Objective: To determine the characteristics and progress of the visual acuity and refractive state of schoolchildren in Huangzhong District, Xining City, Qinghai Province in China. Methods: Cohort study. Department of Ophthalmology, Beijing Children's Hospital carried out a cohort study by collecting the visual acuity and refractive state of Grade 1-5 schoolchildren among 16 primary schools in Huangzhong District, Xining City, Qinghai Province in September 2020 and July 2021. Cycloplegic retinoscopy with eye drop which contained tropicamide (0.5%) and phenylephrine hydrochloride (0.5%) was performed in children with low vision(<1.0). Myopia was defined as the spherical equivalent (SE) ≤-0.5 D after cycloplegic retinoscopy. Measurement data was analyzed by t-test and enumeration data was analyzed by χ² test. Multiple linear regression was used to analyze the influencing factors. Results: The 2 489 individuals with repeated tests in two years were included in the follow-up study, among whom the prevalence of myopia was 26.24%(653/2 489) in 2020, while 32.94% (820/2 489)respectively in 2021. The incidence of myopia in one school year from grades 1 to 5 was 11.19%(47/420), 5.44%(21/386), 6.39%(25/391), 11.52%(44/382) and 11.67%(30/257). The average SE of children in all grades in 2021 increased negatively from the previous year (Grade 1 to Grade 5 increased respectively: 0.40 D, 0.69 D, 0.62 D, 0.52 D and 0.37 D). Conclusions: The prevalence of myopia among schoolchildren in Huangzhong District, Xining City, Qinghai Province was relatively high. There were two peaks of myopia incidence in the first, fourth and fifth grades. Female, age, and the baseline of SE were the related influencing factors for myopia progression.
Child ; Cohort Studies ; Female ; Follow-Up Studies ; Humans ; Mydriatics ; Myopia/epidemiology* ; Ophthalmic Solutions ; Phenylephrine ; Prevalence ; Prospective Studies ; Tropicamide

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

PURPOSE: To evaluate the effectiveness of a cycloplegic regimen using 0.5% tropicamide and 0.5% phenylephrine (Tropherine, Hanmi Pharm), in addition to 1% cyclopentolate, in hyperopic children. METHODS: The medical records of hyperopic patients below the age of 14 years who had undergone cycloplegic retinoscopy were retrospectively reviewed. Cycloplegic refractions were performed using one of two cycloplegic regimens. Regimen 1 was a Tropherine-added regimen comprising the administration of one drop of 1% cyclopentolate followed by two to three drops of Tropherine added at 15-minute intervals. Regimen 2 was a cyclopentolate-only regimen comprising the administration of three to four drops of 1% cyclopentolate at 15-minute intervals. The mean difference between noncycloplegic and cycloplegic refraction was compared between the two regimens. RESULTS: A total of 308 eyes of 308 hyperopic children were included. The mean difference (±standard deviation) in the spherical equivalent (SE) between cycloplegic and noncycloplegic refraction was significantly larger in regimen 2 than in regimen 1, with values of +1.70 ± 1.03 diopters (D) and +1.25 ± 0.89 D, respectively (p=0.001). The SE change after cycloplegia was significantly different between the two regimens only in patients aged 5 years or younger (p=0.001), particularly in those with high hyperopia with an SE ≥5 D (p=0.005) or fully accommodative esotropia (p=0.009). There was no significant difference between the two regimens in patients older than 5 years, regardless of the presence of high hyperopia or fully accommodative esotropia. CONCLUSIONS: The Tropherine-added regimen exerted a weaker cycloplegic effect than the cyclopentolate-only regimen, particularly in children under the age of 5 years with high hyperopia or fully accommodative esotropia. However, the difference in refraction between the two regimens was small. A Tropherine-added regimen can be effective in hyperopic children, with less associated discomfort than the instillation of cyclopentolate.
Child* ; Cyclopentolate* ; Esotropia ; Humans ; Hyperopia ; Medical Records ; Phenylephrine* ; Retinoscopy ; Retrospective Studies ; Tropicamide*

