IMPORTANCE OF DEMOGRAPHIC RISK FACTORS FOR PRIMARY ANGLE CLOSURE

According to the Guidelines of the European Glaucoma Society (fourth edition), the family history in the closing angle is an important factor that makes the family screening vital in these families. It is present in the clinical case in which two twin patients in different circumstances show the same symptoms of angle closure.

Pilocarpine-loaded chitosan-PAA nanosuspension for ophthalmic delivery

Chitosan-poly(acrylic acid) (CS-PAA) nanoparticles, to be used as ophthalmic drug carrier, were successfully prepared using template polymerization of acrylic acid (AA) in a chitosan solution. When the polymerization was done at 70 degrees C for 45 min with a CS/AA weight ratio of 1:1, the surface structure of the prepared nanoparticles was most stable with the smallest mean diameter (92.0 +/- 7.5 nm) and a stable zeta potential (25.5 +/- 2.6 mV) in a buffer solution (pH 4.5). The size of the nanoparticles dramatically increased with the pH value of the medium. Both in vitro and in vivo studies revealed that the prepared nanoparticle suspension was better at sustaining the release of pilocarpine than either simulated tear fluid or commercial eye drops.

[Chitosan-coated ophthalmic submicro emulsion for pilocarpine nitrate]

The study is to design chitosan-coated pilocarpine nitrate submicro emulsion (CS-PN/SE) for the development of a novel mucoadhesive submicro emulsion, aiming to prolong the precorneal retention time and improve the ocular absorption. CS-PN/SE was fabricated in two steps: firstly, pilocarpine nitrate submicro emulsion (PN/SE) was prepared by high-speed shear with medium chain triglycerides (MCT) as oil phase and Tween 80 as the main emulsifier, and then incubated with chitosan (CS) acetic solution. The preparation process was optimized by central composite design-response surface methodology. Besides the particle size, zeta potential, entrapment efficiency and micromorphology were investigated, CS-PN/SE's precorneal residence properties and miotic effect were especially studied using New Zealand rabbits as the animal model. When CS-PN/SE was administered topically to rabbit eyes, the ocular clearance and the mean resident time (MRT) of pilocarpine nitrate were found to be dramatically improved (P < 0.05) compared with PN/SE and pilocarpine nitrate solution (PNs), since the K(CS-PN/SE) was declined to 0.006 4 +/- 0.000 3 min(-1) while MRT was prolonged up to 155.4 min. Pharmacodynamics results showed that the maximum miosis of CS-PN/SE was as high as 46.3%, while the miotic response lasted 480 min which is 255 min and 105 min longer than that of PNs and PN/SE, respectively. A larger area under the miotic percentage vs time curve (AUC) of CS-PN/SE was exhibited which is 1.6 folds and 1.2 folds as much as that of PNs and PN/SE, respectively (P < 0.05). Therefore, CS-PN/SE could enhance the duration of action and ocular bioavailability by improving the precorneal residence and ocular absorption significantly.

[Glaucoma treatment during pregnancy and lactation]

4 cases of glaucoma during pregnancy and lactation are represented to study individual treatment approach in situations like these. Clinical characteristic of medications used and other treatment options are described.

Characterization of pilocarpine-loaded chitosan/Carbopol nanoparticles

Patients using ophthalmic drops are faced with frequent dosing schedules and difficult drop instillation. Therefore, a long-lasting pilocarpine-loaded chitosan (CS)/Carbopol nanoparticle ophthalmic formulation was developed. The physicochemical properties of the prepared nanoparticles were investigated using dynamic light scattering, zeta-potential, transmission electron microscopy, Fourier transform infrared ray spectroscopy (FT-IR) and differential scanning calorimetry (DSC). The sustained-release effects of pilocarpine-loaded nanoparticles were evaluated using in-vitro release and in-vivo miotic tests, and compared with pilocarpine in solution, gel and liposomes. We found that the prepared nanoparticles were about 294 nm in size. DSC and FT-IR studies suggested that an electrostatic interaction between CS and Carbopol contributes at least in part to the stabilization of pilocarpine/CS/Carbopol nanoparticles. When compared with pilocarpine in solution, gel or liposomes, the best slow-release profile of pilocarpine from the prepared nanoparticles occurred in a dissolution test. In the in-vivo miotic study, pilocarpine-loaded CS/Carbopol nanoparticles showed the most significant long-lasting decrease in the pupil diameter of rabbits. The advantages of CS and Carbopol are good biocompatibility, biodegradability and low toxicity. CS is also a mucoadhesive polymer. Thus, pilocarpine/CS/Carbopol nanoparticles may provide an excellent potential alternative ophthalmic sustained-release formulation of pilocarpine for clinical use. CS/Carbopol nanoparticles may also be useful for a variety of other therapeutic delivery systems.

The effect of cataract extraction on the contractility of ciliary muscle

PURPOSE

To evaluate the changes in the pilocarpine-induced contractility of the ciliary muscle in eyes with presbyopia before and after cataract extraction using ultrasound biomicroscopy (UBM).

DESIGN

Prospective interventional case series.

METHODS

A clear corneal phacoemulsification and posterior chamber intraocular lens (AcrySof SA60AT; Alcon Laboratories, Fort Worth, Texas, USA) was implanted in 23 eyes in 15 subjects. UBM was performed with and without instilling 2% pilocarpine, as well as before and two months after cataract extraction. The mean (+/- standard deviation) age was 65.33 +/- 6.09 years (range, 56 to 75 years). The increase in the axial length of the ciliary body (CBAXL) was used as a surrogate indicator of the centripetal ciliary muscle contraction during accommodation. Images of the ciliary body were compared visually using Adobe Photoshop 7.0 (Adobe Systems Inc., San Jose, California, USA).

RESULTS

The CBAXL value with and without pilocarpine before cataract extraction was 1.708 +/- 0.165 mm and 1.689 +/- 0.187 mm, respectively, which was not significantly different (P = .261). The CBAXL value with and without pilocarpine after cataract extraction was 1.998 +/- 0.375 mm and 1.675 +/- 0.279 mm, respectively, which was significantly different (P < .001). The visually compared configurations of the changes in the ciliary body were compatible with the analysis of the measured parameters.

CONCLUSIONS

Pilocarpine induced only subtle movement of the ciliary body before cataract surgery. However, after cataract extraction, it induced significant centripetal movement of the ciliary body compared with that without pilocarpine. This shows that a lenticular sclerotic component may influence both lens movement and the contractility of the ciliary muscle, and is believed to be related to the presbyopia.

Effect of Brimonidine Tartrate 0.15% on Scotopic Pupil: Controlled Trial

PURPOSE

The aim of this study was to evaluate the duration of the effect of one single dose of brimonidine tartrate 0.15% on pupil diameter, under scotopic conditions, when applied topically in 1 eye of normal subjects.

METHODS

The eyes of 19 normal volunteers were randomized so that 1 eye had 1 drop of brimonidine tartrate 0.15% and the other received no medication. Pupil diameter was measured using an infrared pupillometer. The first measure was obtained before the instillation of brimonidine. After that, four measures, with 2-h intervals, were performed.

