Receptor-responses in fresh human ciliary muscle

Monocular transcorneal electrical stimulation induces ciliary muscle thickening in contralateral eye

Transcorneal electrical stimulation (TES) is used as therapy for retinal diseases such as retinitis pigmentosa (RP) and was suggested for assessing retinal sensitivity by determining phosphene thresholds, subjective luminance impressions caused by retinal stimulation. Further applications concerned the accommodation process, revealing an improved accommodative amplitude in presbyopic eyes after TES treatment. The respective changes of the ciliary muscle (CM), the structure most important for near vision, during TES are yet unknown. In a pilot study, we aimed to assess whether monocular TES leads to morphological and functional CM changes and whether central accommodation control is affected. Ten healthy, near-emmetropic adults participated in the trial (4 females, age 26.3 ± 3.6 years). Using a wavefront and a stimulus generator, a biphasic square-wave stimulus (2 s positive and 6 s negative amplitude) of 0 μA average current was produced and transferred to the eye by means of a Dawson-Trick & Litzkow electrode. Prior to the stimulation, an individual determination of phosphene thresholds served to define individual TES current amplitudes, which ranged between 60 and 100 μA. Optical coherence tomography (OCT) imaging of the right eye's temporal ciliary muscle was performed before and during ipsi-as well as contralateral monocular TES in randomized order in the morning and afternoon of the same day. During imaging, subjects fixated a target at 4 m distance and refraction was simultaneously recorded via eccentric infrared photorefraction. OCT images were assessed using previously published custom-developed software, allowing the definition of selective CM thickness (CMT) readings, and plotting of continuous CMT profiles along the muscle border. CMT profiles revealed that both stimulations, on the ipsi- and contralateral eye, induced a thickening of the CM compared to the non-stimulated state. The selective CMT readings confirmed a significant increase with ipsi- (31 ± 30 μm; p = 0.010) and contralateral (25 ± 16 μm; p = 0.001) TES. However, refraction during far vision was not significantly affected by either stimulation (ipsilateral [n = 5]: median Δ_w/-w/o = 0 D; contralateral [n = 7]: Δ_w/-w/o = 0.13 D). Pupil size on average increased during TES, but without reaching significance (ipsilateral [n = 5] median Δ_w/-w/o = 0.23 mm, contralateral [n = 7] Δ_w/-w/o = 0.39 mm). Ipsilateral CM thickening could be explained by local changes within the stimulated ciliary muscle, such as increased blood flow or interstitial fluid rise induced by TES. However, the CMT increase in the right eye when TES was performed contralaterally, on the left eye, indicates an involvement of the central control circuit of accommodation. Further possible explanations for this finding are a synchronization of neuronal activities in the visual pathway, the release of vasoactive neuropeptides, or effects on the central blood pressure regulation. Given a neuromodulation effect on the CM function, TES might have implications for children with accommodation insufficiencies and as additional therapy in myopia control management, e.g. in combination with multifocal contact lens treatment. Our study is important for the clinical application of TES, and the outcome might add crucial knowledge to the current understanding of the accommodation process and inform research and treatment of both myopia and presbyopia.

Pharmacological Treatments for Presbyopia

Accommodation is the change in dioptric power of the eye. It is a dynamic process that allows focusing on an object at all distances. In order to focus sharply, three physiological responses, known as the triad of accommodation, are produced by a change in pupil size, a change in shape and position of the lens, and ocular convergence. This is modulated by the autonomic nervous system, mainly the parasympathetic nervous system. Presbyopia is a refractive condition that occurs with aging, usually manifesting around 40-50 years of age, and is a result of the loss of accommodation in the eye, causing loss of visual performance when focusing on objects placed at different distances, starting with near vision. Glasses, contact lenses, surgical approaches and now pharmacological treatments are accepted methods of treating presbyopia. Pharmacological treatment is a promising new noninvasive option for treating presbyopia. Currently there are three pharmacological approaches to the treatment of presbyopia. The first one aims to produce miosis and, from a pinhole effect, increase depth of focus, and therefore improve uncorrected near visual acuity (UNVA). The second one addresses rehabilitating accommodation in a binocular way, allowing good vision at all distances. Finally, the third strategy uses lipoic acid to restore the lost elasticity of the lens. All of these pharmacological treatments are topical non-invasive eyedrops, with no serious adverse effects having been reported with any of the strategies, and require the right patient selection process to fulfill expectations and needs. The aim of this article is to provide an update on recent advances in this field.

Local ocular renin-angiotensin-aldosterone system: any connection with intraocular pressure? A comprehensive review

The renin-angiotensin system (RAS) is one of the oldest and most extensively studied human peptide cascades, well-known for its role in regulating blood pressure. When aldosterone is included, RAAS is involved also in fluid and electrolyte homeostasis. There are two main axes of RAAS: (1) Angiotensin (1-7), angiotensin converting enzyme 2 and Mas receptor (ACE2-Ang(1-7)-MasR), (2) Angiotensin II, angiotensin converting enzyme 1 and angiotensin II type 1 receptor (ACE1-AngII-AT1R). In its entirety, RAAS comprises dozens of angiotensin peptides, peptidases and seven receptors. The first mentioned axis is known to counterbalance the deleterious effects of the latter axis. In addition to the systemic RAAS, tissue-specific regulatory systems have been described in various organs, evidence that RAAS is both an endocrine and an autocrine system. These local regulatory systems, such as the one present in the vascular endothelium, are responsible for long-term regional changes. A local RAAS and its components have been detected in many structures of the human eye. This review focuses on the local ocular RAAS in the anterior part of the eye, its possible role in aqueous humour dynamics and intraocular pressure as well as RAAS as a potential target for anti-glaucomatous drugs.KEY MESSAGESComponents of renin-angiotensin-aldosterone system have been detected in different structures of the human eye, introducing the concept of a local intraocular renin-angiotensin-aldosterone system (RAAS).Evidence is accumulating that the local ocular RAAS is involved in aqueous humour dynamics, regulation of intraocular pressure, neuroprotection and ocular pathology making components of RAAS attractive candidates when developing new effective ways to treat glaucoma.

A New Angiotensin-Ll- Receptor Blocker, Cgp 48933: Local Tolerance and Effect on Intraocular Pressure. A Pilot Study

CGP 48933, a new angiotensin-II-receptor antagonist, has been shown to lower intraocular pressure (IOP) in two different rabbit glaucoma models in a dose-dependent manner after local application. As a further step a pilot study was performed in human eyes. The trial consisted of three parts. Parts 1 and 2 comprised a double-masked intraindividual trial between CGP 48933 and its vehicle (saline) in five healthy volunteers (Part 1) and five patients with early stages of primary open-angle glaucoma (Part 2), to assess local tolerance and the effect on IOP. Part 3 was a single-masked intraindividual trial between CGP 48933 and saline, to find the effective dose range of the new compound. Local tolerance was assessed as excellent in all subjects. No conjunctival hyperemia burning or itching occurred. There were no significant changes in IOP from baseline in drug or vehicle-treated eyes. In addition, there was no dose-dependent (200 micrograms to 1 mg) effect of CGP 48933 on IOP. Systemic blood pressure, heart rate and pupil size did not change during the observation period. Topical application of CGP 48933 in its present formulation is thus not suitable for lowering IOP in humans.

