Comparison of pupillary diameter variation between conventional phacoemulsification versus femtosecond laser-assisted cataract surgery / Comparação da variação do diâmetro pupilar entre cirurgia de catarata por facoemulsificação convencional versus cirurgia assistida por laser de femtosegundo

ABSTRACT Purpose: To evaluate and compare variations in pupillary diameter before and after cataract surgery by conventional phacoemulsification versus femtosecond laser assisted cataract surgery, using LDV Z8 (Ziemer Ophthalmic). We also evaluated the relationship between pupillary diameter and surgery time and ultrasound time. Methods: Prospective comparative study, carried out at the Center of Excellence in Ophthalmology, Brazil. We included 79 eyes of 67 patients with nuclear opacity. The patients were divided into the control and study groups, including those who underwent cataract surgery with manual phacoemulsification, and femtosecond laser assisted cataract surgery, respectively. All surgeries were performed by the same experienced surgeon. All patients received topical non-steroidal anti-inflammatory drugs on the day before surgery and the same mydriatic eye drops preoperatively. To quantify pupillary size, measurements were performed using a surgical compass: anterior to the phacoemulsification procedure and at the end of the surgery. In the study group, measurements after laser were added. Surgical time and phacoemulsification time were also analyzed. Results: No significant difference was found between the pre-femto × pre-phaco pupil size (8.69 ± 0.44 mm × 8.63 ± 0.72 mm; p=0.643), and the pupil size at the end of surgery (7.96 ± 0.98 mm × 7.78 ± 0.95 mm; p=0.480) and the mean time of surgery (p=0.780). However, in the femtosecond laser assisted cataract surgery group, a transient increase in pupillary diameter after laser treatment was observed, indicating a tendency for greater variation in the femto group. Conclusions: Although pupil size diameter was similar at the end of surgery, the femtosecond laser assisted cataract surgery group presented higher intraoperative pupil variation. The surgeon should be aware of pupil size diameter before surgery for better and safer performance of femtosecond laser assisted cataract surgery.

RESUMO Objetivo: Avaliar e comparar a variação do diâmetro pupilar antes e após a cirurgia de catarata por facoemulsificação convencional versus cirurgia de catarata assistida por laser de femtossegundo, usando o LDV Z8 (Ziemer Ophtalmic). Também avaliamos a relação entre o diâmetro pupilar com o tempo da cirurgia e o tempo de ultrassom. Métodos: Estudo comparativo prospectivo, realizado no Centro de Excelência em Oftalmologia, Brasil. Foram incluídos 79 olhos de 67 pacientes com opacidade nuclear. Os mesmos foram divididos em Grupo Controle, que foi submetido a cirurgia de catarata com facoemulsificação manual, e Grupo Estudo, com catarata assistida por laser de femtossegundo. Todas as cirurgias foram realizadas pelo mesmo cirurgião experiente. Todos os pacientes receberam antiinflamatório não esteróide tópico no dia anterior à cirurgia e o mesmo colírio midriático no pré-operatório. Para quantificar o tamanho da pupila, as medidas foram realizadas usando um compasso cirúrgico: anterior ao procedimento de facoemulsificação e ao final da cirurgia. No grupo de estudo, medidas após o laser foram adicionadas. O tempo cirúrgico e o tempo de facoemulsificação também foram analisados. Resultados: Não foi encontrada diferença significativa entre o tamanho da pupila pré-femto x pré-faco (8,69 ± 0,44 mm x 8,63 ± 0,72 mm; p=0,643), bem como o tamanho da pupila no final da cirurgia (7,96 ± 0,98 mm x 7,78 ± 0,95 mm; p=0,480) e o tempo médio de cirurgia (p=0,780). No entanto, no grupo de catarata assistida por laser de femtossegundo, houve um aumento transitório do diâmetro pupilar após o laser, indicando uma tendência para maior variação no grupo femto. Conclusões: Embora o diâmetro pupilar fosse semelhante ao final da cirurgia, o grupo com catarata assistida por laser de femtossegundo apresentou maior variação intraoperatória da pupila. Portanto, para uma cirurgia de catarata assistida por laser de femtossegundo mais eficiente e segura, o cirurgião deve estar ciente do tamanho do diâmetro pupilar antes do procedimento.

Spontaneous repositioning of posterior chamber intraocular lens: a mere coincidence? / Reposicionamento espontâneo de uma lente intraocular na câmara posterior: uma mera coincidência?

ABSTRACT Despite the recent developments in modern cataract surgery and the application of a vast array of new devices and machines, late in-the-bag intraocular lens dislocation remains a devastating, albeit rare, complication. Various nonsurgical and surgical techniques have been used to manage this complication. We report a case of spontaneous repositioning in the left eye of an anteriorly subluxated in-the-bag intraocular lens. The spontaneous repositioning may have been caused by antagonistic effects related to the topical administration of brimonidine and prednisolone. The dislocation was treated without aggressive manipulation or surgical intervention.

