Pilocarpine Eye Drops Research Articles

Efficacy and Safety of Pilocarpine Eye Drops Combinations for Treating Presbyopia in a Thai Population: A Randomized Crossover Trial

Objective: This study aimed to assess and compare the effectiveness and side effects of various concentrations of pilocarpine eye drops (1.5%, 1.25%, and 1%), with and without 0.1% brimonidine, in treating presbyopia, specifically in a Thai population. Materials and Methods: A prospective, randomized, double-blinded, and crossover trial was conducted at Siriraj Hospital from August 2022 to April 2023. The study included emmetropic individuals aged 40 to 60 with presbyopia (near visual acuity not exceeding J1+) and refractive errors within +/- 0.5D. The ten subjects were assigned randomly to 6 groups for the different concentrations and type of eyedrops using a computer-generated systematic randomization to receive 1.5%, 1.25%, and 1% pilocarpine with and without 0.1% brimonidine. And visual outcomes including visual acuity at distance and near were measured at 2, 4, and 6 hours post-application, with adverse effects monitored. Primary outcome was visual acuity at near after applied topical eye drops. Results: Among the 10 participants (30% male, median age 46.5 years old), 1.25% pilocarpine and combined 1.25% pilocarpine + 0.1% brimonidine significantly improved near visual acuity at all time points (statistically significant with Bonferroni correction). Adverse effects, such as dry eye and irritation, were more common with 1.5% pilocarpine + 0.1% brimonidine. Conclusion: In this preliminary study, 1.25% pilocarpine and 1.25% pilocarpine + 0.1% brimonidine showed promise in effectively treating presbyopia in the Thai study population, with acceptable side effect rates. Further research with larger sample sizes is needed to confirm these findings and provide more robust insights into presbyopia management in the Asian demographic.

Zonular ligament abnormalities intermingled in acute primary angle closure: A diagnostic and therapeutic challenge

PurposeThis study aims to investigate patient characteristics with lens zonular ligament abnormalities in Acute Primary Angle Closure (APAC), identifying related risk factors, and evaluating the efficacy of Pilocarpine, a miotic agent. DesignRetrospective case-control study. MethodsConducted as a retrospective case-control study at Hebei Provincial Eye Hospital from January 1, 2019, to December 31, 2021, the study included APAC cases undergoing ultrasound phacoemulsification with or without glaucoma surgery. Zonular ligament status was determined by intraoperative indicators such as lens equator visibility post-mydriasis and anterior capsule wrinkling during capsulorhexis. Patients were categorized into APAC and APAC with Lens Subluxation (APACLS) groups. Demographic details, Central Anterior Chamber Depth (ACD), Axial Length (AL), ACD difference between eyes (ACDD), Lens Thickness (LT), Lens Position (LP), and Relative Lens Position (RLP) were recorded and compared. Pilocarpine's impact on intraocular pressure reduction was assessed. Statistical analysis involved bilateral t-tests (for normally distributed data comparing both eyes in each group), non-parametric tests (for comparing two groups with non-normally distributed data), binary logistic regression, and Receiver Operating Characteristic (ROC) curve analysis for cutoff value determination related to zonular abnormalities. ResultsThe APAC and APACLS groups showed no significant difference in age of onset (70.11 ± 8.67 years vs. 70.11 ± 8.67 years, P = 0.159) or axial length of the eye (22.35 ± 0.64 mm vs. 22.36 ± 0.78 mm, P = 0.929). In the APACLS group, LT was greater (5.24 ± 0.37 mm vs. 5.01 ± 0.36 mm, P = 0.011), ACD was shallower (1.42 ± 0.24 mm vs. 1.69 ± 0.24 mm, P = 0.000), and ACDD was larger (0.38 ± 0.22 mm vs. 0.18 ± 0.18 mm, P = 0.000). The LP was lower (4.04 ± 0.32 vs. 4.20 ± 0.22, P = 0.013), and RLP was also lower (0.18 ± 0.02 vs. 0.19 ± 0.01, P = 0.015) in the APACLS group. A shallow ACD and a large ACDD were identified as risk factors associated with lens zonular abnormalities in the affected eyes (ACD OR value 63.97, P = 0.027; ACDD OR value 0.029, P = 0.027). Using ROC curve analysis, the cutoff value for ACDD was determined to be 0.375 mm, and for ACD, it was 1.6 mm. After pupil constriction with Pilocarpine eye drops, the proportion of patients whose intraocular pressure normalized was 75.36 % (52/69) in the APAC group and 71.43 % (25/35) in the APACLS group. ConclusionACD and ACDD in the affected eye are indicative of increased risk for APACLS. An ACD <1.6 mm and ACDD >0.375 mm should prompt consideration of zonular ligament abnormalities. Pilocarpine as a miotic treatment is safe and effective for such patients.

