Effect of different mydriatic regimens used for pupil dilation on the vital signs of premature infants for retinopathy of prematurity screening in a Philippine tertiary hospital: A randomized double-blind clinical trial

@#<p style="text-align: justify;"><strong>Objectives.</strong> To determine the safety and efficacy of three different mydriatic regimens in premature infants referred for retinopathy of prematurity (ROP) screening using (1) multiple alternate instillations of 0.5% cyclopentolate hydrochloride and 2.5% phenylephrine (MAI), (2) single instillation of 0.5%/0.5% tropicamide + phenylephrine (SI) and (3) single instillation of 0.5%/0.5% tropicamide + phenylephrine with a cotton wick placed in the inferior fornix (SIW) in a Philippine tertiary hospital.</p><p style="text-align: justify;"><strong>Methods.</strong> A randomized, double-blind, clinical trial included preterm infants for ROP screening at a Philippine tertiary hospital. After instillations via MAI, SI, and SIW, systolic blood pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), heart rate, and oxygen saturation were monitored. Pupillary dilation was also measured.</p><p style="text-align: justify;"><strong>Results.</strong> Sixty preterm infants, 20 to each intervention, were included. The MAI group did not have significant changes relative to its baseline vital signs. The use of SI produced lower DBP (p<0.0106) and MAP (p<0.0027) compared to MAI. The use of SI produced lower DBP (p<0.01) and MAP (p<0.003) compared to MAI. The SIW group exhibited significant increases in SBP (p<0.002) and in MAP (p<0.04) compared to MAI. This increase in SBP exceeded the clinical normal values for <37 weeks old infants. Pupillary dilation did not have significant differences among groups (p=0.24).</p><p style="text-align: justify;"><strong>Conclusion.</strong> Due to significant increase in SBP, it is recommended to discontinue SIW in preterm infants for ROP screening since it may promote the mydriatic's systemic absorption. Except for the clinically increased heart rate in infants aged ?37 weeks at examination, SI was found to be at par with the recommendation of the UK ROP Guidelines of May 2008.</p>

Side effects of 1% cyclopentolate hydrochloride in children and adolescents attended at Centro Universitário FMABC

INTRODUCTION: It is known that vision disorders are within the context of public health problems. In childhood, during the neuropsychomotor development phase, visual changes are crucial, since there is a strong correlation between poor school performance and changes in acuity. For these reasons, ophthalmological examination in children, including refraction, is extremely important, aiming at the early diagnosis of diseases and possible refractive errors that may compromise the child's life and development. 1% cyclopentolate hydrochloride eye drops are the most used during ophthalmic clinical evaluation as a cycloplegic and mydriatic agent to assist in refractive examination. OBJECTIVE: The ocular and systemic side effects of 1% cyclopentolate hydrochloride eye drops were studied in patients who underwent static refractive examination in the strabismus sector of the Ophthalmology Discipline of the Centro Universitário FMABC. METHODS: A drop of 1% cyclopentolate is instilled in both eyes of each patient and the possible ocular and systemic signs and symptoms presented were observed after 40 minutes and 24 hours after instillation. RESULTS: We expect to find ocular side effects more evident than systemic symptoms in the two evaluation times (40 minutes and 24 hours after instillation). All symptoms (ocular and systemic) are reversed spontaneously. CONCLUSION: The present study aims to show that the side effects observed by the topical (ocular) use of cyclopentolate eye drops 1% are few and present spontaneous reversal both from an eye point of view, as well as from a systemic point of view.

Polymicrobial Keratitis of Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi

PURPOSE: To report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi. CASE SUMMARY: A 53-year-old female complained of pain and secretion in her right eye, which started 6 weeks before her visit. She applied steroid ointment, which was received from the dermatologist, to her eyelid 7 days prior to her visit but this treatment worsened her symptoms. At the initial visit, the visual acuity of the right eye was light perception, and purulent secretions were observed. Using a slit lamp, severe conjunctival hyperemia, hypopyon, and a ring-shaped central corneal ulcer were observed. The anterior chamber and fundus were not observed due to corneal lesions but ultrasonography showed no intraocular inflammation. Infectious keratitis was suspected and cultured by corneal scraping. During the incubation period, 0.5% moxifloxacin, 2% voriconazole, and 1% cyclopentolate were administered. A total of 400 mg of moxifloxacin and 100 mg of doxycycline were given orally. In the primary culture, Pseudomonas aeruginosa and Acinetobacter baumannii were identified so 5% ceftazidime, which was sensitive for the antibiotic susceptibility results was further instilled. Thereafter, the keratitis improved but the keratitis again worsened while maintaining the topical treatment. A secondary culture was positive for Ochrobactrum anthropi. Treatment with 1.4% gentamicin, which was sensitive for the antibiotic susceptibility test was added and the keratitis improved. A conjunctival flap was performed because of the increased risk of perforation. CONCLUSIONS: We report polymicrobial keratitis involving Pseudomonas aeruginosa, Acinetobacter baumannii, and Ochrobactrum anthropi for the first time in the Republic of Korea.

