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Intraocular Carbonic Anhydrase Inhibitor


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41. Glaucoma (primary open angle)

of POAG Determination of the individual clinical management plan Reduce IOP pharmacologically taking into account: estimated target IOP for the individual patient likely degree of compliance (the simpler, the better) side effects, contra-indications and drug interactions Most POAG is treated with eye drops prostaglandin analogues are first choice beta-blockers are second choice (relatively high incidence of unwanted effects) other choices are carbonic anhydrase inhibitors and alpha agonists Selective (...) Laser Trabeculoplasty (SLT) is increasingly used as a first line treatment systemic treatment for POAG is rarely needed. Long-term therapy with oral carbonic anhydrase inhibitors may be necessary in a few refractory cases but drug intolerance is common Surgery (incisional or non-incisional) may be required Evidence base *GRADE: Grading of Recommendations Assessment, Development and Evaluation ( ) Sources of evidence Garway-Heath DF, Crabb DP, Bunce C, Lascaratos G, Amalfitano F, Anand N, Azuara

2018 College of Optometrists

42. CRACKCast E071 – Ophthalmology Part B

if: >50%, decreased VA, increased IOP, sickle cell disease g. “really big, really bad, gonna pop, or patient factors” Treatment (if no sickle cell disease) Topical beta blocker Topical alpha-agonist / carbonic anhydrase inhibitor Acetazolamide or IV mannitol +/- Cycloplegics and steroids At risk for: Rebleeding in 2-5 days Corneal blood staining Glaucoma (due to angle recession) Synechia formation Those with hemoglobinopathies: Sickle cell disease / trait ; thalassemia are at increased risk (...) artery and optic nerve Signs Proptosis Limited EOM Visual loss Increased IOP ***Don’t wait for a CT scan if you are suspicious***** Treatment: Carbonic anhydrase inhibitor Topical beta blockers Mannitol 1-2 g/kg LATERAL CANTHOTOMY The procedure: Ensure the patient has one of the absolute / relative indications for this procedure DIP A CONE Informed consent Don PPE Wash the area with saline 1-3 ml 1% lidocaine with epi. Into the lateral canthus (consider light procedural sedation) Devascularize

2017 CandiEM

43. CRACKCast E071 – Ophthalmology Part A

progressing, chronic, bilateral, painless Advance disease before symptoms occur Symptoms: Peripheral to central visual field loss Change in optic cup ratios Treatment: Argon laser trabeculoplasty Filtration surgery Topical BB Selective alpha 2 receptor agonists Carbonic anhydrase inhibitors Prostaglandin agonists Miotics Sympathomimetics Complications: Systemic side effects from eye meds BB –> asthma, heart block, CHF, depression, hypoglycemia Adrenergics–>HTN, dysrhythmias, Carbonic anhydrase inhibitors (...) doesn’t make any difference If IOP > 50, consider: Drugs to cause diuresis Use IV osmotics (mannitol 1 g/kg IV) and acetazolamide (carbonic anhydrase inhibitor – 250 mg IV) and regular drugs If IOP < 50 Timolol 0.5% (dec. AQ production) Pilocarpine 1% (miotic agent) Apraclonidine 1% (alpha 2 agonist–dec. AQ humor production) Prednisolone 1% 12) List 10 ddx for acute painless visual loss Usually only affects one eye Sudden or over days Let’s go through the “list” Vascular occlusion Central retinal

2017 CandiEM

44. Management of Glaucoma

) 8. REHABILITATION 29 9. REFERRAL 30 10. SPECIAL CONDITIONS 31 10.1 Ocular Hypertension 31 10.2 Primary Open Angle Glaucoma Suspect 33 10.3 Steroid-Induced Glaucoma 34 10.4 Neovascular Glaucoma 34 10.5 Intraocular Pressure Monitoring in 35 Post-Refractive Surgery Cases 11. IMPLEMENTING THE GUIDELINES 37 11.1 Facilitating and Limiting Factors 37 11.2 Potential Resource Implications 37 REFERENCES 39 Appendix 1 Example of Search Strategy 45 Appendix 2 Clinical Questions 46 Appendix 3 Van Herick Test (...) • Glaucoma diagnosis should be made based on combination of history (with presence of risk factors), ocular examination and investigation. Recommendation 4 • Medical treatment in glaucoma should be individualised based on patient’s characteristics and drug factors, and adjusted according to target intraocular pressure (IOP). • Prostaglandin analogues should be used as first-line treatment in glaucoma. • Patient education should be given to patients with glaucoma. This includes benefits and side effects