Correction of presbyopia using 0.5% pilocarpine eye drops among Indians.

Pharmacological treatment of presbyopia-spectacle free senescence Therefore, it is of interest to estimate improvement of near vision with 0.5%pilocarpine drops in presbyopic patients. It was a cross-sectional observational study done at tertiary care centre history, comprehensive eye examination, including distant visual acuity distant and near vision, IOP. 1 drop of 0.5%Pilocarpine eye-drops was instilled in both eyes in Patients with full distant vision and impaired near vision, near vision was checked after 2hours. Among 55 participants, 48% were males and 52% were females. Mean age of patients was 44.8 years. Out of 55 patients 58% patients showed improvement of 1 line after instilling drops, 41% patients showed no improvement. Topical 0.5%pilocarpine in treatment of near vision is attractive option for patients and would increase compliance with minimal side effects.

Effects of Miosis on the Visual Acuity Space under Varying Conditions of Contrast and Ambient Luminance in Presbyopia.

Background: Presbyopia is an age-related ocular condition, typically affecting individuals aged over 40 years, characterized by a gradual and irreversible decline in the eye's ability to focus on nearby objects. Correction methods for presbyopia encompass the use of corrective lenses, surgical interventions (corneal or lens based), and, more recently, the FDA-approved topical administration of 1.25% pilocarpine. While prior research has demonstrated the efficacy of daily pilocarpine eye drop application in enhancing near visual acuity by increasing the depth of focus leveraging the pinhole effect, limited knowledge exists regarding its influence on visual acuity under varying conditions of contrast and ambient luminance. Methods: This study aims to investigate the impact of these variables on visual acuity, employing the VA-CAL test, among 11 emmetropic and 11 presbyopic volunteers who reported subjective difficulties with near vision. This study includes evaluations under natural conditions with a pinhole occluder (diameter of 2 mm), and subsequent administration of 1% pilocarpine (Pilomann, Bausch + Lomb, Laval, Canada). Results: The VA-CAL results demonstrate the expected, statistically significant effects of contrast and ambient luminance on visual acuity in both emmetropic and presbyopic volunteers. Furthermore, in emmetropic individuals, the application of pilocarpine resulted in a statistically significant reduction in visual acuity. In contrast, presbyopes did not exhibit statistically significant differences in the visual acuity space under either the pinhole or pilocarpine conditions when compared to natural conditions. Conclusions: The pharmacological treatment of presbyopia with pilocarpine eye drops, intended to enhance near vision, does not adversely affect visual acuity in presbyopes. This suggests that pilocarpine may offer a viable alternative for individuals averse to wearing corrective eyewear.

