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Wasserman BN, Massenzio E, Lee K, Plager DA. Systolic hypertension as side effect of topical low dose atropine drops. Am J Ophthalmol Case Rep 2024; 33:102004. [PMID: 38374946 PMCID: PMC10875192 DOI: 10.1016/j.ajoc.2024.102004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/26/2023] [Accepted: 01/19/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose To present a case of increased systemic hypertension and pupil dilation related to low dose atropine eyedrops. Observations A thirteen-year-old male with progressive myopia received atropine 0.05% ophthalmic drops to slow down myopia progression. He exhibited systemic systolic hypertension, photophobia, and bilateral nonreactive mydriasis. The atropine drops were discontinued, and his blood pressure and pupillary function normalized. Conclusions and importance This case demonstrates sensitivity to low dose atropine with increased systemic blood pressure and pupillary dilation.
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Affiliation(s)
- Barry N. Wasserman
- Wills Eye Hospital, Pediatric Ophthalmology and Strabismus Service, Thomas Jefferson University, Philadelphia, PA, USA
| | - Erik Massenzio
- Wills Eye Hospital, Pediatric Ophthalmology and Strabismus Service, Thomas Jefferson University, Philadelphia, PA, USA
| | - Karen Lee
- Wills Eye Hospital, Pediatric Ophthalmology and Strabismus Service, Thomas Jefferson University, Philadelphia, PA, USA
| | - David A. Plager
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
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Sánchez-Tena MÁ, Ballesteros-Sánchez A, Martinez-Perez C, Alvarez-Peregrina C, De-Hita-Cantalejo C, Sánchez-González MC, Sánchez-González JM. Assessing the rebound phenomenon in different myopia control treatments: A systematic review. Ophthalmic Physiol Opt 2024; 44:270-279. [PMID: 38193312 DOI: 10.1111/opo.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To review the rebound effect after cessation of different myopia control treatments. METHODS A systematic review that included full-length randomised controlled studies (RCTs), as well as post-hoc analyses of RCTs reporting new findings on myopia control treatments rebound effect in two databases, PubMed and Web of Science, was performed according to the PRISMA statement. The search period was between 15 June 2023 and 30 June 2023. The Cochrane risk of bias tool was used to analyse the quality of the selected studies. RESULTS A total of 11 studies were included in this systematic review. Unifying the rebound effects of all myopia control treatments, the mean rebound effect for axial length (AL) and spherical equivalent refraction (SER) were 0.10 ± 0.07 mm [-0.02 to 0.22] and -0.27 ± 0.2 D [-0.71 to -0.03] after 10.2 ± 7.4 months of washout, respectively. In addition, spectacles with highly aspherical lenslets or defocus incorporated multiple segments technology, soft multifocal contact lenses and orthokeratology showed lower rebound effects compared with atropine and low-level light therapy, with a mean rebound effect for AL and SER of 0.04 ± 0.04 mm [0 to 0.08] and -0.13 ± 0.07 D [-0.05 to -0.2], respectively. CONCLUSIONS It appears that the different treatments for myopia control produce a rebound effect after their cessation. Specifically, optical treatments seem to produce less rebound effect than pharmacological or light therapies. However, more studies are required to confirm these results.
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Affiliation(s)
- Miguel Ángel Sánchez-Tena
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
- ISEC LISBOA (Instituto Superior de Educação e Ciências), Lisbon, Portugal
| | - Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Seville, Spain
- Department of Ophthalmology, Clínica Novovisión, Murcia, Spain
| | | | - Cristina Alvarez-Peregrina
- Optometry and Vision Department, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
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Feng J, Zhang Y. The potential benefits of polyphenols for corneal diseases. Biomed Pharmacother 2023; 169:115862. [PMID: 37979379 DOI: 10.1016/j.biopha.2023.115862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/30/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023] Open
Abstract
The cornea functions as the primary barrier of the ocular surface, regulating temperature and humidity while providing protection against oxidative stress, harmful stimuli and pathogenic microorganisms. Corneal diseases can affect the biomechanical and optical properties of the eye, resulting in visual impairment or even blindness. Due to their diverse origins and potent biological activities, plant secondary metabolites known as polyphenols offer potential advantages for treating corneal diseases owing to their anti-inflammatory, antioxidant, and antibacterial properties. Various polyphenols and their derivatives have demonstrated diverse mechanisms of action in vitro and in vivo, exhibiting efficacy against a range of corneal diseases including repair of tissue damage, treatment of keratitis, inhibition of neovascularization, alleviation of dry eye syndrome, among others. Therefore, this article presents a concise overview of corneal and related diseases, along with an update on the research progress of natural polyphenols in safeguarding corneal health. A more comprehensive understanding of natural polyphenols provides a novel perspective for secure treatment of corneal diseases.
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Affiliation(s)
- Jing Feng
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Yangyang Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China.
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Singh RP, Amitava AK, Sharma N, Gupta Y, Raza SA, Bose A, Meena GS. Comparison of cycloplegia with atropine 1% versus cyclopentolate 1. Indian J Ophthalmol 2023; 71:3633-3636. [PMID: 37991295 PMCID: PMC10788739 DOI: 10.4103/ijo.ijo_1159_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE Cycloplegic refraction is mandatory for children to know the eye's refractive status. In this study, we compared cycloplegia induced by cyclopentolate 1% to that induced by atropine 1% by means of retinoscopy. METHODS In this parallel-designed interventional study, we included 67 children aged between 4 and 17 years. After the initial retinoscopy under cyclopentolate 1% (used twice in each eye), we repeated it a week later under atropine ointment 1% (used twice a day for 3 days); both were done by the same trained optometrist masked to the drug. Each eye's refraction was converted to spherical equivalents (SEs), and the values averaged between the two eyes of each child under each drug. We compared SE with paired t-test (JASP 16.4). In addition, we performed correlational analysis, and looked for agreement using the Bland-Altman plot. Significance was set at P < 0.05. Wherever possible, 95% confidence intervals (CIs) are quoted. RESULTS The mean SE with atropine was +1.93 ± 2.0 D, compared to +1.75 ± 1.95 D under cyclopentolate. On average, atropine induced greater cycloplegia by a mere 0.18 D (95% CI: 0.07 to 0.29 D, P value 0.002). The two cycloplegic refractions correlated significantly (Pearson's r: 0.975, P < 0.001). The Bland-Altman plot revealed the limits of agreement as 1.06 and -0.71 D. CONCLUSION Our study suggests that cyclopentolate works for the most part as well as atropine to attain cycloplegia. Atropine may be considered for children less than 15 years of age with greater than 5.0 D of hyperopia. Cycloplentolate, with its advantages of quick action and short duration, should form the first go-to topical cycloplegic in busy outpatient clinics.
