Eyeworld

EW FEATURE 60 byline goes here plus fade AT A GLANCE • text goes here. • text goes here. • text goes here. eye drops with the same or better pressure than before surgery," Dr. Ansari said. Dr. Ansari hasn't observed any difference in IOP spikes after MIGS procedures compared with typical cataract surgery. Another consideration for glau- coma patients in cataract surgery, Dr. Ansari offered, is to pay close attention to the ocular surface. "Chronic use of glaucoma drops can lead to chronic dry eye and chronic ocular surface disease," Dr. Ansari said, reinforcing how many know such conditions can skew measurements for IOL power calcu- lations. "As glaucoma specialists who do a lot of cataract surgery or cataract surgeons who take care of a lot of glaucoma patients, we have to pay extra attention to the ocular surface and make sure we are taking steps to optimize the ocular surface of a patient on glaucoma drops before we do their cataract surgery. If you think you're going to be discontin- uing a patient's glaucoma drop after cataract surgery, you might consider discontinuing it immediately before cataract surgery to help optimize the ocular surface, if you think it's safe for their glaucoma." EW References 1. Ayyala RS, et al. Cystoid macular ede- ma associated with latanoprost in aphakic and pseudophakic eyes. Am J Ophthalmol. 1998;126:602–4. 2. Lima MC, et al. Visually significant cystoid macular edema in pseudophakic and aphakic patients with glaucoma receiving latanoprost. J Glaucoma. 2000;9:317–21. 3. Wand M, et al. Latanoprost and cystoid macular edema in high-risk aphakic or pseudophakic eyes. J Cataract Refract Surg. 2001;27:1397–1401. 4. Ahad MA, et al. Stopping prostaglandin analogues in uneventful cataract surgery. J Cataract Refract Surg. 2004;30:2644–2645. Editors' note: Dr. Parekh has financial interests with Glaukos. Dr. Fudemberg has financial interests with Alcon, Allergan (Dublin, Ireland), Aerie Pharmaceuticals (Irvine, California), and Inotek Pharmaceuticals (Lexing- ton, Massachusetts). Dr. Ansari has financial interests with Ivantis (Irvine, California). Contact information Ansari: hansari@eyeboston.com Fudemberg: sjf003@gmail.com Parekh: parag2020@gmail.com The increase in dropless antibi- otic and steroid options, as well as combined options for fewer drops, could impact postoperative glauco- ma medication regimens, Dr. Parekh said. "With the new 'dropless' regimens, I think there is a higher rate of breakthrough inflammation requiring 'rescue,' compared to the traditional topical regimens," Dr. Parekh said. "Based on this, I would deduce that the topical regimen has more anti-inflammatory power than the dropless regimen … because you have a lot more breakthrough in one situation than you do in the other. Therefore, I would be more nervous if I was going to do the 'dropless' intravitreal injection and the patient was on a prostaglandin. I would watch those patients extra carefully or do something additional on those patients." That "something additional" could include using a low-dose, topical anti-inflammatory regimen to supplement the intravitreal 'drop- less' formulation, which Dr. Parekh said could result in less break- through and less need for rescue. In this case, he would then recommend leaving the previous prostaglandin treatment alone. "It's a new idea so people are going to experiment with it and see what works, see what makes the most sense," Dr. Parekh said. Cataract surgery combined with a microinvasive glaucoma surgery (MIGS) is another case where glauco- ma drop treatments might be altered —in fact, that's often the point of a MIGS procedure. In MIGS cases, Dr. Parekh fol- lows the same postop regimen, let- ting the steroid wash out afterward, followed by taking the patient off prostaglandins or other glaucoma drops in a step-wise fashion. Dr. Ansari said after a goniotomy or iStent (Glaukos, San Clemente, California) coupled with cataract surgery, he will keep patients on their original glaucoma drops and will assess their pressure 1 week postop. If their pressure is low, he will cut back on the drops, reevalu- ating the pressure again at 1 month postop. "Anecdotally, about half of my patients seem to derive some benefit from the MIGS procedure. When I say benefit, I mean that they are on the same number of eye drops but with a lower pressure than they were before surgery or they're on fewer A F R E S H P E R S P E C T I V E ™ © 2017 Lacrivera, a division of Stephens Instruments. All rights reserved. lacrivera.com ( 855 ) 857-0518 dryness and fatigue redness dpi redness irritation vision irritation burning dry itching gritty dryness redness sore tired eyes gritty pain irritation dry vision sensitivity foreign body sensation dryness redness sore tired eyes irritation burning dry itching gritty sensitivity foreign body sensation fatigue redness tired irritation dry sore tired i excess watering gritty sandy sensitivity foreign body sensation itching burning gritty excess tears dryness and fatigue redness dpi redness irritation vision gritty pain irritation dry vision sensitivity foreign body sensation dryness redness sore tired eyes dryness and redness dpi redness vision sensitivity foreign body sensation Your LASIK results speak for themselves. burning dry itching sensitivity foreign body sensation fatigue redness tired irritation dry sore tired i excess watering gritty sandy irritation burning dry itching sensitivity foreign body sensation fatigue irritation dry tired i Don't let post-op dry eye talk over them. sensitivity foreign body sensation itching burning gritty excess tears sensitivity foreign body sensation foreign body sensation gritty foreign body sensation Fight post-op dry eye with the VeraPlug ™ and let your patients enjoy the enhanced visual acuity they expect from day one. VeraPlug. ™ For healthier, happier patients. Managing continued from page 59

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