Pupillometry is used in humans to monitor pain, nociception and analgesia. This single-center, non-randomized, non-blinded intervention trial, evaluated the effect of nose twitching on the pupil size in awake, sedated, and anesthetized horses. Pupil height (H) and length (L) were measured before (Be) and after (Af) nose twitching in fourteen non-painful adult awake horses (T0). The percentage of variation (PSV) was calculated (PSVTn = [(TnAf-TnBe)/TnBe]*100). Measurements were repeated (Tn) after acepromazine (0.04 mg kg-1 IV) (T1), romifidine (0.04 mg kg-1 IV) (T2), morphine (0.1 mg kg-1 IV) (T3), after anesthesia induction with diazepam (0.05 mg kg-1 IV) and ketamine (2.2 mg kg-1 IV), at the time the horse was placed on the operating table (T4) and when the expiratory fraction of sevoflurane was 2% (T5). HAf vs. HBe, LAf vs. LBe as well as PSVH vs. PSVL at each time were compared with a Mann-Whitney Wilcoxon test. The PSVL and PSVH, as well as HBe and LBe over time were compared with the Skillings-Mack test followed by a Wilcoxon test for paired data to make pairwise comparisons (Tn + 1 vs. Tn). In non-sedated horses (T0), the application of the nose twitch induced a significant increase in pupil length (LT0Be: 17.09 [16.05; 19.67] mm versus LT0Af: 19.52 [18.74; 21.40]) mm (p = 0.004). Thirty minutes after acepromazine administration (T1), nose twitching induced a significant increase in pupil length (LT1Be: 16.45 [14.80; 18.66] mm versus LT1Af 18.31 [17.20; 20.52] mm) (p = 0.016) and height (HT1Be: 8.44 [5.68; 12.04] mm versus HT1Af: 11.09 [7.97; 14.3] mm) (p < 0.001). PSVHT1 was significantly greater than PSVLT1 (p = 0.025). PSVH was higher at T1 than at T0 (p = 0.04). It was also significantly higher at T1 than at T2 (p < 0.001). Romifidine induced mydriasis (HT2Be 16.95 [14.73; 18.77] mm versus HT1Be 8.44 [5.68; 12.04] mm) (p < 0,001) (LT2Be 19.66 [18.45; 20.41] mm versus LT1Be 16.45 [14.80; 18.66] mm) (p < 0.001). The results suggest that nose twitching induced a pupillary dilation in the awake horse. This effect was potentiated after the administration of acepromazine but disappeared after the administration of romifidine.

暂无摘要。

Hypoxia is an operational concern in military aviation, and fighter pilots should undertake altitude hypoxia training. Anisocoria is a significant clinical dilemma and may remain a diagnostic challenge for specialists. We present a case of atraumatic unilateral mydriasis during hypobaric chamber training. Our diagnostic dilemma is novel and unique because the authors reported no similar presentation yet, it occurred in a fighter pilot whose occupational future depends on having normal vision, and second, the presence of hypoxia seems to trigger symptoms.

UNASSIGNED: In the pivotal clinical trial that led to Food and Drug Administration De Novo \"approval\" of the first fully autonomous artificial intelligence (AI) diabetic retinal disease diagnostic system, a reflexive dilation protocol was used. Using real-world deployment data before implementation of reflexive dilation, we identified factors associated with nondiagnostic results. These factors allow a novel predictive dilation workflow, where patients most likely to benefit from pharmacologic dilation are dilated a priori to maximize efficiency and patient satisfaction.
UNASSIGNED: Retrospective review of patients who were assessed with autonomous AI at Johns Hopkins Medicine (8/2020 to 5/2021). We constructed a multivariable logistic regression model for nondiagnostic results to compare characteristics of patients with and without diagnostic results, using adjusted odds ratio (aOR). P < .05 was considered statistically significant.
UNASSIGNED: Of 241 patients (59% female; median age = 59), 123 (51%) had nondiagnostic results. In multivariable analysis, type 1 diabetes (T1D, aOR = 5.82, 95% confidence interval [CI]: 1.45-23.40, P = .01), smoking (aOR = 2.86, 95% CI: 1.36-5.99, P = .005), and age (every 10-year increase, aOR = 2.12, 95% CI: 1.62-2.77, P < .001) were associated with nondiagnostic results. Following feature elimination, a predictive model was created using T1D, smoking, age, race, sex, and hypertension as inputs. The model showed an area under the receiver-operator characteristics curve of 0.76 in five-fold cross-validation.
UNASSIGNED: We used factors associated with nondiagnostic results to design a novel, predictive dilation workflow, where patients most likely to benefit from pharmacologic dilation are dilated a priori. This new workflow has the potential to be more efficient than reflexive dilation, thus maximizing the number of at-risk patients receiving their diabetic retinal examinations.