Cycloplegic Refraction in Hyperopic Children: Effectiveness of a 0.5% Tropicamide and 0.5% Phenylephrine Addition to 1% Cyclopentolate Regimen

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.

Estabilidad de una formulación de ciclopentolato 1 por ciento colirio / Stability of a formulation of 1 percent cyclopentolate eye drops

Introducción: el colirio de ciclopentolato al 1 por ciento, se indica para medir los errores de la refracción, producir cicloplejía en procedimientos diagnósticos y también midriasis preoperatoria y postoperatoria, en el tratamiento de la uveítis y en los estados inflamatorios del iris. Objetivo: evaluar el desempeño del método de cromatografía líquida de alta resolución, aplicable al control de la calidad y estudio de estabilidad del colirio. Métodos: para cuantificar el ingrediente farmacéutico activo en el producto terminado, se empleó el método descrito en la Farmacopea de los Estados Unidos (USP 32, 2009). El estudio de vida de estante se desarrolló por un periodo de 24 meses a temperatura controlada entre 15-25 °C; mientras que el de estabilidad acelerada a 40 ± 2 °C y 75 ± 5 por ciento de humedad relativa, durante 6 meses. Resultados: los resultados obtenidos en la evaluación del desempeño del método analítico se encontraron dentro de los límites establecidos. Los resultados del estudio de estabilidad por vida de estante después de transcurridos los 24 meses indicaron que el producto mantiene los parámetros que determinan su calidad durante ese tiempo, y en los acelerados no se observó degradación significativa del producto. Conclusiones: la evaluación del desempeño del método analítico evaluado por cromatografía líquida de alta resolución demostró la confiabilidad del mismo. Se estableció 2 años como fecha de vencimiento en las condiciones señaladas(AU)

Introduction: the 1 percent cyclopentolate eye drops is indicated to measure the refractive errors, to cause cycloplexy in diagnostic procedures and also preoperative and postoperative midriasis in treating uveitis and in inflammatory conditions of the iris. Objective: to evaluate the performance of a high performance liquid chromatography applicable to the quality control and the study of the eye drops stability. Methods: with the purpose of quantifying the active ingredient in the finished product, the method described in the US Pharmacopea (USP 32,2009) was used. The shelf life study was conducted for 24 months at controlled 15-25 ºC temperature whereas the study of accelerated stability at40±2 ºC and 75± 5 percent relative humidity lasted 6 months. Results: the achieved results in the evaluation of the performance of the analytical method were within the set limits. The results for the shelf life stability after 24 months yielded that the product keeps the quality parameters during this time and in the accelerated stability study, there was no sign of significant degradation. Conclusions: the evaluation of the performance of the analytical method based on high performance liquid chromatography showed its reliability. The expiry date was set at 2 years under the stated conditions(AU)

Effects of 1% cyclopentolate hydrochloride on anterior segment parameters obtained with Pentacam in young adults / Efeitos do cloridrato ciclopentolato 1% sobre os parâmetros do segmento anterior obtidos com Pentacam em adultos jovens

Purpose: To investigate the effects of topically applied 1% cyclopentolate hydrochloride on anterior segment parameters obtained with a Pentacam rotating Scheimpflug camera in healthy young adults. Methods: Anterior segment analyses of 25 eyes from 25 young adults (Group 1), before and after 45 min of 1% cyclopentolate hydrochloride application, were performed. For a control group (cycloplegia-free, Group 2), 24 eyes of 24 age- and sex-matched healthy cases were evaluated twice at 45 min intervals. The results obtained from the groups were compared statistically. Results: The mean ages of the groups were 23.04 ± 3.42 (range, 18-29) and 22.4 ± 2.05 (range, 18-27) years for Groups 1 and 2, respectively (p=0.259). In Group 1, measurements between the two analyses were significantly different for the values of anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (ACV) (p<0.05), whereas no statistical difference was found for the central corneal thickness (CCT) and keratometry (K1, K2) measurements. In Group 2, none of these parameters were statistically different between the two analyses. Conclusions: Topically applied 1% cyclopentolate hydrochloride caused an increase in the ACD and ACV values, and a decrease in the ACA value. However, it had no significant effect on the CCT and keratometry measurements. It is important to consider these effects when using the Pentacam device on young adults with cycloplegia and when applying it for various reasons. .

