Descemet Membrane Folds Medication
- Author: Robert H Graham, MD; Chief Editor: Hampton Roy Sr, MD more...
Medication Summary
Medical treatment of Descemet folds requires the treatment of the underlying cause of ocular inflammation. This includes topical steroidal, nonsteroidal, and osmotic agents, as well as topical antibiotics, as needed, for ocular infection.[6] Once the underlying ocular inflammation is treated, the Descemet folds generally resolve.
Corticosteroid
Class Summary
Inhibit edema, fibrin deposition, capillary dilation and proliferation, and deposition of collagen and scar formation.
Prednisolone acetate/prednisolone sodium phosphate (Pred Forte, Pred Mild)
Decreases inflammation and corneal neovascularization. Suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability.
In cases of bacterial infections, concomitant use of anti-infective agents is mandatory; if signs and symptoms do not improve after 2 days, re-evaluate patient. Dosing may be reduced, but advise patients not to discontinue therapy prematurely.
Sold under multiple preparations and suspensions.
Loteprednol etabonate suspension 0.5% (Lotemax)
Structurally similar to other corticosteroids but with a variation that enhances penetration into cells, transforms into inactive metabolite quickly. This drug is less likely then prednisolone acetate to increase intraocular pressure with prolonged use (2% compared to 7%).
Nonsteroidal ophthalmic drops
Class Summary
Used to decrease corneal inflammation.
Ketorolac tromethamine (Acular)
Member of pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drugs for ophthalmic use. Has analgesic, anti-inflammatory, and antipyretic properties and also inhibits prostaglandin biosynthesis.
Diclofenac ophthalmic (Voltaren)
A phenylacetic acid with anti-inflammatory and analgesic properties. Believed to inhibit cyclooxygenase, essential to the synthesis of prostaglandins.
Hypertonic agents
Class Summary
Sodium chloride hypertonic ophthalmic solution used to dehydrate the cornea.
Sodium chloride hypertonic, ophthalmic (Muro 128)
Used for temporary relief of corneal edema. Available as 2% and 5% ophthalmic solution concentrations and 5% ointment. The 5% drop is typically the concentration used.
American Academy of Ophthalmology. External disease and cornea. In: Basic and Clinical Science Course, Section 8. 2006-2007.
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Wilson FM. Slit-lamp biomicroscopy. In: Practical Ophthalmology. 4th ed. 1996:213-229.
Espana EM, Huang B. Confocal microscopy study of donor-recipient interface after Descemet's stripping with endothelial keratoplasty. Br J Ophthalmol. Jul 2010;94(7):903-8. [Medline].
Dirisamer M, van Dijk K, Dapena I, Ham L, Oganesyan O, Frank LE, et al. Prevention and Management of Graft Detachment in Descemet Membrane Endothelial Keratoplasty. Arch Ophthalmol. Nov 14 2011;[Medline].
Thomson Reuters. Physicians Desk Reference. 63rd ed. 2009.
Scuderi B, Driussi GB, Chizzolini M, Salvetat ML, Beltrame G. Effectiveness and tolerance of piroxicam 0.5% and diclofenac sodium 0.1% in controlling inflammation after cataract surgery. Eur J Ophthalmol. Jul 2003;13(6):536-40. [Medline].
Denion E, Dalens PH, Huguet P, Petitbon J, Gerard M. Radial Descemet's membrane folds as a sign of pterygium traction. Eye. Jul 2005;19(7):800-1. [Medline].
Melles GR, Ong TS, Ververs B, van der Wees J. Preliminary clinical results of Descemet membrane endothelial keratoplasty. Am J Ophthalmol. Feb 2008;145(2):222-227. [Medline].
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