Background  Peer physical examination learning is commonly practiced in medical schools during preclinical curricula and has been shown to improve empathy for patients. While there is literature regarding medical student attitudes toward peer physical exam learning, no studies to date have specifically examined student attitudes toward fundoscopy and dilation of the eyes for the purposes of learning fundoscopy. This study evaluates medical student preferences with regards to learning fundoscopy on peers and explores attitudes toward alternate approaches. Methods  First year medical students at the Icahn School of Medicine at Mount Sinai participated in a 2-hour fundoscopy skills workshop in March 2020. Following the session, the authors administered a voluntary survey querying students on attitudes toward peer physical exam learning and its use in learning peer fundoscopy. Primary study endpoints evaluated (1) student attitudes toward the use of peer physical exam learning, (2) learning benefit of the session, including student comfort with conducting the fundoscopy exam, and (3) empathy toward patients experiencing dilation. Secondary endpoints focused on alternative teaching methods and preferences for nonmydriatic fundoscopy. Analysis of survey data was performed using nonparametric Spearman\'s correlations, chi-square tests, t -tests, and Mann-Whitney U tests. Results  A total of 51/138 (37%) students completed the survey, with 78% indicating they felt peer physical exam learning was a helpful instructional method, including for the fundoscopic exam. The session led to improved self-rated fundoscopy skills and empathy for patients. However, when considering learning with dilation versus alternative nonmydriatic techniques, 96% of students indicated a preference for using alternative nonmydriatic techniques. Conclusion  This study found that students\' attitudes toward fundoscopy generally aligned with their overall peer physical exam preferences. However, they preferred not using dilation and learning with nonmydriatic fundoscopic techniques. Assessing student learning preferences and incorporating novel instructional tools can help facilitate more successful fundoscopy skills acquisition. These considerations are particularly important in the context of COVID-19 and with advances in teleophthalmology.

In this case report, we describe a rare imaging finding of foveal duplication identified on spectral domain optical coherence tomography (OCT) through undilated pupils in a 49-year-old asymptomatic anxious lady with type 2 diabetes mellitus who visited the retina clinic for diabetic retinopathy screening. A simple patient counseling for cooperation during a repeat OCT scan with dilated pupils revealed that the twin fovea-like duplication was an illusion. This case illustrates the necessity of pupillary dilation and reimaging in the presence of unusual artifacts, such as foveal duplication, to prevent clinicians from ordering unnecessary additional tests.