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Affiliation(s)
- Ram P Singh
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Abadan K Amitava
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Nikita Sharma
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Yogesh Gupta
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Syed A Raza
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Aparna Bose
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Ganga S Meena
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Suwal R, Singh B, Adhikari S, Khadka D, Suwal B, Khatri B, Shrestha GS. Kaleidos-based binocular vision analyzer for the estimation of refractive errors and horizontal ocular deviation in children. Clin Exp Optom 2023:1-8. [PMID: 37982312 DOI: 10.1080/08164622.2023.2281481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023] Open
Abstract
CLINICAL RELEVANCE Knowing the agreement and interobserver variability of the 2WIN-S photorefractometer with cycloplegic retinoscopy and prism cover test is important for judging the clinical usefulness of the device. BACKGROUND This study aims to determine an agreement and interobserver reliability between 2WIN-S photorefractometer and cycloplegic retinoscopy for estimating refractive errors and between 2WIN-S and prism cover test for measuring horizontal ocular deviation in children. METHODS Two groups of 129 and 64 participants (range, 5 to 16 years) were recruited for the agreement and interobserver reliability studies, respectively. Non-cycloplegic 2WIN-S refraction was compared with cycloplegic retinoscopy for low and moderate myopia and hyperopia. Similarly, corneal reflex-function (CR-function) of 2WIN-S was compared with prism cover test for horizontal ocular deviation. Bland-Altman plots were used to depict agreement, and the intraclass correlation coefficient (ICC) was used for determining interobserver reliability of repeated measures. RESULTS The mean differences in spherical equivalent, J0 (Cartesian astigmatism) and J45 (oblique Jackson cross-cylinder) between cycloplegic retinoscopy and 2WIN-S were 1.10 (95% CI = 0.97 to 1.21, p < 0.001), -0.06 (95% CI = -0.09 to -0.03, p < 0.001) and 0.009 (95% CI = -0.01 to 0.03, p = 0.35), respectively. The overall median difference in the horizontal ocular deviation between prism cover test and 2WIN-S was -4.5 (Interquartile range = -12.0 to 4.0). For constant strabismus, this difference was insignificant (median= -2.0, interquartile range = -11.0 to 6.7, p = 0.19) between prism cover test and 2WIN-S. The ICC was high for the spherical equivalent (0.997; p < 0.001), J0 (0.932; p < 0.001) and J45 (0.901; p < 0.001), whereas it was low-to-moderate for horizontal ocular deviation (0.50; p < 0.001). CONCLUSION 2WIN-S refraction was in agreement with cycloplegic retinoscopy for low and moderate myopia and hyperopia, and requires an adjustment for the consistent differences between cycloplegic retinoscopy and 2WIN-S refraction. The measurement of constant strabismus with 2WIN-S is comparable to that of prism cover test.
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Affiliation(s)
- Rinkal Suwal
- Department of Optometry, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Basanta Singh
- Department of Optometry, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Sikshya Adhikari
- Department of Optometry, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Deepak Khadka
- Department of Ophthalmology, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Barsha Suwal
- Department of Ophthalmology, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Bijay Khatri
- Academic and Research Department, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
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Chia A, Ngo C, Choudry N, Yamakawa Y, Tan D. Atropine Ophthalmic Solution to Reduce Myopia Progression in Pediatric Subjects: The Randomized, Double-Blind Multicenter Phase II APPLE Study. Asia Pac J Ophthalmol (Phila) 2023; 12:370-376. [PMID: 37523428 DOI: 10.1097/apo.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/24/2023] [Indexed: 05/20/2023] Open
Abstract
PURPOSE The purpose of this study was to assess the dose-response effects of low-dose atropine on myopia progression and safety in pediatric subjects with mild-to-moderate myopia. METHODS This phase II, randomized, double-masked, placebo-controlled study compared the efficacy and safety of atropine 0.0025%, 0.005%, and 0.01% with placebo in 99 children, aged 6-11 years, with mild-to-moderate myopia. Subjects received 1 drop in each eye at bedtime. The primary efficacy endpoint was change in spherical equivalent (SE), while secondary endpoints included changes in axial length (AL) and near logMAR (logarithm of the minimum angle of resolution) visual acuity and adverse effects. RESULTS The mean±SD changes in SE from baseline to 12 months in the placebo and atropine 0.0025%, 0.005%, and 0.01% groups were -0.55±0.471, -0.55±0.337, -0.33±0.473, and -0.39±0.519 D, respectively. The least squares mean differences (atropine-placebo) in the atropine 0.0025%, 0.005%, and 0.01% groups were 0.11 D ( P =0.246), 0.23 D ( P =0.009), and 0.25 D ( P =0.006), respectively. Compared with placebo, the mean change in AL was significantly greater for atropine 0.005% (-0.09 mm, P =0.012) and 0.01% (-0.10 mm, P =0.003). There were no significant changes in near visual acuity in any of the treatment groups. The most common ocular adverse events were pruritus and blurred vision, each occurring in 4 (5.5%) atropine-treated children. Changes in mean pupil size and amplitude of accommodation were minimal. CONCLUSIONS Atropine doses of 0.005% and 0.01% effectively reduced myopia progression in children but no effect was noted with 0.0025%. All doses of atropine were safe and well tolerated.
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Affiliation(s)
- Audrey Chia
- Singapore National Eye Centre, Singapore, Singapore
| | - Cheryl Ngo
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | | | | | - Donald Tan
- Singapore National Eye Centre, Singapore, Singapore
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
- Eye and Retina Surgeons, Camden Medical Center, Singapore, Singapore
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Choudhury A, Singh PA, Bajwa N, Dash S, Bisht P. Pharmacovigilance of herbal medicines: Concerns and future prospects. JOURNAL OF ETHNOPHARMACOLOGY 2023; 309:116383. [PMID: 36918049 DOI: 10.1016/j.jep.2023.116383] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The use of herbal medicines for prophylaxis, prevention, and treatment of various ailments is rising throughout the world because they are thought to be safer than allopathic treatments, which they are. However, several investigations have documented the toxicity and adverse drug reactions (ADR) of certain formulations and botanicals if not consumed wisely. AIM OF THE STUDY The goal of the current study is to address herbal medication pharmacovigilance (PV) modeling and related considerations for improved patient safety. Also, focus is laid on the comprehensive and critical analysis of the current state of PV for herbal medications at the national and international levels. MATERIALS AND METHODS Targeted review also known as focused literature review methodology was utilized for exploring the data from various scientific platforms such as Science Direct, Wiley Online Library, Springer, PubMed, Google Scholar using "pharmacovigilance, herbal medicine, traditional medicine, ADR, under reporting, herb toxicity, herb interactions" as keywords along with standard literature pertaining to herbal medicines that is published by the WHO and other international and national organizations etc. The botanical names mentioned in the present article were authenticated using World Flora Online database. RESULTS The historical developments paving the way for PV in regulatory setup were also discussed, along with various criteria's for monitoring herbal medicine, ADR of herbs, phytoconstituents, and traditional medicines, herb-drug interactions, modes of reporting ADR, databases for reporting ADR's, provisions of PV in regulatory framework of different nations, challenges and way forward in PV are discussed in detail advocating a robust drug safety ecosystem for herbal medicines. CONCLUSION Despite recent efforts to encourage the reporting of suspected ADRs linked to herbal medicines, such as expanding the programme and adding community pharmacists and other healthcare professionals as recognized reporters, the number of herbal ADR reports received by the regulatory bodies remains comparatively low. Since users often do not seek professional advice or report if they have side effects, under-reporting, is anticipated to be significant for herbal medications. There are inadequate quality control methods, poor regulatory oversight considering herbs used in food and botanicals, and unregulated distribution channels. In addition, botanical identity, traceability of herbs, ecological concerns, over-the-counter (OTC) herbal medicines, patient-physicians barriers requires special focus by the regulatory bodies for improved global safety of herbal medicines.
