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.

PURPOSE: To report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi. CASE SUMMARY: A 53-year-old female complained of pain and secretion in her right eye, which started 6 weeks before her visit. She applied steroid ointment, which was received from the dermatologist, to her eyelid 7 days prior to her visit but this treatment worsened her symptoms. At the initial visit, the visual acuity of the right eye was light perception, and purulent secretions were observed. Using a slit lamp, severe conjunctival hyperemia, hypopyon, and a ring-shaped central corneal ulcer were observed. The anterior chamber and fundus were not observed due to corneal lesions but ultrasonography showed no intraocular inflammation. Infectious keratitis was suspected and cultured by corneal scraping. During the incubation period, 0.5% moxifloxacin, 2% voriconazole, and 1% cyclopentolate were administered. A total of 400 mg of moxifloxacin and 100 mg of doxycycline were given orally. In the primary culture, Pseudomonas aeruginosa and Acinetobacter baumannii were identified so 5% ceftazidime, which was sensitive for the antibiotic susceptibility results was further instilled. Thereafter, the keratitis improved but the keratitis again worsened while maintaining the topical treatment. A secondary culture was positive for Ochrobactrum anthropi. Treatment with 1.4% gentamicin, which was sensitive for the antibiotic susceptibility test was added and the keratitis improved. A conjunctival flap was performed because of the increased risk of perforation. CONCLUSIONS: We report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi for the first time in the Republic of Korea.
Acinetobacter baumannii ; Acinetobacter ; Anterior Chamber ; Ceftazidime ; Corneal Ulcer ; Cyclopentolate ; Doxycycline ; Eyelids ; Female ; Gentamicins ; Humans ; Hyperemia ; Inflammation ; Keratitis ; Middle Aged ; Ochrobactrum anthropi ; Ochrobactrum ; Pseudomonas aeruginosa ; Pseudomonas ; Republic of Korea ; Slit Lamp ; Ultrasonography ; Visual Acuity ; Voriconazole

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*

PURPOSE: To investigate the frequency of side effects due to the use of cyclopentolate for cycloplegic refraction. METHODS: For 4 months, temperature change and adverse effects in 157 children who visited the pediatric ophthalmology clinic of a university hospital for cycloplegic refraction using cyclopentolate were observed. Topical 1% cyclopentolate was instilled 5 times at 5 minute intervals and temperature measured before and after administration using a tympanic thermometer. Side effects such as facial flushing, skin rash, and central nervous system disorders were recorded while cycloplegic refraction was performed. RESULTS: The mean temperature was increased 36.67 +/- 0.10degrees C to 36.90 +/- 0.09degrees C, but no fever exceeded 38degrees C. Seventeen (10.83%) patients experienced side effects including facial flushes (n = 6), temperature change (n = 5), abnormal central nervous system symptoms (n = 4), and a visible skin rash (n = 2). No patient experienced more than 1 side effect and long term adverse effects were not observed. CONCLUSIONS: The incidence of side effects due to cyclopentolate instillation for cycloplegic refraction was 10.83% in children. Although side effects due to cyclopentolate disappeared without any treatment, cafeful monitoring for their occurrence is necessary.
Central Nervous System ; Central Nervous System Diseases ; Child ; Cyclopentolate* ; Exanthema ; Fever ; Flushing ; Humans ; Incidence ; Ophthalmology ; Thermometers

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: We examined the several refractive errors and measured the axial length of child patients who visited Fatima Hospital and then assessed the distribution of refractive error and axial length. We also compared the patients' life-styles with refractive error and axial length. METHODS: We examined automated refraction, manifest refraction, 1% Cyclogyl refraction, 1% atropine refraction and axial length with an A-scan in patients between 5 and 15 years old. We asked their parents to provide information about the life-style of the patients using a questionnaire. RESULTS: The difference between manifest refraction and 1% Cyclogyl refraction was significant in patients under 9 years of age, but not significant in patients over 10 years of age. We found that the greater degree of myopia the patient had, the longer the total length and vitreous length. Patients who played outdoors for less than 2 hours per day, read more than 2 books per week and had 1 or more parent with myopia, had greater degrees of myopia. CONCLUSIONS: We found that 1% Cyclogyl refraction with manifest refraction is necessary for refraction examination in children, and the degree of myopia is closely related with an indoor life-style, the amount of reading books and the parents myopia.
Adolescent ; Atropine ; Child* ; Cyclopentolate ; Humans ; Life Style* ; Myopia* ; Parents ; Surveys and Questionnaires ; Refractive Errors

PURPOSE: To evaluate the changes of higher-order aberrations of the eye with the application of various mydriatics. METHODS: Higher-order aberrations were measured in 18 eyes of 11 subjects (ages 26 to 37 years; 9 males, 2 females) without any ocular diseases except refractive errors. Repeated measurements were conducted before and after instillation of 1 drop of three different mydriatics: 10% phenylephrine, a combination of 0.5% tropicamide and 0.5% phenylephrine (Mydrin(R)-P), and 1% cyclopentolate. The data from 6 mm pupil size were calculated and analyzed. RESULTS: Average root mean square of higher-order (HO-RMS) aberrations was 0.39 in undilated eyes. The averages HO-RMS after instillation of phenylephrine, Mydrin(R)-P, and cyclopentolate was 0.40, 0.41, and 0.42, respectively. There was no statistically significant difference among the four HO-RMS conditions. The spherical aberration of undilated or phenylephrine-instilled condition was different from that of Mydrin(R)-P or cyclopentolate condition (p<0.05). CONCLUSIONS: The application of mydriatics affected the higher-order aberrations of eyes. These findings should be considered when performing wavefront-guided refractive surgery.
Cyclopentolate ; Humans ; Male ; Mydriatics* ; Phenylephrine ; Pupil ; Refractive Errors ; Refractive Surgical Procedures ; Tropicamide

PURPOSE: To investigate clinical course of esotropia associated with hyperopia after initial wearing of the glasses. METHODS: Patients with onset earlier than 6 months of age, or with vertical strabismus greater than 3delta were excluded. The time intervals between initial wearing of the glasses and decrease of esophoria (tropia) to 8delta or less, minimun amount of hypermetropic correction to straighten the eyes and clinical course after initial prescription of hyperopic spectacles were analyzed. RESULTS: There were 21 boys and 23 girls. The average onset of esotropia was 35.4 months of age, and the timing of initial wearing of the glasses was 44.4 months. The average deviation at near without correction was 29.6 delta. Average refractive error was +4.25 diopters (D) OD and +4.16D OS, with the minimum of +1.63D OD and +1.38D OS in one patient. Among 44 patients, 22 showed esophoria (tropia) of 8 delta or less within two weeks, and five between 2 and 7 weeks. Three were corrected after wearing new glasses by repeat cycloplegic refraction with atropine (2 patients), or with cyclopentolate (1 patients). Esotropia was resolved after occlusion therapy for amblyopia in one patient. Eleven were partially accommodative esotropia. Among 33 refractive accommodative esotropia, two deteriorated to partially accommodative esotropia, one to high AC/A ratio esotropia, and one to exotropia. CONCLUSIONS: Hyperopia as small as +1.50D should be corrected. If significant esotropia remained after seven weeks of initial wearing of hyperopic glasses, it would be prudent to perform cycloplegic refraction again with atropine. Six percent of refractive accommodative esotropia decompensated to partially accommodative esotropia.
Amblyopia ; Atropine ; Cyclopentolate ; Esotropia* ; Exotropia ; Eyeglasses* ; Female ; Glass* ; Humans ; Hyperopia* ; Prescriptions ; Refractive Errors ; Strabismus