Abstract
Purpose
To evaluate the effect of topical tropicamide 1% and phenylephrine 2.5% instillation on macular and peripapillary microvasculature measurements with optical coherence tomography angiography (OCTA).
Methods
Forty eyes of 40 consecutive healthy adults with no known systemic or ocular disease were recruited for this prospective consecutive case study. After complete ophthalmological examination, all patients underwent OCTA measurements (OptoVue Inc, Freemont, CA, USA) to assess foveal avascular zone (FAZ) area, FAZ perimeter, acircularity index of FAZ, foveal density, vessel density of superficial and deep capillary plexus and peripapillary capillary plexus. 6 × 6 mm macular and 4.5 × 4.5 mm peripapillary OCTA images were undertaken before and 30 min after instillation of tropicamide (20 eyes) or phenylephrine (20 eyes) instillation to the right eye, and these were compared to each other and to fellow control eye.
Results
15 male and 25 female patients with a mean age of 43.3 (18–60) years were recruited for the study. Superficial, deep and peripapillary capillary plexus measurements of tropicamide 1% and phenylephrine 2.5% instilled right eyes and left control eyes were similar before and 30 min after instillation (P > 0.05 for all). FAZ assessment tool variables were also similar before and after instillation (P > 0.05 for all) for both eyes.
Conclusion
Topical pupillary dilatation with tropicamide 1% and phenylephrine 2.5% did not affect macular and peripapillary OCTA measurements. Follow-up OCTA images in retina and glaucoma patients can be captured with a dilated or undilated pupil which seems not to be affected by tropicamide or phenylephrine.
Similar content being viewed by others
References
Haddad NJ, Moyer NJ, Riley FC Jr (1970) Mydriatic effect of phenylephrine hydrochloride. Am J Ophthalmol 70(5):729–733
Banaee T, Ansari-Astaneh MR, Pourreza H, Faal Hosseini F, Vatanparast M, Shoeibi N et al (2017) Utility of 1% tropicamide in improving the quality of images for tele-screening of diabetic retinopathy in patients with dark irides. Ophthalmic Epidemiol 24(4):217–221
Gettes BC (1961) Tropicamide, a new cycloplegic mydriatic. Arch Ophthalmol 65:632–635
Ostrin LA, Glasser A (2004) The effects of phenylephrine on pupil diameter and accommodation in rhesus monkeys. Invest Ophthalmol Vis Sci 45(1):215–221
Van Buskirk EM, Bacon DR, Fahrenbach WH (1990) Ciliary vasoconstriction after topical adrenergic drugs. Am J Ophthalmol 109(5):511–517
Takayama J, Mishima A, Ishii K (2004) Effects of topical phenylephrine on blood flow in the posterior segments of monkey and aged human eyes. Jpn J Ophthalmol 48(3):243–248
Takayama J, Mayama C, Mishima A, Nagahara M, Tomidokoro A, Araie M (2009) Topical phenylephrine decreases blood velocity in the optic nerve head and increases resistive index in the retinal arteries. Eye (Lond) 23(4):827–834
Vandewalle E, Abegao Pinto L, Olafsdottir OB, Stalmans I (2013) Phenylephrine 5% added to tropicamide 0.5% eye drops does not influence retinal oxygen saturation values or retinal vessel diameter in glaucoma patients. Acta Ophthalmol. 91(8):733–737
Sambhav K, Grover S, Chalam KV (2017) The application of optical coherence tomography angiography in retinal diseases. Surv Ophthalmol 62(6):838–866
Koustenis A Jr, Harris A, Gross J, Januleviciene I, Shah A, Siesky B (2017) Optical coherence tomography angiography: an overview of the technology and an assessment of applications for clinical research. Br J Ophthalmol 101(1):16–20
Hwang TS, Jia Y, Gao SS, Bailey ST, Lauer AK, Flaxel CJ et al (2015) Optical coherence tomography angiography features of diabetic retinopathy. Retina 35(11):2371–2376
Triolo G, Rabiolo A, Shemonski ND, Fard A, Di Matteo F, Sacconi R et al (2017) Optical coherence tomography angiography macular and peripapillary vessel perfusion density in healthy subjects, glaucoma suspects, and glaucoma patients. Invest Ophthalmol Vis Sci 58(13):5713–5722
Waheed NK, Moult EM, Fujimoto JG, Rosenfeld PJ (2016) Optical coherence tomography angiography of dry age-related macular degeneration. Dev Ophthalmol 56:91–100
Kashani AH, Lee SY, Moshfeghi A, Durbin MK, Puliafito CA (2015) Optical coherence tomography angiography of retinal venous occlusion. Retina 35(11):2323–2331
Camino A, Jia Y, Yu J, Wang J, Liu L, Huang D (2019) Automated detection of shadow artifacts in optical coherence tomography angiography. Biomed Opt Express 10(3):1514–1531
Cheng J, Yu J, Jiang C, Sun X (2017) Phenylephrine affects peripapillary retinal vasculature-an optic coherence tomography angiography study. Front Physiol 8:996
Hohberger B, Muller M, Hosari S, Mardin CY (2019) OCT-angiography: mydriatic phenylephrine and tropicamide do not influence retinal microvasculature in macula and peripapillary region. PLoS ONE 14(10):e0221395
Vuori ML, Kaila T, Iisalo E, Saari KM (1994) Systemic absorption and anticholinergic activity of topically applied tropicamide. J Ocul Pharmacol 10(2):431–437
Vaajanen A, Vapaatalo H (2017) A single drop in the eye—effects on the whole body? Open Ophthalmol J 11:305–314
Harazny JM, Schmieder RE, Welzenbach J, Michelson G (2013) Local application of tropicamide 0.5% reduces retinal capillary blood flow. Blood Press 22(6):371–376
Frost S, Gregory C, Robinson L, Yu S, Xiao D, Mehdizadeh M et al (2019) Effect of pupil dilation with tropicamide on retinal vascular caliber. Ophthalmic Epidemiol 26(6):400–407.
Stavert B, McGuinness MB, Harper CA, Guymer RH, Finger RP (2015) Cardiovascular adverse effects of phenylephrine eyedrops: a systematic review and meta-analysis. JAMA Ophthalmol 133(6):647–652
Brucher VC, Storp JJ, Kerschke L, Nelis P, Eter N, Alnawaiseh M (2019) Influence of mydriasis on optical coherence tomography angiography imaging in patients with age-related macular degeneration. PLoS ONE 14(10):e0223452
Funding
No financial support was received for this submission.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
None of the authors has conflict of interest with the submission.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Özdemir, H.B., Şekeroğlu, M.A. The effect of topical tropicamide and phenylephrine on macular and peripapillary microvasculature: an optical coherence tomography angiography study. Int Ophthalmol 40, 1969–1976 (2020). https://doi.org/10.1007/s10792-020-01371-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10792-020-01371-y