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Intraocular Carbonic Anhydrase Inhibitor

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121. Glaucoma, Angle Recession (Treatment)

range of 25-28 mm Hg and/or when glaucomatous optic nerve or visual field changes are documented over time. After the diagnosis of angle recession is established, its management is similar to that of POAG, with a few special considerations. Use of topical aqueous suppressants in the initial medical treatment is preferred; these include beta-antagonists, alpha-agonists, and carbonic anhydrase inhibitors. Prostaglandin analogs, which increase uveoscleral outflow, have a theoretical benefit in angle (...) al. Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, widened angle recess, and higher baseline intraocular pressure. Arch Ophthalmol . 2008 Jul. 126(7):921-6. . Girkin CA, McGwin G Jr, Long C, Morris R, Kuhn F. Glaucoma after ocular contusion: a cohort study of the United States Eye Injury Registry. J Glaucoma . 2005 Dec. 14(6):470-3. . Ozer PA, Yalvac IS, Satana B, Eksioglu U, Duman S. Incidence and risk factors in secondary glaucomas after blunt

2014 eMedicine.com

122. Glaucoma, Complications and Management of Glaucoma Filtering (Treatment)

prescribe medications to lower IOP. Topical or oral medications, inserts (waferlike strips of medication that are put in the corner of the eye), or eye ointments can be used. Topical medications include the following: Miotics - Increase the outflow of aqueous humor from the eye Epinephrine compounds - Increase the outflow of aqueous humor from the eye Beta-blockers - Reduce the amount of aqueous humor produced in the eye Carbonic anhydrase inhibitors and alpha-adrenergic agonists - Reduce the amount (...) of aqueous humor produced in the eye Prostaglandin analogs - Increase the secondary uveoscleral route of aqueous humor outflow [ ] Oral medication can control IOP. Carbonic anhydrase inhibitors, which slow the production of aqueous humor in the eye, are the most common. Many of the same medications used to treat patients with open-angle glaucoma are used to treat patients with angle-closure glaucoma. Angle-closure glaucoma can cause IOP to rise quickly. To rapidly lower the pressure to prevent vision

2014 eMedicine.com

123. Posner-Schlossman Syndrome (Treatment)

the following: Topical NSAIDs - Diclofenac 0.1% 1 gtt TID/QID or equivalent plus Topical antiglaucoma drops - Timolol 0.25-0.5% 1 gtt BID, brimonidine 0.2% 1 gtt BID/TID, or dorzolamide 2% 1 gtt BID/TID The following can be considered: Topical steroids - Prednisolone acetate 1% 1 gtt QID Systemic carbonic anhydrase inhibitors - Acetazolamide 250 mg PO QID Oral NSAIDs - Indomethacin 75-150 mg/d PO Miotics and mydriatic agents are seldom used because they may have further deleterious effects on the blood (...) , Sears ML. Prostaglandin and eye. Prostaglandins . 1973 Aug. 4(2):157-75. . Eakins KE. Increased intraocular pressure produced by prostaglandins E1 and E2 in the cat eye. Exp Eye Res . 1970 Jul. 10(1):87-92. . Ohira S, Inoue T, Iwao K, Takahashi E, Tanihara H. Factors Influencing Aqueous Proinflammatory Cytokines and Growth Factors in Uveitic Glaucoma. PLoS One . 2016. 11 (1):e0147080. . Kandori M, Miyazaki D, Yakura K, Komatsu N, Touge C, Ishikura R, et al. Relationship between the number

2014 eMedicine.com

124. Pupillary Block, Pseudophakic (Treatment)

be necessary if nausea and vomiting are problematic. To control IOP, immediate treatment includes topical beta-adrenoreceptor antagonists (beta-blockers), alpha2-agonists, and carbonic anhydrase inhibitors. Acetazolamide may be administered by mouth or, if the patient is nauseous and vomiting, by 500 mg IV push. Intravenous or parenteral hyperosmotics (1 g/kg of body weight) may effectively lower IOP immediately but transiently. Available agents include glycerin and isosorbide solution 45% weight/volume (...) (Nd:YAG, argon, or both), but, sometimes, in the case of severe inflammation, a surgical iridectomy may be necessary. Every attempt should be made to medically control IOP and to clear corneal edema before performing a laser iridectomy. Severe cases with membrane formation, nonclearing blood or inflammatory debris, or subluxed IOLs may require intraocular manipulation. Peripheral iridectomy A single peripheral iridectomy may be sufficient to break the block and to relieve the problem. A simple

