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At least 19 recordsLinked to original sources
PubMedDate not supplied

Miotics and retinal detachment: upgrading the community standard.

The majority of ophthalmologists who responded to a questionnaire regarding the relationship between miotics and retinal detachment felt that such a relationship does exist, and that myopia and aphakia/pseudophakia predispose to the formation of new retinal breaks or to retinal detachment from pre-existing breaks with miotics. Horseshoe breaks and dialyses are pre-existing lesions that should be treated prophylactically prior to miotic therapy. Patients with no predisposing pathology or whose eyes have lattice degeneration or operculated breaks should be warned of possible retinal detachment prior to starting miotics. Not performing a peripheral retina examination prior to prescribing a miotic is acceptable, but not optimal, medical practice. Examining the peripheral retina or obtaining a retina consultation prior to prescribing a miotic may be beneficial to the patient and could be invaluable in the defense of litigation.

Humans↗
PubMed1978

Retinal detachment and miotic therapy.

We studied a series of 34 eyes in 31 patients in whom retinal detachment occurred during miotic therapy. In 14 eyes, the duration of miotic use before the development of detachment was two months or less. Most detachments occurred in detachment-prone eyes either by virtue of myopia (62%), aphakia (24%), ipsilateral lattice degeneration (38%) or retinal pathology, in the fellow eye (50%). Virtually all detachments were rhegmatogenous. Distributions of retinal breaks are similar to the corresponding profiles in detached eyes not receiving miotics. The observed phenomena may be accounted for mechanistically, either with or without the role of miotics, so a specific causal role cannot be assigned to any given miotic in any given case. However, our data suggest that detachment-prone eyes may be at increased risk with miotic use, and thus demand careful retinal evaluation and prophylaxis when ominous peripheral symptoms are present.

Adult↗
PubMed1975

A rapid method for measuring miotic activity of drugs in the intact mouse eye.

A rapid and precise method for evaluating the miotic activity of cholinergic drugs has been developed based on Long's method for measuring the rate of mydriasis. The rate of reversal of mydriasis developed previously in the intact mouse eye by a mild mydriatic (phenycyclidine) is used to evaluate the miotic activity. The method provides a useful tool for measuring and comparing the miotic activity of acetylcholine agonists and cholinesterase inhibitors.

Amides↗
PubMed1975

Drugs affecting the cholinergic system in the intact mammalian eye. I. Evaluation of the miotic activity of acetylcholine-like drugs in the mouse eye.

The effect of concentration and pH on the miotic activity of five acetylcholine-like drugs were studied in the intact mouse eye. The data suggests that it is mainly the nonionized form of the drug which contributes to its miotic activity. Acetylcholine-like drugs, degradable by cholinesterases, exert their miotic activity at higher concentrations than do those which are resistant to enzymatic hydrolysis. More active acetylcholine-like drugs appear to be less sensitive to concentration changes.

Acetylcholine↗
PubMed1992

Effects of flurbiprofen and suprofen on the miotic activity of 1% acetylcholine and 0.01% carbachol.

The nonsteroidal antiinflammatory agents (NSAIAs) flurbiprofen and suprofen applied topically to reduce miosis may counteract the desired effects of miotics used during ocular surgery. In a pigmented rabbit model, 1% acetylcholine was shown to cause a greater, significant initial (for the first 30 minutes) constriction (P less than .05) than 0.01% carbachol in eyes pretreated with flurbiprofen and suprofen. From 2 to 8 hours, NSAIA pretreatment had a greater miotic effect with carbachol than with acetylcholine. There were no significant differences between flurbiprofen and suprofen on the miotic effect of carbachol or acetylcholine.

Acetylcholine↗
PubMed1975

Drug-biomolecule interactions: bioelectrometric study of the mechanism of carbachol interactions with the cornea and its relation to miotic activity.

