OBJECTIVE: To evaluate the pressor and mydriatic effects of different concentrations of tropic amide and phenylephrine eye drops: tropicamide 0.5 % (Mydriacyl), phenylephrine hydrochloride 2.5 % (Mydfrin), tropicamide-phenylephrine combination 0.5 %/0.5%(Sanmyd-P), and self-prepared mixture (1:1 dilution) of commercially prepared tropicamide 0.5 percent and phenylephrine 2.5 %. METHODS: A prospective, randomized, double-blind study was carried out involving 160 eyes of 80 patients who were randomly assigned into four groups to receive phenylephrine + tropicamide 0.5 percent/0.5% (Group A), tropicamide + phenylephrine 0.2 %/1.25 (Group B), tropicamide 0.5 % (Group C), or phenylephrine 2.5% (Group D). The main outcome measures were systolic, diastolic, and mean arterial pressures; pulse rate; and horizontal pupillary diameter determined at 10-, 20-, 30-, 45-, and 60-minute intervals postinstillation. Repeated measures analysis of variance and Tukey's honestly significant difference were used to analyze outcomes. RESULTS: There was no significant increase in the systolic and diastolic blood pressure within each group and between groups. The mean increase or decrease in heart rate from baseline did not show a significant difference. Tropicamide-phenylephrine 0.5 %/0.5 % (Group A) and tropicamide-phenylephrine 0.25 %/1.25 % (Group B) yielded the highest mean increase in pupil size across time. CONCLUSION: Tropicamide-phenylephrine 0.5%/0.5 % and tropicamide-phenylephrine 0.25%/1.25% attained better dilation per unit time than the other treatment groups. No significant effect on blood pressure and heart rate was seen in all groups.
Human ; Male ; Female ; Aged ; Adult ; BLOOD PRESSURE ; HEART RATE ; TROPICAMIDE ; MYDRIATICS ; PHENYLEPHRINE ; OPHTHALMIC SOLUTIONS ; HYPERTENSION

In the Philippine setting, hospitals, particularly government, provincial and regional hospitals are equipped with general body scanners. Ophthalmic ultrasound particularly the ocular B-scan ultrasound is not available. Can a B-scan general body ultrasound be used for visualizing gross intra-ocular disease? It is the objective of this study to describe the usefulness of a 7.5MHz general body ultrasound in detecting and supporting diagnosis for specific intra-ocular conditions. After a thorough history and physical examination, a total of 11 eyes were examined with diagnosis of retinal detachments, vitreous hemorrhage, dislocated lens, intra-ocular foreign body and a normal eye for comparison. All examinations were done by only one senior radiology resident. Results obtained from the 7.5MHz transducer were compared to either an ophthalmic B-scan ultrasound, X-rays or as reported by direct visualization. The result of this study is encouraging because the 7.5MHz B-scan general body ultrasound transducer was able to help in the diagnosis of intraocular diseases and intraocular foreign bodies especially when the posterior pole was not visible.
Human ; ECHOGRAPHY ; EYE ; OPHTHALMOLOGY ; OPHTHALMOSCOPY ; ULTRASONOGRAPHY

Human ; Female ; Child ; CONGENITAL ; OCULAR MOTILITY DISORDERS ; OCULOMOTOR NERVE/ABNORMALITIES ; OPHTHALMOLEGIA/CONGENITAL ; APRAXIAS/GENETICS ; CASE REPORTS ; HUMAN ; FEMALE ; CHILD

OBJECTIVE: To compare the macular pigment optical density (MPOD) among Filipinos with and without age¬related macular degeneration (AMD).

METHODS: Consecutive patients with AMD and without posterior segment disease were recruited into the study Baseline MPOD measurements using an autofluorescence spectrometer were obtained. MPOD in the 0.5 degree retinal eccentricity and the average of 3 measurements (MPOD Max) was the primary outcome measure.

RESULTS: 120 patients, aged 50 to 80 years, were included into 3 groups: group 1 (n=40) without retinal disease, group 2 (n=40) with non-neovascular AMD, and group 3 (n=40) with neovascular AMD. The mean baseline MPOD were: 0.382 ± 0.10 DU for group 1, 0.333 ± 0.07 DU for group 2, and 0.283 ± 0.07 DU for group 3. Significant differences were present comparing the MPOD values of the 3 groups.