RESULTS

From 19 participants, 14 were women and 5 were men, with a mean age of 25.05 years (standard deviation, +/- 6.98). Before brimonidine instillation, mean pupil diameter in the control eyes was 5.11 mm, and in the brimonidine eyes it was 5.15 mm. After 8 h, the mean pupil size was 4.01 mm in the treated eyes, and 4.56 mm in the untreated eyes. There was a tendency of miotic effect to be more important on the treated eye, as compared to the control eye in all intervals, but this did not reach statistical significance (P = 0.375). When comparing both eyes, independently of the periods, the treated eye had a smaller diameter than the untreated eye (P = 0.038). The miotic effect was observed for at least 8 h after instillation.

CONCLUSIONS

Miotic response of brimonidine tartrate 0.15% lasted for at least 8 h and has a significant effect on the nontreated eye.

[What should we think? Should Diamox and pilocarpine continue to be prescribed?]

Despite well-known adverse effects, pilocarpine and acetazolamide remain useful medications for the therapeutic management of glaucomatous patients.

Barrier qualities of the mouse eye to topically applied drugs

The mouse eye displays unusually rapid intraocular pressure (IOP) responses to topically applied drugs as measured by the invasive servo-null micropipette system (SNMS). To learn if the time course reflected rapid drug transfer across the thin mouse cornea and sclera, we monitored a different parameter, pupillary size, following topical application of droplets containing 40 microM (0.073 microg) carbachol. No miosis developed from this low carbachol concentration unless the cornea was impaled with an exploring micropipette as used in the SNMS. We also compared the mouse IOP response to several purinergic drugs, measured by the invasive SNMS and non-invasive pneumotonometry. Responses to the previously studied non-selective adenosine-receptor (AR) agonist adenosine, the A(3)-selective agonist Cl-IB-MECA and the A(3)-selective antagonist MRS 1191 were all enhanced to varying degrees, in time and magnitude, by corneal impalement. We conclude that the thin ocular coats of the mouse eye actually present a substantial barrier to drug penetration. Corneal impalement with even fine-tipped micropipettes can significantly enhance entry of topically-applied drugs into the mouse aqueous humor, reflecting either direct diffusion around the tip or a more complex impalement-triggered change in ocular barrier properties. Comparison of invasive and non-invasive measurement methods can document drug efficacy at intraocular target sites even if topical drug penetration is too slow to manifest convincing physiologic effects in intact eyes.

Effects of pharmacologically manipulated amplitude and starting point on edinger-westphal-stimulated accommodative dynamics in rhesus monkeys

PURPOSE

The aim of this study was to determine whether pharmacologically manipulated resting refraction, amplitude, and starting point affect accommodative and disaccommodative dynamics in anesthetized adolescent rhesus monkeys.

METHODS

Pilocarpine and atropine were applied topically to manipulate resting refraction, accommodative amplitude, starting point, and end point in two monkeys with permanent electrodes in the Edinger-Westphal nucleus. Accommodation was centrally stimulated with submaximal and maximal current amplitudes. Dynamic accommodative responses were measured with infrared photorefraction before and during the course of action of the drugs. Accommodative and disaccommodative dynamics were analyzed in terms of peak velocity as a function of amplitude, starting point, and end point.

RESULTS

Pilocarpine caused a myopic shift in resting refraction of 11.62 +/- 1.17 D. Centrally stimulated accommodative amplitude was 10.08 +/- 1.15 D before pilocarpine and 0.68 +/- 0.29 D after pilocarpine. Changes were found in accommodative dynamics as a function of starting point and in disaccommodative dynamics as a function of amplitude and end point. Accommodative amplitude was 11.25 +/- 0.18 D before atropine administration and 0.52 +/- 0.11 D after atropine administration. Accommodative dynamics as a function of amplitude were not substantially altered during the course of pilocarpine-induced accommodation or atropine-induced cycloplegia.

CONCLUSIONS

Accommodative response amplitude is reduced with pilocarpine by shifting the eye to a more myopic state and with atropine by cycloplegia. Pharmacologic manipulations showed that accommodative and disaccommodative dynamics in anesthetized monkeys depend on amplitude, starting point, and end point of the response and on the contributions of neural and receptor activity.

Short-Term Effects of Latanoprost on Anterior Chamber Depth in Patients with Glaucoma or Ocular Hypertension

PURPOSE

Prostaglandin F(2alpha) analogues, such as latanoprost, may cause a decrease in the extracellular matrices, such as collagen, and changes in fibrillin-1; both are components of the ciliary zonules. However, the mechanical effect of these changes on the dynamics of the ciliary zonules is unknown. This study was conducted to evaluate the effect of latanoprost 0.005% on anterior chamber depth (ACD), best corrected visual acuity (BCVA), lens thickness, and anterior chamber dynamics in patients with glaucoma or ocular hypertension.

METHODS

This was a prospective, nonrandomized, autocomparative trial that included 40 patients (40 eyes) with glaucoma or ocular hypertension. ACD was measured with ultrasonography before and after 1 month of treatment with latanoprost. In addition, ACD was measured before and 1 hour after instillation of pilocarpine 2% at baseline and 1 month after treatment with latanoprost. To assess the reproducibility of the ultrasonic measurements, a control group of 20 patients (20 eyes) who did not receive latanoprost was also analyzed.

RESULTS

The mean ACD before treatment with latanoprost and before the instillation of pilocarpine was 3.14 +/- 0.46 mm (SD) and after the instillation of pilocarpine, 3.04 +/- 0.46 mm (SD). After 1 month of treatment with latanoprost, ACD was 2.98 +/- 0.44 mm (SD) before instillation of pilocarpine and 2.91 +/-0.49 mm (SD) after instillation of pilocarpine. P < or = 0.05 was reached for all comparisons.

CONCLUSIONS

These findings suggest that latanoprost decreases ACD in patients with glaucoma or ocular hypertension after 1 month of treatment.

Phase transition water-in-oil microemulsions as ocular drug delivery systems: in vitro and in vivo evaluation

Microemuslion (ME)-based phase transition systems were evaluated for ocular delivery of pilocarpine hydrochloride (model hydrophilic drug). These used two non-ionic surfactants, sorbitan mono laurate and polyoxyethylene sorbitan mono-oleate with ethyl oleate (oil component) and water. These systems undergo phase change from ME to liquid crystalline (LC) and to coarse emulsion (EM) with a change in viscosity depending on water content. This study selected five formulations containing aqueous phase at 5% (w/w) (ME 5%), 10% (w/w) (ME 10%), 26% (w/w) (LC), 85% (w/w) (O/W EM) and 100% (solution) with the model drug at 1% (w/w). Incorporation of pilocarpine hydrochloride did not affect the phase behaviour. The viscosity was increased initially with dilution from ME 5% to ME 10% then LC, indicating structuring of the system, before being reduced in the EM formulation. Drug release depended on the viscosity with lower release rates obtained from formulations with high viscosity. The miotic response and duration of action were greatest in case of ME and LC formulations indicating high ocular bioavailability. Thus, phase transition ME is promising for ocular drug delivery as it provides the fluidity with its viscosity being increased after application increasing ocular retention while retaining the therapeutic efficiency.

Objective measurement of intraocular lens movement and dioptric change with a focus shift accommodating intraocular lens

PURPOSE

To objectively measure the shift and refractive change of the 1CU accommodating intraocular lens (IOL) (HumanOptics) and compare them to that of a monofocal AcrySof MA30 IOL (Alcon Laboratories) in the fellow eye.

SETTING

Ophthalmology Department, St. Thomas' Hospital, London, United Kingdom.