Many Faces of Renin-angiotensin System - Focus on Eye

The renin-angiotensin system (RAS), that is known for its role in the regulation of blood pressure as well as in fluid and electrolyte homeostasis, comprises dozens of angiotensin peptides and peptidases and at least six receptors. Six central components constitute the two main axes of the RAS cascade. Angiotensin (1-7), an angiotensin converting enzyme 2 and Mas receptor axis (ACE2-Ang(1-7)-MasR) counterbalances the harmful effects of the angiotensin II, angiotensin converting enzyme 1 and angiotensin II type 1 receptor axis (ACE1-AngII-AT1R) Whereas systemic RAS is an important factor in blood pressure regulation, tissue-specific regulatory system, responsible for long term regional changes, that has been found in various organs. In other words, RAS is not only endocrine but also complicated autocrine system. The human eye has its own intraocular RAS that is present e.g. in the structures involved in aqueous humor dynamics. Local RAS may thus be a target in the development of new anti-glaucomatous drugs. In this review, we first describe the systemic RAS cascade and then the local ocular RAS especially in the anterior part of the eye.

The ocular renin-angiotensin system: a therapeutic target for the treatment of ocular disease

The renin-angiotensin system (RAS) is most well-known for its role in regulation and dysregulation of blood pressure as well as fluid and electrolyte homeostasis. Due to its ability to cause cardiovascular disease, the RAS is the target of a multitude of drugs that antagonize its pathophysiological effects. While the "classical" RAS is a systemic hormonal system, there is an increasing awareness of the existence and functional significance of local RASs in a number of organs, e.g., liver, kidney, heart, lungs, reproductive organs, adipose tissue and adrenal. The eye is one of these organs where a compelling body of evidence has demonstrated the presence of a local RAS. Individual components of the RAS have been shown to be present in many structures of the eye and their potential functional significance in ocular disease states is described. Because the eye is one of the most important and complex organs in the body, this review also discusses the implications of dysregulation of the systemic RAS on the pathogenesis of ocular diseases and how pharmacological manipulation of the RAS might lead to novel or adjunctive therapies for ocular disease states.

Optomechanical response of human and monkey lenses in a lens stretcher

PURPOSE

To quantify the forces necessary to change the shape and optical power of human and monkey lenses.

METHODS

Cynomolgus monkey (n = 48; age: 3.8-11 years), rhesus monkey (n = 35; age: 0.7-17 years) and human (n = 20, age 8-70 years) eyes obtained postmortem, including the lens, capsule, zonules, ciliary body, and sclera were mounted in an optomechanical lens-stretching system. Starting at zero load, the lenses were symmetrically stretched in a stepwise fashion in 0.25- or 0.5-mm steps. The load, lens diameter, inner ciliary body diameter, and lens power were measured at each step and the diameter- and power-load responses were quantified.

RESULTS

The diameter- and power-load responses were found to be linear in the physiologically relevant range of stretching. The average change in cynomolgus, rhesus, and human lens diameter, respectively, was 0.094, 0.109, and 0.069 mm/g in young lenses, and 0.069, 0.067, and 0.036, mm/g in older lenses. For the same lenses, the average change in lens power was -3.73, -2.83, and -1.22 D/g in young lenses and -2.46, -2.16, and -0.49 D/g in older lenses.

CONCLUSIONS

The force necessary to change the lens diameter and lens power increases with age in human and monkey lenses. The results agree with the Helmholtz theory of accommodation and with presbyopia theories that predict that the force required to disaccommodate the lens increases with age.

Analysis of human crystalline lens accommodation

The behavior of the human crystalline lens during accommodation is analytically studied. The lens is modeled as a closed axisymmetrical membrane shell of varying thickness enclosing an incompressible liquid. To simulate zonular tension associated with lenticular accommodation, an axisymmetrical radial force or displacement is imposed around the shell equator. Two second-order, simultaneous, nonlinear governing differential equations are derived. Numerical results, obtained from the investigation of human lens profiles of three independently published MRI images and a drawing of a microphotograph, demonstrate that when zonular traction within the physiological force range of the ciliary muscle is exerted, both central lens thickness and central optical power increase. Qualitatively, these increases are independent of lens shape. However, the magnitude of these changes is dependent on the initial profile of the lens and is enhanced by the "natural" variation in capsular thickness. Only when a pulling force significantly exceeds the force capacity of the ciliary muscle does the lens flatten and its central thickness and optical power decrease.

The effect of a beta-adrenoceptor antagonist on accommodative adaptation in Hong Kong children

PURPOSE

Increased susceptibility to nearwork-induced accommodative adaptation has been suggested as a risk factor for myopia development. We investigated whether accommodative adaptation may explain in part the high prevalence of myopia in Hong Kong children and examined the effect of beta-antagonism with topical timolol maleate on accommodative adaptation.

METHODS

Thirty children (10 emmetropes and 20 myopes) aged between 8 and 12 years were recruited. Tonic accommodation was measured before and after 5 min of video game-playing using an open-field Shin-Nippon autorefractor. Measurements were repeated 30 min after timolol instillation.

RESULTS

Children with progressing myopia demonstrated accommodative adaptation following the near task, whereas stable myopes showed counter-adaptive, hyperopic accommodative changes. Timolol increased the magnitude of accommodative adaptation in the stable myopes but had little effect on responses of the progressing myopes or emmetropes.

CONCLUSIONS

Neuropharmacological modulation of the accommodative system may have a possible etiological role in the progression of myopia.

Comparative study on the safety and efficacy of different cycloplegic agents in children with darkly pigmented irides

BACKGROUND

The ideal cycloplegic drug that is safe, effective and convenient in children is not yet available. This study aimed to evaluate the safety and efficacy of three cycloplegic regimens in hyperopic children with pigmented irides. The responses to cycloplegia in different age groups and presence of strabismus were also compared.

METHODS

Tropicamide 0.5% and phenylephrine 0.5% (regimen I), tropicamide 1.0% and cyclopentolate 1.0% (regimen II), and atropine 1.0% (regimen III) were evaluated in 25 children using a crossover study design. Cycloplegic refractions were assessed.

RESULTS

The mean age of the children was 5.7 +/- 2.0 years (range 2.5-10.8 years). Six (24.0%) of them had strabismus. The spherical equivalent (SE) refraction for regimens I, II and III were +5.11 +/- 2.04 D, +5.29 +/- 1.89 D and +5.71 +/- 1.90 D, respectively, and were significant different from the manifest SE (+3.95 +/- 2.17 D) (P < 0.001). There was no statistical difference between regimen I and II in children without strabismus (P = 0.258) or aged older than 5 years (P > 0.050).