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Affiliation(s)
- Abinash Choudhury
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India.
| | - Neha Bajwa
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Subhransu Dash
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
| | - Preeti Bisht
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali, 140413, Punjab, India
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Lin T, Hu J, Lin J, Chen J, Wen Q. Epidemiological investigation of the status of myopia in children and adolescents in Fujian Province in 2020. Jpn J Ophthalmol 2023; 67:335-345. [PMID: 37093364 PMCID: PMC10123474 DOI: 10.1007/s10384-023-00991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/24/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The 2020 epidemiological investigation of myopia in children and adolescents in Fujian Province' aimed to provide reference guidelines for the prevention and control of myopia. The purpose of the present study was to address shortfalls in the epidemiological survey of myopia in Fujian and provide a basis for government decision making. STUDY DESIGN A cross-sectional and epidemiological investigation METHODS: Based on their levels of economic development and other economic factors, three cities in Fujian Province (Fuzhou, Xiamen, Longyan) were chosen through cluster random sampling and epidemiological investigation. Final analysis included 41,906 cases. Examinations including visual acuity and mydriatic optometry were performed on all subjects. RESULTS The overall proportion of myopia was 63.35% in boys and 70.55% in girls living in Fujian in 2020. The proportions of myopia in Xiamen and Longyan were similar; both cities showed a higher proportion of myopic cases than Fuzhou. The proportion of girls with myopia was higher than boys. The proportion of primary and middle school students with myopia was higher in economically developed regions compared with underdeveloped regions. The proportion of urban students with myopia was higher than in suburban students. Analysis showed that the prevalence of myopia increased with age. Interestingly, the prevalence of myopia was higher in children born in June and August than in children born in other months. CONCLUSION Children and adolescents in Fujian have a high rate of myopia which increases as the school grade increases. The better the economic conditions are, the higher the myopic rate. In addition, the myopic rate is higher in girls in and students born in June and August. The government, schools, hospitals, and parents should be alerted to this issue and coordinate to control the risk of myopia exacerbation and improve eyesight conditions of students in Fujian Province.
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Affiliation(s)
- Tainan Lin
- Department of Ophthalmology, Fujian Medical University Union Hospital Fuzhou, Fuzhou, People's Republic of China
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fuzhou, People's Republic of China
| | - Jianzhang Hu
- Department of Ophthalmology, Fujian Medical University Union Hospital Fuzhou, Fuzhou, People's Republic of China.
| | - Jinhua Lin
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fuzhou, People's Republic of China
| | - Jinhua Chen
- Department of Ophthalmology, Fujian Medical University Union Hospital Fuzhou, Fuzhou, People's Republic of China
| | - Qian Wen
- Department of Ophthalmology, Fujian Provincial Governmental Hospital, Fuzhou, People's Republic of China
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Duran M, Cevher S. Effect of cycloplegic agents (1% cyclopentolate hydrochloride and 1% tropicamide) on anterior segment parameters. Ther Adv Ophthalmol 2023; 15:25158414231180984. [PMID: 37434779 PMCID: PMC10331352 DOI: 10.1177/25158414231180984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/22/2023] [Indexed: 07/13/2023] Open
Abstract
Background Cycloplegic drops are commonly used in ophthalmology practice. Changes in anterior segment parameters may occur after cycloplegia. These changes can be evaluated with corneal topography. Objective This study aimed to compare the effects of 1% cyclopentolate hydrochloride and 1% tropicamide on anterior segment parameters using the Sirius Scheimpflug imaging technique. Design A cross-sectional study. Methods One hundred twenty eyes of sixty healthy volunteers with spherical equivalent (SE) values of 0 to ±1 diopter (D) were studied. The right eye of each subject had instillation of cyclopentolate hydrochloride 1% (Group 1) and the left eye of each subject had instillation of tropicamide 1% (Group 2). SE, intraocular pressure, and corneal topography measurements were performed before and 40 min after instillation were compared. Results In Group 1, SE, aqueous depth, anterior chamber depth, iridocorneal angle (ICA), anterior chamber volume (ACV), and pupil size (PS) values were significantly increased (p < 0.001, p = 0.01, p < 0.001, p = 0.03, p < 0.001, and p < 0.001, respectively). In Group 2, SE, ICA, ACV, and PS were significantly increased (p < 0.001 for all). Keratometric values (K1 and K2) and central corneal thickness changed insignificantly in both groups (p > 0.05). The effects of the two administered agents on all parameters were similar (p > 0.05). Conclusions Cyclopentolate hydrochloride and tropicamide affected SE, ICA, ACV, and PS values significantly. These parameters are important in intraocular lens (IOL) power calculations. PS is also important in refractive surgery and cataract surgery with multifocal IOL implantation. Although there was an insignificant difference between the agents, the effects of tropicamide on the parameters were smaller than those of cyclopentolate.
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Affiliation(s)
- Mustafa Duran
- Department of Ophthalmology, Specialist of Ophthalmology, Minister of Health Hitit University Erol Olçok Education and Research Hospital, Çorum, Turkey
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Zhou Y, Zhu Y, Huang XB, Xiong YJ, Guo YL, Cai Q, Wang M, Gong YX, Cao X, Li JJ, Cai JR, Song Y, Sun ZM. Changes of Choroidal Thickness in Children after Short-Term Application of 1% Atropine Gel. Ophthalmic Res 2022; 66:421-430. [PMID: 36412621 DOI: 10.1159/000526448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/19/2022] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The aim of the study was to assess changes in choroidal thickness (ChT) after administration of 1% atropine for 1 week in myopic, emmetropic, and hyperopic children. METHODS A total of 235 children aged 4-8 years, which included 46 myopia, 34 emmetropia, and 155 hyperopia patients, were recruited and divided into three groups according to the spherical equivalent with the use of 1% atropine twice a day for 1 week. The ChT was measured at baseline and 1 week. RESULTS In the myopia and emmetropia groups, following administration of 1% atropine gel, the ChT thickened significantly under the fovea (i.e., from 278.29 ± 53.01 μm to 308.24 ± 57.3 μm, p < 0.05; from 336.10 ± 78.60 μm to 353.46 ± 70.22 μm, p < 0.05, respectively), and at all intervals from the fovea, while in the hyperopia group, there was no significant difference in the ChT except the nasal side (p < 0.05). CONCLUSION Topical administration of 1% atropine gel for 1 week significantly increased the subfoveal and parafoveal ChT in children with myopia and emmetropia. Atropine did not increase the ChT in hyperopic children, except on the nasal side.
