Eyeworld

151 EW INTERNATIONAL April 2016 phacoemulsification with IOL inser- tion some time after PKP) achieves better refractive results than triple surgery. generally not so demanding regard- ing refractive perfection and there- fore willing to wear postoperative glasses," Dr. Sheppard said. Shimmura and colleagues 3 con- tend that separating the penetrating keratoplasty part of surgery from cataract extraction and IOL implan- tation (i.e., performing "planned" The investigators think that this sequence allows for a chance to correct post-keratoplasty astig- matism by implanting a toric IOL or performing arcuate keratotomies even in the absence of compression sutures. The triple procedure was per- formed in 11 eyes, with the planned procedure performed in 11 case- matched eyes. "There were 10 eyes (91%) within +/–2.0 D of expected values in the secondary planned phacoemulsification group versus 5 patients (45%) in the triple proce- dure group," the authors reported. "Planning for secondary planned phacoemulsification in penetrating keratoplasty patients with cataracts is a safe and reliable procedure to obtain less post-surgical refractive error; performing a two-stage in- tervention has no effect on corneal endothelial viability after 1 year." According to Dr. Javadi and colleagues, in order to make use of these privileges (better refractive outcomes, correction of post-kera- toplasty astigmatism, etc.) cataract extraction should be postponed at least 1 year after PK, when all sutures are removed and graft cur- vature stable. "This latter approach, however, entails the drawback of delayed visual rehabilitation," they said. "Risks versus benefits should be considered; cataract surgery can- didates may have associated corneal and ocular morbidities that make the surgery itself appear more com- plicated, when in fact the patient is more complicated," Dr. Sheppard said. Long-term risk factor analysis yields comprehensive results Meanwhile, a group of Chinese investigators recently conducted a long-term risk factor analysis for complications after triple surgery involving eyes with high myopia. Triple surgery, in this case, specifically refers to phakic intraoc- ular lens (P-IOL) explantation and phacoemulsification with in-the-bag IOL implantation, and results were presented at the 2015 AAO annual meeting. T:10.75" B:10.75" INDICATIONS AND USAGE PROLENSA ® (bromfenac ophthalmic solution) 0.07% is a nonsteroidal anti-infl ammatory drug (NSAID) indicated for the treatment of postoperative infl ammation and reduction of ocular pain in patients who have undergone cataract surgery. IMPORTANT SAFETY INFORMATION ABOUT PROLENSA ® • PROLENSA ® contains sodium sulfi te, a sulfi te that may cause allergic type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfi te sensitivity in the general population is unknown and probably low. Sulfi te sensitivity is seen more frequently in asthmatic than in non-asthmatic people. • All topical nonsteroidal anti-infl ammatory drugs (NSAIDs), including bromfenac, may slow or delay healing. Concomitant use of topical NSAIDs and topical steroids may increase the potential for healing problems. • There is the potential for cross-sensitivity to acetylsalicylic acid, phenylacetic acid derivatives, and other NSAIDs, including bromfenac. Use with caution in patients who have previously exhibited sensitivities to these drugs. • There have been reports that ocularly applied NSAIDs may cause increased bleeding of ocular tissues (including hyphemas) in conjunction with ocular surgery. Use with caution in patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time. • Use of topical NSAIDs may result in keratitis. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs, including bromfenac, and should be closely monitored for corneal health. Patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (e.g., dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time may be at increased risk for corneal adverse events which may become sight threatening. Topical NSAIDs should be used with caution in these patients. Post-marketing experience with topical NSAIDs suggests that use more than 24 hours prior to surgery or use beyond 14 days post-surgery may increase patient risk for the occurrence and severity of corneal adverse events. • PROLENSA ® should not be instilled while wearing contact lenses. The preservative in PROLENSA ® , benzalkonium chloride, may be absorbed by soft contact lenses. Lenses may be reinserted after 10 minutes following administration of PROLENSA ® . • The most commonly reported adverse reactions in 3%-8% of patients were anterior chamber infl ammation, foreign body sensation, eye pain, photophobia, and blurred vision. Please see brief summary of full Prescribing Information for PROLENSA ® on adjacent page. References: 1. PROLENSA Prescribing Information, April 2013. 2. Data on fi le, Bausch & Lomb Incorporated. 3. Baklayan GA, Patterson HM, Song CK, Gow JA, McNamara TR. 24-hour evaluation of the ocular distribution of (14)C-labeled bromfenac following topical instillation into the eyes of New Zealand white rabbits. J Ocul Pharmacol Ther. 2008;24(4):392-398. PROLENSA is a registered trademark of Bausch & Lomb Incorporated or its affi liates. © Bausch & Lomb Incorporated. All rights reserved. Printed in USA. PRA.0188.USA.15 The PROLENSA ® Effect POWERED FOR PENETRATION Advanced Formulation to Facilitate Corneal Penetration 1-3 pH e ffect Hal og en a ti on e ffect PROLENSA ® delivers potency and corneal penetration with QD dosing at a low concentration 1-3 continued on page 152

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