Eyeworld

40 | EYEWORLD | JUNE 2019 R EFRACTIVE PHARMACEUTICAL FOCUS Contact information Donnenfeld: ericdonnenfeld@gmail.com Lindstrom: rllindstrom@mneye.com by Maxine Lipner EyeWorld Senior Contributing Writer doesn't occur until after the second eye has been treated. Many now think this is not worth the risk. The problem with intracameral antibiot- ics in the U.S. is that no medication has been FDA approved for this. "By definition they're all off-label compounded medications, and there's always the risk of contamination with a compounded medication as well as of dilution errors," Dr. Donnenfeld said. "However, moxi- floxacin is particularly safe in that it's tolerant of higher concentrations." There haven't been any immune responses or any vasculitis, he continued, adding that there have been some reports of pigmentary changes to the iris. "But the risk/reward ratio for moxi- floxacin is in favor of the reward," Dr. Donnen- feld said. "Using it can have a significant impact on reducing the risk of endophthalmitis." Dr. Lindstrom pointed out that most errors occur when the injection is prepared by the physician or nurse instead of a compounding facility. "If you work with a high quality, repu- table compounding pharmacy with a long track record of quality work, I am comfortable with it," he said. "I've used compounded injections of moxifloxacin made by the Phillips Eye Insti- tute, Imprimis, and Leiters." W hen it comes to protecting cataract patients from postop infection, many practitioners rely on intracameral injections at the end of surgery to stave off endophthalmitis, according to Richard Lindstrom, MD. In the U.S., moxifloxacin is the staple, while in Europe most practitioners use cefuroxime, Dr. Lindstrom noted. This is because the Euro- pean Society of Cataract & Refractive Surgeons (ESCRS) study used intracameral cefuroxime to forestall bacteria such as Staph epidermidis, but in the U.S. the impression is that moxifloxacin is better for this. "Moxifloxacin has been used in studies in Latin America, India, and elsewhere with good outcomes, and most U.S. surgeons were using a fluoroquinolone already topically," Dr. Lindstrom said. Eric Donnenfeld, MD, pointed out that until 1.5 years ago vancomycin was commonly used in the U.S. intracamerally. "Then there were some papers on the development of hem- orrhagic occlusive retinal vasculitis (HORV), and the use of vancomycin has decreased dramatically," Dr. Donnenfeld said, adding that this rare condition can potentially lead to bilat- eral blindness since its delayed onset generally Intracameral antibiotics at the end of cataract surgery About the doctors Eric Donnenfeld, MD Ophthalmic Consultants of Long Island Garden City, New York Richard Lindstrom, MD Minnesota Eye Consultants Minneapolis Financial interests Donnenfeld: Alcon, Allergan, Bausch + Lomb, Novartis Lindstrom: Alcon, Allergan, Bausch + Lomb, Novartis, Sun Pharmaceuticals undergoes a sort of pupil dilation fatigue. For the last few treatments, the pupil may not dilate beyond the edge of the lens implant," he said. Robert Maloney, MD, agreed with target- ing for hyperopia. "We typically target between +0.50 and +0.75 in the distance eye. If we are doing monovision, we target about –1.50 in the near eye. The technology allows patients considering monovision to experience different amounts of anisometropia, after the cata- racts have been removed, using trial frames or temporary contacts. It offers a level of custom- ization that's never been possible before," Dr. Maloney said. Dr. Berdahl added, "It won't replace every lens on the market, but I think it will be one of the most important tools in our toolkit of lens- es to help achieve spectacle independence." The future According to Dr. Miller, the FDA approval letter came with strings attached. "The compa- ny is required to do a post-market study that is almost as involved as, if not even more involved than, the premarket approval clinical trial," he said. Dr. Maloney thinks the LAL will be the lens of choice for the next 10 to 15 years. "After that, we will have electro-optical lenses with adjustable sphere and cylinder that also accom- modate," he said. continued from page 38

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