Comparison of the Miotic Effects of Dapiprazole and Dilute Pilocarpine in Patients with the Pigment Dispersion Syndrome

Abstract

Pharmacologically induced miosis can inhibit exercise-induced anterior chamber pigment dispersion in patients with the pigment dispersion syndrome. Long-term inhibition of pigment dispersion in these patients could delay or prevent the development of glaucoma. Unfortunately, most commercially available miotic medications are poorly tolerated by these patients due to their visual side effects. This study evaluates the miotic effects of two medications that cause minimal visual side effects in patients with the pigment dispersion syndrome. Pupil diameter in darkness and amplitude of pupil constriction to light were measured before and 1 h after instillation of two drops of 0. 5 dapiprazole in one eye and two drops of 1/6 pilocarpine in the fellow eye of 10 patients with the pigment dispersion syndrome. Gonioscopic photography of iris contour before and after medications was performed in two patients who had significant posterior iris bowing on baseline examination. Pupil diameter in darkness and amplitude of pupil constriction to light were significantly smaller in eyes treated with 1/6 pilocarpine. Posterior iris bowing was markedly reduced by 1/6 pilocarpine but not by 0. 5 dapiprazole in the two patients with posterior iris bowing. Cholinergic agonists appear to be superior to alpha-adrenergic antagonists as candidate drugs for inhibiting pigment dispersion in patients with the pigment dispersion syndrome.