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. 1999 May;83(5):553–558. doi: 10.1136/bjo.83.5.553

Pilocarpine induces an increase in the anterior chamber angular width in eyes with narrow angles

H Kobayashi 1, K Kobayashi 1, J Kiryu 1, T Kondo 1
PMCID: PMC1723055  PMID: 10216053

Abstract

AIM—To determine the mechanical effects of pilocarpine on the trabecular-iris angle opening in eyes with narrow angles, compared with its effects on healthy control subjects with wide angles.
METHODS—A narrow angle was defined as 25° or less of trabecular-iris angle on ultrasound biomicroscopic examination. The change in anterior chamber depth (ACD), trabecular-iris angle (TIA), angle opening distance (AOD, distance between trabecular meshwork and iris) measured at 250 µm and 500 µm from the scleral spur (AOD250 and AOD500), and iris thickness was determined in 30 eyes of 30 patients (13 men and 17 women, between 63 and 82 years (mean 70.4 years)) with narrow angles and in 30 sex and age matched control subjects with wide angles before and 1 hour after the instillation of 2% pilocarpine hydrochloride by ultrasound biomicroscopy.
RESULTS—In all eyes with narrow angles, pilocarpine increased the TIA, AOD250, and AOD500; these changes increased significantly and linearly as the corresponding pretreatment values decreased (r = 0.807, p = 0.0001; r = 0.787, p = 0.0001; r = 0.852, p = 0.0001). Of 30 eyes with wide angles, 23 eyes whose ACD was 2670 µm and more showed a decrease in the TIA, AOD250, and AOD500; the changes in TIA, AOD250, and AOD500 also significantly correlated with the corresponding pretreatment values (r = 0.913, p = 0.0001; r = 0.882, p = 0.0001; r = 0.895, p = 0.0001). Pilocarpine induced a smaller decrease in ACD in eyes with narrow angles than in those with wide angles (p = 0.0001). There was a linear correlation between the increase in ACD change and the decrease in pretreatment ACD in eyes with narrow angles and those with wide angles (r = 0.781, p = 0.0003; r = 0.798, p = 0.0001).
CONCLUSIONS—The finding that pilocarpine increases angular width in patients with narrow angles indicates that this agent is useful for treating patients with narrow angles and angle closure glaucoma. The prediction of the pilocarpine induced change in the angle may assist ophthalmologists in treating such patients.