Aim: To compare pupil dilation achieved by a single microdose versus two microdoses of tropicamide-phenylephrine fixed combination (TR-PH FC) delivered by the Optejet®. Patients & methods: In this assessor-masked, crossover, noninferiority study, 60 volunteers underwent two treatment visits and received either one (∼8 μl) or two sprays (∼16 μl) of TR-PH FC to both eyes in randomly assigned order. Results: At 35 min postdose, mean change in pupil diameter was 4.6 mm and 4.9 mm following one or two sprays, respectively. The estimated treatment group difference was -0.249 mm (standard error: 0.036; 95% CI: -0.320, -0.177). No adverse events were reported. Conclusion: A single microdose was noninferior to two microdoses of TR-PH FC and achieved clinically significant mydriasis in a timely manner. Clinical Trial Registration: NCT04907474 (ClinicalTrials.gov).
Pupil dilation efficacy and efficiency were evaluated using microdosing via the Optejet®. The Optejet® is a new ophthalmologic drug device that utilizes piezoelectric technology to deliver a fine, controlled, horizontal microdroplet spray with precise volume (∼8 μl), spray pattern and velocity. A single spray versus two sprays of tropicamide-phenylephrine fixed combination (TR-PH FC) were administered to both eyes anesthetic free. Efficacy and safety were evaluated at specific time intervals. The primary end point was the mean change in pupil diameter at 35 min compared with baseline. At 35 min, clinically relevant dilation was observed, with a mean change of 4.55 mm ± 0.68 for one spray and 4.88 ± 0.60 for two sprays. The treatment group difference of one spray of TR-PH FC was noninferior to two sprays (p < 0.001). Rapid dilation was observed at 15 min, and the proportions of eyes that achieved a pupil diameter of ≥6.0 mm were 74% and 83% of patients at 15 min with one spray and two sprays, respectively. The mydriatic agent was well tolerated with the delivery system even in the absence of topical anesthetic, with no ocular or system adverse events reported. Mydriasis is a vital component of routine eye healthcare, and the current standard-of-care mydriatic eye drops potentially have limitations, including contamination, spillage and burning/stinging. Delivery of a mydriatic with the Optejet® may improve patient care flow in the clinical office setting.

Neuromuscular Blockade Agents (NMBA) are used in the management of moderate and severe Acute Respiratory Distress Syndrome (ARDS) patients. They have never been reported to present Central Nervous System adverse reactions. Shortage of cis-atracurium during the pandemic, led to the use of rocuronium. We report three patients with Covid-19 ARDS, who presented bilateral dilated, non-reactive pupils, after continuous rocuronium infusion. Brain CT findings were unremarkable and transcranial doppler tracings did not suggest brain edema or hemorrhage. NMBA\'s discontinuation led to reversal of the pupillary dilation. We believe that impairment of Blood-Brain-Barrier, due to Covid-19, led rocuronium access into the Central Nervous System, leading to this adverse effect. Clinicians should be aware of this adverse reaction when managing patients with Covid-19 ARDS warranting NMBA use.

Design: Prospective, double-masked, controlled, cross-over superiority studies. Materials & methods: Eligible volunteers in two pooled Phase III trials received microdosed mydriatics. MIST-1 study subjects received fixed-combination TR-PH, phenylephrine 2.5% (PH) or tropicamide 1% (TR). MIST-2 study subjects received TR-PH or placebo. Mean change from baseline in pupil diameter was measured by digital pupillometry at 35 min postadministration. Results: Pooled efficacy analysis included 131 subjects. Compared with TR-PH, treatment group difference in 35-min change in mean pupil dilation from baseline was 0.58 mm (p < 0.0001) with TR, 3.87 mm (p < 0.0001) with PH and 4.65 mm (p < 0.0001) with placebo. Adverse events reported were infrequent, transient and mostly mild. Conclusion: TR-PH demonstrated superior pupil dilation compared with each component and placebo. TR-PH was safe & well-tolerated.

Pseudoexfoliation Syndrome (PXFS) is considered a systemic disorder with significant ocular manifestations ranging from corneal decompensation, non-dilating pupil, zonular weakness, subluxated lens, and glaucoma. PXFS may lead to increased complications during routine cataract surgery. Zonular dialysis is a common complication during or after cataract surgery in such patients. However, not all patients with pseudoexfoliation are at a higher risk. We hypothesize that there is an inverse correlation between the maximum pupillary dilation and the degree of zonular disintegration. Available evidence supporting the hypothesis is discussed. We propose a new clinical classification for predicting the zonular strength based on the maximum pupillary dilation so that it can serve as a guide to identify PXFS patients who are at high risk of complications during or after cataract surgery.