Величина объективного аккомодационного ответа (полнота циклоплегии) после диагностических инстилляций различных препаратов

Abstract

Today, a variety of medications are used in ophthalmology practice to o produce cycloplegia and mydriasis. Purpose: to compare the extent of cycloplegia by residual accommodation response after instillations of various medications. Materials and methods. 54 patients, aged 8 to 23, with varied degrees of myopia were instilled twice, with an interval of 10 minutes, with one of the following medications: Cyclopentolate 1 %, Tropicamide 1 %, Midrimax, and Phenylephrine 2.5 %. The patients were examined before the first instillation and 40 minutes after it using autorefractometry and measurement of objective monocular accommodation response (MAO) with a Grand Seiko Binocular Open Field Autorefkeratometer WR-5100K. The value of MOA, i.e. residual accommodation, was used to assess the completeness of cycloplegia. Results. The difference between manifest and cycloplegic refraction was -0.13 D after Cyclopentolate, -0.2 D after Tropicamide, -0.11 D after Midrimax, and -0.02 D after Phenylephrine. No intergroup differences in this parameter were noted (р > 0.05). MAO fell after Tropicamide and Midrimax but remained sufficiently high: -0.83 D and -0.71 D, respectively. Phenylephrine had no paralyzing action on the ciliary muscle; it even strengthened slightly (by 0.12 D) the objective accommodation response. The only medication to provide true cycloplegia was Cyclopentolate 1%: upon presentation of an accommodation task of 3.0 D, МАО was found to be only -0.1 D. The difference in MAO after Cyclopentolate 1% and all other medications is statistically significant, р < 0.05. Conclusion. For a dynamic observation of patients with no suspicion of elevated tone of the ciliary muscle, Cyclopentolate, Tropicamide and Midrimax are equally effective. In cases of primary examination or if a habitually excessive accommodation strain or accommodation spasm is observed, Cyclopentolate or Atropine must be used. Phenylephrine 2.5 % is a curative medication which normalizes the tone of the ciliary muscle and heightens the accommodation response. It is not advisable to use it for diagnostic purposes as mydriasis is weak and cyloplegia is absent. For citation: Tarasova N.A., Tarutta E.P., Markosian G.A., Maksimova M.V. Objective accommodation response value (completeness of cycloplegia) after diagnostic instillations of diverse medications. Russian ophthalmological journal. 2018; 11 (2): 22-6. doi: 10.21516/2072-0076-2018-11-2-22-26 (In Russian).