Search

Background: To investigate the short-term effects of cyclopentolate and tropicamide eyedrops on choroidal thickness (ChT) in myopic children using placebo or low-dose atropine eyedrops., Methods: The analysis included 242 myopic individuals (7-19 years) enrolled in two randomised placebo-controlled clinical trials of low-dose atropine eyedrops. Cycloplegia was induced using either one drop of 1% cyclopentolate (n = 161), two drops of 1% cyclopentolate (n = 32) or two drops of 1% tropicamide (n = 49). ChT measurements were taken using swept-source optical coherence tomography before and 30 min after administering the cycloplegic eye drops. A subset of 51 participants underwent test-retest measurements prior to cycloplegia., Results: Mean changes in subfoveal ChT after two drops of tropicamide and one and two drops of cyclopentolate were -2.5 μm (p = 0.10), -4.3 μm (p < 0.001) and -9.6 μm (p < 0.001), respectively. Subfoveal ChT changes after one and two drops of cyclopentolate were significantly greater than the test-retest changes (test-retest mean change: -3.1 μm; p < 0.05), while the tropicamide group was not significantly different (p = 0.64). Choroidal thinning post-cyclopentolate was not significantly different between atropine and placebo treatment groups (p > 0.05 for all macular locations). The coefficient of repeatability (CoR) in the tropicamide group (range: 8.2-14.4 μm) was similar to test-retest (range: 7.5-12.2 μm), whereas greater CoR values were observed in the cyclopentolate groups (one drop: range: 10.8-15.3 μm; two drops: range: 12.2-24.6 μm)., Conclusions: Cyclopentolate eye drops caused dose-dependent choroidal thinning and increased variation in pre- to post-cycloplegia measurements compared with test-retest variability, whereas tropicamide did not. These findings have practical implications for ChT measurements when cyclopentolate is used, particularly for successive measurements., (© 2023 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Toxoplasmosis is one of the most important protozoa zoonotic diseases worldwide. The present study describes the clinical, seroprevalence findings with ocular toxoplasmosis and the outcome of medicinal treatment of these cats. This study was carried out on 105 cats with various ocular signs, no historical evidence of ocular trauma or drug/vaccine exposure for at least 3 months prior to admission, and without clinical or laboratory evidence of other systemic diseases. Complete case history, physical and ophthalmic examinations were carried out. The seroprevalence of Toxoplasma gondii antibodies was determined using the Toxoplasma Ab Rapid Test and Enzyme Linked Immunosorbent Assay. Out of 105 examined cats with ocular lesions, 60 cats representing 57.14% were seropositive to T. gondii. Out of these 60 cats, 15 cats (25%) had bilateral ocular abnormalities, 25 cats (41.67%) had right-sided ocular disease, and 20 cats (33.33%) had left-sided ocular disease. There were 38 cats (63.33%) with anterior uveitis, 12 cats (20%) with posterior segment involvement, 5 cats (8.33%) with anterior uveitis and anterior chamber abnormalities, 3 cats (5%) with corneal abnormalities and 2 cats (3.34%) with anterior uveitis with concurrent corneal involvement. There was a significant difference in the index values of IgM and IgG between seropositive and seronegative cats with T. gondii antibodies (p⟨0.05). There was no significant difference between the different ages, genders and breeds of cats with seroprevalence of T. gondii antibodies as well as between the age and total number of cats with seropositive and seronegative T. gondii. Out of 60 treated cats, 28 cats (46.7%), 25 cats (41.7%) and 7 cats (11.6%) showed complete, partial and poor response to treatment, respectively. In conclusion, cats showing ocular signs without obvious etiology should be examined serologically for toxoplasmosis and the seropositive cats should be treated with both specific topical and systemic treatments., (Copyright© by the Polish Academy of Sciences.)

Objectives: To evaluate the efficacy of a mydriatic agent for posterior synechiae after phacoemulsification and intraocular lens (IOL) implantation followed by Descemet membrane endothelial keratoplasty (staged DMEK)., Methods: In this prospective study, the outcomes of DMEK with or without mydriasis (0.5% tropicamide and 0.5% phenylephrine hydrochloride [Mydrin-P; Santen, Osaka, Japan]) after the DMEK procedure were analyzed. Patients underwent IOL implantation approximately 4 weeks before DMEK. Six months after DMEK, the iris posterior synechiae severity score was evaluated based on the extent of posterior synechiae affecting the eight areas (45° each) of the pupillary rim (posterior synechiae score; grades 0-8). Best spectacle-corrected visual acuity, central corneal thickness, endothelial cell density, axial length, and the amount of air at the end of the surgery were also evaluated., Results: Fifteen eyes of 15 patients (mydriatic: n=8, control: n=7) were eligible for inclusion. Iris posterior synechiae were detected in all seven eyes (100.0%) in the control group, whereas they were noted in two eyes in the mydriatic group (25%). The mean iris posterior synechiae score was 0.69±1.20 in the mydriatic group and was significantly lower than that in the control group (4.57±0.90; P<0.001). There was no significant difference in other clinical factors. Although the incidence and scores of posterior synechiae in the control group were higher, the incidence was significantly reduced with the use of a mydriatic agent (in the mydriatic group)., Conclusions: Use of a mydriatic agent is an effective measure to prevent postoperative synechiae after DMEK.

Background: The aim of this study is to assess whether pupillary modifications following ocular anticholinergic and cholinergic drugs can identify subjects with neurodegenerative diseases from early stages., Methods: 51 subjects were divided into 3 groups, according to different neurodegenerative diseases, and compared with a control group of 10 patients. Pupil diameter has been measured at different times after topical administration of tropicamide 0.01% in the right eye. Then, topical administration of pilocarpine 0.06% has been performed, followed by pupillary constriction measurement. Pupillary response rates were stratified according to acetylcholinesterase inhibitors intake., Results: Observed mydriasis and pupillary constriction was similar in all study groups at all evaluation times. Patients without acetylcholinesterase inhibitors intake presented greater mydriasis., Conclusions: Although it was not possible to observe significant differences among groups in terms of pupillary response, the analysis of pupillary features may become an useful tool to detect efficacy of acetylcholinesterase inhibitors.

