RESUMEN

BACKGROUND: The present study elucidates a common significant postoperative complication of micropulse transscleral laser treatment (mTLT) and explores its potential management strategies for younger patients with good central vision. CASE PRESENTATION: Three younger Chinese glaucoma patients with good central vision maintained high intraocular pressures (IOPs) (36, 25, and 30 mmHg) on maximally tolerated topical anti-glaucoma medications. All patients were treated with mTLT because of a higher risk of complications with filtering surgery. After the procedure, their best-corrected visual acuities were not significantly changed, IOPs were significantly decreased, and the number of topical anti-glaucoma medicines was gradually decreased. However, all patients complained about reduced near visual acuity (NVA) for 1-5 months. Slit-lamp examination revealed pupillary dilation, and binocular accommodative function examination indicated accommodation loss. After treatment with 2% topical pilocarpine, all patients reported an improvement in NVA. Among them, we could observe pupillary constriction, recovery of accommodation function, and improved NVA, even discontinuation of pilocarpine in Patient 2. CONCLUSION: In younger patients with good central vision, topical pilocarpine might ameliorate accommodation loss and pupillary dilation after mTLT.

Asunto(s)

Acomodación Ocular , Presión Intraocular , Pilocarpina , Humanos , Pilocarpina/uso terapéutico , Pilocarpina/administración & dosificación , Masculino , Femenino , Adulto , Presión Intraocular/fisiología , Acomodación Ocular/fisiología , Agudeza Visual , Mióticos/administración & dosificación , Mióticos/uso terapéutico , Pupila/efectos de los fármacos , Esclerótica/cirugía , Glaucoma/cirugía , Glaucoma/fisiopatología , Terapia por Láser/métodos , Soluciones Oftálmicas , Persona de Mediana Edad , Complicaciones Posoperatorias , Administración Tópica

RESUMEN

Caffeine is a widely used drug that broadly affects human cognition and brain function. Caffeine acts as an antagonist to the adenosine receptors in the brain. Previous anecdotal reports have also linked caffeine intake with changes in pupil diameter. By modifying the retinal irradiance, pupil diameter modulates all ocular light exposure relevant for visual (i.e., perception, detection and discrimination of visual stimuli) and non-visual (i.e., circadian) functions. To date, the extent of the influence of caffeine on pupillary outcomes, including pupil diameter, has not been examined in a systematic review. We implemented a systematic review laid out in a pre-registered protocol following PRISMA-P guidelines. We only included original research articles written in English reporting studies with human participants, in which caffeine was administered, and pupil diameter was measured using objective methods. Using broad search strategies, we consulted various databases (PsycINFO, Medline, Embase, Cochrane Library, bioRxiv and medRxiv) and used the Covidence platform to screen, review and extract data from studies. After importing studies identified through database search (n = 517 imported, n = 46 duplicates), we screened the title and abstracts (n = 471), finding 14 studies meeting our eligibility criteria. After full-text review, we excluded seven studies, leaving only a very modest number of included studies (n = 7). Extraction of information revealed that the existing literature on the effect of caffeine on pupil parameters is very heterogeneous, differing in pupil assessment methods, time of day of caffeine administration, dose, and protocol timing and design. The evidence available in the literature does not provide consistent results but studies rated as valid by quality assessment suggest a small effect of caffeine on pupil parameters. We summarize the numeric results as both differences in absolute pupil diameter and in terms of effect sizes. More studies are needed using modern pupil assessment methods, robust study design, and caffeine dose-response methodology.

Asunto(s)

Cafeína , Pupila , Humanos , Cafeína/farmacología , Cafeína/administración & dosificación , Pupila/efectos de los fármacos , Pupila/fisiología , Estimulantes del Sistema Nervioso Central/farmacología , Estimulantes del Sistema Nervioso Central/administración & dosificación

RESUMEN

SIGNIFICANCE: This study explores the difference between cycloplegic and noncycloplegic refraction in young adult myopes. PURPOSE: From the available literature, it is unclear whether cycloplegia is necessary when refracting young adults. This study investigates the agreement between noncycloplegic autorefraction and cycloplegic autorefraction and investigates factors affecting the agreement between the two methods. METHODS: In total, 125 myopes with ages ranging between 18 and 26 years were included from Australia and Vietnam. Each participant underwent noncycloplegic autorefraction and cycloplegic autorefraction. Cycloplegia was induced with 1% ophthalmic tropicamide. RESULTS: The mean spherical equivalent difference (95% confidence interval) between noncycloplegic autorefraction and cycloplegic autorefraction was -0.20 D (-0.25 to -0.14 D; t124 = -7.18, p<0.0001 ) . A mean difference of >0.25 D was seen in 46.8% of eyes. The lower and upper limits of agreement were -0.80 and 0.41 D, respectively. With univariate analysis, factors including age, degree of refractive error, accommodation amplitude, and distance phorias showed no impact on the average difference between cycloplegic autorefraction and noncycloplegic autorefraction. Yet, eyes with near exophoria ( F2,120 = 6.63, p=0.0019) and Caucasian eyes ( F3,121 = 2.85, p=0.040) exhibited the smallest paired differences. However, in the multivariate analysis, only near exophoria was associated with a lower mean difference. A significantly smaller proportion (34.9%) of eyes with near exophoria had a paired difference of -0.25 D or more compared with esophoria (50%) and orthophoria (65%; χ2 = 6.6, p=0.038). CONCLUSIONS: Noncycloplegic autorefraction results in more myopic refractive error than cycloplegic autorefraction in young adults.