Objetivo: Pesquisar os efeitos do cloridrato de ciclopentolato a 1%, aplicado topicamente, em parâmetros do segmento anterior medidos com a câmera de Scheimpflug Pentacam em adultos jovens e saudáveis. Métodos: A análise do segmento anterior, de 25 olhos de 25 jovens adultos (Grupo 1), antes e após 45 minutos da aplicação de cloridrato ciclopentolato a 1%, foram realizados. Como grupo controle (sem cicloplegia, Grupo 2), 24 olhos de 24 pacientes saudáveis pareados por idade e sexo, foram avaliados duas vezes em intervalos de 45 minutos. Os resultados obtidos com os grupos foram comparados estatisticamente. Resultados: A média de idade dos grupos foram 23,04 ± 3,42 (18-29 anos) e 22,4 ± 2,05 (18-27) anos, respectivamente (p=0,259). No Grupo 1, as medidas entre os dois exames foram significativamente diferentes para os valores de profundidade da câmara anterior (ACD), ângulo da câmara anterior (ACA), e do volume da câmara anterior (ACV) (p<0,05 para todos), enquanto que não foram diferentes para a espessura corneana central (CCT) e ceratometria valores (K1, K2). No Grupo 2, nenhum destes parâmetros foi diferente entre os dois exames. Conclusões: Aplicação tópica de cloridrato de ciclopentolato a 1% causou um aumento nos valores de ACD e ACV e uma diminuição nos valores da ACA. No entanto, ele não teve nenhum efeito significativo sobre as medidas de CCT e ceratometria. É importante considerar esses efeitos sobre as medidas tomadas com Pentacam em adultos jovens com cicloplegia quando aplicá-las em diferentes situações. .

Side Effects after the Use of Cyclopentolate for Cycloplegic Refraction

PURPOSE: To investigate the frequency of side effects due to the use of cyclopentolate for cycloplegic refraction. METHODS: For 4 months, temperature change and adverse effects in 157 children who visited the pediatric ophthalmology clinic of a university hospital for cycloplegic refraction using cyclopentolate were observed. Topical 1% cyclopentolate was instilled 5 times at 5 minute intervals and temperature measured before and after administration using a tympanic thermometer. Side effects such as facial flushing, skin rash, and central nervous system disorders were recorded while cycloplegic refraction was performed. RESULTS: The mean temperature was increased 36.67 +/- 0.10degrees C to 36.90 +/- 0.09degrees C, but no fever exceeded 38degrees C. Seventeen (10.83%) patients experienced side effects including facial flushes (n = 6), temperature change (n = 5), abnormal central nervous system symptoms (n = 4), and a visible skin rash (n = 2). No patient experienced more than 1 side effect and long term adverse effects were not observed. CONCLUSIONS: The incidence of side effects due to cyclopentolate instillation for cycloplegic refraction was 10.83% in children. Although side effects due to cyclopentolate disappeared without any treatment, cafeful monitoring for their occurrence is necessary.

The Analysis of AC/A Ratio in Nonrefractive Accommodative Esotropia Treated with Bifocal Glasses

PURPOSE: To report the long term results of bifocal treatment in nonrefractive accommodative esotropia and to analyze the changes of accommodative convergence to accommodation (AC/A) ratio. METHODS: Sixteen patients treated with bifocal glasses for at least 5 years were evaluated retrospectively. Angle of deviation at near and distance, refractive error, and AC/A ratio by the lens gradient method were analyzed. The changes of AC/A ratios were also compared after dividing the patients according to continuation or cessation of bifocal therapy. RESULTS: Six patients (38%; bifocal stop group, BSG) were able to stop using bifocal glasses at an average age of 10.8 years (range, 6.5 to 15.4 years) during their follow-up. However, the other ten patients (62%; bifocal continue group, BCG) had to continue using bifocal glasses until the final visit, which was 13.8 years on average (range, 11.3 to 18.5 years). The AC/A ratio decreased from time of bifocal prescription to the last visit in both groups, from 4.4 to 2.7 in the BSG and from 5.9 to 4.5 in the BCG. AC/A ratios were significantly higher (p = 0.03) in the BCG than that of the BSG from the beginning of bifocal treatment and this difference was persistent until the final visit (p = 0.03). CONCLUSIONS: The AC/A ratio decreased with age in both groups but was significantly higher throughout the entire follow-up period in the BCG. AC/A ratio at bifocal prescription could be an important factor in predicting response to bifocal treatment.

