Parasympathetic denervation of the ciliary muscle following retinal photocoagulation.

Cynomolgus monkeys underwent unilateral PRP with xenon arc or argon or krypton laser light, employing burn intensity, size, spacing, and topography analogous to standard clinical (eg, Diabetic Retinopathy Study) treatment. Shortly thereafter, accommodative responsiveness to topical eserine and electrical stimulation of the EWN was diminished, accommodative responsiveness to systemic pilocarpine was enhanced, and the number of muscarinic receptors in the ciliary muscle was reduced in the PRP-treated eyes compared to the contralateral controls. In most instances, these parameters returned to normal over 6 to 12 weeks and the abnormalities could be induced again by another round of PRP. However, in some PRP-treated eyes, accommodative responsiveness to EWN stimulation and topical eserine remained subnormal permanently (greater than 1 year). Light and electron microscopy of the ciliary muscle and choroid confirmed the early interruption and degeneration and the subsequent regeneration of the intraocular parasympathetic nerves following PRP. These findings are similar to those seen after surgical removal of the ciliary ganglion and posterior ciliary nerves, and indicate that PRP produces an intraocular parasympathetic denervation of the ciliary muscle. This phenomenon may explain the loss of voluntary accommodation which can follow PRP in prepresbyopic humans. Three cynomolgus monkeys underwent nasal and temporal HRMP in one eye with the argon laser. One to four weeks later, accommodative responses to IM pilocarpine, topical eserine, and electric stimulation of the EWN did not differ markedly in the treated and control eyes. Five weeks after HRMP, posterior PRP was performed in the same eye, sparing the previously treated areas. One to four weeks later, accommodative responses in the PRP-treated eyes were clearly subsensitive to central electrical stimulation, but supersensitive to IM pilocarpine, compared to the contralateral controls. These findings indicate that extensive parasympathetic denervation of the ciliary muscle occurs following PRP but not following HRMP. Consequently, we infer that parasympathetic motor nerve fibers to the ciliary muscle do not travel preferentially with the LPCN, but rather travel primarily if not exclusively with the more numerous SPCN. If the monkey and the human are comparable, sparing the horizontal retinal meridians during clinical PRP so as not to disturb the LPCN will probably not help to preserve ciliary muscle function and accommodation.