RESUMO
SIGNIFICANCE: This study explores the difference between cycloplegic and noncycloplegic refraction in young adult myopes. PURPOSE: From the available literature, it is unclear whether cycloplegia is necessary when refracting young adults. This study investigates the agreement between noncycloplegic autorefraction and cycloplegic autorefraction and investigates factors affecting the agreement between the two methods. METHODS: In total, 125 myopes with ages ranging between 18 and 26 years were included from Australia and Vietnam. Each participant underwent noncycloplegic autorefraction and cycloplegic autorefraction. Cycloplegia was induced with 1% ophthalmic tropicamide. RESULTS: The mean spherical equivalent difference (95% confidence interval) between noncycloplegic autorefraction and cycloplegic autorefraction was -0.20 D (-0.25 to -0.14 D; t124 = -7.18, p<0.0001 ) . A mean difference of >0.25 D was seen in 46.8% of eyes. The lower and upper limits of agreement were -0.80 and 0.41 D, respectively. With univariate analysis, factors including age, degree of refractive error, accommodation amplitude, and distance phorias showed no impact on the average difference between cycloplegic autorefraction and noncycloplegic autorefraction. Yet, eyes with near exophoria ( F2,120 = 6.63, p=0.0019) and Caucasian eyes ( F3,121 = 2.85, p=0.040) exhibited the smallest paired differences. However, in the multivariate analysis, only near exophoria was associated with a lower mean difference. A significantly smaller proportion (34.9%) of eyes with near exophoria had a paired difference of -0.25 D or more compared with esophoria (50%) and orthophoria (65%; χ2 = 6.6, p=0.038). CONCLUSIONS: Noncycloplegic autorefraction results in more myopic refractive error than cycloplegic autorefraction in young adults.
Assuntos
Midriáticos , Miopia , Refração Ocular , Tropicamida , Humanos , Refração Ocular/fisiologia , Adulto Jovem , Midriáticos/administração & dosagem , Adulto , Masculino , Adolescente , Feminino , Miopia/fisiopatologia , Miopia/diagnóstico , Tropicamida/administração & dosagem , Pupila/efeitos dos fármacos , Pupila/fisiologia , Acomodação Ocular/fisiologiaRESUMO
PURPOSE: To investigate the effects of topically applied 1% tropicamide, 2.5% phenylephrine and 1% cyclopentolate on retinal vessel calliper (VC) using optical coherence tomography (OCT). METHODS: Patients who came to the ophthalmology clinic for routine examination and whose OCT films were taken before dilatation and after 30 min of last dilatation drop were included in the study. 90 ophthalmologically healthy subjects were divided into 3 groups of 30 subject each according to the application of the drops as follows: Tropicamide group (Group 1), Phenylephrine group (Group 2), Cyclopentolate group (Group 3). The right eyes of the subjects were dilated with drops and the left eyes were taken as the control group. VC of retinal artery and vein passing through an area one-half to one-disc diameter from the optic disc margin were measured from OCT films. The mean of the sum of superior retinal artery (SRA) and inferior retinal artery (IRA) VC and the mean of the sum of superior retinal vein (SRV) and inferior retinal vein (IRV) VC before and after the drop were compared. RESULTS: There was no statistically significant change in the mean sum of SRA and IRA VC and the mean sum of SRV and IRV VC before and after dilatation drops in all three groups. CONCLUSION: Dilatation drops have no statistically significant effect on retinal artery and vein VC.
Assuntos
Ciclopentolato , Midriáticos , Soluções Oftálmicas , Fenilefrina , Vasos Retinianos , Tomografia de Coerência Óptica , Tropicamida , Humanos , Midriáticos/administração & dosagem , Soluções Oftálmicas/administração & dosagem , Tropicamida/administração & dosagem , Masculino , Feminino , Adulto , Ciclopentolato/administração & dosagem , Vasos Retinianos/efeitos dos fármacos , Vasos Retinianos/diagnóstico por imagem , Fenilefrina/administração & dosagem , Adulto Jovem , Pessoa de Meia-IdadeRESUMO
PURPOSE: To study the pupil dynamics with premixed intracameral anesthetic mydriatic combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) in pediatric cataract surgery. METHODS: Consecutive children aged ≤12 years planned for cataract surgery were recruited. A commercially available premixed combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) was injected at the beginning of surgery without any topical/infusion drugs for mydriasis. Pupil sizes at various points of surgery were studied. RESULTS: We recruited 75 patients with a mean age of 24.3 ± 33.4 months (range: 1 month-11 years). Adequate mydriasis with a single injection was achieved in 93.5% (n = 73 eyes of 70 patients) without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.8 ± 0.79 to 6.1 ± 1.4 mm after injection (mean change of 4.2 ± 1.25 mm from baseline). The mean variability in pupillary diameter was 0.73 ± 1.3 mm. In five eyes, good dilatation was not possible even after repeat injection. CONCLUSION: Fixed-dose premixed intracameral injection is effective in pupil dilatation. It alleviates the need for any topical dilators or additional intraoperative supplementation for pediatric cataract surgery.