Asunto(s)

Midriáticos , Miopía , Refracción Ocular , Tropicamida , Humanos , Refracción Ocular/fisiología , Adulto Joven , Midriáticos/administración & dosificación , Adulto , Masculino , Adolescente , Femenino , Miopía/fisiopatología , Miopía/diagnóstico , Tropicamida/administración & dosificación , Pupila/efectos de los fármacos , Pupila/fisiología , Acomodación Ocular/fisiología

RESUMEN

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a persistent, chronic inflammatory disease of the lungs. Tiotropium, used in the treatment of COPD, is a muscarinic receptor antagonist that provides long-acting bronchodilation. Our study aimed to investigate the effects of Tiotropium on anterior chamber parameters. METHODS: The study was conducted as an observational cross-sectional and prospectively between October 2023 and April 2024. Patients were examined in three groups: Group 1 consisted of untreated COPD patients; Group 2 consisted of healthy volunteers similar age and gender, and Group 3 included COPD patients receiving Tiotropium 18 mcg via HandiHaler. Anterior chamber parameters, intraocular pressure values, and photopic-mesopic pupil diameters were measured at the initial visit for Group 1 and Group 2 patients, and at the third month of treatment for Group 3 patients. RESULTS: Thirty-six patients were included in each group in the study. No significant differences were observed in ocular findings between the patient and control groups. In COPD patients receiving Tiotropium, narrowing of angle parameters, an increase in photopic-mesopic pupil diameters, and intraocular pressure were observed at the third month of treatment. CONCLUSION: This study is the first research that investigate the effects of Tiotropium on anterior chamber parameters, pupil diameters, and intraocular pressure in COPD treatment. In conclusion, patients with COPD receiving Tiotropium therapy for three months showed narrowing in angle parameters, an increase in intraocular pressure, and photopic-mesopic pupil diameter; however, no patients developed drug-induced acute angle closure glaucoma. TRIAL REGISTRATION: An independent ethics committee approved the study (Giresun EAH KEAK 2023/180 and 9.10.2023/02) which was performed in accordance with the Declaration of Helsinki, Guidelines for Good Clinical Practice. The study was conducted as prospectively, observational case-control. The Clinical Trial Number obtained for the study is NCT06525051 and was taken on 2024-07-29.

Asunto(s)

Broncodilatadores , Presión Intraocular , Enfermedad Pulmonar Obstructiva Crónica , Bromuro de Tiotropio , Humanos , Bromuro de Tiotropio/uso terapéutico , Bromuro de Tiotropio/administración & dosificación , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Femenino , Masculino , Estudios Transversales , Persona de Mediana Edad , Estudios Prospectivos , Anciano , Presión Intraocular/efectos de los fármacos , Broncodilatadores/uso terapéutico , Cámara Anterior/efectos de los fármacos , Pupila/efectos de los fármacos

RESUMEN

BACKGROUND: Assessing refractive errors under cycloplegia is recommended for paediatric patients; however, this may not always be feasible. In these situations, refraction has to rely on measurements made under active accommodation which may increase measurements variability and error. Therefore, evaluating the accuracy and precision of non-cycloplegic refraction and biometric measurements is clinically relevant. The Myopia Master, a novel instrument combining autorefraction and biometry, is designed for monitoring refractive error and ocular biometry in myopia management. This study assessed its repeatability and agreement for autorefraction and biometric measurements pre- and post-cycloplegia. METHODS: A prospective cross-sectional study evaluated a cohort of 96 paediatric patients that underwent ophthalmologic examination. An optometrist performed two repeated measurements of autorefraction and biometry pre- and post-cycloplegia. Test-retest repeatability (TRT) was assessed as differences between consecutive measurements and agreement as differences between post- and pre-cycloplegia measurements, for spherical equivalent (SE), refractive and keratometric J0/J45 astigmatic components, mean keratometry (Km) and axial length (AL). RESULTS: Cycloplegia significantly improved the SE repeatability (TRT, pre-cyclo: 0.65 D, post-cyclo: 0.31 D). SE measurements were more repeatable in myopes and emmetropes compared to hyperopes. Keratometry (Km) repeatability did not change with cycloplegia (TRT, pre-cyclo: 0.25 D, post-cyclo:0.27 D) and AL repeatability improved marginally (TRT, pre-cyclo: 0.14 mm, post-cyclo: 0.09 mm). Regarding pre- and post-cycloplegia agreement, SE became more positive by + 0.79 D, varying with refractive error. Myopic eyes showed a mean difference of + 0.31 D, while hyperopes differed by + 1.57 D. Mean keratometry, refractive and keratometric J0/J45 and AL showed no clinically significant differences. CONCLUSIONS: Refractive error measurements, using the Myopia Master were 2.5x less precise pre-cycloplegia than post-cycloplegia. Accuracy of pre-cycloplegic refractive error measurements was often larger than the clinically significant threshold (0.25 D) and was refractive error dependent. The higher precision compared to autorefraction measurements, pre- and post-cycloplegia agreement and refractive error independence of AL measurements emphasize the superiority of AL in refractive error monitoring.

