Post-miosis changes in the anterior chamber structures in primary and lens-induced secondary chronic angle-closure glaucoma

To evaluate post-miosis changes in the anterior chamber structures in various angle-closure glaucomas(ACG). Totally 14 eyes of primary chronic angle-closure glaucoma(PCACG), 12 eyes of lens-induced secondary chronic angleclosure glaucoma(LSACG) and 14 healthy eyes were recruited. After miosis, for PCACG group, intraocular pressure(IOP) and anterior chamber depth(ACD) changed not significantly, while anterior chamber angle widened significantly. LSACG group showed a significant increase in IOP, decrease in ACD, and narrowing in anterior chamber angle. Healthy eyes showed significant decreases in IOP and anterior chamber parameters. Thus, miosis could widen the anterior chamber angle of patients with PCACG, while increase the narrowing of anterior chamber angle and IOP of patients with LSACG. We should pay attention to the distinction between PCACG and LSACG patients and the proper administration of pilocarpine in the treatment of patients with chronic ACG.

Clinical outcomes of combined versus separate carbachol and brimonidine drops in correcting presbyopia

Background:To test and compare in a masked fashion the efficacy of using a parasympathomimetic drug(3%carbachol)and an alpha-2 agonist(0.2%brimonidine)in both combined and separate forms to create optically beneficial miosis to pharmacologically improve vision in presbyopia.Methods:A prospective,double-masked,randomized,controlled clinical trial was conducted.Ten naturally emmetropic and presbyopic subjects between 42 and 58 years old with uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion.All subjects received 3%carbachol and 0.2%brimonidine in both combined and separate forms,3%carbachol alone and 0.2%brimonidine(control)alone in their non-dominant eye in a crossover manner with one week washout between tests.The subjects’pupil sizes and both near and distance visual acuities will be evaluated pre-and post-treatment at 1,2,4,and 8 h,by a masked examiner at the same room illumination.Results:Statistically significant improvement in mean near visual acuity(NVA)was achieved in all subjects who received combined 3%carbachol and 0.2% brimonidine in the same formula compared with those who received separate forms or carbachol alone or brimonidine alone(P<0.0001).Conclusion:Based on the data,the combined solution demonstrated greater efficacy than the other solutions that were tested.Improving the depth of focus by making the pupil small caused statistically significant improvement in near visual acuity,with no change in binocular distance vision.Trial registration:ACTRN12616001565437.Registered 11 November 2016.