Ocular Therapeutics Ashok Garg
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1Ocular Therapeutics
2
3Ocular Therapeutics
Third Edition
Editor-in-Chief
Ashok Garg MS PhD FIAO(Bel) FRCS FRSM ADM FAIMS FICA International and National Gold Medalist Chairman and Medical Director Garg Eye Institute and Research Center Hisar, Haryana, India ForewordSteve A Arshinoff Graham Barrett David J Apple
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Honorary Editors
Eric D Donnenfeld MD FCA Clinical Professor Ophthalmic Consultants of Long Island New York, USA
John D Sheppard MD MMSc Director, Thomas R Lee Center for Ocular Pharmacology Professor of Ophthalmology Eastern Virginia Medical School Virginia Eye Consultants Norfolk, Virginia, USA
Jose M Ruiz Moreno MD PhD Professor Department of Opthalmology Albacete Medical School University of Castilla La Mancha Avenida Almansa, Albacete, Spain
Roberto Bellucci MD Chief, Ophthalmic Unit Hospital and Universty of Verona Via Degli Abeti 17 Salo (BS), Italy
Stephen C Pflugfelder MD Cullen Eye Institute Baylor College of Medicine Houston, Texas, USA
Mitchell Friedlaender MD Head, Division of Ophthalmology Director, Laser Vision Center Scripps Clinic La Jolla, California Rockville, USA
Arbisser Lisa MD Lisa Brothers Arbisser Bettendorf, Iowa, USA
Ahmad K Khalil MD Professor Department of Ophthalmology Research Institute of Ophthalmology Dokki, Cairo, Egypt
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Ashley Behrens MD Executive Medical Director Senior Academy Consultant and KKESH/WEI Professor of International Ophthalmology The King Khaled Eye Specialist Hospital Riyadh, The Kindgom of Saudi Arabia
CS Dhull MS PhD FIAO Director Postgraduate Institute of Medical Sciences Rohtak, Haryana, India
Arturo Perez Arteaga MD Centro Oftalmologico Tlalnepantla Dr Perez-Arteaga Vallarta No. 42 Tlalnepantla, Centro Estado de Mexico
T Mark Johnson MD FRSC Consultant, Vitreoretinal Surgeon National Retina Institute Wisconsin Avenue Chevy Chase, Maryland, USA
NR Biswas MD DN DNB DSc Professor Department of Pharmacology All India Institute of Medical Sciences New Delhi, India
Purendra Bhasin MS Chairman and Medical Director Ratan Jyoti Netralaya Gwalior, Madhya Pradesh, India
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Ocular Therapeutics
First Edition: 2001
Second Edition: 2003
Revised Reprint: 2006
Third Edition: 2013
9789350903209
Printed at
7Dedicated to
My respected Param Pujya Guru Sant Gurmeet Ram Rahim Singh Ji (Insaa) 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
Editor-in-Chief
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9Contributors 13FOREWORD TO THE THIRD EDITION
For me, the most difficult course in medical school was therapeutics. It remained the most difficult during my residency in ophthalmology. There were aspects that made obvious sense, like using penicillin to kill streptococci, and things that made a little sense like drugs that seemed to work for rheumatologic conditions that were themselves as yet poorly defined. We were not sure why they worked but somehow they did. We were instructed to simply memorize the lists of agents which had been shown to have some degree of efficacy, as well as second and third choices in the event of allergy to or suboptimal efficacy of the first choice. Therapeutics always seemed like an amalgam of science, may be science, the art of medicine, and placebo tricks. I recall, not too long ago, on one of my lecture trips to India, being asked about the treatment of an unfortunately too common parasitic disorder in India. I looked at the questioner and said, “Do you know where I am from? I have never seen a case of that in my life and never will in Canada. Please ask one of your esteemed local colleagues.” The principles of therapeutics are universal, such as how to avoid TASS (the chapter herein is appropriately written by an expert Canadian group), but often the management of a local disease relies upon local knowledge both of the disease and the locally available therapies.