2017 Ministry of Health, Malaysia

45. Medical Concepts: Acute Angle Closure Glaucoma

outflow. Steroids – Prednisolone Acetate is the steroid most commonly used in the treatment of angle closure glaucoma. These agents help to reduce intraocular inflammation and in doing so, help to minimize the damage to the optic nerve. Systemic Agents Carbonic Anhydrase Inhibitors – Acetazolamide is the typical agent used, and functions by reducing the production of aqueous humor through the inhibition of the enzyme carbonic anhydrase. These agents are contraindicated in patients with a sulfonamide (...) allergy, sickle cell anemia, renal failure, and Addison’s disease. In addition, it is important to be aware that these agents may cause a metabolic acidosis, since this enzyme normally causes the dehydration of carbonic acid. As such, caution must be exercised in people with diabetes, liver disease, and COPD. 5 Hyperosmotic Agents – Depending on the agent used, these can be administered either orally or intravenously. These agents decrease the intraocular pressure by causing an osmotic diuresis

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2016 CandiEM

46. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

. Hypertension 111 Q8.5. Cardiovascular disease and arrhythmia 113 Q8.6. Depression with or without selective serotonin reuptake inhibitors 115 Q8.7. Anxiety 118 Q8.8. Psychotic disorders with or without medications (lithium, atypical antipsychotics, monoamine oxidase inhibitors) 119 Q8.9. Eating disorders including binge eating disorder 121 Q8.10. Glaucoma 123 Q8.11. Seizure disorder 124 Q8.12. Pancreatitis 124 Q8.13. Opioid use 125 Q8.14. Women of reproductive potential 126 Q8.15. The elderly, age =65 (...) tolerance; ILI = intensive lifestyle intervention; IVF = in vitro fertiliza- tion; LAGB = laparoscopic adjustable gastric banding; LDL-c = low-density lipoprotein cholesterol; LES = lower esophageal sphincter; LSG = laparoscopic sleeve gastrectomy; LV = left ventricle; LVH = left ventricu- lar hypertrophy; LVBG = laparoscopic vertical banded gastroplasty; MACE = major adverse cardiovascular events; MAOI = monoamine oxidase inhibitor; MI = myocardial infarction; MNRCT = meta-analysis of non-randomized

2016 American Association of Clinical Endocrinologists

47. Glaucoma

the outside of the eye. The trabecular meshwork is situated in the apex of the anterior chamber angle and is the main outflow route for aqueous humour. Aqueous humour Aqueous humour is the fluid produced from plasma by the ciliary epithelium of the ciliary body (the circular structure just behind the iris). The enzyme carbonic anhydrase plays a key role in its production. Aqueous humour is secreted into the posterior chamber which is the relatively small fluid-filled space between the lens and iris (...) Glaucoma Glaucoma - NICE CKS Share Glaucoma: Summary Glaucoma is a group of eye diseases that cause progressive optic neuropathy. Glaucoma is commonly associated with raised intraocular pressure (IOP) and characterized by: Visual field defects. Changes to the optic nerve head such as pathological cupping or pallor of the optic disc. Ocular hypertension is consistently or recurrently raised IOP but with no signs of glaucoma. It affects 3-5% of people in the UK over 40 years. It requires

2019 NICE Clinical Knowledge Summaries

48. Oculohypotensive effects of various acetozolamide nanopreparations for topical treatment of animal model-induced glaucoma and their impact on optic nerve. (PubMed)

Oculohypotensive effects of various acetozolamide nanopreparations for topical treatment of animal model-induced glaucoma and their impact on optic nerve. Acetozolamide-ACZ, carbonic anhydrase inhibitor- is still the most effective systemic drug for glaucoma treatment. Due to its limited ocular bioavailability, topical formulations are not available yet. This study introduces within the framework of nanotechnology three nanopreparations of acetozolamide for topical application, one of them (...) is liposomal phospholipid vehicle and the other two preparations are propolis and Punica granatum (pomegranate). The hypotensive effect of these different nanopreparations in lowering the increased intraocular pressure that was induced in experimental rabbits is monitored for 130 hrs. Structural characteristics of the optic nerve dissected from all involved groups were studied by Fourier transfrom infrared spectroscopy. The obtained results indicate the impact of the topically applied acetozolamide

