PURPOSE: We evaluated the long-term surgical outcome and lens complications in children with persistent pupillary membrane following removal using vitreous scissors. METHODS: Patients diagnosed with persistent pupillary membrane who received surgical treatment from 1987 to 2012 were retrospectively reviewed. The removal was performed using vitreous scissors after instillation of miotics. The minimum follow-up period after surgery was four years. Factors of age, sex, visual acuity, refractive errors, and complications during or after surgery were evaluated. RESULTS: A total of 32 eyes of 26 patients were included. The mean age at the initial visit was 22.6 ± 34.7 (range, 0.9 to 141.2) months, and the mean age at surgery was 43.7 ± 36.0 (range, 1.0 to 142.5) months. There were no intraoperative complications using vitreous scissors, and all lesions were completely removed. After a mean follow-up period of 6.5 ± 3.3 (range, 4.0 to 14.8) years, the best corrected visual acuity at the final visit was 0.6 ± 0.9 logarithm of the minimum angle of resolution, and two eyes (6.3%) presented with lens opacity during follow-up. CONCLUSIONS: In children with persistent pupillary membrane, there were no intraoperative complications, and only two patients presented with lens change during the long-term postoperative follow-up period. Surgical removal should be considered a safe and effective treatment for patients with visually significant persistent pupillary membrane.
Cataract ; Child ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Membranes* ; Miotics ; Postoperative Complications ; Refractive Errors ; Retrospective Studies ; Visual Acuity

PURPOSE: The authors report a case of bilateral simultaneous acute angle closure attack following administration of an over-the-counter common cold medication (ingredients: chlorpheniramine maleate, phenylephrine hydrochloride, and belladonna alkaloid). CASE SUMMARY: A 67-year-old man visited the emergency room with a sudden onset of bilateral blurred vision and ocular pain accompanied by headache, nausea, and vomiting. He had taken an over-the-counter common cold medication three times per day for three days before the visit. His visual acuity was 0.3 and 0.7 and intraocular pressure (IOP) was 50 mm Hg and 40 mm Hg in right and left eye, respectively. The refraction in manifest refractive test was +0.75 D sph = -0.75 D cyl x 100 in right eye and +1.25 D sph = -1.25 D cyl x 80 in left eye. The anterior chamber depth was three times the corneal thickness in center and less than 1/4 of the corneal thickness in periphery in both eyes on van Herick method. The angles of both eyes were closed on gonioscopy. He was treated with ocular hypotensive medication and miotics followed by withdrawal of common cold medications. After 10 days, bilateral neodymium-doped yttrium aluminium garnet (Nd:YAG) laser peripheral iridotomies were done. During four months of follow-up, there was no recurrence of angle closure attack, and normal IOP was maintained without glaucoma medications. CONCLUSIONS: Common cold medications which are easily accessible can induce acute angle closure attack in those who are predisposed to develop angle closure attacks, hence attention must be taken in those people when taking common cold medications.
Aged ; Anterior Chamber ; Atropa belladonna ; Chlorpheniramine ; Common Cold* ; Emergency Service, Hospital ; Follow-Up Studies ; Glaucoma ; Gonioscopy ; Headache ; Humans ; Intraocular Pressure ; Miotics ; Nausea ; Phenylephrine ; Recurrence ; Visual Acuity ; Vomiting ; Yttrium

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.
Absorption ; Animals ; Area Under Curve ; Biological Availability ; Chitosan ; chemistry ; Cornea ; metabolism ; Emulsions ; Microscopy, Electron, Transmission ; Miotics ; administration & dosage ; chemistry ; pharmacokinetics ; Ophthalmic Solutions ; Particle Size ; Pilocarpine ; administration & dosage ; chemistry ; pharmacokinetics ; Rabbits ; Random Allocation ; Solubility ; Tears ; metabolism

