Eyeworld

EW CATARACT/IOL 63 New generation ketorolac's two-pronged advantage U se of preservative-free ke- torolac 0.45% (Acuvail, Allergan, Irvine, Calif.) for patients undergoing rou- tine cataract surgery can not only help stave off pain but also improve visual acuity, according to Eric D. Donnenfeld, M.D., co-chair- man, cornea, Nassau University Medical Center, East Meadow, N.Y. Results published in the December 2010 issue of the American Journal of Ophthalmology indicated that nearly twice as many cataract patients re- ceiving Acuvail were pain-free com- pared with controls. There was also a statistically significant improvement in visual acuity from baseline. "The purpose here was to evalu- ate the next generation ketorolac, which is Acuvail," Dr. Donnenfeld said. "There are several unique prop- erties of Acuvail that are different from any previous ketorolac. In fact, they are different from any other non-steroidal that is currently or has previously been available." Investi- gators, led by Dr. Donnenfeld, wanted to perform an evaluation of the efficacy of this concentration and formulation of the product. There are several significant dif- ferences of Acuvail compared to pre- vious NSAIDs. "Number one, it's preservative free," Dr. Donnenfeld said. "Number two and most impor- tantly, this is the first non-steroidal that has been formulated that has a carrier vehicle that increases the safety and efficacy of the medica- tion." Dr. Donnenfeld pointed out that prior to this, all non-steroidals have been in solution. Acuvail has a new vehicle. "Acuvail is combined with a hydroxymethylcellulose vehi- cle that increases the contact time of the non-steroidal on the ocular sur- face to provide additional anti-in- flammatory," Dr. Donnenfeld said. "In addition, it provides a margin of safety because the hydroxymethyl- cellulose is a good stabilizer of the ocular surface and provides in- creased wetting and lubrication of the surface." This has been a con- cern with older NSAID formulations. "The number one concern in the past with non-steroidals has been their anesthetic effect and their effect on the epithelium," Dr. Donnenfeld said. While there has been a history of problems with certain non- steroidals, Dr. Donnenfeld sees Acuvail as different. "This is the first non-steroidal that I have seen that actually improves the ocular surface because of the hydroxymethylcellu- lose," Dr. Donnenfeld said. "The ve- hicle is what makes it unique—it stabilizes the ocular surface and pro- vides safety and efficacy that we have never seen in a non-steroidal before." Included in the study were 511 patients slated to undergo routine cataract surgery. Patients were ran- domized to receive Acuvail or no non-steroidal. "The patients were started on this 1 day before surgery and then continued the day of surgery and 14 days after," Dr. Donnenfeld said. Investigators determined that at day 14, approximately twice as many patients who received Acuvail had a summed ocular inflammation by Maxine Lipner Senior EyeWorld Contributing Editor Managing cataract pain with Acuvail Henderson Capsular Tension Ring (HCTR) For easier cortical removal while maintaining the desired stretch around the entire capsular bag. Ahmed Capsular Tension Segment (CTS) For intraoperative support (secured by iris hook) or permanent support (sutured to sclera). Cionni Capsular Tension Rings For more extensive zonulopathy. Fixation eyelet is sutured to sclera to anchor capsular bag to the eye wall. Morcher ® Capsular Tension Rings For mild zonular instability. Provides equal distribution of force over the entire capsular circumference. For more information, visit fci-ophthalmics.com or call 800.932.4202. Expand Your Options MORCHER ® Capsular Tension Devices exclusively from FCI Ophthalmics FDA Approved Henderson Capsular Tension Ring (HCTR) Ahmed Capsular Tension Segment (CTS) Cionni Capsular Tension Ring Morcher ® Capsular Tension Ring NEW NEW Capsular Tension Devices are made of PMMA material. FCI_EXPAND_EW_Ad 8/6/09 10:03 AM Page 1 continued on page 64 In patients with cataracts, use of Acuvail has been shown to stem pain and improve vision Source: Eric D. Donnenfeld, M.D. March 2011

• Cover