2014 eMedicine.com

125. Pupillary Block, Aphakic (Treatment)

, or if a peripheral iridotomy cannot be performed immediately, then the following agents are recommended: Mydriatic agents (eg, cyclopentolate 2% and phenylephrine 2.5% q15min for 4 doses) Carbonic anhydrase inhibitors (eg, acetazolamide, two 250-mg tab PO or 500 mg IV) Topical beta-blockers (eg, timolol 0.5%), 1 dose Topical alpha-agonists (eg, brimonidine 0.15% or apraclonidine 1%), 1 dose In very early cases, relieving the block may be possible by the vigorous use of strong mydriatics alone (...) of pupillary block greater than 2 weeks' duration. Nd:YAG laser posterior capsulotomy is an alternative to laser iridotomy in selected cases of pupillary block following extracapsular cataract extraction without an intraocular lens. A smaller than optical capsulotomy is recommended to lyse the adhesions. This may not be the treatment of choice because of the possibility of subsequent pupillary block by the vitreous. Iris sphincterectomies may be performed with the Nd:YAG laser. More than 2 weeks Laser

2014 eMedicine.com

126. Phacoanaphylaxis (Treatment)

phacoanaphylaxis is associated with high intraocular pressure (see the image below), aqueous suppressants are indicated. Beta-blockers, alpha-agonists, and carbonic anhydrase inhibitors are used to lower the pressure. Patient with persistently elevated intraocular pressure after cataract surgery was found to have retained lens material and low-grade inflammation. Eye is white and quiet with anterior chamber lens. Next: Surgical Care If persistent or uncontrolled inflammation or elevated intraocular pressure (...) Treatment & Management Updated: Jun 14, 2016 Author: Robert H Graham, MD; Chief Editor: Hampton Roy, Sr, MD Share Email Print Feedback Close Sections Sections Phacoanaphylaxis Treatment Medical Care Treatment of phacoanaphylaxis may be medical or surgical. Medical therapy of phacoanaphylactic uveitis includes topical corticosteroids and may include cycloplegics and medication for elevated intraocular pressure as needed. Treatment should be tailored to the individual patient and adjusted according

2014 eMedicine.com

127. Pregnancy, Special Considerations (Overview)

considerations. First, intense weight loss is not recommended because of risk to fetal viability. Second, carbonic anhydrase inhibitors are contraindicated during pregnancy due to the potential fetal teratogenic effects. Thirdly, the use of diuretics poses the risk of electrolyte and placental blood flow changes. Reports exist of spontaneous improvement with no treatment and very close follow-up care of optic nerve function. However, with visual compromise, interventions, such as bed rest, , optic nerve (...) in mothers who are breastfeeding. [ ] However, timolol has been reported to be compatible with lactation according to the American Academy of Pediatrics. Topical and systemic carbonic anhydrase inhibitors (eg, acetazolamide, dorzolamide, brinzolamide) are contraindicated during pregnancy because of potential teratogenic effects. They should be avoided in mothers who are breastfeeding because of the potential hepatic and renal effects to the infant. However, acetazolamide has been reported

2014 eMedicine.com

128. Glaucoma, Drainage Devices (Overview)

, dorzolamide/timolol) Alpha agonist/carbonic anhydrase inhibitor (eg, brimonidine/brinzolamide) Laser therapy Laser can be used as primary or adjunctive treatment. It is indicated in cases of noncompliance with medications or if the patient is on maximum tolerated medical therapy and needs further intraocular pressure reduction. The following are laser options that may be used for primary open-angle glaucoma: Argon laser trabeculoplasty (ALT) Selective laser trabeculoplasty (SLT) Micropulse diode laser (...) , brimonidine, apraclonidine) Less-selective sympathomimetics (eg, dipivefrin, epinephrine) Carbonic anhydrase inhibitors (eg, dorzolamide, brinzolamide, acetazolamide, methazolamide) Prostaglandin analogs (eg, latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod) Miotic agents (eg, pilocarpine) Hyperosmotic agents (eg, isosorbide dinitrate, mannitol, glycerin) Beta-blocker/alpha agonist combination (eg, brimonidine/timolol) Beta-blocker/carbonic anhydrase inhibitor combination (eg