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2019 PLoS ONE

49. Prevalence of depression and anxiety among participants with glaucoma in a population-based cohort study: The Gutenberg Health Study. (PubMed)

with depression, respectively anxiety as dependent variable and self-reported glaucoma as independent variable were conducted and adjusted for socio-demographic factors, systemic comorbidities (arterial hypertension, myocardial infarction, stroke, diabetes mellitus, chronic obstructive pulmonary disease, cancer), ocular diseases (cataract, macular degeneration, corneal diseases, diabetic retinopathy), visual acuity, intraocular pressure, antiglaucoma eye drops (sympathomimetics, parasympathomimetics, carbonic (...) anhydrase inhibitors, beta-blockers, prostaglandins) and general health status.293 participants (49.5% female) reported having glaucoma. Prevalence of depression among participants with and without self-reported glaucoma was 6.6% (95%-CI 4.1-10.3) respectively 7.7% (95%-CI 7.3-8.2), and for anxiety 5.3% (95%-CI 3.1-8.7) respectively 6.6% (95%-CI 6.2-7.1). Glaucoma was not associated with depression (Odds ratio 1.10, 95%-CI 0.50-2.38, p = 0.80) or anxiety (1.48, 95%-CI 0.63-3.30, p = 0.35) after

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2018 BMC Ophthalmology

50. Surgical Idiopathic Intracranial Hypertension Treatment Trial

Research: headache idiopathic intracranial hypertension (IIH) shunt fenestration acetazolamide visual loss diamox Additional relevant MeSH terms: Layout table for MeSH terms Hypertension Intracranial Hypertension Pseudotumor Cerebri Vascular Diseases Cardiovascular Diseases Brain Diseases Central Nervous System Diseases Nervous System Diseases Acetazolamide Anticonvulsants Carbonic Anhydrase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Diuretics Natriuretic Agents (...) (s) Eye Level Exclusion Criteria Exclusion Intraocular pressure currently >28 mm Hg or >30 mm Hg at any time in the past Refractive error of more than -6.00 or more than +6.00 sphere or more than 3.00 cylinder with the following exceptions: Eyes with more than 6.00 D of myopia but less than 8.00 D of myopia are eligible if: 1) there are no abnormalities on ophthalmoscopy related to myopia that are associated with visual loss (such as staphyloma, retinal thinning in the posterior pole, or more

2018 Clinical Trials

51. Efficacy and Safety of Lens Extraction in Patients With Pseudoexfoliation Glaucoma

will be indicated to achieve an target IOP. Drug: MEDICAL GLAUCOMA TREATMENT The escalation of topical hypotensive medications will be carried out with the following sequence: 1. single topical medication; 2. double topical therapy; 3. triple topical therapy. Beginning, with the exception of individual contraindications, with prostaglandin analogs, followed by topical beta-blockers, carbonic anhydrase inhibitors and finally alpha-agonists.Target IOP will be used in both groups to inform the need of escalation (...) clinical trial to evaluate the efficacy of cataract surgery in reducing the intraocular pressure (IOP) at 12 months and thereby change the course of the disease. The control group will have glaucoma treatment according to standard practice. Condition or disease Intervention/treatment Phase Pseudoexfoliation Glaucoma Intraocular Pressure Procedure: PHACOEMULSIFICATION Drug: MEDICAL GLAUCOMA TREATMENT Not Applicable Study Design Go to Layout table for study information Study Type : Interventional

2018 Clinical Trials

52. Trends in the characteristics of vitrectomy in Eastern China (PubMed)

). The proportion of PPV that was combined with lens extraction and intraocular lens (IOL) implantation increased significantly from 12.81% in 2007 to 25.95% by 2015 (P<0.001). The proportions of patients treated with IOP-lowering drugs in 2007, 2011, and 2015 were 27.40%, 38.20%, and 12.60%, respectively (P<0.001). In 2007, systemic carbonic anhydrase inhibitors (CAI-Ss) and beta blockers (BBs) were the two main types of prophylactic IOP-lowering drugs administered, but their use had decreased in 2015 (P<0.001 (...) ). The preventive use of adrenergic agonists (AAs), topical carbonic anhydrase inhibitors (CAI-Ts), and prostaglandin analogs (PGAs) became increasingly frequent from 2007 to 2015 (P<0.05).The 23-gauge system, rather than the 20-gauge system, had become the mainstream PPV instrument by 2015. The proportion of macular disease patients requiring PPV in China clearly increased, and the rate of prophylactic IOP-lowering drug use decreased by 2015.

