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International Ophthalmology Dec 2020There is a large variation in mydriatic regimens used in screening for retinopathy in preterm infants. Except for the standard instillation of mydriatic drops in their... (Review)
Review
PURPOSE
There is a large variation in mydriatic regimens used in screening for retinopathy in preterm infants. Except for the standard instillation of mydriatic drops in their commercial formulation, other techniques for pupil dilation have also been described. This study aimed to review all techniques that have been used for mydriasis in retinopathy of prematurity eye examination (ROPEE) screening.
METHODS
A comprehensive literature search was performed in PubMed, Cochrane library, Trip database, and Scopus, using the key words: "mydriasis", "techniques", "mydriatics", "dilating drops", "retinopathy of prematurity", "ROP", "phenylephrine", "cyclopentolate", "tropicamide", "smaller mydriatic drops", "reduction in drop size" to February 2019.
RESULTS
Five primary studies were included, assessing the techniques of microdrops, lower conjunctival fornix (LCF) packing and Mydriasert® ophthalmic insert. Reported efficacy was similar to commercial eyedrops instillation. Microdrops appeared to have a superior safety profile. LCF packing and Mydriasert lead to increased blood pressure, without serious complications, necessitating further safety studies.
CONCLUSIONS
Of all alternative mydriasis techniques for ROPEE screening that have been described, microdrops appear to be the safest yet still effective technique in the fragile population of premature infants in risk of ROP.
Topics: Humans; Infant; Infant, Newborn; Infant, Premature; Mydriasis; Mydriatics; Ophthalmic Solutions; Phenylephrine; Pupil; Retinopathy of Prematurity; Tropicamide
PubMed: 32772218
DOI: 10.1007/s10792-020-01542-x -
Hong Kong Medical Journal = Xianggang... Apr 2012To review acute angle closure attacks induced by local and systemic medications. (Review)
Review
OBJECTIVE
To review acute angle closure attacks induced by local and systemic medications.
DATA SOURCES
PubMed literature searches up to August 2011.
STUDY SELECTION
The following key words were used for the search: "drug", "iatrogenic", "acute angle closure glaucoma".
DATA EXTRACTION
A total of 86 articles were retrieved using the key words. Only those concerning acute angle closure attack triggered by local or systemic drug administration were included. For articles on the same or related topics, those published at later or more recent dates were selected. As a result, 44 articles were included and formed the basis of this review.
DATA SYNTHESIS
An acute attack of angle closure can be triggered by dilatation of the pupil, by anatomical changes in the ciliary body and iris, or by movement of the iris-lens diaphragm. Local and systemic medications that cause these changes have the potential to precipitate an attack of acute angle closure. The risk is higher in subjects who are predisposed to the development of angle closure. Many pharmaceutical agents including ophthalmic eyedrops and systemic drugs prescribed by general practitioners and various specialists (in psychiatry, otorhinolaryngology, ophthalmology, medicine, and anaesthesia) can precipitate an acute angle closure attack. The medications include: anti-histamines, anti-epileptics, antiparkinsonian agents, antispasmolytic drugs, mydriatic agents, sympathetic agents, and botulinum toxin.
CONCLUSION
Since acute angle closure attack is a potentially blinding eye disease, it is extremely important to be vigilant and aware of ophthalmic and systemic medications that can lead to such attacks in predisposed subjects and to diagnose the condition when it occurs.