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Affiliation(s)
- Yue Zhou
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yan Zhu
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xiao Bo Huang
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yao Jia Xiong
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Ya Li Guo
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Qi Cai
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Min Wang
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Ye Xun Gong
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Xin Cao
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Jun Jie Li
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Jian Ru Cai
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Yu Song
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
| | - Zhi Min Sun
- Department of Ophthalmology, Second Affiliated Hospital of Nantong University, Nantong, China
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Manna P, Karmakar S, Bhardwaj GK, Mondal A. Accommodative spasm and its different treatment approaches: A systematic review. Eur J Ophthalmol 2022; 33:1273-1286. [PMID: 36384286 DOI: 10.1177/11206721221136438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This article is about the accommodation spasm. The primary rule for near vision is ciliary muscle constriction, synchronised convergence of both eyes, and pupil constriction. Any weaknesses in these components could result in an accommodative spasm. Variable retinoscopic reflex, unstable refractive error, and lead of accommodation in near retinoscopy are common causes of spasm. We conducted a thorough literature search in the PubMed and Google Scholar databases for published journals prior to June 2022, with no data limitations. This review contains twenty-eight case reports, six cohort studies, four book references, four review articles, and two comparative studies after applying the inclusion and exclusion criteria. The majority of studies looked at accommodative spasm, near reflex spasm, and pseudomyopia. The most common causes of accommodative spasm are excessive close work, emotional distress, head injury, and strabismus. Despite side effects or an insufficient regimen, cycloplegic drops are effective in diagnosing accommodation spasm. The modified optical fogging technique is also effective and may be an option for treating accommodative spasm symptoms. Bifocals for near work, manifest refraction, base-in prisms, and vision therapy are some of the other management options. As a result, it requires a comprehensive clinical treatment strategy. This review aims to investigate the various aetiology and treatments responsible for accommodative spasm and proposes widely implementing the modified optical fogging method and vision therapy in clinics as comprehensive management to reduce the future upward trend of accommodative spasm.
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Affiliation(s)
- Prithwis Manna
- Department of Optometry and Vision Science, Amity University, Gurgaon, Haryana, India
| | - Sourav Karmakar
- Department of Optometry and Vision Science, Amity University, Gurgaon, Haryana, India
| | - Gaurav Kumar Bhardwaj
- Department of Optometry and Vision Science, Amity University, Gurgaon, Haryana, India
| | - Animesh Mondal
- Department of Optometry and Vision Science, Amity University, Gurgaon, Haryana, India
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12
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Liu S, He X, Wang J, Du L, Xie H, Yang J, Liu K, Zou H, Xu X, Chen J. Association between axial length elongation and spherical equivalent progression in Chinese children and adolescents. Ophthalmic Physiol Opt 2022; 42:1133-1140. [PMID: 35766199 DOI: 10.1111/opo.13023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is generally believed that a 1-mm axial length (AL) elongation of the eye corresponds to a -3.00 D spherical equivalent (SE) progression, but this is disputed. PURPOSE To investigate the association between AL elongation and SE progression among children and adolescents. METHODS A prospective cohort study of 710 children and adolescents aged 6-16 years was included. Ophthalmic examinations, including cycloplegic SE, AL and corneal curvature, were performed at baseline and 1-year follow-up. The ratio of SE change (ΔSE) to AL change (ΔAL) (ΔSE/ΔAL) was calculated, and its association with age and refractive status was explored using a general linear model. RESULTS Among all participants, 396 (55.77%) were male, with 265 (37.32%) myopes at baseline. The average 1-year ΔSE and ΔAL were 0.61 ± 0.40 D and 0.33 ± 0.22 mm, respectively. Both ΔSE and ΔAL gradually decreased with age (p < 0.001). In the general linear model analyses, age and refractive status were independently associated with ΔSE/ΔAL after adjustment for covariates (age: β ̂ $$ \hat{\beta} $$ = 0.04, p < 0.05; myopia vs nonmyopia: β ̂ $$ \hat{\beta} $$ = 0.28, p < 0.05). Based on the developed formula ΔSE/ΔAL = 1.74 + 0.05*age (for myopes), mean ΔSE/ΔAL in myopes increased from 2.06 D/mm in the 6-year-olds to 2.59 D/mm in the 16-year-olds. In nonmyopes, ΔSE/ΔAL = 1.33 + 0.05*age, and the ratio increased from 1.65 D/mm in the 6-year-olds to 2.18 D/mm in the 16-year-olds. CONCLUSIONS The ratio of ΔSE/ΔAL varied with age and refractive status in children and adolescents. The age-specific ΔSE/ΔAL could be used to estimate SE progression through the actual AL change.
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Affiliation(s)
- Shang Liu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jingjing Wang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Linlin Du
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Hui Xie
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Jinliuxing Yang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
| | - Kun Liu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Haidong Zou
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Xun Xu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, National Clinical Research Center for Eye Diseases, Center of Eye Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
| | - Jun Chen
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai, China
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13
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Szpernal J, Bachman Groth JA, Wynne N, Williams V, Spellecy R, Thuruthumaly C, Carroll J. Pupillary Dilation in Research: More than Meets the Eye. Curr Eye Res 2022; 47:965-977. [PMID: 35499263 DOI: 10.1080/02713683.2022.2053723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: Pupil dilation is a commonly used procedure in vision research. While often considered a minimal risk procedure, there is the potential for significant adverse effects. Methods: Currently, there is variance in practices and protocols among researchers and institutions, perhaps due to a lack of guidelines for safe pupil dilation practices in research settings. In this perspective, we explore variables that can increase the potential for adverse effects and provide suggestions to limit their impact. Prior to dilation, an investigator can assess an individual's medical status and drug regimen when deciding upon a mydriatic agent to be used. Results: Assessing the angle through a variety of methods (i.e. penlight test, van Herick slit lamp, optical coherence tomography, gonioscopy) can also prevent inappropriate dilation of pupils with concerning anatomical features. During dilation, an investigator should look to limit the potential of infection and use caution in repeat dosing of dilation-resistant pupils. Conclusions: Post-dilation, an investigator should closely monitor eyes with elevated risk factors and improve an individual's health literacy on angle closure complications. When combined with proper informed consent processes regarding adverse effects, the aforementioned can allow for risk mitigation in studies using pupil dilation.