BACKGROUND: The authors evaluated the effect of intrathecal mixture of ginsenosides with neostigmine on formalin-induced nociception and made further clear the role of the spinal muscarinic (M) receptors on the activity of ginsenosides. METHODS: A catheter was located in the intrathecal space of male Sprague-Dawley rats. Pain was evoked by injection of formalin solution (5%, 50 microl) to the hindpaw. Isobolographic analysis was done to characterize drug interaction between ginsenosides and neostigmine. The antagonism of ginsenosides-mediated antinociception was determined with M1 receptor antagonist (pirenzepine), M2 receptor antagonist (methoctramine), M3 receptor antagonist (4-DAMP), M4 receptor antagonist (tropicamide). The expression of muscarinic receptor subtypes was examined with RT-PCR. RESULTS: Intrathecal ginsenosides and neostigmine produced an antinociceptive effect during phase 1 and phase 2 in the formalin test. Isobolographic analysis revealed an additive interaction between ginsenosides and neostigmine in both phases. Intrathecal pirenzepine, methoctramine, 4-DAMP, and tropicamide reversed the antinociception of ginsenosides in both phases. M1-M4 receptors mRNA detected in spinal cord of naive rats and the injection of formalin decreased the expression of M1 receptor mRNA, but it had no effect on the expression of other three muscarinic receptors mRNA. Intrathecal ginsenosides little affected the expression of all of muscarinic receptors mRNA in formalin-injected rats. CONCLUSIONS: Intrathecal ginsenosides additively interacted with neostigmine in the formalin test. Furthermore, M1-M4 receptors exist in the spinal cord, all of which contribute to the antinocieption of intrathecal ginsenosides.
Animals ; Catheters ; Diamines ; Drug Interactions ; Formaldehyde ; Ginsenosides ; Humans ; Male ; Neostigmine ; Nociception ; Pain Measurement ; Piperidines ; Pirenzepine ; Rats ; Rats, Sprague-Dawley ; Receptors, Muscarinic ; RNA, Messenger ; Spinal Cord ; Tropicamide

PURPOSE: The present study investigates the effects of pharmacologic pupil dilatation on ocular, corneal and internal aberrations. METHODS: Sixty-two right eyes of 62 healthy participants were included in the present study. Ocular, corneal and internal aberrations were measured with a KR-1W wavefront aberrometer (Topcon Corp., Tokyo, Japan) before mydriasis in mesopic conditions. After pupil dilatation with a mydriatic drug (phenylephrine chloride 0.5% + tropicamide 0.5%) (Mydrin-P, Santen, Osaka, Japan), the measurements were repeated. The wavefront data of 4-mm and 6-mm diameter zones were analyzed. The changes of aberrations before and after mydriasis were evaluated by paired t-test. RESULTS: The values of ocular, corneal and internal spherical aberrations before and after mydriasis on the 4-mm diameter pupil zone were not statistically significantly different. On the 6-mm diameter zone, the ocular and internal spherical aberrations were statistically significantly different (p = 0.025, p = 0.002, respectively, paired t-test). However, the corneal aberrations did not show significant changes. The internal aberrations average before mydriasis was -0.043 (+/-0.21) microm and was shifted in a negative direction to -0.093 (+/-0.17) microm after mydriasis. The ocular aberrations average also changed toward negative after mydriasis. The high-order aberrations and astigmatism did not change significantly. CONCLUSIONS: The ocular and internal spherical aberrations changed toward negative with mydriasis in the participants' eyes suggesting the change of the ocular spherical aberration to be attributed to internal changes.
Astigmatism ; Dilatation ; Eye ; Mydriasis ; Pupil ; Tokyo ; Tropicamide