METHODS

Thirty patients who had bilateral cataract surgery 18 to 24 months previously with a 1CU IOL prospectively randomly allocated to 1 eye and an AcrySof MA30 monofocal IOL to the other eye were examined. Distance correction, near vision, reading fluency, near point, and defocus to minus spheres were measured. Intraocular lens shift to an accommodative stimulus following instillation of pilocarpine 4% was measured with the ACMaster. Refractive change between distance and near was measured with the Tracey wavefront analyzer.

RESULTS

Of the original 30 patients recruited, complete measurements could only be obtained for 20. There was no significant difference in near visual function with either IOL. A small anterior movement of the 1CU was seen with accommodation 0.010 mm +/- 0.028 (SD). After pilocarpine 4% instillation, a forward movement of 0.220 +/- 0.169 mm was seen with the 1CU compared to a backward movement of 0.028 +/- 0.095 with the MA30. There was no significant correlation between distance corrected near visual acuity and IOL movement. No change in spherical equivalent between distance and near was seen on wavefront analysis of either IOL.

CONCLUSIONS

Small forward movement of the 1CU IOL was seen with accommodation and increased following pilocarpine, compared to the posterior movement of the MA30 IOL. The amount of the IOL shift was not sufficient to provide useful near vision, but the difference suggests that the engineering concept behind the 1CU IOL is valid.

Pharmacological-induced Haptic Changes and the Accommodative Performance in Patients With the AT-45 Accommodative IOL

PURPOSE

To investigate the accommodative performance of the AT-45 (eyeonics Inc, Aliso Viejo, Calif) using three-dimensional ultrasound biomicroscopy.

METHODS

The AT-45 haptic region was visualized in vivo 1 month after surgery in four patients using an in-house developed three-dimensional ultrasound biomicroscope. Haptic changes, axial shift, and accommodation amplitude were determined under pharmacologically induced accommodation.

RESULTS

The angulation, depending on the accommodation state, could be distinguished and analyzed. In vivo a mean change in haptic angulation of 3.3 +/- 3.3 degrees (range: 0 degrees to 7 degrees) and a mean forward shift of 0.13 +/- 0.08 mm (range: 0.05 to 0.2 mm) were observed for the AT-45 using pharmacologically induced accommodation. A mean accommodative amplitude of 0.44 +/- 0.24 diopters (D) (range: 0.25 to 0.75 D) was found using a Hartinger coincidence refractometer.

CONCLUSIONS

Minimal angulation changes and axial movements of the AT-45 have been demonstrated using pharmacological stimulation and objective measurement methods. The mechanical performance of the AT-45 in these eyes does not appear to provide the range of accommodation necessary for close work.

[Use of antiglaucoma therapy to reduce acute intraocular pressure rise following neodymium: YAG laser iridotomy in angle-closure glaucoma patients]

AIM

To evaluate the efficacy of topical antiglaucoma therapy in reducing acute intraocular pressure (IOP) elevation after neodymium: Yag laser iridotomy.

PATIENTS AND METHODS

Primary angle-closure glaucoma (PACG) eyes were randomized to receive premedication with latanoprost and pilocarpine, brimonidine 0.2% and pilocarpine or only with pilocarpine before Yag laser iridotomy. Postoperative IOP changes were compared with Wilcoxon signed-ranks test using the fellow eyes in each group.

RESULTS

Postoperative pressure spikes were significantly lower in the groups of patients with local antiglaucoma therapy with pilocarpine than in the control group. Mean elevation of IOP was less in the groups of patients with local antiglaucoma therapy with pilocarpine at 2 hours postoperatively.

CONCLUSION

Local antiglaucoma therapy may reduce the acute IOP rise following Yag laser iridotomy in PACG eyes.

Drug-induced intraocular lens movement and near visual acuity after AcrySof intraocular lens implantation

PURPOSE

To evaluate the factors influencing AcrySof intraocular lens (IOL) (Alcon Laboratories) movement and near visual acuity after cyclopentolate 1% and pilocarpine 2%.

SETTING

Department of Ophthalmology, University of Ankara, Ankara, Turkey.

METHODS

Thirty eyes of 22 patients with AcrySof IOL implantation were included in this prospective study. Near visual acuity (Jaeger) at 35 cm through best distance correction without an add and pupil diameter were measured and correlated with anterior chamber depth (ACD) measured with ultrasound biomicroscopy (UBM) after application of cyclopentolate 1% and pilocarpine 2%, respectively. The magnitude of the change in the ACD was correlated with the accommodation amplitude, patient age, time interval between surgery and imaging, preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and presence of posterior capsule opacification (PCO).

RESULTS

Near visual acuity significantly decreased after application of cyclopentolate 1% and increased after application of pilocarpine 2% (P < .001) in all eyes. The IOL moved anteriorly in 8 (26%) eyes and posteriorly in 22 (74%) eyes after pilocarpine 2%. There was no correlation between the ACD and near visual acuity under cyclopentolate 1% (r = 0.06, P > .05) or pilocarpine 2% (r = 0.04, P > .05). There was a moderate correlation between the anterior IOL movement and accommodation amplitude (P < .05, r = 0.42). There was no correlation between the magnitude of the IOL movement and patient age, time interval between surgery and imaging, the preoperative axial length, capsulorhexis diameter, ACD during cycloplegia, IOL diameter, and the presence of PCO (P > .05).

CONCLUSIONS

There was better near visual acuity in all eyes with the AcrySof MAIOL, although most IOLs move slightly backward after of pilocarpine 2%. This points out pseudoaccommodation rather than pseudophakic accommodation. Ultrasound biomicroscopy is useful in determining the ACD and the relation between the IOL and the surrounding tissues after cataract surgery.

[A case of angle closure glaucoma attack treated during perioperative period of emergency ileus operation]

Angle-closure glaucoma is a severe disease that may lead to loss of eyesight. We report a case of an 80-year-old woman diagnosed as left angle-closure glaucoma just before the emergency ileus operation. Before the operation, pilocarpine eye drop was given for the left eye and laser-iridotomy for the right eye was performed, with mannitol given as indicated by the ophthalmologist. After the operation, eye drop was administered to both eyes until she left the surgical ward 20 days after the operation. Three days after the operation the patient had another attack and mannitol was given again. The cause of the attacks was unclear, but the treatment was effective and the patient showed a good recovery. Twenty six days after the operation, the patient was admitted to the ophthalmic ward and underwent extracapsular extraction of the senile cataract of the left eye, which was also a treatment for the glaucoma. Anatomical structure of the eye, changes in environment, medicine, and anesthetic maneuvers have effects on the eye pressure. In addition to efforts to prevent the attack, quick discovery and adequate treatment are important for angle-closure glaucoma.

Steepening of corneal curvature with contraction of the ciliary muscle

PURPOSE

To measure the changes of corneal curvature during contraction of the ciliary muscle.

SETTING

Department of Ophthalmology, St. Luke's International Hospital, Tokyo, Japan.

METHODS

Twenty-eight eyes of 14 healthy volunteers under 40 years old were enrolled in this prospective randomized controlled study and divided into pilocarpine and control groups. Intraocular pressure (IOP), pupil diameter, and corneal topography were measured before and 40 minutes after instillation of topical pilocarpine 4% or balanced salt solution. Corneal topography was analyzed for the mean ring-power of Placido rings 1 through 25, average corneal power (ACP), and for spherical equivalent, regular astigmatism, asymmetry, and high-order irregularity by Fourier analysis.