RESUMO Apesar dos recentes avanços na cirurgia moderna de catarata e da aplicação de uma ampla gama de novos dispositivos, o deslocamento tardio de uma lente intraocular dentro do saco capsular continua a ser uma complicação devastadora, ainda que rara. Várias técnicas cirúrgicas e não cirúrgicas têm sido usadas para tratar esta complicação. Este é o relato de um caso de reposicionamento espontâneo de uma lente intraocular sub-luxada anteriormente dentro do saco capsular do olho esquerdo. Este reposicionamento pode ter sido causado pelos efeitos opostos da aplicação tópica simultânea de brimonidina e prednisolona. O deslocamento foi tratado sem manipulação agressiva ou intervenção cirúrgica.

Clinical profile of organophosphorous poisoning in children admitted to tertiary care hospital

Background: Organosphophorous compounds are the commonly available insecticides in households. Therefore, children are vulnerable to accidental poisoning. It is associated with significant morbidity and mortality. The aim of this study was to study the clinical profile of organophosphorous poisoning in children.Methods: This was prospective study conducted over a period of two years from January 2018 to January 2020 in department of Pediatrics, Government Medical College Srinagar, Jammu and Kashmir, India. All the patients in the age group of 1-18 years with history and examination suggestive of organophosphorous poisoning were included in this study.Results: In this study there were total of 54 patients. In majority of cases poisoning was accidental. Oral consumption was most common route of poisoning. The most common symptoms were excessive salivation (100%), vomiting (72%), abdominal pain (26%), diarrohea (13%), agitation (11%) and convulsions (3.7%). The most common signs were miosis (78%), bradycardia (59%), fasciculation (57%) and altered sensorium (13%). Respiratory failure and circulatory collapse were two main complications which contributed to mortality in this study.Conclusions: Organophosphorous poisoning is one of the most common poisoning in children. Early diagnosis and treatment is of pivotal importance to prevent mortality.

Intraoperative Floppy Iris Syndrome in patients on alpha 1 blocker tamsulosin: incidence and predictability

Background: Intraoperative Floppy Iris Syndrome (IFIS) was first described by Chang and Campbell in year 2005 in male patients undergoing phacoemulsification surgery who were on Tamsulosin, an alpha 1 blocker drug for their urinary symptoms for enlarged prostate. This condition was characterized by excessive floppiness of iris, prolapse of iris tissue through phaco and sideport incisions and progressive intraoperative miosis, resulting in increased surgical time and various major surgical complications compromising visual outcome.Methods: This study of 78 patients was undertaken to know the incidence and severity of IFIS as well as to predict its occurrence by observing maximum pupil dilation achieved preoperatively.Results: It was observed that majority of patients on tamsulosin dilated poorly and severe IFIS occurred in those with pupil dilation of 5 mm or less after putting mydriatic eye drops preoperatively.Conclusions: It was concluded that if IFIS was predicted and necessary precautions taken, postoperative complications can be reduced significantly with improved visual outcome.

On the shoulders of giants: the case of the Claude Bernard Horner syndrome

The syndrome called mainly in the French world as Claude Bernard Horner was frst described by Francois Pourfour du Petit, in 1727, but more thoroughly defned by the French physiologist, Claude Bernard, in 1852, followed by several physicians who offered different interpretations, mainly Silas Weir Mitchell (1864). The clinical and pharmacological implications, with the fnal wrap-up of the syndrome, were presented by a Swiss ophthalmologist, Johann Friedrich Horner, in 1869. This is a cooperative defnition of a syndrome of the sympathetic disruption of the ocular inervation, with fnal addings mainly about pharmacological approach by Horner, but with credits to many others clinicians and physiologists. This is the case of repeated presentations of a "new sign" in neurology with few additions from one to another.

A síndrome chamada principalmente no mundo francês como Claude Bernard Horner foi descrita pela primeira vez por François Pourfour du Petit, em 1727, mas mais profundamente defnida pelo fsiologista francês, Claude Bernard, em 1852, seguido por vários médicos que ofereceram interpretações diferentes, principalmente Silas Weir Mitchell (1864). As implicações clínicas e farmacológicas, com o desfecho fnal da síndrome, foram apresentadas por um oftalmologista suíço, Johann Friedrich Horner, em 1869. Esta é uma defnição cooperativa de uma síndrome da ruptura da inervação simpática ocular, com adições fnais principalmente sobre a abordagem farmacológica por Horner, mas com créditos para muitos outros médicos e fsiologistas. É o caso de repetidas apresentações de um "novo sinal" na neurologia, com poucas adições de um para o outro.

From the "small doll" until "prostitute's pupil" through Argyll Robertson: the Argyll Robertson's sign, one hundred fifty years from his findings (1869) / Da "pequena boneca" até "pupila da prostituta" através de Argyll Robertson: o sinal de Argyll Robertson, cento e cinquenta anos de seus achados (1869)

A tiny structure, the pupil, attracts too much attention, since the antiquity. The pupil as part of the "'window of/to the soul", the eyes, it can demonstrate a clinical disorder sign, or simply a psychological expression. In this paper, it is studied the situation in which the pupillary reflex to light is compromised, but the accommodation reflex is preserved, what is named after Argyll Robertson, the frst Scottish ophthalmologist, who besides described the signal (1869), he also tried to defned its clinical signifcance. Afterwards, it was clearly demonstrated its relationship with tertiary neurosyphilis.

