RESUMO
OBJECTIVE: To assess the response to topical and/or systemic pilocarpine in dogs with neurogenic dry eye. METHOD: Medical records of dogs diagnosed with dry eye between 2015 and 2018 were reviewed. Cases were excluded if STT values were decreased bilaterally, if dogs were lost to follow-up, or if surgical measures (parotid duct transposition) were undertaken within thirty days of presentation. Dogs were on treatment with topical pilocarpine (0.1%, every 6 hours) and/or oral pilocarpine (starting dose 2%, one drop per 10 kg every twelve hours). RESULTS: Eleven cases were included in the study, seven females and four males with mean age of 10 years. Seven cases had xeromycteria, two cases had facial nerve paralysis, and one case had Horner's syndrome. Seven cases (63.6%) had successful outcome following pilocarpine treatment, return to normal STT (15-25mm/minute), in an average of 24 ± 5.1 days. Of these cases, five had both systemic and topical treatment, one had just topical treatment, and one had just systemic treatment. The average time to normal tear production on treatment with topical pilocarpine ± systemic was 23 days (range 9-48 days). The number of systemic drops until a positive response varied between individuals from 0.8drops/10kg to 7drops/10kg. CONCLUSION: Pilocarpine treatment (topical ± systemic) is an effective therapy for unilateral dry eye disease in cases suspected to be neurogenic in origin. Most cases responded within 30 days. Side effects included topical irritation to the ophthalmic solution and systemic effects from oral pilocarpine, such as diarrhea and regurgitation.
Assuntos
Doenças do Cão/tratamento farmacológico , Síndromes do Olho Seco/veterinária , Pilocarpina/uso terapêutico , Administração Tópica , Animais , Cães , Síndromes do Olho Seco/tratamento farmacológico , Feminino , Masculino , Mióticos/administração & dosagem , Mióticos/uso terapêutico , Soluções Oftálmicas , Pilocarpina/administração & dosagem , Estudos RetrospectivosRESUMO
PURPOSE: We conducted a systematic review and meta-analysis to evaluate the efficacy of different treatment for Demodex blepharitis. Parameters studied were mites count, improvement of symptoms and mites' eradication, stratified on type of treatments and mode of delivery of treatments (local or systemic). METHOD: The PubMed, Cochrane Library, Embase, ClinicalTrials.gov, Google scholar and Science Direct databases were searched for studies reporting an efficacy of treatments for Demodex blepharitis. RESULTS: We included 19 studies (14 observational and 5 randomized clinical trials), for a total of 934 patients, 1741 eyes, and 13 different treatments. For mites count, eradication rate, and symptoms improvement, meta-analysis included fifteen, fourteen and thirteen studies, respectively. The overall effect sizes for efficiency of all treatments, globally, were 1.68 (95CI 1.25 to 2.12), 0.45 (0.26-0.64), and 0.76 (0.59-0.90), respectively. Except usual lid hygiene for mites count, Children's Hospital of Eastern Ontario ointment (CHEO) for both eradication rate and symptoms, and CHEO, 2% metronidazole ointment, and systemic metronidazole for eradication rate, all treatments were efficient. Stratified meta-analysis did not show significant differences between local and systemic treatments (1.22, 0.83 to 1.60 vs 2.24, 1.30 to 3.18 for mites count; 0.37, 0.21 to 0.54 vs 0.56, 0.06 to 0.99 for eradication rate; and 0.77, 0.58 to 0.92 vs 0.67, 0.25 to 0.98 for symptoms improvement). CONCLUSION: We reported the efficiency of the different treatments of Demodex blepharitis. Because of less systemic side effects, local treatments seem promising molecules in the treatment of Demodex blepharitis.