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2018 Clinical ophthalmology (Auckland, N.Z.)

53. Determinants of Corneal Endothelial Cell Loss After Trabeculectomy with Mitomycin C. (PubMed)

% (4.7%) in eyes with XFG and UG, respectively, which was significantly greater than 4.8% (1.8%) in eyes with primary open-angle glaucoma (P<0.001, each), after accounting for the variability in the number and timepoint of ECD measurements. Multivariate mixed-effects model analyses showed that type of glaucoma (XFG and UG) and older age were significantly associated with larger ECD decrease, and preoperative factors (oral carbonic anhydrase inhibitor and vitrectomy) and postoperative choroidal (...) with the preoperative ECD and risk factors for ECD decrease were analyzed using mixed-effects models.In total, 162 eyes of 136 patients were included in this study. Postoperative ECD measurements were performed 3.7±1.8 times (mean±SD) during a median follow-up period of 34 months. The mean intraocular pressure decreased from 25.3±9.6 to 9.2±2.3 mm Hg postoperatively. The marginal mean (SE) ECD decrease at 24 months was 9.3% (1.3%) in all cases. The marginal mean ECD decrease at 24 months was 18.2% (3.1%) and 20.6

2018 Journal of Glaucoma

54. Intravitreal Ranibizumab (Lucentis®) in the Treatment of Non-leaking Macular Cysts in Retinal Dystrophy

and non-leaking macular cysts between Jan 2015 and July 2018 in 1 center. Methods - Phase 1: Patients with best corrected visual acuity (BCVA) < 0.5 will receive carbonic anhydrase inhibitors (CAI) [oral acetazolamide 500mg/day or topical brinzolamide twice daily] and followed up for three months. Phase 2: Patients who do not show an adequate response with CAI will receive three 0.5mg IVR injection at monthly intervals. Outcome - 1) Significant reduction (> 10%) of the central macular thickness (CMT (...) ), 2) Improvement (> 1 line) in BCVA 3) Presence of any complication. Condition or disease Intervention/treatment Phase Retinal Dystrophies Drug: Intravitreal ranibizumab (IVR) injection Drug: Carbonic Anhydrase Inhibitor (CAI) therapy Phase 2 Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial) Estimated Enrollment : 10 participants Allocation: Non-Randomized Intervention Model: Sequential Assignment Intervention Model Description: Phase 1: Patients

2018 Clinical Trials

55. Comparison of Efficacy and Safety of Mitomycin and Aflibercept Used to Support Primary Trabeculectomy.

Ages Eligible for Study: 40 Years and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Primary open-angle glaucoma or capsular glaucoma. Patient's age: over 40 years, no sex preference; Local treatment ineffective due to: Intraocular pressure above 21mmHg at maximum pharmacological therapy (using β-blocker + carbonic anhydrase inhibitor + prostaglandins) or Intolerance to topical treatment or Progression in visual field examination (...) , describing bleb height, extent, vascularity, and leakage with the Seidel test. Effectiveness of aflibercept and mitomycin on the function of the bleb; [ Time Frame: 1 year ] Measurement of intraocular pressure (Goldmann applanation tonometer) and taking a photo of a bleb. Secondary Outcome Measures : Impact of tested substances on visual acuity after surgery [ Time Frame: 1 year ] Examination of a visual acuity 1 week after operation as well as 1 month, 3 months, 6 months, 12 months The influence