Uma estrutura minúscula, a pupila, atrai muita atenção, desde a antiguidade. A pupila como parte da "'janela da alma'", os olhos, poderia demonstrar um sinal de desordem clínica, ou, simplesmente, uma expressão psicológica. Neste trabalho, estuda-se a situação em que o reflexo pupilar à luz é comprometido, mas o reflexo de acomodação é preservado, o que leva o nome de Argyll Robertson, o primeiro oftalmologista escocês que além de descrever o sinal (1869), também tentou defniu seu signifcado clínico. Posteriormente, foi claramente demonstrada sua relação com a neurossíflis terciária.

Efficacy of preoperative nonsteroidal anti-inflammatory drug and the re-dilation technique in minimizing miosis after femtosecond laser in cataract surgery / Eficácia do AINE pré-operatório e da técnica de re-dilatação em minimizar a miose na cirurgia de catarata com laser de femtosegundo

ABSTRACT Purpose: To assess the efficacy of using a nonste­roidal anti-inflammatory drug preoperatively and of applying the re-dilation technique when necessary to minimize pupil size variation when comparing the degree of mydriasis before femtosecond laser pretreatment with that at the beginning of phacoemulsification. Methods: This retrospective study included patients who underwent cataract surgery using the LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Our routine dilating regimen with flurbiprofen, tropicamide, and phenylephrine was used. The re-dilation technique was applied on eyes that manifested with a pupillary diameter that was smaller than the programmed capsulotomy diameter after laser pretreatment. The technique consists of overcoming pupillary contraction by instilling tropicamide and phenylephrine before phacoemulsification. Pupil size was assessed before femtosecond laser application and at the beginning of phacoemulsification. Results: Seventy-five eyes (70 patients) were included. Nine (12%) eyes underwent the re-dilation technique. There was no significant difference in mean pupillary diameter and mean pupillary area between the two studied surgical time points (p=0.412 and 0.437, respectively). The overall pupillary area constriction was 2.4 mm2. Immediately before opening the wounds for phacoemulsification, none of the eyes presented with a pupillary diameter <5 mm, and 61 (85.3%) eyes had a pupillary diameter >6 mm. Conclusion: Preoperative administration of nonsteroidal anti-inflammatory drug and the re-dilation technique resulted in no significant pupil size variation in eyes that were pretreated with the femtosecond laser, when comparing the measurements made before the laser application and at the beginning of phacoemulsification. This approach can avoid the need to proceed with cataract extraction with a constricted pupil.

RESUMO Objetivo: Avaliar a eficácia do uso de anti-inflamatório não-esteróide no pré-operatório e aplicação da técnica de re-dilatação quando necessária para minimizar a variação do tamanho pupilar ao comparar o grau de midríase antes do tra­tamento com laser de femtosegundo no início da facoemulsificação. Métodos: Esse estudo retrospectivo incluiu pacientes que foram submetidos à cirurgia de catarata usando o LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Nosso regime de di­latação de rotina com flurbiprofeno, tropicamida e fenilefrina foi usado. A técnica de re-dilatação doi aplicada em olhos que se manifestaram com um diâmetro pupilar menor do que o diâmetro da capsulotomia programado após o pré-tratamento a laser. A técnica consiste em superar a contração pupilar pela instilação de tropicamida e fenilefrina antes da facoemulsificação. O tamanho pupilar foi avaliado antes da aplicação do laser de femtosegundo e no inicio da facoemulsificação. Resultados: Setenta e cinco olhos (70 pacientes) foram incluídos. Nove (12%) olhos foram submetidos à técnica de re-dilatação. Não houve diferença significativa no diâmetro pupilar médio e na área pupilar média entre os dois tempos cirúrgicos estudados (p=0,412 e 0,437, respectivamente). A constrição global da área pupilar foi de 2,4 mm2. Imediatamente antes de abrir as incisões para a facoemulsificação, nenhum dos olhos apresentava diâmetro pupilar <5 mm e 61 (85,3%) olhos apresentavam um diâmetro pupilar >6 mm. Conclusões: O administração pré-operatória de anti-inflamatório não-esteróide e da técnica de re-dilatação resultaram em uma variação significativa do tamanho pupilar em olhos que foram pré-tratados com laser de femtosegundo, comparando as medidas realizadas antes da aplicação do laser e no inicio da facoemulsificação. Essa abordagem pode evitar a necessidade de prosseguir com a extração da catarata com uma pupila contraída.

