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Schaafsma JD, Arnold RW. Pre-Cycloplegic Exam Benefit of Photoscreening and Accommodation-Relaxing Skiascopy. Clin Ophthalmol 2024; 18:833-846. [PMID: 38504935 PMCID: PMC10950080 DOI: 10.2147/opth.s454430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024] Open
Abstract
Background Seeking a quick way to estimate refractions for challenging pediatric patients, we studied two non-contact methods with particular attention to accuracy and level of stress in uncovering cycloplegic hyperopia. Methods Newly referred and follow-up pediatric eye patients had timed school bus accommodation-relaxing skiascopy (SBARS) and Plusoptix A12 (Px) photoscreener testing before cyclopentolate 1% confirmatory examinations. The ABCD ellipsoid univariate method based on relative blur and vector components was used to compare dry sphero-cylinder refraction estimates with cycloplegic. Receiver operating characteristic (ROC) curves were used to determine screening value. Results Three compared refractions were attempted in 191 racially diverse children of whom 100 were age 0.2-3.9 years and 91 were 4 to 14 years. Plusoptix failed to yield a result in 21 and an additional 21 were interpreted as an excess sphere. Median spherical equivalent did not differ between Px and SBARS for 149 with Px readings but in hyperopic patients, Plusoptix uncovered 27% less hyperopia. The ellipsoid for SBARS of 0.8 was better than 2.4 for Plusoptix (Mann-Whitney p<0.001). Plusoptix was fastest (3-15 seconds) followed by SBARS (15-30 seconds) compared to 30-45 minutes for cycloplegic exam. Conclusion Non-contact quick refractive methods enhanced confirmatory cycloplegic pediatric exam in high-risk pediatric patients.
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Affiliation(s)
| | - Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA
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Contreras-Salinas H, Orozco-Ceja V, Romero-López MS, Barajas-Virgen MY, Baiza-Durán LM, Rodríguez-Herrera LY. Ocular Cyclopentolate: A Mini Review Concerning Its Benefits and Risks. Clin Ophthalmol 2022; 16:3753-3762. [PMID: 36411874 PMCID: PMC9675330 DOI: 10.2147/opth.s388982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/28/2022] [Indexed: 07/30/2023] Open
Abstract
Cycloplegic and mydriatic agents are essential in ophthalmological clinical practice since they provide the means for diagnosing and treating certain eye conditions. In addition, cyclopentolate has proven to possess certain benefits compared to other available cycloplegics and mydriatics. Still, the incidence of some adverse drug reactions related to this drug, especially in susceptible patients, has created interest in reviewing the literature about the benefits and risks of using cyclopentolate. A literature search was conducted in Medline/PubMed and Google Scholar, focusing on identifying cyclopentolate's benefits and risks; the most important benefit was its usefulness for evaluating refractive errors, especially for hyperopic children, pseudomyopia, anterior uveitis, treatment of childhood myopia, idiopathic vision loss, and during examinations before refractive surgery, with particular advantages compared to other cycloplegics. While the risks were divided into local adverse drug reactions such as burning sensation, photophobia, hyperemia, punctate keratitis, synechiae, and blurred vision, which are relatively frequent but mild and temporary; and systemic adverse drug reactions such as language problems, visual or tactile hallucinations and ataxia, but unlike ocular, systemic adverse drug reactions are rare and occur mainly in patients with risk factors. In addition, six cases of abuse were found. The treatment with cyclopentolate is effective and safe in most cases; nevertheless, special care must be taken due to the potential severe ADRs that may occur, especially in susceptible patients like children, geriatrics, patients with neurological disorders or Down's syndrome, patients with a low blood level of pseudocholinesterase, users of substances with CNS effects, and patients with a history of drug addiction. The recommendations are avoiding the use of 2% cyclopentolate and instead employing solutions with lower concentrations, preferably with another mydriatic such as phenylephrine. Likewise, the occlusion of the nasolacrimal duct after instillation limits the drug's absorption, reducing the risk of systemic adverse events.
