Eyeworld

EW CATARACT 37 March 2019 Contact information Donaldson: KDonaldson@med.miami.edu Editors' note: Dr. Donaldson has finan- cial interests with Alcon (Fort Worth, Texas), Bausch + Lomb (Bridgewater, New Jersey), and Johnson & Johnson Vision (Santa Ana, California). 3. Schultz T, et al. Prostaglandin release during femtosecond laser-assisted cata- ract surgery: main inducer. J Refract Surg. 2015;31:78–81. Clinical implications When performing cataract surgery, Dr. Donaldson typically uses Ilevro (nepafenac, Novartis, Basel, Swit- zerland), prescribing the once-a- day agent for 3 days prior. In cases where insurance doesn't allow for a brand-name product, she prescribes generic ketorolac, which must be administered four times a day and can dry the eye, she noted. "We would like to use Omidria, however, it has been difficult because we're a hospital-based academic practice and there are some financial issues involved in bringing this into a hos- pital setting. However, we're work- ing to overcome these barriers," Dr. Donaldson said. "But I think in an ambulatory surgical setting, I would be using Omidria during my cases." While the trend around the country has been to use less drops both before and after cataract sur- gery, Dr. Donaldson thinks NSAIDs still very much have a role. "It has been shown that preoperative topical antibiotics are not helpful, but I think we need to maintain the preoperative treatment with nonsteroidals even if we stop the pretreatment with antibiotics," she said. "I think there still are many good reasons to use nonsteroidals, including the pupillary issues, the potential prevention of CME, and the pain-relieving aspect of it." Practitioners need to be espe- cially diligent with femtosecond patients for several reasons, Dr. Donaldson continued. First, their expectations are higher. Second, there is the effect of the femtosec- ond laser that causes the pupils to decrease in size. "This could poten- tially be changing the risk profile of surgery in the patients with the highest expectations," she said. "Of course, we want the best outcomes for everyone, but achieving it in this group of patients is especially crucial." EW References 1. Diakonis VF, et al. The effect of NSAID pretreatment on aqueous humor prosta- glandin E2 concentration in eyes undergoing femtosecond laser-assisted capsulotomy. J Ophthalmol. 2018;2018:1891249. 2. Schultz T, et al. NSAID pretreatment inhibits prostaglandin release in femtosecond laser- assisted cataract surgery. J Refract Surg. 2015;31:791–4. Strength. COMPLEX CASE MIX. RENOWNED CLINICIANS. DISTINGUISHED FACULTY. GLOBAL ENGAGEMENT. CUTTING-EDGE TECHNOLOGY. DIVERSE SURGICAL TRAINING. EYE-ONLY EMERGENCY ROOM. MENTORSHIP AND CAMARADERIE. 840 Walnut St., Philadelphia, PA 19107 willseye.org | 877.289.4557 Believing is Seeing *Based on a Doximity clinical reputation survey for 2018-2019. Voted #1 ophthalmology residency program in the United States. *

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