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Intraocular Carbonic Anhydrase Inhibitor

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161. 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

162. 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

163. 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

164. Sickle Cell Disease (Diagnosis)

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

165. Sturge-Weber Syndrome (Diagnosis)

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

166. Hyphema (Diagnosis)

), 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 (Diagnosis) 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

167. Pregnancy, Special Considerations (Diagnosis)

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

168. 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

169. Acute Orbital Compartment Syndrome (Treatment)

. 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

170. Pharmacological management of primary open-angle glaucoma: second-line options and beyond

Agents /therapeutic use; Carbonic Anhydrase Inhibitors /therapeutic use; Clinical Trials as Topic; Drug Therapy, Combination; Glaucoma, Open-Angle /drug therapy; Humans; Intraocular Pressure /drug effects; Lipids /therapeutic use AccessionNumber 12009100697 Date bibliographic record published 31/03/2009 Date abstract record published 21/10/2009 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief (...) classes: carbonic anhydrase inhibitors; hypotensive lipids; α2-adrenoceptor agonists; and β-adrenoceptor antagonists. Most treatment arms used combinations of a β-blocker with a carbonic anhydrase inhibitor, an α2-adrenoceptor agonist or a hypotensive lipid. The mean age of patients in included studies ranged from 54 to 71 years. The authors state neither how the papers were selected for the review nor how many reviewers performed the selection. Assessment of study quality The authors did not state

2008 DARE.

171. Laser-1st vs Drops-1st for Glaucoma and Ocular Hypertension

) are permitted according to a pre-specified intervention protocol described in detail in the publicly available trial protocol. This begins with prostaglandin analogues, then beta-blockers followed by alpha agonists or carbonic anhydrase inhibitors. The full range of available doses, treatments and drugs is beyond this short summary. Other Name: SLT; "Laser First" Active Comparator: Medicine-1st Conventional medical therapy [DRUG] without laser. All participants in this arm start their treatment pathway (...) or carbonic anhydrase inhibitors. The full range of available doses, treatments and drugs is beyond this short summary. Drug: Primary Medical Treatment Pathway Primary Medical Treatment Pathway (multiple medications, as required). If IOP not at target additional treatment with all standard medications may be used and ultimately surgery (trabeculectomy ). All available medical treatments (eye-drops) are permitted according to a pre-specified intervention protocol described in detail in the publicly

2013 Clinical Trials

172. Association of ocular hypotensive medication types with dynamic contour tonometry and Goldmann applanation tonometry measurements in a glaucoma and ocular hypertensive population. (PubMed)

, respectively. The number of IOP-lowering agents did not have any statistically significant influence on ΔIOP (p=0.177), DCT (P=0.28) and GAT (P=0.13) measurements. A statistically higher ΔIOP was revealed in monotherapy patients receiving Carbonic Anhydrase Inhibitors (CAIs) (ΔIOP=5.75 mmHg) in comparison to patients receiving Prostaglandin Analogs (ΔIOP=4.09 mm Hg) or beta Blockers (ΔIOP=3.78 mmHg) as single topical therapy (F=4.373, P=0.005). Eyes treated with CAIs as a part of the ocular hypotensive (...) Association of ocular hypotensive medication types with dynamic contour tonometry and Goldmann applanation tonometry measurements in a glaucoma and ocular hypertensive population. The aim of this study was to evaluate the association between different intraocular pressure (IOP)-lowering medications and IOP measurements by dynamic contour tonometry (DCT) and Goldmann applanation tonometry (GAT) in a glaucoma and ocular hypertensive population.In a prospective, observational case series study