Standard treatment for Parkinson's disease (PD) is L-DOPA, but with chronic administration the majority of patients develop L-DOPA-induced dyskinesia (LID). Emerging evidence implicates the cholinergic system in PD and LID. Muscarinic acetylcholine receptors (mAChR) are known to modulate movement and of late have been implicated as possible targets for LID. Therefore the current study investigated the role of M 1 and M 4 mAChRs in LID, on motor performance following L-DOPA treatment, and sought to identify brain sites through which these receptors were acting. We first administered M 1 R-preferring antagonist trihexyphenidyl (0, 0.1, and 1.0 mg/kg, i.p.) or the M 4 R-preferring antagonist tropicamide (0, 10, and 30 mg/kg, i.p.) before L-DOPA, after which LID and motor performance were evaluated. Both compounds worsened and extended the time course of LID, while M 1 R blockade improved motor performance. We then evaluated the effects of tropicamide and trihexyphenidyl on dyskinesia induced by D 1 R agonist SKF81297 or D 2 R agonist quinpirole. Surprisingly, both M 1 R and M 4 R antagonists reduced D 1 R agonist-induced dyskinesia but not D 2 R agonist-induced dyskinesia, suggesting that mAChR blockade differentially affects MSN firing in the absence of postsynaptic DA. Finally, we evaluated effects of striatum- or PPN-targeted tropicamide microinfusion on LID and motor performance. Despite prior evidence, M 4 R blockade in either site alone did not affect the severity of LID via local striatal or PPN infusions. Taken together, these data suggest M 4 R as a promising therapeutic target for reducing LID using more selective compounds., (Copyright © 2019 IBRO. Published by Elsevier Ltd. All rights reserved.)

Purpose: To assess the efficacy of using a nonste-roidal anti-inflammatory drug preoperatively and of applying the re-dilation technique when necessary to minimize pupil size variation when comparing the degree of mydriasis before femtosecond laser pretreatment with that at the beginning of phacoemulsification., Methods: This retrospective study included patients who underwent cataract surgery using the LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Our routine dilating regimen with flurbiprofen, tropicamide, and phenylephrine was used. The re-dilation technique was applied on eyes that manifested with a pupillary diameter that was smaller than the programmed capsulotomy diameter after laser pretreatment. The technique consists of overcoming pupillary contraction by instilling tropicamide and phenylephrine before phacoemulsification. Pupil size was assessed before femtosecond laser application and at the beginning of phacoemulsification., Results: Seventy-five eyes (70 patients) were included. Nine (12%) eyes underwent the re-dilation technique. There was no significant difference in mean pupillary diameter and mean pupillary area between the two studied surgical time points (p=0.412 and 0.437, respectively). The overall pupillary area constriction was 2.4 mm2. Immediately before opening the wounds for phacoemulsification, none of the eyes presented with a pupillary diameter <5 mm, and 61 (85.3%) eyes had a pupillary diameter >6 mm., Conclusion: Preoperative administration of nonsteroidal anti-inflammatory drug and the re-dilation technique resulted in no significant pupil size variation in eyes that were pretreated with the femtosecond laser, when comparing the measurements made before the laser application and at the beginning of phacoemulsification. This approach can avoid the need to proceed with cataract extraction with a constricted pupil.

The burden associated with the rising prevalence of myopia and high myopia, and the associated vision impairment and sight-threatening complications, has triggered the need to evaluate strategies to control the progression of myopia. We provide an overview of the literature on the use of optical (spectacles, contact lenses, and orthokeratology) and pharmaceutical approaches to slow progress of myopia. The evidence indicates that myopia progression can be slowed by varying degrees using these strategies. All approaches play a role in the management of myopia as needs and requirements of an individual vary based on age, suitability, affordability, safety of the approach, subjective needs of the individual, and rate of progression. This review also identifies and discusses the lack of long-term efficacy data and rebound on discontinuation of myopia control products., (Copyright 2018 Asia-Pacific Academy of Ophthalmology.)

Unintentional laser exposure is an increasing concern in many operational environments. Determining whether a laser exposure event caused a retinal injury currently requires medical expertise and specialized equipment that are not always readily available. The purpose of this study is to test the feasibility of using dynamic light scattering (DLS) to non-invasively detect laser retinal injuries through interrogation of the vitreous humor (VH). Three grades of retinal laser lesions were studied: mild (minimally visible lesions), moderate (Grade II), and severe (Grade III). A pre-post-treatment design was used to collect DLS measurements in vivo at various time points, using a customized instrument. VH samples were analyzed by liquid chromatography/tandem mass spectrometry (LC-MS/MS) and relative protein abundances were determined by spectral counting. DLS signal analysis revealed significant changes in particle diameter and intensity in laser-treated groups as compared with control. Differences in protein profile in the VH of the laser-treated eyes were noted when compared with control. These results suggest that laser injury to the retina induces upregulation of proteins that diffuse into the VH from the damaged tissue, which can be detected non-invasively using DLS.

Backgroud: To evaluate the manifestations of increased esodeviation under cycloplegia with 0.5% tropicamide and 0.5% phenylephrine in children with hyperopia and esotropia., Methods: We reviewed the medical record of 34 children with hyperopia and esotropia who underwent a prism alternate cover test before and after instillation of mixed eye drops containing 0.5% tropicamide and 0.5% phenylephrine between November 2014 and October 2015. Increased angle of deviation was defined as 10 prism diopters (PD) or greater deviation after cycloplegia. The factors related to increased angle of deviation were evaluated using univariable and multivariable logistic regression analysis., Results: The median age was 5.0 years (interquartile range, 3.75 to 5.0) and 12 patients (35.3%) were male. The median manifested refractive (MR) was +2.13 diopters (D) (+0.92 to +4.47) and cycloplegic refractive (CR) was +3.50 D (+1.72 to +5.66). The median difference between MR and CR was +0.88 D (+0.50 to +1.28). Thirteen patients (38.2%) showed increased esodeviation under cycloplegia and all had accommodative esotropia. A larger difference between MR and CR was the only significant factor affecting increased esodeviation in both univariable (OR = 4.72, P = 0.029) and multivariable (OR = 5.22, P = 0.047) analyses., Conclusion: Children with hyperopia and esotropia often showed an increased angle of deviation after instillation of 0.5% tropicamide and 0.5% phenylephrine. This phenomenon reminded the clinicians that cycloplegics can have a different effect on esodeviation and suggested that increased angle of esodeviation may help to reveal the latent deviation in some patients with hyperopia and esotropia.

