Eyeworld

EW CATARACT 78 April 2016 inflammation, pain, and macular changes." With this in mind, he currently doses topical brand NSAIDs twice a day and is uncertain whether even that is enough. "Now perhaps Omidria will let me get down to once-a-day dosing or even eliminate topical NSAIDs," Dr. Wittpenn said. Others are looking to perhaps decrease the number of drops pa- tients are taking by eliminating the use of steroids from the postopera- tive mix. However, it's currently a fluid question as to whether or not topical NSAIDs can be used alone. Dr. Trattler pointed out that while most nonsteroidals are FDA ap- proved for control of the inflamma- tion after cataract surgery without a steroid, the 2 together have a synergistic effect because these work on different parts of the inflamma- tory pathway. "There are surgeons who prefer just using a nonsteroidal and that's appropriate, but I like the combination," Dr. Trattler said. Overall, in Dr. Trattler's view, NSAIDs will continue to be an im- portant part of the cataract regimen. "I think we will continue to work to- ward lowering the amount of drops used for patients in and around cataract surgery," Dr. Trattler said. "But we need a nonsteroidal—it's a very important part of postoperative care for cataract surgery." EW References 1. Shorstein NH, et al. Comparative effec- tiveness of three prophylactic strategies to prevent clinical macular edema after phacoemulsification surgery. Ophthalmology. 2015;122:2450–2456. 2. Wittpenn JR, et al. A randomized, masked comparison of topical ketorolac 0.4% plus steroid vs. steroid alone in low-risk cat- aract surgery patients. Am J Ophthalmol. 2008;146:554–560. Editors' note: Dr. Shorstein has no financial interests related to his comments. Dr. Trattler has financial interests with Alcon, Allergan, Bausch + Lomb, and Omeros. Dr. Myers has no financial interests related to his comments. Dr. Wittpenn has financial interests with Bausch + Lomb and Omeros. Contact information Myers: wmyers2020@gmail.com Shorstein: nshorstein@eyeonsight.org Trattler: wtrattler@gmail.com Wittpenn: jrwittpenn@aol.com show that the combination of the 2 products enhanced both of these features. He finds that Omidria main- tains good pupillary dilation. Dr. Wittpenn thinks this could poten- tially reduce or eliminate the need for topical NSAIDs because the levels of ketorolac measured in the animal studies are much greater than what could be achieved topically. Many of the newer agents such as Prolensa and Ilevro are currently being dosed once a day, but this schedule has nothing to do with preventing macular thickening. He pointed out that studies done on the prevention of CME or macular thickening utilized ketorolac dosed 4 times a day or nepafenac dosed 3 times a day. These agents block prostaglandin synthesis by binding to the COX enzymes. "When there are insufficient molecules to block all the enzymes, production of pros- taglandins resumes. These prosta- glandins cannot be eliminated when additional medicine is dosed at a later time. Unlike with an antibiotic where you can hope to kill what you missed with the next, with prosta- glandin synthesis, once it is made it remains in the eye tissue to elicit 3. Check capsulotomy has been released Visitec® FLACS Cannula Innovative tip design allows multiple functions to be performed. Visit us at ASCRS Booth 519 1. Opening all femto incisions (side-port, phaco & LRIs) 2. 25G cannula for injections of OVD and /or other solutions The Visitec single-use capsulorhexis forceps have wide platforms, designed for removing femto capsulotomies. Designed to improve: • Surgical effi ciency • Clinical performance • Patient safety Call your local sales rep or BVI customer service at +44.1865.601256. Visit us at www.beaver-visitec.com Beaver-Visitec International, Sales Limited 85c Park Drive, Milton Park, Abingdon, Oxfordshire, OX14 4RY, UK BVI, BVI Logo and all other trademarks are property of Beaver-Visitec International (BVI) © 2016 BVI New continued from page 77

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