EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/407647
EW CATARACT 32 November 2014 by Vanessa Caceres EyeWorld Contributing Writer M. Stewart Galloway, MD, Crossville, Tenn., presented his retrospective chart review of 1,575 eyes that had received TriMoxi instead of topical antibiotics and steroids. Dr. Galloway injected 0.3 mg of triamcinolone and 0.2 mg of moxifloxacin transzonularly into the anterior vitreous of patients undergoing cataract surgery. The injections occurred with the use of a 27-gauge cannula before removing viscoelastic material. Follow-up evaluations took place at 4 to 7 hours, 3 to 4 weeks, and at 6 months. The mean IOP was 21.8 mm Hg on the day of surgery and 14.5 mm Hg at 3 weeks. "No patients required ocular hypotensives due to a steroid response," Dr. Galloway said. There were no cases of endoph- thalmitis. Dr. Galloway defined CME as any patient with reduced postop visual acuity and any increase in cystoid macular thickness more than 220 μm regardless of the presence or absence of cystic change on OCT. The overall CME rate was 2% in the study overall, but only 1.5% in those without the risk factors of diabetes or epiretinal membranes. The overall inflammation rate was 2.5% postoperatively, and those patients required the short-term addition of topical steroids. The inflammation rate was higher in pa- tients with an epiretinal membrane and those who later developed CME. The injectable approach improved patient medication compliance and decreased postop care requirements. The injection did, however, require slightly more preoperative counseling and led to an increasing number of patients who had a foreign body sensation, which Dr. Galloway attributed to the lack of topical anti-inflammatory use at the wound. The additional counseling came from explaining to patients that they would experience a brief reduction in visual acuity after surgery and to let them know that they would "see" the medica- tion appear as floaters for several days after surgery. Further presentations on the "dropless" approach will be pre- sented at upcoming ophthalmology meetings. The formulations from Imprimis are currently patent pending. Imprimis acquired the intellectual rights to the formula- tions in August of last year. As of June 2014, the formula- tions were available in 29 states with a physician's prescription. The com- pany has compounding pharmacy license applications pending in 10 additional states. Practice implications "Far more often than we may think, patients do not take their medica- tions in the way we prescribe them," said Kevin T. Scripture, MD, Richmond, Ind. That is where Dr. Scripture thinks that going dropless will be quite useful. Dr. Scripture, who has used compounded drug formulations since May 2005 in more than 20,000 patients, said the only anomaly he must stress to patients is that they will see floaters or shadows of the medication for several days after surgery. "It's in a spot in the eye that will cast shadows on the retina," he said. 'Dropless' approach to cataract surgery expands formulations for ophthalmology that became available after the company launched its Go Dropless campaign in April 2014. One formulation, called TriMoxiVanc, combines triamcino- lone, moxifloxacin, and vancomy- cin. A second formulation, called TriMoxi, contains only triamcino- lone and moxifloxacin. In addition to cataract surgery, the formulations can be used with other intraocular procedures. A study presenting some of the first data on the preservative-free injections reported that TriMoxi helped to prevent inflammation, cystoid macular edema (CME), and endophthalmitis after phacoemulsi- fication. At the 2014 ASCRS•ASOA Symposium & Congress in Boston, Injectable formulation aims to boost medication compliance, decrease patient cost G etting patients to comply with their post-cataract surgery drop regimen can be challenging, to say the least—and then patients balk at the out-of-pocket expenses associated with those drops. One pharmaceutical company hopes to make the drop regimen a little simpler for both surgeons and patients. Imprimis Pharmaceuticals (San Diego) has developed sterile and injectable proprietary compound Injection of TriMoxi TriMoxi reflex Source (all): M. Stewart Galloway, MD Use of the injectable formulation has helped improve staff workflow. "Staff time at the office and ASC has been greatly reduced with shorter instructions and calls and fewer call backs to pharmacies." – Ahad Mahootchi, MD