Efficacy of the Canabrava Ring (pupil expansion device) in cataract surgery for eyes with small pupils: the first 30 cases / Eficácia do dispositivo de expansão pupilar Anel de Canabrava em cirurgia de catarata com pupilas pequenas: 30 primeiros casos

ABSTRACT Purpose: To evaluate the outcomes of the first 30 cataract surgeries performed with a new disposable, injector-free, small-pupil expansion device. Methods: This consecutive case series included 30 eyes from 29 patients who underwent cataract surgery using a new disposable small-pupil expansion device called the Canabrava Ring (AJL Ophthalmic S.A, Spain). It is the first iris expansion ring produced with indents that do not align with each other in the superior and inferior regions, resulting in a small vertical length (0.4 mm) that minimizes the risk of endothelial contact. All eyes had poorly dilated pupils of less than 5 mm preoperatively. Fifteen eyes had significant infective or traumatic pathologies preoperatively. Vertical and horizontal pupil diameters were evaluated preoperatively, intraoperatively, and 1 month postoperatively. Results: The mean patient age was 64 ± 11.8 (standard deviation) years. The Canabrava Ring remained engaged throughout all surgeries, except one. All pupils were intraoperatively expanded to a diameter of 6.3 mm. Although preexisting pathology on the innervation of the pupils, the mean pupil diameter returns to a close preoperative size after 1 month surgery. The mean pupil diameters postoperatively and preoperatively were 4.41 and 3.77 mm, respectively (p<0.05). Postoperative complications occurred in eight eyes (one toxoplasmosis reactivation, one retinal detachment, one posterior capsule rupture, one posterior capsule opacification, and four posterior synechiae). These complications occurred in eyes with preexisting traumatic or infective pathologies or synechiae. Conclusion: The Canabrava Ring is effective for expanding and maintaining expansion of small pupils in cataract surgery. The increase in postoperative pupil diameter is clinically diminutive and can most likely be attributed to preexisting pathologies affecting pupil innervation. Further large-scale studies are required to support the present findings.

RESUMO Objetivo: Avaliar a estabilidade intraoperatória, segurança e eficácia dos 30 primeiros casos operados com um novo anel expansor de pupilas. Métodos: Série de casos de 30 olhos de 29 pacientes submetidos a cirurgia de catarata com Anel de Canabrava (AJL Oftalmic, SPAIN). Trata-se do primeiro anel expansor de íris produzido com indentações não alinhadas entre as regiões superiores e inferiores. Devido a isso, apresenta altura vertical de 0,4 mm, diminuindo os riscos de toque endotelial. O diâmetro pupilar dos pacientes era menor que 5 mm. Os diâmetros verticais e horizontais foram avaliados antes, durante e um mês após a cirurgia. Resultados: A idade média dos pacientes foi de 64 ± 11,8 (desvio padrão) anos. O anel permaneceu estável em todas as cirurgias, exceto uma. Todas as pupilas foram expandidas no intraoperatório para um diâmetro de 6,3 mm. Apesar de patologias pupilares pré-existentes, o diâmetro médio da pupila retornou a um tamanho próximo após 1 mês de cirurgia. Os tamanhos médios da pupila no pós-operatório e pré-operatório foram medidos em 4,41 e 3,77 mm, respectivamente (p<0,05). As complicações pós-operatórias ocorreram em 8 olhos: 1 reativação de toxoplasmose, 1 descolamento de retina, 1 ruptura de cápsula posterior, 1 opacificação da cápsula posterior, 4 sinéquias posteriores. Essas complicações ocorreram nos olhos com patologias traumáticas, infecciosas ou sinéquias pré-existentes. Conclusão: O Anel de Canabrava parece efetivo na expansão e manutenção de pupilas pequenas submetidas à cirurgia de catarata. O aumento do diâmetro da pupila pós-operatória é clinicamente pouco relevante e provavelmente pode ser atribuído à patologias pré-existentes que afetam as inervações pupilares. Outros estudos em larga escala são necessários para suportar os achados do estudo.

A Patient Treated with Small-dose Strong Opioids Experienced Photophobia, Disturbance of Consciousness, and Miosis

Strong opioids are useful for managing cancer pain, and common side effects include nausea, vomiting, drowsiness, and constipation. Opioid overdose is known to cause respiratory depression and disturbance of consciousness. We observed a 79-year-old man with stage IVB hepatocellular carcinoma with metastasis to the rib and cancer-related pain being treated with strong opioids who, in spite of receiving a small dose and start volume, experienced strong nausea, photophobia, disturbance of consciousness, and miosis. Oxycodone was stopped to manage the strong nausea, and morphine was stopped to manage the photophobia. Furthermore, fentanyl patch was stopped to manage the disturbance of consciousness and miosis. He did not experience respiratory depression. Thus, photophobia, disturbance of consciousness, and miosis can appear as side effects even at small doses of strong opioids. The results reveal two important clinical issues: (1) photophobia can arise as a side effect of strong opioids, and (2) if photophobia, miosis, disturbance of consciousness arise in opioid-treated patients, they require careful monitoring.