RESULTS

Pilocarpine had no effect on IOP, but it did cause a significant decrease in mean pupil diameter. Simultaneously, pilocarpine increased the mean ring powers for Placido rings 1 through 4 and the ACP (+0.13 diopters (D) +/- 0.17 [SD]; P=.017). By Fourier analysis, the mean spherical component for the central 3.0 mm of the cornea increased in the pilocarpine group (+0.08 +/- 0.15 D; P=.020). There were no changes in components of regular astigmatism, asymmetry, and high-order irregularity.

CONCLUSIONS

The central cornea steepened in curvature and increased in power owing to contraction of the ciliary muscle. The results suggest that changes in corneal curvature increase refractive power during accommodation.

Characterization of the force effect of aqueous and oily eye drops

During the instillation of eye drops the drop impact affects a mechanical irritation on the eye surface. The force impact occurring in the moment of impact may be measured in vitro. Four commercially available eye drop preparations of different consistency and viscosity were tested. In dependance on the drip distance, the quantity of force impact was determined as well as the maximally effecting force during impact in each case. Whereas the force impact increased with all preparations with rising drip distance, only the higher viscosity solutions showed an approximate linear increase of the maximal force. With the aqueous low-viscosity eye drops, peak forces were ascertained. The drop oscillation was considered as the cause. The test results show that the consistency of eye drop preparations and their resulting physical-chemical properties like viscosity influence the quantity of the maximal force during the drop impact.

Influence of pupillary diameter, ciliary muscle tone, and ambient light on nerve fiber layer measurements with scanning laser polarimetry

PURPOSE

To evaluate the influence of the pupillary diameter, ciliary muscle tone, and room light on nerve fiber layer measurements with the scanning laser polarimeter (GDx).

METHODS

One randomly selected eye of ten normal volunteers was examined with the GDx in a two-day protocol under eight testing conditions (pilocarpine 1%, phenylephrine 10%, tropicamide 1%, or no drops with room lights on or off). The twelve parameters, obtained by the GDx, were compared under the eight testing conditions, using two way ANOVA for repeated measurements and Tukey HSD post hoc test.

RESULTS

Ten of the twelve parameters were statistically significantly different (P < 0.05) when measured under the three medication or no medication conditions, controlling for the ambient light status. There were no significant differences when measured with the light on or off, controlling for use of drops.

CONCLUSIONS

Nerve fiber layer measurements with the GDx were influenced by drugs affecting pupillary diameter, but not by the status of room light or ciliary muscle tone.

Quantifying effects of retinal illuminance on frequency doubling perimetry

PURPOSE

To measure and quantify effects of variation in retinal illuminance on frequency doubling technology (FDT) perimetry.

METHODS

A Zeiss-Humphrey/Welch Allyn FDT perimeter was used with the threshold N-30 strategy. Study 1, quantifying adaptation: 11 eyes of 11 subjects (24-46 years old) were tested with natural pupils, and then retested after stable pupillary dilation with neutral density filters of 0.0, 0.6, 1.2, and 1.6 log unit in front of the subject's eye. Study 2, predicting effect of reduced illuminance: 17 eyes of 17 subjects (26-61 years old) were tested with natural pupils, and then retested after stable pupillary miosis (assessed with an infrared camera). A quantitative adaptation model was fit to results of Study 1; the mean adaptation parameter was used to predict change in Study 2.

RESULTS

Study 1: Mean defect (MD) decreased by 10 dB over a 1.6 log unit range of retinal illuminances; model fits for all subjects had r2> 95%. Study 2: Change in MD (DeltaMD) ranged from -7.3 dB to +0.8 dB. The mean adaptation parameter from Study 1 accounted for 69% of the variance in DeltaMD (P <0.0005), and accuracy of the model was independent of the magnitude of DeltaMD (r2< 1%, P >0.75).

CONCLUSIONS

The results confirmed previous findings that FDT perimetry can be dramatically affected by variations in retinal illuminance. Application of a quantitative adaptation model provided guidelines for estimating effects of pupil diameter and lens density on FDT perimetry.

Accommodation measurements in a prepresbyopic and presbyopic population

PURPOSE

To study the efficacy of several subjective and objective methods of accommodation measurement in normal prepresbyopic and presbyopic populations to identify appropriate methods for measuring the outcome of accommodative restorative procedures.

SETTING

University of Houston, College of Optometry, Houston, Texas, USA.

METHODS

Thirty-one normal subjects with a mean age of 43.7 years (range 31 to 53 years) participated. Accommodation was measured monocularly using 3 subjective approaches--the push-up test, minus lenses to blur, and a focometer--and 2 approaches measured with a Hartinger coincidence refractometer, in which accommodation was stimulated with minus lenses to blur and topical pilocarpine 6%.

RESULTS

The push-up method overestimated accommodative amplitude relative to objective measures in 28 subjects. Two subjective methods, minus lenses to blur and the focometer, produced comparable results, but with lower amplitudes in younger subjects and higher amplitudes in older subjects compared with objective methods. Comparable results were obtained when accommodation was stimulated in 1 of 2 ways and measured with the Hartinger. Pilocarpine elicited stronger accommodative responses than distance blur for subjects with low accommodative amplitudes. Pilocarpine 6% produced stronger responses in subjects with light irides than in those with dark irides.

CONCLUSIONS

Hartinger-measured accommodation provides more realistic measurement of accommodative amplitude than the subjective methods tested, especially in the presbyopic population. In presbyopic subjects, the subjective tests resulted in accommodative amplitudes up to 4.0 diopters greater than those measured with objective tests. Measurements of accommodative amplitude are best achieved with objective methods to stimulate and measure accommodation.

Micellar solutions of triblock copolymer surfactants with pilocarpine

Solutions of surface active triblock copolymer Pluronic F127 in the vicinity of the critical micellar concentration (cmc) were prepared with or without pilocarpine (either as the hydrochloride salt or the free base) in water and phosphate buffer. The characteristics parameters of the surface activity (cmc, Gamma and a) were determined for F127 solutions. Additionally, it was found that the pilocarpine solutions without F127 in water exhibits a certain surface activity. The solutions containing F127 (2 wt.%) well above the cmc and pilocarpine (2 wt.% for the salt, or equimolar 1.7 wt.% for the base) were further tested in vivo (miotic response) on rabbit eye. Though the entrapment efficiency of the drug in the micelles was rather low (maximal 1.9%) the pharmacokinetic parameters (duration of miotic response and the area under miotic curve) were improved when compared to the standard pilocarpine solutions. The best results were obtained for the micellar pilocarpine base solution which exhibits significant prolongation of miotic activity and an increase of AUC for 64%.

Effect of intracameral injection of lidocaine and carbachol on the rabbit corneal endothelium

PURPOSE

To determine the effect of intracameral injection of preservative-free lidocaine 1% and carbachol 0.01% on corneal endothelial cells of rabbits.

SETTING

Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.

METHODS

Forty eyes of 20 New Zealand White rabbits were divided into 2 equal groups. In the first group, 1 eye was injected with 0.02 mL of preservative-free lidocaine 1% and the fellow eye was injected with 0.02 mL of normal saline as a control. In the second group, 1 eye was injected with 0.02 mL of carbachol 0.01% and the fellow eye was injected with 0.02 mL of normal saline. Specular microscopy was used to evaluate corneal endothelial cell loss and corneal thickness 1 week and 1 month postinjection. For morphologic studies, corneal buttons were excised and stained with alizarin red with trypan blue. Scanning electron microscopy (SEM) examination was performed.