The Role of Pilocarpine Eye Drops in the Management of Presbyopia: A Systematic Review

Introduction: Presbyopia is characterized by progressive loss of accommodation resulting in loss of visual acuity and is known to affect quality of life. Mainstay treatment include reading spectacles, contact lenses, and a series of surgical techniques. Until recently, pharmacologic treatment have been available. In this paper, we aim to review the role of pilocarpine eye drops in managing presbyopia. Methods: A comprehensive literature search was performed using Medline, EMBASE, and grey literature databases for articles from inception until 06 June 2024. Search terms included “presbyopia”, “presbyopia correction/treatment”, “pilocarpine”, and “pharmacological presbyopia treatment”. All relevant articles examining the efficacy and side effects of pilocarpine formulations and written in the English language were included in the review. Results: The initial search yielded 587 publications, of which 19 met our inclusion criteria and were included in analysis. Pilocarpine, a parasympathomimetic drug, increases the power of accommodation by increasing the lens thickness via the muscarinic receptors on the iris and ciliary muscles. Clinical trials utilizing pilocarpine eye drops in the management of presbyopia have reported positive outcomes in terms of near visual acuity. Pilocarpine HCL ophthalmic 1.25% formulation; Vuity™ and 0.4% formulation, Qlosi™ are currently the only approved pharmacologic treatment options shown to be effective in managing presbyopia. Conclusion: Overall, pilocarpine eye drops appear to be an effective option in improving near visual acuity in presbyopia patients. Long term follow-up data on the use of pilocarpine-based eye drops is not available. With the increase in the number of users overtime, the long-term effects of its prolonged use may be determined. Further research is needed to optimize the concentrations and combinations of pilocarpine and other substances to maximize efficacy and minimize adverse effects.

Vogt-Koyanagi-Harada disease and bilateral simultaneous Adie’s pupil

Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon autoimmune inflammatory malady commonly accompanied by neurological, auditory, and integumentary signs. We report a case of a teenage girl who complained of persistently decreased vision for the last 15 days. There was no systemic association. After 2 weeks, the patient developed tonic pupils. The pupil showed a tonic response to a 0.125% pilocarpine eye drop. Upon examinations, the patient was diagnosed with Vogt-Koyanagi-Harada disease and bilateral Adie’s pupil, which is a rare conditions associated with VKH disease. Early treatment is crucial for preserving vision.

Effects of Schlemm's Canal Suture Implantation Surgery and Pilocarpine Eye Drops on Trabecular Meshwork Pulsatile Motion.

The trabecular meshwork is an important structure in the outflow pathway of aqueous humor, and its movement ability directly affects the resistance of aqueous humor outflow, thereby affecting the steady state of intraocular pressure (IOP). (1) Objective: The purpose of this study was to preliminarily estimate the effects of pilocarpine eye drops and trabeculotomy tunneling trabeculoplasty (3T) on trabecular meshwork (TM) pulsatile motion via phase-sensitive optical coherence tomography (Phs-OCT). (2) Method: In a prospective single-arm study, we mainly recruited patients with primary open-angle glaucoma who did not have a history of glaucoma surgery, and mainly excluded angle closure glaucoma and other diseases that may cause visual field damage. The maximum velocity (MV) and cumulative displacement (CDisp) of the TM were quantified via Phs-OCT. All subjects underwent Phs-OCT examinations before and after the use of pilocarpine eye drops. Then, all subjects received 3T surgery and examinations of IOP at baseline, 1 day, 1 week, 1 month, 3 months, and 6 months post-surgery. Phaco-OCT examinations were performed at 3 and 6 months post-surgery, and the measurements were compared and analyzed. (3) Results: The MV of TM before and after the use of pilocarpine eye drops was 21.32 ± 2.63 μm/s and 17.00 ± 2.43 μm/s. The CDisp of TM before and after the use of pilocarpine eye drops was 0.204 ± 0.034 μm and 0.184 ± 0.035 μm. After the use of pilocarpine eye drops, both the MV and CDisp significantly decreased compared to those before use (p < 0.001 and 0.013, respectively). The IOP decreased from baseline at 22.16 ± 5.23 mmHg to 15.85 ± 3.71 mmHg after 3 months post-surgery and from 16.33 ± 2.51 mmHg at 6 months post-surgery, showing statistically significant differences (p < 0.001). The use of glaucoma medication decreased from baseline at 3.63 ± 0.65 to 1.17 ± 1.75 at 3 months and 1.00 ± 1.51 at 6 months post-surgery; the differences were statistically significant (p < 0.001). Additionally, there was no statistically significant difference in the MV between 3 and 6 months after surgery compared to baseline (p = 0.404 and 0.139, respectively). Further, there was no statistically significant difference in the CDisp between 3 and 6 months after surgery compared to baseline (p = 0.560 and 0.576, respectively) (4) Conclusions: After the preliminary study, we found that pilocarpine eye drops can attenuate TM pulsatile motion, and that 3T surgery may reduce IOP without affecting the pulsatile motion status of the TM.