CONCLUSION: Eyes without retinal disease had higher MPOD than those with early non-neovascular or neovascular AMD.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Macular Pigment ; Macular Degeneration ; Retina ; Retinal Diseases ; Outcome Assessment (health Care)

Methods: A retrospective review of pneumatic retinopexy procedures performed at the UP-PGH from January 1996 to December 2002 was undertaken. Seventeen cases were analyzed as to preoperative and intraoperative variables: age; sex; preoperative visual acuity; presence of proliferative vitreoretinopathy(PVR); extent of retinal detachment; presence of macular detachment; presence, number, and type of lattice degeneration; previous cataract surgery; surgeon factor; and intraoperative use of cryotherapy. Two-tailed Fishers exact test and Chi square test were used in the analysis of statistical significance. Results: The following variables were shown to be significantly correlated with failure: eyes with breaks outside the 11-1 oclock meridians (p=0.02), eyes with less than or equal to 3 quadrants of retinal detachment (p=0.05), and preoperative visual acuity worse than 5/60 (p0.100). Conclusion: Failure in eyes with retinal breaks outside the 11-1 oclock meridians suggested poor patient compliance with regard to postoperative posture. In eyes with less than or equal to three quadrants of detachment, failure may ensue as a result of spillover of subretinal fluid to uninvolved quadrants. Future success with pneumatic retinopexy will rely ultimately on careful patient selection, surgeon familiarity with the technique, and patient cooperation.
Human ; Male ; Female ; Middle Aged ; Adult ; RETINAL DETACHMENT ; VITREORETINOPATHY, PROLIFERATIVE

Mass Screening

Objectives. To determine the safety and efficacy of three different mydriatic regimens in premature infants referred for retinopathy of prematurity (ROP) screening using (1) multiple alternate instillations of 0.5% cyclopentolate hydrochloride and 2.5% phenylephrine (MAI), (2) single instillation of 0.5%/0.5% tropicamide + phenylephrine (SI) and (3) single instillation of 0.5%/0.5% tropicamide + phenylephrine with a cotton wick placed in the inferior fornix (SIW) in a Philippine tertiary hospital.

Methods. A randomized, double-blind, clinical trial included preterm infants for ROP screening at a Philippine tertiary hospital. After instillations via MAI, SI, and SIW, systolic blood pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate, and oxygen saturation were monitored. Pupillary dilation was also measured.

Results. Sixty preterm infants, 20 to each intervention, were included. The MAI group did not have significant changes relative to its baseline vital signs. The use of SI produced lower DBP (p<0.0106) and MAP (p<0.0027) compared to MAI. The use of SI produced lower DBP (p<0.01) and MAP (p<0.003) compared to MAI. The SIW group exhibited significant increases in SBP (p<0.002) and in MAP (p<0.04) compared to MAI. This increase in SBP exceeded the clinical normal values for <37 weeks old infants. Pupillary dilation did not have significant differences among groups (p=0.24).

Conclusion. Due to significant increase in SBP, it is recommended to discontinue SIW in preterm infants for ROP screening since it may promote the mydriatic's systemic absorption. Except for the clinically increased heart rate in infants aged ?37 weeks at examination, SI was found to be at par with the recommendation of the UK ROP Guidelines of May 2008.

Premature Birth ; Tropicamide ; Phenylephrine ; Cyclopentolate ; Mass Screening ; Retinopathy of Prematurity ; Infant, Premature