Purpose: To describe the case and the follow-up of a traumatic choroidal rupture characterized by means of multimodal imaging including color fundus photographs, infrared reflectance, blue autofluorescence, swept-source optical coherence tomography, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCT-A)., Methods: Case report., Results: A 17-year-old boy was referred to our clinic complaining of reduction in visual acuity in the right eye (RE) after a blunt ocular trauma during a soccer match. Dilated fundus examination of RE showed 2 peripapillary choroidal ruptures located temporally and inferiorly to the optic disc. Among different imaging tools useful in the diagnosis and study of choroidal ruptures, particular attention must be paid to OCT-A, which showed the lesions as breaks in the choriocapillaris plexus with a hypointense appearance due to the lack of substance. Moreover, along the break it was possible to see the projection of the underlying choroidal vasculature, which appeared hyperintense. The retinal vascular plexa were spared., Conclusions: All patients presenting with blunt ocular trauma should undergo fundus examination to exclude damage to the optic nerve, retina, and choroid, and need close follow-up to avoid the development of secondary complications such as choroidal neovascularization. Optical coherence tomography angiography might add relevant information in the global evaluation and follow-up of choroidal ruptures in a noninvasive fashion, and could replace other invasive modalities such as FA or ICGA.

Purpose: Prostaglandin analogs induce miosis and lower intraocular pressure (IOP). As pupils of latanoprost-treated eyes may have to be dilated for ophthalmoscopy or intraocular surgery, we studied whether 0.5% tropicamide or 1% atropine alter the effects of 0.005% latanoprost on pupil diameter (PD) and IOP in healthy dogs., Methods: IOP and PD were measured hourly, 8 AM-4 PM, with the right and left eyes serving as control (CE) and treated (TE) eyes, respectively. Measurements were conducted in ten Labrador retrievers with one-week washout: (i) baseline values, (ii) latanoprost at 8 AM, (iii) tropicamide at 8 AM, (iv) latanoprost at 8 AM and tropicamide at 11 AM, and (v) latanoprost at 8 AM and atropine at 11 AM (n = 4)., Results: At 4 PM, TE PD was 5.88 ± 0.59, 3.62 ± 0.66, 6.33 ± 1.00, 5.42 ± 0.57, and 8.12 ± 1.24 mm in sessions 1-5, respectively. TE PD was significantly different between treatment sessions 2, 4, and 5 (P = 0.018, Friedman), being most mydriatic in session 5. At 4 PM, TE IOP was 11.27 ± 2.07, 7.10 ± 1.07, 11.1 ± 2.21, 7.70 ± 1.85, and 8.87 ± 1.42 mm Hg in sessions 1-5, respectively, with no differences between treatment sessions 2, 4, and 5 (P = 0.105, Friedman)., Conclusions: Tropicamide and atropine counteracted latanoprost's miotic effect, with atropine causing significantly larger mydriasis, sufficient for indirect ophthalmoscopy. Neither drug counteracted the hypotensive effect of latanoprost during this study period. Further studies are necessary to evaluate the potential risks in glaucomatous dogs., (© 2015 American College of Veterinary Ophthalmologists.)

Sialorrhea or excessive drooling is a significant medical issue in Parkinson's disease (PD) and neurodegenerative disorders, although it is often underreported by patients. Sialorrhea affects a large proportion of PD patients, ranging up to 78% in advanced stages, with many PD patients considering drooling as their worst non-motor symptom. Sialorrhea affects up to a million patients with diverse neurological impairments, including cerebral palsy, amyotrophic lateral sclerosis (ALS), Huntington's, survivors of stroke and severe traumatic brain injury. Numerous approaches have been attempted to treat sialorrhea in PD patients, including surgical procedures, prosthetic devices, botulinum injections, systemic anticholinergic drugs, and speech and behavioral therapy. A novel drug treatment (NH004) to control the symptoms of sialorrhea is under development. The active ingredient is the anticholinergic drug tropicamide. Anticholinergic drugs work by blocking acetylcholine muscarinic receptors and ultimately decreasing saliva secretion via the reduction of parasympathetic autonomic nervous system activity. The tropicamide is delivered in a thin film designed to adhere to the buccal mucosa and to slowly dissolve within the oral cavity, allowing the drug to reach the underlying salivary gland. A pilot study testing NH004 in PD patients has suggested a potentially useful sialorrhea-reducing effect with NH004 compared to placebo. The advantages of NH004 include local bioavailability with low systemic exposure, rapid onset of action and, importantly, convenience of use for patients. This review summarizes the current knowledge and impact of sialorrhea as a common non-motor symptom in PD, treatment options, the anticholinergic drug tropicamide, the design and development of the thin film drug delivery system, and NH004 for the treatment of sialorrhea.

