Fuchs Endothelial Dystrophy Medication

Updated: May 04, 2018
  • Author: Vikas Mittal, MBBS, MS; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

Patients undergoing keratoplasty may require carbonic anhydrase inhibitors before and after the surgery. They are highly effective in reducing the intraocular pressure (IOP) to desired levels.

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Carbonic anhydrase inhibitors

Class Summary

Carbonic anhydrase (CA) is an enzyme found in many tissues of the body, including the eye. Catalyzes a reversible reaction where carbon dioxide becomes hydrated and carbonic acid dehydrated. By slowing the formation of bicarbonate ions with subsequent reduction in sodium and fluid transport, it may inhibit CA in the ciliary processes of the eye. This effect decreases aqueous humor secretion, reducing IOP.

Acetazolamide (Diamox)

Because of highly predictable effect on IOP. Reduces rate of aqueous humor formation by inhibiting enzyme carbonic anhydrase, which results in decreased IOP. Available in PO and parenteral forms.

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Corticosteroids

Class Summary

These agents are most effective in treating inflammations and preventing and treating graft reactions following keratoplasty operation.

Prednisolone (AK-Pred, Econopred, Prelone)

Acting on the nucleus of the cell, the steroids produce certain proteins that are immunosuppressive and prevent the production of inflammatory mediators. By their action on the cell wall, they decrease the release of PG. The net result is suppression of inflammation and immune reaction. These effects are obtained through such diverse mechanisms of action as anti-inflammatory, antiallergenic, antiexudative, antiangiogenic, and antiproliferative. Although they have systemic effects, their main action is exerted at the site of inflammation. Therefore, topical application is useful to prevent immune reaction and inflammation.

Has a short biological life of 12-36 h, therefore, interferes less with physiological processes.

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Ocular lubricants

Class Summary

Hypertonicity of sodium chloride is used to treat corneal edema.

Sodium chloride hypertonic, ophthalmic (Muro 128, Muroptic-5)

Sterile ophthalmic solution and ointment used to draw water out of cornea of the eye.

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Nonsteroidal anti-inflammatory agents

Class Summary

The inhibition of prostaglandin synthesis, results in vasoconstriction, a decrease in vascular permeability, leukocytosis, and a decrease on IOP. However, these agents have no significant effect on IOP.

Diclofenac ophthalmic (Voltaren)

Diclofenac sodium is designated chemically as 2-[(2,6-dichlorophenyl) amino] benzeneacetic acid, monosodium salt, with an empirical formula of C14 H10 Cl2 NO2 NA. One of a series of phenylacetic acids that has demonstrated anti-inflammatory and analgesic properties in pharmacological studies. Believed to inhibit the enzyme cyclooxygenase, which is essential in the biosynthesis of prostaglandins.

Ketorolac tromethamine 0.5% (Acular)

Member of the pyrrolo-pyrrole group of NSAIDs. When administered systemically, has demonstrated analgesic, anti-inflammatory, and antipyretic activity. Mechanism of action is believed to be due, in part, to its ability to inhibit prostaglandin biosynthesis.

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Cycloplegics/mydriatics

Class Summary

Instillation of a long-acting cycloplegic agent can relax any ciliary muscle spasm that can cause a deep aching pain and photophobia.

Cyclopentolate hydrochloride 1% (AK-Pentolate, Cyclogyl)

An anticholinergic prepared as a sterile, borate buffered solution for topical ocular use. Prevents muscle of ciliary body, and sphincter muscle of iris, from responding to cholinergic stimulation. Induces mydriasis in 30-60 min and cycloplegia in 25-75 min.

Use has been associated with psychotic reactions and behavior disturbances in pediatric patients.

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