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Mydriasis with micro-array print touch-free tropicamide-phenylephrine fixed combination MIST: pooled randomized Phase III trials. Ther Deliv 2021; 12:201-214. [PMID: 33715382 DOI: 10.4155/tde-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Design: Prospective, double-masked, controlled, cross-over superiority studies. Materials & methods: Eligible volunteers in two pooled Phase III trials received microdosed mydriatics. MIST-1 study subjects received fixed-combination TR-PH, phenylephrine 2.5% (PH) or tropicamide 1% (TR). MIST-2 study subjects received TR-PH or placebo. Mean change from baseline in pupil diameter was measured by digital pupillometry at 35 min postadministration. Results: Pooled efficacy analysis included 131 subjects. Compared with TR-PH, treatment group difference in 35-min change in mean pupil dilation from baseline was 0.58 mm (p < 0.0001) with TR, 3.87 mm (p < 0.0001) with PH and 4.65 mm (p < 0.0001) with placebo. Adverse events reported were infrequent, transient and mostly mild. Conclusion: TR-PH demonstrated superior pupil dilation compared with each component and placebo. TR-PH was safe & well-tolerated.
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Cho J, Bruck B, Liu JC, Culican SM. Assessing the Clinical Requirement of 2.5% Phenylephrine for Diagnostic Pupil Examination. J Ocul Pharmacol Ther 2021; 37:284-289. [PMID: 33685234 PMCID: PMC8215398 DOI: 10.1089/jop.2020.0111] [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] [Indexed: 11/18/2022] Open
Abstract
Purpose: To evaluate whether the standard dilating drop regimen consisting of phenylephrine, tropicamide, and proparacaine produces clinically significant improvement in pupil size compared to tropicamide and proparacaine during diagnostic eye examination. Methods: Sixty-three adult patients at Washington University School of Medicine Eye Clinic were enrolled in this prospective, randomized trial. Each patient received one of two dilating drop regimens: phenylephrine + tropicamide + proparacaine (PE+T+PP), which is considered the standard therapy, or tropicamide + proparacaine (T+PP). Main outcome measures were the proportion of pupils able to achieve successful clinical examination without need for additional dilating drops and change in predilation to postdilation pupil size. Comparisons were made using McNemar's test, repeated measures analysis of variance, and Fisher's test to determine whether PE is a necessary component of the standard eye examination. Results: There were no statistically significant differences between the PE+T+PP and T+PE treatment groups in predilation to postdilation changes in average resting pupil size (1.58 ± 0.66 and 2.61 ± 0.79; P = 0.57) or constricted pupil size (2.52 ± 0.93 and 3.56 ± 0.96; P = 0.15). There was no statistically significant difference between patients who obtained a successful dilated pupil examination between those receiving PE+T+PP and those receiving T+PP as determined by the examining physicians (Fisher's, P = 0.67). Conclusion: The addition of phenylephrine to tropicamide and proparacaine did not improve pupillary dilation size or ability to conduct a clinical examination. A single dilating agent using tropicamide should be considered in clinical practice.
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Affiliation(s)
- Junsang Cho
- University of Missouri, School of Medicine, Columbia, Missouri, USA
| | - Brent Bruck
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James C Liu
- Department of Ophthalmology, Duke University, Raleigh, North Carolina, USA
| | - Susan M Culican
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Takkar B, Sharma P, Gaur N, Singh AK, Ramachandran R. Proparacaine-Induced Mydriasis During Strabismus Surgery. Semin Ophthalmol 2016; 33:367-370. [DOI: 10.1080/08820538.2016.1247178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Brijesh Takkar
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Sharma
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Nripen Gaur
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Kumar Singh
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ramachandran
- Dr. R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Ogun OA, Oliver JW, Ashaye AO, Ajayi BG. Evaluating the potentiating effect of amethocaine on tropicamide-induced mydriasis in darkly pigmented irides, using infrared pupillometry. OPHTHALMOLOGY AND EYE DISEASES 2014; 6:13-9. [PMID: 24812528 PMCID: PMC4001628 DOI: 10.4137/oed.s13991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 02/23/2014] [Accepted: 03/03/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine whether prior instillation of amethocaine would increase the rate and magnitude of tropicamide-induced pupillary dilatation in darkly pigmented irides. METHOD A total of 50 healthy Africans aged 18–40 years, with darkly pigmented irides, received a drop of amethocaine in one eye and a drop of placebo in the contralateral eye, followed by two drops of tropicamide in both eyes. Serial pupil diameters were measured using a monocular infrared video pupillometer. Rate of pupillary dilatation was compared in both eyes. Survival statistics were calculated for the time taken to reach a clinically effective dilatation, clinically effective diameter (CED) of 6.0 mm. RESULTS Mean difference in pupil diameters between amethocaine- and placebo-treated eyes was 0.30 ± 0.09 mm (P < 0.002). In all, 62% of amethocaine-treated eyes and only 46% of placebo-treated eyes reached the CED. CONCLUSION We observed a small but statistically significant potentiating effect of a drop of amethocaine on tropicamide-induced dilatation within 20 minutes.
