Email this article 
Post a Comment Drug-induced mydriasis in infants born at different gestation terms
- Authors: Saidasheva E.I.1, Biyanovskaya S.V.1, Kovshov F.V.1, Petrachkova M.S.1, Dolgova O.S.1, Levadnev Y.V.1
-
Affiliations:
- North-Western State Medical University named after I.I. Mechnikov
- Issue: Vol 11, No 4 (2018)
- Pages: 85-92
- Section: Articles
- URL: https://journals.rcsi.science/ov/article/view/11127
- DOI: https://doi.org/10.17816/OV11485-92
- ID: 11127
Cite item
Full Text
Abstract
Background. At the present time, the problem of choice of eye drops to achieve adequate mydriasis with minimal side effects for retinopathy of prematurity screening remains an urgent challenge.
Purpose. To estimate the clinical efficacy of combination mydriatic eye drops Fenicamide in infants born at different gestation terms.
Materials and methods. Under observation, there were 75 newborns (150 eyes) and babies aged from 1 day to 3 months (average, 38.2 ± 32.2 days). Patients were distributed into 3 groups depending on gestational age: group 1 consisted of 25 full-term infants; group 2 – of 25 premature babies, and group 3 – of 25 extremely preterm infants. To achieve mydriasis, 1 drop of combination eye drops (5% phenylephrine and 0.8% tropicamide) was instilled. Dynamics of pupil diameter change in each group of patients was registered within 4 hours, and side effects were recorded within 24 hours. The quality of fundus visualization was estimated using a pediatric retinal camera RetCam 3.
Results. Maximal pupil dilation (average, 6.5 ± 0.5 mm) was reached to 60 ± 14 min after instillation on average; pupil remained dilated within 1 hour, its diameter became normal in 4 hours. Mydriasis varied from 5.9 mm in extremely premature infants to 7 mm in the full-term newborns (p > 0.05), and allowed a full and high quality examination of the fundus in all patients, including the visualization of peripheral zones of the retina for retinopathy of prematurity screening. It was established that drug side effects were absent in 76% (57) of infants, they were present in 24% (18) of infants, mostly as local reaction.
Conclusion. Fenicamide eye drops are an effective mydriatic medication, with a convenient instillation regimen, have minimal side effects, and can be recommended for retinopathy of prematurity screening and monitoring.
Full Text
##article.viewOnOriginalSite##About the authors
Elvira I. Saidasheva
North-Western State Medical University named after I.I. Mechnikov
Author for correspondence.
Email: esaidasheva@mail.ru
Dr. Sci. Med., Professor of the Department of Ophthalmology
Russian Federation, Saint PetersburgSvetlana V. Biyanovskaya
North-Western State Medical University named after I.I. Mechnikov
Email: solncemia@mail.ru
Assistant of the Department of Ophthalmology
Russian Federation, Saint PetersburgFedor V. Kovshov
North-Western State Medical University named after I.I. Mechnikov
Email: fedor_vk@mail.ru
Assistant of the Department of Ophthalmology
Russian Federation, Saint PetersburgMarina S. Petrachkova
North-Western State Medical University named after I.I. Mechnikov
Email: mpetrachkova@mail.ru
Postgraduate of the Department of Ophthalmology
Russian Federation, Saint PetersburgOlga S. Dolgova
North-Western State Medical University named after I.I. Mechnikov
Email: alaknar@yandex.ru
Postgraduate of the Department of Ophthalmology
Russian Federation, Saint PetersburgYuriy V. Levadnev
North-Western State Medical University named after I.I. Mechnikov
Email: yu-lev@yandex.ru
MD, PhD
Russian Federation, Saint PetersburgReferences
- Приказ Минздрава РФ от 10.08.2017 г. № 514н «О порядке проведения профилактических медицинских осмотров несовершеннолетних» [Prikaz Minzdrava RF ot 10.08.2017 g. No. 514n “O porjadke provedenija profilakticheskih medicinskih osmotrov nesovershennoletnih”. (In Russ.)]. Доступно по: https://rg.ru/2017/08/22/minzdrav-prikaz514n-site-dok.html. Ссылка активна на 21.11.2018.
- Приказ Минздрава РФ от 25.10.2012 г. № 442н «Об утверждении Порядка оказания медицинской помощи детям при заболеваниях глаза, его придаточного аппарата и орбиты». Ссылка активна на 21.11.2018. [Prikaz MZ RF from 25.10.2012 г. No. 442н “Ob utverzhdenii Poryadka okazaniya meditsinskoy pomoshchi detyam pri zabolevaniyakh glaza, yego pridatochnogo apparata i orbity”. Accessed 21.11.2018. (In Russ.)]. http://docs.cntd.ru/document/902293121.
- Федеральные клинические рекомендации (Национальный протокол) «Диагностика, мониторинг и лечение активной фазы ретинопатии недоношенных» // Российская педиатрическая офтальмология. - 2015. - Т. 10. - № 1. - С. 54-60. [Federal Clinical Recommendations “Diagnostics, Monitoring and Treatment of Active Phase of Retinopathy of Prematurity”. (The National Protocol). Russian pediatric ophthalmology. 2015;10(1):54-60. (In Russ.)]