Introduction: Cycloplegia allows for an objective refraction in children. Atropine is the gold standard but causes prolonged blurred vision. Cyclopentolate is less effective but less disabling. Tropicamide is a weak cycloplegic. The purpose of this study was to evaluate a cyclopentolate and tropicamide combination (CTA) versus atropine for refraction in black children., Materials and Methods: We performed a prospective study between October 2011 and July 2012 on all children seen in consultation. Objective refraction was performed after cycloplegia with cyclopentolate 0.5% combined with tropicamide 0.5%, and then after cycloplegia with atropine., Results: Thirty-three patients were recruited, 14 boys and 19 girls. The average age was 9.9 years. The mean age of the patients was 9.9 years. Astigmatism was found in 96.9% of cases. It was 1.34±1.32 diopters with CTA and 1.35±1.22 diopters with atropine. The mean axis was 98.15 and 99.8, respectively. Hyperopia and myopia were found in 39 and 27 eyes, respectively with ACT (average 1.73 and 5.37 diopters), and in 41 and 19 eyes with atropine (average 2.06 and 6.11 diopters)., Discussion: There is a good correlation of results with regards to cylindrical and spherical refractive error between the two protocols. Atropine is the best cycloplegic, however ACT provides reliable results., Conclusion: The cyclopentolate-tropicamide combination is satisfactory for routine cycloplegia in children., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Purpose: To evaluate pupil dilation with intra-cameral injection of preservative-free lidocaine 1% (ICL) versus topical eye midriatics during phacoemulsification., Methods: This case-control study included 40 patients with similar bilateral senile cataract scheduled for phacoemulsification and intraocular lens (IOL) implantation. patient's first eye received topical midriatic eye drops as control group and next eye operated by intra cameral preservative free lidocaine 1% without any preoperative or intraoperative midriatics. We did not add epinephrine to the irrigating solution in either group. The first eyes received 3 drops of cyclopentolate 1% and tropicamide 1% each 5 minutes, with first dose 60 minutes before surgery. The horizontal pupil diameter was measured before and after pupil dilation using the same caliper with operation microscope total surgical time was recorded in both groups., Results: Patients included 20 male and 20 female with mean age of 72 and 70.9 years old .4 patients were diabetic and 11 cases had pseudo-exfoliation. Pupil diameter increased in both case and control groups significantly (P value<0.0) but the difference between mean increase in pupil size wasn't significantly different. Mean increase in pupil size was significantly greater in patients without pseudo-exfoliation (4.10 mm vs 3.85 mm, independent t test, P<0.05). There was no significant difference between diabetic and non- diabetic patients regarding of pre- and post-injection diameter of the pupil., Conclusion: Intra-cameral preservative-free lidocaine 1% supply adequate midriasis during cataract surgery by itself.

Purpose: To investigate the effect of 2 commonly used mydriatics on choroidal thickness using enhanced depth imaging optical coherence tomography (EDI-OCT)., Methods: In this prospective study, 90 healthy subjects were enrolled. The participants were randomly divided into 3 groups based on the application of drops. One eye of each subject received a drop of tropicamide 1% in the tropicamide group (n=30), a drop of phenylephrine 2.5% in the phenylephrine group (n=30), and a drop of artificial tear in the control group (n=30). Drops were given thrice at 5 min intervals. Subfoveal choroidal thickness (SFCT) was measured using EDI-OCT before and at 45 min after drop application in both the dilated eye and nondilated contralateral eye., Results: The SFCT was significantly decreased after drop instillation in both the dilated eye and contralateral eye in the tropicamide group (P<0.001 and P=0.001, respectively) and in the phenylephrine group (P<0.001 and P=0.001, respectively). However, the SFCT did not significantly differ after drop instillation in either the dropped eye or contralateral eye in the control group (P=0.108 and P=0.695, respectively)., Conclusion: The findings of the present study revealed that tropicamide and phenylephrine cause a decrease in choroidal thickness.

Objective: To evaluate the effect of 0.5% tropicamide/0.5% phenylephrine mixed eye drop and make the inter-eye comparison of refractive outcomes in Chinese adults with myopia., Methods: Refractive measurements were performed without cycloplegia and repeated 30 minutes later with 0.5% tropicamide/0.5% phenylephrine mixed eye drop (Mydrin-P*) on 341 myopic adults. Vector analysis was used to analyze the data. Changes of spherical equivalent (M) and astigmatism for both J0 and J45 components between these two refractions were calculated as Error&#95;M, Error&#95;J0 and Error&#95;J45. Inter-eye correlations were studied. The inter-eye difference after cycloplegics were described as Diff M, Diff J0 and Diff J45. The effect of anisometropia, age and the higher order aberrations (HOAs) on inter-eye differences toward the cycloplegic agent were analyzed., Results: Difference was found only for the Error&#95;J45 component between the two eyes (p=0.0040). Pearson correlation coefficients between the two eyes for Error&#95;M, Error&#95;J0, and Error&#95;J45 were 0.3140 (p<0.0001), 0.1464 (p=0.0068), and 0.0099 (p=0.8558), respectively. The inter-eye differences (Diff) in response to cycloplegic agent increased with the amount of anisometropia. The oldest group had the highest Diff M values. However, HOAs were found not to be related to the inter-eye differences., Conclusions: Accommodation was still relaxed by tropicamide/phenylephrine eye drops in myopic adults. The changes of refraction due to cycloplegia were not well correlated between the two eyes in myopic patients. Anisometropia and ocular dominance might be an important factor for the inter-eye difference.

Muscarinic acetylcholine receptors (mAChR) are G protein-coupled receptors (M1-M5), grouped together into two functional classes, based on their G protein interaction. Although ubiquitously expressed in the CNS, the M4 protein shows highest expression in the neostriatum, cortex, and hippocampus. Electrophysiological and biochemical studies have provided evidence for overactive mAChR signaling in the fragile X knock-out (Fmr1KO) mouse model, and this has been hypothesized to contribute to the phenotypes seen in Fmr1KO mice. To address this hypothesis we used an M4 antagonist, tropicamide, to reduce the activity through the M4 mAChR and investigated the behavioral response in the Fmr1KO animals. Data from the marble-burying assay have shown that tropicamide treatment resulted in a decreased number of marbles buried in the wild-type (WT) and in the knockout (KO) animals. Results from the open field assay indicated that tropicamide increases activity in both the WT and KO mice. In the passive avoidance assay, tropicamide treatment resulted in the improvement of performance in both the WT and the KO animals at the lower doses (2 and 5 mg/kg), and the drug was shown to be important for the acquisition and not the consolidation process. Lastly, we observed that tropicamide causes a significant decrease in the percentage of audiogenic seizures in the Fmr1KO animals. These results suggest that pharmacological antagonism of the M4 receptor modulates select behavioral responses in the Fmr1KO mice.