Assuntos
Extração de Catarata , Midriáticos , Fenilefrina , Pupila , Tropicamida , Humanos , Midriáticos/administração & dosagem , Pré-Escolar , Masculino , Lactente , Feminino , Extração de Catarata/métodos , Pupila/efeitos dos fármacos , Criança , Tropicamida/administração & dosagem , Fenilefrina/administração & dosagem , Lidocaína/administração & dosagem , Câmara Anterior/efeitos dos fármacos , Catarata , Estudos Prospectivos , Seguimentos , Soluções Oftálmicas/administração & dosagem , Relação Dose-Resposta a DrogaRESUMO
ABSTRACT Minimally invasive glaucoma surgeries are surgical treatment alternatives for glaucoma aimed at reducing intraocular pressure with a better safety profile compared to traditional trabeculectomy. However, in spite of less invasive techniques, complications may develop in any surgical procedure. To the best of our knowledge, this is the first case report of anterior uveitis following combined treatment with cataract surgery and iStent inject® which addresses the management of postoperative inflammation.
RESUMO As cirurgias minimamente invasivas para glaucoma consistem em uma opção de tratamento cirúrgico para glaucoma, a qual promove redução da pressão intraocular com melhor perfil de segurança do que a trabeculectomia. Todavia, complicações são inerentes à realização de procedimentos cirúrgicos, apesar do uso de técnicas menos invasivas. Este é o primeiro relato que apresenta um caso de uveíte anterior após cirurgia combinada de catarata e iStent inject®, além de orientações quanto ao manejo do quadro inflamatório.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Uveíte/tratamento farmacológico , Extração de Catarata/efeitos adversos , Uveíte Anterior/etiologia , Complicações Pós-Operatórias , Titânio , Malha Trabecular/cirurgia , Tropicamida/administração & dosagem , Dexametasona/administração & dosagem , Stents , Glaucoma de Ângulo Aberto/cirurgia , Injeções Intraoculares , Pressão Intraocular , Acetazolamida/administração & dosagemRESUMO
PURPOSE: To evaluate systemic adverse events after screening for retinopathy of prematurity (ROP) performed with mydriatic. METHODS: This was a retrospective case series study. Medical records of consecutive patients who underwent screening for ROP with 0.5% phenylephrine and 0.5% tropicamide eyedrops were retrospectively reviewed. The score of abdominal distention (0-5), volume of milk sucked and volume of stool, along with systemic details (pulse and respiration rates, blood pressure and number of periods of apnea) were collected at 1 week and 1 day before ROP examination, and at 1 day after examination. Results were compared between the days before and after examination. Correlation between body weight at the time of examination and the score of abdominal distention was examined. The numbers of infants with abdominal and/or systemic adverse events were compared between pre- and post-examination periods. RESULTS: Eighty-six infants met the inclusion criteria. The score of abdominal distention increased from 2.0 at 1 day before examination to 2.3 at 1 day after examination (p = 0.005), and the number of infants who had worsened abdominal distension increased after examination (p = 0.01). Infants with lower body weight had a higher score of abdominal distention (p < 0.0001, r = -0.57). The number of infants with reduced milk consumption increased after examination (p = 0.0001), as did the number of infants with decreased pulse rate (p = 0.0008). CONCLUSIONS: Screening for ROP with mydriatic may have adverse effects on systemic conditions. Infants should be carefully monitored after ROP screening with mydriatic.
Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Programas de Rastreamento , Midriáticos/efeitos adversos , Retinopatia da Prematuridade/diagnóstico , Peso Corporal , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Prontuários Médicos , Midriáticos/administração & dosagem , Soluções Oftálmicas/administração & dosagem , Soluções Oftálmicas/efeitos adversos , Fenilefrina/administração & dosagem , Fenilefrina/efeitos adversos , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/patologia , Tropicamida/administração & dosagem , Tropicamida/efeitos adversosRESUMO
OBJECTIVE: To evaluate the efficacy of topical tropicamide when placed at different time intervals before or after a saline drop. ANIMALS STUDIED: Eight healthy Labrador and golden retriever dogs. PROCEDURES: The effect of 1% tropicamide on pupillary diameter (PD) was measured over 240 min when administered alone (control) and then 1 and 5 min prior to, or following, application of a saline drop, with 1-week washout between each of the five trials. Data were analyzed using repeated-measures ANOVA and Tukey post hoc test. RESULTS: Only 6/110 pairwise comparisons among the 5 trials were statistically significant (p ≤ .035), with post-hoc analysis showing no significant differences (p ≥ .14) between the overall means of all trials. In all five trials, maximal PD was reached 30 min after tropicamide application and maintained until 210 min for 180 min (p = .0005). CONCLUSIONS: Our results suggest that waiting 1 min between applications of different ophthalmic solutions may be sufficient for maximal drug effect. Care should be taken when extrapolating these results to other species and different ophthalmic formulations.