Objectives: Anti-vascular endothelial growth factor (anti-VEGF) drugs delivered intravitreally have been proven effective and safe for the treatment of patients diagnosed with neovascular age-related macular degeneration (ARMD). This study evaluated the short-term biologic efficacy and safety of multiple intravitreal injections of bevacizumab in patients with neovascular ARMD. Methods: A prospective, interventional, placebo-controlled, randomized clinical trial was done involving patients with active subfoveal neovascular ARMD. Excluded were patients with significant media opacity, concomitant retinal/ocular diseases, previous intravitreal injections, recent laser treatment or intraocular surgery, and contraindications to the drug. Demographic data were taken and a complete ocular examination, fluorescein angiogram (FA), and optical coherence tomogram (OCT) were performed. Patients received either 3 monthly intravitreal injections of 1.25mg bevacizumab or sham injections. Best-corrected visual acuity (BCVA) and central macular thickness were recorded at baseline, 2, 4, 8, and 12 weeks follow-up. Ocular/Periocular or systemic drug-related side effects or toxicities and iatrogenic complications were noted. Results: Thirty eyes (15 per group) were included in the final analysis. Both treatment and control groups were comparable in baseline characteristics. There was a significant increase in the mean visual acuity (p < 0.001) in eyes treated with bevacizumab across all time periods. The average gain at the end of the study was 11.6 letters. This paralleled a similar significant decrease in central macular thickness for the treatment group (p < 0.02). No major ocular adverse events were noted. Conclusion This study supported the growing body of evidence that intravitreal injections of bevacizumab 1.25 mg result in short-term anatomical as well as functional improvement with minimal adverse events in patients with neovascular ARMD.
Choroidal Neovascularization ; Macular Degeneration ; Bevacizumab

Objective: To determine the applicability of a modified criteria for initiating retinal examinations to screen for retinopathy of prematurity (ROP). Methods: All ROP charts of babies who had initial retinal examination to screen for ROP from January 1, 2005 to December 31, 2008 at the neonatal-intensivecare nursery and eye center of a tertiary hospital were reviewed. Date of birth, sex, age of gestation (AOG), birth weight (BW), postnatal age (PNA), postconceptional age (PCA), and ROP classification were recorded. Descriptive statistics and Student’s t-test were used to analyze the data. Results: A total of 690 eyes of 345 babies, 174 males and 171 females, were included in the study. At the initial retinal exam, the mean AOG was 31.39 ± 2.46 weeks; BW, 1,268.77± 317.12 grams; PNA, 4.56 ± 2.95 weeks; and PCA, 35.94 ± 3.26 weeks. Immature retinas in both eyes were seen in 175 (50.72%) babies, while 113 (32.75%) had ROP of any stage in both eyes and 51 (14.78%) had immature retina in one eye and ROP of any stage in the other eye. Among the 113 babies with ROP, 33 (29.2%) were assessed to have pre-threshold ROP. Conclusion This study supported the applicability of the modified criteria which are in agreement with the Joint Statements of the American Academy of Pediatrics, American Academy of Ophthalmology and American Association of Pediatric Ophthalmology and Strabismus, and the United Kingdom Royal College of Pediatrics and Child Health for initiating retinal exams to screen for ROP.
Retinopathy of Prematurity

OBJECTIVE: To report on the implementation and initial pilot data of diabetic retinopathy (DR) identified using a validated telemedicine program for DR in a multispecialty primary care clinic.
METHODS: This was a retrospective, cross-sectional pilot survey of diabetic patients imaged for the first time at the telemedicine program of The Medical City from November 26, 2012 to August 31, 2013. The retinal images were obtained following the validated program of the Joslin Vision Network nonmydria. tic fundus photography for DR evaluation. These were evaluated by 4 retina specialists using a standardized protocol to assess for diabetic retinal disease and the presence of other retinal findings. The findings were recorded on customized electronic templates.
RESULTS: Seven hundred seventy-six (776) eyes of 388 patients were evaluated using the telemedicine program. The prevalence of DR was 28.2% (219 eyes), with 25.1% (195 eyes) having nonproliferative DR (NPDR). 14.2% 1110 eyes] had mild, 8.2% [64 eyes] moderate, 2.2% [17 eyes] severe, and 0.5% [4 eyes] very severe NPDR. 3.1% (24 eyes) had proliferative DR (PDR), of which 45.8% (11 eyes) had high-risk characteristics. The ungradable rate with selective mydriasis was 1.80% (14 eyes). The rate of referable DR (moderate NPDR or worse, any level of diabetic macular edema, or ungradable images) was 21.90% (170 eyes).
CONCLUSION: In the primary care setting, teleophthalmology can effectively identify patients with diabetic retinal complications and potentially refer these patients to appropriate levels of eye care. Retinopathy was present in over 28% of patients evaluated and over 21% had referable disease that may potentially progress to vision loss. Teleophthalmology for DR in this setting allows early detection of potentially sight threatening disease and may prevent visual loss and complications.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Diabetic Retinopathy ; Macular Edema ; Mydriasis ; Retina ; Retinal Diseases ; Telemedicine ; Primary Health Care