von Dr. med. Ron Lehnert » 11.08.2007, 15:52
Hallo roadrunner,
Du hast Recht - bei erweiterten Pupillen (Mydriasis) kann es Probleme mit dem Eyetracker geben. Deshalb sollte nur bei "normaler" Pupillengrösse der Laserabtrag stattfinden.
Ich habe mal recherchiert und festgestellt, dass es effektive Gegenmittel gibt, welche die Mydriasis aufheben können. Mit Dapiprazol kann man die Pupillen innerhalb einer Stunde (44.3 +/- 26.3 min) wieder "normalisieren". Es sollte also bei geeignetem Gegenmittel nichts dagegen sprechen am OP-Tag die Pupillen weitzutropfen.
1: Ophthalmologe. 1999 Mar;96(3):182-6.
[Clinical use of mydriasis with 10% phenylephrine and its antagonism by 0.5%
dapiprazole]
[Article in German]
Schimidbauer JM, Höh H, Franke G, Petsch E, Siegmund W.
Augenklinik, Klinikum Neubrandenburg.
BACKGROUND: Dapiprazole hydrochloride is an alpha-1-adrenergic inhibitor that
anticipates the mydriatic effect of phenylephrine in dilator muscle receptors in
a competitive way. The aim of this study was to determine for which indications
for mydriasis pupil dilation by phenylephrine alone is sufficient and if the
reversal by dapiprazole is convenient and the practical. MATERIAL AND METHOD: In
286 eyes of 147 outpatients, the pupil was dilated for fluorescein
angiography-FLA (100 eyes of 50 patients), examination of the fundus-Fd (99 eyes
of 52 patients), central argon laser coagulation-cALC) (64 eyes of 32 patients),
peripheral argon laser coagulation-pALC (16 eyes of 9 patients) and Nd:YAG
capsulotomy (7 eyes of 4 patients) with phenylephrine 10% eyes drops, followed by
reversal by dapiprazole 0.5%. The width and mobility of the pupil were tested at
intervals of 10 min. When mydriasis by phenylephrine was insufficient,
tropicamide was applied additionally. RESULTS: In 98% of FLA with scanning laser
ophthalmoscope, 75% of cALC, 76% of Fd, 62% FLA with fundus camera and 38% of
pALC, mydriasis could be reached that was sufficient for the indication.
Diabetics showed significantly more sluggish pupil mobility (t1/2: P < 0.05
mydriasis, P < 0.005 reversal). The mean duration after using dapiprazole until
reaching the starting value (+/- 1 mm) of the pupil was 44.3 +/- 26.3 min. In 86%
of the examined eyes, the pupil reached its starting value within 1 h. The
subjective degree of satisfaction with the application of dapiprazole was
"satisfied" to "very satisfied" (5.4 +/- 1.4 points on a scale from 1 to 7
points). DISCUSSION AND CONCLUSION: In fundus examination, fluorescein
angiography by a laser scanner, diagnostic retinal examination and central laser
coagulation, the combination phenylephrine/dapiprazole was most suitable. In our
opinion, the combination is less suitable for peripheral argon laser coagulation
and fluorescein angiography using a fundus camera.
PMID: 10234966 [PubMed - indexed for MEDLINE]
Hallo roadrunner,
Du hast Recht - bei erweiterten Pupillen (Mydriasis) kann es Probleme mit dem Eyetracker geben. Deshalb sollte nur bei "normaler" Pupillengrösse der Laserabtrag stattfinden.
Ich habe mal recherchiert und festgestellt, dass es effektive Gegenmittel gibt, welche die Mydriasis aufheben können. Mit Dapiprazol kann man die Pupillen innerhalb einer Stunde (44.3 +/- 26.3 min) wieder "normalisieren". Es sollte also bei geeignetem Gegenmittel nichts dagegen sprechen am OP-Tag die Pupillen weitzutropfen.
1: Ophthalmologe. 1999 Mar;96(3):182-6.
[Clinical use of mydriasis with 10% phenylephrine and its antagonism by 0.5%
dapiprazole]
[Article in German]
Schimidbauer JM, Höh H, Franke G, Petsch E, Siegmund W.
Augenklinik, Klinikum Neubrandenburg.
BACKGROUND: Dapiprazole hydrochloride is an alpha-1-adrenergic inhibitor that
anticipates the mydriatic effect of phenylephrine in dilator muscle receptors in
a competitive way. The aim of this study was to determine for which indications
for mydriasis pupil dilation by phenylephrine alone is sufficient and if the
reversal by dapiprazole is convenient and the practical. MATERIAL AND METHOD: In
286 eyes of 147 outpatients, the pupil was dilated for fluorescein
angiography-FLA (100 eyes of 50 patients), examination of the fundus-Fd (99 eyes
of 52 patients), central argon laser coagulation-cALC) (64 eyes of 32 patients),
peripheral argon laser coagulation-pALC (16 eyes of 9 patients) and Nd:YAG
capsulotomy (7 eyes of 4 patients) with phenylephrine 10% eyes drops, followed by
reversal by dapiprazole 0.5%. The width and mobility of the pupil were tested at
intervals of 10 min. When mydriasis by phenylephrine was insufficient,
tropicamide was applied additionally. RESULTS: In 98% of FLA with scanning laser
ophthalmoscope, 75% of cALC, 76% of Fd, 62% FLA with fundus camera and 38% of
pALC, mydriasis could be reached that was sufficient for the indication.
Diabetics showed significantly more sluggish pupil mobility (t1/2: P < 0.05
mydriasis, P < 0.005 reversal). The mean duration after using dapiprazole until
reaching the starting value (+/- 1 mm) of the pupil was 44.3 +/- 26.3 min. In 86%
of the examined eyes, the pupil reached its starting value within 1 h. The
subjective degree of satisfaction with the application of dapiprazole was
"satisfied" to "very satisfied" (5.4 +/- 1.4 points on a scale from 1 to 7
points). DISCUSSION AND CONCLUSION: In fundus examination, fluorescein
angiography by a laser scanner, diagnostic retinal examination and central laser
coagulation, the combination phenylephrine/dapiprazole was most suitable. In our
opinion, the combination is less suitable for peripheral argon laser coagulation
and fluorescein angiography using a fundus camera.
PMID: 10234966 [PubMed - indexed for MEDLINE]