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Affiliation(s)
- Jacob Szpernal
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jane A Bachman Groth
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Niamh Wynne
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vesper Williams
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ryan Spellecy
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Catherine Thuruthumaly
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Joseph Carroll
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, USA.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI, USA
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14
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Mathan JJ, Simkin SK, Gokul A, McGhee CNJ. Down syndrome and the eye: ocular characteristics and ocular assessment. Surv Ophthalmol 2022; 67:1631-1646. [DOI: 10.1016/j.survophthal.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/20/2023]
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15
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Hussein KH, Elmeligy E, Khalphallah A, Al-Lethie ALA. Effect of Topical Cyclopentolate 1% on Ocular Ultrasonographic Features, Intraocular Pressure, Tear Production, and Pupil Size in Normal Donkeys (Equus Asinus). J Equine Vet Sci 2021; 104:103700. [PMID: 34416996 DOI: 10.1016/j.jevs.2021.103700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
This study was performed to investigate the effects of cyclopentolate on ultrasonographic parameters of eye structures, intraocular pressure (IOP), tear production, and pupil size in normal donkeys. Sixteen eyes of eight clinically healthy adult donkeys (2-2.5 years old) weighing 295 ± 34 kg (mean ± standard deviation) were used in this study. Cyclopentolate hydrochloride 1% was instilled in a randomly selected eye and the other eye received normal saline drops as a control. The effect of cyclopentolate was evaluated by ultrasonography. Additionally, changes in IOP and tear production were evaluated for 2 hours post-instillation by tonometry and Schirmer tear test (STT), respectively. Vertical and horizontal pupil diameters were recorded pre-instillation (0), and 15, 30-, 45-, 60-, and 120-minutes post-instillation. After cyclopentolate 1% instillation, iridocorneal angle and width of the entry of ciliary cleft were significantly increased as observed by ultrasonography. IOP was significantly increased starting from 30 minutes till 60 minutes post-instillation of cyclopentolate 1%. Non-significant alteration in the STT was observed in the cyclopentolate-treated eyes compared to the control eyes. Both vertical and horizontal pupil diameters began to significantly increase 30 minutes after cyclopentolate 1% instillation compared to the control saline group. In conclusion, cyclopentolate 1% could be used as a potent cycloplegic drug in donkeys without systemic or ocular side effects.
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Affiliation(s)
- Kamal Hany Hussein
- Department of Animal Surgery, Anaesthesia, and Radiology, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt..
| | - Enas Elmeligy
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Arafat Khalphallah
- Division of Internal Medicine, Department of Animal Medicine, Faculty of Veterinary Medicine, Assiut University, Assiut, Egypt
| | - Al-Lethie A Al-Lethie
- Department of Surgery, Anaesthesiology and Radiology, Faculty of Veterinary Medicine, Aswan University, Aswan, Egypt
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16
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Wong YL, Yuan Y, Su B, Tufail S, Ding Y, Ye Y, Paille D, Drobe B, Chen H, Bao J. Prediction of myopia onset with refractive error measured using non-cycloplegic subjective refraction: the WEPrOM Study. BMJ Open Ophthalmol 2021; 6:e000628. [PMID: 34179509 PMCID: PMC8191615 DOI: 10.1136/bmjophth-2020-000628] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/19/2021] [Indexed: 11/15/2022] Open
Abstract
Background/aims To evaluate the predictive performance of various predictors, including non-cycloplegic refractive error, for risk of myopia onset under pragmatic settings. Methods The Wenzhou Medical University Essilor Progression and Onset of Myopia Study is a prospective cohort study of schoolchildren aged 6–10 years from two elementary schools in Wenzhou, China. Non-cycloplegic refraction, ocular biometry and accommodation measurements were performed. Myopia was defined as spherical equivalent (SE) ≤−0.5 diopter (D). ORs using multivariable logistic regression were determined. Area under the curve (AUC) evaluation for predictors was performed. Results Schoolchildren who attended both baseline and 2-year follow-up were analysed (N=1022). Of 830 non-myopic children at baseline, the 2-year incidence of myopia was 27.6% (95% CI, 24.2% to 31.3%). Female gender (OR=2.2), more advanced study grades (OR=1.5), less hyperopic SE (OR=11.5 per D), longer axial length (AL; OR=2.3 per mm), worse presenting visual acuity (OR=2.3 per decimal), longer near work time (OR=1.1 per hour/day) and lower magnitude of positive relative accommodation (PRA; OR=1.4 per D) were associated with myopia onset. PRA (AUC=0.66), SE (AUC=0.64) and AL (AUC=0.62) had the highest AUC values. The combination of age, gender, parental myopia, SE, AL and PRA achieved an AUC of 0.74. Conclusion Approximately one in four schoolchildren had myopia onset over a 2-year period. The predictors of myopia onset include lower magnitude of PRA, less hyperopic SE, longer AL and female gender. Of these, non-cycloplegic SE and PRA were the top single predictors, which can facilitate risk profiling for myopia onset.
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Affiliation(s)
| | - Yimin Yuan
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Binbin Su
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Yang Ding
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingying Ye
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Björn Drobe
- R&D AMERA, Essilor International, Singapore.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hao Chen
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinhua Bao
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Wenzhou Medical University-Essilor International Research Centre (WEIRC), Wenzhou Medical University, Wenzhou, Zhejiang, China
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17
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García Del Valle I, Alvarez-Lorenzo C. Atropine in topical formulations for the management of anterior and posterior segment ocular diseases. Expert Opin Drug Deliv 2021; 18:1245-1260. [PMID: 33787441 DOI: 10.1080/17425247.2021.1909568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Atropine is an old-known drug which is gaining increasing attention due to the myriad of therapeutic effects it may trigger on eye structures. Nevertheless, novel applications may require more adequate topical formulations. AREAS COVERED This review aims to gather the existing knowledge about atropine and its clinical applications in the ophthalmological field when administered topically. Atropine ocular pharmacokinetics is paid a special attention, including recent evidences of the capability of the drug to access to the posterior segment. Ocular bioavailability and systemic bioavailability are counterbalanced. Finally, limitations of traditional dosage forms and potential advantages of under investigation delivery systems are analyzed. EXPERT OPINION Mydriasis and cyclopegia have been widely exploited for eye examination, management of anterior segment diseases, and more recently as antidotes of chemical weapons. Improved knowledge on drug receptors and related pathways explains atropine repositioning as an outstanding tool to prevent myopia. The ease with which atropine penetrates ocular tissues is a double edged sword, that is, while it ensures therapeutic levels in the posterior segment, the unspecific distribution causes a wide variety of untoward effects. The design of formulations that can selectively deliver atropine to the target tissue for each specific application is an urgent unmet need.