- Сайдашева Э.И., Горелик Ю.В., Буяновская С.В., Ковшов Ф.В. Ретинопатия недоношенных: особенности течения и результаты лечения у детей со сроком гестации менее 27 недель // Российская педиатрическая офтальмология. - 2015. - Т. 10. - № 2. - С. 28-32. [Saidasheva EI, Gorelik YV, Buyanovskaya SV, Kovshov FV. Retinopathy of prematurity: the course and results of treatment in children with gestational age less than 27 weeks. Russian pediatric ophthalmology. 2015;10(2):28-32. (In Russ.)]
- Mёллер Х.У. Вехи развития и нормальные показатели // Хойт К.С., Тейлор Д. Детская офтальмология / Пер. с англ. под общ. ред. Е.И. Сидоренко. - М.: Панфилова; 2015. - Т. 1. - С. 46-56. [Moller HU. Milestones of development and normal indicators. In: Hoyt CS, Taylor D. Pediatric ophthalmology and strabismus. Ed. by E.I. Sidorenko. Moscow: Panphylova; 2015. Vol. 1. P. 46-56. (In Russ.)]
- Carpel EF, Kalina RE. Pupillary responses to mydriatic agents in premature infants. Am J Ophthalmol. 1973;75(6):988-991.
- Caputo AR, Schnitzer RE. Systemic response to mydriatic eyedrops in neonates: mydriatics in neonates. J Pediatr Ophthalmol Strabismus. 1978;15(2):109-122.
- Fleck BW, Dhillon B, Mitchell A. Additive mydriatic effect of 2.5 % phenylephrine and 0.5 % tropicamide eyedrops in premature babies. J Pediatr Ophthalmol Strabismus. 1994;31(2):130.
- Isenberg SJ, Abrams C, Hyman PE. Effects of cyclopentolate eye drops on gastric secretory function in pre-term infants. Ophthalmology. 1985;92(5):698-700.
- Lim DL, Batilando M, Rajadurai VS. Transient paralytic ileus following the use of cyclopentolate-phenylephrine eye drops during screening for retinopathy of prematurity. J Paediatr Child Health. 2003;39(4):318-320.
- Willems L, Allegaert K, Casteels I. Prospective assessment of systemic side effects of topical ophthalmic drug administration for screening for retinopathy of prematurity. Paed Perin Drug Ther. 2006;7(3):121-122. doi: 10.1185/146300906778876224.
- Princelle A, Hue V, Pruvost I, et al. Systemic adverse effects of topical ocular instillation of atropine in two children. Arch Pediatr. 2013;20(4):391-394. doi: 10.1016/j.arcped.2013.01.012.
- Lux AL, Mouriaux F, Guillois B, et al. Serious adverse side effects after pupillary dilation in preterm infants. J Fr Ophtalmol. 2015;38(3):193-198. doi: 10.1016/j.jfo.2014.10.008.
- Patel AJ, Simon JW, Hodgetts DJ. Cycloplegic and mydriatic agents for routine ophthalmologic examination: a survey of pediatric ophthalmologists. J AAPOS. 2004;8(3):274-277. doi: 10.1016/S1091853104000084.
- UK Retinopathy of Prematurity Guideline [Internet]. Royal College of Paediatrics and Child Health, Royal College of Ophthalmologists, British Association of Perinatal Medicine & BLISS; 2008 [cited 2018 Nov 21]. Available from: https://www.rcophth.ac.uk/wp-content/uploads/2014/12/2008-SCI-021-Guidelines-Retinopathy-of-Prematurity.pdf.
- Khoo BK, Koh A, Cheong P, Ho NK. Combination cyclopentolate and phenylephrine for mydriasis in premature infants with heavily pigmented irides. J Pediatr Ophthalmol Strabismus. 2000;37(1):15-20.
- Chew C, Rahman RA, Shafie SM, Mohamad Z. Comparison of mydriatic regiments used in screening for retinopathy of prematurity in preterm infants with dark irides. J Pediatr Ophthalmol Strabismus. 2005;42(3):166-173.
- Neffendorf J, Mota PM, Hildebrand GD. Efficacy and safety of a combination of 0,5 % cyclopentolate with 2,5 % phenylephrine used for ROP screening in 623 consecutive examinations spanning a 30 month period. Programme and Book of Abstracts. EPOS2013: 39th Annual Meeting European Paediatric Ophthalmological Society; 2013 Oct 11-12; The Netherlands. Leiden; 2013. P. 66.
- Lux AL, Degoumois A, Barjol A, et al. Combination of 5 % phenylephrine and 0.5 % tropicamide eye drops for pupil dilation in neonates is twice as effective as 0.5 % tropicamide eye drops alone. Acta Ophthalmol. 2017;95(2):165-169. doi: 10.1111/aos.13175.
- Сайдашева Э.И., Буяновская С.В., Ковшов Ф.В., Леваднев Ю.В. Современные подходы к диагностике и лазерному лечению задней агрессивной ретинопатии недоношенных // Вестник СЗГМУ им. И.И. Мечникова. - 2017. - Т. 9. - № 1. - С. 42-47. [Saidasheva EI, Buynovskaya SV, Kovshov FV, Levadnev YV. The modern approaches to diagnosis and laser treatmentof aggressive posterior retinopathy of prematurity. Vestnik of North-Western State Medical University named after I.I. Mechnikov. 2017;9(1):42-47. (In Russ.)]. doi: 10.17816/mechnikov20179142-47.
Supplementary files