Assuntos
Blefarite/terapia , Infecções Oculares Parasitárias/terapia , Ivermectina/uso terapêutico , Metronidazol/uso terapêutico , Infestações por Ácaros/terapia , Pilocarpina/uso terapêutico , Óleo de Melaleuca/uso terapêutico , Animais , Anti-Infecciosos Locais/uso terapêutico , Antiparasitários/uso terapêutico , Blefarite/parasitologia , Infecções Oculares Parasitárias/parasitologia , Humanos , Mióticos/uso terapêutico , Infestações por Ácaros/parasitologia , ÁcarosRESUMO
PURPOSE OF REVIEW: The recent scientific literature provides evidence of long-term results with small-aperture corneal inlays, as well as new evidence from a multicenter postmarket study of small-aperture intraocular lenses (IOLs) and early reports of the use of topical agents for presbyopia correction through pupil constriction. The field of small-aperture optics is growing and changing rapidly. RECENT FINDINGS: This article reviews what is known to date about various small-aperture optics platforms, including a posterior chamber IOL, add on device, corneal inlay, contact lenses, and pupil-constricting drops. Additionally, the impact of small-aperture technologies on light perception and visual performance, as well as the relative merits of monocular versus binocular small apertures are discussed. SUMMARY: Small-aperture optics are a dynamic, physiologic solution to the problem of presbyopia. They are effective throughout the range of accommodation loss and in pseudophakia. Small-aperture optics offer an opportunity to improve vision in presbyopes with and without cataracts. In some forms, they may also be able to reduce the impact of aberrations or improve vision in eyes with corneal irregularities, scars, or iris damage.
Assuntos
Lentes de Contato , Substância Própria/cirurgia , Lentes Intraoculares , Mióticos/uso terapêutico , Presbiopia/terapia , Próteses e Implantes , Humanos , Presbiopia/fisiopatologia , Pupila/efeitos dos fármacos , Pupila/fisiologia , Acuidade Visual/fisiologiaRESUMO
INTRODUCTION: Amyloidosis accompanied by Sjögren's syndrome (SS) has been reported to occur primarily in the skin, lungs, tongue, and mammary gland. However, SS in association with secondary amyloidosis is rarely reported, and knowledge of its relevance is inadequate. Here we report a case of primary SS diagnosed simultaneously with localized amyloidosis of the lacrimal gland. CASE PRESENTATION: A 45-year-old woman complaining of a left eyelid mass was referred to the hospital and was diagnosed with localized amyloidosis after excisional biopsy. She was then referred to the rheumatology department for additional evaluation for amyloidosis. Subsequently, her diagnosis was primary SS based on the presented symptoms and results of the Schirmer test, serologic testing, and minor salivary gland biopsy. Pilocarpine (10âmg/d) and hydroxychloroquine (200âmg/d) were initiated for the treatment of SS. Six months after the initial diagnosis, the dry eyes and mouth did not worsen and no masses suggestive of localized amyloidosis were reported. CONCLUSION: This is a rare case of amyloidosis, localized to the lacrimal gland, with SS. Therefore, despite its rarity, physicians should be aware of the potential coexistence of secondary amyloidosis, even in the localized form, in patients with SS.
Assuntos
Amiloidose/complicações , Aparelho Lacrimal/patologia , Síndrome de Sjogren/complicações , Amiloidose/tratamento farmacológico , Amiloidose/patologia , Antirreumáticos/uso terapêutico , Biópsia , Feminino , Humanos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/uso terapêutico , Aparelho Lacrimal/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Mióticos/uso terapêutico , Pilocarpina/administração & dosagem , Pilocarpina/uso terapêutico , Doenças Raras , Glândulas Salivares Menores/patologia , Síndrome de Sjogren/sangue , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/tratamento farmacológico , Resultado do TratamentoRESUMO
A six-year-old male patient was admitted to our hospital due to itching and scalding crusts that persisted 10-15 days in both eyes. Upon biomicroscopic examination, 5-6 semi-translucent, yellowish brown living lice attached to the upper eyelashes and a large number of eggs were observed. Following application of pilocarpine hydrochloride (Pilomann 2%, Bausch-Lomb) and topical proparacaine hydrochloride (Alcaine 0.5%, Alcon), the paralyzed parasites and eggs were manually removed by pulling with forceps. The lice were identified as adult forms of pubic louse, Pthirus pubis, and its eggs. The patient was treated with pilocarpine hydrochloride, which was applied thrice a day combined with pure vaseline. One week later, no lice or eggs were seen on the eyelashes.
