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Supported by Alcon Laboratories, Bausch + Lomb, Imprimis Pharmaceuticals, Ocular Therapeutix, and Omeros Corporation 3 local anesthesia and monitored sedation in a community hospital setting? Anesth Analg. 2005; 100:1644–1650. Dr. Kim is professor of ophthal- mology, Duke University School of Medicine, chief of the cornea and external disease division, and director of the refractive surgery service, Duke University Eye Center, Durham, North Carolina. He can be contacted at terry.kim@ duke.edu. References 1. Mohammadpour M, et al. Outcomes of acute postoperative inflammation after cataract surgery. Eur J Ophthalmol. 2007;17:20–28. 2. Epitropoulos AT, et al. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41:1672–1677. 3. Mishima H, et al. The putative role of prostaglandins in cystoid macular edema. Prog Clin Biol Res. 1989;312:251–264. 4. Fung D, et al. What determines patient satisfaction with cataract care under topical Postoperative complications such as CME, corneal edema, endophthalmitis, and persistent iritis are related to inflamma- tion. CME can occur in 3 to 12% of cataract cases and may be associated with decreased visual acuity. 3 Pain continuum As most surgeons tend to focus on patients' postoperative vision, we often overlook the pain continuum associated with cataract surgery. In a peer-reviewed study of 306 subjects undergoing cataract surgery, 37% had mild to mod- erate postoperative pain, with 34% of those requiring oral pain medications. 4 Postoperative pain is the most significant predictor of patient dissatisfaction. Conclusion Our advanced technology and techniques cannot address the inflammation and pain that can compromise visual, anatomic, and satisfaction outcomes after cataract surgery. It is critical to predict and address these inflammatory responders in our effort to prevent and man- age inflammation and improve outcomes. cataract surgery. 1 Early-onset inflammation reduced patients' visual acuity and resulted in pain and anxiety. We must identify patients at increased risk of postoperative inflammation, which increas- es the risk of cystoid macular edema (CME). Common comor- bidities, such as ocular surface disease (OSD), retinal disease, diabetes, corneal disease, auto- immune disease, or glaucoma, may predispose patients to increased postoperative inflam- mation. Furthermore, many of our patients use multiple topical medications that may contain preservatives that could have toxic and inflammatory effects. OSD can cause inflamma- tion and negatively impact outcomes, affecting preopera- tive measurements, postopera- tive visual acuity, and patient satisfaction. In a multicenter clinical tri- al, 8% of hyperosmolar patients had a variable K reading greater than 0.5 D between visits com- pared with patients with normal osmolarity. 2 In addition, 10% of hyperosmolar patients had a greater than 0.5 D difference in their IOL power calculation. 2 Dr. Kim's perioperative inflammation regimen Preoperatively: • Topical ofloxacin 0.3% and nepafenac 0.3% day of surger y Intraoperatively: • Phenylephrine 1%/ketorolac 0.3% injection (in balanced salt solution) Postoperatively: • Topical ofloxacin 0.3% for 1 week • Topical prednisolone acetate 1% for 2 weeks • Topical nepafenac 0.3% for 4 weeks by Edward Holland, MD Strategies to prevent inflammation and CME and relieve pain with anti-inflammatory agents Edward Holland, MD New technology can help cataract surgeons reduce the risk of postoperative inflammation C ontrolling inflam- mation is a key com- ponent of cataract surgery. Inflammation is associated with pain and cystoid macular edema (CME), a leading cause of de- creased vision after intraocular surgery. Although surgery trig- gers inflammation in normal and difficult cases, prolonged phacoemulsification and com- plications increase inflamma- tion. New anti-inflammatory ve- hicles will help decrease toxic- ity, increase solubility, increase ocular concentrations, and decrease dosing. Managing inflammation As inflammation increases in the eye, so does corneal edema, which delays visual recovery. Complicated procedures in- crease the risk of short-term edema and long-term risk of endothelial cell loss. continued from page 2 continued on page 4

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