Acetylcholine chloride 1% usage for intraoperative cataract surgery miosis / Cloridrato de Acetilcolina 1% na obtenção da miose intraoperatória na cirurgia de catarata

Abstract Objective: To test the efficacy of Acetylcholine chloride use in obtaining intraoperative miosis on phacoemulsification cataract surgery. Methods: Patients with cataract diagnosis and elected for surgical phacoemulsification procedure were selected. All patients underwent conventional phacoemulsification procedure performed by a single surgeon and all patients had 0.2 ml of Acetylcholine chloride 1% irrigated in the anterior chamber at the end of the surgery. The pupillary diameter was measured immediately before the beginning of surgery, immediately before and two minutes after the use of acetylcholine chloride 1%. Results: A total of 30 eyes from 30 patients were included in the study. 18 were female, and mean age was of 69.5 years with a 7.2y standard deviation on the population study. The mean pupillary diameter immediately before the beginning of surgery was 7.5 mm with a standard deviation of 0.56 mm; the mean pupillary diameter immediately before the acetylcholine chloride 1% use (after the intraocular lens im-plantation) was 7.1 mm with a standard deviation of 0.57 mm. The mean pupillary diameter two minutes after the use of acetylcholine chloride 1% in the anterior chamber was 3.4 mm with standard deviation of 0.66 mm. The mean maximum action time of ACH chloride 1% was 64 seconds, with a standard deviation of 8 seconds. The mean intraocular pressure on the first postoperative day was 19.1 mmHg with a standard deviation of 2.45 mmHg. Conclusion: We conclude that acetylcholine chloride 1% is an important drug to obtaining intraoperative miosis in cataract surgery.

Resumo Objetivo: Demonstrar a eficácia do cloridrato de acetilcolina 1% na obtenção da miose intraoperatória na cirurgia de catarata pela técnica de facoemulsificação. Métodos: Pacientes com diagnóstico de catarata e indicação de cirurgia foram selecionados para participar do presente estudo. Todos os pacientes foram operados pela técnica de facoemulsificação convencional pelo mesmo cirurgião, todos foram submetidos à aplicação de 0,2 ml do cloridrato de acetilcolina 1% na câmara anterior ao final do procedimento cirúrgico. A medida do diâmetro pupilar foi realizada imediatamente antes do início da cirurgia, imediatamente antes do uso do cloridrato de acetilcolina 1% e após 2 minutos. Resultados: Foram estudados 30 olhos de 30 pacientes, destes, 18 eram do sexo feminino, a média de idade do estudo foi de 69,5 anos com desvio padrão de 7,2 anos. A média do diâmetro pupilar imediatamente antes do início da cirurgia foi 7,55 mm com desvio padrão de 0,56mm, a média do diâmetro pupilar imediatamente antes do uso do cloridrato de acetilcolina 1% (após implante da lente intraocular no saco capsular) foi 7,1mm com desvio padrão de 0,57mm. A média do diâmetro pupilar após 2 minutos da aplicação da acetilcolina na câmara anterior foi de 3,4 mm com desvio padrão de 0,66mm. O tempo médio de ação máxima do medicamento foi de 64 segundos, com desvio padrão de 8 segundos. A média da pressão intraocular no primeiro dia do pós-operatório foi de 19,1 mmHg com desvio padrão de 2,45mmHg. Conclusão: O estudo acima mostrou que a acetilcolina apresenta boa eficácia na obtenção de miose intraoperatória na cirurgia de facoemulsificação, permitindo uma maior facilidade na confecções das suturas corneanas ou corneo-escleral, reduzindo a incidência de sinéquias anteriores periféricas. Concluimos que o cloridrato de acetilcolina 1% é um importante medicamento na obtenção da miose intraoperatória na cirurgia de catarata.

Presentación de un caso: síndrome de claude bernard-horner post resección de higroma quístico / Presentation of a case: claude bernard-horner's syndrome post resection of cystic hygroma

El Higroma quístico es una malformación congénita que consiste en uno o más espacios linfáticos llenos de líquido, suelen reconocerse en recién nacidos, pero típicamente pueden ser visibles cuando aumentan de tamaño conforme al crecimiento del paciente. El Síndrome de Claude Bernard-Horner se caracteriza por una miosis, ptosis palpebral y anhidrosis en pacientes con afectación de la vía oculosimpatica, se considera una complicación neurológica iatrogénica infrecuente. Se presenta una paciente femenina de 4 años con diagnostico posnatal de higroma quístico cervical tras estudio patológico realizado, el cual fue extraído quirúrgicamente. Tres días después la paciente presenta ptosis del parpado superior izquierdo con presencia de miosis y disminución de la sudoración del mismo lado, sin alteraciones en la fuerza y movimiento del miembro superior Izquierdo.

Cystic hygroma is a congenital malformation consisting of one or more lymphatic spaces filled with fluid, usually recognized in newborns, but typically can be visible when they increase in size according to the patient's growth. The Claude Bernard-Horner Syndrome is characterized by miosis, palpebral ptosis and anhidrosis in patients with oculosympathetic pathway involvement, it is considered an infrequent iatrogenic neurological complication. We present a 4-year-old female patient with postnatal diagnosis of cervical cystic hygroma after a pathological study, which was surgically removed. Three days later, the patient presented ptosis of the left upper eyelid with the presence of miosis and decreased sweating on the same side, without alterations in the strength and movement of the left upper limb.