Assuntos
Blefarite/diagnóstico , Infestações por Piolhos/diagnóstico , Phthirus , Animais , Blefarite/complicações , Blefarite/tratamento farmacológico , Blefarite/parasitologia , Criança , Diagnóstico Diferencial , Pestanas/parasitologia , Humanos , Infestações por Piolhos/complicações , Infestações por Piolhos/tratamento farmacológico , Infestações por Piolhos/parasitologia , Masculino , Mióticos/administração & dosagem , Mióticos/uso terapêutico , Soluções Oftálmicas , Pilocarpina/administração & dosagem , Pilocarpina/uso terapêutico , Prurido/etiologiaRESUMO
Temporal lobe epilepsy (TLE) is a common neurological disorder in adulthood. For translational studies of chronic epilepsy, pilocarpine-induced status epilepticus (SE) is frequently selected to recapitulate spontaneous recurrent seizures (SRS). Here we present a protocol of SE induction by intraperitoneal (i.p.) injection of pilocarpine and monitoring of chronic recurring seizures in live animals using a wireless telemetry video and electroencephalogram (EEG) system. We demonstrated notable behavioral changes that need attention after pilocarpine injection and their correlation with hippocampal neuronal loss at 7 days and 6 weeks post-pilocarpine. We also describe the experimental procedures of electrode implantation for video and EEG recording, and analysis of the frequency and duration of chronic recurrent seizures. Finally, we discuss the possible reasons why the expected results are not achieved in each case. This provides a basic overview of modeling chronic epilepsy in mice and guidelines for troubleshooting. We believe this protocol can serve as a baseline for suitable models of chronic epilepsy and epileptogenesis.
Assuntos
Eletrodos Implantados/estatística & dados numéricos , Eletroencefalografia/métodos , Epilepsia do Lobo Temporal/induzido quimicamente , Mióticos/uso terapêutico , Pilocarpina/uso terapêutico , Animais , Modelos Animais de Doenças , Masculino , Camundongos , Mióticos/farmacologia , Pilocarpina/farmacologiaAssuntos
Extração de Catarata/efeitos adversos , Complicações Pós-Operatórias/etiologia , Transtornos da Visão/etiologia , Gerenciamento Clínico , Humanos , Implante de Lente Intraocular/efeitos adversos , Mióticos/uso terapêutico , Midriáticos/uso terapêutico , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/terapia , Transtornos da Visão/patologia , Transtornos da Visão/terapiaRESUMO
Elevated eye pressure is the main risk factor for glaucoma; intraocular pressure rises when the ratio between aqueous humor formation (inflow) and its outflow is unbalanced. Currently, the main goal of medical treatment is the reduction of intraocular pressure. Five main classes of topical drugs are available; they include betablockers, carbonic anhydrase inhibitors, prostaglandin derivatives, sympathomimetics and miotics. Beta-blockers and carbonic anhydrase inhibitors slow the formation of aqueous humor and may be considered as "inflow" drugs; the other three classes reduce the resistance to the drainage of aqueous humor and may be considered as "outflow" drugs. Despite the variety of drugs accessible in the market, there is a real need for ophthalmologists to have more potent medications for this disease. This review focuses on medical treatment of glaucoma with particular attention to novel molecules in pre-clinical or clinical development.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Descoberta de Drogas/métodos , Glaucoma/tratamento farmacológico , Mióticos/uso terapêutico , Prostaglandinas/uso terapêutico , Simpatomiméticos/uso terapêutico , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/efeitos adversos , Animais , Inibidores da Anidrase Carbônica/administração & dosagem , Inibidores da Anidrase Carbônica/efeitos adversos , Humanos , Pressão Intraocular/efeitos dos fármacos , Mióticos/administração & dosagem , Mióticos/efeitos adversos , Prostaglandinas/administração & dosagem , Prostaglandinas/efeitos adversos , Simpatomiméticos/administração & dosagem , Simpatomiméticos/efeitos adversos , Resultado do TratamentoRESUMO
Glaucoma is a painful and often blinding group of ocular diseases for which there is no cure. Although the definition of glaucoma is rapidly evolving, elevated intraocular pressure (IOP) remains the most consistent risk factor of glaucoma in the canine patient. Therapy should be aimed at neuroprotection. The mainstay of therapy focuses on reducing IOP and maintaining a visual and comfortable eye. This article discusses the most current ocular hypotensive agents, focusing on their basic pharmacology, efficacy at lowering IOP, and recommended use in the treatment of idiopathic canine glaucoma.
