Ch. 21 Corneal Edema

Question 1

Name the 4 fisiopathological causes for corneal edema:

Answer 1

1. Primary endothelial failure
2. secondary endothelial failure
3. Elevated IOP
4. Epitelial failure (loss of epithelial pump)

Question 2

How can a corneal edema from endothelial failure can be distinguished from that elevated IOP (at initial stages)?

Answer 2

Endothelial: primarily stromal

Elevated IOP: Primarily subepithelial

Question 3

In which cases can a corticosteroid help in the treatment of corneal edema?

Answer 3

In cases where the is active inflamation, including those caused by infections when the pathogen is under control by ATB.

If no active inflamation, corticosteroid is of no use (i.e. caused by elevated IOP)

Question 4

In the setting of corneal edema, which topical IOP lowering drugs should not be used?

Answer 4

Carbonic anhydrase inhibitors reduce fluid flow out of the cornea and can worsen corneal edema, therefor they sould be avoided.

Prostaglandin analogs can worsen inflamation, so they should be used with caution in Infalmatory conditions.

Question 5

What is the specific use for hipertonic solution in corneal edema?

Answer 5

It is used specifically to reduce epithelial and subepithelial corneal edema.

It does not treat the cause, just reduce the symptoms and allows for better visualization.

It does not treat stromal edema.

Question 6

What treatment options are available for corneal edema?

Answer 6

1. If inflamation present (with no infection, or after it has been controlled): Corticosteroids.
2. If hi IOP: IOP Lowering meds, avoid CAIs
3. If Bullous Keratopathy canditate to surgery: temporary RGP lenses + ATBs
4. If BK not candidate to surgery:
   
   1. Salleras procedure: thermal cautery burns to the bomwan’s membrane.
   2. conjunctival flap
5. surgical: CROSSLINKING,PK,DMEK,DSEK,DSAEK.