Takashi Utsumi

Pupillary dynamics in Parkinson's disease

In 24 patients with Parkinsons disease (PKD), pupillary light reflexes and sensitivities to diluted solutions of adrenergics or cholinergics were measured by means of an infrared videopupillogram. Nine patients were in the cholinergic state (pupil area (PA) decreased, constriction as well as dilatation reduced) and four in the cholinolytic state (PA increased, constriction inhibited, dilatation activated). Seven patients showed physiological dilatation (PA increased, constriction and dilatation activated); some central mechanisms were thought to contribute to this. Four patients showed normal patterns.As the state of PKD became more severe or the duration longer, the number of patients in the cholinergic state decreased and that with other reflex patterns (cholinolytic state or physiological dilatation) increased. Supersensitivity to cholinergics was prominent in the Yahrs 2nd grade patients, although supersensitivity to adrenergics was detected only in the 3rd grade patients. Drug medication had no sta...

Oval pupil in patients with diabetes mellitus : examination by measurement of the dark-adapted pupillary area and pupillary light reflex

Determination of the dark-adapted pupillary area (DAPA) by infrared photography revealed that some diabetic patients show corectopia (oval pupil) in addition to the small DAPA as pupillary abnormalities. The prevalence and clinical details of oval pupil were compared between diabetic patients and healthy subjects. Pupillary light reflexes were also analyzed with an infrared videopupillography in some of the diabetic patients. The healthy subjects were examined for the influence of age on the ratio of the pupillary diameter of the major and minor axes. The ratio was 1.04 +/- 0.02 (mean +/- S.D.) in the healthy subjects, and cases in which the ratio was +2 S.D. or higher than the mean ratio were defined as oval pupil. Oval pupil was observed in 21 (24%) of 86 diabetic patients, and was correlated with heart rate variation (P < 0.05) and DAPA (P < 0.01), which represent an autonomic dysfunction. Quantitative analysis of pupillary light reflexes with an infrared videopupillography revealed that the dark-adapted pupillary area before photic stimulation (P < 0.01) and the maximum %-velocity of constriction (P < 0.05) were significantly less in the oval pupil group than in the round pupil group. Cranial magnetic resonance imaging revealed no abnormalities in the oval pupil group. From these results, a peripheral autonomic disorder was implicated in the etiology of oval pupils in diabetic patients.

Abnormalities of visual-evoked potentials and pupillary light reflexes in a family with autosomal dominant occult macular dystrophy

Occult macular dystrophy (OMD) is an unusual inherited or sporadic macular dystrophy characterized by an essentially normal appearing ocular fundus and normal ocular circulation determined by fluorescein angiography but with a progressive decrease of visual acuity. We present a family with OMD who have a delay in the implicit times of both the visual‐evoked potentials and the pupillary light reflexes. Because these delays are usually indicative of optic nerve disorders, deciding on a diagnosis between OMD and optic nerve disorder should be done carefully. We are not aware of any studies that have reported these findings in patients with OMD.

Incidence of side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in Japanese children: a multicenter study

PurposeTo investigate the incidence rate and side effects of topical atropine sulfate and cyclopentolate hydrochloride for cycloplegia in children aged 15 years or under.MethodsThis prospective study had been conducted at 9 institutions between April 1, 2016 and March 31, 2017 in patients 15 years old or younger who received either atropine or cyclopentolate for refraction assessment. The investigation included patient’s age, symptoms, and whether patients with side effects had any systemic diseases.ResultsA total of 811 patients (mean age ± SD, 4.6 ± 2.2 years) received atropine and 71 (8.8%) patients had side effects. Except in patients under two years old, 1% eye drops showed higher incidence rate of side effects than 0.5% and 0.25% eye drops. Side effects most frequently occurred following the initiation of the instillation on the first day. The symptoms included flush (29/71, 40.8%), fever (21/71, 30.0%), and both (11/71, 15.5%). A total of 2238 patients (5.7 ± 3.0 years) used cyclopentolate and 27 (1.2%) (4.0 ± 2.2 years) patients had side effects. The symptoms included drowsiness (10/27, 37.0%), red eye (4/27, 14.8%), fever (3/27, 11.1%), and flush (3/27, 11.1%).ConclusionsAtropine has a side effect incidence rate 7 times higher than the incidence rate of cyclopentolate. Flush and fever are the most common side effects of atropine and drowsiness is the main side effect of cyclopentolate. These findings should be noted when examining cycloplegic refraction to manage amblyopia and strabismus in children.

Shift of temporal responsivity curve of pattern reversal visually evoked potentials to lower frequencies in patients after recovery from optic neuritis

Purpose:  To investigate the responsivity of the visual system to pattern reversal stimuli of different reversal rates in optic neuritis patients after a full recovery of visual acuity.

Importance of unilateral occlusion in examination of the pupillary light reflex in an aged patient with large-angle exophoria-tropia

We report on a 60-year-old man, who was referred with a suspected absence of light reflex in his left eye. Exophoria-tropia with a large angle of deviation was found during the alternating prism cover test. The range of eye movement was normal. On macroscopic examination, both pupils appeared to be miotic and the light reflex was prompt, but incomplete. When one eye was occluded, the patients miosis disappeared and the light reflex became prompt and complete, i.e., normal. Since he subconsciously performed convergence to achieve a phoric position and gradually noted asthenopia, he underwent strabismus surgery for his exophoria-tropia. After surgery, his pupils were normal even in the binocular state. Therefore, doctors should pay attention to the pupillary findings in elderly patients with comparatively large-angle exophoria-tropia, because their pupils falsely appear to be miotic (phoria-miosis) with a reduced or absent light reflex in the orthophoric position.