RESULTS

Specular microscopy revealed no significant endothelial cell loss and normal endothelial thickness with the intracameral injection of preservative-free lidocaine 1% and carbachol 0.01% compared with the control eye. Alizarin red with trypan blue stain and SEM examinations revealed smooth, distinct, and intact intercellular borders and normal viability of corneal endothelial cells in both groups.

CONCLUSIONS

Intracameral injections of preservative-free lidocaine 1% and carbachol 0.01% do not produce morphologic and functional changes in the corneal endothelial cells of rabbits.

Role of calcitonin gene-related peptide in the phenol-induced neurogenic hypertension in rats

Previous investigations have demonstrated that capsaicin-sensitive sensory nerves are involved in the development of hypertension in some rat models of hypertension. To determine the role played by calcitonin gene-related peptide (CGRP; the predominant neurotransmitter in capsaicin-sensitive sensory nerves) in a rat model of neurogenic hypertension, in which hypertension was induced by injecting 50 microl of 10% phenol in the lower pole of the left kidney, systolic blood pressure (SBP) was monitored by the tail-cuff method throughout the experiment. Fifteen days after injection of phenol, mean arterial pressure (MAP), concentrations of CGRP in the plasma, the expression of CGRP mRNA in dorsal root ganglia (DRG) and CGRP content in laminae I and II of the spinal cord were measured. SBP was significantly increased 5 days after the intrarenal injection of phenol (164+/-7 mm Hg, p<0.01). At the end of experiment, blood pressure (BP) was significantly elevated in the phenol-injected rats compared with the controls (SBP: 187+/-6 vs. 122+/-4 mm Hg, p<0.01; MAP: 157.56+/-3.02 vs. 103.80+/-2.04 mm Hg, p<0.01). Treatment with capsaicin, which selectively depletes neurotransmitters from the capsaicin-sensitive nerves, failed to enhance the development of hypertensive responses to the intrarenal injection of phenol. Intravenous administration of CGRP(8-37), the specific CGRP receptor antagonist, also failed to increase the already elevated MAP. The expression of CGRP mRNA (both alpha- and beta-CGRP isoforms), the content of CGRP in laminae I and II of the dorsal horn of the spinal cord and the concentration of CGRP in the plasma was decreased in the rats treated with phenol. These results suggest that CGRP does not play a counterregulatory role in the phenol-induced hypertensive rats, and support the hypothesis that reduction of CGRP (alpha and beta isoforms) could contribute to a blood pressure elevation in this setting.

Changes in the shape of the anterior and posterior corneal surfaces caused by mydriasis and miosis

PURPOSE

To evaluate changes in the anterior and posterior corneal shape, corneal thickness, and anterior chamber depth (ACD) caused by mydriasis or miosis using scanning-slit corneal topography.

SETTING

Department of Ophthalmology, Iwate Medical University School of Medicine, Iwate, Morioka, Japan.

METHODS

Twenty-eight eyes of 28 healthy volunteers with refractive errors of -6.00 to +0.25 diopters were studied. One eye of each subject had instillation of tropicamide-phenylephrine hydrochloride (Mydrin P) to obtain mydriasis and of pilocarpine hydrochloride 2% (Sanpilo) to obtain miosis. To assess the corneal shape, the best-fit sphere (BFS), axial power, and tangential power were measured for the anterior and posterior corneal surfaces before and after mydriasis and before and after miosis using scanning-slit corneal topography (Orbscan version 3.0, Orbtek, Inc.). The pupil size, corneal thickness, and ACD were also examined before and after mydriasis and before and after miosis.

RESULTS

The mean age of the patients was 31.1 years +/- 5.6 (SD) (range 20 to 46 years). The anterior BFS changed from a mean of 8.04 +/- 0.3 mm at the time of mydriasis to a mean of 8.00 +/- 0.3 mm at the time of miosis. The posterior BFS changed from 6.53 +/- 0.3 mm to 6.46 +/- 0.3 mm, respectively. Thus, the anterior and posterior cornea became significantly steeper after miosis (P<.01). The ACD was significantly more shallow after miosis than after mydriasis. However, there was no significant difference in corneal thickness after mydriasis or miosis.

CONCLUSIONS

The anterior and posterior corneal shapes changed as a result of mydriasis and miosis, and the refractive power of the cornea significantly increased after miosis. To date, changes in refractive power from changes in pupil size have been attributed to a change in the refractive power of the crystalline lens; however, it is now thought that changes in corneal refractive power also occur.

Calcitonin gene-related peptide and substance P induce pronounced motor effects in the female rat urethra in vivo

OBJECTIVE

This study was performed to investigate the influence of calcitonin gene-related peptide (CGRP) and substance P (SP) on the intra-urethral pressure in female rats, as both these neuropeptides have been demonstrated to occur in nerve fibres throughout all layers of the intrinsic external urethral sphincter of the rat.

MATERIAL AND METHODS

Both CGRP and SP were administered intra-arterially relatively close to the bladder in ketamine-anaesthetized female rats. The maximum urethral pressure (MUP) was recorded continuously using a 4 F microtip single-transducer catheter.

RESULTS

Pronounced effects on the intra-urethral pressure were found with both CGRP and SP. CGRP at the maximum dose given (10 micrograms) induced an immediate, pronounced, long-lasting decrease in pressure from 28 +/- 4 to 10 +/- 2 cmH(2)O, amounting to 65% of the MUP. SP (10 micrograms) instead induced a forceful, phasic, peak-like contractile response with a 170% increase in urethral pressure from 33 +/- 6 to 87 +/- 6 cmH(2)O of the initial control level of MUP. Antagonists to CGRP and SP did not induce any pressure changes per se.

CONCLUSION

These results indicate that both CGRP and SP are of importance for the peripheral motor regulation of the external urethral sphincter, and hence possibly also of physiological importance for lower urinary tract function during essential parts of the micturition cycle.

Effect of accommodation and pupil size on the movement of a posterior chamber lens in the phakic eye

PURPOSE

Although a posterior chamber phakic intraocular lens provides effective refractive correction of high myopia and hyperopia, mechanical contact between the implantable contact lens (ICL) and the crystalline lens and inadequate aqueous circulation in the prelenticular space could cause subcapsular opacification. To assess whether and to what extent such mechanical contact occurs, changes in the distance between the STAAR Collamer ICL and the crystalline lens under various conditions were investigated.

DESIGN

Open pilot study.

PARTICIPANTS

Thirteen eyes of 11 myopic and 2 hyperopic patients with a mean age of 38 years (range, 19-53 years) were examined at least 6 months after ICL implantation.

METHODS

A noninvasive, high-resolution biometry technique, partial coherence interferometry, was used to measure distance changes between the ICL and the crystalline lens during subjective accommodation, after instillation of pilocarpine, and under changing light conditions.

MAIN OUTCOME MEASURES

Mean distance changes from the posterior corneal surface to the ICL, from the posterior corneal surface to the anterior surface of the crystalline lens, and the distance between the ICL and the crystalline lens.

RESULTS

In the nonaccommodated state, the mean distance between the ICL and the crystalline lens was 457 microm (range, 123-924 microm). During subjective accommodation, a significant (P<0.01) decrease and, after topical application of pilocarpine, a nonsignificant (P=0.35) decrease of anterior chamber depth was accompanied by a nonsignificant (P = 0.71) reduction of the ICL-crystalline lens distance. Under photopic conditions, a significant mean reduction (P<0.01) of the ICL-crystalline lens distance of -28 microm (range, -16 to -188 microm) was observed.