CONCLUSION

In older children, regimen I was as effective as regimen II and can be used to avoid cyclopentolate toxicity.

Cannabinoid agonists induce contractile responses through Gi/o-dependent activation of phospholipase C in the bovine ciliary muscle

This study was undertaken to investigate the effect of some cannabinoid agonists on the bovine ciliary muscle. Both anandamide and CP 55,940 (cis-3-(2-hydroxy-4-(1,1-dimethyl heptyl) phenyl)-trans-4-(3-hydroxypropyl) cyclohexanol) produced a concentration-dependent contractile response in ciliary muscle. These responses were inhibited by SR 141716A (N-[piperidin-1-yl]-5-(4-cholophenyl)-1-(2,4-dichlorophenyl)-4-methyl-1H-pyrazole-3-carboxamide) (0.1 and 1 microM) but not by SR 144528 (N-[1S)-endo-1,3,3-trimethyl bicyclo[2.2.1] heptan-2-yl] 5-(4-chloro-3-methylphenyl)-1-(4 methoxy benzyl)-pyrazole-3-carboxamide) (1 and 10 microM). A preincubation with G(i/o) protein inhibitor pertussis toxin (500 ng/ml) for 20 min inhibited the contractile action of anandamide and CP 55,940. In addition, the phospholipase C inhibitor U73122 (1[6-[[(17 beta)-3-methoxyestra-1,3,5(10)-trien-17-yl] amino] hexyl]-1H-pyrrole-2,5-dione) blocked the anandamide- and CP 55,940-induced contractions, whereas the protein kinase C activator, phorbol 12,13 dibutyrate (PDBu) significantly potentiated the contractions evoked by cannabinoid receptor agonists. We evaluated the binding of [(3)H]CP 55,940, which specifically labelled a single class of cannabinoid sites with affinity in low subnanomolar range (K(d)=0.6 nM) and the maximal number of binding sites of 1243 fmol/mg protein. Binding of [(3)H]CP 55,940 was inhibited by ligands having a major selectivity for cannabinoid (CB(1)) receptors. These findings provide strong evidence of the involvement of cannabinoid CB(1) receptors promoting contraction in the bovine ciliary muscle. Furthermore, the action of cannabinoid receptor agonists appears to be mediated via phospholipase C. These data also contribute to elucidate the cannabinoid CB(1) receptor pivotal role in the modulation of intraocular pressure and to show that cannabinoid receptor agonists may be regarded as potential antiglaucoma agents.

Pharmacological characterization of the 5-HT1A, 5-HT2 and 5-HT3 receptors in the bovine ciliary muscle

We aimed to investigate the effects of serotonin (5-hydroxytryptamine, 5-HT) on the bovine ciliary muscle and subsequently to characterize and identify the subtypes of 5-HT receptors involved in the serotonin-evoked contractility muscle. The binding of [3H]ketanserin, [3H]granisetron and [3H]8-hydroxy-2-(di-n-propylamino)tetralin ([3H]8-OH-DPAT) was analyzed. All labelled compounds bound with high affinity to a single site in the membrane preparations studied. The affinity (K(d)) of the binding site was 7.5+/-1.2 nM for [3H]ketanserin, 6.9+/-0.8 nM for [3H]granisetron and 4.4+/-0.31 nM for [3H]8-OH-DPAT. The density of receptors (B(max)) was 1062+/-43.0 fmol/mg protein for [3H]ketanserin, 566+/-2.32 fmol/mg protein for [3H]granisetron and 205+/-4.63 fmol/mg protein for [3H]8-OH-DPAT. The serotonin-induced contraction appeared to be competitively antagonized by ketanserin (0.1, 1 and 10 microM) and ondansetron (0.1, 10 and 100 microM) which produced a pA(2) value of 8.5+/-0.12 and 8.0+/-0.19, respectively. 8-OH-DPAT and 5-carboxamidotryptamine (5-CT) proved to be completely ineffective. We conclude that serotonin induces bovine ciliary muscle contraction via 5-HT(2) and 5-HT(3) receptors while the 5-HT(1A) receptors, although present, do not mediate the contractile response.

Effect of beta-adrenoceptor antagonists on autonomic control of ciliary smooth muscle

PURPOSE

Pharmacological intervention with peripheral sympathetic transmission at ciliary smooth muscle neuro-receptor junctions has been used against a background of controlled parasympathetic activity to investigate the characteristics of autonomic control of ocular accommodation.

METHODS

A continuously recording infra-red optometer was used to measure accommodation on a group of five visually normal emmetropic subjects under open- and closed-loop conditions. A double-blind protocol between saline, timolol and betaxolol was used to differentiate between the localised action on ciliary smooth muscle and effects induced by changes in stimulus conditions. Data were collected before and 45 min following the instillation of saline, timolol or betaxolol. Open-loop post-task decay was investigated following 3 min sustained near fixation of a stimulus placed 3 D above the subject's pre-task tonic accommodation level. Closed-loop dynamic responses were recorded for each treatment condition while subjects viewed sinusoidally (0.05-0.6 Hz) or stepwise vergence-modulated targets over a 2 D range (2-4 D).

RESULTS

Open-loop data demonstrate a rapid post-task regression to pre-task tonic accommodation levels for saline and betaxolol control conditions. A slow positive post-task shift was induced by timolol indicating that sympathetic inhibition contributes to accommodative adaptation during sustained near vision. Closed-loop accommodation responses to temporally modulated sinusoidal stimuli showed characteristic features for both saline and betaxolol control conditions. Timolol induced a reduced gain for low- and mid-temporal frequencies (< 0.3 Hz) but did not affect the response at higher temporal frequencies. Response times to stepwise stimuli increased following the instillation of timolol for the near-to-far fixation condition compared with the controls and was related to the period of sustained prior fixation.

CONCLUSIONS

Modulation of accommodation under open- and closed-loop conditions by a non-selective beta-blocker is consistent with the temporal and inhibitory features of sympathetic innervation to ciliary smooth muscle. Although parasympathetic innervation predominates there is evidence to support a role for sympathetic innervation in the control of ocular accommodation.

