Eyeworld

56 The X Factors: Three areas that will improve refractive cataract surgery outcomes by David A. Goldman, MD Strategies to prevent edema and relieve pain by maximizing penetration of anti-inflammatory agents Reducing inflammation and pain increases patient satisfaction and improves visual recovery after cataract surgery I ntraocular lenses (IOLs) re- quire a quiet eye for best visual results. We may be able to predict inflammatory respond- ers before surgery by identifying predisposing conditions and reduce inflammation with new anti-in- flammatory medications that offer greater penetration. Predicting inflammation Diabetes, glaucoma, and macular disease are just a few conditions that may increase postoperative inflammation. In addition, prosta- glandins have been associated with cystoid macular edema (CME) and alpha-blockers such as tamsulosin with intraoperative floppy iris syn- drome. Furthermore, more inflamma- tion may occur in patients with dense cataracts or darkly pigmented irises or those requiring additional surgical time. Managing inflammatory mediators Surgical trauma triggers the in- flammatory cascade. Steroids and nonsteroidal anti-inflammatories (NSAIDs) work at different stages of this process, and I believe there is a synergistic effect when we combine them. NSAID pretreatment reduces intraoperative miosis and increases postoperative comfort. After surgery continued on page 58 David A. Goldman, MD Figure 1. Nonsteroidal anti-inflammatory agents used to treat pain associated with cataract surgery Product Name Indication Bromfenac, 0.07% (Prolensa, Bausch + Lomb) For the treatment of postoperative inflammation and reduction of ocular pain in patients who have undergone cataract surgery Ketorolac tromethamine, 0.45% (Acuvail, Allergan) For the treatment of pain and inflammation following cataract surgery Nepafenac, 0.3% (Ilevro, Alcon) For the treatment of pain and inflammation associated with cataract surgery Phenylephrine and ketorolac injection, 1%/0.3% (Omidria, Omeros) FDA-approved for maintaining pupil size by preventing miosis and for reducing postoperative ocular pain in adult patients Figure 2. Eye drop regimen comparison Which is easier for the patient? Typical regimen Modified regimen • NSAID – QID/BID/QD until the bottle is gone • Steroid • QID for 1 week • TID for 1 week • QD for 1 week • Same regimen throughout postop period • Steroid: 1 drop in the AM • NSAID: 1 drop at night

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