Asunto(s)

Longitud Axial del Ojo , Biometría , Midriáticos , Miopía , Refracción Ocular , Humanos , Estudios Prospectivos , Estudios Transversales , Femenino , Masculino , Refracción Ocular/fisiología , Midriáticos/administración & dosificación , Niño , Miopía/fisiopatología , Biometría/métodos , Adolescente , Reproducibilidad de los Resultados , Pupila/efectos de los fármacos , Pupila/fisiología , Córnea/patología , Córnea/fisiopatología

RESUMEN

BACKGROUND AND OBJECTIVES: Clearances and the area under the plasma concentration-time curve extrapolated to infinity (AUC0-∞) of intravenous (IV) and oral midazolam and alfentanil are probes for hepatic and first-pass cytochrome P450 3A (CYP3A) activity, drug interactions, and phenotyping. Single-time plasma concentrations are also used as a proxy for clearance and AUC0-∞. Pupil diameter change is a noninvasive surrogate for plasma alfentanil. An ideal probe should have minimal intrasubject (interday) variability. Despite their widespread use, the intrasubject variability of CYP3A probes is not well characterized. This investigation determined the intrasubject (interday) variability of midazolam and alfentanil metrics of hepatic and first-pass CYP3A. METHODS: Twelve volunteers were studied in a four-period protocol, with each period identical and separated by approximately 2 weeks. In each period, participants received 1 mg IV midazolam then 15 µg/kg IV alfentanil 1 h later. The next day, they received 3 mg oral midazolam then 60 µg/kg oral alfentanil. Plasma drug concentrations were determined by liquid chromatography-mass spectrometry (LCMS). Dark-adapted pupil diameters were measured coincident with blood sampling. Plasma concentrations and pupil effects (miosis) were analyzed using noncompartmental methods. The results were the coefficient of variation (%CV, mean ± SD) across four sessions in 12 participants. RESULTS: For IV midazolam: AUC0-∞, clearance, and 5 h concentration, the %CVs were 12 ± 3, 12 ± 3, and 18 ± 8. For IV alfentanil AUC0-∞, clearance, 2 h concentration, and area under the effect curve from time zero to infinity (AUEC0-∞), the %CVs were 16 ± 5, 15 ± 4, 22 ± 7, and 50 ± 28. For oral midazolam AUC0-∞, clearance, and 5 h concentration, %CVs were 19 ± 5, 18 ± 4, and 28 ± 11. For oral alfentanil: AUC0-∞, clearance, 4 h concentration, and AUEC0-∞, %CVs were 20 ± 4, 21 ± 4, 42 ± 26, and 37 ± 14. CONCLUSIONS: Midazolam and alfentanil had comparable intrasubject variabilities of clearance and AUC0-∞. Single-time point metrics had greater intrasubject variability than AUC0-∞ and clearance. Miosis was a surrogate for alfentanil concentrations and provided real-time results, but intrasubject variability was greater than that of clearances and AUC0-∞.

Asunto(s)

Alfentanilo , Citocromo P-450 CYP3A , Midazolam , Humanos , Midazolam/farmacocinética , Midazolam/administración & dosificación , Midazolam/sangre , Alfentanilo/farmacocinética , Alfentanilo/administración & dosificación , Citocromo P-450 CYP3A/metabolismo , Masculino , Adulto , Administración Oral , Femenino , Adulto Joven , Hígado/metabolismo , Área Bajo la Curva , Administración Intravenosa , Pupila/efectos de los fármacos

RESUMEN

INTRODUCTION: Pupillary unrest in ambient light (PUAL) describes the fluctuation of pupil diameter observed in normal, awake subjects under typical levels of indoor light. PUAL becomes low to absent in young healthy subjects during opioid intoxication. We sought to determine the age-related distribution of PUAL values in a random sample of ambulatory participants. METHODS: Subjects ≥18 years of age were recruited. All were identified by age range (18-29, 30-49, 50-69, and ≥70), and surveyed for diabetes, beta-blocker use, and prior 24-hour opioid use. Relationship between mean PUAL, age group, comorbidity and opioid use were examined by Kruskal Wallis test, and PUAL and was modeled using stepwise multilevel linear regression, including diabetes, beta blocker use, prior 24-hour opioid use, autonomic dysfunction, and pupil diameter as fixed effects and subject as random effect. RESULTS: Among 150 subjects, 17 reported diabetes, 12 reported beta-blocker use, 14 reported prior 24-hour opioid use, and 120 reported no comorbid conditions. PUAL declined in higher age categories (by 0.0307, P < 0.001), with diabetes (by 0.0481, P = 0.025), and with beta-blocker use (by 0.0616, P = 0.005). Opioid related PUAL decline was observed, but statistical significance varied by model. Among healthy subjects, no PUAL value fell within range indicating high likelihood of opioid toxicity based on previous data from healthy subjects undergoing opioid infusion. CONCLUSION: PUAL declined in higher age groups, diabetes and beta-blocker use, conditions associated with impaired autonomic function, and with opioid use but significance varied depending on the chosen model.

Asunto(s)

Luz , Pupila , Humanos , Adulto , Masculino , Femenino , Persona de Mediana Edad , Adulto Joven , Adolescente , Pupila/fisiología , Pupila/efectos de los fármacos , Anciano , Reflejo Pupilar/fisiología , Reflejo Pupilar/efectos de los fármacos , Analgésicos Opioides , Antagonistas Adrenérgicos beta

