Anterior segment surgery

Intraocular (intracameral) injections Prompt Anterior segment surgery, infections Comeal toxicity, intraocular toxicity, relatively short duration of action... 

Pape LG, Balazs EA. The use of sodium hyaluronate (Healon ) in human anterior segment surgery. Ophthalmol 1980 87 699-705. 

A definitive advance was made with the introduction of viscoelastic substances in anterior segment surgery (Balazs, 1983 Balazs, 1984 Balazs, 1986). Viscoelastic substances (ophthalmic viscosurgical devices, OVD), a class of nonactive surgical implants with viscous and/or viscoelastic properties were intended for use during surgery in the anterior segment of the eye. 

Miyauchi S, Iwata S. Biochemical studies on the use of sodium hyaluronate in the anterior eye segment. IV. The protective efficacy on the corneal endothelium. Curr Eye Res 1984 3 1063-1067 Miyauchi S, Iwata S. Evaluations on the usefulness of viscous agents in anterior segment surgery. I. The ability to maintain the deepness of the anterior chamber. J Ocular Pharm 1986 2 267-274 Miyauchi S, Iwata S. Biochemical studies on the use of sodium hyaluronate in the anterior eye segment. II. The molecular behavior of sodium hyaluronate injected into anterior chamber of rabbits. Curr Eye Res 1987 3 611-617... 

Percival SPB. Complications from use of sodium hyaluronate (Healonid) in anterior segment surgery. Br J Ophthalmol 1982 66 714-716... 

Levobunolol is used for the chronic treatment of elevated lOP in ocular hypertension and open-angle glaucoma. Also like timolol, levobunolol is effective for prophylactic treatment of elevations in lOP after cataract surgery and anterior segment laser procedures. 

Occasionally, an abnormally intense anterior segment inflammatory reaction occurs within the first 5 days after cataract extraction and can be characterized according to etiology as endophthalmitis, toxic iritis, or aseptic iritis. Endophthalmitis is discussed later in the chapter. Toxic iritis is usually produced by implanned intraocular introduction of drugs or chemicals acute aseptic hitis is caused by surgical trauma to the iris or ciliary body or (occasionally) by particulate foreign material inadvertently introduced at the time of surgery. 

Anterior Segment Glucocorticoids also have been implicated in cataract formation. If vision is reduced, cataract surgery may be necessary. Rifabutin, if used in conjunction with clarithromycin or fluconazole for treatment of Mycobacterium avium complex (MAC) opportunistic infections in AIDS, is associated with an iridocyclitis and even hypopyon. This will resolve with glucocorticoids or by stopping the medication. 

Maintaining a deep anterior chamber can be considered the conditio sine qua non for successful anterior segment intraocular surgery. There are diverse pre- and intraoperative precautionary measures available to achieve this oculopression, addition of adrenalin and hyaluronidase to retrobulbar anesthesia, hyperventilation and blood pressure reduction during anesthesia, closed system operation as made possible by phacoemulsification (lens nucleus disintegration via ultrasound), or by intravenous infusion of hyperosmolar substances (Voros-marthy, 1967 Kelman, 1967). 

Litwin AS, Pimenides D. Toxic anterior segment syndrome after cataract surgery secondary to subconjunctival gentamicin. J Cataract Refract Surg 2012 38(12) 2196-7. 

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