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PloS One 2021To evaluate systemic adverse events after screening for retinopathy of prematurity (ROP) performed with mydriatic.
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.
Topics: Body Weight; Drug-Related Side Effects and Adverse Reactions; Female; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Male; Mass Screening; Medical Records; Mydriatics; Ophthalmic Solutions; Phenylephrine; Retinopathy of Prematurity; Tropicamide
PubMed: 34499693
DOI: 10.1371/journal.pone.0256878 -
Journal of Optometry 2019We tested the hypothesis that changes in accommodation after instillation of Phenylephrine Hydrochloride (PHCl) observed in some studies could be caused by changes in...
PURPOSE
We tested the hypothesis that changes in accommodation after instillation of Phenylephrine Hydrochloride (PHCl) observed in some studies could be caused by changes in optics.
METHODS
We performed two experiments to test the effects of PHCl on static and on dynamic accommodation in 8 and 6 subjects, respectively. Objective wavefront measurements were recorded of the static accommodation response to a stimulus at different distances or dynamic accommodation response to a sinusoidally moving stimulus (between 1 and 3 D of accommodative demand at 0.2Hz). The responses were characterized using two methods: one that takes into account the mydriatic optical effects on the accommodation produced by higher-order aberrations of the eye and another that takes into account only power changes paraxially due to the action of the ciliary muscle and regardless of the pupil size.
RESULTS
When mydriatic optical effects were taken into account, differences in responses before and after PHCl instillation were 0.51±0.53 D, and 0.12±0.15, for static and dynamic accommodation, respectively, and were statistically significant (p<0.039). When mydriatic optical effects were not taken into account, the differences in responses before and after PHCl instillation were -0.20±0.51 D, and -0.05±0.14, for static and dynamic accommodation, respectively, and were not statistically significant (p>0.313).
CONCLUSIONS
The mydriatic effect of the PHCl causes optical changes in the eye that can reduce the objective and subjective measurement of accommodation.
Topics: Accommodation, Ocular; Adult; Ciliary Body; Female; Humans; Male; Mydriatics; Phenylephrine
PubMed: 29602687
DOI: 10.1016/j.optom.2018.01.005 -
American Journal of Health-system... May 2018Results of an evaluation of the physical and chemical stability of extemporaneously prepared adult and pediatric ophthalmic solutions containing combinations of...
PURPOSE
Results of an evaluation of the physical and chemical stability of extemporaneously prepared adult and pediatric ophthalmic solutions containing combinations of phenylephrine, tropicamide, and cyclopentolate are reported.
METHODS
A stability study was conducted to help determine the feasibility of innovative formulations to meet an unmet clinical need for combination mydriatic ophthalmic eyedrops. An adult mydriatic ophthalmic solution containing phenylephrine hydrochloride 2.5% and tropicamide 1.0% and a pediatric formulation containing phenylephrine hydrochloride 2.5%, tropicamide 0.5%, and cyclopentolate hydrochloride 0.5% were prepared using proper aseptic techniques. Triplicate samples of each formulation were stored for 60 days at refrigeration temperatures (2-8 °C) and analyzed on day 0 and days 7, 14, 28, and 60. At each time point, the stability samples were assessed by visual inspection, pH measurement, and stability-indicating high-performance liquid chromatography (HPLC) analysis.
RESULTS
Over the 60-day storage period, there was no significant change in the visual appearance or pH level of any of the adult or pediatric solution samples. The results of HPLC analysis indicated that all samples retained 97-102% of the initial drug concentrations for up to 60 days.
CONCLUSION
Both adult and pediatric ophthalmic formulations containing combinations of phenylephrine, tropicamide, and cyclopentolate were stable physically and chemically for up to 60 days when stored at refrigeration temperatures (2-8 °C).
Topics: Adult; Chemistry, Pharmaceutical; Child; Chromatography, High Pressure Liquid; Cyclopentolate; Drug Combinations; Drug Compounding; Drug Stability; Drug Storage; Humans; Hydrogen-Ion Concentration; Mydriatics; Ophthalmic Solutions; Phenylephrine; Refrigeration; Time Factors; Tropicamide
PubMed: 29691266
DOI: 10.2146/ajhp161068 -
Journal of Cataract and Refractive... Feb 2006
Topics: Cornea; Humans; Keratomileusis, Laser In Situ; Mydriatics; Myopia; Pupil; Tropicamide
PubMed: 16564977
DOI: 10.1016/j.jcrs.2005.12.048 -
Journal of the Chinese Medical... Apr 2021This study aimed to investigate the short-term effect of cycloplegia on higher-order aberrations (HOAs) in school-age myopic children who received 0.25% atropine for...
