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Postoperative Corneal Edema Medication

  • Author: Michael Taravella, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc  more...
 
Updated: Mar 03, 2016
 

Medication Summary

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

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Ophthalmics, Other

Class Summary

May reduce inflammation in cornea by creating an osmotic gradient across an intact blood barrier.

Sodium chloride hypertonic, ophthalmic (Muro 128 5%, Altachlore 5%)

 

For osmotic pressure control and water distribution.

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Antibiotics

Class Summary

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

Trimethoprim/polymyxin B ophthalmic (Polytrim Ophthalmic Solution)

 

Used for ocular infections involving cornea or conjunctiva resulting from strains of microorganisms susceptible to this antibiotic combination.

Polymyxin B ophthalmic

 

Polymyxin B is used for ocular infection of the cornea or conjunctiva caused by susceptible microorganisms.

Polymyxin B/bacitracin ophthalmic (Ak-Poly-Bac, Polycin)

 

Bacitracin prevents transfer of mucopeptides into the growing cell wall, which causes inhibition of bacterial cell wall synthesis. Polymyxin B damages bacterial cytoplasmic membrane and alters permeability, causing intracellular constituents to leak.

Azithromycin ophthalmic (AzaSite)

 

This ophthalmic macrolide antibiotic is indicated for bacterial conjunctivitis caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections.

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Corticosteroids

Class Summary

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

Prednisolone acetate (Pred Forte, Omonipred, Pred Mild)

 

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.

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Alpha 2-adrenergic agonists

Class Summary

Can decrease intraocular pressure by decreasing aqueous production.

Brimonidine (Alphagan P)

 

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

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Beta-adrenergic blockers

Class Summary

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

Timolol ophthalmic (Timoptic, Istalol, Betimol)

 

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

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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, Eye Bank Association of America

Disclosure: Received none from AMO/VISX for consulting.

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, Contact Lens Association of Ophthalmologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Hospital

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Texas Medical Association

Disclosure: Nothing to disclose.

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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.
 
 
 
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