Objective: To determine the effects of topical 0.5% tropicamide on anterior segment morphology (ASM) and intraocular pressure (IOP) in normal and glaucomatous cats. ANIMALS USED: Normal cats and cats with inherited primary congenital glaucoma (PCG)., Procedures: Control IOP curves were performed in untreated normal and PCG cats. In the first experiment, tropicamide was applied OD in eight normal and nine PCG cats. IOP and pupillary diameter (PD) were measured at 0, 30, and 60 min, then hourly until 8 h post-treatment. In a second experiment, six normal and seven PCG cats received tropicamide OD. High-resolution ultrasound images were obtained at 0, 1, 5, and 10 h post-treatment to measure ASM changes. IOP and PD were measured OD at 0, 1, 2, 3, 5, 7, and 9 h., Results: In untreated normal cats IOP OU decreased throughout the day. In PCG cats IOP OU had wide fluctuations over time. In normal cats IOP response varied in the treated eye but did not change significantly in untreated eyes. IOP significantly increased from baseline in both eyes of all treated PCG cats. Increases in IOP were associated with some ASM changes. Cats with PCG had a significantly smaller angle recess areas, diminished ciliary clefts and decreased iris-lens contact. ASM changes were not strongly correlated with IOP in all cats., Conclusions: The ASM of PCG cats is markedly different from normal cats, and clinically significant increases in IOP OU occur in cats with PCG after tropicamide treatment. The mechanism for this increase remains unclear., (© 2011 American College of Veterinary Ophthalmologists.)

The complex immunological effects of interferon and ribavirin therapy in hepatitis C virus may also exacerbate or trigger the development of autoimmunity. A rare case of Vogt-Koyanagi-Harada disease associated with ribavirin and interferon-alpha treatment for chronic hepatitis C infection is presented. The potential role of interferon and/or ribavirin therapy is discussed. Physicians should be aware of the association between interferon-alpha 2a and ribavirin use for hepatitis C infection and the development of Harada disease. This severe ophthalmological complication requires close follow-up of hepatitis C virus-infected patients on interferon-alpha treatment.

Purpose: To compare short-acting mydriatics versus long-acting mydriatics and to assess their effect on postoperative frequency and severity of posterior synechia after combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation., Methods: We retrospectively reviewed the records of 69 eyes of 69 patients who received a combined operation by the same surgeon for rhegmatogenous retinal detachment and cataracts. The mean follow-up period in both groups was 43 weeks. The frequency and severity of posterior synechia were analyzed at baseline and over a 6-month follow-up period., Results: Of the 69 eyes, 29.7% (11 of 37) in the long-acting mydriatic group versus 9.4% (3 of 32) in the short-acting mydriatic group had developed posterior synechia. The difference was statistically significant (P = 0.036). Additionally, when the severity of posterior synechia was measured in hour units, there was a statistically significant difference in severity between the 2 groups (long-acting mydriatic group, 0.76 +/- 1.52 hours; short-acting mydriatic group, 0.13 +/- 0.42 hours; P = 0.020)., Conclusion: The frequency and severity of posterior synechia after a combined operation may be reduced by the use of a short-acting mydriatic.

Allergic contact dermatitis due to mydriatic eyedrops is rare despite extensively used by ophthalmologists. Phenylephrine is responsible for most of the cases in the literature. We reported two other cases due to phenylephrine eyedrops with an unusual evolution characterized by chronic debilitating blepharoconjunctivitis.

A 7-month-old-intact male domestic shorthair cat was presented with fever, anterior uveitis in the right eye and respiratory distress when handled. These signs along with mild changes in serum protein levels and the exclusion of other potential causes were suggestive of feline infectious peritonitis (FIP). As the disease progressed, more clinical signs consistent with FIP, including renal involvement and later pleural effusion, became evident. Non-pruritic cutaneous lesions, characterized by slightly raised intradermal papules over the dorsal neck and over both lateral thoracic walls, were recognized at the end stage of the disease. The identification of papules in well-haired skin was difficult, and clipping of the fur facilitated their detection. Definitive diagnosis of FIP was made by histopathology and by immunohistochemical demonstration of coronavirus antigen in macrophages within kidney and skin lesions. The case was classified as a mixed form of FIP. Recognition of associated cutaneous lesions may facilitate a diagnosis of FIP in suspicious cases.

Objective: To record intraocular pressure (IOP) of three different dog breeds following administration of one drop of 1% tropicamide., Animals: Three dog breeds -- Golden Retrievers (n = 20), Siberian Huskies (n = 20) and English Cocker Spaniels (n = 36) -- were studied., Procedure: IOPs were measured using a Tonopen following corneal anesthesia with a single drop of 0.5% proxymetacaine. A drop of 0.5% tropicamide was then administered bilaterally and a second IOP measurement was taken 30 min later (postdilation). The difference between the two measurements was considered as the effect of mydriasis on IOP., Results: Dogs had an average IOP of 14.9 +/- 3.2 mmHg, with 95% confidence limits ranging from 8 to 22 mmHg. There were significant differences between breeds (P < 0.006) with Siberian Huskies having higher IOPs (17.2 +/- 3.7 mmHg) than the other breeds (Spaniels: 14.2 +/- 2.8 mmHg, P < 0.01; Retrievers: 14 +/- 1.9 mmHg, P < 0.001). The majority (60%) of dogs displayed 5 mmHg or less in IOP change postmydriasis. Siberian Huskies showed the highest IOP levels, and also had the greatest variability with dilation., Conclusions and Clinical Relevance: Interbreed variability in effect of tropicamide of canine IOP is evident.

We report a case of acute transient myopia associated with ciliochoroidal effusion induced by anorexiants. The patient had had myopic laser in situ keratomileusis 7 years earlier. Acute bilateral myopia associated with anterior chamber shallowing, intraocular pressure elevation, diffuse ciliochoroidal effusion, and perimacular retinal folds was relieved 14 days after discontinuation of anorexiant medications. Tropicamide and atropine were used to deepen the anterior chamber. Sympathomimetic drugs such as phendimetrazine and ephedrine are used as anorexiants and may induce transient myopia associated with ciliochoroidal effusion, shallow anterior chamber, and acute angle-closure glaucoma.

A healthy 5-year-old girl presented with bilateral hyphema as an initial symptom of uveitis. The ocular findings and the patient's age suggested that the uveitis was due to juvenile rheumatic arthritis or chronic iridocyclitis.

