New Alternatives in Post-Cataract PharmacologySkip to main content. Does the rule prevent eye strain? What happens if you sleep with your eyes open? What to know about sulfa allergies What does it mean when steroid drops cataract surgery see stars? Top ten foods for healthy eyes Seven causes of pinpoint pupils. US Ophthalmic Review, ;4 2:
Steroids still most popular choice in postcataract surgery treatment
Find a Job Post a Job. Cataract surgeons agree that postoperative eye drops are not ideal for many reasons, including lack of compliance; low bioavailability; potential toxicity; and expense. So, many surgeons are exploring new ways to deliver postop medications. Some are choosing to use fewer drops, while others are choosing to forego topical medications altogether and inject medications instead.
And, with medications that need to be used as frequently as four times a day, compliance drops off. Also, some patients are sensitive to the preservatives, particularly if they have been on medication a long time.
Some patients develop punctate keratopathy, which impacts negatively on comfort and vision. I think all of us realize that there are problems with drops. This alone is a thorn in our sides and reason enough to move away from eye drops.
Subjectively, 31 percent reported difficulty instilling the eye drops, 42 percent believed that they never missed their eye when instilling drops, and Injections Additionally, a growing body of evidence is showing that intraocular administration of antibiotics is safe and effective for infection prophylaxis. Masket co-authored a study that found no increased safety risk associated with intracameral injection of moxifloxacin compared with balanced salt solution.
Visual acuity, intraocular pressure, endothelial cell counts, corneal pachymetry, corneal clarity and edema, and anterior chamber cells and flare were evaluated preoperatively and for three months postoperatively. At both time points, optical coherence tomography results showed no statistically significant differences between the two treatment groups. Shorstein and colleagues at Kaiser Permanente in California found that intraocular administration of antibiotic is more effective for preventing postoperative endophthalmitis than topical antibiotic.
The researchers found that intracameral antibiotic was more effective than topical antibiotic alone for preventing endophthalmitis; and they found that combining topical gatifloxacin or ofloxacin with an intracameral agent was not more effective than using an intracameral agent alone.
I look forward to the day when we have delivery systems that can emit low-dose medication over a long period of time to manage the anti-inflammatory component of postoperative treatment. I believe that it needs to take the form of both a steroid and a nonsteroidal agent because there is strong evidence that NSAIDs are more effective at preventing cystoid macular edema than are steroids. Other surgeons are comfortable injecting both anti-inflammatory and anti-infective agents postoperatively.
Shorstein began injecting antibiotics in After all, we are injecting right into the space where one would want to have the antibiotic.
In the latter half of , we began to think about an alternative delivery of corticosteroid to prevent postoperative macular edema. There were a couple of articles in the literature showing the effectiveness of injected triamcinolone subconjunctivally, and we started doing that in late Shorstein published a study that examined the relationship between chemoprophylaxis and the occurrence of acute, clinical, postoperative macular edema.
There were confirmed cases of macular edema. The risk and safety of triamcinolone injection were similar to those of topical prednisolone acetate alone.
Those of us who were injecting the triamcinolone began asking if we should be adding NSAID drops routinely for patients who undergo phacoemulsification. In a recently published study, it was found to maintain mydriasis, prevent miosis and reduce early postoperative pain when administered in irrigation solution during intraocular lens replacement, with a safety profile similar to that of placebo.
This is extremely important in patients who have had previous laser peripheral iridotomies and glaucoma and in patients who are taking alpha-2 antagonist medications for urologic or cardiovascular conditions, because these are the patients who develop floppy iris syndrome intraoperatively. No other product, compounded or commercial, offers an intraocular nonsteroidal.
The nonsteroidal, in combination with phenylephrine, a very potent dilator, helps us a great deal in maintaining the pupil during cataract surgery. It is well-known that if the pupil drops below 6 mm during cataract surgery, visualization decreases, your surgical time increases and your complication rate increases. Omidria was approved by the FDA in Weinstock says that he is only using Omidria in select patients currently, because it is not covered by all insurance companies.
I will consider using it in all patients who have insurance coverage, because you never know who is going to have floppy iris syndrome. Intracameral phenylephrine and ketorolac injection OMS for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification.
Ferguson cites the challenges and the drawbacks to injection: If the patient is a steroid responder, then many additional visits, meds, expense, and family inconvenience will be required for IOP control. Ferguson says that there is a simpler schedule and ease of administration, adding up to improved patient compliance—only one bottle, four times a day, with a scheduled taper, and there is safety in the event of an untoward reaction to any of the components.
Also, there is no potential for disappointment, because patients understand from the start that they will need to use the drops for three to four weeks postoperatively. And let me reiterate, because it provides the option of discontinuing or altering components, it avoids the risks of depot medicine.
Evaluation of eyedrop administration by inexperienced patients after cataract surgery. J Cataract Refract Surg. Evaluation of the safety of prophylactic intracameral moxifloxacin in cataract surgery. Comparative effectiveness of antibiotic prophylaxis in cataract surgery. Comparative effectiveness of three prophylactic strategies to prevent clinical macular edema after phacoemulsification surgery.
Also By The Authors Cataract. Premium IOL and refractive surgery patients—and surgeons—may have a new option to protect against a bad outcome. After decades of not much change, microscopes are beginning to change the way surgeons operate. Larger studies are needed to determine the best dosage and method of delivery of current experimental therapies. Physician burnout appears to be on the rise. Multiple factors continue to push ASCs to the forefront as a better alternative to the hospital.
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