PURPOSE: To screen for diabetic autonomic neuropathy of the pupil using 0.5% apraclonidine and 0.1% pilocarpine and to evaluate the early diagnostic value of this pharmacologic pupillary test by assessing the relationship between pupillary and cardiovascular autonomic neuropathies. METHODS: A total of 22 diabetic patients were recruited. Baseline pupillary diameter (PD) and the difference in PD between the test eye and the control eye before and after instillation of apraclonidine and pilocarpine were measured. All patients also underwent cardiovascular autonomic function (CAF) testing. RESULTS: Baseline PD in room light correlated with duration of diabetes mellitus (DM, p=0.049) and the presence of DM retinopathy (DMR, p=0.022). Eleven patients (50%) had positive apraclonidine tests, and two patients had positive pilocarpine tests. The patients who had positive pilocarpine tests also had positive apraclonidine tests. Patients who had a positive pupillary test had a significantly higher rate of positive CAF tests (p=0.032). CONCLUSIONS: Pupillary autonomic neuropathy was related to the duration of diabetes and the degree of DMR. There was also a significant correlation between pupillary autonomic neuropathy and cardiovascular autonomic neuropathy (CAN). Also, sympathetic nerve dysfunction occurred prior to parasympathetic dysfunction in this study. A simple pharmacologic pupillary test can help manage complications in diabetic patients because patients with pupillary autonomic dysfunction have an increased risk of CAN.
Adrenergic alpha-Agonists/administration & dosage/diagnostic use ; Adult ; Aged ; Clonidine/administration & dosage/*analogs & derivatives/diagnostic use ; Diabetic Nephropathies/*diagnosis/physiopathology ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Miosis/*chemically induced/physiopathology ; Miotics/administration & dosage/diagnostic use ; Ophthalmic Solutions ; Pilocarpine/administration & dosage/*diagnostic use ; Pupil/drug effects/*physiology ; Reproducibility of Results

PURPOSE: Lithium-pilocarpine induced status epilepticus (LPSE) causes selective and age-dependent neuronal death, although the mechanism of maturation-related injury has not yet been clarified. The activating transcription factor-2 (ATF-2) protein is essential for the normal development of mammalian brain and is activated by c-Jun N-terminal kinase (JNK). It induces the expression of the c-jun gene and modulates the function of the c-Jun protein, a mediator of neuronal death and survival. Therefore, we investigated the expression of c-Jun and ATF-2 protein in the immature and adult rat hippocampus to understand their roles in LPSE-induced neuronal death. MATERIALS AND METHODS: Lithium chloride was administrated to P10 and adult rats followed by pilocarpine. Neuronal injury was assessed by silver and cresyl violet staining, performed 72 hours after status epilepticus. For evaluation of the expression of ATF-2 and c-Jun by immunohistochemical method and Western blot, animals were sacrificed at 0, 4, 24, and 72 hours after the initiation of seizure. RESULTS: Neuronal injury and expression of c-Jun were maturation-dependently increased by LPSE, whereas ATF-2 immunoreactivity decreased in the mature brain. Since both c-Jun and ATF-2 are activated by JNK, and targets and competitors in the same signal transduction cascade, we could speculate that ATF-2 may compete with c-Jun for JNK phosphorylation. CONCLUSION: The results suggested a neuroprotective role of ATF-2 in this maturation-related evolution of neuronal cell death from status epilepticus.
Activating Transcription Factor 2/*metabolism ; Animals ; Antimanic Agents/pharmacology ; Blotting, Western ; Hippocampus/drug effects/*metabolism ; Immunohistochemistry ; Lithium/pharmacology ; Miotics/pharmacology ; Pilocarpine/pharmacology ; Proto-Oncogene Proteins c-jun/*metabolism ; Rats ; Status Epilepticus/*chemically induced

PURPOSE: To report three cases of Urrets-Zavalia syndrome after deep lamellar keratoplasty. CASE SUMMARY: A retrospective chart analysis of two men who underwent deep lamellar keraplasty after corneal chemical burns and one woman who was treated with deep lamellar keratoplasty due to lattice dystrophy was performed. To maintain the anterior chamber depth and prevent formation of a double anterior chamber after deep lamellar keratoplasty, air or gas (C3F8) was injected into the anterior chamber for all three cases. After injections of air or gas (C3F8) into the anterior chamber, pupillary blocks occurred and intraocular pressures increased. Afterwards, intraocular pressures were well-controlled, but the pupil remained irreversibly fixed and dilated despite the use of miotics. CONCLUSIONS: Urrets-Zavalia syndrome, a postoperative complication, was first reported in a patient who underwent penetrating keratoplasty for keratoconus. This syndrome can also occur after deep lamellar keratoplasty on rare occasions.
Anterior Chamber ; Burns, Chemical ; Corneal Transplantation ; Female ; Humans ; Intraocular Pressure ; Keratoconus ; Keratoplasty, Penetrating ; Male ; Miotics ; Postoperative Complications ; Pupil ; Retrospective Studies

OBJECTIVETo compare the action of miosis of 1% pilocarpine liposome with 1% pilocarpine solution in rabbits.