Purpose: To compare the mydriatic effect and safety between different concentrations of tropicamide and phenyle-phrine in preoperative mydriasis for phaco-emulsification., Methods: Two hundred and seventeen consecutive eyes in the same number of Chinese patients undergoing phaco-emulsification under local or topical anaesthesia in a university-based eye hospital were analyzed. Patients were randomized into two groups by cluster randomization, each group receiving a different preoperative mydriatic regimen. Regimen A consisted of tropicamide 1.0% with phenylephrine 2.5%, and Regimen B consisted of tropicamide 0.5% with phenylephrine 0.5%. The main outcome measures were horizontal pupillary diameter, systolic, diastolic and pulse pressure and pulse rate., Results: The group who received Regimen A attained a mean horizontal pupillary diameter of 7.00 +/- 1.06 mm. Their pupils were significantly larger than those receiving Regimen B (6.61 +/- 1.03 mm, P = 0.007). No untoward cardiovascular effects were noted in either groups., Conclusion: Regimen A attained better preoperative mydriasis for phacoemulsification than Regimen B. Both regimens were safe with regard to their cardiovascular effects. The combination of tropicamide 1.0% and phenylephrine 2.5% is recommended as preoperative mydriatic for phacoemulsification in Chinese patients who have darkly pigmented irides.

To gain a comparative estimate of cycloplegic agents with mild effect vs conventional atropinization, a study was performed on refraction in 57 children after instillations of cyclopentolate and atropine and in 57 children after instillations of tropicamide and atropine. A difference was determined in refraction after instillation of cycloplegic agents with mild effect and atropine. It turned out that by depth of cycloplegic effect cyclopentolate is reaching that of atropine. Cyclopentolate can be used in initial study of refraction in children with hypermetropic and myopic refraction and in repeated studies of any refraction. Tropicamide is less effective cycloplegic agent than cyclopentolate and thus it can be used in initial studies of refraction in children with myopia and in repeat studies of refraction in children with myopia and hypermetropia and also in cases of intolerance of other cycloplegic agents.

Previous studies have evaluated the efficacy of several interventions to decrease the progression of myopia. These include devices that alter the perception of the visual environment and pharmacological treatments. There is no conclusive evidence thus far that alteration of the pattern of spectacle wear, bifocals, ocular hypotensives, or contact lenses retards the progression of myopia. Several randomised clinical trials have demonstrated that the rate of progression of myopia is lower in children given atropine eye drops than those given placebo. However, atropine is associated with short term side effects such as photophobia and possible long term adverse events including light induced retinal damage and cataract formation. Other more selective antimuscarinic agents such as pirenzipine are presently being evaluated. Further well conducted randomised clinical trials with large sample sizes and adequate follow up designed to evaluate treatments to retard the progression of myopia should be conducted, since the identification of an effective intervention may have a greater public health impact on the burden and morbidity from myopia than the few treatments currently available.

Introduction: The influence of photorefractive keratectomy (PRK) on drug penetration into the eye is not yet established, as this procedure may alter the barrier function of the cornea as well as the blood ocular barrier. Pupillary response to topical tropicamide depends on its penetration into the anterior chamber. The purpose of this study was to examine the influence of PRK on pupillary response to topical tropicamide, and hence to evaluate whether PRK alters drug penetration into the eye., Methods: Pupillary diameter was measured using infrared pupillometer at 0, 15 and 30 min after instillation of 0.1% tropicamide to both eyes of 28 patients 4 weeks after PRK in one eye. The untreated eye served as control., Results: Pupillary diameter before and 30 min after dilation was 7.4 +/- 1.2 and 8.0 +/- 1.0 mm in the treated eyes and 7.5 +/- 1.2 and 8.1 +/- 1.0 mm in the untreated eyes, respectively (p = 0.45). Percentage of pupillary dilation (delta pupillary diameter/pupillary diameter at 0 min x 100) was also similar in treated and untreated eyes for the entire study group (12.5 and 10.5%, respectively, p = 0.17). A trend for greater dilation was seen in patients with myopia above 6 diopters (13.7 and 10.5% in treated and untreated eyes, respectively, p = 0.11) and cornea thinner than 540 microm (14.2 and 10.1% in treated and untreated eyes, respectively, p = 0.1)., Discussion: Our results confirm animal and human studies that found restoration of the ocular drug barrier at 4 weeks following PRK. The trend for greater penetration in patients with high myopia and thin corneas warrants further study on a larger cohort of this subgroup., (Copyright 2002 S. Karger AG, Basel)

We describe a patient with multiple superior corneal infiltrates in both eyes, separated from the limbus by an intervening clear zone, that appeared 1 day after uneventful laser in situ keratomileusis. The overlying epithelium was intact, and the flap and interface were uninvolved. Based on these features, a clinical diagnosis of sterile corneal infiltrates was made and the eyes were treated with topical antibiotics and steroids. The infiltrates resolved during the ensuing weeks without corneal scarring. Good visual acuity was maintained. Recognition of this benign complication is important because aggressive corneal scrapings are not required. The infiltrates appear to be immunogenic in origin, although the exact etiopathogenesis is not clear.

Topic: To evaluate the efficacy of interventions such as eyedrops, bifocal lenses, or contact lenses in retarding the progression of myopia in myopic children., Clinical Relevance: Myopia is a common ocular disorder, and high myopia (myopia at least -6.0 diopters) is associated with potentially blinding conditions. At present, there are no general guidelines on interventions that may decrease myopia progression in children, but some interventions such as contact lenses are offered on an ad hoc basis. METHODS OR LITERATURE REVIEWED: English and non-English language articles published from 1968 to 2000 were retrieved using a keyword search of MEDLINE, Embase, Cochrane Library, and Science Citation Index databases. Randomized controlled trials with comparisons of the effectiveness of interventions to decrease myopia progression in myopic children were reviewed., Results: Ten clinical trials of different interventions to retard myopia progression were reviewed, including three trials that evaluated atropine and one trial that evaluated soft contact lenses. Atropine eye drops of 0.5% concentration were effective in clinical trials, but no significant effect was found for tropicamide or timolol eyedrops. Five of the six trials on bifocal spectacle lenses with various additions failed to show significant retardation, and results of the remaining trial were barely significant (P = 0.047). A trial of soft contact lenses failed to show significant effects., Conclusions: The latest evidence from randomized clinical trials does not provide sufficient information to support interventions to prevent the progression of myopia. Long-term large-scale double-masked randomized clinical trials, including cycloplegic refraction, are needed before any recommendations about interventions in clinical practice to prevent high myopia in myopic children are considered.