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Selected References

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  1. ARMALY M. F., JEPSON N. C. Accommodation and the dynamics of the steady-state intraocular pressure. Invest Ophthalmol. 1962 Aug;1:480–483. [PubMed] [Google Scholar]
  2. Abramson D. H., Coleman D. J., Forbes M., Franzen L. A. Pilocarpine. Effect on the anterior chamber and lens thickness. Arch Ophthalmol. 1972 Jun;87(6):615–620. doi: 10.1001/archopht.1972.01000020617001. [DOI] [PubMed] [Google Scholar]
  3. Abramson D. H., Franzen L. A., Coleman D. J. Pilocarpine in the presbyope. Demonstration of an effect on the anterior chamber and lens thickness. Arch Ophthalmol. 1973 Feb;89(2):100–102. doi: 10.1001/archopht.1973.01000040102006. [DOI] [PubMed] [Google Scholar]
  4. Anderson D. R., Jin J. C., Wright M. M. The physiologic characteristics of relative pupillary block. Am J Ophthalmol. 1991 Mar 15;111(3):344–350. doi: 10.1016/s0002-9394(14)72320-7. [DOI] [PubMed] [Google Scholar]
  5. Aslanides I. M., Libre P. E., Silverman R. H., Reinstein D. Z., Lazzaro D. R., Rondeau M. J., Harmon G. K., Coleman D. J. High frequency ultrasound imaging in pupillary block glaucoma. Br J Ophthalmol. 1995 Nov;79(11):972–976. doi: 10.1136/bjo.79.11.972. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gabelt B. T., Crawford K., Kaufman P. L. Outflow facility and its response to pilocarpine decline in aging rhesus monkeys. Arch Ophthalmol. 1991 Jun;109(6):879–882. doi: 10.1001/archopht.1991.01080060143044. [DOI] [PubMed] [Google Scholar]
  7. Jin J. C., Anderson D. R. The effect of iridotomy on iris contour. Am J Ophthalmol. 1990 Sep 15;110(3):260–263. doi: 10.1016/s0002-9394(14)76341-x. [DOI] [PubMed] [Google Scholar]
  8. Kaufman P. L., Bárány E. H. Residual pilocarpine effects on outflow facility after ciliary muscle disinsertion in the synomolgus monkey. Invest Ophthalmol. 1976 Jul;15(7):558–561. [PubMed] [Google Scholar]
  9. Kobayashi H., Kobayashi K., Kiryu J., Kondo T. Ultrasound biomicroscopic analysis of the effect of pilocarpine on the anterior chamber angle. Graefes Arch Clin Exp Ophthalmol. 1997 Jul;235(7):425–430. doi: 10.1007/BF00947061. [DOI] [PubMed] [Google Scholar]
  10. Lütjen-Drecoll E., Tamm E., Kaufman P. L. Age-related loss of morphologic responses to pilocarpine in rhesus monkey ciliary muscle. Arch Ophthalmol. 1988 Nov;106(11):1591–1598. doi: 10.1001/archopht.1988.01060140759051. [DOI] [PubMed] [Google Scholar]
  11. Makabe R. Vergleichende Untersuchungen der Kammerwinkelweite mit Echographie und Gonioskopie. Klin Monbl Augenheilkd. 1989 Jan;194(1):6–9. doi: 10.1055/s-2008-1046326. [DOI] [PubMed] [Google Scholar]
  12. Mindel J. S., Kharlamb A. B. Alteration of acetylcholine synthesis by pilocarpine. In vivo and in vitro studies. Arch Ophthalmol. 1984 Oct;102(10):1546–1549. doi: 10.1001/archopht.1984.01040031262032. [DOI] [PubMed] [Google Scholar]
  13. Moses R. A., Grodzki W. J., Jr Choroid tension and facility of aqueous outflow. Invest Ophthalmol Vis Sci. 1977 Nov;16(11):1062–1064. [PubMed] [Google Scholar]
  14. Pavlin C. J., Harasiewicz K., Foster F. S. Ultrasound biomicroscopy of anterior segment structures in normal and glaucomatous eyes. Am J Ophthalmol. 1992 Apr 15;113(4):381–389. doi: 10.1016/s0002-9394(14)76159-8. [DOI] [PubMed] [Google Scholar]
  15. Pavlin C. J., Harasiewicz K., Sherar M. D., Foster F. S. Clinical use of ultrasound biomicroscopy. Ophthalmology. 1991 Mar;98(3):287–295. doi: 10.1016/s0161-6420(91)32298-x. [DOI] [PubMed] [Google Scholar]
  16. Pavlin C. J., McWhae J. A., McGowan H. D., Foster F. S. Ultrasound biomicroscopy of anterior segment tumors. Ophthalmology. 1992 Aug;99(8):1220–1228. doi: 10.1016/s0161-6420(92)31820-2. [DOI] [PubMed] [Google Scholar]
  17. Pavlin C. J., Ritch R., Foster F. S. Ultrasound biomicroscopy in plateau iris syndrome. Am J Ophthalmol. 1992 Apr 15;113(4):390–395. doi: 10.1016/s0002-9394(14)76160-4. [DOI] [PubMed] [Google Scholar]
  18. Pavlin C. J., Sherar M. D., Foster F. S. Subsurface ultrasound microscopic imaging of the intact eye. Ophthalmology. 1990 Feb;97(2):244–250. doi: 10.1016/s0161-6420(90)32598-8. [DOI] [PubMed] [Google Scholar]
  19. Potash S. D., Tello C., Liebmann J., Ritch R. Ultrasound biomicroscopy in pigment dispersion syndrome. Ophthalmology. 1994 Feb;101(2):332–339. doi: 10.1016/s0161-6420(94)31331-5. [DOI] [PubMed] [Google Scholar]
  20. Ritch R. The pilocarpine paradox. J Glaucoma. 1996 Aug;5(4):225–227. [PubMed] [Google Scholar]
  21. SCHEIE H. G. Width and pigmentation of the angle of the anterior chamber; a system of grading by gonioscopy. AMA Arch Ophthalmol. 1957 Oct;58(4):510–512. doi: 10.1001/archopht.1957.00940010526005. [DOI] [PubMed] [Google Scholar]
  22. Tamm E., Croft M. A., Jungkunz W., Lütjen-Drecoll E., Kaufman P. L. Age-related loss of ciliary muscle mobility in the rhesus monkey. Role of the choroid. Arch Ophthalmol. 1992 Jun;110(6):871–876. doi: 10.1001/archopht.1992.01080180143043. [DOI] [PubMed] [Google Scholar]
  23. Tello C., Chi T., Shepps G., Liebmann J., Ritch R. Ultrasound biomicroscopy in pseudophakic malignant glaucoma. Ophthalmology. 1993 Sep;100(9):1330–1334. doi: 10.1016/s0161-6420(93)31479-x. [DOI] [PubMed] [Google Scholar]
  24. Tello C., Liebmann J., Potash S. D., Cohen H., Ritch R. Measurement of ultrasound biomicroscopy images: intraobserver and interobserver reliability. Invest Ophthalmol Vis Sci. 1994 Aug;35(9):3549–3552. [PubMed] [Google Scholar]
  25. Tiedeman J. S. A physical analysis of the factors that determine the contour of the iris. Am J Ophthalmol. 1991 Mar 15;111(3):338–343. doi: 10.1016/s0002-9394(14)72319-0. [DOI] [PubMed] [Google Scholar]
  26. Van Buskirk E. M. The canine eye: lens depression and aqueous outflow. Invest Ophthalmol Vis Sci. 1980 Jul;19(7):789–792. [PubMed] [Google Scholar]
  27. Wilensky J. T., Ritch R., Kolker A. E. Should patients with anatomically narrow angles have prophylactic iridectomy? Surv Ophthalmol. 1996 Jul-Aug;41(1):31–36. doi: 10.1016/s0039-6257(97)81991-1. [DOI] [PubMed] [Google Scholar]

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