Assuntos
Cães , Midriáticos/administração & dosagem , Soluções Oftálmicas/administração & dosagem , Tropicamida/administração & dosagem , Animais , Esquema de Medicação , Feminino , Masculino , Pupila/efeitos dos fármacos , Fatores de TempoRESUMO
Infrared thermography provides functional imaging by picturing the temperature pattern of the region imaged. The temperature correlates to the blood flow pattern and is used in the diagnosis of diseases like breast cancer, peripheral vascular disorders, diabetic neuropathy and fever screening. In the present study, the usage of ocular thermography for diagnosis of diabetic retinopathy is explored. Ocular thermograms using infrared imaging camera were obtained for normal subjects (80 volunteers - 40 males and 40 females) age groups 21-30, 31-40, 41-50 and 51-60 years, non-proliferative diabetic retinopathy (NPDR) patients (50 volunteers -25 males and 25 females) and proliferative diabetic retinopathy (PDR) patients (20 volunteers -10 males and 10 females) belonging to age group of 51-60 years. The temperature at various points of interest (POIs) and horizontal temperature profiles were studied. Ocular surface temperature (OST) and effect of eye dilation on OST was studied for control, age matched NPDR and PDR. Statistical analyses were carried out to find the significance of correlation between OST of controls and NPDR and PDR. The global minimum temperature on the ocular surface for controls (21-60 years) was found to be at cornea which is about 34.79 ± 0.68 °C, and maximum at the inner canthus viz. 36.08 ± 0.62 °C. Dilation studies showed an average increase of 0.82 ± 0.13 °C in cornea and 0.75 ± 0.14 °C in conjunctiva and limbus (p < 0.001). The temperature of cornea is around 33.22 ± 0.12 °C and 32.64 ± 0.12 °C for NPDR and PDR patients respectively, in the age group of 51-60 years. OST of NPDR patients was 0.60 ± 0.15 °C lesser than that of age matched normal eyes (p < 0.001) at cornea and limbus regions and 0.71 ± 0.20 °C at inner canthus. The OST of PDR patients was lesser than age matched controls by 1.18 ± 0.12 °C at cornea, 0.9 ± 0.13 °C at inner canthus and 1.0 ± 0.14 °C at other POIs. During dilation studies a positive variation of 0.61 ± 0.12 °C in cornea and 0.48 ± 0.13 °C in conjunctiva and limbus was observed (p < 0.001) in NPDR eyes. Similarly an average increase of 0.62 ± 0.11 °C in cornea and an average increase of 0.47 ± 0.15 °C in conjunctiva and limbus were observed (p < 0.001) in PDR eyes. The OST of NPDR and PDR patients was less compared with age matched counterparts in both pre and post dilation studies. Dilation of eye showed increase in OST for both controls and diabetic retinopathy patients. The degree of increase is less compared with controls. The variation in OST observed during pre and post dilatation studies of diabetic retinopathy patients is a functional marker of pathology, and can be used as a parameter for diagnosis.
Assuntos
Temperatura Corporal/fisiologia , Retinopatia Diabética/fisiopatologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Midriáticos/administração & dosagem , Pupila/efeitos dos fármacos , Fluxo Sanguíneo Regional/fisiologia , Termografia , Tropicamida/administração & dosagem , Adulto JovemRESUMO
Purpose: To evaluate whether the standard dilating drop regimen consisting of phenylephrine, tropicamide, and proparacaine produces clinically significant improvement in pupil size compared to tropicamide and proparacaine during diagnostic eye examination. Methods: Sixty-three adult patients at Washington University School of Medicine Eye Clinic were enrolled in this prospective, randomized trial. Each patient received one of two dilating drop regimens: phenylephrine + tropicamide + proparacaine (PE+T+PP), which is considered the standard therapy, or tropicamide + proparacaine (T+PP). Main outcome measures were the proportion of pupils able to achieve successful clinical examination without need for additional dilating drops and change in predilation to postdilation pupil size. Comparisons were made using McNemar's test, repeated measures analysis of variance, and Fisher's test to determine whether PE is a necessary component of the standard eye examination. Results: There were no statistically significant differences between the PE+T+PP and T+PE treatment groups in predilation to postdilation changes in average resting pupil size (1.58 ± 0.66 and 2.61 ± 0.79; P = 0.57) or constricted pupil size (2.52 ± 0.93 and 3.56 ± 0.96; P = 0.15). There was no statistically significant difference between patients who obtained a successful dilated pupil examination between those receiving PE+T+PP and those receiving T+PP as determined by the examining physicians (Fisher's, P = 0.67). Conclusion: The addition of phenylephrine to tropicamide and proparacaine did not improve pupillary dilation size or ability to conduct a clinical examination. A single dilating agent using tropicamide should be considered in clinical practice.