Role of Pilocarpine in Postmortem Interval Estimation

Background: Estimation of time interval since death is an important aspect of forensic medicine, it is used as an evidence in both civil and criminal cases. There are multiple techniques used worldwide but reaction of pupil to chemical agents is currently the topic of interest. Studies on the role of pilocarpine in estimating the post-mortem interval (PMI) are very limited worldwide so the current study aimed to estimate the time interval since death using pilocarpine eye drops. Methods: An experimental Cross-sectional study was conducted at the department of forensic medicine and toxicology of a tertiary care hospital of Karachi (Autopsy Lab). The diameter of the pupil of each eye was measured using a Vernier caliper. After that 2% pilocarpine eye drops were administered to both eyes. About 10 to 15 minutes was allowed for pupillary reaction. The pupillary diameter was measured again after 25 minutes. The data was analyzed using Statistical Package for Social Science (SPSS) for Windows Version 22. p-value ≤ 0.05 was considered as significant. Results: The mean age of the study participants was 61 ± 13.4 years and reported significant association with the postmortem interval. The mean postmortem interval was 5 hours 42 minutes ± 3 hours 19 minutes. It has been noted that the longest duration of pupillary reaction was 16 hours 2 minutes. There was a strong correlation of postmortem interval with the change in pupillary diameter after pilocarpine drops. Soon after death, in initial 2 hours the change in pupillary diameter after pilocarpine was 98.8% while the percentage of pupillary reaction decreases as long as the time since death. After 16 hours of death there was no change in pupillary diameter after administering pilocarpine drops. Conclusion: It can be concluded that pupillary reaction after pilocarpine eye drops is significantly associated with time interval since death as 98.8% response was recorded in first two hours after death. The longest postmortem interval up to which the pupil can response to eye drop is 16 hours. Keywords: Pilocarpine, Postmortem interval, Pupillary reaction

Influence of Pilocarpine Eyedrops on the Ocular Biometric Parameters and Intraocular Lens Power Calculation.

To evaluate the influence of pilocarpine eyedrops on the ocular biometric parameters and whether these parameter changes affect the intraocular lens (IOL) power calculation in patients with primary angle-closure glaucoma (PACG). Twenty-two PACG patients and fifteen normal subjects were enrolled. Ocular biometric parameters including the axial length (AL), anterior chamber depth (ACD), lens thickness (LT), mean keratometry (Km), and white-to-white distance (WTW) were measured by using a Lenstar LS 900 device before and at least 30 minutes after instillation of 2% pilocarpine eyedrops. Lens position (LP) was calculated, and the IOL power prediction based on the ocular biometric parameters was performed using the Barrett Universal II, Haigis, Hoffer Q, Holladay I, or SRK/T formulas before and after pilocarpine application. In both PACG and normal groups, pilocarpine eyedrops induced a slight but statistically significant increase in the mean AL (0.01 mm for both groups) and mean LT (0.02 mm and 0.03 mm, respectively) but a significant decrease in the mean ACD (0.03 mm and 0.05 mm, respectively) and mean LP (0.02 mm and 0.04 mm, respectively). No significant changes in the mean Km and WTW were noticed in both groups. In addition, the IOL power calculation revealed insignificant changes before and after the pilocarpine instillation in both groups, regardless of the formula used. Pilocarpine eyedrops can induce slight changes in the ocular biometric parameters including the AL, ACD, LT, and LP. However, these parameter changes will not result in a significant difference in IOL power estimation.

