Postoperative Corneal Edema Medication

  • Author: Michael Taravella, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 14, 2012
 

Medication Summary

The goal of pharmacotherapy is to reduce morbidity and to prevent complications.

Next

Hypertonic solutions and ointments

Class Summary

Create an osmotic gradient, and draw fluid from the cornea.

View full drug information

Sodium chloride hypertonic, ophthalmic (Muro 128, Adsorbonac)

 

For osmotic pressure control and water distribution.

Previous
Next

Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive, covering all likely pathogens in the context of the clinical setting.

View full drug information

Polymyxin B ophthalmic (Polytrim drops, Polysporin ointment)

 

For ocular infections, involving cornea or conjunctiva, resulting from strains of microorganisms susceptible to this antibiotic. Available as a solution and ointment.

Previous
Next

Corticosteroids

Class Summary

Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.

View full drug information

Prednisolone acetate (Pred Forte)

 

Treats acute inflammations following eye surgery or other types of insults to the eye.

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Previous
Next

Alpha 2-adrenergic agonists

Class Summary

Can decrease IOP.

View full drug information

Brimonidine (Alphagan)

 

Selective alpha 2-receptor that reduces aqueous humor formation and increases uveoscleral outflow.

Previous
Next

Beta-adrenergic blockers

Class Summary

These agents reduce elevated and normal IOP, with or without glaucoma.

View full drug information

Timolol ophthalmic (Timoptic, Blocadren)

 

May reduce elevated and normal IOP, with or without glaucoma, by reducing production of aqueous humor or by outflow.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Michael Taravella, MD  Director of Cornea and Refractive Surgery, Rocky Mountain Lions Eye Institute; Professor, Department of Ophthalmology, University of Colorado School of Medicine

Michael Taravella, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, and Eye Bank Association of America

Disclosure: Nothing to disclose.

Coauthor(s)

Mark Walker, MD  Medical Director, Laser Eye Connection

Mark Walker, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and Contact Lens Association of Ophthalmologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard W Allinson, MD  Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD, is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Christopher J Rapuano, MD  Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Institute

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology

Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; RPS Ownership interest Other; EyeGate Pharma Consulting fee Consulting; Bausch & Lomb Honoraria Speaking and teaching; Bausch & Lomb Consulting; Merck Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

  1. Claesson M, Armitage WJ, Stenevi U. Corneal oedema after cataract surgery: predisposing factors and corneal graft outcome. Acta Ophthalmol. Mar 2009;87(2):154-9. [Medline].

  2. Smolin G, Thoft RA, Dohlman CH. Endothelial function. In: The Cornea: Scientific Foundations and Clinical Practice. 3rd ed. Lippincott William & Wilkins: 1994:635-643.

  3. Stark WJ, Worthen DM, Holladay JT, et al. The FDA report on intraocular lenses. Ophthalmology. Apr 1983;90(4):311-17. [Medline].

  4. Taylor DM, Atlas BF, Romanchuk KG, Stern AL. Pseudophakic bullous keratopathy. Ophthalmology. Jan 1983;90(1):19-24. [Medline].

  5. Waring GO 3rd. The 50-year epidemic of pseudophakic corneal edema. Arch Ophthalmol. May 1989;107(5):657-9. [Medline].

  6. Archives of Ophthalmology. Closed-loop anterior chamber lenses. Arch Ophthalmol. Jan 1987;105(1):19-21. [Medline].

  7. Hagan JC 3rd. A clinical review of the IOLAB Azar model 91Z flexible anterior chamber intraocular lens. Ophthalmic Surg. Apr 1987;18(4):258-61. [Medline].

  8. Mamalis N, Anderson CW, Kreisler KR, Lundergan MK, Olson RJ. Changing trends in the indications for penetrating keratoplasty. Arch Ophthalmol. Oct 1992;110(10):1409-11. [Medline].

  9. Liu E, Slomovic AR. Indications for penetrating keratoplasty in Canada, 1986-1995. Cornea. Jul 1997;16(4):414-9. [Medline].

  10. Burdon MA, McDonnell P. A survey of corneal graft practice in the United Kingdom. Eye. 1995;9 (Pt 6 Su):6-12. [Medline].

  11. Williams KA, Muehlberg SM, Lewis RF, Coster DJ. How successful is corneal transplantation? A report from the Australian Corneal Graft Register. Eye. 1995;9 (Pt 2):219-27. [Medline].

  12. Haamann P, Jensen OM, Schmidt P. Changing indications for penetrating keratoplasty. Acta Ophthalmol (Copenh). Aug 1994;72(4):443-6. [Medline].

  13. Morishige N, Chikama T, Yamada N, Takahashi N, Morita Y, Nishida T, et al. Effect of preoperative duration of stromal edema in bullous keratopathy on early visual acuity after endothelial keratoplasty. J Cataract Refract Surg. Feb 2012;38(2):303-8. [Medline].