Assuntos
Técnicas de Diagnóstico Oftalmológico/normas , Midriáticos/farmacologia , Fenilefrina/farmacologia , Pupila/efeitos dos fármacos , Adulto , Idoso , Anestésicos Locais/administração & dosagem , Anestésicos Locais/farmacologia , Interações Medicamentosas , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Midriáticos/administração & dosagem , Soluções Oftálmicas/administração & dosagem , Avaliação de Resultados em Cuidados de Saúde , Fenilefrina/administração & dosagem , Propoxicaína/administração & dosagem , Propoxicaína/farmacologia , Estudos Prospectivos , Tropicamida/administração & dosagem , Tropicamida/farmacologiaRESUMO
SIGNIFICANCE: After a dilated eye examination, many patients experience symptoms of prolonged light sensitivity, blurred vision, and cycloplegia associated with pharmacological mydriasis. Phentolamine mesylate ophthalmic solution (PMOS) may expedite the reversal of mydriasis in patients, potentially facilitating return to functional vision and reducing barriers to obtaining dilated eye examinations. PURPOSE: The protracted reversal time after pharmacologically induced pupil dilation impairs vision. We tested the hypothesis that PMOS rapidly reduces pupil diameter in this acute indication. METHODS: In this double-masked placebo-controlled, randomized, two-arm crossover phase 2b trial, we evaluated the effects of one drop of 1% PMOS applied bilaterally in subjects who had their pupils dilated by one of two common mydriatic agents: 2.5% phenylephrine or 1% tropicamide. End points included change in pupil diameter, percent of subjects returning to baseline pupil diameter, and accommodative function at multiple time points. RESULTS: Thirty-one subjects completed the study (15 dilated with phenylephrine and 16 with tropicamide). Change in pupil diameter from baseline at 2 hours after maximal dilation with 1% PMOS was -1.69 mm and was significantly greater in magnitude compared with placebo for every time point beyond 30 minutes (P < .05). At 2 hours, a greater percentage of study eyes given 1% PMOS returned to baseline pupil diameter compared with placebo (29 vs. 13%, P = .03), which was this also seen at 4 hours (P < .001). More subjects treated with PMOS in the tropicamide subgroup had at least one eye returning to baseline accommodative amplitude at 2 hours (63 vs. 38%, P = .01). There were no severe adverse events, with only mild to moderate conjunctival hyperemia that resolved in most patients by 6 hours. CONCLUSIONS: Phentolamine mesylate ophthalmic solution at 1% reversed medically induced pupil dilation more rapidly than placebo treatment regardless of which mydriatic was used (adrenergic agonists and cholinergic blockers) with a tolerable safety profile.
Assuntos
Antagonistas Adrenérgicos alfa/farmacologia , Midriáticos/administração & dosagem , Fentolamina/farmacologia , Pupila/efeitos dos fármacos , Acomodação Ocular/fisiologia , Administração Oftálmica , Adolescente , Adulto , Estudos Cross-Over , Método Duplo-Cego , Humanos , Masculino , Soluções Oftálmicas , Fenilefrina/administração & dosagem , Distúrbios Pupilares , Tropicamida/administração & dosagem , Adulto JovemRESUMO
PURPOSE OF THE STUDY: Macular pigment (MP), comprising the dietary carotenoids lutein, zeaxanthin and meso-zeaxanthin, is believed to benefit eye health and vision. Numerous clinical and research devices and techniques are currently available to facilitate MP optical density (MPOD) measurement. One of those techniques, dual-wavelength fundus autofluorescence (AF) is being increasingly used for measurement of MP in the eye. There is substantial methodological variation across the published studies that have employed this technique, including in relation to the use of mydriasis, the possible influence of which does not appear to have been addressed in the literature. This prospective cross-sectional study was designed to investigate the effect of mydriasis on MP measurement quality and MPOD values obtained with dual-wavelength AF using the Heidelberg Spectralis HRA+OCT device. MATERIALS AND METHODS: Twenty-one healthy participants were recruited to the study. The mean age of participants was 44.8 years (± 14.63). Pupil size and MPOD were measured in one eye for each participant, initially under natural pupil conditions and subsequently 30 minutes following instillation of one drop of 0.5% tropicamide. RESULTS: Despite providing MPOD measurements for the majority of undilated eyes (85.7% of eyes herein), pupillary dilation resulted in statistically significant changes in MPOD (p < .001 for central eccentricities). Our results indicate that the changes in MPOD were not uniform across the spatial profile. Marked improvements were also observed in image quality post-dilation (p < .002 for central eccentricities). CONCLUSIONS: This study clearly demonstrates that dual-wavelength AF measurements of MPOD in the same eye vary as a function of pupillary dilation status, with MPOD under-estimated across the entire spatial profile of MP for natural relative to dilated pupillary conditions. Mydriasis should, therefore, be used routinely for MPOD measurements using dual wavelength AF, pupil size should be reported and image quality optimized in order to ensure accurate MPOD quantification.