Benign food-borne type B botulism presenting as unilateral internal ophthalmoplegia: a case report

BackgroundFood-borne botulism is a rare neuromuscular junction disorder due to the effect of toxins released from Clostridium botulinum ingested by eating improperly stored food. Its classic manifestation is a rapidly evolving descending symmetrical flaccid paralysis with dysautonomia.Case presentationWe have described a case of type B food-borne botulism with a benign clinical course characterized by an initially unilateral tonic mydriatic pupil. An extensive neurophysiological evaluation inclusive of pilocarpine eye drop(s) test, facial and limbs nerve stimulation and sudomotor tests, was decisively leading the diagnostic process.ConclusionsThe importance of what has been described here lies in underlining that it is always advisable to consider food-borne botulinum intoxication, even in the case of unilateral/asymmetrical internal ophthalmoplegia without generalized progressive involvement of the voluntary muscles.

High-Frequency Deep Sclerotomy as Adjunctive Therapy in Open-Angle Glaucoma Patients

Introduction: Glaucoma is a chronic, progressive disease of the optic nerve that can cause vision loss and blindness. High-frequency deep sclerotomy (HFDS) is a novel ab interno procedure used to lower intraocular pressure (IOP). This study aims at examining hypotensive effects of HFDS in patients with medically uncontrolled primary open-angle glaucoma (POAG). Methods: 23 patients (23 eyes) participated in this study. They were all affected by POAG and used maximum prescribed medical therapy. It is important to note that the target IOP was not detected in any study participant. The target IOP is the highest IOP value at which no new damages of the optic nerve occur. The procedure was performed with a custom-made, high-frequency dissection probe by applying bipolar current of 500 kHz. Six pockets (1 mm deep, 0.3 mm high, and 6 mm wide) were made ab interno in nasal sclera (through trabecular meshwork and Schlemm’s canal). Tobramycin/dexamethasone and pilocarpine eye drops were administered postoperatively for a month. Results: The mean value of the base IOP had been 25.6 mm Hg before the procedure. Significant complications were not recorded either during the surgery or in a postoperative follow-up period. The average IOP for our patients reduced by 8.6 mm Hg (33.6%) after a year. The mean value of the instilled anti-glaucoma eye drops had been 2.78 (SD = 0.45) before the HFDS and 0.61 (SD = 1.04) at the end of the research. The target IOP was not achieved in five cases (21.7% of our sample). Discussion/Conclusion: This study presents the data on our first surgical experience with HFDS that was conducted on 23 patients who had medically uncontrolled POAG. The results indicate that HFDS is safe and efficient in reducing IOP.

Efficacy of 2% Pilocarpine on Intraocular Pressure (IOP) Lowering Effect in Uncontrolled Primary Open Angle Glaucoma (POAG) Patients with Maximal Medication

Objective: To evaluate the additive intraocular pressure (IOP) lowering effect of 2% pilocarpine eye drops in medically uncontrollable primary open angle glaucoma (POAG) patients. Materials and Methods: The present study was a retrospective study on POAG patients whose IOP were unable to be controlled with topical hypotensive agents who refused glaucoma surgery. Pilocarpine eye drops (2%) was considered as an additive treatment option. The main measurement was IOP at baseline and after adding pilocarpine eye drops (2%) at 1-, 3- and 6-months. Statistical analysis was described in terms of mean ± standard deviation (SD). Comparisons of numerical variables were done using paired t-test. A p-values of less than 0.05 was considered statistically significant. Results: Thirty-one eyes in 19 patients with open angle glaucoma were enrolled. The mean age of the patients was 62 years. Thirteen patients were male. The mean number of baseline medications was 4.0±0.3. IOP was reduced from 25.0±2.1 mmHg at baseline to 19.0±1.98 mmHg after one month, to 19.0±1.86 mmHg after three months, and to 19.0±1.73 mmHg after six months, which was statistically significant (p&lt;0.001). Conclusion: Pilocarpine eye drops (2%), when used additional with others topical hypotensive agents, was effective for IOP lowering. Patients in the present study reported reduced IOP. The efficacy of pilocarpine eye drops (2%) made it a viable treatment option, particularly for the uncontrollable open angle glaucoma patient who refused glaucoma surgery. Keywords: Pilocarpine eye drops (2%); Intraocular pressure (IOP); Medically uncontrollable; POAG