The practice of medicine consists of two steps. The first and perhaps most critical is diagnosis. We all like to believe that we are expert diagnosticians after we have been in practice for a few years. We read journals and textbooks about common and rare disorders to hone our diagnostic skills, and we competed as residents, and still do in various journals to believe we are better than, or at least, just as good, at diagnosis as our peers. We generally leave therapy to be looked up in a recent book, kept in our memory banks, or those of our computers or cell phones, or looked up when needed on the Internet. We believe subconsciously that learning diagnosis creates a permanent addition to our skill set, and can gain us esteem, but that learning therapeutics always seems to only make current trends more easily available transiently.
But textbooks of therapeutics were always the ones that I consulted most frequently after the first 5 years out of my residency. I usually knew what I was looking at, but wanted to see if what I had been taught was still current, and more importantly I wanted to see if some of those nebulous connections between diagnosis and 14therapy had been enhanced or redirected by new science. Medical and ophthalmic therapeutics only slowly evolves to become more rational and more efficacious. So, we keep reading newer textbooks looking for answers, often in areas that we had not even questioned.
Dr Ashok Garg, along with honoary editors has again assembled a stellar list of editors and authors to try to provide the reader with an updated book for the answers we all seek when confronted by patient problems. The goal of the book, in its 69 chapters, is to provide a quick overview of the therapeutic problem, the ophthalmologist is facing, and to recommend what is currently thought to be the optimum therapy. Hopefully, as you read, along the way each of you will be inspired to see things a bit differently from how you previously viewed the particular issue you are investigating, and perhaps even change a paradigm that may have outlasted its usefulness. After all, we must continually change our paradigms to avoid becoming old and outdated.
The book will hopefully help you, challenge you, make you think, and be well worn in time for the 4th edition, to have served its purpose. Therapeutics is ever changing, and we must eagerly embrace the changes and try to understand them, before we can use them optimally for the benefit of our patients.
Steve A Arshinoff MD FRCSC
Toronto, Ontario, Canada
Email: ifix2is@sympatico.ca
15FOREWORD TO THE THIRD EDITION
There are many textbooks that have been published in the field of Ophthalmology but Dr Ashok Garg with his energy and insights has created a unique publication with this new textbook on Ocular Therapeutics.
The book contains introductory chapters on basic physiology and drug administration as well as several chapters emphasizing the fundamental role of ocular therapeutics in specific areas of ophthalmology. Dr Ashok Garg is the major contributor to this section and is to be commended for structuring the chapters in a format which is comprehensible and clinically relevant.
The next section focuses on the role of ocular therapeutics in ophthalmic surgery. Together with several international experts, this section of the book is a logical companion to the fundamentals of the previous chapters and highlights the important role of ocular therapeutics in a clinical practice and includes refractive surgery and strategies for the prevention of endophthalmitis. The topics selected cover a broad range of general and subspecialty interests.
The final section on Recent Advances in Ocular Therapeutics addresses conditions such as anti-VEGF treatment and considers the future development of nanotechnology in ophthalmology. The authors who have contributed to this textbook have been selected for their in-depth knowledge and expertise in specific areas and together with Dr Ashok Garg have created an excellent resource on ocular therapeutics for practising Ophthalmologists.
I would like to commend Dr Ashok Garg for his efforts in creating a comprehensive textbook which will be extremely valuable to all Ophthalmologists when selecting appropriate treatment for their patients.
Graham Barrett
Clinical Professor
Department of Ophthalmology
Lions Eye Institute
Head, Department of Ophthalmology
Sir Charles Gairdner Hospital, Nedlands
Western Australia, Australia
President
Asia Pacific Association of Cataract and Refractive Surgeons
e-mail: graham.barrett@uwa.edu.au
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17FOREWORD TO THE SECOND EDITION
It is a distinct pleasure to write Foreword of second edition of the Textbook of Ocular Therapeutics edited by Dr Ashok Garg, Garg Eye Institute and Research Center, Hisar, Haryana, India, and my fellow Dr Suresh K Pandey, Center for Research on Ocular Therapeutics and Biodevices, Albert Florens Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA.