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Affiliation(s)
- Ines García Del Valle
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
| | - Carmen Alvarez-Lorenzo
- Departamento De Farmacología, Farmacia Y Tecnología Farmacéutica, I+D FarmaGroup, Facultad De Farmacia and Health Research Institute of Santiago De Compostela (IDIS), Universidade De Santiago De Compostela, Santiago De Compostela, Spain
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18
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Li L, Fu J, Chen W, Meng Z, Sun Y, Su H, Yao Y, Dai W. Difference of refractive status before and after cycloplegic refraction: the Lhasa Childhood Eye Study. Jpn J Ophthalmol 2021; 65:526-536. [PMID: 33656708 DOI: 10.1007/s10384-021-00828-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the differences between cycloplegic and noncycloplegic refraction as well as associated factors in grade one students of primary schools, and explore the effectiveness of noncycloplegic refraction for refractive error screening. STUDY DESIGN Cross-sectional study. METHODS A school-based study of 1856 students was conducted in Lhasa, Tibetan Plateau, China. Cycloplegia was achieved with two drops of 1% cyclopentolate and 1 drop of Mydrin P at a 5-min interval. Autorefraction was performed under both cycloplegic and noncycloplegic conditions. Bland-Altman analysis, receiver operating characteristic curve analysis, univariate and multiple linear regression models were used for analysis. RESULTS Of the 1856 children enrolled, 1830 (98.60%) completed all procedures. The average age was 6.83 ± 0.46 years. 965 (52.73%) children were boys and 1737 (94.92%) were Tibetan. Overall, there was a significant difference between cycloplegic and noncycloplegic SE of 0.90 ± 0.76D (P < 0.001). However, the intra-class coefficient correlation (ICC) for cylinder between these two methods was high (ICC = 0.941, 95% CI, 0.935-0.946). Larger differences between cycloplegic and noncycloplegic SE were associated with hyperopic RE and higher cylindrical value (P < 0.001). The prevalence of myopia, emmetropia and hyperopia with and without cycloplegia was (3.93% vs 14.59%), (9.95% vs 45.8%) and (86.21% vs 39.56%), respectively. Myopia, emmetropia and hyperopia based on noncycloplegic refraction was defined as SE ≤ - 0.625D, - 0.625 < SE ≤ 0D, and SE > 0D, respectively. CONCLUSIONS Lack of cycloplegia leads to underestimation of hyperopia, with overestimation of myopia and emmetropia. Larger hyperopic refraction exhibited greater difference between cycloplegic and noncycloplegic refraction.
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Affiliation(s)
- Lei Li
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jing Fu
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Weiwei Chen
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China.,Beijing Institute of Ophthalmology, Beijing, China
| | - Zhaojun Meng
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yunyun Sun
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Han Su
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yao Yao
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Wei Dai
- Strabismus and Pediatric Ophthalmology, Beijing Ophthalmology and Visual Sciences Key Laboratory Ophthalmology Department of Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No.1, Dong Jiao Min Xiang Street, Dongcheng District, Beijing, 100730, People's Republic of China
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19
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Wong K, Lim CW, Malvankar-Mehta MS, Hutnik C. Effectiveness of topical cycloplegics as anterior segment analgesics: systematic review and meta-analysis. Can J Ophthalmol 2021; 56:256-267. [PMID: 33548176 DOI: 10.1016/j.jcjo.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/07/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Topical cycloplegic agents often are used in ophthalmology in the context of management of ocular inflammation. Preliminary searches of the literature provided little evidence to support their use in relieving pain or reducing inflammation. The goal of this study was to evaluate the current literature for any evidence regarding the effectiveness of cycloplegics for treatment of pain or inflammation in patients with anterior segment injury or inflammation through a systematic review and meta-analysis. METHODS Using multiple keywords relating to cycloplegics and inflammatory and infectious eye conditions, a search was conducted on multiple scientific databases for relevant articles. A 2-level screening approach was used and articles that were relevant to the topic were included in the systematic review. Data from these articles, if applicable, were extracted for meta-analyses. Statistical assessments involved computation of I2statistics, Z-value, and χ2 statistics. RESULTS We screened 5753 articles for relevance. Seven were included in the systematic review and 5 were included in the meta-analysis. There was considerable heterogeneity between the included studies. Statistical analysis revealed significant reductions in pain using homatropine and cyclopentolate after 2 days. Nonsignificant changes in the anterior chamber cells and flare were seen using cyclopentolate and atropine at different follow-up times. CONCLUSIONS Little published evidence exists in the literature to guide the use of cycloplegics on relieving pain and treating inflammation. Therefore, higher-quality randomized controlled trials with longer follow-up times are needed to fully understand the role that cycloplegics play in reducing pain in inflammatory conditions.
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Affiliation(s)
- Kevin Wong
- Ivey Eye Institute, St. Joseph's Health Care, London, Canada; Schulich School of Medicine and Dentistry, Western University, London, Canada.
| | - Carter W Lim
- University of Ottawa, Faculty of Medicine, Ottawa, Canada; Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Monali S Malvankar-Mehta
- Ivey Eye Institute, St. Joseph's Health Care, London, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Cindy Hutnik
- Ivey Eye Institute, St. Joseph's Health Care, London, Canada; Schulich School of Medicine and Dentistry, Western University, London, Canada
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20
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Imai T, Hasebe S, Furuse T, Morisawa S, Hasebe K, Nagata Y, Tokutake T, Moriyama Y. Adverse reactions to 1% cyclopentolate eye drops in children: an analysis using logistic regression models. Ophthalmic Physiol Opt 2020; 41:424-430. [PMID: 33300632 DOI: 10.1111/opo.12773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the frequency, symptoms and risk factors for adverse reactions to two-times instillation of 1% cyclopentolate in children. STUDY DESIGN Prospective, observational study. METHODS The subjects were 646 patients who underwent cycloplegic refraction with cyclopentolate (mean age; 7.0 ± 3.5 years, age range; 0-15 years). Five minutes after instillation of 0.4% oxybuprocaine hydrochloride, a 1% cyclopentolate eye drop was instilled twice, with an interval of 10 min. Fifty minutes later, two certified orthoptists evaluated adverse reactions using a questionnaire and interviewed the patients' guardians. The relationship between the adverse reaction rates and age, gender, additional instillation, complications of the central nervous system (CNS), time of day and season were analysed using binominal and polytomous logistic regression models. RESULTS The overall frequency of adverse reactions was 18.3% (118/646 patients). The main symptoms included conjunctival injection (10.5%, 68/646), drowsiness (6.8%, 44/646) and facial flush (2.2%, 14/646). The odds ratio (OR) of conjunctival injection increased with patient's age (p < 0.05), in boys (p < 0.01) and in winter (p < 0.001). In contrast, the OR of drowsiness decreased with age (p < 0.001). Facial flush was observed mostly in children younger than 4 years. CNS complications were not a significant risk factor for any of the symptoms. CONCLUSIONS Adverse reactions to 1% cyclopentolate eye drops were more frequent than previously expected, but all were mild and transient. The probability of each symptom was associated with a clear age-specific trend.
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Affiliation(s)
- Toshihiro Imai
- Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Satoshi Hasebe
- Kawasaki Medical School General Medical Center, Okayama, Japan.,Department of Ophthalmology, Kawasaki Medical School, Okayama, Japan
| | - Takashi Furuse
- Kawasaki Medical School General Medical Center, Okayama, Japan.,Department of Ophthalmology, Kawasaki Medical School, Okayama, Japan
| | - Shin Morisawa
- Kawasaki Medical School General Medical Center, Okayama, Japan.,Department of Ophthalmology, Kawasaki Medical School, Okayama, Japan
| | - Kayoko Hasebe
- Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yuka Nagata
- Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoki Tokutake
- Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yumiko Moriyama
- Kawasaki Medical School General Medical Center, Okayama, Japan
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21
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Szpernal J, Carroll J, Spellecy R, Bachman Groth JA. Characterizing Current Attitudes and Practices for Human Subject Safety in Studies Involving Pupil Dilation. J Empir Res Hum Res Ethics 2020; 16:54-64. [PMID: 33135560 DOI: 10.1177/1556264620968989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Standards in pupil dilation practices regarding the safety of human subjects are not present in vision research despite the potential for significant adverse effects. We developed two surveys to examine current practices around pupil dilation among vision researchers and individuals associated with oversight of human subjects research. While both groups note an absence of adverse events associated with pupil dilation, vision researcher practices differed with informed consent use and measures taken to minimize complications. For Institutional Review Boards, general risk assumption associated with dilation was not unanimous and there was a lack of specific guidance available to researchers for minimizing risk. These results uncover the need for standardized practices regarding pupil dilation in human subjects research.