2013 Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics

173. Economic Evaluation of Femtosecond Laser Assisted Cataract Surgery

of Central retinal vein or artery occlusion History of uveitis History of optic nerve head neuropathy except glaucoma Progressive glaucoma Nystagmus Uncontrolled diabetes mellitus General history of dementia or psychotic disorders Pregnancy, breast feeding General medications: Alpha-blockers, Carbonic anhydrase inhibitors Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact (...) procedures of one surgeon. Phacoemulsification machine used to perform cataract surgery in each center will be the same for all patients included in the center. The IOL (IntraOcular Lens) used in each center will be the same for all patients treated in the center. Experimental: Femto Corneal incision, anterior capsulorhexis and lens fragmentation by femtosecond laser Device: Femtosecond laser-assisted cataract surgery Each patients randomized in the femto arm will undergo a femtosecond laser assisted

2013 Clinical Trials

174. Efficacy and Safety of Intravitreal Aflibercept Injection for Subacute Central Serous Chorioretinopathy

Patient who has active intraocular inflammation or infection Patient who has uncontrolled glaucoma IOP was more than 25 mmHg in spite of anti-glaucoma medication Visual field defect which affect best corrected visual acuity Patient who has been used systemic or topical carbonic anhydrase inhibitor within 1 month Cushing syndrome History of intravitreal steroid injection to study eye Patient who has been used or plan to use systemic drug which is toxic to crystalline lens, retina or optic nerve (...) Criteria: Clinical diagnosis of idiopathic CSC. 18 to 60 years old, woman and man. Subretinal fluid is found at OCT. Symptom duration is from 6 weeks to 4 months. Patient who agree to participate in the study. Exclusion Criteria: Patient who was treated previously for CSC Patient who has choroidal neovascularization or other macular disease Patient who has other ophthalmologic disease that may affect patient's vision. History of any intraocular surgery, except cataract extraction prior to 3 months

2013 Clinical Trials

175. Phase I/II Trial to Find Maximum Tolerated Dose (MTD) and Dose Limiting Toxicities (DLT) of TLC399 (ProDex) in Patients With Macular Edema Due to Retinal Vein Occlusion (RVO)

steroids, carbonic anhydrase inhibitors, or warfarin/heparin within 1 month prior to the Screening visit or anticipated use at any time during the study. Use of immunosuppressants, immunomodulators, antimetabolites, and/or alkylating agents within 6 months prior to the Screening visit or anticipated use at any time during the study. BCVA score < 34 letters (approximately 20/200 Snellen equivalent) in the non-study eye using the chart ETDRS method at the Screening visit. Known allergy (...) : up to 1 year ] Number of SAEs and treatment-related severe AEs Part 2: Mean change of intraocular pressure (IOP) [ Time Frame: Months 1-12 ] Evaluate the mean changes in intraocular pressure (IOP) in patients receiving TLC399 (ProDex) treatment from baseline up to 1 year Part 2: Mean change of letters read correctly (using BCVA) [ Time Frame: Months 1-12 ] Evaluate the change in BCVA from baseline up to 1 year Part 2: Change of central retinal thickness (using OCT) [ Time Frame: Months 1-12

2013 Clinical Trials

176. Safety Study of Aqueous Suppression After Ahmed Glaucoma Valve (AGV) Implantation

of Drugs Anti-Arrhythmia Agents Antihypertensive Agents Carbonic Anhydrase Inhibitors Enzyme Inhibitors (...) ) surgery the intraocular pressure (IOP) classically goes through 2 phases. The hypotensive phase occurs immediately after surgery, lasts around 1 week. This is followed by the hypertensive period where the IOP tends to rise steadily above 21mmhg. The hypertensive response seems to occur more commonly after Ahmed GDD surgery than nonvalved implants, It was reported to occur in 40% to 80% of cases. Although the hypertensive phase can last as long as 6 months it is usually during the first 1 to 4 weeks