METHODS18 white rabbits were randomly divided into 3 groups. Test group received 1% pilocarpine liposome, positive control group received 1% pilocarpine solution, negative control group received liposome. Each eye drop instilled into left eye of rabbits and sterile saline solution instilled into right eye as control. The pupil diameter was measured at time intervals of beginning, 0.25, 0.5, 1, 2, 3, 4, 5, 7 hours.

RESULTSThe mean pupil diameter change of 3 groups in both eyes was not significant (P > 0.05) at beginning. The strongest action of miosis took place 0.25 h in positive control group and 0.5 h in test group after instillation. The dilation of pupil in both groups took place 1 h and 3 h, and the restoration of pupil in both groups took place at 5 h and 7 h. The mean pupil diameter of negative control group was not significant in seven hours.

CONCLUSIONSThe results suggest that 1% pilocarpine liposome improves the bioavailability and prolong the duration of its action.

Animals ; Delayed-Action Preparations ; Female ; Liposomes ; pharmacology ; Male ; Miotics ; pharmacology ; Pilocarpine ; administration & dosage ; pharmacology ; Pupil ; drug effects ; Rabbits ; Random Allocation

PURPOSE: To evaluate the effects of DMSO on the iris muscle contractility and to compare DMSO with other detergents(ethanol and triton-x 100). METHODS: After anesthesizing rats with an intraperitoneal injection of pentobarbital sodium, each animal was fixed under microscope. The pupil response to the drugs was examined by CCD camera and the video edge motion detector was used for measurement of alteration of the pupil size. The pupil response to the drugs was recorded by MacLab chart(version 3.6/s). RESULTS: Miosis induced by DMSO was initiated after 5 minutes, peaked at around 30 minutes and maintained until 3 hours after instillation. Miotic effect of DMSO was in a dose dependent manner ranging 0.01%-10% and was not reversed after washout. All detergents used in the present experiment induced miosis, however, DMSO elicited the strongest miotic response. After pretreatment with atropine, DMSO-induced miotic response was not affected, showing similar changes with control group. CONCLUSIONS: Taken together, it is concluded that DMSO induces miosis by inducing relaxation of iris dilator muscle.
Animals ; Atropine ; Detergents ; Dimethyl Sulfoxide* ; Injections, Intraperitoneal ; Iris* ; Miosis ; Miotics ; Pentobarbital ; Pupil ; Rats* ; Relaxation

Puillary capture in an unusual complication of posterior chamber intraocuIar lens (PCL) implantation and may occur in the early or late postoperative period. An analysis of clinical records was made in 27 pupillary capture cases receiving PCL from Jan 1, 1986 to Mar. 31, 1990. Twenty-two cases (81.5%) were male, and five cases (18.5%) were female. Among the captured PCL, 6.0mm optic and 13.5mm length PCLs were most commonly implanted. All PCLs used in the study had lO degrees angulation of the IOL loops and asymmetric fixation of loop was noted in 5.9% of all pupillary catpure cases. The interval between cataract operation and pupillary capture was variable but most cases (81.5%) of pupillary capture were developed within one year after operation. The subjective symptoms and signs of pupillary capture were decreased vision, glare, double vision, conjunctival injection, tearing and discomfortness while 12 cases (44.4%) had no subjectIve symptoms The reposition of pupillary capture was successfully done by using mydriatics and miotics in 15 of 27 cases (55.6%) and surgical correction was needed in only 2 cases. The recurrence was developed in 53.3% of cases that were corrected with mydriatics Complictions of pupillary capture were iridocapsular or iridolenticular adhesion, atrophy and depigmentation of iris, transient iritis, and pupillary distortion.
Atrophy ; Cataract ; Diplopia ; Female ; Glare ; Humans ; Iris ; Iritis ; Male ; Miotics ; Mydriatics ; Postoperative Period ; Recurrence

Occlusion or stenosis of lacrimal punctum may be from congenital origin, but can be caused by a variety of factors such as inflamations, tumors, traumas, and systemic diseases that invade punctum. Occlusion or stenosis of punctum was reported after use of drugs, such as strong miotics or idoxuridine also. The initial procedure to be employed in punctal stenosis caused by most factors is punctal dilation. In 1985, Awan used a new application of laser in the treatment of punctal stenosis, reporting good result. Two Korean adults with acquired punctal stenosis were treated by laser punctoplasty with good results.
Adult ; Constriction, Pathologic* ; Humans ; Idoxuridine ; Miotics