Topics: Acute Disease; Anticonvulsants; Antidepressive Agents; Cholinergic Antagonists; Glaucoma, Angle-Closure; Humans; Mydriatics; Risk Factors
PubMed: 22477738
DOI: No ID Found -
Journal of Pediatric Ophthalmology and... 1981Systolic blood pressure (SBP) was measured by doppler methods at 5, 15, 30, 45, and 60 minutes in 52 premature infants after triple instillation of aqueous phenylephrine... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Systolic blood pressure (SBP) was measured by doppler methods at 5, 15, 30, 45, and 60 minutes in 52 premature infants after triple instillation of aqueous phenylephrine 2.5% and tropicamide 1.0%. Systolic blood pressures were insignificantly increased 3.9 +/- 2.0 mm Hg (mean +/- S.E.) at 15 minutes when compared with controls matched for initial blood pressure, birth weights and age at examination. Though a 964 gm, 28-week Caucasian male with retinopathy of prematurity had been uneventfully dilated, pupillary dilatation one week later with triple instillations of phenylephrine 2.5% and tropicamide 1.07% was accompanied by an acute increase in systolic blood pressure to 108 mm Hg at 15 minutes, which remained elevated for 150 minutes. A new lower dose, single instillation mydriatic became available whose final concentration was phenylephrine 2.5%, tropicamide 0.5% and cyclogyl 0.5%. A single drop was found to produce mydriasis equal to the triple instillation regime. The single administration produced no significant effect on systolic blood pressure in 30 low birth weight infants (birth weight less than 1750 gm) when compared with balanced salt solution (placebo) in a randomized, double--masked study. Mechanisms of acute hypertension after topical mydriasis are discussed.
Topics: Blood Pressure; Female; Humans; Infant, Newborn; Infant, Premature; Male; Mydriatics
PubMed: 7299611
DOI: 10.3928/0191-3913-19810901-11 -
Archives of Ophthalmology (Chicago,... Jun 1975A patient had tolerance, habituation, and addiction to the topical use of a combination of cyclopentolate hydrochloride and tropicamide. He also developed a blotchy,...
A patient had tolerance, habituation, and addiction to the topical use of a combination of cyclopentolate hydrochloride and tropicamide. He also developed a blotchy, diffuse epithelial keratitis that disappeared when the drugs were discontinued.
Topics: Administration, Topical; Adult; Amides; Anxiety; Cyclopentolate; Drug Combinations; Drug Tolerance; Humans; Keratitis; Male; Mydriatics; Nausea; Phenylacetates; Pyridines; Salivation; Substance Withdrawal Syndrome; Substance-Related Disorders; Tremor; Vomiting
PubMed: 1131081
DOI: 10.1001/archopht.1975.01010020446011 -
The Medical Letter on Drugs and... Jun 2024
Topics: Humans; Mydriasis; Phentolamine; Ophthalmic Solutions; Mydriatics; Administration, Ophthalmic
PubMed: 38905525
DOI: 10.58347/tml.2024.1705c -
Archives of Ophthalmology (Chicago,... Apr 1987The effect of 2% pilocarpine nitrate in countering mydriasis, cycloplegia, and change in visual acuity due to 0.5% tropicamide was studied in 23 healthy volunteers.... (Clinical Trial)
Clinical Trial
The effect of 2% pilocarpine nitrate in countering mydriasis, cycloplegia, and change in visual acuity due to 0.5% tropicamide was studied in 23 healthy volunteers. There was no significant difference in the decrease in pupil size or the rate of return of accommodation between the eye that received pilocarpine and the control eye. The effect of tropicamide on visual acuity was slight. In four (17%) of 23 eyes that received pilocarpine, visual acuity was reduced to 6/36 or worse. It is suggested that the use of 2% pilocarpine in the attempted reversal of 0.5% tropicamide to improve a patient's vision is not helpful and may possibly be harmful.
Topics: Accommodation, Ocular; Adolescent; Adult; Female; Glaucoma; Humans; Male; Mydriatics; Pilocarpine; Pupil; Pyridines; Tropicamide; Visual Acuity
PubMed: 3566601
DOI: 10.1001/archopht.1987.01060040056032 -
Lancet (London, England) Nov 2003
Topics: Fundus Oculi; Humans; Mydriatics; Ophthalmoscopy; Retinal Detachment
PubMed: 14615132
DOI: 10.1016/S0140-6736(03)14764-2 -
Indian Journal of Ophthalmology Mar 2014Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with... (Comparative Study)
Comparative Study
CONTEXT
Intracameral mydriatic solution can eliminate the disadvantages of repeated eye drop instillation regimen and provide adequate mydriasis for phacoemulsification with added advantages.
