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EW CATARACT 37 June 2016 this study is not available to U.S. surgeons, although many 3-piece IOLs are available for the sutureless technique. "If one, however, already has to make a large incision to remove an anterior chamber IOL or PMMA lens, or if one has a rim of remaining capsule present that they want to take advantage of, it's hard to beat a Gore-Tex sutured 1-piece PMMA lens for stability and safety," Dr. Safran said. "That lens isn't going to go anywhere." Sutureless option The sutureless technique is excellent, Dr. Safran said, but in some cases the haptics can erode or dislodge from the tunnels. And if further surgery on the eye is required, then the IOL may be less stable than one secured with the sutured method. Addition- ally, eyes that become hypotonous after surgery can see the sutureless IOLs work their way out of tunnels, while that is not an issue for sutured lenses. "So both methods have advan- tages and disadvantages that make them non-equivalent depending on the situation," Dr. Safran said. Although the authors were based in Pondicherry, India, Dr. Henderson said the findings apply well to U.S. and other surgeons, although a difference may be the types of IOLs that are available in other countries. Since U.S. surgeons are less familiar with the sutureless technique, Dr. Henderson urged them to watch and perform the first handful of cases with a more experi- enced mentor. Additionally, travel- ing to places where high volumes of secondary IOLs are implanted may be worthwhile for many surgeons wishing to incorporate these tech- niques. Additionally, "for the sutureless technique, an IOL with longer and flexible haptics is desirable to avoid haptic damage during the proce- dure," Dr. Henderson said. the U.S. market of many of the 1-piece PMMA IOLs with holes in the haptics that surgeons prefer to use with the method. For instance, the 1-piece PMMA lens sutured in method (glued in) allows use of a large range of different IOLs, smaller incisions, and avoids suture ero- sion. The sutured lens technique is limited by the disappearance from Sutured differences Among important differences in the techniques seen by Steven Safran, MD, Lawrenceville, New Jersey, are that the intrascleral haptic S:10" 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 38

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