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Affiliation(s)
| | - Vanessa Orozco-Ceja
- Pharmacovigilance Department, Laboratorios Sophia, S.A. de C.V, Zapopan, Jalisco, México
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Sheth J, Goyal A, Natarajan D, Warkad VU, Sachdeva V, Kekunnaya R. Clinical Profile, Neuroimaging Characteristics, and Surgical Outcomes of Patients With Acute Acquired Non-accommodative Comitant Esotropia. J Pediatr Ophthalmol Strabismus 2022; 60:218-225. [PMID: 35938637 DOI: 10.3928/01913913-20220630-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the clinical presentations, neuroimaging findings, and surgical outcomes in patients with acute acquired non-accommodative comitant esotropia (AACE). METHODS A retrospective review of records of all patients diagnosed as having AACE between January 2011 and December 2019 across three tertiary eye care centers was done. Cases with AACE onset after age 1 year were included. Patients were divided into two groups based on age of onset of esotropia: childhood (16 years or younger) and adult (older than 16 years). Surgical success was defined as postoperative horizontal deviation of 8 prism diopters (PD) or less at the last follow-up visit. RESULTS A total of 338 patients (220 males and 119 females; mean age at presentation: 12.60 ± 9.8 years) met the study criteria. The mean age at onset of esotropia in the childhood and adult onset groups was 3.61 ± 1.1 and 26.6 ± 8.7 years, respectively. There were significantly more individuals with myopia (30%) in the adult onset group compared to the childhood onset group (6%) (P = .004). Thirty-seven (16%) had positive neuroimaging findings (16.4% adult onset vs 9.4% childhood onset). A total of 148 (44%) patients underwent surgery for esotropia, and the overall success rate was 73%. Mean preoperative esotropia was comparable in either group (P = .20), but surgical success was better in the adult onset group (75.6% vs 66.3% in the childhood onset group). Mean duration of follow-up postoperatively was 13.6 ± 12 months. CONCLUSIONS Two-thirds of the patients had childhood onset of AACE. Intracranial pathology was found in 1 of 6 patients. Surgical success was better in the adult onset group, which was not influenced by preoperative esotropia, neuroimaging findings, or refractive status, but was dependent on age at onset of esotropia and duration between onset and intervention. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Liu X, Ye L, Chen C, Chen M, Wen S, Mao X. Evaluation of the Necessity for Cycloplegia During Refraction of Chinese Children Between 4 and 10 Years Old. J Pediatr Ophthalmol Strabismus 2020; 57:257-263. [PMID: 32687211 DOI: 10.3928/01913913-20200407-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/30/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the effect of atropine cycloplegia on the refractive status of children aged 4 to 10 years and to evaluate the necessity of cycloplegia for different refractive states and ages during refractive correction. METHODS This retrospective study included patients with low, moderate, and high myopia and hyperopia who were divided into two groups by age: 4 to 6 years (n = 5,320) and 7 to 10 years (n = 6,475). Every patient underwent cycloplegia with atropine sulphate. Refractive errors were measured by retinoscopy. RESULTS Within each group, the differences between cycloplegic and non-cycloplegic refractive errors (DIFFC-N) were significant. DIFFC-N was negatively correlated with age (r = -0.356, P < .001). The differences in refractive error between prescribed glasses and non-cycloplegic refraction (DIFFG-N) were largest in the groups with high myopia (0.83 ± 1.15 diopters [D] in the 4 to 6 years group and 0.60 ± 1.47 D in the 7 to 10 years group). After cycloplegia, 62.5% of the patients with mild myopia became emmetropic or hyperopic in the 4 to 6 years group, and 11.3% of the patients with mild myopia became emmetropic or hyperopic in the 7 to 10 years group. CONCLUSIONS Without cycloplegia, autorefraction tends to overestimate refractive error in children with myopia. For accurate glasses prescriptions, cycloplegia should be used for children between 4 and 10 years, especially for children with high myopia. [J Pediatr Ophthalmol Strabismus. 2020;57(4):257-263.].
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Arnold AW, Arnold SL, Sprano JH, Arnold RW. School bus accommodation-relaxing skiascopy. Clin Ophthalmol 2019; 13:1841-1851. [PMID: 31631961 PMCID: PMC6790215 DOI: 10.2147/opth.s219031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Accurate estimation of hyperopia and astigmatism is challenging in delayed children. Conventional skiascopy holds rows of increasing power ± lenses vertically in front of one eye. The school bus accommodation-relaxing skiascopy (SBA-RS) design holds child-friendly, lenses +1 to +10D horizontally so that a higher power fogs the nontested eye-relaxing accommodation without cycloplegia. Methods Design: Evaluation of diagnostic test. Subjects: Patients undergoing comprehensive eye examination in a pediatric ophthalmology practice. Cycloplegic (cyclopentolate 1%) retinoscopy was compared to dry SBA-RS and Retinomax (Righton, Japan) during pediatric eye examinations. Outcome measures: correlations, Chi-square and receiver operating characteristic (ROC) curve. Results Of 470 patients with a median age 6 years, 238 were under the age of 60 months and 110 had developmental delays. For those with cycloplegic spherical equivalent hyperopia over 0.7 D, median (90% CI) value for retinoscopy was +2.63 D (+0.75, +6.88), for SBA-RS was +2.50 D (+0.50, +6.75) and less for 184 with Retinomax +1.88 D (-1.56, +6.13) but similar despite delays. Astigmatic cylinder SBA-RS +1.50 D (+0.25, +4.00) lagged retinoscopy +1.75 D (+0.75,+4.50) but Retinomax was greater +2.00 D (+0.25, +4.64). Cycloplegic refractive components such as spherical equivalent, cylinder, and J0 and J45 power vectors correlated highly and were near unity with SBA-RS and Retinomax with the latter deviating greater. SBA-RS screened for amblyopia risk factors up to 92% sensitive and 94% specific. Conclusion Accommodation-relaxing horizontal skiascopy very precisely estimates astigmatism power and axis and only lags cycloplegic refraction by about 0.15D in hyperopic patients fairly independent of neurodevelopmental delay. This technique can quickly estimate refraction even in delayed patients potentially reducing some need for cycloplegia. Clinical Trials Registry NCT03668067.