Assuntos
Pigmento Macular/metabolismo , Midriáticos/administração & dosagem , Imagem Óptica/métodos , Pupila/efeitos dos fármacos , Retina/metabolismo , Tropicamida/administração & dosagem , Administração Oftálmica , Adulto , Idoso , Estudos Transversais , Densitometria , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Tomografia de Coerência ÓpticaRESUMO
PURPOSE: The aim of this study was to evaluate the changes in the prevalence of myopia in Taiwanese schoolchildren over the past few decades and to analyze the risk factors for myopia. DESIGN: Analysis of 8 consecutive population-based myopia surveys conducted from 1983 through 2017. PARTICIPANTS: An average of 8917 (5019-11 656) schoolchildren 3 to 18 years of age were selected using stratified systematic cluster sampling or by probability proportional to size sampling. METHODS: All participants underwent complete ophthalmic evaluations. Three drops of 0.5% tropicamide were used to obtain the cycloplegic refractive status of each participant. Questionnaires were used to acquire participant data from the 1995, 2005, 2010, and 2016 surveys. MAIN OUTCOME MEASURES: Prevalence of myopia (spherical equivalence of ≤-0.25 diopter [D]) and high myopia (≤-6.0 D) was assessed. Multivariate analyses of risk factors were conducted. RESULTS: The prevalence of myopia among all age groups increased steadily. From 1983 through 2017, the weighted prevalence increased from 5.37% (95% confidence interval [CI], 3.50%-7.23%) to 25.41% (95% CI, 21.27%-29.55%) for 7-year-olds (P = 0.001 for trend) and from 30.66% (95% CI, 26.89%-34.43%) to 76.67% (95% CI, 72.94%-80.40%) for 12-year-olds (P = 0.001 for trend). The prevalence of high myopia also increased from 1.39% (95% CI, 0.43%-2.35%) to 4.26% (95% CI, 3.35%-5.17%) for 12-year-olds (P = 0.008 for trend) and from 4.37% (95% CI, 2.91%-5.82%) to 15.36% (95% CI, 13.78%-16.94%) for 15-year-olds (P = 0.039 for trend). In both the 2005 and 2016 survey samples, children who spent less than 180 minutes daily on near-work activities showed significantly lower risks for myopia developing (<60 minutes: odds ratio [OR], 0.48 and 0.56; 60-180 minutes: OR, 0.69 and 0.67). In the 2016 survey, spending more than 60 minutes daily on electronic devices was associated significantly with both myopia and high myopia (OR, 2.43 and 2.31). CONCLUSIONS: The prevalence of myopia among schoolchildren increased rapidly from 1983 through 2017 in Taiwan. The major risk factors are older age and time spent on near-work activities. Use of electronic devices increased the amount of time spent on near-work and may increase the risk of developing myopia.