Forty-one chapters, separated in 2 sections, of this book provide a detailed outline for therapy for the basic categories of ocular diseases including infections and inflammations, immune therapy, viscoelastic agents, antioxidants and antiretroviral drugs, antiglaucoma drugs and many others. Detailed and most recent information about the ophthalmic dyes, viscoelastic agents as well as details about the ocular drug toxicity are also addressed in several chapters. An entire new section on applied ocular therapeutics in ophthalmic surgery has been added that includes 11 excellent chapters. A comprehensive text on posterior capsule opacification, cataract surgery in children, ophthalmic dyes for cataract and retinal surgery, photodynamic therapy for age-related macular degeneration as well as indocyanine green angiography and dry eye management are a superb addition to the second edition of this remarkable book. All chapters of the textbook will be very helpful to the practising ophthalmic surgeon in providing clinically useful dosages that are useful in the clinic or field situation. I commend the hard work done by Drs Garg and Pandey to produce this high quality ocular therapeutics textbook.
Chapter 26 on Ocular Drug Toxicity (Complications) of the book is interesting from my perspective. I personally have spent the last 20 years of my professional career describing and evaluating complications of intraocular lenses. Therefore, the topic of complications is in my opinion very important and is a major service provided by this book. Complications of various drugs including toxicity of surgical solutions are covered. This is invaluable to the surgeons who may not have a complete library at hand for consultation on the spot during a clinical practice.
The textbook, for which Drs Garg and Pandey should be congratulated, displays a well-defined view of basic and applied aspect of ocular pharmacology and therapeutics. Each chapter is comprehensive in nature, represents the recent advances in the 18area of ocular pharmacology and therapeutics. The team of a well-known Indian medical publisher M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, provided excellent layout and high quality illustrations for the book. I hope that Textbook of Ocular Therapeutics will appear in several more editions with the entry into the new millennium.
David J Apple MD
Fellow, American Ophthalmological Society
Professor, Ophthalmology and Pathology
Pawek-Vallotton Chair of Biomedical Engineering
Director, Ophthalmic Pathology Laboratory and Center for
Research on Ocular Therapeutics and Biodevices
Director, World Health Organization Collaborative Center for
Developing World Ophthalmology
Co-Director, Magill Research Center for Vision Correction
Storm Eye Institute, Medical University of South Carolina
Charleston, South Carolina, USA
e-mail: appledj@musc.edu
19PREFACE TO THE THIRD EDITION
Ocular Therapeutics have undergone tremendous advances both for anterior and posterior segment diseases in the last one decade. A wide array of new safe, effective drugs with least side effects are available for various ophthalmic surgeries and ocular diseases— new effective FOTE drug therapy based on advanced technology along with invasive and noninvasive ocular drug delivery systems are now available which include the use of nanoparticles, liposomes and dendrimers. Versidoser drug delivery platforms shall revolutionize the FOTE drug delivery system. Genetic, regenerative drugs and stem cell based drug therapy shall make the treatment customized to individual need of ocular disease extent making it more cost-effective and safe.
The third edition of this book has been completely updated with addition of all new ocular drugs and delivery systems in every group of medicine used in ophthalmic disease and surgeries. Sixty-nine chapters of this line have been grouped as preliminary section, Applied Ocular Therapeutics and Recent Advances. In this comprehensive book leading International Ocular Drug Experts have shared their experiences and evidence-based knowledge in the form of chapters.
We are grateful to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja (Director-Publishing), who took keen interest in this project, and all staff members of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, who worked over time to prepare the book Ocular Therapeutics, possible in short time.
We hope the comprehensive book on Ocular Therapeutics shall serve as ready reference for all ophthalmologists world- wide who are engaged in eradication of global blindness and make every effort to make eye 6/6 by synergistic combination of ophthalmic drugs and surgery.