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Affiliation(s)
- Andrew W Arnold
- Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA
| | - Stephanie L Arnold
- Pacific Northwest University College of Osteopathic Medicine, Yakima, WA, USA
| | - Jacob H Sprano
- Kansas City University of Osteopathic Medicine, Kansas City, MO, USA
| | - Robert W Arnold
- Alaska Blind Child Discovery, Alaska Children's Eye & Strabismus, Anchorage, AK, USA
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Esodeviation without correction for tapering hyperopia in refractive accommodative esotropia. Can J Ophthalmol 2018; 53:453-457. [PMID: 30340709 DOI: 10.1016/j.jcjo.2018.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/04/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate clinical features for prescription of tapered hyperopia in patients with refractive accommodative esotropia (RAET). METHODS The clinical features in patients with RAET who began tapering of hyperopia were analyzed. Within a range that can sustain corrected visual acuity and stereoacuity, patients were prescribed for tapered hyperopic correction by 0.25-diopters (D) interval, up to a maximum of 1.0 D. At every visit, visual acuity and esodeviation with and without correction, amount of tapered hyperopia, and near stereoacuity were measured. RESULTS One hundred and six patients were enrolled in this study. The follow-up period was 3.1 ± 0.2 years and frequency of visits was 6.3 ± 0.6. Tapering hyperopia was initiated at 6.1 ± 2.9 years, and baseline refraction was 7.6 ± 1.5 D. The esodeviation without correction was 24.3 ± 8.5 prism diopters (PD), and median near stereoacuity was 400 arc sec. The median amount of tapered hyperopia at visit was 0.5 D. At the final visit, there were no significant deteriorations in visual acuity, esodeviation with correction, or near stereoacuity (p > 0.05, all). The amount of tapered hyperopia was positively correlated with correction and the reduced esodeviation without correction (p = 0.03). CONCLUSIONS Esodeviation without correction should be considered for tapering hyperopia for patients with RAET. Esodeviation without correction can be easily measured, and its decline may be used as a clinical indicator for tapering hyperopia.
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Incidence of side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in Japanese children: a multicenter study. Jpn J Ophthalmol 2018; 62:531-536. [PMID: 30046935 DOI: 10.1007/s10384-018-0612-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the incidence rate and side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in children aged 15 years or under. METHODS This prospective study had been conducted at 9 institutions between April 1, 2016 and March 31, 2017 in patients 15 years old or younger who received either atropine or cyclopentolate for refraction assessment. The investigation included patient's age, symptoms, and whether patients with side effects had any systemic diseases. RESULTS A total of 811 patients (mean age ± SD, 4.6 ± 2.2 years) received atropine and 71 (8.8%) patients had side effects. Except in patients under two years old, 1% eye drops showed higher incidence rate of side effects than 0.5% and 0.25% eye drops. Side effects most frequently occurred following the initiation of the instillation on the first day. The symptoms included flush (29/71, 40.8%), fever (21/71, 30.0%), and both (11/71, 15.5%). A total of 2238 patients (5.7 ± 3.0 years) used cyclopentolate and 27 (1.2%) (4.0 ± 2.2 years) patients had side effects. The symptoms included drowsiness (10/27, 37.0%), red eye (4/27, 14.8%), fever (3/27, 11.1%), and flush (3/27, 11.1%). CONCLUSIONS Atropine has a side effect incidence rate 7 times higher than the incidence rate of cyclopentolate. Flush and fever are the most common side effects of atropine and drowsiness is the main side effect of cyclopentolate. These findings should be noted when examining cycloplegic refraction to manage amblyopia and strabismus in children.
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Bagheri A, Givrad S, Yazdani S, Reza Mohebbi M. Optimal Dosage of Cyclopentolate 1% for Complete Cycloplegia: A Randomized Clinical Trial. Eur J Ophthalmol 2018; 17:294-300. [PMID: 17534806 DOI: 10.1177/112067210701700303] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the optimal dosage of cyclopentolate for adequate cycloplegia with minimal side effects. METHODS A prospective randomized clinical trial of patients 3.5 to 20 years of age referred to a strabismus clinic during a 1-year period. Eligible patients were randomly divided into three groups. In Group 1, the cycloplegic effect of one drop of cyclopentolate was compared with two drops; in Group 2, the effect of two drops was compared with three drops; and in Group 3, the effect of one drop was compared with three drops. RESULTS This study includes 192 eyes of 96 patients with a mean age of 11.0 +/- 5.7 years. Strabismus was present in 43 patients (44.8%). A total of 146 patients (76%) were hyperopic, 33 (17.2%) were myopic, and 13 (6.8%) were slightly hyperopic or myopic at the two stages of the study. Overall, only 16 eyes, including 9 eyes in Group 1 (16.4%), 2 eyes in Group 2 (3.2%), and 5 eyes in Group 3 (8.6%), had > or = 0.5 D difference in spherical equivalent refractive error at two stages of the study; however, intergroup differences were not statistically significant (p=0.16, chi-square test). Within each group, the percentage of eyes with <0.5 D difference was significantly greater than those with > or = 0.5 D difference (p<0.001 in all three groups, binomial test). Side effects were more prevalent using more frequent drops. CONCLUSIONS A single drop of cyclopentolate 1% suffices for cycloplegic refraction. There were less frequent side effects using one drop of cyclopentolate, compared to two or three drops.
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Affiliation(s)
- A Bagheri
- Department of Ophthalmology and Ophthalmic Research Center, Labbafinejad Hospital, Shaheed Beheshti University of Medical Science, Tehran, Iran.
