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Fuchs Endothelial Dystrophy Medication

  • Author: Daljit Singh, MBBS, MS, DSc; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Mar 16, 2016
 

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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Contributor Information and Disclosures
Author

Daljit Singh, MBBS, MS, DSc Professor Emeritus, Department of Ophthalmology, Guru Nanak Dev University; Director, Daljit Singh Eye Hospital, India

Daljit Singh, MBBS, MS, DSc is a member of the following medical societies: American Society of Cataract and Refractive Surgery, Indian Medical Association, All India Ophthalmological Society, Intraocular Implant and Refractive Society, India, International Intra-Ocular Implant Club

Disclosure: Nothing to disclose.

Coauthor(s)

Vikas Mittal, MBBS, MS Medical Director and Consultant Cornea Surgeon, Sanjivni Eye Care, India

Vikas Mittal, MBBS, MS is a member of the following medical societies: All India Ophthalmological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

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 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

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor, Ravijit Singh, MD, to the development and writing of this article.

References
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Familial Fuchs endothelial dystrophy in a 65-year-old female. The other eye presented similarly. Her father and older brother were reported to have the same malady.
The left eye of a 75-year-old man showing fully developed Fuchs endothelial dystrophy. The optical section shows marked thickening of the central part of the cornea and lifting up of the epithelium. Bullae formation is seen on the nasal side. The epithelium is thickened.
Close-up view of the limbal area of the same patient as in Media file 2. It clearly shows thickening of the epithelium, bullae formation, and vascularization of the cornea.
An optical section through the right cornea of the same patient as in Media file 3. It shows edema of the cornea and severe endothelial changes. The endothelial cell count in this eye was 800 cells/mm2.
Severe cornea guttata in a 61-year-old woman. The endothelium is speckled with pigment. This patient had complained of mistiness in her otherwise excellent vision.
Slit lamp examination under high magnification of a 54-year-old man, showing severe cornea guttata. The cornea illuminated by retroillumination from the edge of the slit light on the iris resembles dewdrops.
Pseudoguttata produced by uveal inflammation. Corneal edema is also present. The other eye was normal. These "guttata" disappeared completely under treatment.
Specular endothelial microscopy in a case of severe cornea guttata with transparent cornea. The guttata lesions have affected many individual cells and groups of cells.
Corneal edema in the eye of a 67-year-old woman.
 
 
 
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