Eyeworld

40 | EYEWORLD | DECEMBER 2022 HOT TOPICS IN OPHTHALMOLOGY ATARACT C by Liz Hillman Editorial Co-Director About the physicians Richard Hoffman, MD Drs. Fine, Hoffman, & Sims Eugene, Oregon Neal Shorstein, MD Seva Foundation Berkeley, California T he use of NSAIDS in the context of cataract surgery remains a hot topic among surgeons. In 2015, the Amer- ican Academy of Ophthalmology published the Topical Nonsteroidal Anti-inflammatory Drugs and Cataract Surgery OTA, which concluded that 1) "there is a lack of level 1 evidence that supports the long-term benefit of NSAID therapy to prevent vision loss from CME … " and 2) there is no evidence that preop NSAID use "[affects] long-term visual outcomes." 1 Following this report, in 2016 the ASCRS Cataract Clinical Committee published a paper in the Journal of Cataract & Refractive Surgery calling out NSAIDs' "history of significant safety and demonstrable effectiveness." 2 "Topical NSAIDs have been useful in pre- venting intraoperative miosis, postoperative in- flammation, and the development of CME," the authors wrote. "In addition, they may modulate postoperative pain and inhibit the proliferation of LECs that are responsible for PCO. Nonste- roidal anti-inflammatory drugs have a synergis- tic effect with steroids on the development of CME but may be used alone in high-risk eyes in which topical steroid use may be detrimental. Whether used solely in eyes at increased risk for the development of CME or universally in all patients having cataract surgery, the benefits of these topical medications should be assessed by each clinician as appropriate for their particular practice or patient population. … A thorough understanding of the potency, approaches for avoiding and treating CME, and adverse reac- tions and contraindications of these medications should help surgeons maximize their benefits and improve surgical outcomes and patient satisfaction." EyeWorld spoke with Richard Hoffman, MD, and Neal Shorstein, MD, who were both authors on this paper, to hear their current perspectives on NSAID use in the context of cataract surgery. Dr. Hoffman said there are "a whole host of different anti-inflammatory products for cataract surgery, including steroids and nonste- roidals." In the latter category, he said topical NSAIDs are the mainstay, but intracameral administration is now an option with Omidria (phenylephrine and ketorolac intraocular solution, Rayner). What's up with NSAIDs? continued on page 42 Dr. Shorstein said his practice has been to inject steroid as the sole anti-inflammatory agent following routine cataract surgery. Source: Neal Shorstein, MD

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