Optimal dosage of cyclopentolate 1% for cycloplegic refraction in hypermetropes with brown irides.

To find the optimal dosage of cyclopentolate 1% for cycloplegic refraction in hypermetropes with brown irides, we investigated the difference in cycloplegic auto-refractions obtained after one, two, and three instillations in the same patient. The mean hypermetropia found after three instillations was statistically significantly more compared to that found after one instillation. There was no statistically significant difference in the mean hypermetropia between two and three instillations. There was no significant effect of gender, age, and the presence and type of horizontal deviation. These observations suggest that two drops of cyclopentolate 1% 10 min apart are sufficient for cycloplegic refraction in hypermetropes.

Effects of Pupil Dilation and Constriction Agents on Trabecular Meshwork Cells

PURPOSE: To investigate the effects of pupil dilation and constriction agents on the survival and production of nitric oxide (NO) in cultured human trabecular meshwork cells (HTMC). METHODS: Primarily cultured HTMC were exposed to 0, 0.01, and 0.1 mg/ml of tropicamide, cyclopentolate, atropine, or pilocarpine for 2 hours. Cellular survival and production of NO were assessed using the MTT assay and Griess assay, respectively. RESULTS: Tropicamide, cyclopentolate, atropine, and pilocarpine decreased cellular survival at the concentration of 0.1 mg. At the concentration of 0.01 mg/ml, all agents decreased production of NO to some extent, although the reduction was not statistically significant. CONCLUSIONS: Pupil dilation and constriction agents may be toxic to HTMC if used at high concentrations or if used frequently in the short-term but may not affect trabecular outflow.

Comparative Study on the Efficacy of Different Cycloplegic Agents in Myopic Adults

PURPOSE: To evaluate the efficacy of 3 cycloplegic regimens in adults with myopia. METHODS: Refraction, accommodation amplitude, residual accommodation and biometric findings were assessed before and after instillation of regimen I (tropicamide 0.5% and phenylephrine 0.5%), regimen II (cyclopentolate 1.0%), and regimen III (combination of regimen I and II). RESULTS: In myopic adults aged 22 to 26 years, cycloplegic refraction revealed less myopia than manifested refraction. Although there was no difference in residual accommodation among the 3 regimens, regimen II and III were more effective in reducing myopia, accommodation, and axial length. The difference in cycloplegic refraction between regimen I and II was more prominent in patients who had larger amplitude of accommodation and residual accommodation with regimen I. CONCLUSIONS: Cycloplegic refraction should be used even in adult myopes. For patients with stronger accommodation and larger residual accommodation with tropicamide, cycloplegic refraction with cyclopentolate may be used to ensure relaxation.

Fibrinous anterior uveitis following laser in situ keratomileusis.

A 29-year-old woman who underwent laser in situ keratomileusis (LASIK) for myopic astigmatism in both eyes presented with severe pain, photophobia and decreased visual acuity in the left eye eight days after surgery. Examination revealed severe anterior uveitis with fibrinous exudates in the anterior chamber, flap edema and epithelial bullae. Laboratory investigations for uveitis were negative and the patient required systemic and intensive topical steroids with cycloplegics to control the inflammation. This case demonstrates that severe anterior uveitis may develop after LASIK and needs prompt and vigorous management for resolution.