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Wallace DK, Repka MX, Lee KA, Melia M, Christiansen SP, Morse CL, Sprunger DT. Amblyopia Preferred Practice Pattern®. Ophthalmology 2018; 125:P105-P142. [DOI: 10.1016/j.ophtha.2017.10.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022] Open
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Lyu IJ, Park KA, Oh SY. Increase in esodeviation under cycloplegia with 0.5% tropicamide and 0.5% phenylephrine mixed eye drops in patients with hyperopia and esotropia. BMC Ophthalmol 2017; 17:247. [PMID: 29233124 PMCID: PMC5727972 DOI: 10.1186/s12886-017-0644-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 12/04/2017] [Indexed: 11/17/2022] Open
Abstract
Backgroud To evaluate the manifestations of increased esodeviation under cycloplegia with 0.5% tropicamide and 0.5% phenylephrine in children with hyperopia and esotropia. Methods We reviewed the medical record of 34 children with hyperopia and esotropia who underwent a prism alternate cover test before and after instillation of mixed eye drops containing 0.5% tropicamide and 0.5% phenylephrine between November 2014 and October 2015. Increased angle of deviation was defined as 10 prism diopters (PD) or greater deviation after cycloplegia. The factors related to increased angle of deviation were evaluated using univariable and multivariable logistic regression analysis. Results The median age was 5.0 years (interquartile range, 3.75 to 5.0) and 12 patients (35.3%) were male. The median manifested refractive (MR) was +2.13 diopters (D) (+0.92 to +4.47) and cycloplegic refractive (CR) was +3.50 D (+1.72 to +5.66). The median difference between MR and CR was +0.88 D (+0.50 to +1.28). Thirteen patients (38.2%) showed increased esodeviation under cycloplegia and all had accommodative esotropia. A larger difference between MR and CR was the only significant factor affecting increased esodeviation in both univariable (OR = 4.72, P = 0.029) and multivariable (OR = 5.22, P = 0.047) analyses. Conclusion Children with hyperopia and esotropia often showed an increased angle of deviation after instillation of 0.5% tropicamide and 0.5% phenylephrine. This phenomenon reminded the clinicians that cycloplegics can have a different effect on esodeviation and suggested that increased angle of esodeviation may help to reveal the latent deviation in some patients with hyperopia and esotropia.
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Affiliation(s)
- In Jeong Lyu
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Ophthalmology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Pediatric Eye Evaluations Preferred Practice Pattern®: I. Vision Screening in the Primary Care and Community Setting; II. Comprehensive Ophthalmic Examination. Ophthalmology 2017; 125:P184-P227. [PMID: 29108745 DOI: 10.1016/j.ophtha.2017.09.032] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 12/22/2022] Open
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Wallace DK, Christiansen SP, Sprunger DT, Melia M, Lee KA, Morse CL, Repka MX. Esotropia and Exotropia Preferred Practice Pattern®. Ophthalmology 2017; 125:P143-P183. [PMID: 29108746 DOI: 10.1016/j.ophtha.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- David K Wallace
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephen P Christiansen
- Department of Ophthalmology, Boston University School of Medicine, Boston, Massachusetts
| | - Derek T Sprunger
- Indiana University Health Physicians, Midwest Eye Institute, Indianapolis, Indiana
| | | | - Katherine A Lee
- Pediatric Ophthalmology, St. Luke's Health System, Boise, Idaho
| | | | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
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Intraoperative intorsional traction test of the inferior oblique. Eye (Lond) 2017; 32:384-390. [PMID: 28912520 DOI: 10.1038/eye.2017.200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/10/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeWe present a novel variation of the traction test of the inferior oblique (IO) muscle. We demonstrate the correlation between the traction test and clinically graded IO overaction and describe the utility of this test to confirm IO weakening.MethodsWe performed a retrospective chart review on all patients who underwent IO surgery and intraoperative intorsion traction tests by a single surgeon over a 10-year period. We compared the traction test results, in 'clock hours' of freedom, before and after IO surgery. We correlated the torsion test at start of surgery with clinical observed IO overaction (scale 0 to +4) in 67 IO operations (56 myectomies, 6 anterior transpositions, 4 myotomies, and 1 recession) and compared to a control group of 23 eyes with minimal or no IO overaction.ResultsThe mean intorsion freedom in the eyes undergoing IO surgery was less than in control eyes (1.63 vs 1.89 clock hour; P<0.00005). There was a significant inverse relationship between grading of clinical IO action and the intorsion test result (Pearson rank coefficient, (r=-0.45; P<0.00001)). Myectomy produced the greatest change in torsion freedom (mean 1.32 clock hour), with all myectomies showing at least 1 clock hour extra freedom after the surgery.ConclusionsThe intorsion traction test confirmed that the IO stiffness correlated with pre-operative IO overaction grade. While it can be helpful in confirming that the entire IO muscle was weakened, it does not substitute for the careful inspection at the end of surgery to ensure there are no remaining IO fibers.
