Cycloplegic effect of 0.5% tropicamide and 0.5% phenylephrine mixed eye drops: objective assessment in Japanese schoolchildren with myopia.

PURPOSE: To evaluate the cycloplegic effect of mixed eye drops containing 0.5% tropicamide and 0.5% phenylephrine in myopic children, and to determine whether their efficacy was associated with their clinical characteristics. METHODS: Eighty-one myopic children (age, mean +/- SD, 11.0 +/- 1.5 years; mean spherical equivalent refractive error, -4.27 +/- 1.41 D; range, -1.57 to -8.66 D) were recruited. One drop of Mydrin-P was administered to each eye twice, with an interval of 5 min between. Twenty-five minutes after the second drop, accommodative responses were measured with an open-view autorefractometer, while the subject was encouraged to accommodate by binocularly looking at a Maltese cross located at a distance of 33 cm. The difference between the refractive reading and that obtained with a Maltese cross at 500 cm was regarded as residual accommodation (RA). The repeatability of this measurement was also evaluated. RESULTS: The mean RA was 0.21 +/- 0.29 D (range, -0.31 to 0.99 D). There was no association in RA between the right and left eyes, between RA and age, or between RA and sex, but RA was weakly correlated with refractive error (r = 0.274, P = 0.019). The intersubject difference found in RA can be explained mostly by the extent of repeatability (+/-0.71 D). CONCLUSION: The insignificant magnitude of RA indicated that the mixed eye drop is an acceptable and useful cycloplegic agent in Japanese schoolchildren with a wide range of myopic refractive errors.

Laserinterferometric assessment of pilocarpine-induced movement of an accommodating intraocular lens: a randomized trial.

PURPOSE: To measure the axial movement of an accommodating intraocular lens (IOL) induced by ciliary muscle contraction after application of pilocarpine. DESIGN: Randomized, controlled, patient- and examiner-masked trial with intrapatient comparison. PARTICIPANTS AND CONTROLS: One hundred ten eyes of 55 patients with age-related bilateral cataract. METHODS: This study was divided into 3 parts. In the first, the accommodating IOL (1CU) was compared with a 3-piece open-loop acrylic IOL that served as the control. In the second, to assess the effect of capsule fibrosis on the potential accommodating performance of the accommodating IOL, extensive polishing of the anterior capsule with a slit cannula was compared with standard surgery. In the third, the effect of a posterior capsulorhexis was compared with that of standard surgery. Anterior chamber depth (ACD) was assessed with partial coherence interferometry, measured before and after topical application of pilocarpine 2%, and near visual acuity (VA) was evaluated 3 months after surgery. MAIN OUTCOME MEASURE: Pilocarpine-induced change in ACD. RESULTS: The accommodating IOL showed a forward movement under pilocarpine with a median amplitude of movement of -314 microm (95% confidence interval [CI]: -148 to -592), compared with the backward movement of 63 microm (95% CI: 161 to -41) for the open-loop control IOL (P = 0.001). Capsule polishing and a posterior capsulorhexis had no effect on IOL movement with the accommodating IOL. The median near VA with distance correction was 20/60. CONCLUSION: Pilocarpine induced a small but significant forward movement of the accommodating IOL. However, the amount of movement was calculated to result in a refractive change of <0.5 diopters (D) in most patients, reaching 1 D or slightly more in only single cases, with a large variability of movement. Neither polishing of the capsule bag nor a posterior capsulorhexis could enhance the accommodative ability.

Ultrasound biomicroscopy in the assessment of secondary glaucoma after vitreoretinal surgery and silicone oil injection.

This retrospective study was undertaken to evaluate the utility of Ultrasound Biomicroscopy (UBM) in the assessment of the anterior chamber in patients affected by silicone oil-related glaucoma after vitreoretinal surgery. UBM showed high reflectivity of angular structure, anterior chamber alterations and a fairly trophic ciliary body.

Assessment of muscarinic transmission in the superior cervical and ciliary ganglion of the cat.

This study was undertaken to determine if muscarinic mechanisms are involved in synaptic transmission in the parasympathetic ciliary ganglion as has been clearly shown for sympathetic ganglia. Cats were anesthetized, and following topical ephedrine, pupillary constrictions were elicited by electrical stimulation of the intracranial oculomotor nucleus. Nictitating membrane contractions were evoked by electrical stimulation of the preganglionic cervical nerve. Frequency-response curves were repeated after infusion with hexamethonium (0.6-1.0 mg/kg min-1) and after subsequent administration of atropine (500 micrograms/kg. i.v.). In other experiments, effects of nicotinic (DMPP) and muscarinic (McN-A-343) agonists on postganglionic ciliary nerve activity were measured. Treatment with hexamethonium reduced nictitating membrane responses at all frequencies of stimulation (by about 75% at 16-32 Hz). The residual nictitating membrane contractions were subsequently blocked by the addition of atropine. In contrast, hexamethonium totally abolished miosis produced by CNS preganglionic oculomotor nerve stimulation. The nicotinic agonist, DMPP, produced nictitating membrane contractions, miosis, and increased ciliary nerve firing. In contrast, McN-A-343 contracted the nictitating membrane but failed to increase postganglionic ciliary nerve activity. These results suggest that, unlike sympathetic ganglia, a significant degree of muscarinic transmission does not occur in the parasympathetic ciliary ganglion.