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366 results for

Intraocular Carbonic Anhydrase Inhibitor

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141. Glaucoma, Neovascular (Treatment)

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

142. Glaucoma, Hyphema (Treatment)

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

143. 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

144. 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

145. Glaucoma and Penetrating Keratoplasty (Diagnosis)

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

146. Glaucoma, Primary Open Angle (Diagnosis)

, 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

147. Glaucoma, Drainage Devices (Diagnosis)

, 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

148. Acute Orbital Compartment Syndrome (Follow-up)

. Immediately employ medical therapy. Osmotic agents and carbonic anhydrase inhibitors are part of established protocols at many centers. Most experts also recommend high-dose steroid therapy as a standard of care. Less agreement exists for use of topical beta-blockers and multiple osmotic agents. Irreversible optic-nerve pathology may occur with as little as 2 hours of ischemia. Rapid employment of medical therapy and ophthalmologic consultation should proceed promptly once the diagnosis is made. Previous (...) canthal tendon (ie, inferior cantholysis), which allows complete mobility of the lower lid. Visual loss without definite signs consistent with increased IOP is not an indication for this procedure. Other primary indications for lateral canthotomy and cantholysis include an intraocular pressure (IOP) greater than 40 mm Hg and proptosis, which may be used as a criterion for unconscious patients whose visual acuity cannot be determined. Secondary criteria include afferent pupillary defect

2014 eMedicine Emergency Medicine

149. Sturge-Weber Syndrome (Treatment)

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. Sturge-Weber Syndrome (Treatment)

[ , ] NA NA 32% *NA = not available Previous Next: Pharmacologic Treatment of Glaucoma The goal of treatment is control of intraocular pressure (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 Although medical treatment of SWS glaucoma usually fails (...) for long-term surgical success. Medical therapy can also be used as an adjunct to surgery. Topical antiglaucoma therapy for extended periods of time is sometimes helpful postoperatively to further reduce borderline IOP elevations without the need for reoperation. Initial medical therapy with a topical beta blocker, followed sequentially with the addition of a carbonic anhydrase inhibitor (systemic in infants and topical in older children) and topical prostaglandin (latanoprost [Xalatan

2014 eMedicine.com

151. Sickle Cell Disease (Treatment)

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

152. 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 (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIyNDIyNC10cmVhdG1lbnQ= processing > Pseudophakic (Irvine-Gass) Macular Edema Treatment & Management Updated: Sep 25, 2018 Author: David G Telander, MD, PhD; Chief Editor: Michael Taravella, MD Share Email Print Feedback Close Sections Sections Pseudophakic (Irvine-Gass) Macular Edema Treatment Medical Care Treatment is aimed at the underlying etiology; however, several of the common treatments may help different causes of cystoid macular edema (CME). Steroids Corticosteroids directly inhibit the enzyme

2014 eMedicine.com

153. Aniridia in the Newborn (Treatment)

. Miotics often are tried first; they improve aqueous outflow by contracting the ciliary muscle. However, the induced myopia may not be well tolerated by young patients. Adrenergic agonists, beta-blockers, and carbonic anhydrase inhibitors also may be tried, but they often are ineffective long term as the patient becomes refractory to them. Whenever a new medication is to be instituted, a trial should be performed, adding and removing only one medication at a time. Optical correction Patients (...) > Aniridia in the Newborn Treatment & Management Updated: Apr 06, 2017 Author: Sophie Bakri, MD; Chief Editor: Donny W Suh, MD, FAAP Share Email Print Feedback Close Sections Sections Aniridia in the Newborn Treatment Medical Care Medical management of glaucoma associated with aniridia Medical therapy of the glaucoma is the initial treatment of choice. It initially may be efficacious in reducing intraocular pressure, but most patients with aniridia who have glaucoma eventually require surgical therapy

2014 eMedicine.com

154. Aniridia (Treatment)

steroid pulses Vitamin A ointments Autologous serum drops Topical bevacizumab drops have been reported in one study. [ ] Limbal stem cell transplantation The medical treatment of aniridia is directed toward control of intraocular pressure, which includes the topical use of the following: Miotics Beta-blockers Sympathomimetics Carbonic anhydrase inhibitors Prostaglandin analogues The chances of failure with local antiglaucoma treatment are high. Treatment of photophobia and nystagmus in patients (...) with aniridia is as follows: Tinted or iris contact lenses Tinted spectacle lenses Tinted intraocular lenses (IOLs) [ ] By the above measures, reducing the amplitude and frequency of nystagmus is possible. Refractive errors are treated with careful refraction and complete correction. Treatment of amblyopia and strabismus in patients with aniridia is as follows: Usually, the potential visual acuity in both eyes should be symmetrical. When the vision is unequal without structural difference, vigorous