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Changes in the anterior segment after cycloplegia with a biometer using swept-source optical coherence tomography. PLoS One 2017; 12:e0183378. [PMID: 28806400 PMCID: PMC5555612 DOI: 10.1371/journal.pone.0183378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 07/26/2017] [Indexed: 12/27/2022] Open
Abstract
The aim of this study was to investigate changes in the anterior segment of the eye after cycloplegia. A biometer combined with swept-source optical coherence tomography (SSOCT) was used for measurements. Patients with strabismus or amblyopia who underwent cycloplegia were included. The axial length, central corneal thickness, anterior chamber depth, and lens thickness were measured with the biometer-SSOCT system before and after cycloplegia. Altogether, 10 eyes of 10 patients (mean age 7.20 ± 3.08 years, range 4-14 years) were evaluated. The mean measurements before cycloplegia were 22.75 ± 0.96 mm axial length, 516 ± 33 μm central corneal thickness, 3.40 ± 0.21 mm anterior chamber depth, and 3.77 ± 0.26 mm lens thickness. The corresponding values after cycloplegia were 22.75 ± 0.95 mm, 519 ± 34 μm, 3.68 ± 0.16 mm, and 3.42 ± 0.20 mm, respectively. The mean lens thickness had significantly decreased (P < 0.001) after cycloplegia, and the mean anterior chamber depth had significantly increased (P < 0.001). The means of the axial length (P = 0.66) and central corneal thickness (P = 0.17) had not changed significantly. The change in lens thickness was significantly correlated with the change in anterior chamber depth (r = -0.73, P = 0.02). The new biometer-SSOCT combination proved useful for accurately detecting changes in the anterior segment of the eye after cycloplegia in pediatric patients. The biometer's measurements indicated increased anterior chamber depth and decreased lens thickness after cycloplegia. The anterior chamber depth increased relative to the decrease in lens thickness.
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Yoo SG, Cho MJ, Kim US, Baek SH. Cycloplegic Refraction in Hyperopic Children: Effectiveness of a 0.5% Tropicamide and 0.5% Phenylephrine Addition to 1% Cyclopentolate Regimen. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:249-256. [PMID: 28471102 PMCID: PMC5469928 DOI: 10.3341/kjo.2016.0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/14/2016] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Seul Gi Yoo
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Myung Jin Cho
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Ungsoo Samuel Kim
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea.,Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Korea
| | - Seung Hee Baek
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea.
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Polling JR, Kok RGW, Tideman JWL, Meskat B, Klaver CCW. Effectiveness study of atropine for progressive myopia in Europeans. Eye (Lond) 2016; 30:998-1004. [PMID: 27101751 PMCID: PMC4941076 DOI: 10.1038/eye.2016.78] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/10/2016] [Indexed: 12/29/2022] Open
Abstract
PurposeRandomized controlled trials have shown the efficacy of atropine for progressive myopia, and this treatment has become the preferred pattern for this condition in Taiwan. This study explores the effectiveness of atropine 0.5% treatment for progressive high myopia and adherence to therapy in a non-Asian country.MethodsAn effectiveness study was performed in Rotterdam, the Netherlands. Overall 77 children (mean age 10.3 years±2.3), of European (n=53), Asian (n=18), and African (n=6) descent with progressive myopia were prescribed atropine 0.5% eye drops daily. Both parents and children filled in a questionnaire regarding adverse events and adherence to therapy. A standardized eye examination including cycloplegic refraction and axial length was performed at baseline and 1, 4, and 12 months after initiation of therapy.ResultsMean spherical equivalent at baseline was -6.6D (±3.3). The majority (60/77, 78%) of children adhered to atropine treatment for 12 months; 11 of the 17 children who discontinued therapy did so within 1 month after the start of therapy. The most prominent reported adverse events were photophobia (72%), followed by reading problems (38%), and headaches (22%). The progression rate of spherical equivalent before treatment (-1.0D/year±0.7) diminished substantially during treatment (-0.1D/year±0.7) compared to those who ceased therapy (-0.5D/year±0.6; P=0.03).ConclusionsDespite the relatively high occurrence of adverse events, our study shows that atropine can be an effective and sustainable treatment for progressive high myopia in Europeans.
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Affiliation(s)
- J R Polling
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Optometry and Orthoptics, Faculty of Health, University of Applied Sciences, Utrecht, The Netherlands
| | - R G W Kok
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J W L Tideman
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - B Meskat
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - C C W Klaver
- Department of Ophthalmology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Early alignment versus delayed alignment in patients with hyperopia and esotropia. J AAPOS 2016; 20:3-6. [PMID: 26917063 DOI: 10.1016/j.jaapos.2015.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/16/2015] [Accepted: 10/17/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the clinical outcomes in hyperopic and esotropic patients with and without early alignment after spectacle correction. METHODS The medical records of patients with hyperopia and esotropia who were initially treated at a single center with full spectacle correction of their hyperopia from 1994 to 2009 were retrospectively reviewed. Patients with ≤10(Δ) of residual esotropia after 2 months were assigned to the early-alignment group; those with >10(Δ) were assigned to the delayed-alignment group. The main outcome measure was final stereoacuity of each group. RESULTS Of 136 patients who met the inclusion criteria, 85 (63%) were aligned after 2 months, whereas 51 (37%) had residual esotropia. The early-alignment group had more patients with high-grade stereoacuity ≤100 arcsec (37% vs 19%) and significantly better stereoacuity results overall (P = 0.037). Almost 70% of patients with poor alignment at 2 months required strabismus surgery, whereas 30% improved after over 1 year in spectacles alone, achieving a final alignment of ≤10(Δ) without surgery. CONCLUSIONS These results suggest that earlier correction of esotropia results in better final stereoacuity. The desire for early correction, however, should be tempered by the knowledge that 30% of patients with poor early alignment may eventually achieve alignment without surgery, a result that should be considered when counseling parents about the need for strabismus surgery.