Comparison study between Pilocarpine and Tropicamide drops on corneal topography and their effect on IL-6 and TNF-α levels in tear

Corneal stability is essential for contact lenses and refractive surgery. It seems that paralyzing eye drops or expansion of the ciliary muscle affect the radius of curvature and the strength of the cornea, and this effect is to increase the strength of the cornea during muscle spasm and decrease it in the relaxed state of the muscle. On the other hand, different factors (such as contact lens wear, ocular surface disorders, trauma, dry eye, and immunosuppression) could alter the immune defense mechanisms of the outer eye and permit microorganisms to invade the cornea. Therefore, the present study compared Pilocarpine and tropicamide drop on corneal topography and their effect on IL-6 and TNF-α levels in tear. This prospective study was performed on sixty normal and healthy eyes of sixty volunteers with a mean age of 38.19 years and without any ocular pathology. Volunteers were divided into two groups of thirty. In the first group, corneal topography of both eyes was measured before and 30 minutes after instillation of topical tropicamide 1% in only one eye. The other eye was the control eye, and no drop was given. The same routine was performed in the second group, except that subject received one drop of Pilocarpine 2% in one eye. Statistical comparison between groups for the central corneal power, corneal radius, and corneal astigmatism was performed using paired t-test. IL-6 and TNF-α levels in tear were analyzed using two Luminex commercial assays with Bio-Plex 200TM System (Bio-Rad, Hercules, California, USA). In group 1, no significant changes were found in corneal radius, power, and astigmatism. However, in group 2 subjects who received pilocarpine eye drops, the mean corneal radius value decreased significantly by 0.05 mm. The mean corneal power increased by +0.32 D. There was no significant difference change in corneal astigmatism in both groups. Evaluation of IL-6 levels in tears showed a significant difference between the control and treatment groups (P = 0.041). But no significant difference was observed between the Pilocarpine and the Tropicamide groups (P = 0.761). Evaluation of TNF-α level in tears also showed no significant difference between these groups (P = 0.088). Pilocarpine induced ciliary muscle contraction, which may cause pressure on the corneal limbus and scleral spur, resulting in changes in corneal curvature. But tropicamide eye drop did not affect corneal radius and other corneal parameters, and corneal topography can be carried out after the installation of tropicamide eye drop.

Persistent Pupillary Dilatation After Cycloplegic Refraction in Child Taking Systemic Benzatropine

Cyclopentolate is a substance that has a mydriatic and cycloplegic effect and is used frequently by ophthalmologists before pediatric glasses prescription. In this case, a child came to the clinic for glasses prescription, but later her pupil didn’t return to normal size even after using the antidote (Pilocarpine eye drop 2%). Accidentally, we found that she is on systemic medication containing Benztropine which has a mydriatic effect. After the stoppage of the systemic Benztropine, the pupils return to their normal size after two weeks. That case gives an important rationale to check the medications taken by the patient before giving cycloplegic drugs, which could help in the diagnosis and treatment of mysterious situations. Keywords Benzatropine; Cyclopentolate; Eye Medication; Ophthalmology