Adenylyl cyclase activity mediated by beta-adrenoceptors in immortalized human trabecular meshwork and non-pigmented ciliary epithelial cells

Non-pigmented ciliary epithelial (NPE) and trabecular meshwork (TM) cells are important in maintaining normal aqueous humor dynamics through the inflow and outflow routes, respectively. The current studies were undertaken to evaluate the ability of several beta-adrenergic receptor agonists to stimulate various antagonists to inhibit cAMP production in cultured immortalized human TM and NPE cells using an automated enzyme immunoassay. Isoproterenol was the most potent agonist in both the NPE and TM cells. The rank order of potency of agonists in NPE and TM cells, respectively, was: isoproterenol [EC50 = 37 and 66 nM] > epinephrine [EC50 = 112 and 526 nM] > albuterol [EC50 = 426 and 785 nM] > norepinephrine [EC50 = 3 and > 10 microM] > phenylephrine [EC50 > 10 microM for both] = dopamine [EC50 > 10 microM for both](n = 3-19). The isoproterenol-induced cAMP production was inhibited by various antagonists with the following rank order of potency in NPE and TM cells, respectively: propranolol [Ki = 0.2 and 0.3 nM] = ICI-118551 [Ki = 0.5 and 0.4 nM] > levobunolol [Ki = 1.1 and 2.1 nM] > levobetaxolol [Ki = 13 and 14 nM] = racemic betaxolol [Ki = 43 and 19 nM] > dextrobetaxolol [Ki = 2,705 and 1,980 nM] > atenolol [Ki > 4,000 nM for both] (n = 3-7). These detailed pharmacological studies using a variety of agonists and antagonists further supported the presence of beta2-adrenergic receptors in immortalized human NPE and TM cells.

Noradrenaline receptor-mediated potentiation of caffeine-induced Ca( 2+)-activated K(+) currents in bovine ciliary muscle cells

PURPOSE

Adrenoceptor-mediated modulation of a caffeine (CAF)-induced [Ca(2+)](i) elevation and resulting Ca(2+)-activated K(+) current (I(CAF)) in bovine ciliary muscle (CM) cells were investigated.

METHODS

The nystatin-perforated patch clamp technique for the measurement of membrane currents and a microscope based fura-2 fluorescence imaging of [Ca(2+)](i) were applied to CM cells freshly dissociated with collagenase and identified with smooth muscle-specific alpha-isoactin.

RESULTS

Under voltage-clamped conditions, noradrenaline (NA) potentiated I(CAF) in a NA concentration-dependent manner without producing current responses to NA when NA was applied alone. NA-induced potentiation of I(CAF) occurred within 20 sec after the application of NA, while the NA-potentiated I(CAF) gradually recovered to the control level within 30 min after removal of NA. Despite the little current response to NA applied alone, NA elicited a [Ca(2+)](i) elevation in a manner similar to that induced by CAF although the NA-induced [Ca(2+ )](i) elevation was smaller than the CAF-induced [Ca(2+ )](i) elevation. In contrast to the significant potentiation of I(CAF) with NA, NA produced little potentiation of the CAF-induced [Ca(2+)](i) elevation. The NA-induced potentiation of I( CAF) was antagonized by an alpha(1) adrenoceptor antagonist, prazosin. Neither clonidine nor isoproterenol had an effect on I(CAF), suggesting that alpha(2) and beta adrenoceptor are not involved in the response to NA.

CONCLUSIONS

These results suggest that NA potentiates I( CAF) via alpha(1) adrenoceptor activation and that the NA-induced potentiation occurs at Ca(2+)-activated K(+) channels but not CAF-induced Ca(2+) releasing sites.

The effect of angiotensin II on uveoscleral outflow in rabbits

PURPOSE

In our previous study, we showed that the AT1 receptor antagonist increased uveoscleral outflow (USF) when topically applied to the rabbit eye. However this increase was too small to demonstrate a clear physiological role for ocular angiotensin II (AII). Hence, the purpose of this study was to determine whether ocular AII influenced USF regulation, and if so, how this occurred.

METHODS

USF was measured by the FITC-dextran perfusion method in albino rabbits. AII and its receptor antagonists were directly applied into the anterior chamber by adding into the perfusate and by perfusing with FITC-dextran. We also analyzed angiotensin receptors on the rabbit ciliary body membrane by a receptor binding assay with 125I-[Sar1), Ile8]-AII as a ligand.

RESULTS

CS-088 (1 microg/ml) increased USF by 24% while AII decreased USF in a concentration-dependent manner between 10 and 500 nM. Its maximum decrease of 19% occurred at 500 nM. At this AII concentration the USF reduction was antagonized by 1 microg/ml CS-088, an AT1-receptor antagonist, but not by the same concentration of PD-123,177, an AT2-receptor antagonist. Specific 125I-[Sar1, Ile8]-AII binding to the rabbit ciliary body membranes was inhibited by CS-088 with an inhibition constant of 7.05 nM, whereas inhibition by PD-123,177 was not observed.

CONCLUSIONS

Ocular AII was indicated to attenuate USF via AT1 receptors in rabbits, however its physiological effect was not critical in IOP regulation.

The regulation of trabecular meshwork and ciliary muscle contractility

Current models of aqueous humor outflow no longer treat trabecular meshwork (TM) as an inert tissue passively distended by the ciliary muscle (CM). Instead, ample evidence supports the theory that trabecular meshwork possess smooth muscle-like properties and is actively involved in the regulation of aqueous humor outflow and intraocular pressure. In this model, trabecular meshwork and ciliary muscle appear as functional antagonists, with ciliary muscle contraction leading to a distension of trabecular meshwork with subsequent reduction in outflow. and with trabecular meshwork contraction leading to the opposite effect. Smooth-muscle relaxing substances would therefore appear to be ideal candidates for glaucoma therapy with the dual goal of reducing intraocular pressure via the trabecular meshwork and of improving vascular perfusion of the optic nerve head. However, for such substances to effectively lower intraocular pressure, the effect on the ciliary muscle would have to he minimal. For this reason, more information is needed on the signalling processes involved in regulating trabecular meshwork and ciliary muscle contractility. This review attempts to outline current knowledge of signal transduction pathways leading to relaxation and contraction of ciliary muscle and trabecular meshwork. Pathways can be classified as involving or not involving changes of membrane voltage and of requiring or not requiring external calcium: possibly, other pathways exist. These different pathways involve different ion channels and isoforms of PKC and are expressed to a differing degree in ciliary muscle and trabecular meshwork, leading to differential responses when exposed to relaxing or contracting pharmacological agents. Some of these agents. like tyrosine kinase inhibitors and inhibitors of PKC. have been shown to relax trabecular meshwork while leaving ciliary muscle comparatively unaffected. This profile makes these substances appear as ideal drugs for simultaneously improving ocular outflow and retinal circulation, parameters that determine the time course of visual deterioration in glaucoma.