PURPOSE: To report the long term results of bifocal treatment in nonrefractive accommodative esotropia and to analyze the changes of accommodative convergence to accommodation (AC/A) ratio. METHODS: Sixteen patients treated with bifocal glasses for at least 5 years were evaluated retrospectively. Angle of deviation at near and distance, refractive error, and AC/A ratio by the lens gradient method were analyzed. The changes of AC/A ratios were also compared after dividing the patients according to continuation or cessation of bifocal therapy. RESULTS: Six patients (38%; bifocal stop group, BSG) were able to stop using bifocal glasses at an average age of 10.8 years (range, 6.5 to 15.4 years) during their follow-up. However, the other ten patients (62%; bifocal continue group, BCG) had to continue using bifocal glasses until the final visit, which was 13.8 years on average (range, 11.3 to 18.5 years). The AC/A ratio decreased from time of bifocal prescription to the last visit in both groups, from 4.4 to 2.7 in the BSG and from 5.9 to 4.5 in the BCG. AC/A ratios were significantly higher (p = 0.03) in the BCG than that of the BSG from the beginning of bifocal treatment and this difference was persistent until the final visit (p = 0.03). CONCLUSIONS: The AC/A ratio decreased with age in both groups but was significantly higher throughout the entire follow-up period in the BCG. AC/A ratio at bifocal prescription could be an important factor in predicting response to bifocal treatment.
Accommodation, Ocular/*physiology ; Adolescent ; Child ; Cyclopentolate/administration & dosage ; Esotropia/*physiopathology/*therapy ; *Eyeglasses ; Female ; Humans ; Male ; Phenylephrine/administration & dosage ; Retrospective Studies ; Statistics, Nonparametric ; Tropicamide/administration & dosage

PURPOSE: To investigate the effects of pupil dilation and constriction agents on the survival and production of nitric oxide (NO) in cultured human trabecular meshwork cells (HTMC). METHODS: Primarily cultured HTMC were exposed to 0, 0.01, and 0.1 mg/ml of tropicamide, cyclopentolate, atropine, or pilocarpine for 2 hours. Cellular survival and production of NO were assessed using the MTT assay and Griess assay, respectively. RESULTS: Tropicamide, cyclopentolate, atropine, and pilocarpine decreased cellular survival at the concentration of 0.1 mg. At the concentration of 0.01 mg/ml, all agents decreased production of NO to some extent, although the reduction was not statistically significant. CONCLUSIONS: Pupil dilation and constriction agents may be toxic to HTMC if used at high concentrations or if used frequently in the short-term but may not affect trabecular outflow.
Atropine ; Constriction ; Cyclopentolate ; Humans ; Nitric Oxide ; Pilocarpine ; Pupil ; Trabecular Meshwork ; Tropicamide

PURPOSE: To evaluate the efficacy of 3 cycloplegic regimens in adults with myopia. METHODS: Refraction, accommodation amplitude, residual accommodation and biometric findings were assessed before and after instillation of regimen I (tropicamide 0.5% and phenylephrine 0.5%), regimen II (cyclopentolate 1.0%), and regimen III (combination of regimen I and II). RESULTS: In myopic adults aged 22 to 26 years, cycloplegic refraction revealed less myopia than manifested refraction. Although there was no difference in residual accommodation among the 3 regimens, regimen II and III were more effective in reducing myopia, accommodation, and axial length. The difference in cycloplegic refraction between regimen I and II was more prominent in patients who had larger amplitude of accommodation and residual accommodation with regimen I. CONCLUSIONS: Cycloplegic refraction should be used even in adult myopes. For patients with stronger accommodation and larger residual accommodation with tropicamide, cycloplegic refraction with cyclopentolate may be used to ensure relaxation.
Adult ; Aged ; Cyclopentolate ; Dietary Sucrose ; Humans ; Mydriatics ; Myopia ; Phenylephrine ; Refractive Errors ; Relaxation ; Tropicamide