Efeitos da ibopamina 2 por cento tópica nos resultados da campimetria visual computadorizada / Effects of 2 percent ibopamine eye drops on computerized visual field results

OBJETIVO: Avaliar os efeitos do uso do colírio de ibopamina a 2 por cento nos resultados da campimetria visual computadorizada em indivíduos normais. MÉTODOS: Voluntários oriundos do CEROF-UFG, sem alterações ao exame oftalmológico que pudessem afetar o campo visual foram selecionados. Os indivíduos foram submetidos a exame de perimetria computadorizada SITA-standard 24-2 antes e após dilatação com o colírio de ibopamina a 2 por cento ou ciclopentolato, com intervalo mínimo de 3 dias entre si e em ordem aleatória. Índices globais e número de pontos alterados foram comparados entre os grupos. RESULTADOS: Foram avaliados 30 olhos de 30 indivíduos normais. Não houve diferença estatisticamente significativa entre o "mean deviation" (MD) nos pacientes não dilatados e nos mesmos após a instilação da ibopamina (MD: -1,05 ± 0,26 dB vs. -1,47 ± 0,20 dB, P=0,08), o que ocorreu após cicloplegia (MD: -3,19 ± 0,29 dB), P<0,001 para ambos. Na avaliação entre cicloplegia e pré-dilatação, nota-se significância para o "pattern standard deviation" (P=0,04), o que não ocorreu na avaliação com ibopamina. O número de pontos alterados no "pattern deviation" não apresentou diferença significativa entre todos os pares. Quanto ao número de pontos do "total deviation", houve diferença estatisticamente significativa antes da dilatação e após o uso do cicloplégico (n: 8,86 ± 1,51 vs. 25,72 ± 2,96 pontos, P<0,001) e entre olhos após a instilação do cicloplégico e da ibopamina (ibopamina: 9,75 ± 1,85 pontos, P<001). CONCLUSÃO: O colírio de ibopamina 2 por cento aparentemente não afeta os resultados da perimetria computadorizada em indivíduos normais.

PURPOSE: To evaluate the influence of 2 percent ibopamine eye drops on the results of computerized visual field exams. METHODS: Normal volunteers from CEROF-UFG were selected, with no variance in the ophthalmologic examination that could affect the visual field test. The volunteers underwent computerized visual field test before and after dilation with 2 percent ibopamine eye drop or cyclopentolate, with a minimum interval of three days between them and in a random order. Global indices and number of altered points were compared between the groups. RESULTS: Thirty eyes of 30 normal individuals were selected. There was no statistically significant difference on Mean Deviation (MD) before and after dilation with ibopamine (MD: -1.05 ± 0.26 dB vs. -1.47 ± 0.20 dB, P=0.08). However, after cycloplegia (MD: -3.19 ± 0.29 dB), there was a significant difference on MD (P<0.001 for both ibopamine and pre-dilation). No significant difference was detected in the Pattern Standard Deviation when comparing ibopamine with pre-dilation and cycloplegia values, but it was statistically significant comparing pre-dilation to cycloplegia (P=0.04). The number of altered points in the Pattern Deviation graphic were not significant comparing all pairs. There was a statistically significant difference in the number of altered points in the total deviation graphic before dilation and after cycloplegia (n: 8.86 ± 1.51 vs. 25.72 ± 2.96 points, P<0.001), and comparing cycloplegia with ibopamine (ibopamine: 9.75 ± 1.85 points, P<0.001). CONCLUSION: Ibopamine 2 percent eye drops seem to not modify the results of visual field tests in normal individuals.

Comparison of the level of difference between cycloplegic and noncycloplegic refraction in different age groups

The goal of this study was to compare the level of difference between cycloplegic and noncycloplegic refraction in different age groups. This correlation study was performed on 400 eyes of 200 participants in Khatam Al-Anbia hospital. For all participants, non cycloplegic refraction was done. Cycloplegia was performed, using Cyclopentolate 1%. Then cycloplegic refraction was done with the same autorefractometer. The amount of accommodation suppressed by the drug and possible effects of age, gender, type of refractive error and occupation on this amount was compared in different age groups. SPSS ver.13 statistical software was used for data analysis. P-value less than 0.05 considered as significant. Average age of participants was 20.11 +/- 15.50 [range 2-59]. The amount of accommodation suppressed by cyclopentolate 1% was significantly different among various age groups [p < 0.001]. The amount of accommodation suppressed by Cyclopentolate 1% showed no difference between myopic and hyperopic patients in any age groups [p > 0.10 for each eye]. Also, there was no correlation between occupation, sex and the amount of accommodation suppressed during cycloplegia [p = 0.45 and p > 0.10 respectively]. Cycloplegic refraction is an effective procedure for patients under 50 years old. The type of refractive error, sex and occupation had no effect on the amount of accommodation suppressed by Cyclopentolate 1%

Is age relevant for the success of treatment of anisometropic amblyopia?

