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Secondary Open-Angle Glaucomas
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Jonathan Myers, L. Jay Katz, Anand Mantravadi
Within the first week, many of the materials dispersed during surgery can lead to elevated pressures. Alpha-chymotrypsin frequently results in reduced facility of outflow in the first 2 days following intracapsular cataract extraction. Retained viscoelastic material is a source of trabecular obstruction manifesting in the first postoperative day. Increased IOPs are seen with all current viscoelastics; no definitive difference in incidence has been shown among them. Meticulous removal at the time of surgery may reduce the frequency of this complication. Hyphema following surgery also blocks outflow and can lead to elevated IOP. Debris, inflammation, and trabecular edema may also play roles in acutely elevated pressures postoperatively. Preexisting glaucoma increases the frequency and severity of acute post-operative pressure elevations. These complications are best treated medically with aqueous suppressants and topical steroids. Fibrin clots may be treated with intracameral injection of tissue plasminogen activator (Figure 10.14). Surgical evacuation of viscoelastic or blood is reserved for pressures that do not respond to medical therapy and threaten the optic nerve.
Novel methods of antifungal administration
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Various case reports describe intracameral injection of amphotericin B in the treatment of keratomycosis caused by Aspergillus and other molds, like Colletotrichum, and in endophthalmitis caused by molds such as Paecilomyces [232,233,235–237]. Six of 7 patients treated with intracameral injections achieved resolution or significant improvement of this infection [236]. The only reported adverse effect in these reports is uveitis. Anterior chamber injections have been described for amphotericin B in the treatment of endophthalmitis in doses ranging from 5 mcg to 50 mcg for the treatment of endophthalmitis caused by Paecilomyces [238,239], Coccidioides [240], Cylindrocarpon [238], and Acremonium [238]. Intravitreous injections of amphotericin B (concurrent with surgery [i.e., vitrectomy], systemic, and other local antifungal therapies) have also been utilized in the treatment of ophthalmic fungal infections in an attempt to compensate for its poor penetration into vitreal fluid. Endophthalmitis due to Fusarium [238,241], Acremonium [238,241–243], Aspergillus [238], and Candida [238,243–249] has been treated with intravitreal doses of amphotericin ranging from 5 to 10 mcg, and many reports have used multiple intravitreous injections per infection. Fibrinous iritis has been reported with intravitreal injections of amphotericin B at doses of 10 mcg, but not after dosage reduction to 5 mcg [246]. Retinal or pigment epithelial toxicity secondary to such use has also been described [238]. Loss of retinal ganglion cells, vitreous inflammation, corneal edema, neovascularization, and inflammation have also been reported as consequences of such administration [225].
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
Nepafenac is a potent anti-inflammatory drug; it is in routine clinical use as topical drops for pre and post- operative management during cataract surgery. There has been no previous study to evaluate the safety of intracameral use of nepafenac or its efficacy in ameliorating inflammation incited during cataract surgery. We have therefore sought to assess and report the safety of single intracameral administration of 0.3% and 1% nepafenac over a period of 2 weeks. Nepafenac is commercially available in two concentrations 0.1% and 0.3%, we considered testing the toxicity with the higher concentration, i.e. 0.3% by intracameral route which would naturally reflect the safety of the lower concentration also, in addition we have also evaluated a much higher concentration of nepafenac i.e. 1% to ensure a wide margin of safety. There was no adverse response to intracameral injection of 0.3% or 1% nepafenac, clinical evaluation showed an absence of irritation to the drug, the anterior chamber remained normal and quite without any signs of toxicity immediately after injection and as inspected at various time points up to 2 weeks.