Accommodation, Ocular

[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

Systemic absorption of ocular cyclopentolate in children.

Cyclopentolate plasma levels were quantitated and heart rate and pupil size were monitored after ocular application of the drug to juveniles. In all, 12 children were given one 35-microliters eyedrop of either 1% cyclopentolate (n = 6) or placebo (n = 6) in randomized order in the lower cul-de-sac of one eye. A sensitive radioreceptor assay was used to determine the systemic drug absorption. With the exception of one child, detectable cyclopentolate concentrations were seen in plasma at as early as 3 min after the ocular drug application. There was a marked interindividual variation in peak plasma cyclopentolate concentrations ranging from undetectably low to 5.8 ng/ml (median, 2.9 ng/ml). In some children a second drug concentration peak was detected. Cyclopentolate increased the pupillary diameter from 4.8 +/- 1 mm before drug application to 8 +/- 0.9 mm at 30 min after administration, but the children's heart rate did not alter.

Absorption

Reduced mydriasis from repeated doses of tropicamide and cyclopentolate.

Pupils are often dilated for examination the day before surgery and again on the day of surgery. The following experiment was performed to determine the effect of serial doses of two commonly used mydriatic agents: on two consecutive days the pupil of one of the eyes of 28 subjects was dilated with tropicamide 1%, and the pupil of one of the eyes of 30 subjects was dilated with cyclopentolate hydrochloride 1%. The other eyes in both groups were dilated only on the second day, and thus served as controls. Pupil sizes were measured from photographs before and after dilation. The pupils of the eyes treated twice with either drug did not dilate as well after the second dose as those of the control eyes (P less than .005 for tropicamide, P less than .001 for cyclopentolate). The pupils of the eyes twice-treated with tropicamide were an average of 0.15 mm smaller than the control pupils; those twice-treated with cyclopentolate were 0.36 mm smaller. For subjects treated with cyclopentolate, this decreased mydriasis was related to age (P less than .05) and to eye color (P less than .025): the younger and blue-eyed subjects dilated less on the second day than the older and brown-eyed subjects. If full mydriasis is required at surgery, pupils should probably not be dilated with either tropicamide or cyclopentolate the day before surgery.

Adult

[Acute psychosis caused by poisoning with cyclopentolate].

The authors report on a 17-year-old female patient who suffered an acute psychotic attack after local application of cyclopentolate 1.0% in both eyes. The literature is reviewed with regard to systemic side effects of local application of cyclopentolate. Toxicity of cyclopentolate may be found in every age group even if tolerated without side effects before and it has no specificity for patients with certain (especially brain) diseases. The rapid short-term cycloplegic effect and the rare cases of systemic toxicity support the authors opinion that cyclopentolate is a very useful and well-tolerated diagnostic substance.

Adolescent

Comparison of the effect of atropine and cyclopentolate on myopia.

We evaluated the effectiveness of cycloplegics in the treatment of myopia. Patients were selected randomly and divided into three groups: Group 1 received atropine 1% eye drops every other night; Group 2 received cyclopentolate 1% eye drops every night; and Group 3 received normal saline eye drops every night. All the patients were rechecked every three months. The results were evaluated at the end of one year. Ninety-six patients were evaluated, 32 in each group. The mean myopic progression was -0.219 D in the atropine group, -0.578D in the cyclopentolate group, and -0.914D in the saline group. Analysis showed that atropine and cyclopentolate are effective in slowing the progression of myopia. The effect of atropine is better than that of cyclopentolate.

Administration, Topical

Pharmacokinetics of topically applied cyclopentolate HCl and tropicamide.

