2 OPTM4102_Systemic Drug, Ocular Effects_JC_2024(1).pdf

OPTM4102 Seminar 2: Systemic Medications and Ocular Effects Dr Jason Charng [email protected]  Acknowledgement of country The University of Western Australia acknowledges that its campus is situated on Noongar land, and t...

OPTM4102 Seminar 2: Systemic Medications and Ocular Effects Dr Jason Charng [email protected]  Acknowledgement of country The University of Western Australia acknowledges that its campus is situated on Noongar land, and that Noongar people remain the spiritual and cultural custodians of their land, and continue to practise their values, languages, beliefs and knowledge. Artist: Dr Richard Barry Walley OAM Objectives 1. Review the relationship between systemic medications and ocular effects 2. Explore the clinical manifestations of amiodarone on the cornea 3. Discuss the clinical manifestations of plaquenil on the retina 3  Systemic Medications and Ocular Effects Do systemic drugs reach the eye easily? reach. retina Inject sth ->. is designed the drug Unless can inject locally in sub-retina. the eye. to target · ) Potential. :.... drop (eye how to reach the drug. eye Topical # retina , choroid , tear-film - 4 https://www.allaboutvision.com/resources/anatomy.htm Vortex keratopathy (Cornea verticillata) 5 Case 1: amiodarone and the cornea medication to treat irregular heart beat systemic. Amiodarone: Introduction - - C Toxic An antiarrhythmic medication, first introduced in 1961. It works partly by increasing the time before a heart cell can contract again It is indicated to treat and prevent a number of types of irregular heartbeats. Types of conditions includes ventricular tachycardia , ventricular fibrillation, wide complex tachycardia, atrial fibrillation , and paroxysmal supraventricular tachycardia inject into the spine. It can be administered orally, intravenously, and intraosseously Common side effects include feeling tired, tremor, nausea, and constipation Many adverse effects Long half-life 6  Case 1: amiodarone and the cornea Amiodarone: Clinical Presentation symptoms Symptoms, signs, impact on vision, treatment, prognosis H 10: 13 Vision 7 DOI: 10.1056/NEJMicm1406501 Case 1: amiodarone and the cornea Vortex keratopathy: Anatomy https://www.hindawi.com/journals/joph/2018/5315137/ 8 Case 1: amiodarone and the cornea Vortex keratopathy: Anatomy day 39 after medication Day 128 Day 194 Oo 9 Part I Systemic Medications and Ocular Effects Vortex keratopathy: Anatomy 10 https://www.frontiersin.org/articles/10.3389/fneur.2018.00204/full Case 1: amiodarone and the cornea Vortex keratopathy: Anatomy Taken up by If lysosomes O 5th taken C-. up 39 days post amiodarone by lysosomes it stays there forever drug , z be this. can't ↓ waste despose system for a cell. be break down. 11 Case 1: amiodarone and the cornea Vortex keratopathy: Anatomy 128 days post amiodarone - - 12 Case 1: amiodarone and the cornea Vortex keratopathy: Anatomy after taking ↑ % of the drug. across time e The cells uptake the ingredient. 194 days post amiodarone - - 13 Case 1: amiodarone and the cornea Vortex keratopathy: Anatomy Superficial epithelium Suprabasal Basal Wingaells. O How does amiodarone reach cornea? 14 Bull’s Eye Maculopathy 15 Case 2: plaquenil and the retina Plaquenil Plaquenil (Hydroxychloroquine) https://ajn.timesofisrael.com/doctors-warning-over-covid-19-cure/ 16 Case 2: plaquenil and the retina 28 : 18 Plaquenil: Introduction Plaquenil (Hydroxychloroquine) –Prevent or treat malaria –Treat symptoms of rheumatoid arthritis –Treat systemic lupus erythematosus Side effects include: gastrointestinal upset (vomiting, diarrhea, stomach cramps), skin rash, headache, dizziness, and ocular toxicity Ocular toxicity impacts cornea, ciliary body, and retina. 17 Case 2: plaquenil and the retina Plaquenil: retina Nomal Early stage: asymptomatic Advanced toxicity: –Sign: Bullseye maculopathy –Symptoms: colour vision changes and/or paracentral scotomas (visual field). Patient take plaquenil. IRREVERSIBLE -O central vision , colour vision 1 hypopicment. wing of - lost picment. 18 Case 2: plaquenil and the retina Plaquenil: Bullseye maculopathy healthy 1. how long has the drug been taken how 2. heavy the dosage. 19 https://pubmed.ncbi.nlm.nih.gov/26992838/ Case 2: plaquenil and the retina Plaquenil: Bullseye maculopathy 20 Case 2: plaquenil and the retina Bullseye Maculopathy (Clinical Investigations) 21 Case 2: plaquenil and the retina 40 : 30 Plaquenil: Retinal investigations ↓ dark Square : location FP. field z H ↳ atten. of the vision the radius of. Visual field 22 https://pubmed.ncbi.nlm.nih.gov/26992838/  Case 2: plaquenil and the retina Plaquenil: Retinal investigations electro.... to convert > electro light energy- energy. -1 I measure electroactivity the for the eye -. - 23 https://pubmed.ncbi.nlm.nih.gov/26992838/  Any cells in the eye , Case 2: plaquenil and the retina once they are gone they , are gone. Normal Plaquenil: Retinal investigations Normal. 46 30 : Sneuclear layer through here. come no signal dead ↑ RPE dead too. photoreceptor OCT No outer sect, means can' convert photoreceptor light energy to electric energy. O No ⑳ O at photoreceptor all. 24 => :. localised delivery is normally use.