Selectivity of muscarinic agonists including (+/-)-aceclidine and antimuscarinics on the human intraocular muscles

The average EC50 value and the maximum response of carbachol on the human circular ciliary muscle obtained within 24 h of postmortem hypoxia was 517 nmol/l and 135 mg, respectively. These values for carbachol did not differ significantly from that of the longitudinal ciliary muscle. However, when tested at 1 mumol/l of carbachol, the peak response of the longitudinal muscle occurred at 59 sec vs 173 sec for that of the circular muscle of 70 year old donors. The relative potency of the muscarinic agonists on the circular muscle was oxotremorine-M, 1 > carbachol, 1/4 > pilocarpine, 1/19 > aceclidine, 1/132. The relative order of potency of agonists was similar for the longitudinal muscle. Only pilocarpine and aceclidine were partial agonists which produced 80-85% of the maximum response. When compared with the EC50 values of aceclidine on the iris sphincter and the longitudinal ciliary muscles, the agonist potency was only 1/28 for the latter tissue. Implications of these findings in relation to the use of these agonists in glaucoma are discussed. The pKB values of muscarinic antagonists on the circular ciliary muscle were: atropine, 8.8; cyclopentolate, 7.8; tropicamide, 7.4; P.F. HHSiD, 7.0; pirenzepine, 6.4; and methoctramine, 5.7. Nearly equal pKB values of each antagonist were obtained for the longitudinal ciliary muscle and iris sphincter. Based on the affinity constants of various competitive antagonists, the human iris as well as ciliary muscles may contain M3, M2 or M4 subtypes of muscarinic receptors.

Effects of phorbol ester on carbachol-induced contraction in bovine ciliary muscle: possible involvement of protein kinase C

The aim of the research was to characterize muscarinic receptors of bovine ciliary muscle and to investigate the desensitization process. The role of protein kinase C was analyzed. The results show that muscarinic receptors of bovine ciliary muscle have the pharmacological characteristics of the M3 subtype. Acute exposure to phorbol esters (1 microM phorbol 12,13-dibutyrate, PDB, or 0.1 microM phorbol 12-myristate 13-acetate, PMA, for 15 and 5 min, respectively) resulted in antagonism of muscarinic receptor-mediated contraction. Long-term pretreatment (18 h) with PMA to down-regulate protein kinase C resulted in potentiation of carbachol-induced contraction, reduction of agonist-induced desensitization and loss of phorbol ester-induced desensitization. Staurosporine (3 microM) and H7 [1-(5-isoquinolinesulfonyl)-2-methyl-piperazine] (1 microM), protein kinase C inhibitors, produced a significant potentiation of the contractile effect of carbachol, reduced the desensitization produced by repeated addition of carbachol and suppressed that induced by phorbol esters. In vitro incubation with carbachol, PDB or PMA did not cause any modification of the binding of labeled [3H]quinuclidinyl benzilate. In vitro incubation with PDB and PMA produced, as expected, a significant translocation of protein kinase C from the cytosol to the membrane. The incubation of the ciliary muscle with carbachol, using the protocol of exposure that induced maximal desensitization of contractile responses, produced a significant redistribution of the enzyme from the cytosol to the membrane. These findings suggest that agonist-induced modulation of functional cholinergic sensitivity in ciliary muscle is correlated, at least partially, to the translocation of protein kinase C from the cytosol to the membrane. The desensitization by phorbol esters is completely due to protein kinase C activation; during the desensitization process, direct modification of the density and affinity of muscarinic receptors is not involved.

Cytoplasmic Ca2+ mobilization and Ca(2+)-dependent membrane currents in dispersed bovine ciliary muscle cells

PURPOSE

The dependence of plasmalemma Ca2+ influx and Ca2+ release from intracellular stores on Ca2+ activated K+ channels of bovine ciliary muscle (CM) cells were examined.

METHODS

The nystatin-perforated patch clamp technique for the measurement of membrane currents and a microscope based fura-2 fluorescence imaging of [Ca2+]i were applied to CM cells freshly dissociated with collagenase and identified with smooth muscle-specific alpha-isoactin.

RESULTS

At holding voltages (VH) of > -60 mV, CM cells showed spontaneous transient outward currents (STOCs) and caffeine (> 10(-4) M) induced large transient outward currents (ICAF). Both STOCs and ICAF were abolished by tetraethylammonium chloride (10(-3) M) and charybdotoxin (10(-7) M), but not by apamin (10(-6) M), suggesting that both currents are mediated by Ca(2+)-activated K+ channels similar to those with medium (MK) or large (BK-type) conductance. Both STOCs and ICAF were gradually abolished in the nominally Ca(2+)-free and Co(2+)-containing solutions but were resistant to L-type Ca2+ channel blockers, including nicardipine, verapamil and diltiazem and a N-type channel blocker, omega-contoxin. The [Ca2+]i-elevation during high K+ (100 mM)-depolarization was prevented by Ca(2+)-free and Co(2+)-containing solutions but not by nicardipine.

CONCLUSIONS

These results suggest that CM cells possess MK or BK type-like Ca(2+)-activated K+ channels and that L-type Ca2+ channels play minor roles for the maintenance of Ca(2+)-dependent responses in contrast to other types of smooth muscle cells.

The mechanisms of the ocular autonomic dysfunction during the intracarotid amytal suppression test

We report the eye findings during selective injections of amytal to the internal carotid artery and to trunk and branches of the middle cerebral artery in three patients. This report comes a propos of our previous observation that fairly dense visual obscuration (probably secondary retinal suppression by the amytal), pupillary dilatation (mydriasis) and impairment of visual accommodation (cycloplegia) are not uncommon during the intracarotid amytal suppression test (AST). Selective injections in these three cases offered additional-insight into the mechanisms of the autonomic dysfunction observed in the eye ipsilateral to injection of amytal (EII). Injection of amytal into the trunk and branches of the middle cerebral artery, above the origin of the ophthalmic artery, did not produce ocular autonomic changes in any of the three patients. Injection of amytal in the internal carotid, below the origin of the ophthalmic artery, resulted in pupillary dilatation in the EII in two of the three patients. Based on the anatomy of the vasculature and autonomic innervation of the eye, we postulate that the pupillary dilatation and deficit of visual accommodation observed after intracarotid amytal injection are secondary to parasympathetic suppression in the ciliary ganglion. Amytal reaches the ciliary ganglion via the posterior ciliary arteries, branches of the ophthalmic artery. In summary, injection of amytal in the internal carotid artery below the origin of the ophthalmic artery, but not above it, can impair visual acuity and in some cases, entirel suppress the vision in the EII secondary to retinal suppression. Dilatation of the pupil due to parasympathetic dysfunction is also common and is likely secondary to suppression of the ciliary ganglion in the orbit.

Sympathetic overactivity of intraocular muscles evaluated by accommodation in patients with hyperthyroidism

Sympathetic overactivity occurs in Graves' disease, but little is known about autonomic nervous function in the eyes of subjects with this disease. We examined this function of the intraocular muscles in 12 patients with hyperthyroid Graves' disease and 12 healthy controls. Pupil size, pupillary unrest, and accommodation were measured with a computer-assisted infrared optometer and pupillometer. The mean and the coefficient of variation of the areas of the pupils were used to express pupil size and the degree of pupillary unrest, respectively. Accommodation was measured with the target light beam moving slowly and steadily, or instantaneously, and the results are expressed as the change in the eye's refractive power in response to these movements. The mean pupil size of the patients was not different from that of the controls. Pupillary unrest in the patients was smaller than in the controls. Accommodation in the patients was lower than that of the controls. Five patients were examined again 3 months later when they became euthyroid; pupillary unrest and accommodation had improved in all five patients. There were no significant differences in the activity of sympathetic nerves governing intraocular muscles in patients with or without eyelid retraction. These results indicate that intraocular muscles are sympathetically overactive in patients with hyperthyroidism, and suggest that eyelid retraction is not caused by sympathetic overactivity alone, but by another factor or factors, in addition.

