Eyeworld

DECEMBER 2019 | SUPPLEMENT TO EYEWORLD | 7 Previous dosing schedule Fewer drops Fewer drops plus sub-tenons Steroid 4 times a day, taper down to once a day over 30 days 1 bottle of triple drop Week 1: 4 drops per day. Week 2: 3 drops per day. Week 3: 2 drops per day. Week 4: 1 drop per day 1 bottle of triple drop Week 1–4 1 drop per day Antibiotic 4 times a day for 10 days NSAID 1 time a day for 30 days Supported by an unrestricted educational grant from EyePoint Pharmaceuticals, ImprimisRx, Ocular Therapeutix, and Omeros Compounded combination therapies streamline topical drop regimens By William Wiley, MD William Wiley, MD P rescription eye drops are a significant source of frustration for cataract surgery patients. Using multiple medications on dif- ferent dosing schedules can be confusing, and they must cope with the expense and trips to the pharmacy. To streamline the process, we began using a compounded formulation. As a result, our patients usually need to instill only 1 drop per day. prednisolone and gatifloxacin to address potential abrasions, lim- bal relaxing incisions, or other conditions that could arise. 1 We worked with a com- pounding pharmacy to create this formulation of predniso- lone acetate 1%, gatifloxacin 0.5%, and bromfenac 0.075%. We can prescribe compounded medications from a compound- ing pharmacy following strict requirements under section 503B by the FDA and the Fed- eral Food, Drug and Cosmetic Act. We bulk order the drops and provide them so patients do not need to visit the pharmacy. It can be tapered or used with a bolus of steroid else- where. If we use dexameth- asone intraocular suspension plus this drop, the dexameth- asone ophthalmic insert in the lower punctum with this drop, or sub-tenons triamcinolone/ moxifloxacin, patients need to instill only one drop of this compound per day. The compounded drop has had a favorable safety record. We have used this technique in 4,000 eyes, virtually eliminating endophthalmitis, reducing post- op inflammation, and signifi- cantly reducing CME. n Conclusion The triple combination drop al- lows once-daily dosing, if used in combination with a steroid and virtually eliminates CME and endophthalmitis. Reference 1. Walters TR, et al. Bromfenac ophthalmic solution 0.07% dosed once daily for cataract surgery: results of 2 randomized controlled trials. Ophthal- mology. 2014;121:25–33. Dr. Wiley is medical director of the Cleveland Eye Clinic. He can be contacted at drwiley@clevelandeye- clinic.com. Searching for better options When we began looking for simpler alternatives to tradition- al eye drop regimens, we inject- ed a compounded formulation of triamcinolone and moxiflox- acin into the vitreous. It worked well but lasted only 2 weeks and originally did not contain an NSAID. We were not sure how long the antibiotic lasted, but it did prevent endophthalmitis. Inflammation occurred postop in some patients, who needed to return to using drops. There was also a 2% risk of cystoid macular edema (CME). To prevent postop inflam- mation, we placed the steroid sub-tenons, where it lasted 4 to 6 weeks. It did not cause float- ers, and postop inflammation or rebound did not occur. Bromfenac virtually eliminates CME, so we added it to our regimen, along with

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