Optimal Dosage of Cyclopentolate 1% for Complete Cycloplegia: A Randomized Clinical Trial

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.

Pimecrolimus 1% cream versus betamethasone 17-valerate 0.1% cream in the treatment of facial discoid lupus erythematosus: a double-blind, randomized pilot study

BACKGROUND

Discoid lupus erythematosus (DLE) is commonly treated with topical agents, the most important of which are glucocorticosteroids. However, prolonged use of these agents, especially on sensitive areas such as the face, may result in side-effects (e.g. atrophy and telangiectases) by altering collagen synthesis. Therefore, alternative treatments are needed for these patients.

AIM

To investigate and compare the efficacy of topical pimecrolimus 1% cream and topical betamethasone 17-valerate 0.1% cream on facial lesions of DLE.

METHODS

This was a randomized double-blind pilot study, performed in outpatient clinics of two major referral hospitals. Ten patients aged 20-53 years with moderate to severe DLE of the face were randomized into two groups for 8 weeks of treatment and 8 weeks of follow-up after treatment. In this double-blind study, one group applied pimecrolimus 1% cream twice daily and the other group applied betamethasone valerate 0.1% cream twice daily to facial lesions. Efficacy end-points included a combined score based on evaluation of erythema, infiltration and presence of scale.

RESULTS

Efficacy end-points showed significant improvement in both groups. A decrease of 86% and 73% in clinical severity scores was obtained for pimecrolimus and betamethasone, respectively (P = 0.043). There was no significant difference between the two groups in terms of efficacy (P = 0.1). No adverse effect was found at the end of the 8-week trial in any of our patients.

CONCLUSIONS

The efficacy of pimecrolimus 1% cream is comparable with that of betamethasone valerate 0.1% cream in treating facial DLE.

Juvenile pilocytic astrocytomas do not undergo spontaneous malignant transformation: grounds for designation as hamartomas

AIM

To determine whether juvenile pilocytic astrocytomas WHO grade I have the potential for spontaneous malignant transformation.

METHODS

A literature search was performed, cross-referencing juvenile pilocytic astrocytoma, pilocytic astrocytoma, astrocytoma grade I, optic glioma, glioma, low-grade gliomas, polar spongioblastoma, gliocytoma embryonale, and malignant transformation, anaplasia or anaplastic change. Bibliographic PubMed and Google searches were performed, and reference ophthalmology and neuropathology textbooks were utilised.

RESULTS

A total of 52 purported cases of malignant transformation were found. Twenty-two of these tumours, however, did not initially match criteria for juvenile pilocytic astrocytoma WHO grade I and were excluded. Six other cases were located within the irradiated field but represented anaplasias developing independently of the primary tumour. The remaining 24 malignancies had all been previously irradiated.

CONCLUSION

Juvenile pilocytic astrocytomas WHO grade I do not undergo spontaneous anaplastic transformation. Malignant transformations have only been demonstrated following radiation therapy. Earlier clinical and histopathological opinions regarding juvenile pilocytic astrocytomas as hamartomatous lesions are reaffirmed.