BACKGROUND
This study aimed to investigate the short-term effect of cycloplegia on higher-order aberrations (HOAs) in school-age myopic children who received 0.25% atropine for cycloplegic refraction.
METHODS
We performed a retrospective chart review of 24 myopic children between the ages of 5 and 15 years, who had received one topical drop of 0.25% atropine for three consecutive nights before undergoing cycloplegic refraction. Auto-refraction, visual acuity, and HOAs measured with the iTrace aberrometer were compared before and after atropine use. To account for the effect of cycloplegia, the amount of HOAs under matching scanning sizes was compared.
RESULTS
There were statistically significant differences in the spherical equivalent, with a hyperopic shift after atropine use (p < 0.001). Corrected visual acuity and spherical aberrations showed no significant change under the respective pupil and scanning sizes before and after atropine use. Under identical scanning sizes, there was a significant change in total spherical aberration (from 0.03 to 0.06 μm, p = 0.044) and internal spherical aberration (from -0.10 to -0.05 μm, p = 0.049) after atropine use. Differences in corneal spherical aberration were insignificant.
CONCLUSION
The positive shift of spherical aberration induced by the inhibition of accommodation in myopic children may have a possible effect against myopic progression. Future studies can focus on the long-term effect on HOAs and impact on visual quality with lower concentrations of atropine.
Topics: Adolescent; Atropine; Child; Child, Preschool; Female; Humans; Male; Medical Audit; Mydriatics; Myopia; Outcome Assessment, Health Care; Retrospective Studies
PubMed: 33496515
DOI: 10.1097/JCMA.0000000000000495 -
Eye (London, England) May 2024Two quantitative models for myopia have been proposed and used for myopic intervention, one derived from feedback theory, and the other from physiological and mechanical...
BACKGROUND
Two quantitative models for myopia have been proposed and used for myopic intervention, one derived from feedback theory, and the other from physiological and mechanical considerations. This paper shows that they both predict the same results indicating that they are valid and reliable. These models are the only ones that can make predictions about the effect of atropine and lenses on myopia, explain multiple observations heretofore unexplained and offer possible interventions.
OBJECTIVE
Using their predictive power we test the models by calculating and comparing the effect of accommodation, lenses or atropine. The models offer a rationale that makes atropine equivalent to a positive lens for purposes of refractive development.
METHODS
This report includes thought experiments, actual experiments and trials, as well as an analysis of clinical data and integrates and tests results from all of them for far-reaching conclusions.
RESULTS
Both models accurately predict the same myopia progression caused by near work. These models are simple but powerful enough to suggest what treatments are indicated. Interventions for prevention and control of myopia are evaluated analytically, in particular atropine and optical treatments, such as positive lenses and under correction.
CONCLUSION
Optical treatments have enormous potential; atropine is of questionable value since there are ways to get the same or superior effect with lenses of power calculated as described here.
Topics: Atropine; Humans; Accommodation, Ocular; Myopia; Mydriatics; Eyeglasses; Models, Biological; Refraction, Ocular; Disease Progression
PubMed: 38087120
DOI: 10.1038/s41433-023-02884-3 -
The Pan African Medical Journal 2018After birth, remnants of pupillary membrane which constitute the vascular supply to the crystalline lens can persist. These are contiguous to the iris collarette causing...
After birth, remnants of pupillary membrane which constitute the vascular supply to the crystalline lens can persist. These are contiguous to the iris collarette causing possible deprivation amblyopia by obstructing the pupillary area. We here report the case of a 4-year-old child, born to consanguineous parents, presenting with bilateral persistent pupillary membrane associated with high myopia. Clinical examination showed bilateral remnants of pupillary membrane, intact iris sphincter and diffuse chorioretinal atrophy in the fundus of eye . Visual acuity was difficult to assess. On the other hand, refraction test showed high myopia RE -10.75 (-3.25, 29°) LE -10 (-0.75, 180°). Treatment of bilateral persistent pupillary membrane is based on mydriatic agents, surgical excision or laser destruction. We opted for the use of mydriatic agents with total optical correction and amblyopia treatment.
Topics: Amblyopia; Child, Preschool; Eye Abnormalities; Humans; Mydriatics; Myopia
PubMed: 30100976
DOI: 10.11604/pamj.2018.29.222.14297 -
Journal of Pediatric Ophthalmology and... 1983Two infants, aged three days and six weeks, respectively, presented with dense extensive persistent pupillary membranes as sporadic isolated findings. A clear central...