RESUMEN

PURPOSE: Subluxation of the crystalline lens (Ectopia Lentis, EL) can lead to significant visual impairment and serves as a diagnostic criterion for genetic disorders such as the Marfan syndrome. There is no established criterion to diagnose and quantify EL. We prospectively investigated the distance between the zonular fibre insertion and the limbus (ZLD) in healthy subjects as a parameter to assess the position of the lens, quantify EL and provide normative data. METHODS: This prospective, observational, cross-sectional study includes one-hundred-fifty eyes of 150 healthy participants (mean age 28 years, range 4-68). Pupils were dilated with tropicamide 0.5% and phenylephrine 2.5% eyedrops. ZLD was measured in mydriasis at the slit lamp as the distance between the most central visible insertions of the zonular fibres on the lens surface and the corneoscleral limbus. Vertical pupil diameter (PD) and refractive error were recorded. If zonular fibre insertions were not visible, the distance between limbus and the pupillary margin was recorded as ZLD. RESULTS: 145 right and 5 left eyes were examined. 93% of study subjects were Caucasian, 7% were Asian. In eyes with visible zonular fibre insertions (n = 76 eyes), ZLD was 1.30 ± 0.28 mm (mean ± SD, range 0.7-2.1) and PD was 8.79 ± 0.57 mm (7.5-9.8). In the remaining 74 eyes, ZLD was 1.38 ± 0.28 mm (0.7-2.1), and PD was 8.13 ± 0.58 mm (6.7-9.4). For all eyes, ZLD was 1.34 ± 0.29 mm (0.7-2.1), and PD was 8.47 ± 0.66 mm (6.7-9.8). Refractive error and sex did not significantly affect ZLD. Smaller PD and older age were associated with larger ZLD (P < 0.001 and P = 0.036, respectively). CONCLUSION: Average ZLD was 1.34 mm in eyes of healthy subjects. Older age correlated with larger ZLD. These normative data will aid in diagnosing and quantifying EL.

Asunto(s)

Desplazamiento del Cristalino , Cristalino , Humanos , Desplazamiento del Cristalino/diagnóstico , Masculino , Femenino , Estudios Prospectivos , Estudios Transversales , Adulto , Niño , Adolescente , Persona de Mediana Edad , Adulto Joven , Anciano , Preescolar , Cristalino/diagnóstico por imagen , Cristalino/patología , Limbo de la Córnea/patología , Pupila/efectos de los fármacos

RESUMEN

Purpose: To assess over 2 weeks, the effect of 3 different low concentrations of atropine on pupillary diameter and accommodative amplitude in children with myopia. Methods: Fifty-eight children with myopia [spherical equivalent (SE) of -0.50 diopters (D) or worse, astigmatism of less than or equal to 2.00 D] were randomly allocated to 3 groups receiving 0.01%, 0.02%, or 0.03% atropine eye drops, once nightly for 2 weeks. The primary outcome was the change from baseline in pupillary diameter and accommodative amplitude with each of the concentrations. Results: Fifty-seven participants (114 eyes), aged between 6 and 12 years, completed the 2-week trial (mean age 9.3 ± 1.7 years and mean SE -3.53 ± 1.79 D). After 2 weeks of use, all the 3 concentrations were found to have a statistically significant effect on both the pupillary diameter and accommodative amplitude. Accommodative amplitude reduced by an average of 5.23 D, 9.28 D, and 9.32 D, and photopic pupil size increased by an average of 0.95 ± 1.05 mm, 1.65 ± 0.93 mm, and 2.16 ± 0.88 mm with 0.01%, 0.02%, and 0.03%, respectively. Of the eyes, a total of 5.3% and 5.9% of the eyes on 0.02% and 0.03% atropine had a mean residual accommodative amplitude of <5 D. The percentage of eyes having a pupillary dilation >3 mm were 4.8%, 10.5%, and 23.5% for 0.01%, 0.02%, and 0.03% atropine, respectively. Conclusions: Low-dose atropine had an effect on pupillary diameter and accommodative amplitude. With the highest concentration assessed, that is, 0.03% nearly 1 of 4 eyes had pupillary dilation of >3 mm. Clinical Trial Registration number: NCT03699423.

Asunto(s)

Acomodación Ocular , Atropina , Midriáticos , Miopía , Soluciones Oftálmicas , Pupila , Humanos , Atropina/administración & dosificación , Atropina/farmacología , Niño , Miopía/tratamiento farmacológico , Miopía/fisiopatología , Acomodación Ocular/efectos de los fármacos , Pupila/efectos de los fármacos , Masculino , Femenino , Soluciones Oftálmicas/administración & dosificación , Midriáticos/administración & dosificación , Midriáticos/farmacología , Midriáticos/uso terapéutico , Relación Dosis-Respuesta a Droga

RESUMEN

BACKGROUND: A reliable estimation of time since death can be important for the law enforcement authorities. The compound method encompassing supravital reactions such as the chemical excitability of the iris can be used to further narrow intervals estimated by temperature-based methods. Postmortem iris excitability was mostly assessed by parasympatholytic or parasympathomimetic substances. Little is known regarding sympathomimetic agents. The present study aims to describe the postmortem iris excitability using the sympathomimetic drug phenylephrine. METHODS: Cadavers were included after body donors gave written informed consent during lifetime. Exclusion criteria were known eye disease, or a postmortem interval exceeding 26 hours. A pupillometer with a minimum measurement range of 0.5 mm was used to determine the horizontal pupil diameter before and 20 minutes after the application of phenylephrine. Increase in pupil diameter was labeled as positive reaction, unchanged pupil diameter was labeled as negative reaction, and decrease in pupil diameter was labeled as paradox reaction. RESULTS: 30 eyes from 16 cadavers (median age = 80.0; 9 males, 7 females) were examined. Initial pupil size was in median 3.5 mm (interquartile range [IQR]: 3.0-4.5 mm) and progressed to 4.0 mm (IQR: 3.5-5.0 mm) 20 minutes after drug instillation. The achieved pupil diameter difference comprised in median 0.5 mm (IQR: 0.0-1.0 mm). A positive reaction was observed in 21 cases. Negative reactions were observed in 5 cases and paradox reactions in 4 cases. Overall, there was a statistically significant difference in diameter between the initial and the reactive pupil (P = 0.0002). CONCLUSION: Although relatively rarely used, sympathomimetic drugs seem to be eligible for chemical postmortem iris excitability. Currently, assessment of postmortem iris excitability usually only involves parasympatholytic and parasympathomimetic agents. The findings of the present study give a hint that the application of a third agent with a sympathomimetic mechanism of action could provide additional information. Further studies assessing such a triple approach in the compound method in comparison with the current gold standard for estimation of time since death are mandatory to ensure reliable results.