2013 Clinical Trials

177. Impact of a Tolerability Switch to Dorzolamide/Timolol Preservative-free Fixed Combination on Ocular Surface Symptoms

table for MeSH terms Glaucoma Glaucoma, Open-Angle Ocular Hypertension Eye Diseases Timolol Dorzolamide Adrenergic beta-Antagonists Adrenergic Antagonists Adrenergic Agents Neurotransmitter Agents Molecular Mechanisms of Pharmacological Action Physiological Effects of Drugs Anti-Arrhythmia Agents Antihypertensive Agents Carbonic Anhydrase Inhibitors Enzyme Inhibitors (...) topical intraocular pressure lowering therapy and that were scheduled to switch current therapy to preservative-free DTFC. Outcome Measures Go to Primary Outcome Measures : Change in Glaucoma Symptom Scale questionnaire [ Time Frame: 8 weeks ] The main study objective was to assess a change in the patient-reported Glaucoma Symptom Scale questionnaire, filled in at baseline (Week 0) and at the end of the 8 week of therapy with preservative-free DTFC. Secondary Outcome Measures : Change in Functional

2013 Clinical Trials

178. Immediate Anterior Chamber Paracentesis With A 30-Gauge Needle for Acute Primary Angle

by Naris Kitnarong, Siriraj Hospital: paracentesis primary acute angle closure iridotomy filtration glaucoma Additional relevant MeSH terms: Layout table for MeSH terms Glaucoma Glaucoma, Angle-Closure Ocular Hypertension Eye Diseases Acetazolamide Anticonvulsants Carbonic Anhydrase Inhibitors Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Diuretics Natriuretic Agents Physiological Effects of Drugs (...) will be adjusted according to the level of IOP. The maximal dose is 4 tablets per day. It will be discontinued if the IOP is less than 21 mmHg. All affected eyes will receive laser peripheral iridotomy with 24 hours after presentation. This a standard treatment for Acute angle-closure glaucoma Procedure: Paracentesis At presentation, patients received immediate anterior chamber paracentesis with a 30-gauge needle. The intraocular pressure (IOP) was recorded at immediately, 15 and 30 minutes, and then 1, 24

2013 Clinical Trials

179. Transconjunctival Needling Revision Versus Medical Treatment

with sweeping movement up and down, back and forth. Active Comparator: Medical treatment Eyes with primary glaucoma surgery failure with encapsulated blebs were treated with medical treatment (hypotensive eye drops) Drug: Medical treatment Hypotensive eye drops are initialized one by one regarding intraocular pressure control. Nonspecific beta blocker and/or prostaglandin, followed by carbonic anhydrase inhibitors and/or selective alpha agonist. Other Names: Timoptol 0,5% Xalatan Trusopt Alphagan Outcome (...) of Sao Paulo General Hospital Study Details Study Description Go to Brief Summary: When the glaucoma filtering surgery failures (intraocular pressure rises again), the options is start to use the hypotensive eye drops again (medical treatment). However, in some cases (encapsulated blebs), there is a simple surgical revision that can revival the primary failure surgery. It calls transconjunctival needling revision. In this study, the investigators compare the efficacy of this revision versus medical

2013 Clinical Trials

180. Topical Treatment of Uveitic Macular Edema

intraocular pressure-lowering medications and/or prior glaucoma surgery are acceptable) Media clarity and pupillary dilation sufficient to allow OCT testing and retinal photography Best-corrected visual acuity of 5/200 or better Patient-level Exclusion Criteria Use of oral acetazolamide or other systemic carbonic anhydrase inhibitors at baseline Known allergy or hypersensitivity to any component of the study drugs Women who are pregnant or breastfeeding (pregnancy test should be administered prior (...) defined as 20% or greater reduction in central subfield thickness by OCT or resolution of edema recurrence [ Time Frame: 4 weeks ] proportion of patients with recurrence of macular edema defined as greater than 20% increase in central subfield thickness to a value >320 microns by OCT or presence of cysts in an eye that previously had resolution of macular edema Intraocular pressure (IOP) increase [ Time Frame: 4 weeks ] number of patients with intraocular pressure increase at least 10mmHg over

2013 Clinical Trials

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