CONCLUSIONS

Partial coherence interferometry biometry enabled noninvasive high-precision investigation of ICL dynamics. No significant changes between the ICL and the crystalline lens were detected during subjective accommodation and after application of pilocarpine. However, under photopic conditions, with constriction of the pupil, the distance between the ICL and the crystalline lens was significantly reduced. This mechanism might cause inadequate aqueous circulation in the prelenticular space and might be one of the causes of subcapsular opacification in some of the eyes after ICL implantation.

Oral pilocarpine for the treatment of ocular symptoms in patients with Sjögren's syndrome: a randomised 12 week controlled study

OBJECTIVE

To evaluate the efficacy and side effects of oral pilocarpine for the treatment of ocular symptoms in patients with primary Sjögren's syndrome (SS).

METHODS

A 12 week, single centre, randomised controlled study was performed. Twenty nine patients were randomly assigned to receive oral pilocarpine (5 mg twice a day), 28 only artificial tears, and 28 inferior puncta occlusion. Patients receiving oral pilocarpine and those with inferior puncta occlusion also received artificial tears. Patients were evaluated at baseline and throughout the study for their subjective global assessment of dry eyes and for their objective assessment of dry eyes (Schirmer's-I test, rose bengal test, and imprint test).

RESULTS

Patients taking oral pilocarpine had significant improvement in subjective global assessment of dry eyes, as was evaluated by improvement of >55 mm on a visual analogue scale (VAS) for responses to the eye questionnaire, compared with patients treated with artificial tears (p<0.001) and those with inferior puncta occlusion (p<0.05). Furthermore, patients receiving oral pilocarpine also showed greater objective improvement, as measured by the rose bengal test (p<0.05), while Schirmer's-I test showed no differences between the treated groups. Commonly reported adverse events were headache, increased sweating, nausea, and vomiting in the pilocarpine group, while one patient in the inferior puncta occlusion group had blepharitis and was withdrawn from the study.

CONCLUSION

10 mg of pilocarpine daily given to patients with SS for 12 weeks had a beneficial effect on subjective eye symptoms, as evaluated by improvement >55 mm on a VAS. Additionally, an improvement of rose bengal staining was noted, but an increase in tear production, as measured by the Schirmer-I test, was not substantiated.

Subjective and objective measurement of human accommodative amplitude

PURPOSE

To assess objective and subjective methods to measure accommodation in a young human population.

SETTING

Research laboratory, University of Houston, College of Optometry, Houston, Texas, USA.

METHODS

Accommodation was measured in the right eye of 15 young subjects (9 women and 6 men) whose ages ranged from 23 to 28 years and 1 36-year-old subject. The mean age of all subjects was 26 years. Accommodation was stimulated and measured with 4 techniques. Two subjective measures (focometer and minus-lens procedures) were used. Accommodation was also stimulated with minus-lens-induced blur and with pilocarpine 6% and measured objectively with a Hartinger coincidence refractometer.

RESULTS

Accommodative amplitudes measured with the 2 subjective methods agreed with each other but differed from the objectively measured amplitudes. Objectively measured accommodative amplitudes were similar in all subjects, with a mean of about 7.0 diopters. Accommodation stimulated with pilocarpine reached a maximum 33 minutes after administration. Individuals with light irides showed a stronger accommodative response to pilocarpine than subjects with dark irides.

CONCLUSIONS

Subjective measures of accommodation tend to overestimate true accommodative amplitude. Methods exist to measure accommodation objectively. These include stimulating accommodation with trial lenses or pilocarpine 6% and measuring the accommodative response with an objective optometer such as a Hartinger coincidence refractometer. Objective measures of accommodation should be used to determine whether accommodation can be restored in presbyopes.

Theoretical and Measured Pseudophakic Accommodation After Implantation of a New Accommodative Posterior Chamber Intraocular Lens

OBJECTIVE

To analyze different techniques of measuring accommodation after implantation of a new accommodative posterior chamber intraocular lens (PCIOL).

METHODS

In this comparative, nonrandomized interventional study, we analyzed 15 eyes of 15 patients (aged 44-84 years) at 6 months after cataract surgery and PCIOL implantation (Akkommodative 1CU; HumanOptics AG, Erlangen, Germany) and compared these results with those of an age-matched control group (n = 15). We used the following methods to measure accommodation: dynamic measurement with objective (videorefractometry [PowerRefractor; PlusOptix, Erlangen] and streak retinoscopy) and subjective (subjective near point [push-up test and accommodometer] and defocusing) techniques, as well as static measurement of the change in anterior chamber depth (ACD) using the IOLMaster (Zeiss, Jena, Germany) after pharmacological stimulation using 2% pilocarpine eye drops.

MAIN OUTCOME MEASURES

Theoretical accommodation calculated from the forward shift of the lens optics (decrease of ACD) using paraxial geometrical optics and measured accommodation amplitude.

RESULTS

Accommodation amplitude (mean +/- SD; range; median) results after 6 months in the study and control groups were as follows: 1.00 +/- 0.44; 0.75-2.13; 1 diopter (D); and 0.35 +/- 0.26; 0.10-0.65; 0.25 D, respectively, using the PowerRefractor; 0.99 +/- 0.48; 0.13-2.00; 0.88 D; and 0.24 +/- 0.21; -0.13-0.75; 0.25 D, respectively, using retinoscopy; 1.6 +/- 0.55; 0.50-2.56; 1.7 D; and 0.42 +/- 0.25; 0.00-0.75; 0.50 D, respectively, using subjective near point; and 1.46 +/- 0.53; 1.00-2.50; 1.75 D; and 0.55 +/- 0.33; 0.25-0.87; 0.50 D, respectively, using defocusing. Anterior chamber depth decreased in the study and control groups as follows: 0.78 +/- 0.12; 0.49-1.91; 0.65 mm; and 0.16 +/- 0.09; 0.00-0.34; 0.18 mm, respectively, after applying 2% pilocarpine eyedrops, indicating an accommodation of 1.16 +/- 0.22; 0.72-1.88; 1.05 D vs 0.22 +/- 0.13; 0.00-0.47; 0.23 D (P =.001).

CONCLUSIONS

Accommodation after implantation of a presumably accommodative PCIOL can be measured with clinical methods or derived from the biometric data of the eye and the measured ACD decrease using geometrical optics. For clinical purposes, pseudophakic accommodation should be assessed with a variety of different techniques, including subjective and objective measurements. The theoretical approach using geometrical optics may be an additional indicator for the accommodative response in patients with pseudophakic eyes and may allow a subdivision of the measured accommodation into true pseudophakic accommodation and pseudoaccommodation.

