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Intraocular Carbonic Anhydrase Inhibitor

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141. Glaucoma, Pigmentary (Treatment)

anhydrase inhibitors are useful agents for treating pigmentary glaucoma and are generally well tolerated. Systemic agents should be reserved for particularly difficult circumstances or when the risks of surgery are unacceptably high. Miotic therapy Parasympathomimetics may also be administered. Pupillary miosis increases resistance to aqueous flow from the posterior chamber, past the lens surface, and through the pupil into the anterior chamber. This increased resistance allows aqueous pressure to build (...) > Pigmentary Glaucoma Treatment & Management Updated: Oct 23, 2018 Author: Jim C Wang (王崇安), MD; Chief Editor: Hampton Roy, Sr, MD Share Email Print Feedback Close Sections Sections Pigmentary Glaucoma Treatment Approach Considerations The intraocular pressure (IOP) in pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) is subject to large spontaneous fluctuations. This tendency should be kept in mind when considering treatment and evaluating IOP response to therapies. Despite full PDS features

2014 eMedicine.com

142. Glaucoma, Drainage Devices (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

143. Hyphema (Treatment)

), 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 (Treatment) 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

144. Pregnancy, Special Considerations (Follow-up)

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

145. Retinal Detachment, Postoperative (Follow-up)

Inpatient Care Most vitreoretinal procedures are performed as ambulatory outpatient procedures. Previous Next: Inpatient & Outpatient Medications Following vitreoretinal surgery, the patient is usually prescribed a topical prophylactic antibiotic, a topical corticosteroid (eg, prednisolone acetate), and a cycloplegic (eg, atropine 1%). The intraocular pressure is monitored during the postoperative period and treated as necessary with beta-blockers, alpha-agonists, carbonic anhydrase inhibitors (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIyNDYwOS1mb2xsb3d1cA== processing > Postoperative Retinal Detachment Follow-up Updated: Feb 28, 2017 Author: Lihteh Wu, MD; Chief Editor: Andrew A Dahl, MD, FACS Share Email Print Feedback Close Sections Sections Postoperative Retinal Detachment Follow-up Further Outpatient Care According to the surgeon's discretion, an intraocular gas bubble may have been placed into the vitreous in the surgical repair of the RRD. If this is the case, the patient must adopt a certain head position for several weeks. Next: Further

2014 eMedicine.com

146. Macular Edema, Pseudophakic (Irvine-Gass) (Follow-up)

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

147. Pupillary Block, Aphakic (Follow-up)

, 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

148. Dystrophy, Fuchs Endothelial (Follow-up)

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

149. Sturge-Weber Syndrome (Follow-up)

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

150. Choroidal Detachment (Follow-up)

with the lens or pseudophakos can lead to rapid corneal endothelial failure and decompensation, extensive anterior and posterior synechiae, and acceleration of cataract changes in phakic patients. It can also trigger aqueous misdirection. Next: Inpatient & Outpatient Medications Prescribe topical steroids and cycloplegics. Oral steroids may be indicated. Consider topical IOP-lowering agents, oral carbonic anhydrase inhibitors, and systemic osmotics in patients with significant IOP elevation. Avoid (...) anticoagulants or aspirin with suprachoroidal hemorrhage. [ ] Previous Next: Deterrence/Prevention In open globe surgery, particularly glaucoma surgery, hypotony must be avoided by careful suturing techniques. During surgery, take care not to suddenly decompress the globe; use a paracentesis tract to slowly deflate it. Preoperative osmotics or carbonic anhydrase inhibitors can be used to decrease the IOP to a safe level before surgery. Whether or not to discontinue aspirin or anticoagulants in preparation

2014 eMedicine.com

151. Hyphema (Follow-up)

), 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 (Follow-up) 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

152. Glaucoma, Pigmentary (Follow-up)

anhydrase inhibitors are useful agents for treating pigmentary glaucoma and are generally well tolerated. Systemic agents should be reserved for particularly difficult circumstances or when the risks of surgery are unacceptably high. Miotic therapy Parasympathomimetics may also be administered. Pupillary miosis increases resistance to aqueous flow from the posterior chamber, past the lens surface, and through the pupil into the anterior chamber. This increased resistance allows aqueous pressure to build (...) > Pigmentary Glaucoma Treatment & Management Updated: Oct 23, 2018 Author: Jim C Wang (王崇安), MD; Chief Editor: Hampton Roy, Sr, MD Share Email Print Feedback Close Sections Sections Pigmentary Glaucoma Treatment Approach Considerations The intraocular pressure (IOP) in pigment dispersion syndrome (PDS) and pigmentary glaucoma (PG) is subject to large spontaneous fluctuations. This tendency should be kept in mind when considering treatment and evaluating IOP response to therapies. Despite full PDS features

