Transient changes of intraocular pressure and anterior segment configuration after diagnostic mydriasis with 1% tropicamide in children

Abstract

Background: This study investigated the association of transient changes in intraocular pressure (IOP) with changes in the anterior chamber configuration in children after diagnostic mydriasis with 1% tropicamide. Methods: In this prospective case-control study, 163 hospital clinic-based samples of unrelated children with or without myopia were enrolled. Complete ophthalmological examinations, including visual acuities, cycloplegic refraction, slitlamp examination, fundus examination, IOP, axial length measurement and Pentacam examination were performed. Results: Lens thickness in emmetropic children was significantly greater than in myopic children of both genders, both before and after mydriasis. In a comparison of the biometric differences before and after mydriasis, IOP was not different, but the lens thickness after mydriasis was significantly less in myopic and emmetropic children of both genders. The mean anterior chamber angle, anterior chamber depth and anterior chamber volume significantly increased after mydriasis in myopic and emmetropic children of both genders. These parameters were not related to the changes of IOP under multiple regression analysis. There were no statistically significant differences between groups in either biometric parameters or anterior chamber configurations. Conclusion: While the present findings do not show a significant change in IOP following mydriasis, there was wide inter-individual variation, with some children showing an increase in IOP of up to 8.0 mmHg and some showing a decrease of a similar amount. This variation suggests that IOP should be monitored when mydriatics or cycloplegics are used in children.

Effects of Diagnostic Mydriasis with Tropicamide and Phenylephrine on Intraocular Pressure

“…This mean age is similar to that reported in other studies [14,15,24]. Hung et al, and Tsai et al, did a similar study but in children [17,23]. This mean age of patients needing diagnostic mydriasis may be a reflection of disorders that cause visual impairment in our environment such as cataracts, age-related macular degeneration and diabetic retinopathy; which are all age-related.…”

“…In this study, post dilatation IOP was checked 5 times as such, the tendency of changes being missed was reduced to the barest minimum. In the same vein, Tsai et al, whose study was in children noted no significant, difference between mean pre and post dilatation IOPs [23]. Their study population being children and the fact that IOP was rechecked just once, at 45 minutes may have been responsible for this difference.…”

“…Diagnostic mydriasis using these pharmacological agents is not without consequences. Many studies have shown that pupillary dilatation can cause a change in IOP, most supporting an increase in IOP in normal eyes and also abnormal eyes notably those that are glaucomatous [14][15][16][17][18][19][20][21][22] and others showing no significant change [23,24].…”

When to use the Bonferroni correction

“…The Bonferroni correction itself was applied to a wide variety of statistical procedures, most frequently as a post‐hoc test after anova or when multiple ‘ t ’ tests and Pearson's ‘ r ’ were employed. It was also used to correct non‐parametric tests such as the Mann‐Whitney test, the Wilcoxon test, the Kruskal‐Wallis test, chi‐square (χ) contingency table test, and Fisher's 2 × 2 exact test . It was less commonly used in studies involving regression and multiple regression, or in studies involving the intraclass correlation coefficient (ICC), and was rarely used to test goodness‐of‐fit of data to statistical models such as Rasch model or the normal distribution .…”

Study Design and Methodologies for Evaluation of Anti-glaucoma Drugs

“…Pharmacologic pupil dilation with tropicamide or other mydriatics has been reported to have a variable effect on IOP. Some studies suggest pharmacologic pupil dilation does not alter IOP at all whereas others have found increases of up to a few mm Hg in normal dogs [43], cats [44,45] and humans [46,47]. Although these differences may sometimes achieve statistical significance, and indicate that IOP should be measured prior to pupil dilation in anti-glaucoma drug efficacy studies, the magnitude of the increase (if any) is clinically unimportant and in the author's experience has not resulted in a toxicologically adverse finding for IOP.…”