Asunto(s)

Cadáver , Iris , Fenilefrina , Cambios Post Mortem , Pupila , Simpatomiméticos , Humanos , Masculino , Femenino , Iris/efectos de los fármacos , Iris/anatomía & histología , Iris/fisiología , Fenilefrina/farmacología , Pupila/efectos de los fármacos , Pupila/fisiología , Anciano de 80 o más Años , Anciano , Simpatomiméticos/farmacología

RESUMEN

PURPOSE: To study the pupil dynamics with premixed intracameral anesthetic mydriatic combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) in pediatric cataract surgery. METHODS: Consecutive children aged ≤12 years planned for cataract surgery were recruited. A commercially available premixed combination of phenylephrine (0.31%), tropicamide (0.02%), and lidocaine (1%) was injected at the beginning of surgery without any topical/infusion drugs for mydriasis. Pupil sizes at various points of surgery were studied. RESULTS: We recruited 75 patients with a mean age of 24.3 ± 33.4 months (range: 1 month-11 years). Adequate mydriasis with a single injection was achieved in 93.5% (n = 73 eyes of 70 patients) without additional pharmacotherapy or intervention. The mean pupillary diameter increased from 1.8 ± 0.79 to 6.1 ± 1.4 mm after injection (mean change of 4.2 ± 1.25 mm from baseline). The mean variability in pupillary diameter was 0.73 ± 1.3 mm. In five eyes, good dilatation was not possible even after repeat injection. CONCLUSION: Fixed-dose premixed intracameral injection is effective in pupil dilatation. It alleviates the need for any topical dilators or additional intraoperative supplementation for pediatric cataract surgery.

Asunto(s)

Extracción de Catarata , Midriáticos , Fenilefrina , Pupila , Tropicamida , Humanos , Midriáticos/administración & dosificación , Preescolar , Masculino , Lactante , Femenino , Extracción de Catarata/métodos , Pupila/efectos de los fármacos , Niño , Tropicamida/administración & dosificación , Fenilefrina/administración & dosificación , Lidocaína/administración & dosificación , Cámara Anterior/efectos de los fármacos , Catarata , Estudios Prospectivos , Estudios de Seguimiento , Soluciones Oftálmicas/administración & dosificación , Relación Dosis-Respuesta a Droga

RESUMEN

PURPOSE: The relationship between attention deficit hyperactivity disorder (ADHD) and visual impairment remains poorly understood, and the impact of visual impairment on the development of ADHD is uncertain. The aim of this study was to investigate the refractive profile and ocular biometric characteristics in patients diagnosed with ADHD and compare them with a control group. Additionally, we aimed to explore the potential influence of sex and medication intake. METHODS: A cohort of 100 participants, including 50 individuals with ADHD and 50 age- and sex-matched control subjects, was included in this study. Ocular biometric parameters were measured, and refractive error was assessed using cycloplegic and non-cycloplegic autorefraction. Subgroup analyses were performed within the ADHD group based on sex, medication intake and age to investigate potential associations with the ocular findings. RESULTS: We observed no statistically significant differences in axial length, corneal topography parameters or anterior chamber characteristics between ADHD and control subjects. However, subgroup analysis within the ADHD group revealed that the prevalence of ametropia under cycloplegia was significantly higher in unmedicated (69.6%) compared to medicated (37.5%) (X2(2) = 7.320, p = 0.026) participants. Pupil diameter was significantly larger in medicated (3.91 mm) compared to unmedicated (3.58 mm; p = 0.017) individuals. Males had flatter (p = 0.004) and thicker (p = 0.008) corneas than females. Older ADHD participants had higher refractive error (p = 0.008 for non-cycloplegic and p = 0.0.003 for cycloplegic), axial length (p = 0.002) and corneal astigmatism (p = 0.049). CONCLUSIONS: Our study provides compelling evidence that individuals diagnosed with ADHD exhibit a similar incidence of refractive errors and ocular parameters compared to normal subjects. Nonetheless, the prevalence of refractive errors appears to be higher in unmedicated ADHD patients, suggesting the potential benefit of stimulant treatment. Additionally, stimulant use is associated with an increase in pupil diameter.

Asunto(s)

Trastorno por Déficit de Atención con Hiperactividad , Estimulantes del Sistema Nervioso Central , Pupila , Refracción Ocular , Errores de Refracción , Humanos , Masculino , Femenino , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Errores de Refracción/fisiopatología , Errores de Refracción/diagnóstico , Pupila/efectos de los fármacos , Pupila/fisiología , Estimulantes del Sistema Nervioso Central/uso terapéutico , Estimulantes del Sistema Nervioso Central/administración & dosificación , Refracción Ocular/fisiología , Adolescente , Niño , Topografía de la Córnea , Agudeza Visual/fisiología , Adulto Joven , Adulto