Assuntos
Doenças do Cão/tratamento farmacológico , Glaucoma/veterinária , Agonistas Adrenérgicos/administração & dosagem , Agonistas Adrenérgicos/uso terapêutico , Animais , Inibidores da Anidrase Carbônica/administração & dosagem , Inibidores da Anidrase Carbônica/uso terapêutico , Agonistas Colinérgicos/administração & dosagem , Agonistas Colinérgicos/uso terapêutico , Cães , Sistemas de Liberação de Medicamentos/veterinária , Gasotransmissores/uso terapêutico , Glaucoma/tratamento farmacológico , Mióticos/administração & dosagem , Mióticos/uso terapêutico , Prostaglandinas/administração & dosagem , Prostaglandinas/uso terapêutico , Quinases Associadas a rho/antagonistas & inibidoresRESUMO
OBJECTIVE: To investigate the effects of intracameral carbachol in phacoemulsification surgery on central macular thickness (CMT), total macular volume (TMV) and retinal vessel caliber (RVC). MATERIALS AND METHODS: In this prospective consecutive case series, 82 patients underwent uneventful phacoemulsification and in-the-bag intraocular lens implantation. Unlike patients in the control group (43 eyes), patients in the study group (42 eyes) were injected with intracameral 0.01% carbachol during surgery. Spectral-domain optical coherence tomography (OCT) was used to analyze the parameters of CMT, TMV and RVC. RESULTS: On the first postoperative day, mean CMT and TMV decreased markedly in the carbachol group, though these values did not change significantly in the control group. During follow-up visits, no statistically significant differences between the groups occurred regarding changes in mean CMT (p = 0.25, first day; p = 0.80, first week; p = 0.95, first month). However, change in mean TMV between groups on the first postoperative day was statistically significant (p = 0.01, first day; p = 0.96, first week; p = 0.68, first month). RVC values were similar on the preoperative and postoperative first days in both groups (p > 0.05). DISCUSSION: Results suggest that the effect of intracameral carbachol on macular OCT is related to pharmacological effects, as well as optic events (e.g. miosis). CONCLUSION: Intracameral carbachol given during cataract surgery decreases macular thickness and volume in the early postoperative period but does not exert any gross effect on RVC.
Assuntos
Carbacol/efeitos adversos , Macula Lutea/efeitos dos fármacos , Mióticos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carbacol/uso terapêutico , Feminino , Humanos , Implante de Lente Intraocular , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Mióticos/uso terapêutico , Facoemulsificação , Artéria Retiniana/efeitos dos fármacos , Veia Retiniana/efeitos dos fármacos , Tomografia de Coerência ÓpticaRESUMO
Pupil abnormalities in leprosy usually result from chronic iritis with loss of stroma, iris miosis, a sluggish reaction to light, and poor dilation in response to anticholinergic mydriatics. We report two patients with long-standing lepromatous leprosy who developed tonic pupils characterized by mydriasis, absence of reaction to light and hypersensitivity to weak cholinergic solution. Examination revealed iritis and iris atrophy. In both cases, instillation of dilute 0.1% pilocarpine caused miosis in the affected eyes. Tonic pupil occurs in many conditions, but its association with leprosy had not been previously reported.
