Eyeworld

MAY 2020 | EYEWORLD | 49 C Contact Goldberg: goldbed@hotmail.com Chu: yrchu@chuvision.com Dr. Goldberg expects intracameral medica- tions, including those inserted into the cannula, to gain traction among cataract surgeons. Dr. Chu, who has participated in FDA clin- ical trials using punctal plugs to deliver drugs, said such therapies are promising and attractive because plugs can be removed and, theoretically, titrated based upon how many plugs are placed. Dr. Goldberg, who participated in clinical trials for Dextenza, said it has provided clinical benefits to patients, but wider use of it awaits Medicare payment approval. An intracameral option for dilation is Omidria (phenylephrine and ketorolac injection, Omeros). Dr. Chu, who uses a standard drop dilation regimen, participated in the clinical trials for Omidria and found it effective. His practice is now conducting some post-market evaluations of the product. Although some practices have had good results with Omidria, Dr. Goldberg said pay- ment issues continues to limit his use of that treatment. Dexycu (dexamethasone, EyePoint Phar- maceuticals) is another promising intracameral option to treat postoperative inflammation. double-masked prospective U.S. multicenter study by Fram et al., OMNI demonstrated 50% reduction in summed ocular inflammation score over the 23% reduction seen with the control of Pred Forte (prednisolone, Allergan), Vigamox (moxifloxacin, Novartis), and Ilevro (nepafenac, Novartis). 1 "I'm sure some of the success of OMNI is from the simplified patient use to one bottle a couple of times a day instead of three different bottles on three different dosing schedules," Dr. Goldberg said. Dr. Chu, who has experience with many intracameral and combination therapies, uses intracameral drugs for patients who may have difficulty using topical drops or who have med- ical conditions, such as diabetes and inflamma- tory conditions, which may increase their risk of CME or prolonged postop healing. "We have had good experience with intra- cameral and subconjunctival medications, but some patients had slower visual recovery, and some had more postop inflammation than oth- ers," Dr. Chu said. Dr. Goldberg has experienced good results from the use of intracameral injections, al- though use among his patients has been limited by health plan payment. "If I could do it, I would," Dr. Goldberg said. "There's good data that supports the use of intracameral moxifloxacin." Reference 1. Fram N, et al. Prospective U.S. multicenter study of safety and efficacy of combination drop prednisolone phosphate, moxifloxacin, and ketorolac in treating postop inflammation and pain after cataract surgery. 2017 ASCRS•ASOA Symposium & Congress. Relevant disclosures Goldberg: Ocular Science, Ocular Therapeutix Chu: None Dexamethasone/moxifloxacin HCI (OMNI, OSRX) Prednisolone/gatifloxacin/bromfenac (OMNI, OSRX) Source (all): Damien Goldberg, MD

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