Reduction of Phenylephrine Drop Size in Infants Achieves Equal Dilation With Decreased Systemic Absorption

Lynch, Mary G.; Brown, Reay H.; Goode, Stephen M.; Schoenwald, Ronald D.; Chien, Du-Shien

doi:10.1001/archopht.1987.01060100066027

Cited by 35 publications

(11 citation statements)

References 16 publications

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“…One group experimented with a microspray device based on a respiratory nebulizer but apparently discontinued those efforts without publishing any follow-on data regarding device reliability, dosing repeatability, or manufacturing costs [15]. In neonates, an 8-μl droplet of PE-2.5% produced the same dilation as a 30-μl drop administered to the contralateral eye [16]. In adults, equivalent pupil dilation occurred with 10-μl versus 30-μl topical doses of PE-2.5% [17].…”

Section: Discussionmentioning

confidence: 40%

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High-precision piezo-ejection Ocular microdosing: Phase II Study on Local and Systemic Effects of Topical Phenylephrine

Ianchulev

Weinreb²,

Tsai

et al. 2017

Ther. Deliv.

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Aim: Conventional eyedropper-delivered volumes (25-50 μl) exceed the eye's usual tear-film volume (7 μl) and precorneal reservoir capacity, risking overflow and ocular/systemic complications. Piezoelectric high-precision microdosing may circumvent these limitations. Results & methodology: In this masked, nonrandomized, cross-over study, subjects (n = 12) underwent pupil dilation with topical phenylephrine (PE) administered by 32-μl eyedropper (2.5% or 10% formulation) and 8-μl electronic microdosing (10% formulation). Microdosing with PE-10% achieved comparable peak dilation as 10% eyedropper-delivery and superior dilation to 2.5% eyedropper-delivery (p = 0.009) at 75 min. Microdosing significantly reduced 20-min plasma PE levels versus PE10% eyedropper; neither treatment altered heart rate/blood pressure. Eye irritation occurred significantly less frequently with microdosing than PE10% eyedrops. Conclusion: Piezo-ejection PE microdosing achieves comparable biological effect as eyedropper dosing; reduced systemic absorption may decrease risk of systemic side effects.

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Section: Discussionmentioning

confidence: 40%

“…Smaller ocular PE drop size significantly reduces systemic absorption; in infants, reducing PE-2.5% eyedrop size from 30 to 8 μl decreased plasma PE by >50% [16]. In the current study, systemic PE levels were lower after ocular microdosing versus eyedropper delivery of PE-10%.…”

Section: Discussionmentioning

confidence: 41%

High-precision piezo-ejection Ocular microdosing: Phase II Study on Local and Systemic Effects of Topical Phenylephrine

Ianchulev

Weinreb²,

Tsai

et al. 2017

Ther. Deliv.

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“…23 The combination of anticholinergic (0.5% cyclopentolate) and sympathomimetic (2.5% phenylephrine) drops used in this study is more effective in preterm infants than anticholinergic drops alone. 24 In single-drug dilating protocols, smaller dilated pupil sizes have been reported in newborn term infants than in our termaged prematurely born infants (5 mm dilation with 0.5% cyclopentolate 18 and 4.5-5 mm with 2.5% phenylephrine alone 19 ). This resulted in larger pupil area:VCD 2 ratios for the present study than in the term infant study.…”

Section: Discussionmentioning

confidence: 40%

Ocular Biometry in Preterm Infants: Implications for Estimation of Retinal Illuminance

Mactier

Maroo

Bradnam

et al. 2008

Invest. Ophthalmol. Vis. Sci.

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Stimulus luminance and troland values cannot be used to infer retinal illuminance when comparing eyes of markedly differing sizes or transmissivities. Error in estimating retinal illuminance in prematurely born infants is inevitable because of uncertainty regarding media transmissivity, but this discrepancy can be minimized by using directly measured pupil diameter and data presented herein for eye size in this population.

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“…Because of the well-known systemic side effects of phenylephrine, we instill this drug with a micropipette. It has, in fact, been shown [13] that a decrease in the volume of the standard drop is associated with lower plasma levels of phenylephrine, and consequently, fewer systemic side effects, without adversely affecting its action on the pupil.…”

Section: Observation Methodsmentioning

confidence: 44%

Retinopathy of prematurity (ROP): Optimal timing of clinical evaluation and standard procedures

et al. 1990

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The authors present the protocol currently used in their institution for initial and follow-up evaluation of infants at high risk for developing retinopathy of prematurity (ROP). After topical anesthesia and lid speculum insertion, the examination is carried out using an indirect binocular ophthalmoscope with a +20 or +28-diopter lens. Mydriasis is achieved by instilling one drop of 1% tropicamide, followed by one drop of 0.5% tropicamide + 2.5% phenylephrine 15 minutes later and after an additional 15 minute interval, another drop of 1% tropicamide. If mydriasis is insufficient after one hour, one drop of a 0.5% tropicamide-5.0% phenylephrine solution may be instilled. The initial examination is performed between the third and fourth weeks of life. If any areas of retinal immaturity are found, the examination is repeated every other week and, later, every three to four weeks, until vascularization has reached the ora serrata. Should any sign of ROP be present during the first examination, the patient is examined weekly or every other week depending on the severity of clinical findings.

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Reduction of Phenylephrine Drop Size in Infants Achieves Equal Dilation With Decreased Systemic Absorption

Cited by 35 publications

References 16 publications

High-precision piezo-ejection Ocular microdosing: Phase II Study on Local and Systemic Effects of Topical Phenylephrine

High-precision piezo-ejection Ocular microdosing: Phase II Study on Local and Systemic Effects of Topical Phenylephrine

Ocular Biometry in Preterm Infants: Implications for Estimation of Retinal Illuminance

Retinopathy of prematurity (ROP): Optimal timing of clinical evaluation and standard procedures

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