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Saeed AM, Abdrabbo MA. LASIK as an alternative line to treat noncompliant esotropic children. Clin Ophthalmol 2012; 5:1795-801. [PMID: 22267914 PMCID: PMC3258089 DOI: 10.2147/opth.s26827] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of laser-assisted in situ keratomileusis (LASIK) in facilitating strabismus management in noncompliant children with fully accommodative esotropia. SETTING Ebsar Eye Center, Benha University (Benha, Egypt). METHODS The study comprised 20 eyes of ten consecutive patients with accommodative esotropia. All patients were noncompliant with glasses and had refractive stability. They received brief general anesthesia and had bilateral LASIK using Wavelight® Algretto Wave® Eye-Q Excimer Laser (Alcon, Inc, Hunenberg, Switzerland) to fully correct their hyperopic refractive errors aiming to achieve orthophoria. Preoperative and postoperative best corrected visual acuity, cycloplegic refraction, angle of squint, and any LASIK complications were recorded. Follow-up period was 9 months. RESULTS The age of patients ranged 5.1-9.2 years and the hyperopic error range was +3.5 D to +6.75 D, with anisometropia 2 D or less. No patient had decreased best corrected visual acuity or loss of fusion ability. The postoperative refractive error ranged from -0.75 D to +1.5 D at the end of the study period. All patients achieved orthophoria. No significant intraoperative or postoperative complications were recorded. CONCLUSION LASIK appears to be effective and relatively safe to treat accommodative esotropic children by reducing their hyperopic refractive error, however, patient selection is critical. Larger studies with longer follow-up are necessary to determine its long-term effects.
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The maximal tolerable reduction in hyperopic correction in patients with refractive accommodative esotropia: a 6-month follow-up study. Am J Ophthalmol 2011; 151:535-41.e2. [PMID: 21236414 DOI: 10.1016/j.ajo.2010.09.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/19/2010] [Accepted: 09/21/2010] [Indexed: 11/23/2022]
Abstract
PURPOSE To investigate the optimal amount of safe under-correction in patients with refractive accommodative esotropia. DESIGN Prospective noncomparative interventional case series. METHODS Patients with refractive accommodative esotropia wore trial glasses based on cycloplegic refraction, then -0.25 diopters (D) of minus sphere lenses were placed on both lenses of the trial glasses and the deviation was measured. Minus spheres of -0.25 D were continuously added until the angle of deviation increased; the minus spheres added just before the deviation increase were defined as the maximal tolerable amount of under-correction. A total of 38 patients were prescribed under-corrected spectacles up to -1.5 D and followed for 6 months. RESULTS Thirty-one patients underwent the maximal tolerable amount of under-correction and 7 underwent -1.5 D of under-correction. A mean -0.89 D of under-correction was performed. We observed no deterioration in visual acuity, stereoacuity, or fusional ability during the follow-up period in any of the patients. Small increase in the angle of deviation of 2 prism diopters was noted in 2 patients. The mean spherical equivalent refractive error of both eyes (P = .012) and age of onset (P = .006) showed strong positive correlations with the maximal tolerable amount of under-correction. CONCLUSIONS A reduction in hyperopic correction by the maximal tolerable amount of under-correction was performed without notable short-term side effects. The spherical equivalent refractive error and age of onset appear to be useful clinical indices in determining the appropriate amount of under-correction.
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Loewen N, Barry JC. The use of cycloplegic agents. Results of a 1999 survey of German-speaking centers for pediatric ophthalmology and strabology. Strabismus 2009. [DOI: 10.1076/0927-3972(200006)821-2ft091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Li CH, Chen PL, Chen JT, Fu JJ. Different corrections of hypermetropic errors in the successful treatment of hypermetropic amblyopia in children 3 to 7 years of age. Am J Ophthalmol 2009; 147:357-63. [PMID: 18930448 DOI: 10.1016/j.ajo.2008.08.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 08/22/2008] [Accepted: 08/23/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the improvement in visual acuity (VA) in children 3 to 7 years old with hypermetropic amblyopia after full or partial hypermetropic correction. DESIGN Retrospective interventional case series. METHODS Medical records of 182 children with hypermetropic amblyopia treated with partial or full hypermetropic correction from January 1, 2001 to July 31, 2007 were evaluated. Improvement in the VA of the amblyopic eye, changes in the power of glasses, and the reduction in hypermetropia were assessed. RESULTS Ninety-three children underwent full hypermetropic correction and the mean VA of their amblyopic eyes improved by 0.46 logarithm of minimal angle of resolution (logMAR). Eighty-one children underwent partial hypermetropic correction and the mean VA of their amblyopic eyes improved by 0.48 logMAR. The reduction in hypermetropia was 0.44 diopters (D)/year and 0.43 D/year, respectively. Changes in glasses at four to eight weeks of follow-up were noted in 11 children receiving full correction, all of whom were older than 5 years. Ten children, aged 3 to 5 years, with hypermetropia of more than 3 D and receiving partial correction, required a change of glasses and most (seven children) had underdiagnosed accommodative esotropia. CONCLUSIONS Both full correction and partial correction of hypermetropic errors improved the VA of 3 to 7-year-old children with hypermetropic amblyopia. The reduction in hypermetropia was similar after full and partial hypermetropic correction. However, for children older than 5 years, full correction should be undertaken with care because the accompanying blur at distance can hinder compliance. For younger children, especially with a high degree of hypermetropia, full correction might be required to avoid strabismus, which would cancel the effects of spectacle correction.
