China
Africa
Explore chapters and articles related to this topic
Surgical removal of subretinal hemorrhage
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Side-effects and complications of intracameral rtPA include hyphema, corneal stromal thickening, elevated intraocular pressure (IOP), breakthrough vitreous hemorrhage, endophthalmitis, retinal break with detachment, sub-retinal rebleed, and exudative retinal detachment with pigmentary retinopathy following spontaneous resolution. To minimize the rate of rebleed, lower doses of rtPA have been advocated, suggesting comparable success rates, although repeat injections may be necessary. The creation of fibrin degradation products as a result of the plasminogen cascade is theoretically toxic, and some argue for their removal by washout following the use of rtPA,12 but this practice is uncommon.
Special Senses
Published in Pritam S. Sahota, James A. Popp, Jerry F. Hardisty, Chirukandath Gopinath, Page R. Bouchard, Toxicologic Pathology, 2018
Kenneth A. Schafer, Oliver C. Turner, Richard A. Altschuler
Corneal endothelial cells help maintain clarity of the cornea, and loss of corneal endothelial cells results in corneal edema. Corneal endothelial cells may be physically removed by intracameral medical devices or by administration of compounds (e.g., 5-fluorouracil) (Grant 1986). Damage to the endothelium may be due to administration of phototoxic chemicals or changes in ionic concentration, bicarbonate levels, pH, and tonicity of the local environment (Hull et al. 1984).
Laser Surgery in the Treatment of Glaucoma
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
The patient is given pilocarpine to maximally open the cyclodialysis cleft. Compression gonioscopy may also be helpful in diagnosis. If the anterior chamber has shallowed and the filtering angle is not visible, the patient is given retrobulbar anesthesia and the chamber deepened by intracameral sodium hyaluronate (plain Healon), an agent that will irrigate easily from the eye. The number, extent, and location of the clefts can now be established.
Long-acting ocular drug delivery technologies with clinical precedent
Published in Expert Opinion on Drug Delivery, 2022
Matthew N. O’Brien Laramy, Karthik Nagapudi
Intracameral administration involves the direct insertion or injection through the cornea into the anterior fluid-filled chamber in front of the lens [28]. In this way, the drug does not need to permeate through the tear film and cornea. Intracameral injections are currently used to administer prophylactic antibiotics or anesthetics associated with ophthalmic surgery [29–32]. Limited consensus guidelines exist for intracameral injection, due in part to the small number of clinical programs and marketed products administered via this route [28]. Marketed products administer 100 to 200 μL of solution using topical anesthesia, aseptic technique, and slow injection speeds [29–32]. Clinical practice may employ larger volumes to fully displace the anterior chamber volume and reduce variation in delivered dose [33,34].
Intravitreal Bevacizumab for Inflammatory Neovascularization of the Lens after Traumatic Open Globe Injury
Published in Ocular Immunology and Inflammation, 2020
Je Hyung Hwang, Kyeong Do Jeong, Kyu Ho Chung, Jung Hyun Park, Jin Choi, Won Hyuk Oh, Jae Suk Kim
One month after the second injection, the mutton-fat KP and anterior chamber inflammation disappeared, but severe posterior synechiae and neovascularization on the iris and lens capsule were observed in the left eye (Figure 4). We therefore performed 0.05 cc bevacizumab injection to regress the neovascularization. The drug was injected into the vitreous cavity (3.5 mm away from the corneal limbus). Initially, intracameral injection was considered, but the injection was made into the vitreous cavity because anterior chamber was cloudy due to inflammation and we were concerned that the injection would affect corneal endothelial cells. One week after bevacizumab injection, we performed cataract surgery; however, during the surgery, it was observed that the new vessels had not regressed, and massive hemorrhage was present in the iris and new intralenticular vessels (Figure 5); the iris and new intralenticular vessels were also connected to each other (Figure 6). We therefore cauterized the new vessels and performed lens extraction by irrigation/aspiration after opening the anterior capsule. However, the remaining lens capsules were removed because the anterior and posterior lens capsules were damaged by the neovascularization and recurrent hemorrhage, and inserting an intraocular lens was not possible.
Intracameral Use of Nepafenac: Safety and Efficacy Study
Published in Current Eye Research, 2018
Ramesh Jha, Vismapratap Sur, Arnab Bhattacharjee, Tanushri Ghosh, Vinod Kumar, Aditya Konar, Sarbani Hazra
Achieving and maintaining appropriate mydriasis is a prerequisite for intraocular surgery, cataract surgery in particular. It is imperative to have a well-dilated pupil, to view and work on the lens and avoid any injury to the iris. Mydriasis is achieved by repeated preoperative topical use of mydriatic agents. Also, non-steroidal anti-inflammatory drug (NSAIDS) drops are used preoperatively because entry into the anterior chamber and breakdown of blood aqueous barrier causes a release of prostaglandins. The disadvantage of preoperative topical drops is, slow corneal penetration1, systemic absorption can lead to significant side effects, i.e., cardiovascular effects, and hypertension.2,3 To avoid the drawbacks mentioned above, intracameral use of mydriatics, as well as NSAIDs, have since long been popular.4–6 A synergistic combination of mydriatics and NSAIDs to address both the requirements, i.e. dilatation of pupil and prevent intraoperative miosis is an attractive option for ophthalmologists. Keeping in view the clinical need, US FDA has recently approved a combination of phenylephrine 1% and ketorolac 0.3% (Omidria)® for intracameral use to prevent intraoperative miosis and control post-operative pain following cataract surgery.7