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Miopia/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Masculino , Midriáticos/administração & dosagem , Razão de Chances , Prevalência , Fatores de Risco , Instituições Acadêmicas , Taiwan/epidemiologia , Tropicamida/administração & dosagem , Testes VisuaisAssuntos
Extração de Catarata , Assistentes de Oftalmologia/normas , Soluções Oftálmicas/administração & dosagem , Gravação em Vídeo , Adulto , Idoso , Idoso de 80 Anos ou mais , Sistemas de Liberação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ofloxacino/administração & dosagem , Povidona-Iodo/administração & dosagem , Propoxicaína/administração & dosagem , Tropicamida/administração & dosagemRESUMO
Purpose: To evaluate the effect of Mydrane (contains tropicamide, phenylephrine hydrochloride, and lidocaine hydrochloride) on time needed to induce mydriasis and mydriasis stability during cataract surgery. Methods: This was an observational, non-interventional, multicenter study of patients undergoing cataract surgery who received Mydrane for mydriasis and intraocular anesthesia. The study was conducted at seven ophthalmology departments at university hospitals in Poland. Patients admitted for cataract surgery within a 2-week period were asked to participate in the study. Patients whose pupils dilated to a diameter ≥6 mm after topical mydriatic administration during preoperative examinations were scheduled to receive Mydrane and included in the registry. No additional inclusion criteria were used. Patients' medical histories, examination results, and operative details were recorded. Pupil diameter was measured during surgery. Surgeons were asked to complete a Likert-based survey in parallel. Results: A total of 307 patients were enrolled. The mean pupil diameter was 7.0 ± 1.0 mm before capsulorhexis and 6.9 ± 1.2 mm before lens implementation. A pupil diameter ≥6 mm was achieved in 91.9% and 87.6% of patients before capsulorhexis and lens implantation, respectively. We asked 58 surgeons whether they agreed with the statement "Mydriasis was obtained in a short time after the administration of Mydrane"; the surgeons agreed with this statement after 92.2% (283/307) of surgeries. In addition, after 88.2% of surgeries, the surgeons agreed with the statement "Mydriasis was stable after the administration of Mydrane." Conclusions: Mydriasis was rapidly and stably obtained after Mydrane injection, as demonstrated by pupil diameter measurements during surgery and surgeons' feedback.
Assuntos
Anestésicos Locais/administração & dosagem , Extração de Catarata/métodos , Midriáticos/administração & dosagem , Pupila/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Combinação de Medicamentos , Feminino , Humanos , Injeções Intraoculares , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Fenilefrina/administração & dosagem , Fatores de Tempo , Tropicamida/administração & dosagemRESUMO
PRéCIS:: Small but significant decreases in optical coherence tomography angiography (OCTA)-measured circumpapillary capillary density (cpCD) were observed in healthy eyes dilated with 2.5% phenylephrine/0.5% tropicamide. Although likely clinically insignificant, ophthalmologists should consider these changes when interpreting OCTA results from dilated eyes. PURPOSE: The purpose of this study was to investigate the effect of pupil dilation using 2.5% phenylephrine and 0.5% tropicamide on quantitative assessment of retinal microvasculature using OCTA. METHODS: OptoVue AngioVue high density (HD) and non-HD OCTA macula and optic nerve head (ONH) images were obtained at 15-minute intervals predilation and postdilation in 26 healthy participants (mean age: 40.0; 95% confidence interval=33.9, 46.1 y). Superficial macular vessel density (VD) was measured in the whole image VD and the parafoveal region VD. ONH capillary density was measured in the whole image capillary density and the cpCD region. Differences between predilation and postdilation densities were assessed using linear mixed effects models to account for within-patient correlation. RESULTS: Instillation of dilating drops resulted in a small but statistically significant reduction in non-HD ONH whole image capillary density of 0.6%, from a mean of 45.2% (95% confidence interval=41.9%, 48.4%) to 44.6% (41.4%, 47.8%) (P=0.046). A similar reduction in non-HD ONH cpCD of 0.8% also was observed, from a mean of 49.3% (45.3%, 53.3%) to 48.5% (44.5%, 52.4%) (P=0.025). No postdilation decreases in macular VD or HD ONH capillary density were observed. CONCLUSIONS: Pupil dilation using topical 2.5% phenylephrine and 0.5% tropicamide results in a small but statistically significant reduction in non-HD ONH whole image and cpCD in healthy eyes. The observed reduction likely is not clinically significant because the observed reduction was within the previously reported range of measurement variability. Further studies should consider investigating these effects in nonhealthy eyes with glaucoma and media opacities, as well as older individuals.