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Affiliation(s)
- Chia-Hung Li
- Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
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23
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Influence de l’instillation de 2 ou 3 gouttes de cyclopentolate à 0,5 % sur la réfraction de l’enfant caucasien non strabique. J Fr Ophtalmol 2008; 31:51-5. [DOI: 10.1016/s0181-5512(08)70330-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Affiliation(s)
- P Dureau
- Service d'Ophtalmologie Pédiatrique du Docteur Caputo, Fondation Ophtalmologique Adolphe-de-Rothschild, 25-29, rue Manin, 75940 Paris cedex 19, France.
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Hofmeister EM, Kaupp SE, Schallhorn SC. Comparison of tropicamide and cyclopentolate for cycloplegic refractions in myopic adult refractive surgery patients. J Cataract Refract Surg 2005; 31:694-700. [PMID: 15899444 DOI: 10.1016/j.jcrs.2004.10.068] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2004] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare tropicamide 1%, a shorter-acting cycloplegic agent, with cyclopentolate 1% for cycloplegic refractions in adult refractive surgery patients. SETTING Navy Refractive Surgery Center, Ophthalmology, Naval Medical Center, San Diego, California. METHODS The study was prospective, single center, with randomized sequencing of cycloplegic agent; each patient received both agents. Thirty consecutive myopic adult refractive surgery patients (mean age 35.4 years) participated. A complete preoperative examination, including cycloplegic refraction, was obtained twice, 1 week apart. The patient and the examiner were masked to the medication. Main outcome measures included cycloplegic and manifest refractions, best corrected distance acuity, near-point accommodation, pupil diameters, and subjective appraisal of experience with cycloplegic agents. RESULTS Twenty-eight of 30 patients completed both examinations. Both eyes were measured, but comparisons were limited to right and left eyes, independently. No statistically significant difference was found between the tropicamide and cyclopentolate cycloplegic refractions (mean difference in MSE +/- SD, OD=0.054 +/- 0.214 diopters (D), t=1.33, P=.10; OS=0.054 +/- 0.253 D, t=1.12, P=.14). Five eyes of 3 patients had a difference of 0.50 D or greater between the 2 agents; less myopia with cyclopentolate. Near-point testing revealed less residual accommodation with cyclopentolate (difference in MSE, OD=-0.27 +/- 0.51 D, t=2.68, P=.006; OS=-0.32 +/- 0.49 D, t=3.46, P=.001). Subjectively, 24 of 28 (86%) patients preferred tropicamide, 1 (4%) preferred cyclopentolate, and 3 (10%) had no preference. CONCLUSIONS There was no statistically significant difference in mean cycloplegic refractions. Cyclopentolate was more effective than tropicamide in reducing accommodative amplitude in adult myopes (near-point testing). Patients strongly preferred tropicamide.
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Affiliation(s)
- Elizabeth M Hofmeister
- Navy Refractive Surgery Center, Department of Ophthalmology, Naval Medical Center, San Diego, California 92134-1005, USA
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Fan DSP, Rao SK, Ng JSK, Yu CBO, Lam DSC. Comparative study on the safety and efficacy of different cycloplegic agents in children with darkly pigmented irides. Clin Exp Ophthalmol 2004; 32:462-7. [PMID: 15498055 DOI: 10.1111/j.1442-9071.2004.00863.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The ideal cycloplegic drug that is safe, effective and convenient in children is not yet available. This study aimed to evaluate the safety and efficacy of three cycloplegic regimens in hyperopic children with pigmented irides. The responses to cycloplegia in different age groups and presence of strabismus were also compared. METHODS Tropicamide 0.5% and phenylephrine 0.5% (regimen I), tropicamide 1.0% and cyclopentolate 1.0% (regimen II), and atropine 1.0% (regimen III) were evaluated in 25 children using a crossover study design. Cycloplegic refractions were assessed. RESULTS The mean age of the children was 5.7 +/- 2.0 years (range 2.5-10.8 years). Six (24.0%) of them had strabismus. The spherical equivalent (SE) refraction for regimens I, II and III were +5.11 +/- 2.04 D, +5.29 +/- 1.89 D and +5.71 +/- 1.90 D, respectively, and were significant different from the manifest SE (+3.95 +/- 2.17 D) (P < 0.001). There was no statistical difference between regimen I and II in children without strabismus (P = 0.258) or aged older than 5 years (P > 0.050). CONCLUSION In older children, regimen I was as effective as regimen II and can be used to avoid cyclopentolate toxicity.
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Affiliation(s)
- Dorothy S P Fan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong.
