JAN 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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January 2012 EW NEWS & OPINION Remembering Eric John Arnott, B.M., B.Ch., B.A.O., D.O., F.R.C.S., F.R.C.Ophth. by Richard Packard, M.D. June 12, 1929– December 1, 2011 E ric Arnott was a combina- tion of establishment doyen and visionary inno- vator prepared to chal- lenge accepted medical opinion. He was one of the first oph- thalmic surgeons to recognize in the work of Charles Kelman, the inven- tor of phacoemulsification, a new approach to cataract surgery that heralded the dawn of small-incision surgery. Dr. Kelman had found a method of removing the cataract through an incision of 3.5 mm com- pared to the 12 mm required for most surgery at the time. This meant that patients no longer had to lay in bed for 2 weeks after their surgery with all movement restricted. In 1971, Dr. Arnott went to the U.S. and attended one of Dr. Kelman's first courses. Upon returning to England, he raised the money to buy the very expensive equipment needed. When he started performing this surgery, it raised a storm of protest amongst his colleagues, but Dr. Arnott carried on undeterred and until 1977 was one of only a hand- ful of surgeons to practice and teach this procedure outside the U.S. The early machines for this minimally invasive surgery were crude by com- parison with modern methods; nonetheless it was the beginning of a trend. Today almost all cataract surgery is carried out using a varia- tion of the technique Dr. Arnott was instrumental in helping to pioneer. Dr. Arnott was born on June 12, 1929, in Sunningdale, Berkshire, the second son of Sir Robert Arnott Bt. The family was an important part of the Anglo-Irish establishment, own- ing Arnotts Stores, the Irish Times, and Phoenix Park racecourse. He was continued on page 10 3 NEVANAC® (nepafenac ophthalmic suspension) 0.1%, topical ophthalmic Initial U.S. Approval: 2005 Revised: 9/2007 Dr. Arnott and his wife, Veronica BRIEF SUMMARY 1 INDICATIONS AND USAGE NEVANAC® ophthalmic suspension is indicated for the treatment of pain and inflammation associated with cataract surgery. 2 DOSAGE AND ADMINISTRATION 2.1 Recommended Dosing One drop of NEVANAC® should be applied to the affected eye(s) three-times-daily beginning 1 day prior to cataract surgery, continued on the day of surgery and through the first 2 weeks of the postoperative period. 2.2 Use with Other Topical Ophthalmic Medications NEVANAC® may be administered in conjunction with other topical ophthalmic medications such as beta-blockers, carbonic anhydrase inhibitors, alp ha-agonists, cycloplegics, and mydriatics. 3 DOSAGE FORMS AND STRENGTHS Sterile ophthalmic suspension: 0.1% 3 mL in a 4 mL bottle 4 CONTRAINDICATIONS NEVANAC® is contraindicated in patients with previously demonstrated hypersensitivity to any of the ingredients in the formula or to other NSAID. 5 WARNINGS AND PRECAUTIONS 5.1 Increased Bleeding Time With some nonsteroidal anti-inflammatory drugs including NEVANAC®, there exists the potential for increased bleeding time due to interference with thrombocyte aggregation. There have been reports that ocularly applied nonsteroidal anti-inflammatory drugs may cause increased bleeding of ocular tissues (including hyphemas) in conjunction with ocular surgery. It is recommended that NEVANAC® ophthalmic suspension be used with caution in patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time. 5.2 Delayed Healing Topical nonsteroidal anti-inflammatory drugs (NSAIDs) including NEVANAC®, may slow or delay healing. Topical corticosteroids are also known to slow or delay healing. Concomitant use of topical NSAIDs and topical steroids may increase the potential for healing problems. 5.3 Corneal Effects Use of topical NSAIDs may result in keratitis. In some susceptible patients, continued use of topical NSAIDs may result in epithelial breakdown, corneal thinning, corneal erosion, corneal ulceration or corneal perforation. These events may be sight threatening. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs including NEVANAC® and should be closely monitored for corneal health. Postmarketing experience with topical NSAIDs suggests that patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (e.g., dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time may be at increased risk for corneal adverse events which may become sight threatening. Topical NSAIDs should be used with caution in these patients. Postmarketing experience with topical NSAIDs also suggests that use more than 1 day prior to surgery or use beyond 14 days post surgery may increase patient risk and severity of corneal adverse events. 5.4 Contact Lens Wear NEVANAC® should not be administered while using contact lenses. 6 ADVERSE REACTIONS Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to the rates in the clinical studies of another drug and may not reflect the rates observed in practice. 6.1 Ocular Adverse Reactions The most frequently reported ocular adverse reactions following cataract surgery were capsular opacity, decreased visual acuity, foreign body sensation, increased intraocular pressure, and sticky sensation. These events occurred in approximately 5 to 10% of patients. Other ocular adverse reactions occurring at an incidence of approximately 1 to 5% included conjunctival edema, corneal edema, dry eye, lid margin crusting, ocular discomfort, ocular hyperemia, ocular pain, ocular pruritus, photophobia, tearing and vitreous detachment. Some of these events may be the consequence of the cataract surgical procedure. 6.2 Non-Ocular Adverse Reactions Non-ocular adverse reactions reported at an incidence of 1 to 4% included headache, hypertension, nausea/vomiting, and sinusitis. See full prescribing information for NEVANAC®. ALCON LABORATORIES, INC. Fort Worth, Texas 76134 USA © 2011 Alcon, Inc. 3/11 NPF11500JAD

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