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Affiliation(s)
- Jacob Szpernal
- School of Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Joseph Carroll
- Department of Ophthalmology & Visual Sciences, 5506Medical College of Wisconsin, Milwaukee, USA.,Department of Cell Biology, Neurobiology & Anatomy, Medical College of Wisconsin, Milwaukee, USA.,Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, USA
| | - Ryan Spellecy
- Center for Bioethics and Medical Humanities, Medical College of Wisconsin, Milwaukee, USA
| | - Jane A Bachman Groth
- Department of Ophthalmology & Visual Sciences, 5506Medical College of Wisconsin, Milwaukee, USA
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22
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Nguyen HTT, Hoang TT, Tran AP, Tran HDM. Combined Interventions for Nonorganic Visual Loss in a Case with Pseudo-Myopia: A Perspective from Vietnam. Case Rep Ophthalmol 2020; 11:229-233. [PMID: 32774285 PMCID: PMC7383162 DOI: 10.1159/000508236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/26/2020] [Indexed: 11/19/2022] Open
Abstract
A previously healthy 10-year-old girl developed painless visual loss. She was diagnosed with a spasm of accommodation confirmed by cycloplegic refraction. She was prescribed low-dose atropine and again reported acute visual loss that was inconsistent with the level of daily function. She was referred to a pediatric psychiatrist with suspicion for a nonorganic visual disorder and was diagnosed with conversion disorder. She received psychotherapy and continued the treatment with low-dose atropine. Her visual acuity at distance returned to normal. Psychogenic visual loss can mimic organic disorders; hence, ophthalmologists should be aware of cases without the agreement between visual signs and daily manifestation.
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Affiliation(s)
| | - Tung Thanh Hoang
- Hanoi Medical University, Hanoi, Vietnam.,The University of Sydney School of Medicine, Sydney, New South Wales, Australia
| | | | - Huy Dinh Minh Tran
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Hai Yen Vision Institute, Ho Chi Minh City, Vietnam
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23
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Mitsukawa T, Suzuki Y, Momota Y, Suzuki S, Yamada M. Anterior Segment Biometry During Accommodation and Effects of Cycloplegics by Swept-Source Optical Coherence Tomography. Clin Ophthalmol 2020; 14:1237-1243. [PMID: 32440090 PMCID: PMC7213076 DOI: 10.2147/opth.s252474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose We analyzed changes in the crystalline lens during accommodation and the effects of cycloplegics by swept-source anterior-segment optical coherence tomography (AS-OCT). Materials and Methods Twenty healthy volunteers (7 males and 13 females, aged 22–34 years), with no history of eye disease except for refractive errors, were recruited. Biometric parameters, including anterior chamber depth (ACD), lens thickness (LT), and anterior and posterior curvature of the lens (ACL and PCL), were measured using AS-OCT (CASIA2). The measurements were performed with or without an accommodative demand of 5.0 diopters (D). The same tests were repeated following the topical administration of 1% cyclopentolate or a compounding agent comprising 0.5% tropicamide and 0.5% phenylephrine. Results The AS-OCT system was capable of simultaneous visualization of all optical components of the anterior segment in a single frame. ACD, LAC, and LPC decreased and LT increased significantly during 5.0 D accommodative stimulation in both eyes. Both cyclopentolate and tropicamide/phenylephrine eyedrops led to deeper ACD, thinner LT, and flatter LAC. There were no significant differences in all lens parameters despite having 5.0 D accommodative stimulation in both eyes with cycloplegia. Conclusion Our results suggest that both tropicamide/phenylephrine and cyclopentolate eyedrops have enough cycloplegic effects in young adults.
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Affiliation(s)
- Tadahiro Mitsukawa
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
| | - Yumi Suzuki
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
| | - Yosuke Momota
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
| | - Shun Suzuki
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
| | - Masakazu Yamada
- Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, Tokyo 181-8611, Japan
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24
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Chun J, Kim Y, Shin KY, Han SH, Oh SY, Chung TY, Park KA, Lim DH. Deep Learning-Based Prediction of Refractive Error Using Photorefraction Images Captured by a Smartphone: Model Development and Validation Study. JMIR Med Inform 2020; 8:e16225. [PMID: 32369035 PMCID: PMC7238094 DOI: 10.2196/16225] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/03/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023] Open
Abstract
Background Accurately predicting refractive error in children is crucial for detecting amblyopia, which can lead to permanent visual impairment, but is potentially curable if detected early. Various tools have been adopted to more easily screen a large number of patients for amblyopia risk. Objective For efficient screening, easy access to screening tools and an accurate prediction algorithm are the most important factors. In this study, we developed an automated deep learning–based system to predict the range of refractive error in children (mean age 4.32 years, SD 1.87 years) using 305 eccentric photorefraction images captured with a smartphone. Methods Photorefraction images were divided into seven classes according to their spherical values as measured by cycloplegic refraction. Results The trained deep learning model had an overall accuracy of 81.6%, with the following accuracies for each refractive error class: 80.0% for ≤−5.0 diopters (D), 77.8% for >−5.0 D and ≤−3.0 D, 82.0% for >−3.0 D and ≤−0.5 D, 83.3% for >−0.5 D and <+0.5 D, 82.8% for ≥+0.5 D and <+3.0 D, 79.3% for ≥+3.0 D and <+5.0 D, and 75.0% for ≥+5.0 D. These results indicate that our deep learning–based system performed sufficiently accurately. Conclusions This study demonstrated the potential of precise smartphone-based prediction systems for refractive error using deep learning and further yielded a robust collection of pediatric photorefraction images.
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Affiliation(s)
- Jaehyeong Chun
- Department of Industrial and System Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Youngjun Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung Yoon Shin
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Hyup Han
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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25
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Bello C, van Rensburg A, Meineri M, Luedi MM. Eye Drops: Must-Knows for Anesthesiology and Perioperative Care. A A Pract 2020; 13:155-157. [PMID: 31206385 DOI: 10.1213/xaa.0000000000001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Eye drops such as topical β-blockers are widely used to treat glaucoma and other ocular diseases. We provide an overview of ophthalmic solutions, including β-adrenergic receptor antagonists, for anesthesiologists and others involved in perioperative care. We summarize current evidence about systemic effects of topical β-blockers and other commonly used ophthalmic agents such as parasympathomimetic eye drops, carbonic anhydrase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and emerging products such as combinations of multiple substances. We call for careful preoperative assessment and perioperative management of individuals using eye drops, especially critically ill patients, children, or those undergoing major surgery.