Anormalidades da pupila em pacientes com doença de Hansen, ocorrem mais comumente devido a irite crônica com perda do estroma iriano, miose, diminuição da reação à luz, e dificuldade de dilatação em resposta a colírios anticolinérgicos. Relatamos dois pacientes com doença de Hansen na forma lepromatosa que desenvolveram pupilas tônicas, caracterizadas por midríase, ausência de reação a luz e para perto e hipersensibilidade a fraca concentração de solução colinérgica. O exame revelou irite e atrofia iriana. Em ambos os casos a instilação de pilocarpina 0,1% causou miose nos olhos afetados. A pupila tônica tem sido relatada em muitas condições, mas sua associação com doença de Hansen ainda não havia sido descrita.
Assuntos
Humanos , Feminino , Adulto , Hanseníase Virchowiana/complicações , Pupila Tônica/etiologia , Pupila Tônica/tratamento farmacológico , Pilocarpina/uso terapêutico , Miose/induzido quimicamente , Resultado do Tratamento , Mióticos/uso terapêuticoRESUMO
Pupil abnormalities in leprosy usually result from chronic iritis with loss of stroma, iris miosis, a sluggish reaction to light, and poor dilation in response to anticholinergic mydriatics. We report two patients with long-standing lepromatous leprosy who developed tonic pupils characterized by mydriasis, absence of reaction to light and hypersensitivity to weak cholinergic solution. Examination revealed iritis and iris atrophy. In both cases, instillation of dilute 0.1% pilocarpine caused miosis in the affected eyes. Tonic pupil occurs in many conditions, but its association with leprosy had not been previously reported.
Assuntos
Hanseníase Virchowiana/complicações , Pupila Tônica/tratamento farmacológico , Pupila Tônica/etiologia , Adulto , Feminino , Humanos , Miose/induzido quimicamente , Mióticos/uso terapêutico , Pilocarpina/uso terapêutico , Resultado do TratamentoRESUMO
PURPOSE: The purpose of the study was to report a patient with primary angle closure associated with a different nonpupillary block mechanism in which an abnormally thick peripheral iris assumes a cross-sectional shape resembling a cobblestone. METHODS: This is a case report focussing on clinical and imaging description. RESULTS: Slit-lamp biomicroscopy revealed patent laser peripheral iridotomies OU. The anterior chamber was relatively deep in the center but 360 degrees narrow at the periphery, associated with an abnormally elevated iris contour OU. On dark-room gonioscopy, the angles were occludable with few areas of peripheral anterior synechiae. Anterior segment-adapted spectral domain-optical coherence tomography revealed an unusual iris profile. Despite a flat contour and normal thickness until the mid-periphery, the iris assumed a rectangular cross-sectional shape (resembling a cobblestone) with an abnormal increase in its thickness in the periphery (360 degrees OU). Ultrasound biomicroscopy imaging showed a normal ciliary sulcus and ciliary body configuration, revealing no cysts at 360 degrees. Definitive relief of appositional angle closure was achieved with laser peripheral iridoplasty OU. CONCLUSIONS: This unusual anatomic condition of the peripheral iris, which has different characteristics when compared with ordinary cases of thick peripheral iris roll, may lead to angle closure and intraocular pressure elevation despite a patent iridotomy. Clinicians should be aware of this anatomic condition whenever dealing with cases of angle closure.
Assuntos
Glaucoma de Ângulo Fechado/etiologia , Doenças da Íris/complicações , Tomografia de Coerência Óptica , Adulto , Feminino , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/tratamento farmacológico , Gonioscopia , Humanos , Pressão Intraocular , Doenças da Íris/diagnóstico , Doenças da Íris/tratamento farmacológico , Microscopia Acústica , Mióticos/uso terapêutico , Pilocarpina/uso terapêuticoRESUMO
PURPOSE: To present a selected case series of plateau iris syndrome (PIS) that attempts to highlight the varied outcomes. METHODS: Retrospective review of three selected cases of plateau iris. RESULTS: Case 1 with 23 years follow-up highlights the benign nature of the disease with no disc and field changes. Case 2 represents the progressive form of the disease. Case 3 demonstrates the better efficacy of pilocarpine in comparison to other anti-glaucoma medications in the treatment of plateau iris. CONCLUSION: The understanding of the varied clinical course of plateau iris syndrome, as demonstrated by the above cases, might aid in therapeutic decision making.
