Eyeworld

by Eric Donnenfeld, MD Reducing inflammation: clinical impact of ultrasound energy applied during cataract surgery developed to treat postoperative inflammation and prevent pain from cataract surgery. It was formulated in a drug-delivery vehicle designed to improve solubility, absorption, bioavail- ability, and residence time com- pared with conventional topical treatments. 10 Conclusion We have a variety of excellent choices to help improve pa- tient compliance and surgical outcomes. Researchers should continue to work to determine the optimal combination of drug and delivery method to eliminate postoperative inflam- mation. References 1. Kholdebarin R, et al. Multicenter study of compliance and drop administra- tion in glaucoma. Can J Ophthalmol. 2008;43:454–461. 2. Winfield AJ, et al. A study of the causes of non-compliance by patients prescribed eye- drops. Br J Ophthalmol. 1990;74:477–480. 3. An JA, et al. Evaluation of eyedrop admin- istration by inexperienced patients after cataract surgery. J Cataract Refract Surg. 2014;40:1857–1861. 4. OMIDRIA (package insert). Seattle: Omeros Corporation, 2014. continued from page 5 Surgeons can help prevent inflammation by making the most of current technology C ompared with stan- dard phacoemulsifica- tion, the femtosecond laser delivers energy more efficiently into the eye, with less heat and col- lateral damage, reducing trauma and inflammation from the outset. Eric Donnenfeld, MD " We should have zero tolerance for inflammation. " –Eric Donnenfeld, MD With the femtosecond laser, tightly focused, ultrashort light pulses cause photo-disruption by creating high-energy densi- ties in the cornea, capsule, or lens. It creates a plasma-induced ablation of only a few microns, functioning too quickly to cause thermal effects in the tissue. Current femtosecond laser platforms are highly automated and precise, replacing manual techniques for capsulotomy, fragmentation, and corneal inci- sions and significantly reducing effective phacoemulsification time and energy. Future of cataract surgery I think future cataract surgery will focus more on fluidics control and less on ultrasound energy. Irrigation/aspiration (I/A) and phacoemulsification systems may offer larger-bore I/A, better fluidics, and less bev- eled phacoemulsification tips to complement laser-assisted cataract surgery (LACS). I think we can perform ul- trasound-free procedures today in approximately half of cas- es, even with more significant cataracts. I have minimized my ultrasound energy substantially by using the femtosecond laser for softening. A multicenter international field study assessed standard coaxial phacoemulsification, coaxial microincision cataract surgery, and bimanual (biaxial) microincision cataract surgery. 1 The mean effective phacoemul- sification time and mean power usage for microincision surgery with femtosecond laser assis- tance were similar to or less than the values for standard coaxial small incision cataract surgery. Research has shown that LACS may cause less endothelial cell loss, less corneal swelling, and less trauma to the endothe- lial cells compared with manual phacoemulsification. 2 Nagy et al. reported signifi- cantly less macular edema with the femtosecond laser. 3 Zero tolerance We should have zero tolerance for inflammation. It increases 5. Lindstrom RL, et al. Intracameral phen- ylephrine and ketorolac injection (OMS302) for maintenance of intraoperative pupil diameter and reduction of postoperative pain in intraocular lens replacement with phacoemulsification. Clin Ophthalmol. 2014;8:1735–1744. 6. Rosenberg E, et al. Initial experience, visual outcomes and efficacy of intracamer- al phenylephrine and ketorolac (1%/0.3%) during cataract surgery. Presented at the 2016 ASCRS•ASOA Symposium & Congress. 7. Galloway MS. Transzonular steroid/anti- biotic as cataract prophylaxis: retrospective analysis of 2300 patients. Presented at the 2014 American Academy of Ophthalmology annual meeting. 8. Lewis J. Macular edema following intravitreal triamcinolone as an alternative to post-cataract anti-inflammatory drops. Paper presented at the 2014 American Academy of Ophthalmology annual meeting. 9. Data on file, Ocular Therapeutix. 10. Sun Pharma press release, April 9, 2016. Dr. Mah is director of the cor- nea service and co-director of the refractive surgery service, Scripps Clinic, La Jolla, California. He can be contacted at Mah.Francis@ Scrippshealth.org. Advanced therapeutic and surgical options to eliminate post-cataract surgery inflammation and pain 6

• Cover