RESUMEN

PURPOSE: To investigate the long-term effects of topical latanoprost 0.005% treatment on pupillary functions in early-stage primary open-angle glaucoma (POAG) eyes using automated pupillometry. METHODS: This prospective study involved 20 eyes of 20 treatment-naive subjects with early-stage POAG. After comprehensive ophthalmic examination, static and dynamic pupillometry measurements were performedbefore treatment, at the 1st follow-up visit (1.10 ± 0.30 months) and the 2nd follow-up visit (25.85 ± 10.26 months) after treatment initiation. Dynamic parameters included resting diameter (mm), amplitude (mm), latency (ms), duration (ms), and velocity (mm/s) of pupil contraction and dilation. Static pupillometry parameters were pupil diameter (PD, mm) in high-photopic, low-photopic, mesopic and scotopic conditions. RESULTS: The velocity of pupil dilation significantly decreased during the 1st visit (p = 0.008) and the 2nd visit (p = 0.0003) of treatment compared to the pre-treatment visit. The resting PD was also significantly higher after the 1st visit (p = 0.003) and the 2nd visit (p = 0.001) compared to the pre-treatment visit. However, the difference in resting PD measured between the 1st and 2nd visits did not reach statistical significance (p = 0.065). There were no significant changes in other dynamic parameters (p > 0.05 for all). Additionally, a mild, but not significant, mydriatic effect was observed in PD measurements under scotopic, mesopic and low photopic lighting conditions after follow-up. None of the static and dynamic parameters correlate with age, changes in intraocular pressure (IOP) or mean deviation (MD) values of visual field tests. CONCLUSION: The long-term topical latanoprost 0.005% treatment in early-stage POAG has a slight mydriatic effect on the pupil. Further longitudinal clinical studies with larger patient cohorts are necessary to better understand the effects of latanoprost on pupillary functions.

Asunto(s)

Antihipertensivos , Glaucoma de Ángulo Abierto , Presión Intraocular , Latanoprost , Soluciones Oftálmicas , Pupila , Humanos , Latanoprost/administración & dosificación , Glaucoma de Ángulo Abierto/tratamiento farmacológico , Glaucoma de Ángulo Abierto/fisiopatología , Estudios Prospectivos , Masculino , Femenino , Pupila/efectos de los fármacos , Persona de Mediana Edad , Antihipertensivos/administración & dosificación , Presión Intraocular/efectos de los fármacos , Presión Intraocular/fisiología , Estudios de Seguimiento , Administración Tópica , Anciano , Adulto , Campos Visuales/fisiología , Tonometría Ocular , Prostaglandinas F Sintéticas/administración & dosificación

RESUMEN

PURPOSE: To investigate the impact of accommodation function on the difference between cycloplegic and noncycloplegic subjective and automatic refraction in adult myopes. METHODS: Myopic patients between 18 and 50 years old evaluated at Peking University Third Hospital who underwent cycloplegic and noncycloplegic automatic and subjective refraction were enrolled. Accommodation function, including negative and positive relative accommodation (PRA/NRA) and accommodation response (binocular cross cylinder, BCC) was examined. RESULTS: Of the 3268 individuals enrolled, the mean age was 27.3 ± 6.9 years, and 34.8% of participants were male. The noncycloplegic spherical equivalent (SE) was 0.23 ± 0.29 D and 0.64 ± 0.61 D more myopic than cycloplegic subjective and automatic refraction. Adjusting for associated factors, participants with at least 0.50 D of more myopia SE refraction by noncycloplegic subjective refraction were more likely to be older (odds ratio [OR], 1.029; 95% confidence interval [CI], 1.013-1.045) and with insufficient (OR, 1.514; 95% CI, 1.093-2.096) and excessive (OR, 2.196; 95% CI, 1.538-3.137) NRA value. The automatic refraction SE difference of at least 1.00 D more myopia was more likely to be found in individuals with older age (OR, 1.036; 95% CI, 1.022-1.050) and accommodative lead (OR, 1.255; 95% CI, 1.004-1.568). CONCLUSION: A quarter of adult myopes had at least 0.50 and 1.00 D of subjective and automatic SE difference with cycloplegia. The accommodation function significantly affects the difference between cycloplegic and noncycloplegic refraction. Investigating the differences in refraction measurement guarantees the proper use of cycloplegia in adults for myopia correction.

Asunto(s)

Acomodación Ocular , Midriáticos , Miopía , Refracción Ocular , Humanos , Masculino , Acomodación Ocular/fisiología , Adulto , Femenino , Refracción Ocular/fisiología , Midriáticos/administración & dosificación , Miopía/fisiopatología , Miopía/diagnóstico , Persona de Mediana Edad , Adulto Joven , Adolescente , Estudios Retrospectivos , Agudeza Visual/fisiología , Pupila/efectos de los fármacos , Pupila/fisiología

RESUMEN

Pupil diameter fluctuates in association with changes in brain states induced by the neuromodulator systems. However, it remains unclear how the neuromodulator systems control the activity of the iris sphincter (constrictor) and dilator muscles to change the pupil size. The present study compared temporal patterns of pupil dilation during movement when each muscle was pharmacologically manipulated in the human eye. When the iris sphincter muscle was blocked with tropicamide, the latency of pupil dilation was delayed and the magnitude of pupil dilation was reduced during movement. In contrast, when the iris dilator muscle was continuously stimulated with phenylephrine, the latency and magnitude of rapid pupil dilation did not differ from the untreated control eye, but sustained pupil dilation was reduced until the end of movement. These results suggest that the iris sphincter muscle, which is under the control of the parasympathetic pathway, is quickly modulated by the neuromodulator system and plays a major role in rapid pupil dilation. However, the iris dilator muscle receives signals from the neuromodulator system with a slow latency and is involved in maintaining sustained pupil dilation.NEW & NOTEWORTHY By pharmacologically manipulating the pupil dilator and constrictor muscles of human eye separately, we found that the pupil constrictor muscle is a primary controller of rapid pupil dilation upon brain arousal. However, the pupil dilator muscle, which is innervated by the sympathetic nervous system and is generally considered as a major regulator of pupil dilation, is not involved in rapid pupil dilation, but was involved in long-lasting pupil dilation.