The effect of topical beta-adrenoceptor antagonists on accommodation in emmetropia and myopia

Using topical instillation of non-selective and selective beta-adrenoceptor antagonists we examine the proposal that a deficit in inhibitory sympathetic innervation of ciliary smooth muscle may be a specific precursor to the onset and development of late-onset myopia (LOM). Post-task accommodative hysteresis, a possible consequence of such a deficit, was assessed by measuring the time-course of regression of accommodation when open-loop (darkness) conditions were immediately imposed following far and near tasks. For the proposal to be feasible only LOMs should exhibit post-task responses which fail to differentiate the type of beta-antagonist employed. As the overall profile of responses to beta-adrenoceptor antagonism was equivalent for each of the three different refractive groups (emmetropes N = 6; early-onset myopes N = 5; LOMs N = 5) we conclude that a propensity to LOM is not associated with a deficit in sympathetic inhibition.

In vivo determination of the biomechanical properties of the component elements of the accommodation mechanism

A method of obtaining in vivo information about the component elements of the accommodation mechanism is described. Changes in axial lens thickness during accommodation are measured continuously by ultrasonographic biometry. The measurements are fitted with a dynamic biomechanical model of the mechanism of accommodation. This gives a time constant that depends both on the direction of accommodation and on the properties of the lens, zonules and choroid. Two ratios can be calculated that give information about the visco-elastic properties of the lens, zonules and choroid. This information is especially useful to evaluate the changes that lead to presbyopia.

Tonic accommodation: a review. II. Accommodative adaptation and clinical aspects

Part I of this review considered basic aspects of tonic accommodation (TA), i.e. the accommodative response observed under degraded stimulus conditions. Part II considers accommodative adaptation, i.e. the apparent change in TA following periods of sustained fixation, and clinical aspects of both baseline TA and accommodative adaptation. It is suggested that the apparent post-task shift in TA reflects the slow rate of decay of the stimulus-mediated adaptive accommodative response, while the actual level of tonic innervation to the ciliary muscle remains relatively constant. The clinical implications of both TA and accommodative adaptation are discussed with regard to night, space and instrument myopia and refractive error development, notably nearwork-induced myopia. It is concluded that the evidence for any association between this form of myopia and either TA or accommodative adaptation is equivocal, and furthermore it seems likely that TA plays only a minor role in influencing the closed-loop steady-state accommodative response.

Tonic accommodation: a review. I. Basic aspects

In the absence of an adequate visual stimulus, accommodation adopts an intermediate position of approximately 1 D. Since this position was believed to reflect the level of tonic innervation to the ciliary muscle, this response has been termed tonic accommodation (TA). Part I of this review will consider various aspects of this parameter, including its reference to closed-loop accommodative function and autonomic physiology. In addition, both the methods of measurement and appropriate terminology for this function will be discussed. It is concluded that the response, which becomes apparent under so-called 'stimulus-free' conditions, in fact probably represents an aggregate response resulting from multiple, non-optical stimuli. Thus the designation tonic accommodation may not be appropriate, since it fails to describe accurately the heterogeneous composition of the stimulus-free accommodative response. An associated paper (to be published as part II of this review) will examine accommodative adaptation and both clinical aspects of TA and adaptation of TA.

Application of a simple mechanical model of accommodation to the aging eye

A simple model for the mechanics of accommodation in the human eye, previously proposed, is applied to the eye at different ages. Data from work by R. F. Fisher is used to derive values for the elasticity of lens-plus-zonules and data from work by G. W. H. M. van Alphen and W. Graebel is used to derive values for the elasticity of the choroid, each at a series of ages. The model is applied in two ways: (i) the elasticity of one component is allowed to change with age, while the other (and also ciliary muscle force) is held constant and the effect on accommodative amplitude is estimated; (ii) both elasticities are allowed to change with age, and muscle force is assumed to take on values producing a constant change in the radius of the "ciliary ring". It is shown that, in principle, age-related changes in choroid could account for a substantial component of the observed loss of accommodative amplitude, and it is suggested that this may be the case for monkeys, but not for humans. For the case of "all components changing", which is probably the case for humans, the ciliary muscle is likely to become stronger with age.

Characterization of acetylcholine- and endothelin-induced calcium entry in cultured human ciliary muscle cells

We characterized the effects of acetylcholine and endothelin on cultured human ciliary muscle cells, using the calcium-sensitive dye fura-2 to measure intracellular calcium and intracellular microelectrodes to measure the membrane potential. Both agonists, endothelin and acetylcholine, had a typical biphasic effect on the intracellular calcium concentration. Calcium peaked initially, because of its release from intracellular stores, and then reached a plateau, owing to entry of extracellular calcium. Endothelin-induced calcium entry was almost completely blocked by addition of extracellular La3+ (50 mumol/l) and Ni2+ (1 mmol/l). Acetylcholine-induced calcium entry was likewise almost completely abolished by La3+ and Ni2+. Both endothelin and acetylcholine led to an initial transient hyperpolarization with a subsequent depolarization. The hyperpolarization of the membrane potential had a time course similar to the initial calcium peak, while the depolarization occurred parallel to the calcium plateau. The depolarization induced by both agonists was reduced in the presence of La3+ and Ni2+. Verapamil (10 mumol/l) had no effect on either the calcium entry or the depolarization. Acetylcholine did not induce a [Ca2+]i peak when it was applied during the endothelin-induced [Ca2+]i plateau and vice versa. The [Ca2+]i plateau was not higher with concomitant than with single application of acetylcholine or endothelin. Thus, calcium entry and membrane depolarization induced by acetylcholine and endothelin seem to be mediated by a common La(3+)- and Ni(2+)-sensitive but verapamil-insensitive mechanism.

Evidence for protein kinase C modulation of the ciliary muscle response to carbachol and desensitization

The role of protein kinase C (PKC) in the desensitization of muscarinic receptor-mediated responses in bovine ciliary muscle was examined. Exposure of the bovine ciliary muscle to phorbol esters, used to activate PKC, resulted in antagonism of muscarinic receptor-mediated contraction. On the other hand, staurosporine, a known PKC inhibitor, caused a significant potentiation of the contractile effect induced by carbachol. Staurosporine reduced the desensitization induced by repeated additions of carbachol and completely suppressed that induced by phorbol esters. The results also indicate that desensitization mediated by phorbol esters as well as that mediated by muscarinic receptor agonists is heterologous.