A study of replacement of timolol-pilocarpine with latanoprost in pseudoexfoliation glaucoma

The aim of the study was to evaluate the efficacy of replacing current dual local therapy (timolol and pilocarpine) with latanoprost 0.005% in 71 pseudoexfoliation glaucoma patients with controlled intraocular pressure (IOP). 39 patients switched to latanoprost 0.005%) and 32 patients continued timolol-pilocarpine therapy. Mean diurnal (IOP) was measured at baseline, after 0.5, 1, 3 and 6 months of treatment. After 6 months 38 patients with latanoprost and 30 patients with timolol-pilocarpine had completed the study. At baseline the mean diurnal IOP was 20.4 +/- 2.0 mmHg for patients in latanoprost treatment group and 21.4 +/- 2.1 mmHg for patients in timolol-pilocarpine group. At the end of the study, after 6 months of treatment, the mean diurnal IOP values were 16.6 +/- 2.4 and 17.9 +/- 2.0 mmHg respectively. IOP was statistically significantly reduced from baseline (p < 0.001). The mean diurnal IOP change from baseline was -3.3 +/- 0.5 mmHg (mean +/- SEM, ANCOVA) for the patients treated with latanoprost and -3.2 +/- 0.4 mmHg for the patients treated with timolol + pilocarpine. This difference in IOP reduction between groups was not statistically significant (z = 0.69; p = 0.49). This study showed that combination therapy (timolol plus pilocarpine) in pseudoexfoliation glaucoma can effectively be replaced by latanoprost monotherapy.

An electrophoretic method to deliver topical drugs to the eye

It is possible that many patients avoid complete ophthalmic exams because pupil dilation is slow, reversal sluggish, and vision blurred. Others experience incomplete dilation during exams or prior to surgery when good dilation is essential to successful outcome. Iontophoresis, the application of low-level electrical current to promote traversal of desired molecules across a boundary, has been used for many years and has recently become common in transdermal drug delivery. We now investigate iontophoresis as a method of accelerating drug absorption into the ocular anterior segment. In vivo rabbit studies assessed iontophoresis effects on the performance of dilators and constrictors. 1-mA and 4-mA direct current levels applied for 2-minute durations yielded dilation time-history measurements. Subsequent in vitro tests at a wide range of current densities showed minimal chemical modifications in ocular pharmaceuticals. Drug samples processed through high-performance liquid chromatography (HPLC) pinpointed minimal structural changes. Detailed in vivo rabbit testing is under way. Using 2 dilators and constrictors in crossed testing with 0.5-mA to 1.25-mA current levels and 20-sec to 60-sec durations, we recorded dilation progress by digital photography. Initial studies showed faster, larger dilations and quicker reversal using iontophoresis. Drug testing showed chemical structures remaining constant for clinically useful current levels, < or = 1 mA (< or = 1.25 mA/cm2 current density). Drug pH and HPLC retention times were constant within this range, and resistivity varied linearly as expected for increasing current. Rabbit testing will quantify improved drug speed and efficacy, validate the charge delivery electrode design, and indicate iontophoretic current and duration for further use. Tested ocular drugs showed no degradation when exposed to clinically useful iontophoretic currents. Preliminary results indicate significant time reductions for dilation and reversal, plus increases in maximum dilation. This procedure may aid clinicians by allowing more rapid complete examinations and surgical preparations for patients. Making dilation more convenient will also improve patient acceptance of exams, aiding earlier detection and treatment of ocular disease.

Effect of pupil size on multifocal pattern visual evoked potentials

The purpose of this study was to investigate the influence of pupil diameter on the amplitude and latency of multifocal visual evoked potentials (mfVEP). The multifocal objective perimeter (Accumap; Objectivision) was used to stimulate the visual field at 56 sites extending to 32 degrees using a pseudo-random pattern stimulus. The mfVEP were recorded using bipolar occipital electrodes, 7 min/eye. Ten normal subjects were recruited from the community and one eye was randomly selected for testing. The mfVEP were recorded at four different pupil diameters (2 mm, 4 mm, 6 mm, 8 mm), obtained by applying tropicamide (0.5%) or pilocarpine (2%) in different dilutions. Appropriate refractive correction was provided to overcome cycloplegia and achieve a visual acuity of 6/7.5 or better. Analysis revealed that at most pupil diameters the normalized full field amplitude did not show significant variation, except at the most miotic pupil diameter (2 mm), where the amplitude became reduced, based on 2-way anova and Tukey's T method. There was, however, significant correlation between latency and pupil area (correlation coefficient: upper field -0.63, lower field -0.76). The results suggest that even in the presence of mydriatics or miotics, the mfVEP test can be used to assess diseases that affect amplitude, provided near correction is used. The interpretation of latency, however, must be made with caution, as a borderline conduction defect with a dilated pupil may appear normal.

Influence of process parameters of high-pressure emulsification method on the properties of pilocarpine-loaded nanoparticles

Poly(lactide-co-glycolide) nanoparticles loaded with pilocarpine hydrochloride were prepared by the high-pressure emulsification-solvent evaporation method. The nanoparticles were produced using polyvinylalcohol (PVA), carbomer (Carbopol 980) or poloxamer (Lutrol F-68) as stabilizers during emulsification. The influence of pressure and number of cycles on the nanoparticle properties was investigated. For comparison, nanoparicles without high-pressure treatment of the emulsion were made. The nanoparticle size, drug loading and release properties depended strongly on the homogenization pressure and number of cycles applied. Nanoparticles obtained without high pressure homogenization showed larger size and high values of polydispersity index, especially when carbopol and poloxamer were used as emulsifiers. Drug loading and encapsulation efficiency of all samples also decreased with pressure. The low drug loading could be due to two reasons. First, the high pressure promoted drug diffusion out of protoparticles during emulsification either by size reduction or shear forces. Secondly, the characteristics of the outer water phase of the emulsion also influenced the nanoparticle drug loading. This was proven by the different drug loadings measured when nanoparticles were made with PVA, carbopol or poloxamer at equal pressures applied. The main factor influencing the release properties of nanoparticles was the pressure used during emulsification. Faster drug release was observed from nanoparticles obtained after high-pressure emulsification compared to those prepared without homogenization of the emulsion.

Ultrasonographic biomicroscopy, Scheimpflug photography, and novel provocative tests in contralateral eyes of Chinese patients initially seen with acute angle closure

OBJECTIVES

To compare ocular biometry of the contralateral eyes of individuals seen with acute angle closure (AAC) with eyes of population-based control subjects, and to assess novel provocative tests to study the mechanism of AAC.

DESIGN

Prospective case-control study.

PARTICIPANTS

Chinese persons seen as incident cases of AAC and Chinese population-based controls.

METHODS

Slitlamp assessment, ultrasonographic biomicroscopy, Scheimpflug photography, and provocative testing were performed.

MAIN OUTCOME MEASURES

Ocular biometric parameters including anterior chamber depth, limbal anterior chamber depth, axial length, lens thickness, and radius of corneal curvature were obtained. Ultrasonographic biomicroscopy parameters that include the angle-opening distance at 500 micro m and the angle-recess area were noted. Scheimpflug photography produced a single measure of angle width.

RESULTS

Contralateral eyes of cases of AAC had shorter axial lengths, shallower anterior chamber depths, thicker lenses, and steeper radii of corneal curvature (P<.01). After adjusting for age and sex, cases had a mean adjusted axial length that was 1.2 mm shorter, an optical anterior chamber depth that was 0.63 mm shallower (24% shallower than controls), and lenses that were, on average, 0.35 mm thicker (P<.01). Furthermore, using multiple logistic regression to adjust for age and sex, patients with primary angle-closure glaucoma were 19 times as likely to have a shallower limbal anterior chamber depth (25%; 95% confidence interval, 8.3-45.2). Adjusting for age and sex, the mean angle-opening distance at 500 microm was 0.14 U less for cases, with a mean of 0.26 U in controls, making the angle-opening distance at 500 microm, on average, 54% less among cases. Scheimpflug photographs revealed an adjusted angle width of 21.6 degrees for controls and 15.1 degrees for cases (P<.05). Dynamic testing showed that the angle of control eyes tended to shallow less when going from light to dark and tended to open more when given 1 drop of pilocarpine hydrochloride.