  14. Desir J, Abramowicz M. Congenital hereditary endothelial dystrophy with progressive sensorineural deafness (Harboyan syndrome). Orphanet J Rare Dis. Oct 15 2008;3:28. [Medline].

  15. Srinivasan S, Skarmoutsos P, O'Donnell C, Kaye SB. Localized bullous keratopathy secondary to posterior polymorphous dystrophy. Clin Experiment Ophthalmol. Nov 2008;36(8):800-1. [Medline].

  16. Dick HB, Kohnen T, Jacobi FK, Jacobi KW. Long-term endothelial cell loss following phacoemulsification through a temporal clear corneal incision. J Cataract Refract Surg. Jan-Feb 1996;22(1):63-71. [Medline].

  17. Hayashi K, Hayashi H, Nakao F, Hayashi F. Risk factors for corneal endothelial injury during phacoemulsification. J Cataract Refract Surg. Oct 1996;22(8):1079-84. [Medline].

  18. Werblin TP. Long-term endothelial cell loss following phacoemulsification: model for evaluating endothelial damage after intraocular surgery. Refract Corneal Surg. Jan-Feb 1993;9(1):29-35. [Medline].

  19. Hoffer KJ. Cell loss with superior and temporal incisions. J Cataract Refract Surg. May 1994;20(3):368. [Medline].

  20. Lundberg B, Jonsson M, Behndig A. Postoperative corneal swelling correlates strongly to corneal endothelial cell loss after phacoemulsification cataract surgery. Am J Ophthalmol. Jun 2005;139(6):1035-41. [Medline].

  21. Morikubo S, Takamura Y, Kubo E, Tsuzuki S, Akagi Y. Corneal changes after small-incision cataract surgery in patients with diabetes mellitus. Arch Ophthalmol. Jul 2004;122(7):966-9. [Medline].

  22. Richard J, Hoffart L, Chavane F, Ridings B, Conrath J. Corneal endothelial cell loss after cataract extraction by using ultrasound phacoemulsification versus a fluid-based system. Cornea. Jan 2008;27(1):17-21. [Medline].

  23. Storr-Paulsen A, Norregaard JC, Ahmed S, Storr-Paulsen T, Pedersen TH. Endothelial cell damage after cataract surgery: divide-and-conquer versus phaco-chop technique. J Cataract Refract Surg. Jun 2008;34(6):996-1000. [Medline].

  24. Koch DD, Liu JF, Glasser DB, Merin LM, Haft E. A comparison of corneal endothelial changes after use of Healon or Viscoat during phacoemulsification. Am J Ophthalmol. Feb 15 1993;115(2):188-201. [Medline].

  25. Lugo M, Cohen EJ, Eagle RC Jr, Parker AV, Laibson PR, Arentsen JJ. The incidence of preoperative endothelial dystrophy in pseudophakic bullous keratopathy. Ophthalmic Surg. Jan 1988;19(1):16-9. [Medline].

  26. Adamis AP, Filatov V, Tripathi BJ, Tripathi RC. Fuchs' endothelial dystrophy of the cornea. Surv Ophthalmol. Sep-Oct 1993;38(2):149-68. [Medline].

  27. Edelhauser HF, Van Horn DL, Hyndiuk RA, Schultz RO. Intraocular irrigating solutions. Their effect on the corneal endothelium. Arch Ophthalmol. Aug 1975;93(8):648-57. [Medline].

  28. Edelhauser HF, Gonnering R, Van Horn DL. Intraocular irrigating solutions. A comparative study of BSS Plus and lactated Ringer's solution. Arch Ophthalmol. Mar 1978;96(3):516-20. [Medline].

  29. Olson RJ, Kolodner H, Riddle P, Escapini H Jr. Commonly used intraocular medications and the corneal endothelium. Arch Ophthalmol. Dec 1980;98(12):2224-6. [Medline].

  30. Mamalis N, Edelhauser HF, Dawson DG, Chew J, LeBoyer RM, Werner L. Toxic anterior segment syndrome. J Cataract Refract Surg. Feb 2006;32(2):324-33. [Medline].

  31. Kang HM, Park JW, Chung EJ. A retained lens fragment induced anterior uveitis and corneal edema 15 years after cataract surgery. Korean J Ophthalmol. Feb 2011;25(1):60-2. [Medline]. [Full Text].

  32. Homer PI, Peyman GA, Sugar J. Automated vitrectomy in eyes with vitreocorneal touch associated with corneal dysfunction. Am J Ophthalmol. Apr 1980;89(4):500-6. [Medline].

  33. Smolin G, Thoft RA, Dohlman CH. Corneal dystrophies and degenerations. In: The Cornea: Scientific Foundations and Clinical Practice. 3rd ed. Lippincott William & Wilkins: 1994:520-522.

  34. Gothard TW, Hardten DR, Lane SS, Doughman DJ, Krachmer JH, Holland EJ. Clinical findings in Brown-McLean syndrome. Am J Ophthalmol. Jun 15 1993;115(6):729-37. [Medline].