Endothelin-evoked contractions in bovine ciliary muscle and trabecular meshwork: interaction with calcium, nifedipine and nickel

In the present study, we compared contractile responses of isolated bovine ciliary muscle and trabecular meshwork strips to endothelin-1 and carbachol. 1. Endothelin-1 is a potent contracting agent for ciliary muscle and trabecular meshwork. The EC50 was 5 x 10(-9) mol/l for both tissues. The maximal force evoked by endothelin was 73% of the maximal carbachol response in trabecular meshwork and 52% in ciliary muscle. 2. Carbachol contracted both tissues with an EC50 of 2 x 10(-7) mol/l. 3. In ciliary muscle, the tension was completely dependent on extracellular calcium. 4. In trabecular meshwork, 23 +/- 4% of the endothelin- and 42 +/- 10% of the carbachol-induced force response remained after removal of extracellular calcium. 5. Nifedipine (10(-5) mol/l) had only a slight relaxing effect in both tissues. 6. Nickel (10(3) mol/l) inhibited the development of force in both tissues. The relaxation induced by nickel was more pronounced in endothelin- than in carbachol-induced contractions. Different intracellular mechanisms mediating the action of endothelin and carbachol can be described: i) a calcium- and a nickel-sensitive pathway in both tissues and ii) an additional mechanism independent of external calcium in trabecular meshwork. These results indicate functional differences between the contractile region of trabecular meshwork and ciliary muscle. Endothelin may participate in accommodation and regulation of the intraocular pressure.

Measurements of intracellular calcium and contractility in human ciliary muscle

Electromechanical and pharmacomechanical coupling was investigated in human ciliary muscle by measuring the intracellular free calcium in single cultured ciliary muscle cells and the contractility in meridional ciliary muscle strips. The basal resting calcium concentration was 75 +/- 8.7 nmol/l, n = 23. Application of acetylcholine (0.1 mmol/l) and carbachol (0.1 mmol/l) resulted in an initial [Ca2+]i peak followed by a recovery phase and a [Ca2+]i plateau. The initial [Ca2+]i peak was still observed in the absence of extracellular calcium and in the presence of verapamil (0.1 mmol/l). During its plateau [Ca2+]i was decreased by withdrawal of extracellular calcium or application of verapamil (0.1 mmol/l). Depolarization induced by a high level of extracellular potassium yielded only a small transient [Ca2+]i peak without a [Ca2+]i plateau. In isolated ciliary muscle strips, muscarinic stimulation (carbachol 0.1 mmol/l) resulted in an initial phasic and a subsequent tonic contraction. Removal of external calcium reduced the phasic contraction to 30.6 +/- 4.4% (n = 8) and completely abolished the tonic one. Verapamil (0.1 mmol/l) had only a slight relaxing effect when applied during the tonic contraction. We conclude that human ciliary muscle contraction is mediated by calcium release from intracellular stores and calcium entry through calcium channels, which are most probably receptor-operated. Depolarization of the muscle cell membrane and calcium entry through voltage-operated calcium channels do not contribute significantly to human ciliary muscle contraction.

Differential smooth muscle-like contractile properties of trabecular meshwork and ciliary muscle

The contractile properties of bovine trabecular meshwork and ciliary muscle strips were investigated using an electromagnetic force-length transducer for isometric force measurements. Acetylcholine, pilocarpine and aceclidine administration resulted in dose-dependent contractions of trabecular meshwork and ciliary muscle. Absolute forces were approximately 10 times larger in ciliary muscle than in trabecular meshwork. Maximal force evoked by aceclidine (5 x 10(-5) M), when compared to the pilocarpine (5 x 10(-5) M) response, was significantly higher in trabecular meshwork than in ciliary muscle. The results were 172.5 +/- 12.6% (n = 7) and 138.9 +/- 4.0% (n = 8, P less than 0.05), respectively. Depolarization induced by raised external potassium (120 mM), when compared to the acetylcholine response (10(-3) M), resulted in a small contraction of 19.3 +/- 4.2% in trabecular meshwork (n = 5), and of 59.0 +/- 13.7% in ciliary muscle (n = 4, P less than 0.01). Both responses were inhibited by atropine (10(-5) M). The differential potassium effect may be explained by the large number of cholinergic nerve endings in ciliary muscle as compared to trabecular meshwork tissue. Recently, a dissociation between the effects of aceclidine on outflow resistance and accommodation has been described. Our data are consistent with these observations and provide evidence for a direct role of trabecular meshwork contractility in aqueous outflow regulation.

Contraction of porcine ocular ciliary muscle by epidermal growth factor-urogastrone

Epidermal growth factor-urogastrone (EGF) caused a concentration-dependent contractile response in porcine ocular ciliary muscle preparations. The half-maximal contraction was observed at 23 ng/ml EGF (4 nM). The contractile action of EGF, which was not abolished by the removal of extracellular calcium, was not affected by atropine, tetrodotoxin, phentolamine and indomethacin. In addition to causing contractions on its own, the contractile action of EGF was potentiated in the presence of prostaglandin E1 and vasopressin. Our data point to a potential role for EGF in the regulation of ciliary muscle tension.

Biochemical and functional evidence for the presence of dopamine D1 receptors in the bovine ciliary body

The present paper reports both functional and biochemical evidence for the presence of dopamine D1 receptors in the bovine ciliary body. Dopamine (DA) and dopamine D1 agonists (such as SKF 38,393) but not D2 agonists (such as LY 141,865) produced a concentration-related decrease in the tone induced by a maximally active concentration of carbachol (1 x 10(-4)-5 x 10(-4) M). The maximal relaxation obtained was 100% of the carbachol response using 10(-5) M dopamine or 5 x 10(-6) M SKF 38,393. SCH 23,390, a D1 antagonist, but not (-)-sulpiride, antagonized the effect of DA and SKF 38,393. In accordance with the functional data, radioreceptor binding experiments revealed the existence of a high affinity saturable [3H]SCH 23,390 binding to membranes prepared from ciliary body (Bmax: 344 fmol mg protein-1; Kd: 0.87 nM). The binding was specifically displaced by SCH 23,390, dopamine and dopamine D1 agonists, but not by norepinephrine, D2 agonists, or antagonists such as LY 141,865 and sulpiride. No specific binding was found when using dopamine D2 ligands, such as tritiated spiroperidol.

The influence of alpha-adrenergic agents on tonic accommodation

This study has examined the effect of an alpha-1 adrenergic agonist (phenylephrine HCl, 2.5%) and a non-selective alpha antagonist (thymoxamine HCl, 0.5%) on tonic accommodation (TA). TA was measured at 1 min intervals throughout a 45 min period using an objective infra-red optometer (Canon Autoref R-1). Additionally pupil diameter and the near-point of accommodation (NPA) were monitored in order to assess the efficacy of the instilled drug. A double-blind protocol was adopted between thymoxamine, phenylephrine and a saline control for 7 emmetropic subjects. There was no significant difference between the values of TA obtained under the three pharmacological conditions. However, both adrenergic agents induced changes in pupil diameter and NPA. Furthermore in all conditions TA increased by approximately 0.25D while the subject sat passively in darkness. The data indicates that alpha-adrenergic innervation alters the closed-loop accommodative response independently of TA.