Assuntos
Angiofluoresceinografia , Midriáticos/administração & dosagem , Fenilefrina/administração & dosagem , Pupila/efeitos dos fármacos , Vasos Retinianos/anatomia & histologia , Tomografia de Coerência Óptica , Tropicamida/administração & dosagem , Administração Oftálmica , Adulto , Idoso , Capilares/anatomia & histologia , Capilares/diagnóstico por imagem , Combinação de Medicamentos , Feminino , Voluntários Saudáveis , Humanos , Pressão Intraocular , Masculino , Microvasos , Pessoa de Meia-Idade , Soluções Oftálmicas , Vasos Retinianos/diagnóstico por imagem , Adulto JovemRESUMO
The aim of this study is to compare Mydrane (combination of tropicamide 0.02%, phenylephrine 0.31% and lidocaine 1%) and mydriatic drops (tropicamide 1% and phenylephrine 10%) used for cataract surgery in terms of efficacy in pupil dilation and impact on corneal endothelial cell density (CD) and central corneal thickness (CCT). Prospective study including 64 eyes of 64 patients that underwent phacoemulsification with intraocular lens implantation. Patients were randomized into two groups: Mydrane group received: tropicamide and phenylephrine one day preoperatively and Mydrane during the surgery. Reference group received: tropicamide and phenylephrine preoperatively. Pupil size was measured only in Mydrane group, in the same eye of the same patient one day preoperatively after mydriatic drops were given and during the surgery, after intracameral Mydrane injection. CD and CCT were evaluated one day preoperatively and one month postoperatively in all patients and compared between Mydrane and reference groups. The results show CCT and CD significantly decreased after surgery in both groups. There is no difference in this decrease between groups. In Mydrane group there was no difference in dilated pupil diameter between Mydrane and mydriatic drops. Gender, diabetes mellitus, POAG, alpha-1 blocker treatment failed to affect pupil dilation obtained with Mydrane. Cataract surgery affects CCT and CD regardless of which mydriatic protocol had been used. Pupil diameter was similar after drops instillation and after Mydrane injection in all patients from the Mydrane group.
Assuntos
Extração de Catarata/métodos , Catarata/terapia , Midriáticos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Catarata/tratamento farmacológico , Extração de Catarata/efeitos adversos , Feminino , Humanos , Injeções Intraoculares , Lidocaína/administração & dosagem , Lidocaína/efeitos adversos , Masculino , Pessoa de Meia-Idade , Midriáticos/efeitos adversos , Fenilefrina/administração & dosagem , Fenilefrina/efeitos adversos , Estudos Prospectivos , Tropicamida/administração & dosagem , Tropicamida/efeitos adversosRESUMO
SIGNIFICANCE: The Welch Allyn SureSight (Welch Allyn, Skaneateles Falls, NY) and Plusoptix PowerRefractor (Plusoptix, Nuremberg, Germany) are often used with infants, but little is known about the repeatability and validity of their peripheral refractive error measurements. Selecting the best instrument will support future refractive error and emmetropization studies. PURPOSE: The purpose of this study was to determine the validity and repeatability of peripheral refractive error measurements and peripheral refraction profiles measured with the Welch Allyn SureSight and Plusoptix PowerRefractor compared with the criterion standard Grand Seiko WR-5100K (Grand Seiko Co., Hiroshima, Japan). METHODS: Cycloplegic (tropicamide 1%) autorefraction was measured in the right eyes of 21 adult subjects (31.4 ± 10.4 years) with the three instruments in randomized order on two separate visits, at least 24 hours apart, centrally, and at 30 and 20° temporal and nasal gaze. RESULTS: The SureSight measurements were within 0.24 D and not significantly different from the Grand Seiko WR-5100K in any gaze (P < .65), whereas the PowerRefractor measurements were more myopic by as much as -0.97 D and significantly different in four of the five gaze directions (P < .04). The 95% limits of agreement between occasions by gaze ranged from ±0.38 to ±0.61 D for the SureSight, similar to or slightly better than the WR-5100K (±0.31 to ±1.51 D) and the PowerRefractor (±0.72 to ±1.71 D). There were no significant differences between visits for any instrument in any gaze (P < .94). The repeatability of the SureSight was also better than that for the Grand Seiko when peripheral refraction was represented by quadratic fits to the data. CONCLUSIONS: These findings suggest that the Welch Allyn SureSight is the most suitable portable autorefractor to use to monitor peripheral autorefraction based on better repeatability between occasions and better validity compared with the criterion standard Grand Seiko WR-5100K.
Assuntos
Refração Ocular/fisiologia , Erros de Refração/diagnóstico , Testes Visuais/instrumentação , Acomodação Ocular/efeitos dos fármacos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Midriáticos/administração & dosagem , Erros de Refração/fisiopatologia , Reprodutibilidade dos Testes , Tropicamida/administração & dosagem , Adulto JovemRESUMO
Purpose: The axial separation between the iris and the intraocular lens (IOL) in pseudophakic eyes can cause rays originating from the far temporal field to miss the IOL, resulting in negative dysphotopsia (ND). We developed an experimental model to test the hypothesis that obstruction of rays from the far temporal field can generate ND and an accompanying loss of visual sensitivity in the far temporal field. Methods: The right eyes of 10 phakic subjects were fitted with soft contact lenses containing a 5.50-mm central clear zone and a 12-mm outer diameter opaque annulus. In three of the subjects, eyes were dilated with 1% tropicamide solution, and effective aperture diameters were determined optically (pupil camera) and psychophysically (narrow beam detection). Visual field extent (Goldmann bowl) and temporal and inferotemporal meridian sensitivities (Octopus perimeter) were measured. A wide-angle model was constructed to quantify the impact of the annular opacity on retinal illuminance. Results: All 10 subjects observed a dark crescent in the far temporal and inferotemporal fields. The opaque annulus reduced effective horizontal pupil diameters from 8 mm to 5.5 mm on-axis and from >2 mm to <1 mm at 90°. Perimetry revealed a 10° reduction in temporal and inferotemporal field extent and increasing loss of sensitivity beyond 70°. The wide-angle model confirmed significant vignetting (>50% beyond 70°), approaching zero retinal illuminance beyond 85°. Conclusions: Vignetting of rays originating from the far temporal field by axially separated apertures can create symptoms mirroring perceptual reports of negative dysphotopsia in symptomatic pseudophakic patients.