A prospective cohort study of 200 anisometropic amblyopes was conducted. The patients were classified into two groups. Group A: Patients less than 12 years of age. This consisted of 144 (72%) patients, the average age being 7.77 years (+/-2.34, range 1 to 12). Group B: Patients more than 12 years of age. This comprised 56 (28%) patients, the average age being 19.8 years (+/-5.47, range 12 to 30). Criterion for success was defined as best corrected visual acuity of 20/40 (0.5 logMAR equivalent) or better. The Chi-square test was used to compare baseline characteristics and success rates. There were no significant differences in the baseline characteristics between the two groups ( P =0.07). The treatment was successful in 108 (75%) in Group A and in 34 (60.7%) in Group B ( P = 0.07). There was no statistically significant change in the success rate of treatment of anisometropic amblyopia, even beyond 12 years of age.

Análise comparativa entre a refração clínica subjetiva e a automatizada obtida por sensor de frentes de onda / Comparative analyses between clinical refraction and automatic refraction obtained through a wave front sensor

OBJETIVO: Avaliar e comparar os resultados obtidos da refração estática clínica com a obtida por sensor de frentes de onda. MÉTODOS: Estudo prospectivo, não seqüencial, de 279 olhos de 147 pacientes. Todos os pacientes foram examinados sob cicloplegia. Primeiro realizamos a refração clínica e a seguir a automatizada por sensor de frentes de onda. Os dados refracionais obtidos foram decompostos para análise vetorial. Foram analisados separadamente os dados de um olho por paciente e dos dois olhos. RESULTADOS: A diferença entre a refração clínica e a automatizada foi de -0,19 DE combinada com -0,06 DC no eixo de 15° para os dados de um olho por paciente e -0,17 DE combinada com -0,05 DC no eixo de 3° para todos os olhos da amostra. CONCLUSÃO: Os dados da refração clínica são comparáveis com os da refração obtida por um sensor de frentes de onda.

PURPOSE: To evaluate and compare refractive errors obtained through clinical subjective and automatized wavefront refraction analyses in eyes under cycloplegia. METHODS: Prospective study of 147 patients, 279 eyes, undergoing preoperative examination for refractive surgery. Clinical subjective refraction was performed first followed by wavefront refraction. Results on astigmatism obtained from refraction were decomposed in power vectors for statistical analyses. Data were first analyzed in one eye and then in both eyes. RESULTS: The mean difference between clinical subjective refraction and automatized wavefront refraction on cycloplegic eyes was of -0.19 SD combined with -0.06 CD in the 15° axis for data in one eye, and -0.17 SD combined with -0.05 CD in the 3° axis for data in both eyes of the same patient. CONCLUSION: In the present study clinical subjective refraction and automatized wavefront refraction under cycloplegia had similar numerical values.

The Difference Comparison according to Child Refractive Method and Effect of Life Style on Myopia

PURPOSE: We examined the several refractive errors and measured the axial length of child patients who visited Fatima Hospital and then assessed the distribution of refractive error and axial length. We also compared the patients' life-styles with refractive error and axial length. METHODS: We examined automated refraction, manifest refraction, 1% Cyclogyl refraction, 1% atropine refraction and axial length with an A-scan in patients between 5 and 15 years old. We asked their parents to provide information about the life-style of the patients using a questionnaire. RESULTS: The difference between manifest refraction and 1% Cyclogyl refraction was significant in patients under 9 years of age, but not significant in patients over 10 years of age. We found that the greater degree of myopia the patient had, the longer the total length and vitreous length. Patients who played outdoors for less than 2 hours per day, read more than 2 books per week and had 1 or more parent with myopia, had greater degrees of myopia. CONCLUSIONS: We found that 1% Cyclogyl refraction with manifest refraction is necessary for refraction examination in children, and the degree of myopia is closely related with an indoor life-style, the amount of reading books and the parents myopia.