Effects of tramadol on tear production, intraocular pressure, and pupil size in dogs: clinical study / Efeitos do tramadol sobre a produção lacrimal, a pressão intraocular e o diâmetro pupilar de cães: estudo clínico

This study aimed to evaluate the effects of tramadol on tear production, intraocular pressure (IOP) and pupil diameter (PD) in healthy dogs. Dogs were randomly assigned to receive 4mg kg-1 (n=11) and 6mg kg-1 (n=11) of tramadol hydrochloride intramuscularly. Tear production (Schirmer tear test, STT-1), IOP (applanation tonometry) and the PD (electronic pachymetry) were assessed before, 30 and 60 minutes after administration of tramadol. Data were compared by analysis of variance for repeated measures (P<0.05). Parameters evaluated before, at 30 and 60min, in dogs treated with 4 and 6mg kg-1, were respectively: (STT-1) 22.50±3.38, 21.14±3.94 and 21.09±2.99mm min-1; and 23.05±3.73,22.64±3.76 and 22.82±3.25mm min-1. (IOP) 18.14±2.68, 17.68±2.59 and 18.23±3.84mmHg; and 19.05±2.27, 18.91±2.74 and 17.64±2.34mmHg. (PD) 6.71±0.65, 7.22±1.42 and 6.90±1.39mm; and 6.25±1.08, 6.80±1.27 and 6.49±0.90mm. All parameters evaluated did not change significantly among time points and dose regimen. Based on the conditions under which the experiments were conducted, tramadol did not affect tear production, IOP and PD in dogs, and could be used as a preoperative analgesic for intraocular surgery and pain control for any cause in patients affected by uveitis, glaucoma and keratoconjunctivitis sicca.

Objetivou-se estudar os efeitos da administração sistêmica do tramadol sobre a produção lacrimal, a pressão intraocular (PIO) e o diâmetro pupilar (DP) em cães saudáveis. Os cães foram aleatoriamente tratados com 4mg kg-1 (n=11) e 6mg kg-1 (n=11) de cloridrato de tramadol por via intramuscular. A produção lacrimal (Teste da lágrima de Schirmer, TLS-1), a PIO (tonometria de aplanação) e o DP (paquimetria eletrônica) foram mensurados antes, 30 e 60min após a aplicação do tramadol. Os dados obtidos foram avaliados pelo teste de análise de variância para medidas repetidas (P<0,05). Os parâmetros avaliados antes, aos 30 e aos 60min, em cães tratados, respectivamente, com 4 e 6mg kg-1, foram de: (TLS-1) 22,50±3,38, 21,14±3,94 e 21,09±2,99mm min-1; e 23,05±3,73, 22,64±3,76 e 22,82±3,25mm min-1. (PIO) 18,14±2,68, 17,68±2,59 e 18,23±3,84mmHg; e 19,05±2,27, 18,91±2,74 e 17,64±2,34mmHg. (DP) 6,71±0,65, 7,22±1,42 e 6,90±1,39mm; e 6,25±1,08, 6,80±1,27 6,49±0,90mm. Não houve diferença significativa entre os tempos e doses estudadas para quaisquer variáveis. Nas condições deste estudo, o tramadol não alterou a produção lacrimal, a PIO e o DP de cães, podendo ser utilizado como analgésico pré-operatório em cirurgias intraoculares e no controle da dor oriunda de qualquer etiologia em pacientes acometidos por uveíte, glaucoma e ceratoconjuntivite seca.

A study on effect of pre-operative topical prednisolone acetate, nepafenac and placebo, on intraoperative mydriasis and its sustenance during cataract surgery: a randomized trial.

Background: The objective of the current study was to study the effects of preoperative use of topical anti-inflammatory prednisolone acetate, nepafenac and placebo, on the sustenance of intraoperative mydriasis during cataract surgery. Methods: This study comprised of 60 patients scheduled for cataract surgery. Patients (20 in each group) were randomized to receive placebo, prednisolone acetate, and nepafenac. These eye drops were given 3 times daily for the 2 days prior to surgery. The pupillary diameters were measured by the surgeon using Casterveijo’s Caliper before the corneal section and at the end of surgery. The primary result was the number of patients with pupil ≥6 mm at the end of the surgery; the secondary result was the number of patients with pupil ≥6 mm at the beginning of the surgery. It was a single-center, masked, randomized clinical study. Results: All the patients achieved pupil ≥6 mm at the beginning of the surgery. The number of patients in the prednisolone (16/20) and nepafenac (17/20) groups with pupil ≥6 mm was greater than in the placebo group in the maintenance of intraoperative mydriasis (7/20 – p=0.003). There was no statistically significant difference among the prednisolone and nepafenac groups in the maintenance of intraoperative mydriasis (p=0.791). There were no complications during surgery or related to the pre-operative use of the eye drops. Conclusion: Pre-operative use of prednisolone acetate and nepafenac was effective in maintaining the intraoperative mydriasis when compared with placebo.

