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Dereń-Szumełda JK, Dorecka M, Zandecki Ł, Mrukwa-Kominek E. Effectiveness of a Standardized Combination of Intracameral Mydriatics and Anaesthetic on Mydriasis during Cataract Surgery with Coexisting Diseases. Life (Basel) 2023; 14:14. [PMID: 38276263 PMCID: PMC10817656 DOI: 10.3390/life14010014] [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: 11/20/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To examine the effectiveness of a standardized combination of intracameral mydriatics and anesthetic (SCIMA) on mydriasis in patients with coexisting diseases such as diabetes mellitus (DM) and pseudoexfoliation syndrome (PXF) during phacoemulsification. METHODS Patients with cataract were included in the study if they achieved pupil dilation diameter ≥ 6.0 mm after the administration of mydriatic eyedrops (ME) during the first visit (V1). During the second visit (V2), pupil size measurements were obtained for phacoemulsification surgery with SCIMA. Effective mydriasis was defined as a pupil diameter ≥ 6.0 mm just prior to capsulorhexis without the use of additional pupil dilating agents. The measurements after ME administration during V1 and after SCIMA use during V2 were compared. RESULTS 103 patients (103 eyes) were divided into 3 groups: cataract and DM (n = 35), cataract and PXF (n = 32), and cataract without DM or PXF (n = 36). SCIMA administration allowed the achievement of effective mydriasis (≥6.0 mm) in all groups (n = 103; 100%). Mydriasis was significantly larger (p ≤ 0.001) after ME (7.3 mm) than after SCIMA (6.8 mm) administration. CONCLUSIONS Patients with cataract and such comorbidities as DM or PXF are likely to achieve effective pharmacological mydriasis during cataract phacoemulsification after SCIMA application. Mydriasis after ME is slower and larger, while SCIMA is faster.
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Affiliation(s)
| | - Mariola Dorecka
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-514 Katowice, Poland;
| | - Łukasz Zandecki
- Collegium Medicum, Jan Kochanowski University of Kielce, Żeromskiego 5, 25-369 Kielce, Poland;
| | - Ewa Mrukwa-Kominek
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland;
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Ceglana 35, 40-514 Katowice, Poland
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Gao R, Liu J, Zhou X, Huang L, Huang W, Xue Y, Wang F, Gong S, Wu R, Wang Y. Influence of Pilocarpine Eyedrops on the Ocular Biometric Parameters and Intraocular Lens Power Calculation. J Ophthalmol 2023; 2023:7680659. [PMID: 37455794 PMCID: PMC10348856 DOI: 10.1155/2023/7680659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To evaluate the influence of pilocarpine eyedrops on the ocular biometric parameters and whether these parameter changes affect the intraocular lens (IOL) power calculation in patients with primary angle-closure glaucoma (PACG). Methods Twenty-two PACG patients and fifteen normal subjects were enrolled. Ocular biometric parameters including the axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (Km), and white-to-white distance (WTW) were measured by using a Lenstar LS 900 device before and at least 30 minutes after instillation of 2% pilocarpine eyedrops. Lens position (LP) was calculated, and the IOL power prediction based on the ocular biometric parameters was performed using the Barrett Universal II, Haigis, Hoffer Q, Holladay I, or SRK/T formulas before and after pilocarpine application. Results In both PACG and normal groups, pilocarpine eyedrops induced a slight but statistically significant increase in the mean AL (0.01 mm for both groups) and mean LT (0.02 mm and 0.03 mm, respectively) but a significant decrease in the mean ACD (0.03 mm and 0.05 mm, respectively) and mean LP (0.02 mm and 0.04 mm, respectively). No significant changes in the mean Km and WTW were noticed in both groups. In addition, the IOL power calculation revealed insignificant changes before and after the pilocarpine instillation in both groups, regardless of the formula used. Conclusions Pilocarpine eyedrops can induce slight changes in the ocular biometric parameters including the AL, ACD, LT, and LP. However, these parameter changes will not result in a significant difference in IOL power estimation.