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Affiliation(s)
- Olufunmilola A Ogun
- Department of Ophthalmology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Jeffrey W Oliver
- Consulting Biomedical Engineer, Cedar Park, TX, USA. ; Senior Biomedical Engineer, Optical Radiation Branch, Bioeffects Division, Air Force Research Laboratory, Tri-Services Research Laboratory, Fort Sam Houston, Texas, USA
| | - Adeyinka O Ashaye
- Department of Ophthalmology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Benedictus Gk Ajayi
- Department of Ophthalmology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
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Abstract
PURPOSE Two combinations of dilation drops [1% tropicamide and 2.5% phenylephrine (TP) vs. 1% tropicamide and 1% cyclopentolate (TC)] were compared to determine time course and magnitude of dilation for patients with dark irides. METHODS Forty-five subjects, aged 4 to 32 years, with dark irides were enrolled. Photographs were taken before dilation and at 5, 10, 15, 20, 40, and 60 min after instillation of drops. Subjects received TP in one eye and TC in the fellow eye, with eyes randomized to the combination received. An examiner masked to drug combination and time used digital analysis to calculate pupil diameter for each photograph. TP and TC were compared to determine the time to reach both 6- and 7-mm pupil diameter and the percentage of subjects reaching these diameters. RESULTS Ninety-eight percent of pupils reached 6 mm with either combination; however, 80% reached 7 mm with TP and only 58% with TC (p = 0.0062, McNemars exact test). Time at which 50% of pupils reached 6 mm was not significantly different between drug combinations (TP 11 min vs. TC 12 min, Kaplan-Meier survival analysis). However, time at which 50% reached 7 mm was statistically and clinically significant (TP 32 min vs. TC 52 min, p = 0.0325). For subjects < or =10 years vs. >10 years, there was no significant difference in time at which 50% reached a 6- or 7-mm pupil with TP or TC; however, in every case, the younger group took longer. CONCLUSIONS A 6-mm pupil dilation may be obtained with either TP or TC; however, more subjects achieved a 7-mm pupil with TP than TC and had a faster time course to attain that size.
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Behndig A. Effects on Pupil Size and Accommodation from Topical Lidocaine Hydrochloride and Tetracaine Hydrochloride. J Ocul Pharmacol Ther 2007; 23:591-8. [DOI: 10.1089/jop.2007.0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Anders Behndig
- Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden
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Haddad DE, Rosenfield M, Portello JK, Krumholz DM. Does prior instillation of a topical anaesthetic alter the pupillary mydriasis produced by tropicamide (0.5%)? Ophthalmic Physiol Opt 2007; 27:311-4. [PMID: 17470245 DOI: 10.1111/j.1475-1313.2007.00472.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE It is common clinical practice to instill a topical anaesthetic prior to the instillation of a mydriatic agent into the eye. The main rationale for using the anaesthetic is to increase corneal permeability, so that more of the mydriatic agent reaches the receptor sites within the anterior chamber. It addition, as mydriatics generally cause stinging, prior use of an anaesthetic should reduce the degree of discomfort. The aim of the present study was to determine whether the efficacy of mydriasis produced by an antimuscarinic agent is enhanced by prior instillation of a topical anaesthetic. METHOD The study was performed using a double-masked protocol on 20 healthy young subjects. One drop of either proparacaine (proxymetacaine) (0.5%) or isotonic saline was instilled into the eye, followed by one drop of tropicamide (0.5%). Pupil diameter was measured using a customized photographic device at 0, 10, 20, 30 and 60 min following drug instillation. Additionally, subjects were asked to rate the degree of discomfort following the instillation of each drop on a scale from 0 (no discomfort) to 10 (agony). RESULTS There was no significant difference in either the rate of onset of mydriasis, or the maximum pupil diameter achieved between the two conditions. The mean change in pupil diameter produced by tropicamide after the instillation of saline or proparacaine was 2.31 and 2.28 mm, respectively. The mean discomfort scores following instillation of saline and proparacaine were 1.15 and 1.65, respectively, while mean discomfort scores following the instillation of tropicamide after saline or proparacaine were 4.00 and 0.85, respectively. CONCLUSIONS Instillation of a topical anaesthetic does significantly reduce the degree of discomfort produced by the instillation of tropicamide. However, it does not produce any significant increase in either the magnitude or rate of onset of mydriasis.