Asunto(s)

Nivel de Alerta/fisiología , Músculo Liso/fisiología , Midriáticos/farmacología , Sistema Nervioso Parasimpático/fisiología , Pupila/fisiología , Adulto , Femenino , Humanos , Masculino , Músculo Liso/efectos de los fármacos , Vías Nerviosas/efectos de los fármacos , Vías Nerviosas/fisiología , Sistema Nervioso Parasimpático/efectos de los fármacos , Fenilefrina/farmacología , Pupila/efectos de los fármacos , Tropicamida/farmacología , Adulto Joven

RESUMEN

Βeta oscillatory activity (human: 13-35 Hz; primate: 8-24 Hz) is pervasive within the cortex and basal ganglia. Studies in Parkinson's disease patients and animal models suggest that beta-power increases with dopamine depletion. However, the exact relationship between oscillatory power, frequency and dopamine tone remains unclear. We recorded neural activity in the cortex and basal ganglia of healthy non-human primates while acutely and chronically up- and down-modulating dopamine levels. We assessed changes in beta oscillations in patients with Parkinson's following acute and chronic changes in dopamine tone. Here we show beta oscillation frequency is strongly coupled with dopamine tone in both monkeys and humans. Power, coherence between single-units and local field potentials (LFP), spike-LFP phase-locking, and phase-amplitude coupling are not systematically regulated by dopamine levels. These results demonstrate that beta frequency is a key property of pathological oscillations in cortical and basal ganglia networks.

Asunto(s)

Potenciales de Acción/fisiología , Ganglios Basales/metabolismo , Ritmo beta/fisiología , Corteza Cerebral/metabolismo , Dopamina/farmacología , Enfermedad de Parkinson/metabolismo , Trastornos Parkinsonianos/metabolismo , Potenciales de Acción/efectos de los fármacos , Animales , Ganglios Basales/diagnóstico por imagen , Ganglios Basales/efectos de los fármacos , Ganglios Basales/fisiopatología , Ritmo beta/efectos de los fármacos , Carbidopa/farmacología , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/efectos de los fármacos , Corteza Cerebral/fisiopatología , Chlorocebus aethiops , Dopamina/metabolismo , Electrodos Implantados , Tecnología de Seguimiento Ocular , Femenino , Humanos , Levodopa/farmacología , Imagen por Resonancia Magnética , Red Nerviosa/diagnóstico por imagen , Red Nerviosa/efectos de los fármacos , Red Nerviosa/metabolismo , Red Nerviosa/fisiopatología , Compuestos Orgánicos/farmacología , Enfermedad de Parkinson/diagnóstico por imagen , Enfermedad de Parkinson/fisiopatología , Trastornos Parkinsonianos/diagnóstico por imagen , Trastornos Parkinsonianos/fisiopatología , Pupila/efectos de los fármacos , Pupila/fisiología , Técnicas Estereotáxicas

RESUMEN

OBJECTIVE: Pupillometry has been used to assess pain intensity and response to analgesic drugs in adults. The aim of this study was to verify the usefulness and effectiveness of the pupillometer to assess pain and depth of sedation in pediatric patients undergoing painful procedures and to optimize pain management by observing pupillary variations induced by opioids. PATIENTS AND METHODS: This is a prospective, monocentric study conducted in the sedation room of the Pediatric Intensive Care Unit of Fondazione Policlinico A. Gemelli in Rome. A population of 22 pediatric patients who underwent painful procedures was enrolled. Eleven children were sedated by opioid drugs. Heart rate, systolic blood pressure, diastolic blood pressure, bispectral index, maximum pupil size (Size), pupil change (CH), Neurological Pupil Index (NPi) were collected over four times: before starting the procedure; before the painful stimulus (when the patient was sedated); when the painful stimulus was applied; at the end of the procedure. A NeurOptics NPi-200 pupillometer was used for the study. RESULTS: Statistical significance in the variation of haemodynamic parameters was less significant than the variation obtained by analyzing the pupillary parameters: a significant change in NPi and CH in the transition from wakefulness to sedation and from the application of the painful stimulus to awakening was found in both study populations, patients who have received opioids and patients who have not received opioids. Changes in the mean CH of the pupil diameter correlate with the depth of sedation, and the size values vary in relation to the administration of opioids. CONCLUSIONS: Our findings highlight the potential role of pupillometry as a non-invasive method to objectively quantitate pain response in children to reach an efficient analgesic approach.

Asunto(s)

Analgésicos Opioides/farmacología , Dolor/diagnóstico , Pupila/fisiología , Reflejo Pupilar/fisiología , Adolescente , Adulto , Analgésicos Opioides/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Presión Sanguínea/fisiología , Niño , Preescolar , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Lactante , Masculino , Dolor/tratamiento farmacológico , Dimensión del Dolor/métodos , Estudios Prospectivos , Pupila/efectos de los fármacos , Reflejo Pupilar/efectos de los fármacos , Adulto Joven

RESUMEN

We performed pupillometer testing on 132 patients with Parkinson's disease, stratified into two groups according to the disease stage. Neurological examinations and pupillometry were performed in the ON state. Patients in the Hoehn and Yahr stages 1 and 2 comprised the early group, and patients in stages 3-5 formed the late group. We performed age- and sex-matched (2:1) propensity score matching to compensate for the effect of age on pupil light reflex. Eight pupillometer parameters were measured and compared between the two groups. After the propensity score matching, the early group had 64 patients and the late group had 32 patients. The late group had a longer disease duration and took a higher levodopa equivalent dose than the early group. The constriction velocity (P = 0.006) and maximum constriction velocity (P = 0.005) were significantly faster in the early group than in the late group. Pupil size, minimum diameter, and dilation velocity were similar in both groups. The pupillary contraction velocity decreased with the disease progression, suggesting that the progression of Parkinson's disease could be identified by the pupil constriction velocity.