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Affiliation(s)
- Ruxin Gao
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Jinkun Liu
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Xiaojie Zhou
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Luping Huang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Weiyi Huang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Yingying Xue
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Fei Wang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Songjian Gong
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Renyi Wu
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
| | - Yuhong Wang
- Department of Ophthalmology, Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361001, China
- Department of Ophthalmology, Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen 361001, China
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How are pupillary parameters affected in pseudoexfoliation syndrome? A quantitative study. Int Ophthalmol 2023:10.1007/s10792-023-02648-8. [PMID: 36854815 DOI: 10.1007/s10792-023-02648-8] [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: 07/18/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE We evaluated the effects of pseudoexfoliation syndrome on dynamic, static pupillary parameters (scotopic, mesopic, photopic) and the pupil dilation speed, with automatic pupillometry. MATERIAL AND METHODS The study group included 140 eyes with clinically visible pseudoexfoliation material (PXM) of 110 patients. The study group was compared with the control group formed by including 140 eyes of 110 patients. Scotopic measurements at 0.4 lx illumination, mesopic measurements at 4 lx illumination, and photopic measurements at 40 lx illumination were performed. Dynamic measurements were made at 500 lx illumination. The mean pupil dilation speed at 10th second was calculated. In addition, the eyes (80 patients) with clinically unilateral PXM were compared with the other eyes of the patients. RESULTS The mean scotopic, mesopic, photopic and dynamic pupil diameters of eyes with clinical PXM were compared with the control group, all values were found to be significantly lower in eyes with PXM. (p < 0.0001, p < 0.0001, p < 0.0001, p < 0.0001, respectively). The mean speed of pupil dilation at the 10th second was also significantly lower in the pseudoexfoliation syndrome group (p < 0.0001). The measurement results of the patients with clinical PXM were significantly lower than the other unaffected eyes (p = 0.001, p = 0.004, p = 0.048, p = 0.035, respectively). The mean speed of pupil dilation at 10th second was also significantly lower in eyes with PXM (p = 0.009). CONCLUSION Results clearly reveal that pseudoexfoliation syndrome affects iris mechanisms. Although pseudoexfoliation syndrome is a systemic syndrome, we can say that the emergence of iris dysfunction findings is parallel with the clinical observation of PXM.
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Wang J, Rattner A, Nathans J. A transcriptome atlas of the mouse iris at single-cell resolution defines cell types and the genomic response to pupil dilation. eLife 2021; 10:e73477. [PMID: 34783308 PMCID: PMC8594943 DOI: 10.7554/elife.73477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/25/2021] [Indexed: 01/02/2023] Open
Abstract
The iris controls the level of retinal illumination by controlling pupil diameter. It is a site of diverse ophthalmologic diseases and it is a potential source of cells for ocular auto-transplantation. The present study provides foundational data on the mouse iris based on single nucleus RNA sequencing. More specifically, this work has (1) defined all of the major cell types in the mouse iris and ciliary body, (2) led to the discovery of two types of iris stromal cells and two types of iris sphincter cells, (3) revealed the differences in cell type-specific transcriptomes in the resting vs. dilated states, and (4) identified and validated antibody and in situ hybridization probes that can be used to visualize the major iris cell types. By immunostaining for specific iris cell types, we have observed and quantified distortions in nuclear morphology associated with iris dilation and clarified the neural crest contribution to the iris by showing that Wnt1-Cre-expressing progenitors contribute to nearly all iris cell types, whereas Sox10-Cre-expressing progenitors contribute only to stromal cells. This work should be useful as a point of reference for investigations of iris development, disease, and pharmacology, for the isolation and propagation of defined iris cell types, and for iris cell engineering and transplantation.