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Affiliation(s)
- Corina Bello
- From the Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adriaan van Rensburg
- Department of Anesthesiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Massimiliano Meineri
- Department of Anesthesiology, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Markus M Luedi
- From the Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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26
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Saito J, Imaizumi H, Yamatani A. Physical, chemical, and microbiological stability study of diluted atropine eye drops. J Pharm Health Care Sci 2019; 5:25. [PMID: 31844539 PMCID: PMC6894105 DOI: 10.1186/s40780-019-0154-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Atropine eye drops are indicated for juvenile myopia progression, cycloplegia, amblyopia, and strabismus. According to the package insert, 10 mg/mL atropine eye drops must be diluted for pediatric patients to prevent systemic adverse effects. Compounding units in hospital pharmaceutical departments or community pharmacies are compelled to prepare this essential medication; however, validated atropine stability data is limited and the shelf life after preparation is extremely short. As it is a long-term treatment, a longer shelf life is necessary to improve patient care. This study aimed to demonstrate the physical, chemical, and microbiological stability of diluted atropine eye drops over a period of six months. Methods Preparation consists of dilution of a 10 mg/mL atropine solution (Nitten Atropine Ophthalmic Solution 1%; Nitten Pharmaceutical Co., Ltd.) in 0.9% NaCl to concentrations of 0.1, 1.0, 2.5, and 5.0 mg/mL, followed by a sterilizing filtration procedure and then an aseptic filling process of 5 mL in 5 mL polyethylene eyedropper bottles. The entire process is carried out in an overpressure isolator. All concentration products were kept for six months at 25 °C or 5 °C. Visual inspection was conducted and pH, osmolality, and atropine concentration were measured at day 0, day 14, day 28, and every month until six months. Atropine concentration was measured using liquid chromatography tandem mass spectrometry. The sterility was monitored using a method adapted from the Japanese Pharmacopoeia sterility assay. Results Atropine remained within ±5% of the target value in the six batches. Osmolality (285 mOsm/kg) as well as pH (5.88) were kept constant. No variations in solution characteristics (crystallization, discoloration) were noted. Sterility was maintained. Conclusions This study validated the physical, chemical, and microbiological stability of 0.1, 1.0, 2.5, and 5.0 mg/mL atropine sulfate eye drops conserved inside polyethylene eyedroppers for six months at 25 °C or 5 °C.
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Affiliation(s)
- Jumpei Saito
- 1Department of Pharmacy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 175-8535 Japan.,2Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 175-8535 Japan
| | - Hitomi Imaizumi
- 1Department of Pharmacy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 175-8535 Japan
| | - Akimasa Yamatani
- 1Department of Pharmacy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 175-8535 Japan.,2Division of Clinical Pharmacology and Oral Formulation Development, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 175-8535 Japan
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27
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Nentwich MM, Barthelmeß S. Management der Amblyopie im Kindesalter. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Deduction of Novel Genes Potentially Involved in the Effects of Very Low Dose Atropine (0.003%) Treatment on Corneal Epithelial Cells Using Next-Generation Sequencing and Bioinformatics Approaches. ACTA ACUST UNITED AC 2019; 55:medicina55090589. [PMID: 31540331 PMCID: PMC6780702 DOI: 10.3390/medicina55090589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022]
Abstract
Background and Objectives: Atropine is a nonselective muscarinic antagonist which has been used to prevent worsening of myopia in children. Different concentrations of atropine were used for myopia, ranging from 0.01% to 1.0%. However, there are still potential toxicity of different doses of atropine to the cornea. Here, we present a study of investigating novel genes potentially involved in the effects of very low dose atropine treatment (0.003%) on corneal epithelial cells using next-generation sequencing (NGS) and bioinformatics approaches. Materials and Methods: Human corneal epithelial cells were treated with 0.003% atropine, cultured until confluence, and RNA extracted for differential expression profiling of mRNA and microRNA (miRNA) between control and atropine-treated corneal epithelial cells. The functional enrichment analysis for differentially expressed genes was performed using two bioinformatics databases, including Database for Annotation, Visualization and Integrated Discovery (DAVID) and Ingenuity® Pathway Analysis (IPA). In addition, potential miRNA-mRNA interactions involved in atropine-treated corneal epithelial cells were predicted and validated using different miRNA target prediction databases. Results: Our results showed 0.003% atropine might suppress the apoptosis of corneal epithelial cells, potentially through Ras and protein kinase A signaling pathways. We also validated the possible miRNA regulations by using TargetScan and miRDB databases. Hsa-miR-651-3p-EPHA7, hsa-miR-3148-TMEM108 and hsa-miR-874-5p-TBX6 were validated as possible miRNA regulations involved in corneal epithelial cells treated with 0.003% atropine. Conclusions: These findings may contribute novel insights into therapeutic strategies for treating cornea with 0.003% atropine.
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Abstract
Amblyopia is a visual deficit that occurs during childhood and results in an abnormal development of the normal cortical visual pathway. It is defined as the reduction of best corrected visual acuity of one or rarely both eyes, which is not explained by structural abnormalities of the eye alone. During the sensitive period amblyopia is completely or partially reversible. The main causes of amblyopia are strabismus and refractive errors. Congenital cataracts are less common but if present may cause pronounced amblyopia. In Germany the prevalence of Amblyopia is approximately 5%, which is relatively high in relation to other countries, even though data are not completely comparable. As amblyopia can only be successfully treated during the first years of life, early detection of amblyogenic factors is important. Screening tests help in identifying children at risk of amblyopia, while only a thorough ophthalmological examination including cycloplegic refraction reliably detects all risk factors of amblyopia. Treatment consists of removal of the amblyogenic factors and stimulation of the amblyopic eye.
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Affiliation(s)
- M M Nentwich
- Augenklinik, Julius-Maximilians Universität Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland.
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30
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Haba Y, Shiga T, Naito T. Acute Exacerbation of Fever Following Administration of Tropicamide and Phenylephrine Ophthalmic Solution: A Case Report. DRUG SAFETY - CASE REPORTS 2019; 6:2. [PMID: 30756204 PMCID: PMC6372420 DOI: 10.1007/s40800-019-0096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 24-year-old woman with atopic dermatitis and persistent fever (axillary temperature of 37–38 °C for 6 months) received combination ophthalmic drops containing tropicamide and phenylephrine (Mydrin®-P), which exacerbated her fever within 15 min after instillation. Her axillary fever reached 40.1 °C but resolved the following day. No new dermatological symptoms developed. Although the patient’s fever may have been caused by either tropicamide or phenylephrine, neither of which have been reported to induce fever in topical formulations, atopic dermatitis and tropicamide’s inhibitory effect on perspiration under hot and humid conditions may have been the more probable cause. While drug-induced fever has been reported for other ophthalmic anticholinergic agents, this is the first reported case of possible fever exacerbation by an ophthalmic formulation of tropicamide, if the causative agent is assumed to be tropicamide.
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Affiliation(s)
- Yuichiro Haba
- Juntendo University School of Medicine, Tokyo, Japan.
| | | | - Toshio Naito
- Juntendo University School of Medicine, Tokyo, Japan
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