The Effects of Two Non-Steroidal Anti-Inflammatory Drugs, Bromfenac 0.1% and Ketorolac 0.45%, on Cataract Surgery

PURPOSE: To compare the additive effects of two types of non-steroidal anti-inflammatory drugs (NSAIDs), bromfenac 0.1% or ketorolac 0.45%, relative to topical steroid alone in cataract surgery. MATERIALS AND METHODS: A total 91 subjects scheduled to undergo cataract operation were randomized into three groups: Group 1, pre/postoperative bromfenac 0.1%; Group 2, pre/postoperative preservative-free ketorolac 0.45%; and Group 3, postoperative steroid only, as a control. Outcome measures included intraoperative change in pupil size, postoperative anterior chamber inflammation control, change in macular thickness and volume, and ocular surface status after operation. RESULTS: Both NSAID groups had smaller intraoperative pupil diameter changes compared to the control group (p<0.05). There was significantly less ocular inflammation 1 week and 1 month postoperatively in both NSAID groups than the control group. The changes in central foveal subfield thickness measured before the operation and at postoperative 1 month were 4.30+/-4.25, 4.87+/-6.03, and 12.47+/-12.24 microm in groups 1 to 3, respectively. In the control group, macular thickness and volume increased more in patients with diabetes mellitus (DM), compared to those without DM. In contrast, in both NSAID groups, NSAIDs significantly reduced macular changes in subgroups of patients with or without DM. Although three ocular surface parameters were worse in group 1 than in group 2, these differences were not significant. CONCLUSION: Adding preoperative and postoperative bromfenac 0.1% or ketorolac 0.45% to topical steroid can reduce intraoperative miosis, postoperative inflammation, and macular changes more effectively than postoperative steroid alone.

Antagonism of obidoxime on sarin induced miosis and visual impairment in rabbits / 中国药理学与毒理学杂志

OBJECTIVE The antagonism of obidoxi me on sarin induced miosis and visual impair-ment was evaluated and its antagonistic mechanism was investigated.METHODS ① 30 min after sarin (2 μg /0.1 mL per eye)was given as an eyedrop,the ability of the 2.5%,5.0%,7.5% obidoxi me and 1 .0% atropine to reverse effects of sarin on pupil dia meter and light reflex were evaluated at different ti mes.② Another 36 rabbits received sarin and at 30 min afer sarin exposure,the drugs above were ad-ministrated and their effects on pupillary light reflex,as well as the AChE activity of cornea,iris and reti-na were recorded 4h after the treatment.RESULTS ① Miosis and impaired pupillary light reflex oc-curred soon after sarin exposure but the abnormal pupil width and pupillary light reflex had disappeared by 48 h after sarin exposure;Subcequent to 1 .0% atropine treatment,the pupil dilatedinstead while the impaired light reflex did not i mprove significantly;unlike atropine,soon after ad ministration of 2.5%, 5.0%,7.5% obidoxi me,the pupil dia meter and light reflex were significantly increased(P <0.01 )and then had beco me normal totally by 24 h post-dose,much faster than those of the control and atropine treatment group.However,there was no significant difference in the recovery ti me between the different dose groups of obidoxi me.② 4h after treatment,the AChE activity in cornea and irisof sarin-treated group were (42 ±4)%,(26 ±2)%,respectively;the AChE activity in cornea of 2.5%,5.0%,7.5%obidoxi me were (74 ±1 1 )%,(81 ±10)% and (74 ±7)%,respectively,and the AChE activity in iris were(39 ±10)%,(43 ±8)% and (43 ±8)%,respectively ,co mpared with sarin-treated group,AChE activities of cornea and iris as well as light reflex of the obidoxi me-treated group were significantly increased(P<0.01 ).But there was no difference in light reflex and AChE activity between the sarin-treated and atropine-treated groups.CONCLUSION Obidoxi me showed better antagonism of sarin-induced ocular effects than that of the commonly used drug,atropine;the antagonistic mechanism is likely closely related to its rapid reactivation of the inhibited AChE in the cornea and iris.

Manejo a nivel primario de cuerpo extraño en ojo / Manage in primary care of foreign bodies in the eye

Los cuerpos extraños en ojo es quizás la forma más común de presentación del trauma ocular. En la consulta de emergencias es usual observar traumas oculares de los cuales la mayoría son asociados con cuerpos extraños en cornea o a nivel tarsal. Dada la dificultad de acceso de algunas zonas del país a los servicios especializados en oftalmología, en el Servicio de Emergencias de Valverde Vega nació la necesidad de redactar esta actualización con lo más reciente en manejo de cuerpos extraños, con el fin de brindar la mejor atención a los usuarios con este tipo de patologías. Durante este proceso hemos concluido que el manejo ha variado en relación a la enseñanza básica del médico general en las escuelas de medicina.

Probably the most frequent presentation of ocular trauma is foreign bodies in the eye; it is a usual consultation in the emergency service, and most are associated to foreign bodies in the cornea or at the tarsus. SincetheaccesstoophthalmologicconsultationinCostaRica is limited, the Emergency Service in Valverde Vega needed to update procedures for a correct management of foreign bodies in the eye, in order to give the best attention possible to those pathologies. During this process we concluded that the management of the foreign bodies has evolved from the basic training the physicians had in medical school.

Idiopathic Horner’s Syndrome: An Enigma.

