Clinical Applications of Antibiotics and Anti-inflammatory Drugs in Ophthalmology Ashok Garg, John D Sheppard, Eric D Donnenfeld, Mitchell Friedlaender
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1Clinical Applications of Antibiotics and Anti-inflammatory Drugs in Ophthalmology
2Clinical Applications of Antibiotics and Anti-inflammatory Drugs in Ophthalmology
Editors Ashok Garg MS PhD FIAO (Bel) FRSM ADM FAIMS FICA International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Centre 235-Model Town, Dabra Chowk, Hisar-125005, India John D Sheppard MD MMSc Clinical Director-Thomas R Lee Center for Ocular Pharmacology Associate Professor of Ophthalmology Eastern Virginia Medical School 241 Corporate Boulevard Norfolk, Virginia 23502, USA Eric D Donnenfeld MD FCA Clinical Associate Professor North Shore University Hospital and Nassau County Medical Center Founding Partner, Ophthalmic Consultants of Long Island Center, New York, USA Mitchell Friedlaender MD Head, Division of Ophthalmology, Director, Laser Vision Center, Scripps Clinic, 10666, North Torrey Pines Road, La Jolla, CA 92037, Rockville, USA Foreword: Christopher J Rapuano
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Clinical Applications of Antibiotics and Anti-inflammatory Drugs in Ophthalmology
© 2007, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication and Photo CD Rom should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2007
9788184480320
Typeset at JPBMP typesetting unit
Printed at Gopsons
4DEDICATIONS
To
  • My Respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji for his blessings and motivation.
  • My Respected Parents, teachers, my wife Dr. Aruna Garg, son Abhishek and daughter Anshul for their constant support and patience during all these days of hard work.
  • My dear friend Dr. Amar Agarwal, a leading International Ophthalmologist from India for his continued support and guidance.
Ashok Garg
  • My wife of 25 years, Clelia, whose understanding and patience have allowed my time to be dedicated to the discovery of new treatments of dry eye and other severe ocular diseases, and whose own experience with dry eye has provided me with marvelous insight into the human side of patient concerns.
John D Sheppard
  • My wonderful wife and children who make everything possible.
Eric Donnenfeld
  • My mentors at the Francis I. Proctor Foundation. G. Richard O'Connor, H Bruce Ostler, and Phillips Thygeson.
Mitch Friedlaender5
6CONTRIBUTORS 10FOREWORD
Antibiotic and anti-inflammatory therapy in the treatment of ocular conditions is a critically important area in the field of ophthalmology. For better or worse, it is also rapidly changing. The recent worldwide outbreak of Fusarium keratitis related to a specific contact lens disinfection product highlights our need to keep informed not only about new treatments for ocular infections, but also novel methods of infection prevention. Fourth generation topical fluoroquinolones have changed the landscape for treatment of corneal ulcers but also surgical prophylaxis over the last several years. Originally touted as being very difficult medications against which to develop resistance, we are now learning that more and more organisms are becoming resistant to them. New diagnostic technology is better demonstrating some untoward effects of our ocular surgeries. For example, optical coherence tomography has become a widely used, non-invasive tool to diagnose mild cystoid macular edema. We are now better able to identify certain conditions, such as cystoid macular edema, and therefore treat them more effectively. As an added benefit, we are also better able to prevent some side effects from occurring in the first place. As new medications and technologies are developed and new conditions emerge, however, it is increasingly difficult to obtain accurate and up-to-date information in this field.
Dr Ashok Garg has assembled an impressive cast of international authors to accomplish this task. The book begins with Section 1 which covers fundamentals including the ocular defense system, ocular drug delivery systems and drug permeability. Section 2 covers specific antibiotic therapies and clinical applications. New generation fluoroquinolones, new uses of tetracyclines and topical azithromycin are all discussed. Pre- and postoperative cataract surgery regimens, endophthalmitis prophylaxis and management and treatment of corneal ulcers are also covered in detail. Section 3 concentrates on anti-inflammatory conditions and their management. Medical treatment of anterior and posterior uveitis, cystoid macular edema, post refractive surgery inflammation and blepharitis are all covered. The use of nonsteroidal anti-inflammatory therapy to optimize refractive and cataract surgery outcomes is expertly reviewed. The 4 and final section discusses recent advances in antibiotic and anti-inflammatory therapies including toxic anterior 11segment syndrome, topical immune therapy and nanotechnology in ophthalmology. Dr Garg and his co-editors conclude the book with a look into future drugs in ophthalmology. They have splendidly completed their mission of putting together a world-class text that should be beneficial to all practicing ophthalmologists.
Dr Christopher J Rapuano md
Co-Director, Cornea Service, Wills Eye Institute
Co-Director, Refractive Surgery Department, Wills Eye Institute, Professor of Ophthalmology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
Cornea Service, Wills Eye Institute, 840 Walnut Street, Suite 920, Philadelphia, PA 19107, USA
Phone: 215-928-3180 Fax: 215-928-3854
E-mail: cjrapuano@willseye.org
12PREFACE
Pre- and postoperative prophylaxis is an essential component of both cataract and refractive surgeries. Corneal refractive surgeons are specially concerned with two classes of microorganisms those that likely exist on patient ocular surface and those that are introduced during surgery. In last few years tremendous research work has been done specially in the field of Topical Antibiotics and Anti-inflammatory drugs. Fourth generation Fluoroquinolones specially Moxifloxacin and Gatifloxacin best achieve the two main goals of antibiotic prophylaxis sterilizing the ocular surface and preventing infections. Excellent potency, therapeutic penetration, broad coverage and low toxicity also make these antibiotics ideal for clinical use against ocular external infections. Recently introduced NSAID topical Nepafenac holds great promise for Refractive lens procedures and CME management. Proper NSAID and Anti-infective regimen is critical for cataract prophylaxis.
Present book has been written with the aim of providing complete up to date pharmacotherapeutic information about commercially available Antibiotics and Anti-inflammatory drugs in ophthalmology. Clinical and surgical applications of these in various ocular conditions is special attraction of this book. A number of known international ophthalmologists who are masters in ocular therapeutics field have shared their experiences in form of 45 chapters of this book.
Our special gratitude to Shri Jitendar P Vij (CEO), Mr Tarun Duneja (General Manager, publishing) and all staff members of M/s Jaypee Brothers Medical Publisher who took keen interest in this project and completed it expeditiously.
Last but not the least we are hopeful this practical handbook shall be useful companion of every ophthalmologist OPD Desk as a primary reference book to reduce visual threatening infections and blindness.
Editors