Eyeworld

EW CATARACT 25 November 2018 w w w. i n n o v a t i v e x c i m e r. c o m AMOILS EPITHELIAL SCRUBBER Uniform epithelium removal in 5 7 seconds Corneal Xlinking Improved clinical outcomes of CXL and PRK with Amoils Epithelial Scrubber • Minimize total procedure time • Avoid alcohol damage to surrounding tissue • No need for subsequent scraping order online www.innovativexcimer.com T.800.461.1200 www.innovativexcimer.com Achieve superior results with CME following cataract surgery." The PREMED study has shown that the combination of steroid and NSAID is superior to just steroid or just NSAID in the prevention of CME, he said. While in theory the idea of totally dropless cataract surgery appeals to Dr. Mamalis, in practice he thinks that it has a long way to go. "Anything that we could do that would decrease potential problems with compliance issues is going to be an advantage because we still have patients who when we give them the drops just don't use them," he said. But the main issue currently is that there is still no approved medication for doing this, he stressed, adding that this means using compounding pharmacies and that there have been some issues with those. "In Texas, there was an outbreak of patients who had severe posterior segment inflammation following problems with how the medications were compounded," Dr. Mamalis said. "It would be ideal if we had an FDA-approved medi- cation that could be put together in ways that we know what we're getting, but this doesn't exist at the moment." EW References: 1. Ferguson TJ, et al. Evaluation of a trabec- ular micro-bypass stent in pseudophakic pa- tients with open-angle glaucoma. J Glaucoma. 2016;25:896–900. 2. Haripriya A, Chang DF. Intracameral antibiotics during cataract surgery: evidence and barriers. Curr Opin Ophthalmol. 2018; 29:33–39. Editors' note: Dr. Berdahl has financial affiliations with Alcon (Fort Worth, Texas), Allergan (Dublin, Ireland), Bausch + Lomb, and Imprimis. Dr. Mamalis and Dr. Stephenson have no financial interests related to their comments. Contact information: Berdahl: john.berdahl@vancethompsonvision.com Mamalis: nick.mamalis@hsc.utah.edu Stephenson: eyedrdee@aol.com to vancomycin. "I spoke to several retina doctors and one who I have worked with for the last 30 years has used it forever and has never had a problem," she said. "If you put van- comycin in the bottle, that's the first medicine for endophthalmitis that they're going to inject intracameral- ly anyway, so I'm concerned but not worried about HORV." Nick Mamalis, MD, profes- sor of ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, doesn't start his patients on drops prior to their arriving at his center. "I found that there were some issues with confusion and compliance," Dr. Mamalis said. Prior to surgery, patients get three sets of a fourth generation fluoro- quinolone, such as moxifloxacin or gatifloxacin, as well as three sets of a topical NSAID, such as ketorolac, Dr. Mamalis noted. He likes to have the NSAID on board when starting sur- gery since there's the possibility that it can decrease some of the blood aqueous breakdown that occurs normally during cataract surgery, he explained. At the conclusion of the case, Dr. Mamalis injects 0.1 cc of pre- servative-free moxifloxacin intraca- merally into the anterior chamber, which he thinks helps prevent endophthalmitis. "There's good evidence from multiple studies both in Europe and the U.S. that intraca- meral antibiotics show a significant decrease in the risk of postoperative endophthalmitis," 2 Dr. Mamalis said. In addition, postoperatively, he still has patients use a fourth genera- tion fluoroquinolone for 7 days. Dr. Mamalis terms this the "belt and suspenders" approach to guarding against endophthalmitis. "Also, postoperatively they'll have the usual prednisolone four times a day for at least 2 weeks with a taper and a topical NSAID four times a day with a taper," Dr. Mamalis said. "There has been evi- dence through the years that using a combination of NSAID and steroid not only helps to calm the postop- erative inflammation but also helps to decrease the risk of postoperative

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