Myopia during bromocriptine treatment

Drug-induced ciliary body oedema: a new theory

Drug-induced oedema of the ciliary body is rare, and occurs predominantly following exposure to sulphonamides. In a 31-year-old patient in her 37th week of pregnancy, we observed reversible myopia of -4.75 dioptres following the ingestion of chlorthalidone. In a second case report we describe, in a 61-year-old patient suffering from aspirin-sensitive asthma, recurrent ciliary body oedema with a marked spastic component which was triggered by the medications acetazolamide, dipivefrine and pilocarpine. We explain oedema of the ciliary body on the basis of the eicosanoids. We believe that the oedema is caused mainly by prostaglandins and that leucotrienes are predominantly responsible for the spastic component. We postulate a drug-induced elevation in eicosanoid concentrations, as well as certain interrelationships between ciliary body oedema and aspirin-sensitive asthma.

Pharmacogeriatrics

The elderly comprise one of the fastest growing populations in the United States. By the year 2020, an estimated 45 million will be classified as elderly. Aging is a highly variable process as declines occur in physiologic functions. Alterations in cardiovascular, renal and hepatic function have the greatest effect on drug therapy. All pharmacokinetic and pharmacodynamic variables may be altered by age. Adverse drug reactions, drug interactions and poor compliance are frequent and may further complicate drug therapy. A review of those processes that commonly influence pharmacologic response and patient compliance to drug therapy is appropriate.

Teratogenicity of bromocryptine in pregnant rats

The teratogenicity of bromocryptine (CB-154, Sandoz, Basel) was studied in three groups of pregnant rats which received 0.625 mg/kg/day, 1.25 mg/kg/day, and 2.5 mg/kg/day bromocryptine, respectively, i.m. and in a control group of pregnant rats which received the solvent only. There was no significant difference in the birth rate, fetal resorption rate, male/female ratio and malformation rate between the four groups. There was a significant elevation of the average fetal and placental weights between the experimental and the control fetuses. Bromocryptine does cross the placental barrier and in our study might act as growth promoting factor.

The mechanism of transient myopia induced by sulfonamide therapy

We performed acute and convalescent A-scan echographic ocular measurements documenting the anterior chamber depth, lens thickness, and axial length of a patient with acute transient sulfamethoxazole-induced myopia. Shallowing of the anterior chamber, independent of changes in the thickness of the lens, was the only anatomic variation found that could explain the myopia. Swelling of the ciliary body, with forward movement of the lens-iris diaphragm, could produce this transient anatomic change.