EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78719
February 2012 Pharmaceutical focus Not just a drop in the phaco bucket by Maxine Lipner Senior EyeWorld Contributing Editor acetate as the "go to" drop. "It's probably the most commonly used steroid in and around cataract sur- gery," he said. He typically uses this for routine cataract cases. Dr. O'Brien agreed that pred- E ven with modern phaco technique, there's no get- ting around it: Practition- ers still need steroids and NSAIDs, according to Terrence P. O'Brien, M.D., Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami. There is still inflammation triggered that makes use of steroids a neces- sary part of the equation. Likewise, while NSAIDs can reduce the inflam- mation at the time of surgery, by themselves they are not enough. "Physicians tried to go it alone with non-steroidals, and many times the patients would have some rebound inflammation or come in with more discomfort or more inflammation," Dr. O'Brien said. Steroids power Steroids such as prednisolone acetate (Pred Forte, Allergan, Irvine, Calif.), Lotemax (loteprednol, Bausch + Lomb, Rochester, N.Y.), and Durezol (difluprednate, Alcon, Fort Worth, Texas) continue to be a key part of the cataract surgery routine. All of these, however, are not the same. William Trattler, M.D., director of cornea, Center for Excellence in Eye Care, Miami, sees prednisolone Could continued from page 24 11. Thompson JR. The demand incidence of cataract in Asian immigrants to Britain and their descendants. British Journal of Ophthal- mology 1989; 73: 950-954. 12. Carter K, Worwood M. Haptoglobin: a re- view of the major allele frequencies worldwide and their association with diseases. Int J Lab Hematol 2007;29: 92–110. 13. Langlois MR, Delanghe JR, De Buyzere ML, Bernard DR, Ouyang J. Effect of haptoglo- bin on the metabolism of vitamin C. Am J Clin Nutr 1997;66: 606–610. 14. Cahill LE, El-Sohemy A. Haptoglobin geno- type modifies the association between dietary vitamin C and serum ascorbic acid deficiency. Am J Clin Nutr. 2010;92: 1494- 1500. 15. Delanghe JR, Langlois MR. Haptoglobin polymorphism and body iron stores. Clin Chem Lab Med 2002;40: 212– 216. 16. Ness AR, Cappuccio FP, Atkinson RW, Khaw KT, Cook DG. Plasma vitamin C levels in men and women from different ethnic back- grounds living in England. International Jour- nal of Epidemiology 1999;28: 450–455. 17. Hughes K, New AL, Lee BL, Ong CN. Plasma vitamins A, C and E in the general population of Singapore, 1993 to 1995. Ann Acad Med Singapore 1998;27: 149–153. nisolone acetate has been the "pro- totypical corticosteroid" for years. He pointed out that one drawback is that this is a suspension rather than a solution and needs to be agitated prior to installation to provide ef- fect. By contrast, difluprednate, a newer ophthalmic corticosteroid, is an emulsion, with each drop deliver- ing a uniform amount of active drug. "Difluprednate has been shown to be more potent in controlling in- flammation than prednisolone ac- etate in patients with uveitis," Dr. O'Brien said. It has also been shown to be a more potent steroid with fewer drops required relative to prednisolone acetate, he said. Dr. Trattler sees difluprednate as the steroid that provides the strongest anti-inflammatory impact. "Eric Donnenfeld has a study show- ing that patients who were on Durezol had much less swelling after cataract surgery as opposed to pa- tients that were just treated with prednisolone acetate," he said. (See in-depth article on this titled "Cataract competition on steroids," p. 44). With this in mind, Dr. Trattler thinks that Durezol is going to be the one that is going to really help if you have a patient who has a larger cataract. It can also help with others who are more at risk for in- flammation after cataract surgery such as those with diabetes or Fuchs corneal dystrophy. Likewise, Dr. continued on page 28