Editors
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21PREFACE TO THE SECOND EDITION
We are extremely happy and encouraged to receive the overwhelming response to first edition of Textbook of Ocular Therapeutics from all over the world. Keeping in view of this tremendous response, we are presenting the revised and updated second edition of this book within a short period of publication of the first edition.
Research in Ocular Therapeutics is an ongoing continuous process and in last 18–24 months a number of new therapeutic products specially in the field of antiglaucoma, antibiotics, antiallergics, ophthalmic dyes, steroidal and non-steroidal anti-inflammatory drugs have been developed commercially to treat the various ophthalmic diseases in a better way.
The second edition of Textbook of Ocular Therapeutics has been written to serve as a comprehensive drug information resource. It was conceived and developed after thorough research of the matter and through a team effort and shall be of great value to both the students and private practitioners. Ophthalmologists shall find the book specially useful in their daily practice.
In the second edition, besides incorporating latest therapeutic drugs, a separate section on Applied Ocular Therapeutics has been added for the benefit of readers to get insight into the role of specific medications in various ophthalmic surgeries.
The text of book is designed in a pharmacotherapeutic format with emphasis on drug entities, commercial product information and specific formulation availability.
We are thankful to contributors, our friends, family members and well wishers who helped us in every possible manner to prepare this edition.
Our sincere thanks are due to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, specially to Shri Jitendar P Vij (Group Chairman) who extended full cooperation to prepare the book and worked hard to publish it expeditiously.
We hope readers shall find the book as a valuable companion in ophthalmic drug product information, selection and use. With God's grace we shall continue the work with future editions. Therefore, your comments and suggestions are always welcome and valuable to us.
Editors
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23PREFACE TO THE FIRST EDITION
Textbook of Ocular Therapeutics has been written to provide succinct, reliable rapid access drug information and facilitate therapeutic decision making.
Due to inspired research in the last decade, a number of new topical drugs are available for better management of different ophthalmic conditions. Significant advancement has taken place in the fields of topical antibiotics, anti-inflammatory (Steroidal and NSAID therapy), third generation antibiotics and NSAIDs are now commercially available for topical use. Tremendous strides have also been made in the field of topical antiglaucoma drugs specially with the advent of Topical Latanoprost, Brimonidine and Acetazolamide eyedrops. A lot of research work is being done on neuroprotective agents. Use of antioxidants in ophthalmology has brought a ray of hope for medical management of Senile cataract and age-related macular degeneration.
Every effort has been made in this book to incorporate the latest advances made in the different branches of ocular therapeutics. The chapters of this textbook has been designed to serve as quick reference to ophthalmologists. In the last chapters of the book Topical and Systemic drugs with common dosages used in ophthalmology has been added to serve as ready reckoner. Textbook of Ocular Therapeutics is a comprehensive ophthalmic drug information resource. Detailed information on specific entities as well as many drug combinations has been included.
I am thankful to Dr David J Apple (USA), Dr Suresh K Pandey (USA), Dr Amar Agarwal (Chennai, India), Dr Athiya Agarwal (Chennai, India), Dr Zetterstorm (Germany), Dr Keinkel (Australia) and Dr Patterson (UK), who gave valuable suggestions and tips for preparing the text of the book.
I am grateful to my family members and my wife Dr Aruna Garg who by their tender care and devotion helped me in this formidable task.
It is only appropriate that I thank and acknowledge my gratitude to my staff, Mr Anil Hans (Delhi Type College and Computers, Hisar, Haryana, India), and colleagues who assisted in the writing, editing and production of this text.
My sincere thanks are due to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, specially Shri Jitendar P Vij (Group Chairman) who extended full cooperation to prepare this book and published it expeditiously.
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I hope the readers shall find this book as a valuable guide in ophthalmic drug product selection and use. I intend to continue the efforts with future editions, therefore your comments, suggestions are always welcome.
Editor