Eyeworld

18 | EYEWORLD | JUNE 2019 ASCRS NEWS EYEWORLD JOURNAL CLUB Contact information Kapadia: Manasvee.Kapadia@UHhospitals. org by Rahul Raghu, MD, Huy Ly, MD, Ashraf Ahmad, MD, Samuel Dresner, MD, Patrick Pham, MD, Linda Ohsie Bajor, MD, Loretta Szczotka-Flynn, OD, PhD, Manasvee Kapadia, MD In this study, Nassiri et al. retrospec- tively compared the postoperative outcomes of patients who received 0.2 mL intravitreal triamcinolone acetonide/moxifloxacin (Tri- Moxi, ImprimisRx) and a non-steroidal an- ti-inflammatory eye drop with those patients who received a standard eye drop regimen. A total of 1,195 eyes from 919 patients operated on by two surgeons at a single institution were included in the study. Although there were no formal criteria for the assignment of patients to each of the two treatment arms, the baseline characteristics of the study groups were statisti- cally comparable, with exception of median age, which showed a small but statistically significant difference. The patients' postoperative outcome was reviewed with particular attention paid to intra- ocular inflammation, corneal edema, and rate of high intraocular pressure, which was defined as 24 mm Hg or higher. Though the Tri-Moxi medication group experienced a greater severity of corneal edema on postoperative day 1, there were no other statistically significant differences between the two groups. As a result, intravitreal therapy was concluded to have shown non-in- feriority to standard therapy for the outcomes measured. Of note, intraocular pressure tended to increase from baseline in both groups at postoperative day 1, but this normalized by subsequent follow-up visits and there were no statistically significant differences in intraocular pressure between the two treatment groups at postoperative month 1. The results and conclusions of this study provide compelling evidence for considering Tri-Moxi as an alternative to standard therapy. By using a large sample size, the study allows for generalizability of its statistical findings. An emphasis was placed on limiting confounding demographic variables. The baseline character- istics of the two groups within the study were relatively comparable, with a minor difference in median age as noted previously. Additionally, elevated postoperative IOP has been cited as a concern for use of an V ision loss secondary to cataract is cited as the most common cause of reversible blindness, globally affecting more than 250 million people 1 . With the increasing aging population, the current estimate of 3.6 million annual cataract surgeries performed here in the U.S. is only expected to rise 2 . Numerous ad- vances in phacoemulsification technology have helped to make the procedure safer, more effi- cient, and contributed to better visual outcomes. Despite this, innovation in perioperative management has remained relatively stagnant. Prescription of a topical antibiotic, steroid, and NSAID are the standard of care for most surgeons before and/or after cataract sur- gery. While many patients are able to adhere to postoperative topical drop regimens, these drops do have the potential to be burdensome and difficult to handle for a subset of patients. For this reason, other alternatives are being used. One way of providing medications is the intracameral technique, where the medication is injected through the side port incision at the time of cataract surgery and into the anterior chamber of the eye. However, with this tech- nique, the drug is quickly removed from the anterior chamber due to normal aqueous humor dynamics. Another technique is "dropless" cat- aract surgery, whereby injection of pharmaco- logic agents is given into the anterior vitreous at the time of surgery. There are two approaches for delivery, either transzonular or through pars plana. This technique allows the drug to remain in the eye for a prolonged period of time, there- by reducing or even completely eliminating the need for postoperative topical eye drops. Beyond the increased convenience that dropless cataract surgery may offer patients, there is evidence that injectable agents may also be more cost effective as compared to their top- ical counterparts 3 . The ESCRS Endophthalmitis Study Group demonstrated that at least from an infectious standpoint, there is a meaningful reduction in postoperative endophthalmitis 4 . Review of "Comparative analysis of moxifloxacin versus standard surgery" Manasvee Kapadia, MD Residency program director Case Western Reserve University/ University Hospitals Cleveland Medical Center

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