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Cristalino/fisiologia , Modelos Teóricos , Transtornos da Percepção/fisiopatologia , Transtornos da Visão/fisiopatologia , Campos Visuais/fisiologia , Adulto , Lentes de Contato Hidrofílicas , Feminino , Humanos , Luz , Masculino , Pessoa de Meia-Idade , Midriáticos/administração & dosagem , Ajuste de Prótese , Pupila/efeitos dos fármacos , Retina/efeitos da radiação , Tropicamida/administração & dosagem , Testes de Campo Visual , Adulto JovemRESUMO
Purpose: Mixed eye drops containing 0.5% tropicamide and 0.5% phenylephrine are commercially available for cycloplegic refraction. Determining the pharmacokinetics (PK) and distribution of tropicamide and phenylephrine simultaneously in ocular tissues is an important but challenging issue. Herein, we developed a sensitive and selective ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method for simultaneous determination of tropicamide and phenylephrine concentrations in rabbit ocular tissues and plasma. Methods: The two analytes were extracted with ethyl acetate using etofesalamide as an internal standard and separated using a chromatographic C8 column with isocratic elution. Mass spectrometry analysis was performed with positive electrospray ionization and data were acquired in a multiple reaction monitoring mode. Results: We validated this method over a concentration range of 5-1,600 ng/mL for tropicamide and 1-320 ng/mL for phenylephrine in ocular tissues, as well as 0.5-64 ng/mL for both compounds in plasma. Inter- and intraday precisions in all samples were both <12.9% and the accuracy was within 92.1%-108.4%. The highest concentration of tropicamide was found in aqueous humor (Cmax: 29430 ng/g), while was in cornea for phenylephrine (Cmax: 3465 ng/g). All the ocular tissues concentrations were much higher than those of blood. Conclusion: This UPLC-MS/MS method allowed us to determine the PK and distribution of tropicamide and phenylephrine in rabbit ocular tissue, which may be helpful in the future development and application of mydriatic agents.
Assuntos
Olho/química , Fenilefrina/farmacocinética , Plasma/química , Tropicamida/farmacocinética , Administração Tópica , Agonistas de Receptores Adrenérgicos alfa 1/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 1/farmacocinética , Animais , Humor Aquoso/química , Cromatografia Líquida/métodos , Córnea/química , Olho/efeitos dos fármacos , Midriáticos/administração & dosagem , Midriáticos/farmacocinética , Soluções Oftálmicas/administração & dosagem , Fenilefrina/administração & dosagem , Coelhos , Reprodutibilidade dos Testes , Espectrometria de Massas em Tandem/métodos , Tropicamida/administração & dosagemRESUMO
PURPOSE: To compare the use of topical dilation drops vs topical drops with the addition of intracameral epinephrine in resident-performed cataract surgery and the effects on pupil expansion device (PED) use, surgical costs, and surgical times. SETTING: Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA. DESIGN: Retrospective chart review. METHODS: Resident-performed primary cataract surgical cases using topical dilation drops only or drops with the addition of intracameral epinephrine were analyzed for PED use, surgical time, and costs in all patients and in patients with a history of tamsulosin use. RESULTS: In the topical group, PEDs were used in 31.1% of cases compared with 13.5% of cases in the intracameral group (P < .0001). History of tamsulosin use was noted in about one third of cases in both groups. For patients with a history of tamsulosin use, PED use decreased from 52.7% in the topical cases to 17.9% in the intracameral group (P < .0001). Surgical times were on average 7.1 minutes slower with PED use than without PED use. There was a medication savings of $50.44 USD per case in the intracameral group compared with the topical group. Factoring in the $100 to $130 USD per PED used, total surgical costs were $19 267 USD less in the intracameral group over 6 months. CONCLUSIONS: Intracameral epinephrine with lidocaine decreases the need for PED use during cataract surgery, lowers intraoperative costs, and improves efficiency compared with topical dilation drops alone.