2018 Clinical Trials

56. High intensity focused ultrasound cyclocoagulation in dogs with primary glaucoma: a preliminary study (PubMed)

, corresponding to their pre-operative IOP (group 1 ranging from 21 to 30 mm Hg, group 2 from 31 to 40 and group 3 for 40 and above). Ciliary process sonication was achieved with a probe containing one high-frequency transducer operating at 21 MHz during 5 seconds. Six sites were treated in patients from group 1, 8 in group 2, 10 in group 3, under general anesthesia. Post-operative treatment consisted of systemic meloxicam and topical carbonic anhydrase inhibitors, beta-blockers and prostaglandins analogues (...) High intensity focused ultrasound cyclocoagulation in dogs with primary glaucoma: a preliminary study The objective was to assess the effect of high intensity focused ultrasound (HIFU) on intraocular pressure (IOP) in dogs with primary glaucoma (PG). Seven dogs (13 eyes) presenting with PG as diagnosed by a raised IOP (> 20 mm Hg) associated with consistent gonioscopy and ultrasound biomicroscopy of the ciliary cleft, with no other ocular disease. Patients were divided into 3 groups

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2018 Open veterinary journal

57. The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma

pressure of 21mmHg and six month eye tests; and timolol first-line medication, an initial target pressure of 21mmHg and 24 month eye tests. Medication switching occurred when side-effects were reported at follow-up visits and included the choice of timolol, latanoprost, dorzolamide (carbonic anhydrase inhibitor) and brimonidine (alpha-adrenergic agonist). Location/setting The Netherlands/secondary care. Methods Analytical approach: A discrete event simulation was used to simulate the lifetime health (...) abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The study evaluated the long-term health and cost-effectiveness of various strategies for the treatment of primary open-angle glaucoma. The authors concluded that aiming for a low intraocular pressure in all glaucoma patients was optimal and that initial treatment with latanoprost was also an acceptable cost

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2012 NHS Economic Evaluation Database.

58. Latanoprost versus timolol as first choice therapy in patients with ocular hypertension

anhydrase inhibitors). Patients could switch between treatments if there were side effects or limited treatment effect. Location/setting The Netherlands/secondary care. Methods Analytical approach: The analysis was based on a two-part decision model. The first part was a decision tree that covered the first 15 months of therapy, which used a Monte Carlo simulation to sample age and initial intraocular pressure of the patient cohort. The second part was a Markov model with six-month cycles (...) -effectiveness of first-line treatment with either latanoprost or timolol for the management of ocular hypertension. Interventions Treatment starting with latanoprost was compared with treatment starting with timolol. Further lines of treatment included monotherapy, combination therapy, and laser trabeculoplasty. Four drugs (representing major generic classes) were used: timolol (beta-blockers), latanoprost (hypotensive lipids), brimonidine (alpha2-adrenergic agonists), and dorzolamide (topical carbonic

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2012 NHS Economic Evaluation Database.

59. Dorzolamide-timolol in Combination With Anti-vascular Endothelial Growth Factor Injections for Wet Age-related Macular Degeneration

Substances Growth Inhibitors Ophthalmic Solutions Pharmaceutical Solutions Carbonic Anhydrase Inhibitors Enzyme Inhibitors (...) domain optical coherence tomography [ Time Frame: 18 weeks ] Change in mean maximum PED height on spectral domain optical coherence tomography from baseline to final visit. Visual acuity [ Time Frame: 18 weeks ] Change in mean best available visual acuity from baseline to final visit. Mean intraocular pressure (IOP) [ Time Frame: 18 weeks ] Change in mean IOP from baseline to final visit. Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study

2017 Clinical Trials

60. Comparison of Efficacy and Complications of Cyclophotocoagulation and Second Glaucoma Drainage Device after Initial Glaucoma Drainage Device Failure. (PubMed)

initial GDD, no light perception vision, or follow-up <1 year. Failure was defined as ≥1 of (1) reoperation for lowering IOP; (2) explantation of second GDD; (3) persistent hypotony; (4) use of oral carbonic anhydrase inhibitor for lowering IOP in the study eye; or (5) loss of light perception. Reoperation for lowering IOP included additional GDD implantation or additional cyclodestruction, except if additional cyclodestruction was within 6 months of the initial session.A total of 75 eyes (35 (...) Comparison of Efficacy and Complications of Cyclophotocoagulation and Second Glaucoma Drainage Device after Initial Glaucoma Drainage Device Failure. Compare intraocular pressure (IOP) control and complication rates of a second glaucoma drainage device (GDD) to diode transscleral cyclophotocoagulation (TSCPC) following failure of an initial GDD.Eyes with 1 GDD that required a second GDD or TSCPC for glaucoma control were included. Exclusion criteria were a cyclodestructive procedure before

2017 Journal of Glaucoma

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