The augmentation of carbachol miotic activity attributable to enhanced transcorneal absorption, which results from the action of cationic adjuvants included in ophthalmic vehicles, suggested a study of carbachol-corneal tissue interaction as a further step toward understanding the phenomenon. The present study was performed in vivo using an innocuous electrometric technique. A fixed charge density of the corneal epithelial surface versus carbachol concentration profile was obtained from the electrometric results; it revealed three distinct concentration regions defined by precipitous decreases of fixed charge over extremely small concentration ranges. This anomalous behavior is attributed to cooperative alterations in the binding affinities of fixed anionic sites on the tissue surface, which result in an all-or-none release of protons and/or other nicrocations. The unmasked anionic sites become reoccupied with carbachol except in the last region where the reoccupation by carbachol is competitive with other cations in the solution in contact with the surface. This behavior, postulated on the basis of the construction of a carbachol-tissue binding isotherm from which thermodynamic interaction affinities were computed, was corroborated by the observed dependency of the duration of miotic activity on carbachol concentration. Allosteric interactions between anionic binding sites, which are mediated through electron inductive and electrostatic field effects and likely involve a cooperative alteration in tissue water structure, are implicated as underlying the observed phenomena.

Animals↗
PubMed1992

[Modification of the visual field during temporary interruption of miotic treatment].

The visual field of 27 eyes with chronic open angle glaucoma was examined with the "Octopus 1-2-3" automatic perimeter. The visual fields with and without miotics were compared using the "mean defect" (MD) as parameter. The MD decreases significatively (p = 0.003) after interruption of the miotic treatment. As presumed, the IOP and the pupillary diameter increased significantly (p less than 0.001). The CLV insignificatively decreased. The short term modifications of the pupillary diameter seem to be a more important factor than this of IOP.

Aged↗
PubMed1978

Factors determining the potency of cholinomimetic miotic drugs and their effect upon the light reflex in man.

1. Television pupillometry was used to measure the effect of six topically applied cholinomimetic drugs on the resting diameter and light reflex amplitude of the human pupil. Drug potency was obtained from dose response curves. 2. The tertiary amines arecoline, aceclidine and pilocarpine were considerably more effective miotics than the choline esters carbachol, methacholine and acetylcholine. 3. All the drugs which caused miosis also reduced light reflex amplitude proportionally. 4. The in vitro potency of these drugs was also measured on preparations of rabbit iris sphincter and guinea pig ileum. 5. Dose response relationships for pilocarpine in man and in vitro showed evidence of partial agonist activity on the rabbit iris only. 6. A comparison of the in vivo and in vitro results showed that three factors influenced the potency of topically applied miotics: accessibility to the iris; sensitivity to cholinesterase; and cholinoceptor agonist potency.

Adult↗
PubMed1975

Miotic drugs, glaucoma, and retinal detachment.

It has been reported in the literature, and is the clinical impression of many ophthalmologists, that the use of miotic drugs and especially Phospholine Iodide increases the incidence of retinal detachment. A review of 1,000 cases of retinal detachment is reported with a breakdown of the percentage of patients who previously had glaucoma and the various drugs with which they had been treated prior to the development of their retinal detachments. The incidence of bilateral cases is also studied and conclusions are drawn as to whether or not there is any increased incidence of retinal detachment or in the bilaterality in patients who are on miotic medications.

Adult↗
PubMedDate not supplied

Uniocular miotic therapy.

The beneficial and harmful effects of 2% pilocarpine and 0.125% echothiophate iodide were evaluated on the prospective study of uniocular miotic therapy using the fellow eye as a control. Thirty primary open-angle glaucoma patients were treated with pilocarpine alone over a median time of 55 months. Twenty-nine similar patients were treated initially with echothiophate iodide and subsequently with pilocarpine over a median time of 54 months. Pilocarpine is cataractogenic but the changes are less marked and require more time than those induced by echothiophate iodide. In the combined group of 118 eves of 59 patients there were 11 optic disc changes and dix glaucomatous field defects. There was no difference in incidence between the treated and control eyes. The results suggest that one should be conservative in prescribing miotics, including pilocarpine alone, for patients suspected of having glaucoma.