2014 eMedicine.com

129. Glaucoma and Penetrating Keratoplasty (Overview)

Inflammation, graft rejection, retinal detachment, subconjunctival fibrosis Topical carbonic anhydrase inhibitors Induce permanent graft failure in eyes with borderline endothelial counts Prostaglandin analogues Uveitis, cystoid macular edema in aphakia and pseudophakia, and recurrent herpes simplex infection in patients with previous history of herpes Adrenergic agents Epithelial toxicity and cystoid macular edema in aphakia and pseudophakia Contributor Information and Disclosures Author Kristin Schmid (...) of the Procedure In 1969, Irvine and Kaufman reported the high incidence of increased intraocular pressure (IOP) following PKP. [ ] They reported a mean maximum pressure of 40 mm Hg in aphakic transplants and 50 mm Hg in combined transplants and cataract extraction in the immediate postoperative period. Since then, numerous authors have reported on the incidence and management of PKPG. Previous Next: Epidemiology Frequency The incidence of PKPG varies from 9-31% in the early postoperative period

2014 eMedicine.com

130. Glaucoma, Primary Open Angle (Overview)

, dorzolamide/timolol) Alpha agonist/carbonic anhydrase inhibitor (eg, brimonidine/brinzolamide) Laser therapy Laser can be used as primary or adjunctive treatment. It is indicated in cases of noncompliance with medications or if the patient is on maximum tolerated medical therapy and needs further intraocular pressure reduction. The following are laser options that may be used for primary open-angle glaucoma: Argon laser trabeculoplasty (ALT) Selective laser trabeculoplasty (SLT) Micropulse diode laser (...) , brimonidine, apraclonidine) Less-selective sympathomimetics (eg, dipivefrin, epinephrine) Carbonic anhydrase inhibitors (eg, dorzolamide, brinzolamide, acetazolamide, methazolamide) Prostaglandin analogs (eg, latanoprost, bimatoprost, travoprost, tafluprost, latanoprostene bunod) Miotic agents (eg, pilocarpine) Hyperosmotic agents (eg, isosorbide dinitrate, mannitol, glycerin) Beta-blocker/alpha agonist combination (eg, brimonidine/timolol) Beta-blocker/carbonic anhydrase inhibitor combination (eg

2014 eMedicine.com

131. Sickle Cell Disease (Overview)

of prophylactic exchange transfusions. Perioperative measures to reduce the incidence of anterior segment ischemia include the following: Nonsympathomimetic local anesthesia Minimization of topical sympathomimetics Supplemental oxygen for 48 hours after surgery Avoiding wide encircling scleral buckling elements, expansile concentrations of intraocular gases, and carbonic anhydrase inhibitors Closely monitoring and treating elevated intraocular pressure Anterior segment ischemia after surgery is an emergency (...) anhydrase inhibitors, because they may cause further sickling and worsen the outflow obstruction. If the intraocular pressure remains elevated after a judicious trial of medical therapy, surgical intervention with an anterior chamber lavage is indicated. The goal of treatment is to eliminate existing neovascularization and, thus, to eliminate the sequelae of proliferative sickle retinopathy (PSR). Modalities to treat proliferative sickle retinopathy include diathermy, cryotherapy, xenon arc

2014 eMedicine.com

132. Sturge-Weber Syndrome (Overview)

is preferable in SWS. The chance of achieving seizure control with medical therapy in patients with SWS varies. Glaucoma medications The goal of treatment is control of IOP to prevent optic nerve injury. This can be achieved with the following agents: Beta-antagonist eye drops - Decrease the production of aqueous fluid Carbonic anhydrase inhibitors - Also decrease production of aqueous fluid Adrenergic eye drops and miotic eye drops - Promote drainage of aqueous fluid Dye laser photocoagulation Treatment (...) the presence of infantile glaucoma include the following: Corneal diameter of more than 12 mm during the first year of life Corneal edema Tears in the Descemet membrane (Haab striae) Unilateral or bilateral myopic shift Optic nerve cupping greater than 0.3 Any cup asymmetry associated with intraocular pressure (IOP) above the high teens Optic nerve damage - Resulting in myopia, anisometropia, amblyopia, strabismus, and visual field defects Diagnosis In young patients, examination under anesthesia or deep