Histochemical differences within the ciliary muscle and its function in accommodation

During accommodation, the ciliary muscle is known to move forward-inward. This movement depends on the stiffness of the ciliary muscle connections with the scleral spur. These connections are mediated by the tips of the meridional muscle. If the tips are weakened by pharmacological or surgical means, accommodation suffers. For normal accommodation, it is therefore necessary that the tips stiffen before the contraction of the main part of the muscle. We have therefore looked at the primate eye for enzymatic and ultrastructural differences between the tips and the bulk of the muscle viz, the reticular and circular portion. Myosin ATPase was stained after either alkaline or acid preincubation. Lactate dehydrogenase (LDH), succinic dehydrogenase (SDH), NADH-tetrazoliumreductase (TR) and lipids were stained using conventional methods. The results of the enzyme staining were a modest difference between the meridional tips and the bulk. The tips stained stronger for ATPase following both preincubation methods, and for LDH, whereas the bulk cells stained stronger for SDH, NADH-TR and lipids. The tips contained fewer mitochondria and more myofibrils. In all these respects, the tips of the meridional muscle resemble the fast fibers of striated muscle.

Endothelin depolarizes membrane voltage and increases intracellular calcium concentration in human ciliary muscle cells

The ciliary muscle which is involved in accommodation and regulation of aqueous humour outflow resistance resembles smooth muscle in other parts of the body. In the present investigation we used an established primary cell line (H7CM) to study the effects of endothelin, a novel vasoconstrictor peptide, on membrane voltage (V) and intracellular calcium in cultured human ciliary muscle cells. Membrane voltage was measured in confluent monolayers of H7CM cells using conventional microelectrodes. Intracellular calcium concentration [( Ca]i) was measured in single H7CM cells using the fluorescent calcium indicator fura-2. Under resting conditions V averaged -66.9 +/- 0.7 mV (mean +/- SEM, n = 125). Endothelin (10(-10)-10(-6)M) induced a dose-dependent reversible membrane voltage depolarization and a dose-dependent rise in [Ca]i. The initial calcium peak was followed by a recovery phase during which oscillations of [Ca]i occurred. The initial calcium peak was not dependent on the presence of extracellular calcium and was not abolished in the presence of the calcium antagonist verapamil (10(-4)M). Thus it is probably mediated by a release of calcium from intracellular reservoirs. We conclude that cultured human ciliary muscle cells express a functional endothelin receptor.

Substance P as a transmitter in the human ciliary muscle

The present experiments, carried out on the human fresh ciliary muscle, were undertaken to define whether substance P is involved as an excitatory transmitter in the contractile response evoked by electrical stimulation. Our results show that, following cholinergic and adrenergic blockade, the resistant component of contraction was completely abolished by (D-Pro2-D-Trp7,9)-SP, a synthetic analogue of substance P with antagonistic activity. Moreover the effects of exogenous substance P were investigated.

Pharmacological characterization of human ciliary muscle adrenoceptors in vitro

The in vitro pharmacological characteristics of adrenoceptors of the human ciliary muscle were investigated. Tissue was obtained from 30 eyes used previously for corneal transplantations which had been enucleated 6-24 hr after death. Experiments were performed within 2 days of enucleation. Strips of the meridional and circular portion of the ciliary muscle were attached to a tension gauge in an organ bath and the effect of drugs added to the perfusion medium was monitored isometrically. The muscle was precontracted with physostigmine (10(-5) M) and acetylcholine (10(-5) M). The non-selective beta adrenoceptor agonist isoproterenol (10(-6)-10(-3) M) caused a dose-related relaxation of the ciliary muscle, an effect which was completely inhibited by the non-selective beta adrenoceptor antagonist timolol (10(-5) M), while the beta 1 adrenoceptor antagonist betaxolol (10(-5) M) had no effect. The beta 2 adrenoceptor agonist salbutamol (10(-6)-10(-3) M) produced a dose-related relaxation of the ciliary muscle, an effect which was completely blocked by the beta 2 adrenoceptor antagonist L1 32-468 (10(-5) M). The non-selective alpha adrenoceptor agonist noradrenaline (10(-6)-10(-3) M) also caused a dose-related relaxation of the ciliary muscle. The non-selective alpha adrenoceptor antagonists phentolamine (10(-5) M) and thymoxamine (10(-5) M) and the alpha 1 adrenoceptor antagonist prazosin (10(-5) M) partially blocked the response to noradrenaline, while the alpha 2 adrenoceptor antagonist idazoxan (10(-5) M) and timolol (10(-5) M) had no effect. The alpha 1 adrenoceptor agonist phenylephrine (5 X 10(-6)-5 X 10(-3) M) caused a dose-dependent relaxation in five out of 12 isoproterenol-sensitive muscle strips. Further, it was not possible to block the phenylephrine-induced relaxation with thymoxamine (10(-5) M). The alpha 2 adrenoceptor agonist clonidine (10(-6)-10(-3) M) had no effect. No qualitative difference between drug effects on the meridional and circular ciliary muscles was observed. We conclude from these data that beta 2, and most probably alpha 1, adrenoceptors are present on both the meridional and circular portions of the ciliary muscle of the human eye.

Effects of adrenergic drugs on accommodation and distant refraction in daylight and darkness. A laseroptometric study

Near point accommodation was measured using a RAF near point rule, and distant refraction in daylight and darkness were determined using a laseroptometer in a double-blind cross-over study on 10 healthy test subjects (19-31 years). Determinations were made before and 40 min after topical instillations of 3 X 10 microliters 10% phenylephrine, 0.5% thymoxamine, 1% adrenaline, 3% isoproterenol, 0.5% timolol and 0.5% betaxolol. Combinations of 3 X 10 microliters 0.5% thymoxamine + 10% phenylephrine, 0.5% timolol + 1% adrenaline and 0.5% betaxolol + 3% isoproterenol were also administered. The near point of accommodation decreased 0.8 +/- 0.3 diopter after instillations of the alpha 1 adrenoceptor agonist phenylephrine, while an increase of 0.6 +/- 0.2 diopter was determined after administration of the alpha adrenoceptor antagonist thymoxamine. Thymoxamine plus phenylephrine did not alter the pretreatment values. Beta adrenoceptor stimulation by isoproterenol or beta adrenoceptor inhibition by timolol or betaxolol had no effect on the near point accommodation. The difference between distant refraction in daylight and darkness, that is low-luminance myopia, amounted to -1.25 +/- 0.1 diopter. Phenylephrine caused a myopic shift in distant refraction in daylight and darkness of 0.32 +/- 0.1 and 0.9 +/- 0.2 diopter, respectively. This effect was due to the mydriatic action of phenylephrine.(ABSTRACT TRUNCATED AT 250 WORDS)