Assuntos
Doenças da Íris , Adulto , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Pressão Intraocular/fisiologia , Doenças da Íris/fisiopatologia , Doenças da Íris/terapia , Masculino , Pessoa de Meia-Idade , Mióticos/uso terapêutico , Estudos RetrospectivosRESUMO
PURPOSE: The aim of this study was to investigate the usefulness of a long-acting miotic (physostigmine) after phacoemulsification in preventing peripheral anterior synechiae (PAS), lens dislocation, and high postoperative intraocular pressure. METHODS: This was a prospective randomized controlled trial of 400 patients (400 eyes) scheduled for phacoemulsification. Patients were randomly assigned either to receive a single application of physostigmine ointment directly after phacoemulsification or not. The main outcome measures were the change of intraocular pressure (IOP) before and after surgery, number of extra outpatient clinic visits within 4 weeks postoperatively, verbal rating pain scale (VRS), status of the angle by gonioscopy, and best corrected visual acuity (BCVA). RESULTS: There was no significant difference in IOP and BCVA between both groups. There were more patients who reported a VRS score of more than 3 in the physostigmine group (P=0.021). PAS or (anterior) lens dislocation was not observed. CONCLUSION: In eyes without co-morbidity, the routine use of physostigmine ointment has lost its rationale.
Assuntos
Subluxação do Cristalino/prevenção & controle , Mióticos/uso terapêutico , Hipertensão Ocular/prevenção & controle , Facoemulsificação/efeitos adversos , Fisostigmina/uso terapêutico , Aderências Teciduais/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gonioscopia , Humanos , Pressão Intraocular/efeitos dos fármacos , Subluxação do Cristalino/etiologia , Masculino , Pessoa de Meia-Idade , Mióticos/administração & dosagem , Hipertensão Ocular/etiologia , Pomadas , Medição da Dor , Facoemulsificação/métodos , Fisostigmina/administração & dosagem , Estudos Prospectivos , Aderências Teciduais/etiologia , Resultado do Tratamento , Acuidade Visual/efeitos dos fármacosRESUMO
In this study, the aminated gelatin was grafted with carboxylic end-capped poly(N-isopropylacrylamide) (PN) via a carbodiimide-mediated coupling reaction to fabricate biodegradable in situ forming delivery systems for intracameral administration of antiglaucoma medications. The chemical structure of the graft copolymers (GN) was confirmed by Fourier transform infrared (FTIR) spectroscopy. When the feed molar ratio of NH(2)/COOH was 0.36, the grafting ratio, efficiency and degree of grafting, and weight ratio of PN to aminated gelatin was 25.6, 18.6%, 52.6%, and 1.9, respectively. As compared to PN, the GN samples possessed better thermal gelation ability and adherence, indicating remarkable phase transition properties. Under gelatinase degradation, the remaining weight of GN was significantly lower than those of PN at each time point from 8 h to 4 weeks. Cytocompatibility studies showed that the culture of anterior segment cells with both in situ forming gels does not affect proliferation and has little effect on inflammation. Higher encapsulation efficiency (~62%) and cumulative release (~95%) were achieved for GN vehicles, which was attributed to initial fast temperature triggered capture of pilocarpine and subsequent progressive degradation of gelatin network. In a rabbit glaucoma model, the performance of delivery carriers was evaluated by biomicroscopy, intraocular pressure (IOP), and pupil size change. Intracameral administration of pilocarpine using GN was found to be more effective than other methods such as instillation of eye drop and injection of free drug or PN containing drug in improving ocular bioavailability and extending the pharmacological responses (i.e., miosis and IOP lowering effect and preservation of corneal endothelial cell density).