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Affiliation(s)
- Jie Wang
- Department of Molecular Biology and Genetics, Johns Hopkins University School of MedicineBaltimoreUnited States
- Howard Hughes Medical Institute, Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Amir Rattner
- Department of Molecular Biology and Genetics, Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Jeremy Nathans
- Department of Molecular Biology and Genetics, Johns Hopkins University School of MedicineBaltimoreUnited States
- Howard Hughes Medical Institute, Johns Hopkins University School of MedicineBaltimoreUnited States
- Department of Neuroscience, Johns Hopkins University School of MedicineBaltimoreUnited States
- Department of Ophthalmology, Johns Hopkins University School of MedicineBaltimoreUnited States
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Maloca PM, Carvalho ER, Hasler PW, Balaskas K, Inglin N, Petzold A, Egan C, Tufail A, Scholl HPN, Valmaggia P. Dynamic volume-rendered optical coherence tomography pupillometry. Acta Ophthalmol 2021; 100:654-664. [PMID: 34750988 DOI: 10.1111/aos.15063] [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: 11/16/2020] [Revised: 09/29/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess intrapupillary space (IPS) changes in healthy subjects with regard to decreased iris motility in patients with pseudoexfoliation glaucoma (PEXG) or non-arteritic anterior ischaemic optic neuropathy (NAION) in a feasibility study in a clinical environment. METHODS Scotopic and photopic IPS measurements using three-dimensionally rendered swept-source optical coherence tomography (SS-OCT) data were obtained and compared for all subjects. Intrapupillary space (IPS) parameters were evaluated such as absolute volumetric differences, relative light response for volumetric ratios and pupillary ejection fraction (PEF) for functional contraction measurements. RESULTS From a total of 122 IPS from 66 subjects, 106 IPS were eligible for comparison providing values for 72 normal, 30 PEXG and 4 NAION eyes. In healthy, PEXG and NAION subjects, scotopic overall mean IPS was 8.90, 3.45 and 4.16 mm3 , and photopic overall mean IPS was 0.87, 0.74 and 1.13 mm3 , respectively. Three-dimensional contractility showed a mean absolute difference of 8.03 mm3 for normals (defined as 100% contractility), 2.72 mm3 for PEXG (33.88% of normal) and 3.03 mm3 for NAION (38.50% of normal) with a relative light response ratio between scotopic and photopic volumes of 10.26 (100%), 4.69 (45.70%) and 3.67 (35.78%), respectively. Pupillary ejection fraction (PEF) showed a contractile pupillary emptying of 88.11% for normals, 76.92% for PEXG and 70.91% for NAION patients. CONCLUSION This 3D pupillometry OCT assessment allows for quantitative measurements of pupil function, contractility and response to light. More specifically, PEF is presented as a potential (neuro)-pupillary outcome measure that could be useful in the monitoring of ophthalmic disorders that affect pupillary function.
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Affiliation(s)
- Peter M. Maloca
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
- Moorfields Eye Hospital London UK
| | | | - Pascal W. Hasler
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
| | | | - Nadja Inglin
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
| | - Axel Petzold
- Moorfields Eye Hospital London UK
- National Hospital for Neurology and Neurosurgery UCLH & UCL Institute of Neurology Queen Square London UK
- Dutch Expertise Centre Neuro‐ophthalmology Amsterdam UMC The Netherlands
| | | | | | - Hendrik P. N. Scholl
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
| | - Philippe Valmaggia
- Institute of Molecular and Clinical Ophthalmology Basel (IOB) Basel Switzerland
- OCTlab Department of Ophthalmology University Hospital Basel Basel Switzerland
- Department of Ophthalmology University of Basel Basel Switzerland
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Borkenstein AF, Borkenstein EM, Malyugin B. Ophthalmic Viscosurgical Devices (OVDs) in Challenging Cases: a Review. Ophthalmol Ther 2021; 10:831-843. [PMID: 34617249 PMCID: PMC8589875 DOI: 10.1007/s40123-021-00403-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022] Open
Abstract
Ophthalmic viscoelastic devices (OVDs) are currently used in cataract surgery and have significantly improved the safety and effectiveness of this surgical procedure. OVDs are classified according to the zero-shear viscosity and the cohesion-dispersion index in cohesive, dispersive, and viscoadaptives. OVDs create and maintain anterior chamber depth and visibility, protecting the corneal endothelium and other intraocular tissues during surgery. The selection of the most adequate OVD is especially relevant when performing cataract surgery in challenging cases, such as in hard, mature cataracts, flat anterior chamber, pseudoexfoliation syndrome, intraoperative floppy iris syndrome, or glaucoma surgery. In such cases, OVD is crucial for facilitating the surgical procedure and the associated minimal complication rate. The use of a combination of OVDs (soft-shell technique and modifications), the use of blue-colored OVDs, and the combination of sodium hyaluronate with lidocaine have also been described as useful tools in some of these challenging cases.
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Affiliation(s)
- Andreas F Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Kreuzgasse 35, 8010, Graz, Austria.
| | - Eva-Maria Borkenstein
- Borkenstein and Borkenstein, Private Practice at Privatklinik Kreuzschwestern, Kreuzgasse 35, 8010, Graz, Austria
| | - Boris Malyugin
- Department of Cataract and Implant Surgery, S. Fyodorov Eye Microsurgery Complex State Institution, Beskudnikovsky Boulevard 59A, Moscow, 127486, Russia
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