PURPOSE: To maximize effective use of mydriatic drugs through comparing the pupillary dilation effects between 1% tropicamide and 2.5% phenylephrine. METHODS: Fifty people requiring pupillary dilation were divided into 3 groups. Group 1 was treated with one drop of 1% tropicamide in the right eye and one drop of 2.5% phenylephrine in the left eye. Group 2 was treated twice during a 5-minute interval with 1% tropicamide in the right eye. Group 3 was treated twice during a 5-minute interval with 2.5% phenylephrine in the right eye. Groups 2 and 3 were treated with 2.5% phenylephrine and 1% tropicamide in the left eye, administered during a 5-minute interval. The pupillary size was measured in all groups for 40 minutes following eye drops administration. RESULTS: The mean patient age was 15.7 years. Group 1 included 10 patients, and groups 2 and 3 included 20 patients each. Eight patients in group 1 and 16 patients in group 2 developed a larger right pupil. Fourteen patients in group 3 developed a larger left pupil. CONCLUSIONS: Our study showed that 1% tropicamide, with its parasympathetic antagonistic mechanism of action, was more effective at inducing pupillary dilation than 2.5% phenylephrine, and the combination of 1% tropicamide and 2.5% phenylephrine was more effective than multiple drops of single eye drops.
Adolescent ; Adult ; Child ; Child, Preschool ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Humans ; Male ; Muscarinic Antagonists/*administration & dosage ; Mydriatics/*administration & dosage ; Ophthalmic Solutions ; Phenylephrine/*administration & dosage ; Pupil/*drug effects ; Refractive Errors/diagnosis/physiopathology ; Retrospective Studies ; Tropicamide/*administration & dosage ; Young Adult

BACKGROUNDCa(2+) in the central nervous system plays important roles in brain physiology, including neuronal survival and regeneration in rats with injured facial motoneurons. The present research was to study the modulations of intracellular free Ca(2+) concentrations by cholinergic receptors in rat facial nucleus, and the mechanisms of the modulations.

METHODSThe fluorescence intensity of facial nucleus in Fluo-3 AM loaded acute brainstem slices was detected by applying intracellular free Ca(2+) measurement technique via confocal laser scanning microscope. The changes of fluorescence intensity of facial nucleus indicate the average changes of intracellular free Ca(2+) levels of the neurons.

RESULTSAcetylcholine was effective at increasing the fluorescence intensity of facial nucleus. Muscarine chloride induced a marked increase of fluorescence intensity in a concentration dependent fashion. The enhancement of fluorescence intensity by muscarine chloride was significantly reduced by thapsigargin (depletor of intracellular Ca(2+) store; P < 0.01), rather than Ca(2+) free artifical cerebrospinal fluid or EGTA (free Ca(2+) chelator; P > 0.05). And the increase of fluorescence intensity was also significantly inhibited by pirenzepine (M(1) subtype selective antagonist; P < 0.01) and 4-DAMP (M(3) subtype selective antagonist; P < 0.01). In addition, fluorescence intensity was markedly increased by nicotine. The enhancement of fluorescence intensity by nicotine was significantly reduced by EGTA, nifedipine (L-type voltage-gated Ca(2+) channel blocker), dihydro-beta-erythroidine (alpha4beta2 subtype selective antagonist), and in Ca(2+) free artificial cerebrospinal fluid (P < 0.01), but not in the presence of mibefradil (M-type voltage-gated Ca(2+) channel blocker) or thapsigargin (P > 0.05).

CONCLUSIONSThe data provide the evidence that muscarinic receptors may induce the increase of intracellular free Ca(2+) levels through the Ca(2+) release of intracellular Ca(2+) stores, in a manner related to M(1) and M(3) subtypes of muscarinic receptors in rat facial nucleus. Nicotine may increase intracellular free Ca(2+) concentrations via the influx of extracellular Ca(2+)+ mainly across L-type voltage-gated Ca(2+) channels, in a manner related to the alpha4beta2 subtype of nicotinic receptors.

Acetylcholine ; pharmacology ; Aniline Compounds ; administration & dosage ; Animals ; Brain Stem ; cytology ; drug effects ; metabolism ; Calcium ; metabolism ; Diamines ; pharmacology ; Facial Nerve ; cytology ; Female ; Fluorescent Dyes ; administration & dosage ; In Vitro Techniques ; Male ; Microscopy, Confocal ; Motor Neurons ; drug effects ; metabolism ; Muscarinic Agonists ; pharmacology ; Nicotine ; pharmacology ; Nicotinic Agonists ; pharmacology ; Piperidines ; pharmacology ; Pirenzepine ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Receptors, Cholinergic ; metabolism ; Receptors, Muscarinic ; metabolism ; Receptors, Nicotinic ; metabolism ; Tropicamide ; pharmacology ; Xanthenes ; administration & dosage