Eyeworld

TAKE A LOOK AT LASTACAFT ™ For patients with itching due to allergic conjunctivitis… • FDA approved to prevent ocular itching all day 1 • Proven to work fast: Effi cacy shown at 3 minutes 2-4 • Proven to last all day: Prevents ocular itching through 16 hours 2-4 INDICATIONS AND USAGE LASTACAFT ™ is an H 1 histamine receptor antagonist indicated for the prevention of itching associated with allergic conjunctivitis. Important Safety Information WARNINGS AND PRECAUTIONS To minimize contaminating the dropper tip and solution, care should be taken not to touch the eyelids or surrounding areas with the dropper tip of the bottle. Keep bottle tightly closed when not in use. Patients should be advised not to wear a contact lens if their eye is red. LASTACAFT ™ should not be used to treat contact lens-related irritation. Remove contact lenses prior to instillation of LASTACAFT ™ . The preservative in LASTACAFT ™ , benzalkonium chloride, may be absorbed by soft contact lenses. Lenses may be reinserted after 10 minutes following administration of LASTACAFT ™ . LASTACAFT ™ is for topical ophthalmic use only. ADVERSE REACTIONS The most frequent ocular adverse reactions, occurring in < 4% of LASTACAFT ™ treated eyes, were eye irritation, burning and/or stinging upon instillation, eye redness, and eye pruritus. The most frequent non-ocular adverse reactions, occurring in < 3% of subjects with LASTACAFT ™ treated eyes, were nasopharyngitis, headache, and infl uenza. Some of these events were similar to the underlying disease being studied. Please see adjacent page for brief prescribing information. ©2011 Allergan, Inc., Irvine, CA 92612 ™ mark owned by Allergan, Inc. www.Lastacaft.com APC88VA11 107532 1. LASTACAFT ™ Prescribing Information. 2. Torkildsen G, Shedden A. The safety and effi cacy of alcaftadine 0.25% ophthalmic solution for the prevention of itching associated with allergic conjunctivitis. Curr Med Res Opin. 2011;27(3):623-631. 3. Data on fi le, Allergan, Inc., 2005; Clinical Study Report 05-003-11. 4. Data on fi le, Allergan, Inc., 2005; Clinical Study Report 05-003-13. Tue Feb 15 17:08:11 PST 2011 - 672062_10x13_x1.ps EW NEWS & OPINION 28 A relatively simple way to remove large amounts of contaminants from the ocular surface during pha- coemulsification has been described in the Journal of Cataract & Refractive Surgery. Study author Ian C. Francis, Ph.D., department of ophthalmol- ogy, Prince of Wales Hospital, Uni- versity of New South Wales, Sydney, Australia, and colleagues, described the technique as "macrowash," a minor but potentially helpful adjust- ment to more traditional "mi- crowash" procedures. "During our 36 years of per- forming surgery, up to late 2008, surface contaminants, whether in small or large amounts, were dealt with by repeated irrigation with a 27-gauge Rycroft cannula or similar instrument," Dr. Francis noted. The cannula would be attached to a 15 mL container of irrigating fluid. "This 'microwash technique' sometimes used the entire 15 mL container of balanced salt solution, frequently without ridding the cornea of surface contaminants," Dr. Francis reported. "Recently, it was noted that by removing the cannula from the irrigating container and ir- rigating the cornea and surrounding tissue with a relatively high-volume flow of BSS, the ocular surface was immediately cleared of large amounts of surface contaminants. This is referred to as a 'macrowash' technique." Macrowash advantages It is important to remove large amounts of surface contaminants from the eye during surgery for a va- riety of reasons, Dr. Francis ex- plained. "Surface contaminants, includ- ing oil, fragments of conjunctival mucus, and other debris, usually de- rived from the lids, frequently circu- late on the corneal surface at the commencement of cataract surgery, despite high quality draping," Dr. Francis noted. "There is always a concern that as a result of surface contaminants, and despite exclusion of the lids, surface infection or wound contamination might subse- quently occur. Indeed, the organ- isms that most commonly cause endophthalmitis are derived from the eyelid margin and preocular tear film." Dr. Francis believes he and his colleagues have found a way to markedly improve a surgeon's field of view and decrease the risk of in- fection. "We describe a technique of irrigating and thereby rapidly and effectively clearing the cornea of rel- atively large amounts of surface con- taminants that reduce surgical visibility and may contribute to en- dophthalmitis," Dr. Francis noted. The macrowash technique, de- scribed earlier, has advantages over other techniques to reduce contami- nants on the ocular surface. "Some colleagues report that a macrowash can also be achieved by using the open end of the irrigating cannula of the phacoemulsification system, with the irrigating system under surgeon foot control or with a large bore Rycroft cannula," Dr. Francis reported. "To use the phaco or irrigation/aspiration cannula to irrigate the cornea means the instru- ment has to be removed from the eye, which is counterproductive to operating time and could be associ- ated with repeated wound trauma." Large amounts of fluid irrigation can be wasteful and unnecessary, but this technique uses a relatively small amount of balanced salt solution. The method described in this report is flexible, allowing an operator to use either microwash or macrowash "simply by temporary removal/replacement of the Rycroft cannula," Dr. Francis reported. Microwash may be desirable be- cause it is "effective for small quanti- ties of surface contaminants and works within seconds of irrigation," Dr. Francis noted. Microwash also minimally interferes with a sur- geon's field of view. Images depict- ing microwash show little fluid movement, while macrowash shows multiple large fluid waves. "Given that postoperative en- dophthalmitis ultimately involves the introduction of an offending agent through the corneal incision, which can occasionally occur at the time of surgery, it seems appropriate to use every reasonable modality to minimize this," Dr. Francis reported. "We believe that when a microwash fails to clear the cornea of surface contaminants despite being repeated once or twice, a macrowash may be an effective method. We therefore recommend this technique to our surgical colleagues." Sujatha Mohan, M.D., Rajan Eye Care Hospital, Chennai, India, said her clinic prevents post-op in- fections by relying on different measures. Toward the end of surgery, Dr. Mohan uses a drop of povidone io- dine on the eye, and after one minute, washes it out with the fluo- roquinolone Vigamox (moxi- floxacin, Alcon, Fort Worth, Texas). Dr. Mohan also uses patching rou- tinely for a few hours post-op. Using this regimen, Dr. Mohan said her clinic has never had a case of frank endophthalmitis. Further, bacteria have become less problem- atic over the past 3 years that the clinic has been patching regularly and using this regimen, she said. "Pollution is very high in India," Dr. Mohan said. "We used to see mild [infections] after cataract surgery [before these measures]. We don't see them anymore." EW Editors' note: Dr. Francis reported no financial interests related to this study. Dr. Mohan has no financial interests related to her comments. Contact information Francis: iancfrancis@gmail.com Mohan: +91 044 2834 0500, rajaneye@md2.vsnl.net.in March 2011 by Matt Young EyeWorld Contributing Editor Macrowash technique removes large amounts of contaminants

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