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Goldstein JH, Schneekloth BB. Atropine Versus Cyclopentolate Plus Tropicamide in Esodeviations. Ophthalmic Surg Lasers Imaging Retina 1996. [DOI: 10.3928/1542-8877-19961201-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Affiliation(s)
- A J Flach
- Department of Ophthalmology, University of California, San Francisco Medical Center, USA
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Stolovitch C, Alster Y, Loewenstein A, Lazar M. Influence of the time interval between instillation of two drops of cyclopentolate 1% on refraction and dilation of the pupil in children. Am J Ophthalmol 1995; 119:637-9. [PMID: 7733189 DOI: 10.1016/s0002-9394(14)70222-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Because the usual length of time to instill two drops of cyclopentolate 1% (five to ten minutes) is time-consuming and inconvenient to clinical staff as well as to the child and the child's parents, we investigated the influence of the time interval between the instillation of the two drops on refraction and mydriasis in children. METHODS We conducted a crossover study on 48 children at the Tel-Aviv Medical Center. Gender, iris color, ethnic origin, and age were recorded. Two cyclopentolate 1% eyedrops were instilled at a one- or five-minute time interval. Retinoscopy was performed and the mydriatic effect was recorded. One week later, the procedure was repeated, this time with a different time interval. RESULTS The time interval between the instillation of the two drops had no significant influence on retinoscopy results (P = .65 and P = .50 for right and left eyes, respectively) or on pupil dilation (P = .377 and P = .113 for right and left eyes, respectively). CONCLUSIONS Instilling two drops of cyclopentolate 1% one minute apart is as effective as instilling them five minutes apart.
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Affiliation(s)
- C Stolovitch
- Department of Ophthalmology, Tel-Aviv Medical Center, Israel
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30
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Stolovitch C, Loewenstein A, Nemmet P, Lazar M. Atropine cycloplegia: how many instillations does one need? J Pediatr Ophthalmol Strabismus 1992; 29:175-6. [PMID: 1432503 DOI: 10.3928/0191-3913-19920501-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Atropine is accepted generally as the most efficient cycloplegic agent. Although it is considered a relatively safe drug, toxic local and systemic side effects do occur. The recommended regimen for atropine cycloplegia has been 7 to 10 applications within 3 to 4 days. We compared the cycloplegic effect of four instillations of atropine drops to the effect of eight instillations. The results showed that the cycloplegia obtained after eight instillations was not greater than after four instillations.
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Affiliation(s)
- C Stolovitch
- Department of Ophthalmology, Ichilov Hospital, Tel Aviv, Israel
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31
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Auffarth G, Hunold W. Cycloplegic refraction in children: single-dose-atropinization versus three-day-atropinization. Doc Ophthalmol 1992; 80:353-62. [PMID: 1473451 DOI: 10.1007/bf00154384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A new scheme for refractive measurements under atropine cycloplegia was tested in 90 strabismic children aged two to several years. Refraction was determined by an autorefractor (CANON R 10) 90 minutes after application of two drops of atropine (0.5% atropine children < 2 1/2 years; 1.0% atropine children > 2 1/2 years) and compared with the results after 3 days of receiving 1 atropine eyedrop 3 times daily. In 86.5% the spherical equivalents differ not more than 1.0 diopter (p = 0.05); the correlation was 0.99. Astigmatic corrections were in agreement in 95.5%, the axis of cylinders in 93.0% (p = 0.05); the correlations were 0.95 and 0.97. The residual accommodation 90 minutes after 2 drops of atropine was not more than 1 diopter in all children. The additional cycloplegic effect of the three-day-atropinization was only 0.5 diopters. This new type of application allows a more rapid and less toxic assessment of refraction than the usual three-day-atropinization.
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Affiliation(s)
- G Auffarth
- Department of Ophthalmology, Marienhospital, Aachen, Germany
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32
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Jones LWJ, Modes DT. Possible allergic reactions to cyclopentolate hydrochloride: case reports with literature review of uses and adverse reactions. Ophthalmic Physiol Opt 1991. [DOI: 10.1111/j.1475-1313.1991.tb00189.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Preslan MW, Beauchamp GR. Accommodative Esotropia: Review of Current Practices and Controversies. Ophthalmic Surg Lasers Imaging Retina 1987. [DOI: 10.3928/1542-8877-19870101-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zetterström C. A cross-over study of the cycloplegic effects of a single topical application of cyclopentolate-phenylephrine and routine atropinization for 3.5 days. Acta Ophthalmol 1985; 63:525-9. [PMID: 3907259 DOI: 10.1111/j.1755-3768.1985.tb05239.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Static refraction in children after the topical instillation of atropine twice a day during 3.5 days was compared with the refraction after a single instillation of one drop of 0.85% cyclopentolate + 1.5% phenylephrine in a randomized cross-over study. Atropine eye drops were applied by the parents at home, while the combination drop was applied by personnel at the eye clinic. Refraction was determined by retinoscopy in 40 children (3-6 years) in a single blind manner. No statistically significant difference in cycloplegic effect was found between the 2 methods. The results imply that in clinical practice a single instillation of a combination of 0.85% cyclopentolate and 1.5% phenylephrine can be substituted for conventional "full" atropinization during 3.5 days.
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Abstract
Cycloplegic drugs are the principal medications used in the diagnosis of accommodative esotropia. The same cycloplegics can be used as a "medical patch" in the treatment of amblyopia. Miotics may be as good as glasses in controlling accommodative esotropia but are almost never better. The response to miotics does not rule out the presence of accommodative esotropia. Miotics also may be used as a supplementary agent to glasses, bifocals, or surgery in the treatment of esotropia. The most widely used miotics today include phospholine iodide and DFP with iris cysts being the major local side effect in the eye with the use of miotics in children. Miotics and other drugs are valuable tools in the treatment of accommodative esotropia; however, the use must be correlated with other tools, including surgery, patching, glasses, and orthoptic exercises.
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