2014 eMedicine.com

153. Glaucoma, Phacomorphic (Follow-up)

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

154. Glaucoma, Malignant (Follow-up)

body, increasing zonular tension with flattening and posterior movement of the lens and deepening the anterior chamber. Topical phenylephrine is used to tighten the zonules by stimulating the longitudinal muscle of the ciliary body. Topical beta-blockers, alpha-adrenergic agonists, and topical and oral carbonic anhydrase inhibitors are effective in decreasing aqueous humor production and lowering intraocular pressure, presumably decreasing aqueous misdirection. Osmotic agents used to decrease (...) vitreous volume include oral glycerol or isosorbide, or intravenous mannitol. Hyperosmotic agents are very effective in lowering intraocular pressure and have an onset of action in minutes reaching its maximum peak at 60 minutes. They should be used with caution due to possible metabolic disorders and intravascular volume overload; they are contraindicated in patients with renal or heart failure. Medical treatment works in approximately one half of patients. Medical management should be continued

2014 eMedicine.com

155. Glaucoma, Primary Open Angle (Follow-up)

= 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

156. Glaucoma, Neovascular (Follow-up)

glaucoma are recommended. Other agents include topical beta-blockers (eg, levobunolol [Betagan], timolol [Timoptic]), topical brimonidine (Alphagan), topical carbonic anhydrase inhibitor (eg, dorzolamide [Trusopt], brinzolamide [Azopt]), and oral carbonic anhydrase inhibitor (eg, acetazolamide [Diamox]). Topical pilocarpine is contraindicated because it may increase inflammation. The role of topical latanoprost (Xalatan) is unclear in the treatment of early NVG. The successful use of photodynamic (...) . Medical therapy is indicated, with topical atropine and steroids being the most important agents. Antiglaucoma medications, topical beta-blockers, and carbonic anhydrase inhibitors are also recommended. The role of topical brimonidine and latanoprost in advanced disease is unclear. Topical pilocarpine and echothiophate iodide are contraindicated (may cause increased inflammation and hyperemia). Oral glycerol and intravenous mannitol are recommended only if IOP is elevated symptomatically. Anti-VEGF

2014 eMedicine.com

157. Glaucoma, Hyphema (Follow-up)

to glaucomatous optic nerve damage and central retinal artery occlusion at even slightly increased pressure. Glaucoma can be treated with topical medications (eg, beta-blockers [Timoptic bid and new generation drops]). Avoid oral carbonic anhydrase inhibitors, especially acetazolamide (eg, Diamox), in patients with sickle cell trait or disease. These drugs tend to increase sickling of erythrocytes. Methazolamide may be a better choice in this situation (Neptazane 50 mg PO q8h). Use hyperosmotic agents like (...) Glaucoma Treatment & Management Updated: Jul 27, 2018 Author: Inci Irak Dersu, MD, MPH; Chief Editor: Hampton Roy, Sr, MD Share Email Print Feedback Close Sections Sections Hyphema Glaucoma Treatment Medical Care Treatment of microhyphemas in which the intraocular pressure (IOP) is not elevated usually involves limiting activities that cause rapid movements of the globe during the first 72 hours. Patients who have concurrent elevation of IOP may require topical and oral ocular hypotensive medications

2014 eMedicine.com

158. Glaucoma, Drainage Devices (Follow-up)

= 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

159. Glaucoma and Penetrating Keratoplasty (Follow-up)

agents (eg, timolol, betaxolol), adrenergic agents (eg, epinephrine, dipivefrin), alpha2-adrenergic agonists (eg, brimonidine, apraclonidine hydrochloride), miotics (eg, pilocarpine, echothiophate iodide, carbachol), prostaglandin analogues (eg, latanoprost), topical carbonic anhydrase inhibitors (eg, dorzolamide, brinzolamide), and systemic carbonic anhydrase inhibitors (eg, acetazolamide, methazolamide, dichlorphenamide). Beta-adrenergic blocking agents have been the cornerstone of glaucoma (...) of the blood-aqueous barrier, and they can initiate graft rejection. In aphakic patients, miotics can increase the risk of a retinal detachment. Topical carbonic anhydrase inhibitors (eg, dorzolamide, brinzolamide) have similar ocular hypotensive efficacy as betaxolol 0.5% and are not associated with clinically significant electrolyte disturbances or systemic adverse effects seen with systemic carbonic anhydrase inhibitors. However, they should be used with caution in patients with PKPG, especially

2014 eMedicine.com

160. Glaucoma, Complications and Management of Glaucoma Filtering (Follow-up)

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

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