Purpose: To report a rare case of true exfoliation of the lens capsule following panuveitis, with slit-lamp photographs before and following the development of the true exfoliation., Methods: Case report. Review of the history and clinical features of a 70-year-old woman who developed true exfoliation during the treatment for panuveitis., Results: After 7 months of treatment for bilateral panuveitis with topical steroid and tropicamide, the patient developed a thin, transparent membrane arising on the lens surface in the right eye. A diagnosis of true exfoliation of the lens capsule was made., Conclusions: True exfoliation of the lens capsule following uveitis may occur due to the weakening of the anterior capsule by metabolic disorder caused by uveitis and precipitated by repeated mydriasis.

Purpose: To examine the effect of tropicamide on flare intensity under phakic and pseudophakic conditions and to differentiate between the possible mechanisms of action of tropicamide on aqueous flare., Setting: Department of Ophthalmology, Vienna General Hospital, University of Vienna, Vienna, Austria., Methods: In this prospective study, aqueous flare was measured with the laser flare-cell meter in 20 eyes of 20 patients with age-related cataract enrolled for cataract surgery. Measurements were performed before and 30, 90, and 180 minutes after pupil dilation with tropicamide 0.5%. This measurement was performed in the phakic eye on the day before surgery and in the pseudophakic eye on postoperative days 1, 3, 7, and 28., Results: After tropicamide instillation, aqueous flare decreased preoperatively and on all postoperative days. There was a continuous flare decrease until 3 hours after instillation, reaching a maximum decrease of about 30%. Pupil diameter reached its maximum after 30 minutes., Conclusion: Tropicamide significantly decreased aqueous flare, seemingly by pharmacological means, not volumetric changes. The time between drug application and measurement should be kept constant.

Purpose: This study examined whether safe and effective mydriasis can be achieved in premature infants with heavily pigmented irides using combination cyclopentolate 0.2% and phenylephrine 1% eyedrops., Methods: A prospective, randomized double-blind study was performed to compare combination cyclopentolate 0.2% and phenylephrine 1% eye-drops with triple instillation of tropicamide 0.5% and phenylephrine 2.5%. Twenty-eight consecutive babies with dark irides and birthweight <1600 g referred for screening for retinopathy of prematurity comprised the study population. Infants' eyes were randomly dilated twice with both regimens within a 2-week period. Blood pressure, heart rate, and pupil size were measured., Results: Good mydriasis was achieved in both groups with no significant differences in pupil size or blood pressure (systolic, diastolic, or mean arterial pressures) over starting baseline values. Pulse rates decelerated below the baseline values in both groups, but these differences were not large., Conclusion: The single combination eyedrop of cyclopentolate 0.2% and phenylephrine 1% is as effective and safe a mydriatic for infants with dark irides as both tropicamide 0.5% and phenylephrine 2.5%.

Background: Paremyd, a mydriatic formulation of 0.25% tropicamide and 1.0% hydroxyamphetamine hydrobromide provides adequate dilation for binocular indirect ophthalmoscopy in young Caucasians. We studied the clinical effectiveness of Paremyd in dilating heavily pigmented eyes by comparing its mydriatic efficacy in Blacks, Asians and Caucasians with light and dark brown irides. We also evaluated the efficacy of one drop of dapiprazole (Rev-Eyes) in reversing Paremyd-induced mydriasis in our subject sample., Methods: In a masked, randomized, controlled experimental design, several visual functions which included pupillary dilation, near visual acuity, amplitude of accommodation, ocular hyperemia, and discomfort glare were measured at 30-min intervals, for a total of 300 min, in subjects dilated with a single drop of Paremyd in each eye. Ease of binocular indirect ophthalmoscopy was also assessed. A 3-way analysis of variance was used to assess changes in these measures as function of irides color/pigmentation (designated as light or dark brown iris color), presence or absence of dapiprazole, and test time interval., Results: We found that subjects in our light brown irides group (mainly Caucasians) dilated faster than subjects in our dark brown irides group (mainly Blacks). Dapiprazole increased the speed of recovery from pupillary dilation for all subjects, but more so for those with light rather than dark brown irides. Similarly, subjects with light rather than dark brown irides recovered accommodative function more quickly. Although neither the use of dapiprazole nor the degree of iris color/pigmentation was significantly related to visual acuity or glare discomfort, there was a clear trend that these visual measures were affected to a greater degree in subjects with dark brown (primarily Blacks) rather than light brown irides. Overall, Paremyd provided adequate dilation for binocular indirect ophthalmoscopy in all subjects irrespective of iris color/pigmentation., Conclusions: Our data indicate that a single drop of Paremyd provides adequate mydriasis, without significant side effects, for routine fundus examination of all subjects, independent of iris color/pigmentation. Furthermore, a single drop of dapiprazole was effective in speeding the return of pupillary dilation in most subjects, but had no significant effect on accommodation, near visual acuity or glare discomfort. Side effects such as stinging upon instillation, conjunctival hyperemia, and a few instances of ptosis, with possible additional cost to patients, appear to lessen its overall clinical benefit.