Pilocarpine eye drop: As an indicator of post mortem interval

Post mortem interval (PMI) determination is a particularly crucial detail often needed in medico-legal cases. Though, today, several methods of estimating PMI exist, most of these methods lack practical relevance, which brings about a need to find new, cost-efficient, and more reliable methods. One such temperature independent method is the evaluation of post-mortem pupillary reactivity to various pharmacological substances. The objective of the present work is to test and provide evidence of the effectiveness of pupillary reactivity to pilocarpine eye drop as an indicator to determine PMI. A total of 133 deceased with known PMI were instilled with 2% pilocarpine eye drops and measure change in pupil diameter using ImageJ freeware. A negative correlation between the changes of pupil diameter under the influence of the pilocarpine eye drop showed less change with increase PMI. Pearson correlation showed the negative correlation between the pupillary changes with PMI with p value 0.0001, 0.00017, 0.0341 and 0.0021 where á=0.05 for natural death, hanging, burn and poisoning respectively. Observations showed postmortem chemical excitability could be used as an indicator in PMI using pilocarpine eye drop.

Determining pupillary reaction time using pilocarpine eye drop – A post mortem study

Post-mortem miotic changes in the pupil using pharmacological solutions have been a topic of discussion among researchers as well as medico-legal experts to determine time since death. For many decades, researchers used different methods such as eye drop method and injection method to observe pupillary changes as convenience to make this study useful in the autopsy room. However, different researchers also used the different onset of reaction time to observe pupillary miotic changes without testing its effectiveness. The objective of the present study is to determine the reaction time for effective post mortem miotic changes in pupil using pilocarpine eye drops. Total 200 deceased with known time of death were instilled with the 2% pilocarpine eye drop into conjuctival sac and changes were analysed using ImageJ freeware every 10 minutes up to 50 minutes. In this study, author observed no statistically significant difference in reactivity of both the eyes in different time interval in different sex (p= 0.097). However, significant difference found in reactivity of both the eyes in different time interval in different age group (p= 0.0006) and cause of death (p = 0.015) at α < 0.05 using t-test and one way ANOVA test. Author concluded that left eye reacts faster than right eye and a significant number of pupillary miotic changes are observed up to 30 minutes. Therefore, minimum 30 minutes are effective time period to observe post mortem pupillary miotic changes for pilocarpine eye drop which could be useful to determine time since death. This is the first study of its kind on an Indian population.

Adie's Pupil after Chickenpox Infection

A 2-year-old girl with recent chickenpox infection was noted to have a fixed and dilated right pupil. Diluted 0.1% pilocarpine eyedrop test was successful in constructing the dilated right pupil. Cranial nerve examination and computer tomography brain scan were otherwise normal. We report this case as internal ophthalmoplegia, or post-viral Adie's pupil, which appears to be extremely rare.

A multicentric study of pharmacological treatment for presbyopia.

To evaluate the safety, efficacy, and patient satisfaction with a pharmacological treatment of presbyopia performed with the Benozzi's method. A non-randomized multicentric case-series retrospective study was developed. Were included patients from 5 centers of Argentina, from January 2010 to June 2019, aged at baseline between 40 and 60 years old, with binocular uncorrected distance visual acuity (UDVA) of 25/20 or better, and with uncorrected near visual acuity (UNVA) at least Jaeger (J) 2 or worse. The treatment was performed with a patented formulation (pilocarpine and diclofenac preservative-free eye drops). The main outcome was binocular UNVA and UDVA. Differences were evaluated by paired t-test. The presence of side effects and patient's satisfaction were also evaluated. Data was analyzed in separated groups according to their follow-up time, from 2 to 10 years. A total of 148 patients were included. At baseline, the UNVA for the different groups were between J3 and J8 which was improved to J1 to J2. The mean baseline UDVA has been ranged between 0.02 and 0.04 logMAR. The mean baseline UDVA has been ranged between 0.02 to 0.04 logMAR, after treatment were between 0.01 to 0.03, without a statisticallysignificant improvement. Side effects were spontaneously resolved, and subjective evaluation shows that patients were satisfied. This first multicentric shows that Benozzi's method for presbyopia treatment was safety and improves the UNVA without affecting the UDVA, maintaining their efficacy even after 10 years, in a population aged between 40 and 60 years old, from different ophthalmic centers in Argentina.