2014 eMedicine.com

133. Sturge-Weber Syndrome (Overview)

is preferable in SWS. The chance of achieving seizure control with medical therapy in patients with SWS varies. Glaucoma medications The goal of treatment is control of IOP to prevent optic nerve injury. This can be achieved with the following agents: Beta-antagonist eye drops - Decrease the production of aqueous fluid Carbonic anhydrase inhibitors - Also decrease production of aqueous fluid Adrenergic eye drops and miotic eye drops - Promote drainage of aqueous fluid Dye laser photocoagulation Treatment (...) the presence of infantile glaucoma include the following: Corneal diameter of more than 12 mm during the first year of life Corneal edema Tears in the Descemet membrane (Haab striae) Unilateral or bilateral myopic shift Optic nerve cupping greater than 0.3 Any cup asymmetry associated with intraocular pressure (IOP) above the high teens Optic nerve damage - Resulting in myopia, anisometropia, amblyopia, strabismus, and visual field defects Diagnosis In young patients, examination under anesthesia or deep

2014 eMedicine.com

134. Hyphema (Overview)

), is recommended. If intraocular pressure is still elevated, a topical carbonic anhydrase inhibitor should be added. In patients with sickle cell trait or sickle cell disease, methazolamide and topical beta-blockers should be substituted. [ , ] If intraocular pressure is still uncontrolled, systemic medication should be given during the acute phase of the hyphema. Acetazolamide (20 mg/kg/d) may be administered in 4 divided doses for intraocular pressure of greater than 22 mm Hg. However, acetazolamide can (...) Hyphema (Overview) Hyphema: Overview, Elevated Intraocular Pressure, Secondary Hemorrhage Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE5MDE2NS1vdmVydmlldw== processing > Hyphema Updated: Jan 18, 2019 Author

2014 eMedicine.com

135. Hyphema, Postoperative (Overview)

), is recommended. If intraocular pressure is still elevated, a topical carbonic anhydrase inhibitor should be added. In patients with sickle cell trait or sickle cell disease, methazolamide and topical beta-blockers should be substituted. [ , ] If intraocular pressure is still uncontrolled, systemic medication should be given during the acute phase of the hyphema. Acetazolamide (20 mg/kg/d) may be administered in 4 divided doses for intraocular pressure of greater than 22 mm Hg. However, acetazolamide can (...) Hyphema, Postoperative (Overview) Hyphema: Overview, Elevated Intraocular Pressure, Secondary Hemorrhage Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE5MDE2NS1vdmVydmlldw== processing > Hyphema Updated: Jan 18

2014 eMedicine.com

136. Macular Edema, Pseudophakic (Irvine-Gass) (Treatment)

groups. [ ] Carbonic anhydrase inhibitors (CAIs) The RPE is important in the maintenance of the blood-retinal barrier and in the prevention of a surplus of extracellular and intracellular fluid within the retina. The enzyme carbonic anhydrase is present on the apical and basal surfaces of the RPE cell membrane. CAIs, such as acetazolamide, enhance the pumping action of RPE cells, facilitating the transport of fluid across the RPE. [ ] Antivascular endothelial factor (anti-VEGF) If the macular edema (...) . Bevacizumab is a monoclonal antibody able to inactivate the effects of VEGF. The role VEGF has in pseudophakic CME is not clear, yet several authors have reported resolution of CME after administration of bevacizumab for their patients retrospectively. However, one report by Spitzer et al did not see any beneficial effects with this treatment. [ ] Prospective studies are needed. More recently, combination therapy (intraocular steroids with anti-VEGF agents) can be effective in treating refractory