Horner’s syndrome (Bernard-Horner’s syndrome or oculosympathetic palsy) is a clinical syndrome caused by paralysis of the cervical sympathetic trunk. It is characterized by miosis, ptosis, enophthalmos and anhidrosis. Most of the cases are due to vascular causes, trauma or cancer. Occasionally, Horner’s syndrome is encountered in a patient where no cause can be ascertained. Here, we describe one such case.

Nondisjunction and chromosomal anomalies / La no disyunción y las anomalías cromosómicas

La no segregación es el fracaso de los cromosomas homólogos en separarse correctamente durante la meiosis. Esto resulta en la producción de gametos que contienen una cantidad de cromosomas mayor o menor a la encontrada en una célula normal. Consecuentemente, el individuo puede desarrollar una trisomía o monosomía. La no disyunción puede ocurrir en meiosis I o meiosis II de la división celular, es una causa de diversas condiciones médicas anormales, incluyendo el Síndrome de Down (trisomía del cromosoma 21), Síndrome de Patau (trisomía del cromosoma 13), Síndrome de Edward (trisomía del cromosoma 18) y Síndrome de Turner (la presencia de un solo cromosoma X). A pesar de que es la causa de numerosos trastornos genéticos, aún no se conoce su etiología exacta y el proceso en el cual se lleva a cabo. La no disyunción se origina en el mayor de los casos de errores en la meiosis II materna, sin embargo, la meiosis paterna y la meiosis I materna influyen en ella. La edad materna se considera como un factor de riesgo de las trisomías, igual que la alteración de la recombinación y otros factores que pueden afectar la segregación cromosó-mica, tal como la genotoxicidad y translocaciones cromosómicas. Esta revisión se realizará con base en artículos publicados entre 2003 y 2009 en ISI Web, Science Direct, PUED, SPRINGER y SCIELO; se interpretará y analizará en ella los resultados de estos estudios que lograron demostrar conclusiones importantes y sobresaltaron factores interesantes que pueden ser el punto de partida para próximas investigaciones.

Nondisjunction is the failure of homologous chromosomes to disjoin correctly during meiosis. This results in the production of gametes containing a greater or lesser chromosomal amount than normal ones. Consequently the individual may develop a trisomal or monosomal syndrome. Non disjunction can occur in both Meiosis I and Meiosis II of the cellular division. It is a cause of several abnormal medical conditions, including Down's syndrome (trisomy of chromosome 21), Patau's Syndrome (trisomy of chromosome 13), Edward's Syndrome (trisomy of chromosome 18) and Turner's Syndrome (the presence of only one X chromosome). It is also the main cause of many genetic disorders, however its origin and process remains vague. Although it results in the majority of cases from errors in the maternal meiosis II, both paternal and maternal meiosis I do influence it. The maternal age, is considered a risk factor of trisomies, as well as recombination alterations and many others that can affect the chromosomal segregation, such as genotoxicity and chromosomal translocations. We will review the results of previously realized studies between the years 2003 and 2009, found in ISI WEB, PUED, SCIENCE DIRECT,SPRINGER LINK and SCIELO, that led to important conclusions and highlighted interesting factors that can be the starting point to future investigation.

Effects of Dimethyl Sulfoxide (DMSO) on the Contraction of the Rat Iris Muscle

PURPOSE: To evaluate the effects of DMSO on the iris muscle contractility and to compare DMSO with other detergents(ethanol and triton-x 100). METHODS: After anesthesizing rats with an intraperitoneal injection of pentobarbital sodium, each animal was fixed under microscope. The pupil response to the drugs was examined by CCD camera and the video edge motion detector was used for measurement of alteration of the pupil size. The pupil response to the drugs was recorded by MacLab chart(version 3.6/s). RESULTS: Miosis induced by DMSO was initiated after 5 minutes, peaked at around 30 minutes and maintained until 3 hours after instillation. Miotic effect of DMSO was in a dose dependent manner ranging 0.01%-10% and was not reversed after washout. All detergents used in the present experiment induced miosis, however, DMSO elicited the strongest miotic response. After pretreatment with atropine, DMSO-induced miotic response was not affected, showing similar changes with control group. CONCLUSIONS: Taken together, it is concluded that DMSO induces miosis by inducing relaxation of iris dilator muscle.

The Pupils of Korean Neonates

In an attempt to know the nature of the pupils in neonates, the authors studied the pupil diameter and net miosis to the light stimulation of 70 neonates ranging from 27.3 weeks to 42.0 weeks of gestational age. The mean corneal diameter was 9.3mm. The mean pupil diameters of awakening infants (200 1ux) and in bright light stimulation were 3.1mm and 2.1mm respectively. All the cases had the response to light stimulation and the mean net miosis was 1.0mm. Anisocoria of 0.5mm to 1.0mm was detected in 11 infants (16%). Thus it may be warranted that the careful investigation to search for neurologic abnormalities is necessary if the pupil size of the neonate is more than 2 standard deviation from the mean (smaller than 1.7mm or larger than 4.5mm in dim illummation), or if their pupils do not respond to light challenge.