2014 eMedicine.com

155. Synechia, Peripheral Anterior (Treatment)

. The appropriate management of peripheral anterior synechiae depends on the disease process that leads to peripheral anterior synechiae formation. The following drug categories may be considered depending on the primary diagnosis: topical beta-blockers, topical alpha-agonists, topical carbonic anhydrase inhibitors, oral carbonic anhydrase inhibitors, topical prostaglandin analogs, miotics, cycloplegics, and topical corticosteroids. Treat intraocular pressure (IOP) as necessary. Topical alpha-agonists, beta (...) -blockers, carbonic anhydrase inhibitors, and prostaglandin analogs may be useful in lowering intraocular pressure in eyes with peripheral anterior synechiae. Miotics are useful in pupil block due to primary angle closure but may accentuate angle closure in posterior pushing mechanisms. Miotics or prostaglandin analogs likely will not be useful in cases where 360° peripheral anterior synechiae exist. Inflammatory states Topical steroids minimize inflammation and, therefore, peripheral anterior synechiae

2014 eMedicine.com

156. 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

157. 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

158. Nonpseudophakic Cystoid Macular Edema (Overview)

reoccur in the absence of treatment. [ ] The major determinant of fluid movement in the retina is the Müller cell. Müller cells have bicarbonate-related transport mechanisms that control movement of potassium and sodium ions (and thus fluid), partly explaining the role for carbonic anhydrase inhibitors such as acetazolamide in the treatment of cystoid macular edema. Additional routes of ion control are achieved through the Kir2.1 and Kir4.1 channels that buffer changes in intracellular potassium (...) > Nonpseudophakic Cystoid Macular Edema Updated: Sep 28, 2018 Author: Hamoon Eshraghi, MD; Chief Editor: Hampton Roy, Sr, MD Share Email Print Feedback Close Sections Sections Nonpseudophakic Cystoid Macular Edema Overview Background Although the most common cause of cystoid macular edema (CME) is due to after cataract extraction or other intraocular surgery, numerous other conditions are associated with the clinical appearance of fluid-filled, cystoid spaces in the macular region. CME is a final common pathway

2014 eMedicine.com

159. Nonpseudophakic Cystoid Macular Edema (Diagnosis)

reoccur in the absence of treatment. [ ] The major determinant of fluid movement in the retina is the Müller cell. Müller cells have bicarbonate-related transport mechanisms that control movement of potassium and sodium ions (and thus fluid), partly explaining the role for carbonic anhydrase inhibitors such as acetazolamide in the treatment of cystoid macular edema. Additional routes of ion control are achieved through the Kir2.1 and Kir4.1 channels that buffer changes in intracellular potassium (...) > Nonpseudophakic Cystoid Macular Edema Updated: Sep 28, 2018 Author: Hamoon Eshraghi, MD; Chief Editor: Hampton Roy, Sr, MD Share Email Print Feedback Close Sections Sections Nonpseudophakic Cystoid Macular Edema Overview Background Although the most common cause of cystoid macular edema (CME) is due to after cataract extraction or other intraocular surgery, numerous other conditions are associated with the clinical appearance of fluid-filled, cystoid spaces in the macular region. CME is a final common pathway

2014 eMedicine.com

160. Burns, Chemical

be required. (For more information, see Medscape Reference article .) Measure intraocular pressure serially to detect pressure increases. Occasionally treat the injured eye with long-acting cycloplegic, mydriatic, and carbonic anhydrase inhibitor for 2 weeks or until pain disappears. This treatment decreases the potential for pupillary constriction, , and early glaucoma. Encourage mobility of the globe to avoid development of conjunctival adhesions (symblepharon). Ocular chemical injury remains one (...) identify hazardous agents. In some cases, members of the HAZMAT team may have to use chemical analysis to identify the agent. The presence of carbon monoxide, cyanide, hydrogen sulfide, oxygen, and combustible gases can be detected using different instruments. Colorimetric detector tubes can approximate the concentrations of chemicals in the air. Alpha, beta, and gamma radiation detectors can record radioactive contamination. Contacting the 24-hour hotline of Chemtrec (Chemical Manufacturers

2014 eMedicine Surgery

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