Aged↗
PubMed1975

Malignant glaucoma" in an eye with no antecedent operation or miotics.

The diagnosis of malignant glaucoma was entertained preoperatively in a patient with no previous history of glaucoma surgery or use of miotics. The marked asymmetry in the anterior chamber depth and angle configuration between the two eyes was the significant clue. The findings at operation confirmed the diagnosis. The closure of the angle appeared to be due to retrovitreal fluid displacing the vitreous and the iris-lens diaphram forward.

Aged↗
PubMed1977

Malignant glaucoma induced by miotics postoperatively in open-angle glaucoma.

A case of malignant glaucoma that developed in a patient with primary open-angle glaucoma is described. The malignant course was induced during the immediate postoperative period by the inadvertent use of miotics. The malignant course was successfully managed by osmotic agents, acetazolamide, cycloplegics, mydriatics, and topical steroids.

Female↗
PubMed1979

Retinal detachments and topical ocular miotics.

There is increasing suspicion that topical ocular miotic therapy in selected persons may precipitate retinal detachments. This is a rare event and probably does not occur in patients free of retinal pathology. Data supporting a possible cause and effect relationship, obtained from the National Registry of Drug-Induced Ocular Side Effects, a survey of the Retina Society, medicolegal decisions, and a review of the literature, is presented.

Administration, Topical↗
PubMed1979

Effects of epinephrine, benzalkonium chloride, and intraocular miotics on corneal endothelium.

Drugs formulated for use both inside and outside of the eye were tested for their potential toxic effects on the corneal endothelium. Commercially available epinephrine 1:1000 was toxic to the corneal endothelium, but solutions diluted fivefold caused no endothelial damage. The toxic agent was the sodium bisulfite 0.1% preservative. Benzalkonium chloride is highly toxic to corneal endothelium in its commonly used concentration of 0.01% and had to be diluted one thousand times to prevent endothelial damage. Ophthalmic medications for extraocular use should never be used intracamerally. Miotics commonly used in surgery during intraocular lens implantation are generally nontoxic to the cornea, though caution is advised in the use of carbachol in patients with preexisting endothelial disease and in patients having procedures in which substantial mechanical trauma to the endothelium may occur.

Animals↗
PubMed1978

Effects of intraocular miotics on cultured bovine corneal endothelium.

Two cases of severe corneal oedema occurred after the use of intraocular pilocarpine. Experimental investigations were conducted with cultured bovine corneal endothelial cells exposed for 5 minutes to 1% pilocarpine solutions of varying composition. Cells were destroyed in solutions not isotonic with aqueous humour, and calcium-free ionic solutions caused loss of cell adhesion without loss of viability. Low pH or the presence of 1% pilocarpine had no detectable effects; 1% acetylcholine chloride in 5% mannitol (Miochol) also caused cell destruction, and this preparation was found to be considerably hypertonic. The minimum requirements for the formulation of intraocular miotics are discussed.

Acetylcholine↗
PubMed1976

The effect of miotics on the intraocular pressure of conscious owl monkeys.

The intraocular pressure of conscious, unsedated owl monkeys (Aotus trivirgatus) was measured with an applanation tonometer. Untreated eyes of the conscious animals were found to have higher values than those reported for owl monkeys anesthetized with pentobarbitone. Locally applied pilocarpine, carbachol, and oxotremorine gave concentration-related reduction in pressure, oxotremorine being the most potent and having longer duration of effect than the other compounds. Slight reductions were also observed with aceclidine and R. S. 86. These results are discussed in relation to the effects of miotics in man.

Anesthesia, Local↗
PubMed1975

Optic discoscopy through a miotic pupil.

A technique is described whereby visualization of the posterior pole of the retina is accomplished through a very miotic pupil. The technique is simple and quick to perform. A wide field of view is maintained as well as stereopsis.

Constriction↗