CONCLUSIONS

Contralateral eyes of individuals having an AAC attack tend to be shorter and have more crowded anterior segments than those of healthy controls. These static measures of ocular biometry indicate why some individuals are predisposed to AAC. Dynamic measures of the response to luminance changes and pilocarpine therapy indicate that differential reactions to these stimuli are also associated with an AAC attack.

Changes in intraocular pressure and pupil size following intramuscular administration of hydromorphone hydrochloride and acepromazine in clinically normal dogs

OBJECTIVE

To investigate the effects of intramuscularly administered hydromorphone hydrochloride and acepromazine on intraocular pressure (IOP) and pupil size (PS).

ANIMALS STUDIED

Seventeen dogs free of clinically relevant ocular abnormalities.

PROCEDURE

Measurements of IOP and PS were obtained and the dogs were injected intramuscularly with hydromorphone (0.04-0.08 mg/kg) and acepromazine (0.04 mg/kg). Measurements of IOP and PS were repeated 10 min and 25 min later.

RESULTS

Though a decreasing trend in IOP values was demonstrated, no significant difference was noted in IOP from the initial examination to examination following intramuscular administration of hydromorphone and acepromazine. Significant miosis was present in 16 of 17 dogs at 10 min and 25 min following administration of hydromorphone and acepromazine.

CONCLUSION

Hydromorphone (0.04-0.08 mg/kg) and acepromazine (0.04 mg/kg) cause significant miosis in dogs at 10 and 25 min following intramuscular administration.

Pupillary response to four concentrations of pilocarpine in normal subjects: application to testing for Adie tonic pupil

PURPOSE

To determine the amount of pupillary constriction to four different concentrations of pilocarpine in normal human subjects and to determine if pupillary constriction correlates with bioavailability of the instilled concentrations. The amount of pupillary constriction to dilute pilocarpine is utilized as a diagnostic test for Adie tonic pupil as distinguished from a normal pupil response.

DESIGN

Twenty healthy volunteers had automated binocular infrared pupillography in the dark after instillation of four different concentrations of dilute pilocarpine. Ocular penetration of eye drops was also assessed using 2% fluorescein sodium as a tracer.

METHODS

Prospective institutional double-masked study of both eyes of twenty healthy volunteers, ten with brown irides, ten with blue irides, between the ages of 20-40 years.

RESULTS

A pilocarpine dose-dependent curve showed decreased pupil size within 15 minutes, peaking at 30-60 minutes. No difference was noted between right and left eyes, iris color, or corneal permeability.

CONCLUSIONS

Normal pupils constrict to dilute concentrations of pilocarpine (0.25% or 0.125%), but constrict insignificantly to concentrations of 0.0313% or 0.0625%. Pupil constriction with 0.0625% pilocarpine should distinguish an Adie pupil from normal. This confirms the utility of this simple office diagnostic procedure.

Efficacy and safety of immediate anterior chamber paracentesis in the treatment of acute primary angle-closure glaucoma: a pilot study

OBJECTIVE

To study the safety and effectiveness of immediate anterior chamber paracentesis, combined with antiglaucomatous medications, in the intraocular pressure control and relief of symptoms of acute primary angle-closure glaucoma (PACG).

DESIGN

Prospective noncomparative case series.

PARTICIPANTS

Eight consecutive patients with their first attack of acute PACG, with intraocular pressure > or =50 mmHg, were recruited into the study.

INTERVENTION

On presentation, each patient received topical pilocarpine (4%) and timolol (0.5%), immediate anterior chamber paracentesis, and systemic acetazolamide and mannitol as primary treatment. The intraocular pressures at 15 and 30 minutes, and then at 1, 2, 3, 12, and 24 hours, were documented by applanation tonometry.

MAIN OUTCOME MEASURES

Symptoms, visual acuity, intraocular pressure, corneal edema, angle status on gonioscopy, pupillary size, and reaction.

RESULTS

Ten eyes of eight patients seen with acute PACG were recruited. The mean intraocular pressure was reduced from 66.6 +/- 9.1 mmHg to 15.1 +/- 3.5 mmHg immediately after paracentesis, and then to 17.1 +/- 7.0 mmHg at 15 minutes, 21.7 +/- 10.2 mmHg at 30 minutes, 22.7 +/- 11.0 mmHg at 1 hour, and 20.1 +/- 14.6 mmHg at 2 hours after paracentesis. The mean intraocular pressure was less than 21 mmHg at 2 hours and beyond. There was instant symptomatic relief for all patients. No complications from the paracentesis were encountered.

CONCLUSIONS

From this preliminary study, immediate paracentesis seems to be safe and effective in controlling the intraocular pressure and eliminating symptoms in acute PACG.

In situ gelling xyloglucan formulations for sustained release ocular delivery of pilocarpine hydrochloride

Thermoreversible gels formed in situ by aqueous solutions of an enzyme-degraded xyloglucan polysaccharide were evaluated as sustained release vehicles for the ocular delivery of pilocarpine hydrochloride. In vitro release of pilocarpine from gels formed by warming xyloglucan sols (1.0, 1.5 and 2.0% w/w) to 34 degrees C followed root-time kinetics over a period of 6 h. The miotic responses in rabbit following administration of xyloglucan sols were compared with those from in situ gelling Pluronic F127 sols and from an aqueous buffer solution containing the same drug concentration. Sustained release of pilocarpine was observed with all gels, the duration of miotic response increasing with increase of xyloglucan concentration. The degree of enhancement of miotic response following sustained release of pilocarpine from the 1.5% w/w xyloglucan gel was similar to that from a 25% w/w Pluronic F127 gel.

[Pigment dispersion syndrome in a patient with megalocornea]

CASE REPORT

A case of a patient of 12 years old with megalocornea and bilateral pigment dispersion syndrome is reported. An ultrasound biomicroscopic study was performed with the UBM 840 (Zeiss-Humphrey, 50 MHz) and an iris concavity with an iridolenticular and iridozonular contact was observed. A new exam after pilocarpine instillation drops showed the resolution of the iris concavity, zonular and lenticular contact.

DISCUSSION

The anterior chamber configuration of this patient analyzed with ultrasound biomicroscopy allowed us to understand the mechanism of the pigment dispersion syndrome.

Poly(2-hydroxyethyl methacrylate) film as a drug delivery system for pilocarpine

This work investigates pilocarpine trapped in a matrix diffusion-controlled drug delivery system using hydrophilic inserts of Poly(2-hydroxyethyl methacrylate) (pHEMA) to ensure an increased bioavailability of pilocarpine and prolong the length of time in which the medication remains in the eyes of the test subjects. The physical and chemical properties of pilocarpine were investigated to elucidate the mechanism of drug-polymer interaction and the effect on drug release behavior of controlled release polymeric devices. In vitro release studies indicated that pilocarpine continued to be released from the inserts for a 24 h period. The results of intraocular pressure tests performed on albino rabbits were consistent with the observed in vitro behavior. The pressure decrease was significant for a period longer than 48 h. It confirms that the inserts, as sustainable releasing devices, are promising carriers for ophthalmic drug delivery systems.