Purpose: The selection of a cycloplegic agent depends on the desired outcome, the characteristics of the patient receiving the drug, and the associated risks. The Orinda Longitudinal Study of Myopia (OLSM) has used 1% tropicamide to assess the ocular components and cycloplegic refractions in a large cohort of predominantly Caucasian children. Although tropicamide has provided adequate cycloplegia and mydriasis for the OLSM cohort, conventional clinical wisdom and scientific investigations have suggested that tropicamide might not produce adequate cycloplegia and mydriasis for subjects with darker iris pigmentation. In this study one drop of 1% tropicamide followed by one drop of 1% cyclopentolate was used to determine their effectiveness in producing adequate cycloplegia and mydriasis for cycloplegic refraction and ocular component measurements in a group of African-American children., Methods: Nineteen children [age range 5.5 to 15.6 years, mean 8.4 years +/- (SD) 2.5 years] were tested at Family HealthCare of Alabama, Eutaw, AL. Their accommodative responses were measured using a Canon R-1 autorefractor prior to and at 30, 45, and 60 min after instillation of one drop of 0.5% proparacaine, 1% tropicamide (Mydriacyl), and 1% cyclopentolate (Cyclogyl) in both eyes. A target of 20/155 letters in a 4x4 grid positioned behind a +6.50 diopter (D) Badal lens provided accommodative stimuli of 1.00 D, 2.00 D, and 4.00 D., Results: All results are presented as mean +/-1 SD. Pupils, measured from video frames, dilated rapidly and maximally at 30 min after instillation of eye drops (7.3+/-0.5 mm) Predilation, the mean accommodative responses were 0.17+/-0.29 D for the 1.00 D stimulus, 1.01+/-0.40 D for the 2.00 D stimulus, and 2.77+/-0.74 for the 4.00 D stimulus. At 30 min after drop instillation, the responses were 0.07+/-0.14 D for the 1.00 D stimulus, 0.36+/-0.35 D for the 2.00 D stimulus, and 0.77+/-0.61 for the 4.00 D stimulus. Results were very similar at 45 and 60 min after drop instillation., Conclusions: Combining 1% tropicamide and 1% cyclopentolate was very effective in providing both cycloplegia and mydriasis adequate for ocular biometry and cycloplegic refractions 30 min after drop instillation in African-American children.

None of the numerous methods for optic and drug treatment of the accommodation cramp effectively arrests it without long tiresome training or atropine, which limits visual working capacity for a long time and therefore, precludes starting the treatment on an outpatient basis immediately. Use of an available, simple, and effective combined method for treating the accommodation cramp helped prevent true myopia in 94.3% of young children in the main group, whereas 38.3% children in the control group developed myopia.

Twenty highly myopic children (> or = -6.0 D) were treated with 0.5% atropine eyedrops once per night. Twelve subjects were initially treated with a short-acting cycloplegic agent, tropicamide (0.5%) (Group A), and the other eight subjects did not receive any myopic therapy before atropine (Group B). These cases were followed for up to five years. In Group A, the mean myopic progression rate after 0.5% atropine treatment was -0.01 +/- 0.04 D/M (Diopter/Month), which was significantly lower than that of the period during tropicamide treatment (-0.12 +/- 0.09 D/M) (p < 0.05). In Group B, the mean myopic progression rate after atropine therapy was begun was -0.04 +/- 0.06 D/M, which was also significantly slower than that of non-medication, -0.14 +/- 0.07 D/M (p < 0.05). The results suggested that 0.5% atropine is effective for slowing down myopic progression, even in highly myopic children.

Study Objective: To study the safety of instillation of eyedrops prior to ophthalmic surgery, which may potentially affect myocardial function, using continuous ST segment recording., Design: Prospective study., Setting: Ambulatory surgery preoperative area at a university hospital., Patients: 30 nonpremedicated ASA status III adults (aged 73 to 92 years) scheduled for cataract surgery with monitored anesthesia care (MAC)., Interventions: All patients were given ophthalmic drugs consisting of phenylephrine 2.5%, flubiprofen 0.03%, mydriacyl 1%, and cyclopentolate 1%., Measurements and Main Results: ST segments were continuously monitored after the instillation of the eyedrops for a period of up to 15 minutes. A change of 2 mm or more in ST segments from baseline was considered significant. Results showed no significant change in ST segment. No patient reported any new cardiac symptoms or showed any evidence of dysrhythmias or hemodynamic changes., Conclusions: The lack of significant finding most likely reflects the safety of these ophthalmic drops in their present dilute concentration, but it is also possible that the software and/or monitors used were not sensitive enough in their current configuration to detect possible subtle changes. Based on the results of this study, we conclude that the preoperative ophthalmic drugs used in our institution do not seem to have any adverse cardiovascular effects in this elderly patient population who are about to undergo cataract surgery with MAC.

Background and Objective: The correction of the total hypermetropic refractive error in the management of esodeviations is well accepted. The choice of the appropriate cycloplegic agent is still not settled. Despite evidence that atropine will more effectively uncover the total refractive error, cyclopentolate in combination with other cycloplegic agents continues to be recommended. This study evaluates the use of atropine compared with a combination of cyclopentolate and tropicamide and analyzes age, size of the refractive error, and size of the esodeviation as possible contributing variables in the response., Patients and Methods: The records of 74 patients who underwent refraction with atropine 1% on one occasion and a combination of 1% cyclopentolate and 1% tropicamide on another occasion were reviewed. The mean and range of refractive errors for each eye for each group were determined. Comparisons were made for groups depending on age, size of the refractive error, and size of the esodeviation., Results: The amount of hypermetropia determined with atropine was significantly higher than the amount determined with the combination of cyclopentolate and tropicamide. This difference was significant for three age groups of three groups with increasing amounts of hypermetropia, and two groups with differing amounts of esodeviations. In addition, 11% of right eyes and 19% of left eyes showed 1.25 D or more of hypermetropia with atropine., Conclusion: Refraction with 1% atropine ointment yields a significantly larger amount of hypermetropia than does refraction with a combination of cyclopentolate and tropicamide. This difference is statistically significant regardless of age, amount of hypermetropia, or size of the esotropia.

Purpose: Ocular signs and symptoms that occurred in people exposed to sarin gas in a subway sarin gas attack were studied., Methods: Among victims of sarin gas exposure, 96 were treated by us., Results: Ocular signs and symptoms caused by sarin gas exposure included miosis, conjunctival injection, and ocular pain., Conclusions: Ocular signs and symptoms spontaneously resolved between three and 21 days after exposure in most cases. Treatment with 0.5% tropicamide ophthalmic solution was effective in decreasing ocular pain.