Eyeworld

EW CATARACT 36 March 2019 Research highlight by Maxine Lipner EyeWorld Senior Contributing Writer cataract surgery, Dr. Donaldson said. "Also, there had been two stud- ies 2,3 that had shown differences in prostaglandin levels," she said. "We wanted to confirm that and also look at our patients because we were noticing that the pupils were going down substantially." Researchers also investigated the degree of pupillary miosis across various laser platforms in earlier studies. Twenty patients were included in the study with the femtosecond laser only being used for the capsu- Considering their role in forestalling prostaglandin release C an use of an NSAID help curtail prostaglandin release in patients un- dergoing femtosecond laser capsulotomy during cataract surgery? A study 1 in the Journal of Ophthalmology indicated that the amount of prostaglandin in the aqueous humor was significantly lower in the eyes that received an NSAID, according to Kendall Don- aldson, MD, professor of ophthal- mology, Bascom Palmer Eye Insti- tute, Plantation, Florida. "We broke it down just looking at this one component of the pro- cedure," Dr. Donaldson said, adding that the other femtosecond-related aspects of the procedure are so vari- able with regard to the amount of energy used. They wanted to look at the part of that procedure that varies less by surgeon style. Monitoring prostaglandin levels Investigators were inspired to take a closer look at prostaglandin levels af- ter noticing that cataract procedures with the femtosecond laser seemed to be characterized by a decrease in pupil size compared to traditional Keeping NSAIDs part of the femtosecond phaco picture A mature cataract may require more energy for removal, placing the patient at higher risk for postoperative inflammation, including CME. Source (all): Kendall Donaldson, MD Small pupil in a diabetic patient, at higher risk for CME Patient with pupillary miosis induced by femtosecond laser pretreatment of the lens during cataract surgery lotomy creation. Of the 20 patients, 10 had pretreatment four times a day with the nonsteroidal generic ketorolac 3 days preoperatively, Dr. Donaldson said. Investigators observed pupillary miosis in most patients undergoing femtosecond cataract surgery. "The miosis was more pronounced in the patients who did not have pre- treatment with a nonsteroidal," Dr. Donaldson said. "Also, the levels of prostaglandins were much lower in the patients who were pretreated." This was consistent with the litera- ture, where it has been established that pretreatment with a nonsteroi- dal before cataract surgery can help give a more dilated pupil. Omidria (Omeros, Seattle), which includes the NSAID ketorolac as well as phenylephrine, is FDA approved for use during cataract surgery, and could be included in future studies as researchers try to prevent miosis in patients receiving femtosecond laser treatments, Dr. Donaldson said. "We're trying to figure out how to avoid miosis because it can in- crease the risks of cataract surgery," Dr. Donaldson said, explaining that physicians want to avoid introduc- ing a new complication with fem- tosecond technology, which could offer safety benefits. To avoid a potential downside, investigators are trying to find better ways to prepare these patients, she said. "I think we have to have a way to keep the pupils dilated for femto- second cataract surgery, whether it be pretreatment or something like Omidria during cataract surgery," Dr. Donaldson said. "We have to find a way to reduce the prosta- glandin release so we don't get that pupillary miosis. Our goal is to make the surgery as safe as possible."

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