AIMS
Evaluating the role of intracameral irrigating solution (0.5% lignocaine + 0.001% epinephrine) in initiating and maintaining the pupillary mydriasis during phacoemulsification. Secondary aims were to observe the effect of surgical time, nucleus density and ultrasound time on mydriasis during the procedure.
SETTINGS AND DESIGN
The study is a prospective interventional case series, conducted at tertiary care institution.
MATERIALS AND METHODS
Thirty patients underwent phacoemulsification under topical anesthesia for visually significant cataract. Pupillary dilatation was achieved by intracameral irrigation of mydriatic solution alone. Pupillary diameter was measured serially during surgery and ultrasound time and total surgical time were noted.
STATISTICAL ANALYSIS USED
Paired samples student-t test was done to compare means. Spearman correlation coefficient was used to study the effect of various parameters on mydriasis.
RESULTS
Thirty eyes completed the study. The pupil size increased from 2.1 mm (Range 2-3.5 mm SD ± 0.32) to 6.9 mm (Range 5-9 mm SD ± 1.02) in 30 seconds time after intracameral mydriatic solution delivery, and was 7.0 mm (Range 3.5 - 9 mm SD ± 0.20) at the end of surgery. Duration of surgery, grade of nucleus and ultrasound time had statistically insignificant effect on mydriasis.
CONCLUSIONS
Intracameral solution containing 0.5% lignocaine and 0.001% epinephrine provides rapid mydriasis which is adequate for safe phacoemulsification and is unaffected by other parameters.
Topics: Adult; Aged; Anterior Chamber; Cataract; Female; Follow-Up Studies; Humans; Injections; Lens, Crystalline; Male; Middle Aged; Mydriasis; Mydriatics; Ophthalmic Solutions; Phacoemulsification; Preoperative Care; Prospective Studies; Pupil; Ultrasonography
PubMed: 23571260
DOI: 10.4103/0301-4738.109521 -
Journal of Pediatric Ophthalmology and... 1978During routine dilation of 48 newborns, systemic responses and pupil dilation were monitored. Both 10 percent aqueous and viscous phenylephrine caused blanching around... (Clinical Trial)
Clinical Trial Comparative Study
During routine dilation of 48 newborns, systemic responses and pupil dilation were monitored. Both 10 percent aqueous and viscous phenylephrine caused blanching around the eyes and produced considerable rise in blood pressure. Dilatation average 4.7 mm. In a double blind study, a 2.5 percent solution caused no skin blanching and no change in pressure or heart rate. Average dilation was 4.5 mm. No blood pressure changes were observed with either one percent cyclopentolate or one percent tropicamide. Average dilatations were 5.0 mm and 5.3 mm respectively. The above agents, used individually for a total dosage of three drops in each eye did not provide adequate dilation for a thorough funduscopic examination. Our protocol at United Hospitals Medical Center is a safe combination of drugs and provides excellent dilatation averaging greater th an 7 mm. No skin blanching or change in heart rate was observed.
Topics: Birth Weight; Blood Pressure; Clinical Trials as Topic; Cyclopentolate; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Gestational Age; Hemodynamics; Humans; Infant, Newborn; Mydriatics; Phenylephrine; Pupil; Skin; Tropicamide
PubMed: 368306
DOI: 10.3928/0191-3913-19780301-14 -
Retina (Philadelphia, Pa.) Sep 2009To compare short-acting mydriatics versus long-acting mydriatics and to assess their effect on postoperative frequency and severity of posterior synechia after combined...
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.
Topics: Aged; Atropine; Female; Humans; Iris; Lens Implantation, Intraocular; Lens, Crystalline; Male; Middle Aged; Mydriatics; Phacoemulsification; Phenylephrine; Postoperative Complications; Retinal Detachment; Retrospective Studies; Tissue Adhesions; Treatment Outcome; Tropicamide; Vitrectomy
PubMed: 19491725
DOI: 10.1097/IAE.0b013e3181a3b85c