Two infants, aged three days and six weeks, respectively, presented with dense extensive persistent pupillary membranes as sporadic isolated findings. A clear central pupillary aperture was unable to be achieved with mydriatic agents. The patients were treated by surgical removal of the membranes at age five days and six months respectively. Surgery was without complication and visual development has been normal. We suggest that early intervention in the first weeks or months of life is necessary to prevent the development of amblyopia. If mydriasis is unsuccessful, surgery is recommended followed by optical correction and occlusion therapy as necessary.
Topics: Anterior Chamber; Humans; Hyaluronic Acid; Infant; Infant, Newborn; Iris; Male; Membranes; Mydriatics; Pupil; Surgical Instruments
PubMed: 6886954
DOI: 10.3928/0191-3913-19830701-06 -
Optometry and Vision Science : Official... Dec 1997The use of a topical anesthetic before the instillation of a mydriatic is recommended in order to enhance both the rate and magnitude of pupillary dilation. However,... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
PURPOSE
The use of a topical anesthetic before the instillation of a mydriatic is recommended in order to enhance both the rate and magnitude of pupillary dilation. However, there is a paucity of data supporting the prior use of topical anesthetics with tropicamide, the most commonly used mydriatic agent in optometric practice. Therefore, we conducted a study to determine the clinical effect of proparacaine on tropicamide-induced pupillary dilation.
METHODS
We investigated the effects of prior instillation of 0.5% proparacaine (Ophthetic) on pupillary dilation with 0.5% tropicamide (Mydriacyl) using a double-blind, placebo-controlled protocol on two groups of young adult subjects. Thirty subjects, aged between 18 and 30 years, were divided into 2 groups of 15, based on whether they had light- or dark-colored irides. The pupils of both eyes of each subject were dilated with tropicamide, but only one eye, chosen at random, received proparacaine (experimental condition), whereas the other was administered a saline placebo (control condition). Pupil diameter was measured using a ruler and magnifying loupe.
RESULTS
Subjects with light-colored irides had a greater average pupil dilation than subjects with dark-colored irides. There was a small, statistically significant difference in pupil diameter between the control and experimental conditions, but only for subjects with light-colored irides. The rate of pupillary dilation to peak pupil diameter and the rate of decrease in pupil diameter after peak pupil diameter was reached did not differ between experimental conditions or subject groups.
CONCLUSIONS
Although prior instillation of topical proparacaine produced a statistically significant difference in pupil diameter for subjects with light-colored irides, the result was not clinically significant. Therefore, we do not recommend the use of a topical anesthetic before tropicamide-induced mydriasis for young adult patients.
Topics: Administration, Topical; Adolescent; Adult; Anesthetics, Local; Double-Blind Method; Eye Color; Humans; Mydriatics; Ophthalmic Solutions; Pilot Projects; Propoxycaine; Pupil; Reference Values; Tropicamide
PubMed: 9423996
DOI: 10.1097/00006324-199712000-00026 -
Journal of Cataract and Refractive... May 2003A 56-year-old woman was evaluated for the surgical correction of hyperopia (+3.0 diopters). Two drops of cyclopentolate 1% were instilled in both eyes for measurement of... (Review)
Review
A 56-year-old woman was evaluated for the surgical correction of hyperopia (+3.0 diopters). Two drops of cyclopentolate 1% were instilled in both eyes for measurement of the cycloplegic refraction and wavefront analysis. Immediately after the second instillation, the patient reported drowsiness, dizziness, nausea, and fatigue. Ten minutes later, stimulatory central nervous system symptoms in the form of restlessness, cheerfulness, and a 20-minute-long roar of laughter were observed, interrupted by a new sedative phase. Basic medical and neurologic examinations were unremarkable except for gait ataxia. Four hours later, the examination was continued uneventfully. As surgical treatment of refractive errors and measurement of cycloplegic refraction using cyclopentolate become more frequent, ophthalmologists should be aware of this unusual acute event.
Topics: Acute Disease; Cyclopentolate; Female; Humans; Hyperopia; Keratomileusis, Laser In Situ; Middle Aged; Mydriatics; Ophthalmic Solutions; Preoperative Care; Psychoses, Substance-Induced; Pupil
PubMed: 12781295
DOI: 10.1016/s0886-3350(02)01651-6