  35. Liu GJ, Okisaka S, Mizukawa A, Momose A. Histopathological study of pseudophakic bullous keratopathy developing after anterior chamber of iris-supported intraocular lens implantation. Jpn J Ophthalmol. 1993;37(4):414-25. [Medline].

  36. Cormier G, Brunette I, Boisjoly HM, LeFrançois M, Shi ZH, Guertin MC. Anterior stromal punctures for bullous keratopathy. Arch Ophthalmol. Jun 1996;114(6):654-8. [Medline].

  37. Brightbill FS. Penetrating keratoplasty for pseudophakic bullous keratopathy. In: Corneal Surgery: Theory, Technique and Tissue. Mosby Inc; 1992:151-163.

  38. Koenig SB, Schultz RO. Penetrating keratoplasty for pseudophakic bullous keratopathy after extracapsular cataract extraction. Am J Ophthalmol. Apr 15 1988;105(4):348-53. [Medline].

  39. Brightbill FS. Lens replacement in pseudophakic bullous keratopathy: anterior chamber intraocular lenses. In: Corneal Surgery: Theory, Technique and Tissue. 2nd ed. Mosby Inc; 1992:163-7.

  40. Brightbill FS. Posterior chamber intraocular lenses-scleral fixated. In: Corneal Surgery: Theory, Technique and Tissue. 2nd ed. Mosby Inc; 1992:171-176.

  41. Donaldson KE, Gorscak JJ, Budenz DL, Feuer WJ, Benz MS, Forster RK. Anterior chamber and sutured posterior chamber intraocular lenses in eyes with poor capsular support. J Cataract Refract Surg. May 2005;31(5):903-9. [Medline].

  42. Pande M, Noble BA. The role of intraocular lens exchange in the management of major implant-related complications. Eye. 1993;7 (Pt 1):34-9. [Medline].

  43. Weene LE. Flexible open-loop anterior chamber intraocular lens implants. Ophthalmology. Nov 1993;100(11):1636-9. [Medline].

  44. Zaidman GW, Goldman S. A prospective study on the implantation of anterior chamber intraocular lenses during keratoplasty for pseudophakic and aphakic bullous keratopathy. Ophthalmology. Jun 1990;97(6):757-62. [Medline].

  45. Donnenfeld ED, Ingraham HJ, Perry HD, Russell S, Foulks G. Soemmering's ring support for posterior chamber intraocular lens implantation during penetrating keratoplasty. Changing trends in bullous keratopathy. Ophthalmology. Aug 1992;99(8):1229-33. [Medline].

  46. Bleckmann H, Kaczmarek U. Functional results of posterior chamber lens implantation with scleral fixation. J Cataract Refract Surg. May 1994;20(3):321-6. [Medline].

  47. Terry MA, Ousley PJ. Replacing the endothelium without corneal surface incisions or sutures: the first United States clinical series using the deep lamellar endothelial keratoplasty procedure. Ophthalmology. Apr 2003;110(4):755-64; discussion 764. [Medline].

  48. Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. Sep 2006;25(8):886-9. [Medline].

  49. Melles GR. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. Cornea. Sep 2006;25(8):879-81. [Medline].

  50. Price MO, Price FW Jr. Descemet's stripping with endothelial keratoplasty: comparative outcomes with microkeratome-dissected and manually dissected donor tissue. Ophthalmology. Nov 2006;113(11):1936-42. [Medline].

  51. Price MO, Price FW. Descemet's stripping endothelial keratoplasty. Curr Opin Ophthalmol. Jul 2007;18(4):290-4. [Medline].

  52. Wandling GR Jr, Rauen MP, Goins KM, Kitzmann AS, Sutphin JE, Kwon YH, et al. Glaucoma therapy escalation in eyes with pseudophakic corneal edema after penetrating keratoplasty and Descemet's stripping automated endothelial keratoplasty. Int Ophthalmol. Jan 13 2012;[Medline].

  53. Terry MA, Saad HA, Shamie N, et al. Endothelial keratoplasty: the influence of insertion techniques and incision size on donor endothelial survival. Cornea. Jan 2009;28(1):24-31. [Medline].

 
Previous
Next
 
Pseudophakic bullous keratopathy. Large multiple bullae, such as depicted here, are associated with moderate to severe pain and discomfort.
Pseudophakic bullous keratopathy in a patient with a Binkhorst style iris-fixated lens.
Pseudophakic bullous keratopathy. This patient has a closed-loop anterior chamber intraocular lens (Leiske model).
Specular microscopy of a normal cornea. Note the compact, uniform hexagonal appearance of the endothelial cells.
Specular microscopy illustrating moderate polymegathism and polymorphism. This is thought to be evidence of endothelial physiologic stress.
Fuchs endothelial dystrophy. The apparently empty spaces are occupied by guttate.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.