The effects of pharmacological accommodation and cycloplegia on axial length and choroidal thickness.

To investigate the effects of pharmacological accommodation and cycloplegia on ocular measurements. Thirty-three healthy subjects [mean (±SD) age, 32.97 (±5.21) years] volunteered to participate in the study. Measurement of the axial length, macular and choroidal thickness, refractive error, and corneal topography, as well as anterior segment imaging, were performed. After these procedures, pharmacological accommodation was induced by applying pilocarpine eye drops (pilocarpine hydrochloride 2%), and the measurements were repeated. The measurements were repeated again after full cycloplegia was induced using cyclopentolate eye drops (cyclopentolate hydrochloride 1%). The correlations between the measurements were evaluated. A significant increase in subfoveal choroidal thickness after applying 2% pilocarpine was identified (without the drops, 319.36 ± 90.08 µm; with pilocarpine instillation, 341.60 ± 99.19 µm; with cyclopentolate instillation, 318.36 ± 103.0 µm; p<0.001). A significant increase in the axial length was also detected (without the drops, 23.26 ± 0.83 mm; with pilocarpine instillation, 23.29 ± 0.84 mm; with cyclopentolate instillation, 23.27 ± 0.84 mm; p=0.003). Comparing pharmacological accommodation and cycloplegia revealed a significant difference in central macular thickness (with pilocarpine instillation, 262.27 ± 19.34 µm; with cyclopentolate instillation, 265.93 ± 17.91 µm; p=0.016). Pilocarpine-related miosis (p<0.001) and myopic shift (p<0.001) were more severe in blue eyes vs. brown eyes. Pharmacological accommodation may change ocular measurements, such as choroidal thickness and axial length. This condition should be considered when performing ocular measurements, such as intraocular lens power calculations.

Presbyopia Treatment With Eye Drops: An Eight Year Retrospective Study.

PurposeThe purpose of this study was to evaluate the safety and efficacy across time, of patients topically treated with Benozzi's method for presbyopia.MethodsA nonrandomized case series retrospective study was developed, including patients with emmetropia with binocular uncorrected distance visual acuity (UDVA) of 25/20 or better, and with uncorrected near visual acuity (UNVA) at least Jaeger 2 or worse. The study was set in Buenos Aires, Argentina, from January 2011 to June 2018, with at least 1-year follow-up. Patients were treated with pilocarpine and diclofenac preservative-free eye drops (Benozzi Method; US 8.524.758 B2, EP1.938.839 B1), and the main outcome measured was binocular UNVA at different follow-up times. Other parameters, as the UDVA and presence of side effects, were evaluated.ResultsA total of 910 patients were included with a mean age at baseline of 48.67 ± 3.72 years old (range, 40–59 years). The baseline UNVA was 4.74 ± 1.53 and at 8 years of follow-up was decreased to 1.36 ± 0.48 (Jaeger scale). The mean binocular UDVA at baseline was 0.00 ± 0.01 logarithm of the minimum angle of resolution (logMAR) and after 8 years of follow-up was 0.03 ± 0.04 logMAR. All side effects reported (decrease of light perception, headaches, symptoms of ocular surface dryness, and dizziness) were spontaneously resolved in patients who continued with the treatment.ConclusionsThe efficacy of the pharmacological treatment of presbyopia to improve the UNVA without affecting the UDVA is shown. Side effects were well tolerated and resolved before 1 year of treatment.Translational RelevanceThis is a nonsurgical option for patients with emmetropic presbyopia who do not wish to wear glasses, which is a pharmacological treatment with eye drops.