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Dubois V, Wittles N, Lamont M, Madge S, Luck J. Randomised controlled single-blind study of conventional versus depot mydriatic drug delivery prior to cataract surgery. BMC Ophthalmol 2006; 6:36. [PMID: 17129389 PMCID: PMC1702365 DOI: 10.1186/1471-2415-6-36] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 11/27/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A prerequisite for safe cataract surgery is an adequately dilated pupil. The authors conducted a trial to assess the efficacy (in terms of pupil diameter) of a depot method of pre-operative pupil dilatation, as compared with repeated instillations of drops (which is time-consuming for the nursing staff and uncomfortable for the patient). METHODS A prospective randomised masked trial was conducted comprising 130 patients with no significant ocular history undergoing elective clear corneal phacoemulsification. 65 patients had mydriatic drops (Tropicamide 1%, Phenylephrine 2.5%, Diclofenac sodium 0.1%) instilled prior to surgery, 65 had a wick soaked in the same drop mixture placed in the inferior fornix. Horizontal pupil diameters were recorded on a millimetre scale immediately prior to surgery. RESULTS There was no significant difference in pupil size between the two groups (p = 0.255, Student's t-test). CONCLUSION There was no significant difference between the mydriasis obtained with the depot system compared with conventional drop application. Use of a depot mydriatic delivery system appears to be a safe and efficient method of drug delivery. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Register ISRCTN78047760.
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Affiliation(s)
- Vincent Dubois
- Eye Unit, Royal United Hospital, Combe Park, Bath, B&NES, BA1 3NG, UK
| | - Nadia Wittles
- Eye Unit, Royal United Hospital, Combe Park, Bath, B&NES, BA1 3NG, UK
| | - Meon Lamont
- Eye Unit, Royal United Hospital, Combe Park, Bath, B&NES, BA1 3NG, UK
| | - Simon Madge
- Eye Unit, Royal United Hospital, Combe Park, Bath, B&NES, BA1 3NG, UK
| | - Jon Luck
- Eye Unit, Royal United Hospital, Combe Park, Bath, B&NES, BA1 3NG, UK
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Abstract
PURPOSE We investigated whether two drops of 0.5% tropicamide produced a wider pupillary dilation when compared with a single drop and saline control in subjects with dark-colored irides. METHODS Twelve young adult subjects with dark irides and who were free from ocular disease participated in the study. One eye of each subject, selected at random, was designated as experimental and the fellow eye as control. A single drop of 0.5% tropicamide was instilled in the lower cul-de-sac of each eye in turn. Immediately after, a second drop of 0.5% tropicamide was instilled in the experimental eye and a single drop of unpreserved saline into the control eye. A double-masked experimental protocol was followed. Digital images of both pupils of each subject were taken at baseline (predrug instillation) and then every 5 minutes up to 30 minutes postdrug instillation and at 40, 50, and 60 minutes. The images were subsequently viewed on a PC monitor, and pupil size was measured using a calibrated millimeter scale. RESULTS Pupil diameter increased as a function of time for both conditions reaching a maximum between 20 and 30 minutes after drop instillation. Pupil diameter was greater under the experimental condition compared with the control (analysis of variance p < 0.001). Pupil diameter reached at least 6 mm under both the experimental and control conditions. CONCLUSION In young healthy subjects, compared with a single drop of tropicamide, two drops were associated with a greater degree of pupillary dilation on average over the 60-minute study period. However, the magnitude of the difference was small and not clinically significant. A single drop of tropicamide produced a pupillary diameter of at least 6 mm, which should be sufficient for the conduct of a thorough dilated fundus examination.
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Affiliation(s)
- John Siderov
- Anglia Vision Research, Department of Optometry and Ophthalmic Dispensing, Anglia Ruskin University, Cambridge, United Kingdom.
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