Changes of Higher Order Aberrations with the Use of Various Mydriatics

PURPOSE: To evaluate the changes of higher-order aberrations of the eye with the application of various mydriatics. METHODS: Higher-order aberrations were measured in 18 eyes of 11 subjects (ages 26 to 37 years; 9 males, 2 females) without any ocular diseases except refractive errors. Repeated measurements were conducted before and after instillation of 1 drop of three different mydriatics: 10% phenylephrine, a combination of 0.5% tropicamide and 0.5% phenylephrine (Mydrin(R)-P), and 1% cyclopentolate. The data from 6 mm pupil size were calculated and analyzed. RESULTS: Average root mean square of higher-order (HO-RMS) aberrations was 0.39 in undilated eyes. The averages HO-RMS after instillation of phenylephrine, Mydrin(R)-P, and cyclopentolate was 0.40, 0.41, and 0.42, respectively. There was no statistically significant difference among the four HO-RMS conditions. The spherical aberration of undilated or phenylephrine-instilled condition was different from that of Mydrin(R)-P or cyclopentolate condition (p<0.05). CONCLUSIONS: The application of mydriatics affected the higher-order aberrations of eyes. These findings should be considered when performing wavefront-guided refractive surgery.

The Clinical Course of Esotropia Associated with Hypermetropia after Initial Wearing of Glasses

PURPOSE: To investigate clinical course of esotropia associated with hyperopia after initial wearing of the glasses. METHODS: Patients with onset earlier than 6 months of age, or with vertical strabismus greater than 3delta were excluded. The time intervals between initial wearing of the glasses and decrease of esophoria (tropia) to 8delta or less, minimun amount of hypermetropic correction to straighten the eyes and clinical course after initial prescription of hyperopic spectacles were analyzed. RESULTS: There were 21 boys and 23 girls. The average onset of esotropia was 35.4 months of age, and the timing of initial wearing of the glasses was 44.4 months. The average deviation at near without correction was 29.6 delta. Average refractive error was +4.25 diopters (D) OD and +4.16D OS, with the minimum of +1.63D OD and +1.38D OS in one patient. Among 44 patients, 22 showed esophoria (tropia) of 8 delta or less within two weeks, and five between 2 and 7 weeks. Three were corrected after wearing new glasses by repeat cycloplegic refraction with atropine (2 patients), or with cyclopentolate (1 patients). Esotropia was resolved after occlusion therapy for amblyopia in one patient. Eleven were partially accommodative esotropia. Among 33 refractive accommodative esotropia, two deteriorated to partially accommodative esotropia, one to high AC/A ratio esotropia, and one to exotropia. CONCLUSIONS: Hyperopia as small as +1.50D should be corrected. If significant esotropia remained after seven weeks of initial wearing of hyperopic glasses, it would be prudent to perform cycloplegic refraction again with atropine. Six percent of refractive accommodative esotropia decompensated to partially accommodative esotropia.

Degeneraçöes periféricas da retina em pacientes candidatos à cirurgia refrativa / Peripheral retina degeneration in patients candidates for refractive surgery

Objetivo: O objetivo desse estudo é verificar em indivíduos míopes candidatos à cirurgia refrativa a prevalência dos diferentes tipos de lesöes retinianas periféricas degenerativas de acordo com o tipo de miopia. Métodos: De forma prospectiva, no período de um ano, foram examinados os olhos dos pacientes no Setor de Cirurgia Refrativa do Departamento de Oftalmologia da Universidade Federal de Säo Paulo - Escola Paulista de Medicina que durante a sua consulta inicial apresentassem refraçäo com equivalente esférico superior ou igual a -1,00 dioptria esférica, e näo tivessem antecedentes pessoais de doença ou cirurgia ocular no período. Foi investigada a existência de lesöes e/ou degeneraçöes periféricas predisponentes ao descolamento regmatogênico de retina. Resultados : O grupo foi composto, em sua maioria, por adultos jovens (média de idade de 31 anos). Foram observados olhos com miopia baixa (263 olhos, 31 por cento ), moderada (300 olhos, 36 por cento ) e alta (277 olhos, 33 por cento ); em 35,4 por cento dos pacientes (27 por cento dos olhos) foram encontradas degeneraçöes periféricas, sendo o branco com e sem pressäo a alteraçäo mais frequente (23,4 por cento dos pacientes ou 17,5 por cento dos olhos). Entre as lesöes predisponentes ao descolamento regmatogênico da retina, a mais encontrada foi a degeneraçäo em treliça (8,6 por cento dos pacientes ou 6 por cento dos olhos). Conclusöes: As alteraçöes periféricas predisponentes ou näo ao descolamento regmatogênico de retina apresentaram aumento de prevalência de acordo com o aumento do grau de miopia, com exceçäo das roturas. Todos os pacientes com miopia alta e candidatos à cirurgia refrativa devem ter a periferia retiniana de ambos os olhos examinada.