The time course of accommodative loss after the topical application of 0.5% and 1.0% concentrations of cyclopentolate HCl and tropicamide was measured over a 20-min interval in 50 age- and sex-matched subjects between 20 and 30 years of age. Computer-assisted measures of residual accommodation provided detailed data on the temporal aspects of the cycloplegia induced by these commonly utilized drugs when used alone or with the topical anesthetic proparacaine HCl. The pattern of recovery of ocular accommodation from cycloplegia was also measured over a 5-h period, starting 2 h after drug application. The results show that latency, depth of cycloplegia, and rate of accommodative loss are regulated to drug type and concentration, and are influenced by the iris coloration of the test eye. The rate of onset of cycloplegia was not accelerated in blue or brown irides by the preadministration of proparacaine. Regardless of iris pigmentation, recovery from tropicamide cycloplegia was much faster than recovery from cyclopentolate cycloplegia. In contrast, the depth of cyclopentolate cycloplegia present in brown irides during the recovery phase was much greater than in blue irides. Mechanisms to explain these observations are proposed and clinical implications of these findings are presented.

Accommodation, Ocular

Possible allergic reactions to cyclopentolate hydrochloride: case reports with literature review of uses and adverse reactions.

Cyclopentolate has been widely used as a cycloplegic and mydriatic agent for over 30 years. It has gained widespread use as the cycloplegic drug of first choice for most children over the age of 1 year and allows many optometrists and ophthalmologists to carry out quick, successful cycloplegic refractions with few complications. During this time very few side-effects have been reported with the most commonly used 1% solution. This paper outlines two cases in which a possible allergic-type reaction occurred shortly after the instillation of 1% cyclopentolate hydrochloride in 'Minims' form (Smith and Nephew). This article also reviews the uses and side-effects of cyclopentolate and aims to warn practitioners about the possibility of such reactions, ways of avoiding their occurrence and suitable measures to take should they occur.

Child

[Cycloplegia with cyclopentolate for testing-refraction of children (author's transl)].

A comparative study of the cycloplegic effect of 1% cyclopentolate and atropine or homatropine was done by means of Lindner's method of retinoscopy. In 53% of 1.5- to 6-year-old strabismic patients the hypermetropic refraction was higher (average 0.6 dpt) under the use of atropine, and in 27% of 6- to 11-year-old children cyclopentolate was more effective than homatropine (average 0.5 dpt). Therefore, atropine should be used for children with convergent squint up to 6 years, in order to get full correction of hypermetropia. In other cases cyclopentolate is preferable because of its rapid and strong efficiency of brief duration.

Accommodation, Ocular

Cyclopentolate in treatment of sarin miosis.

1. Six young male volunteers were exposed to sarin vapour (isopropyl methyl phosphonofluoridate) at a concentration of 0.5 mg/m(3) for 30 min (concentration time (Ct) 15 (mg min)/m(3)).2. The resulting clinical syndrome was treated by instilling 0.06 ml of a 1% solution of cyclopentolate into the conjunctival sac.3. Visual acuity, retinoscopy, objective and subjective refraction and pupil sizes were noted before the trial, after exposure to sarin and after treatment with cyclopentolate.4. No appreciable difference was demonstrated between the control objective retinoscopy values and those obtained after cyclopentolate treatment of the clinical syndrome induced by sarin. Reduced near visual acuity was observed in some subjects treated with cyclopentolate as compared with acuity after exposure to sarin alone, considered to be due to the partial cycloplegia produced by treatment. Visual acuity after exposure to sarin alone was improved in some instances by the miosis produced.5. It is suggested that unless full dark adaptation is a consideration, treatment of the ophthalmic condition resulting from exposure to this dosage of sarin should be reserved for those experiencing distressing ocular symptoms.

Adult

[The cycloplegic effect of atropine in comparison with the cyclopentolate-tropicamide-phenylephrine combination].

Atropine is thought to produce the most effective cycloplegia in early childhood. Cyclopentolate and Tropicamide are the best known short acting cycloplegic agents. Phenylephrine is an adrenergic agent and has also a cycloplegic effect. In this study we compared a combination of Cyclopentolate, Tropicamide and Phenylephrine with Atropine and observed no difference between them.

Accommodation, Ocular