2014 eMedicine.com

137. Dystrophy, Fuchs Endothelial (Treatment)

of warm dry air (evaporation) A hair dryer, kept at arm's distance, can be used to blow warm air over the cornea for 5-10 minutes upon awakening. Drying of the cornea may improve the vision of the patient for some time. Lowering the intraocular pressure (IOP) Lowering the intraocular pressure (IOP) is useful when it is even mildly raised. It occasionally helps even when the pressure is normal, especially in borderline cases of corneal decompensation. Topical carbonic anhydrase inhibitors should (...) membrane can be manually removed, as they will be seen as bluish-stained residual fragments. A 5-mm to 5.5-mm sclerocorneal tunnel is prepared similar to making a tunnel in manual small incision cataract surgery. Making the tunnel temporal is desirable, so as to induce minimal astigmatism. If required, cataract surgery with intraocular lens implantation (phacoemulsification or manual small incision cataract surgery) is performed at this stage because the view is comparatively better after removing

2014 eMedicine.com

138. Glaucoma, Unilateral (Treatment)

> Unilateral Glaucoma Treatment & Management Updated: Sep 05, 2017 Author: Ingrid U Scott, MD, MPH; Chief Editor: Hampton Roy, Sr, MD Share Email Print Feedback Close Sections Sections Unilateral Glaucoma Treatment Medical Care Increased EVP Although topical glaucoma medications and oral carbonic anhydrase inhibitors may be used initially to control IOP, the underlying etiology must be resolved to achieve long-term IOP control. Medications that decrease aqueous production are more effective than drugs (...) glaucoma and neovascular glaucoma. Acta Ophthalmol . 2009 Apr 27. . Gandolfi SA, Cimino L, Sangermani C, et al. Improvement of spatial contrast sensitivity threshold after surgical reduction of intraocular pressure in unilateral high-tension glaucoma. Invest Ophthalmol Vis Sci . 2005 Jan. 46(1):197-201. . Jain SS, Rao P, Kothari K, et al. Posterior scleritis presenting as unilateral secondary angle-closure glaucoma. Indian J Ophthalmol . 2004 Sep. 52(3):241-4. . Kirsch M, Henkes H, Liebig T, et al

2014 eMedicine.com

139. Glaucoma, Primary Open Angle (Treatment)

= processing > Primary Open-Angle Glaucoma (POAG) Treatment & Management Updated: Mar 14, 2019 Author: Kristin Schmid Biggerstaff, MD; Chief Editor: Inci Irak Dersu, MD, MPH Share Email Print Feedback Close Sections Sections Primary Open-Angle Glaucoma (POAG) Treatment Medical Care Major drug classes for medical treatment of POAG include the following: alpha-agonists, beta-blockers, carbonic anhydrase inhibitors, miotic agents, prostaglandin analogs, and rho kinase inhibitors. Various classes of glaucoma (...) findings. Next: Surgical Care Surgery is indicated when glaucomatous optic neuropathy worsens (or is expected to worsen) at any given level of IOP and the patient is on maximum tolerated medical therapy (MTMT). MTMT varies considerably between individuals, and it may consist of medicines from 1 or several classes (including a beta-adrenergic antagonist, a prostaglandin agent, an alpha-agonist, and a topical carbonic anhydrase inhibitor). Some patients are observed to progress simply because compliance

2014 eMedicine.com

140. Glaucoma, Phacomorphic (Treatment)

the pupillary block that is causing the glaucoma. Initial management should address the acute nature of the angle closure and include beta-blockers, alpha 2-adrenergic agonists, and carbonic anhydrase inhibitors. Miotics can worsen the secondary angle closure attack by increasing iridolenticular contact. Argon laser peripheral iridoplasty (ALPI) has been studied and has been shown to be safe and effective as a first-line treatment of acute phacomorphic glaucoma. [ ] This would still need to be followed (...) ) as initial treatment for acute phacomorphic angle-closure (phacomorphic glaucoma) before cataract extraction: a preliminary study. Eye (Lond) . 2005 Jul. 19(7):778-83. . Leung CK, Chan WM, Ko CY, Chui SI, Woo J, Tsang MK, et al. Visualization of anterior chamber angle dynamics using optical coherence tomography. Ophthalmology . 2005 Jun. 112(6):980-4. . Lee JW, Lai JS, Yick DW, Tse RK. Retrospective case series on the long-term visual and intraocular pressure outcomes of phacomorphic glaucoma. Eye (Lond

2014 eMedicine.com

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