Eyeworld

EW CATARACT 35 a second injection may help amplify the effect. "There is a synergy provid- ed by the second injection when a pupil starts to dilate but is not good enough for (complete) dilation," Dr. Cochener said. Complications have not been an issue with this intracameral approach. "So far we haven't noticed any except the absence of effect when we are dealing with a small pupil," Dr. Cochener said, adding that there were no signs of induced inflammation or endothelial cell density changing the morphology of cells or even macular changes. So far, Mydrane has only been approved for dilation, but the drop also appears to have an analgesic effect. "We were able to demonstrate that this was good for (alleviating) pain of the patient," Dr. Cochener said. Going forward, a large trial specifically focused on this effect should be planned. Dr. Labetoulle emphasized that future studies will have to be conducted to decide the place of Mydrane in practice. This includes determining where Mydrane might fit in the context of femtosecond la- ser-assisted cataract surgery (FLACS). "The patients for FLACS do not need to be dilated before the femtosecond laser," Dr. Labetoulle said. "But we know that after the femtosecond laser there may be miosis because of inflammation, so the advantage of Mydrane will need to be tested in these cases." EW Reference 1. Labetoulle M, et al. Evaluation of the effica- cy and safety of a standardised intracameral combination of mydriatics and anaesthet- ics for cataract surgery. Br J Ophthalmol. 2016;100:976–985. Editors' note: Dr. Findl has no finan- cial interests related to his comments. Dr. Cochener and Dr. Labetoulle have financial interests with Thea. Contact information Cochener: beatrice.cochener@ophtalmologie-chu29.fr Findl: oliver@findl.at Labetoulle: marc.labetoulle@aphp.fr Labetoulle said. "There is anxious- ness that starts from 1 hour prior to the surgery until the end because the patient is being asked about the quality of the pupil." Investigating Mydrane Study results with the newly approved intracameral Mydrane have been promising on several fronts, found Dr. Labetoulle, who led the investigation. 1 "The primary endpoint was that Mydrane did as well as the usual eye drop regimen," Dr. Labetoulle said, adding that the Mydrane release was not only found to be as good as drops, but pupil size was more stable over time. In addition, at the end of surgery with Mydrane, pupil size was better compared to drops. Patients reported less burning and stinging at 7 and 28 days after surgery, Dr. Labetoulle said. "The quality of the corneal epithelium was better at the end of surgery and consecutively, but this was not tested as an endpoint," he said. Dr. Labetoulle emphasized, however, that while Mydrane is ef- fective for those with normal pupils, who have been proven to have good dilation, the same is not true for those who have issues. Those includ- ed in the study were tested for the quality of their dilation prior to the start of the investigation. "We have to remember that Mydrane is not a magic eye drop," Dr. Labetoulle said, adding that if there is synechiae be- tween the pupil and the lens, a prior history of trauma or acute glaucoma, pupil dilation will not be good. Dr. Cochener concurred. "For the normal pupil, it works well, but when you're dealing with a small pupil, this pupil never reacts using the normal regimen of drops. With Mydrane, it's not going to work either," she said. "Mydrane is designed to replace the regimen of the topical drops that we are using to prepare the normal pupil." She stressed the importance of ensuring that the patient responds to dilating drops ahead of time. While Mydrane won't work for everyone, if a patient partially re- sponds to the intracameral approach,

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