Effect of oral donepezil on intraocular pressure in normotensive Alzheimer patients

Donepezil, a selective acetylcholinesterase (AChE) inhibitor, has been shown to reduce intraocular pressure (IOP) in ocular normotensive rabbit eyes. The aim of this investigation was to evaluate the effect of oral donepezil on IOP and pupil diameter after mid-term oral treatment in normotensive persons. Thirty-two newly diagnosed Alzheimer patients with normal IOP and no further antiglaucomatous treatment were included in the study. IOP and pupil diameter were evaluated before and 4 weeks after daily intake of 5 mg donepezil. IOP and pupil diameter were significantly lower/smaller after 4 weeks of treatment. The mean IOP of all 63 eyes was 14.1 mmHg before and 12.8 mmHg after treatment (8.8% reduction). Mean pupil diameter constricted from 3.9 to 3.6 mm (-7.4%). These findings show that donepezil, and, possibly, other selective AChE inhibitors, can potentially be used to treat glaucoma. They are also known to have neuroprotective effects in Alzheimer's, and, therefore, might have an additional therapeutic benefit.

Outcome after acute traumatic subdural and epidural haematoma in Switzerland: a single-centre experience

BACKGROUND: Acute epidural and subdural haematomas remain among the most common causes of mortality and disability resulting from traumatic brain injury. In the last three decades improvements in rescue, neuromonitoring and intensive care have led to better outcomes. The purpose of this study was to evaluate the impact of these strategies on outcome in patients treated in a single institution in Switzerland. METHODS: A total of 76 consecutive patients who underwent emergency craniotomy for acute traumatic epidural and subdural haematoma at University Hospital Bern between January 2000 and December 2003 were included in this study. RESULTS: Thirty-seven patients presented with an epidural haematoma and 46 with a subdural haematoma. In seven patients both haematomas could be documented. The median age was 54 years (IQR 28). The median initial GCS score was 7 (IQR 6). The median time from primary injury to surgery was 3 hours (IQR 2.5 hours). The median stay in the ICU was 3 days (IQR: 3 days). The outcome was favourable (GOS 4 and 5) in 43 patients (57%). Thirteen patients (17%) remained severely or moderately disabled (GOS 3). Finally, a total of 21 patients (28%) died or remained in a persistent vegetative state (GOS 1 and 2). Mortality was 41% for acute subdural haematoma (19/46) and 3% (1/37) for patients with epidural haematoma. Only age, GCS at admission and pupil abnormalities seemed to be associated with outcome. Time to surgery was not. CONCLUSION: In patients admitted with acute traumatic epidural and subdural haematomas that are treated within a median of 3 hours after primary injury, factors such as age, initial GCS and pupil abnormalities still appear to be the most important factors correlating with outcome.

Effects of anxiety on decision making and visual search behaviour in complex sport situations

Based on the Attentional Control Theory (ACT; Eysenck et al., 2007), performance efficiency is decreased in high-anxiety situations because worrying thoughts compete for attentional resources. A repeated-measures design (high/low state anxiety and high/low perceptual task demands) was used to test ACT explanations. Complex football situations were displayed to expert and non-expert football players in a decision making task in a controlled laboratory setting. Ratings of state anxiety and pupil diameter measures were used to check anxiety manipulations. Dependent variables were verbal response time and accuracy, mental effort ratings and visual search behavior (e.g., visual search rate). Results confirmed that an anxiety increase, indicated by higher state-anxiety ratings and larger pupil diameters, reduced processing efficiency for both groups (higher response times and mental effort ratings). Moreover, high task demands reduced the ability to shift attention between different locations for the expert group in the high anxiety condition only. Since particularly experts, who were expected to use more top-down strategies to guide visual attention under high perceptual task demands, showed less attentional shifts in the high compared to the low anxiety condition, as predicted by ACT, anxiety seems to impair the shifting function by interrupting the balance between top-down and bottom-up processes.

Pupillometry: the eyes shed fresh light on the mind

Recent studies provide promising methodological advances in the use of pupillometry as on-line measurement of cognitive processes and show that visual attention allocation, mind-wandering, mental imagery, and even rhyme expectations can influence the size of the human pupil.

Ophthalmic complications and local anesthesia. Pathophysiology and types of eye complications after intraoral dental anesthesia, and clinical recommendations

The present article reviews the different types of ophthalmologic complications following administration of intraoral local anesthesia. Since the first report by Brain in 1936, case reports about that topic have been published regularly in the literature. However, clinical studies evaluating the incidence of ophthalmologic complications after intraoral local anesthesia are rarely available. Previous data point to a frequency ranging from 0.03% to 0.13%. The most frequently described ophthalmologic complications include diplopia (double vision), ptosis (drooping of upper eyelid), and mydriasis (dilatation of pupil). Disorders that rather affect periorbital structures than the eye directly include facial paralysis and periorbital blanching (angiospasm). Diverse pathophysiologic mechanisms and causes have been reported in the literature, with the inadvertent intravascular administration of the local anesthetic considered the primary reason. The agent as well as the vasopressor is transported retrogradely via arteries or veins to the orbit or to periorbital structures (such as the cavernous sinus) with subsequent anesthesia of nerves and paralysis of muscles distant from the oral cavity. In general the ophthalmologic complications begin shortly after administration of the local anesthesia, and disappear once the local anesthesia has subsided.

Shaping the PSF to nearly top-hat profile: CHEOPS laboratory results

Spreading the PSF over a quite large amount of pixels is an increasingly used observing technique in order to reach extremely precise photometry, such as in the case of exoplanets searching and characterization via transits observations. A PSF top-hat profile helps to minimize the errors contribution due to the uncertainty on the knowledge of the detector flat field. This work has been carried out during the recent design study in the framework of the ESA small mission CHEOPS. Because of lack of perfect flat-fielding information, in the CHEOPS optics it is required to spread the light of a source into a well defined angular area, in a manner as uniform as possible. Furthermore this should be accomplished still retaining the features of a true focal plane onto the detector. In this way, for instance, the angular displacement on the focal plane is fully retained and in case of several stars in a field these look as separated as their distance is larger than the spreading size. An obvious way is to apply a defocus, while the presence of an intermediate pupil plane in the Back End Optics makes attractive to introduce here an optical device that is able to spread the light in a well defined manner, still retaining the direction of the chief ray hitting it. This can be accomplished through an holographic diffuser or through a lenslet array. Both techniques implement the concept of segmenting the pupil into several sub-zones where light is spread to a well defined angle. We present experimental results on how to deliver such PSF profile by mean of holographic diffuser and lenslet array. Both the devices are located in an intermediate pupil plane of a properly scaled laboratory setup mimicking the CHEOPS optical design configuration. © (2014) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.