EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/407647
EW CATARACT 33 November 2014 inferonasal zonules. I have checked with an endoscopic cyclophotocoag- ulation probe, and the zonules don't get damaged. Much of the drug sits 360 degrees around the ciliary processes," he said. Steven G. Safran, MD, Lawrenceville, N.J., is intrigued by the formulation, although he has not yet tried it. "I'm interested in seeing how it plays out," he said. He has not had any endophthalmitis cases with his current approach, so he is not motivated to change his regimen. Still, he likes the idea of avoiding compliance headaches. One of his concerns would be contamination sometimes associated with compounded injectables, he added. Another would be any issue with the use of the Crystalens (Bausch + Lomb, Bridgewater, N.J.), In very rare cases—maybe one in every 2,000—bleeding will occur from the injection hitting the ciliary body, Dr. Scripture said. However, that has never caused long-term problems. Although some surgeons may be concerned about an IOP increase, Dr. Scripture said this happens about as often as it would with the use of topical drops. The only time Dr. Scripture will avoid the injection is if a patient has related medication allergies. Pearls, praises, and concerns Ahad Mahootchi, MD, Zephyrhills, Fla., said that using the injectable formulation in more than 500 patients since last year has been a process. "I did get rid of the postop antibiotic drops from the start. Reducing or eliminating the steroid or nonsteroidal drops has been a slower process," he said. After sev- eral months of trial and error, he is down to one drop of NSAID a day. "In my early days with it, I tried leaving a little in the anterior chamber under the inferior iris—not necessary or desirable. I tried using the leftover drug subconjunctivally, which wasn't necessary. Now I just use the leftover drug on the cornea at the end of the case," he said. He previously saw quiet eyes in most eyes on postop day 1 and at all visits after that point; now, half of the eyes are 20/25 or better on day 1. He has not seen inflammatory is- sues in the first 2 weeks; his patients have experienced floaters only in the first 24 hours. Dr. Mahootchi has found it helpful to individualize what drops, if any, patients use, and he still recommends lubricant drops for the first few days after surgery. Use of the injectable formu- lation has helped improve staff workflow. "Staff time at the office and ASC has been greatly reduced with shorter instructions and calls and fewer call backs to pharmacies," he said. A pearl to consider is how one performs the injection, Dr. Mahootchi said. "I use the same 30-gauge cannula for TriMoxiVanc that I use for intracameral anesthe- sia. I slide the cannula through the VII ÅÂÐÎ-ÀÇÈÀÒÑÊÀß ÊÎÍÔÅÐÅÍÖÈß ÏÎ ÎÔÒÀËÜÌÎÕÈÐÓÐÃÈÈ 27–29 àïðåëÿ 2015 ã. ÅÊÀÒÅÐÈÍÁÓÐÃ ÂÒÎÐÎÅ ÑÎÎÁÙÅÍÈÅ ÎÐÃÀÍÈÇÀÒÎÐ Åêàòåðèíáóðãñêèé öåíòð ÌÍÒÊ «Ìèêðîõèðóðãèÿ ãëàçà» ÎÐÃÊÎÌÈÒÅÒ Ðîññèÿ, 620149, ã. Åêàòåðèíáóðã, óë. Àêàäåìèêà Áàðäèíà, 4à Òåëåôîí: (343) 231-01-59 Ôàêñ: (343) 231-00-03 Å-mail: eakonauka@gmail.com www.eyeclinic.ru Äèñêóññèîííûå âîïðîñû ñîâðåìåííîé îôòàëüìîõèðóðãèè where injecting the formulation into the vitreous at the end of the case could possibly cause an anterior vault. Dr. Mahootchi sees a difference in patient results, based on the amount of steroid that reaches the vitreous. That seems to affect iritis flare-ups at 3 weeks out. "I think you have to get at least 0.2 cc of the drug into the vitreous. There is more rebound iritis 3 weeks postop with 0.15 cc, so getting the volume up is important." An endoscopic study done informally by Dr. Mahootchi with the Crystalens has shown that the approach is not damaging zonules. In the rare occasions that Dr. Mahootchi sees a capsular block at day 1, it will resolve spontaneously, or he will push the lens back off the anterior capsule in the office. "The inflated vitreous probably pushed the lens forward, and a seal forms to the anterior capsule," he said. "The final refractive result is un- affected. I haven't seen a vault since injecting more slowly and spending a few seconds at the end of the case to tap vaulting thin lenses back to- ward the posterior capsule." EW Editors' note: Drs. Galloway and Mahootchi have financial interests with Imprimis. Drs. Safran and Scripture have no financial interests related to their comments. Contact information Galloway: eyeguy@frontiernet.net Mahootchi: am@seebetterflorida.com Safran: safran12@comcast.net Scripture: kscripture@wweyecenters.com