Asunto(s)

Progresión de la Enfermedad , Examen Neurológico , Enfermedad de Parkinson/patología , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico/métodos , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/tratamiento farmacológico , Pupila/efectos de los fármacos , Reflejo Pupilar/fisiología , Visión Ocular/efectos de los fármacos , Visión Ocular/fisiología

RESUMEN

OBJECTIVE: Phacoemulsification is the most common cataract surgery that needs optimum circumstances in the field of surgery. This comparative pre- and postoperative study assessed the efficacy and safety of using adrenaline in the irrigating solution as an adjunct to preoperative topical mydriatics in dark irides during Phaco surgery. PATIENTS AND METHODS: This was a prospective observational study that enrolled 421 cataract patients (421 eyes) with dark irides, who were scheduled for Phaco surgery from January 2019 to August 2020. All patients received intraoperative irrigation of a balanced salt solution containing adrenaline. The pulse rate and systolic and diastolic blood pressure of all patients were recorded pre- and postoperatively. In addition, the presence of intraoperative floppy-iris syndrome (IFIS), need for pupil mechanical dilatation, and incidence of posterior capsular rupture were recorded. RESULTS: The sample consisted of 421 patients (421 eyes) all had dark irides. Pulse rate and systolic and diastolic blood pressure did not significantly increase post-operatively (p <0.001). Mechanical dilatation of the pupil was performed in one patient (0.24%) and seven eyes (1.66%) were found to have IFIS. There was no case of posterior capsule rupture. CONCLUSIONS: In comparison with the use of preoperative topical mydriatics alone, adding intracameral adrenaline to the irrigation fluid maintains better pupillary dilatation throughout Phacoemulsification surgery, thereby providing better clinical outcomes in dark irides, even in those with IFIS. Its use has no incremental effect on either blood pressure or pulse rate.

Asunto(s)

Epinefrina/administración & dosificación , Epinefrina/farmacología , Color del Ojo , Facoemulsificación/métodos , Administración Tópica , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Epinefrina/efectos adversos , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Inyecciones , Complicaciones Intraoperatorias/epidemiología , Iris/efectos de los fármacos , Enfermedades del Iris/epidemiología , Masculino , Persona de Mediana Edad , Midriáticos/uso terapéutico , Estudios Prospectivos , Pupila/efectos de los fármacos , Irrigación Terapéutica/métodos

RESUMEN

Infrared thermography provides functional imaging by picturing the temperature pattern of the region imaged. The temperature correlates to the blood flow pattern and is used in the diagnosis of diseases like breast cancer, peripheral vascular disorders, diabetic neuropathy and fever screening. In the present study, the usage of ocular thermography for diagnosis of diabetic retinopathy is explored. Ocular thermograms using infrared imaging camera were obtained for normal subjects (80 volunteers - 40 males and 40 females) age groups 21-30, 31-40, 41-50 and 51-60 years, non-proliferative diabetic retinopathy (NPDR) patients (50 volunteers -25 males and 25 females) and proliferative diabetic retinopathy (PDR) patients (20 volunteers -10 males and 10 females) belonging to age group of 51-60 years. The temperature at various points of interest (POIs) and horizontal temperature profiles were studied. Ocular surface temperature (OST) and effect of eye dilation on OST was studied for control, age matched NPDR and PDR. Statistical analyses were carried out to find the significance of correlation between OST of controls and NPDR and PDR. The global minimum temperature on the ocular surface for controls (21-60 years) was found to be at cornea which is about 34.79 ± 0.68 °C, and maximum at the inner canthus viz. 36.08 ± 0.62 °C. Dilation studies showed an average increase of 0.82 ± 0.13 °C in cornea and 0.75 ± 0.14 °C in conjunctiva and limbus (p < 0.001). The temperature of cornea is around 33.22 ± 0.12 °C and 32.64 ± 0.12 °C for NPDR and PDR patients respectively, in the age group of 51-60 years. OST of NPDR patients was 0.60 ± 0.15 °C lesser than that of age matched normal eyes (p < 0.001) at cornea and limbus regions and 0.71 ± 0.20 °C at inner canthus. The OST of PDR patients was lesser than age matched controls by 1.18 ± 0.12 °C at cornea, 0.9 ± 0.13 °C at inner canthus and 1.0 ± 0.14 °C at other POIs. During dilation studies a positive variation of 0.61 ± 0.12 °C in cornea and 0.48 ± 0.13 °C in conjunctiva and limbus was observed (p < 0.001) in NPDR eyes. Similarly an average increase of 0.62 ± 0.11 °C in cornea and an average increase of 0.47 ± 0.15 °C in conjunctiva and limbus were observed (p < 0.001) in PDR eyes. The OST of NPDR and PDR patients was less compared with age matched counterparts in both pre and post dilation studies. Dilation of eye showed increase in OST for both controls and diabetic retinopathy patients. The degree of increase is less compared with controls. The variation in OST observed during pre and post dilatation studies of diabetic retinopathy patients is a functional marker of pathology, and can be used as a parameter for diagnosis.

Asunto(s)

Temperatura Corporal/fisiología , Retinopatía Diabética/fisiopatología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Midriáticos/administración & dosificación , Pupila/efectos de los fármacos , Flujo Sanguíneo Regional/fisiología , Termografía , Tropicamida/administración & dosificación , Adulto Joven