CRIM 2653 Chapter Notes - Chapter 10.1: Intravitreal Administration, Cytomegalovirus Retinitis, Bone Marrow Suppression
23 May 2020
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topical NSAIDs for eye
-anti-virals are well tolerated, oral ones, not much systemic side effects
-HIV aids patient →vitreous is clear so not much inflammation since not much immune
system remaining and another herpes virus attack retina, before days of HAART this
used to be very common, they get CMV retinitis occur, so white areas with infarcats and
lots of hemorrphage which leads to blinding and retinal detachment since chewed up, in
old days we get IV ganciclovir which are powerful anti virals,
if disease only for eye, or systemic side effects against gangciclovir like bone marrow
suppression, so we can treat locally, so give intravitreal injections either of ganciclovir or
fascarnet, even commercially available implants, so surgery and sew implant into eye
wall and release gangciclovir over about 9months, not great option, AIDS patient lived a
lot longer now
-anti-fungals →fungal infections in eye not so common →pharmacies can make up
Natamycin to treat fungal keratitis (fungal infection of cornea)→patients immune
compromised, they are set up for fungal infection in blood stream, fungemia (fungus in
blood stream) they can see choroid and choroidla lesions break through in retina and
vitreous, we get this picture, patients hard to treat, oral and topical antifungasl don’t
work for these things, can be given Amphotericin B or IV fluoconazole but again toxicity
is an issue and costs
-topical steroids →necessary and we need them to fight inflammation which can occur
in idiopathically or surgery we perform, everything we do is controlled insult so we have
some inflammation, eye surgery be on steroids for weeks- few months, and thankfully
have a lot of topical steroids we can use, commonly used prednisolone acetate and less
commonly used these weaker ones which are reserved for corneal inflammations
-problem with topical steroids →but like any steroid in body, we can get an infection
since lose immune response, and potentiate viral infection like herpes, and also
increases pressure changes expression of proteins and some genes in Schlemm’s canal
and drainage of aqueous can be reduced, pressure of eye can go up, and long term use
can cause cataracts, long term=many months-few yrs, patients who need steroids due
to ongoing uveatis will develop cataracts →for this reason, steroids should only be used
under supervision of opthamologists →most marked when used topical steroids, but
