Eyeworld

111 EW FEATURE April 2017 • Controversies in cataract surgery but rather the lack of availability of a U.S. [Food and Drug Administra- tion] approved product." Widespread European use of a trial-tested formulation of cefurox- son, MD, clinical professor of oph- thalmology, Tufts University School of Medicine, Boston. "However, the body of evidence that it is effective and safe is so overwhelming that most physicians accept it as a viable method to prevent infection. The biggest obstacle for using intraca- meral antibiotics in the U.S. is not because of a question of its efficacy ime (Aprokam, Thea Pharmaceuti- cals, Clermont-Ferrand, France)— about 75% of surgeons in ESCRS use intracameral antibiotics—demon- strated the appeal of such a treat- ment option.¹ Research continues In the 3 years since release of the ASCRS 2014 Intracameral Antibiotic Review and Position Paper, 2 addi- tional U.S. and international studies have been published that demon- strated intracameral antibiotics' ability to reduce postop endophthal- mitis, Dr. Mamalis noted. The largest U.S. study was done by a Kaiser Permanente group using either cefuroxime or moxifloxacin and found a significantly decreased incidence of postop endophthalmi- tis and no association with increased postop adverse events. 3 Another large study in India found a 0.02% endophthalmitis rate among 38,160 eyes of charity patients who received intracameral moxifloxacin prophy- laxis, which was one-fourth the rate of the 37,777 eyes that did not receive intracameral moxifloxacin. 4 "I believe there have been suf- ficient published reports in peer-re- viewed journals to support the use intracameral antibiotics, even before there is a commercially available FDA-approved product," Dr. Hen- derson said. "U.S. surgeons have the benefit of learning from the expe- rience of our European colleagues. The high acceptance rate and proven efficacy in Europe substan- tiate the move toward intracameral antibiotics." Concerns remain Not everyone is convinced that a broad shift to intracameral antibiot- ics is prudent. Andrzej Grzybowski, MD, pro- fessor and chair of ophthalmology, University of Warmia and Mazury, Olsztyn, Poland, said that among the unanswered questions about in- tracameral antibiotics are why some studies do not show a protective effect from them, why many studies show similar effects from topical antibiotics, and most important- ly, which intracameral antibiotics should be used. Dr. Grzybowski noted "there are many arguments against cefu- INDICATIONS AND USAGE PROLENSA ® (bromfenac ophthalmic solution) 0.07% is a nonsteroidal anti-infl ammatory drug (NSAID) indicated for the treatment of postoperative infl ammation and reduction of ocular pain in patients who have undergone cataract surgery. IMPORTANT SAFETY INFORMATION ABOUT PROLENSA ® • PROLENSA ® contains sodium sulfi te, a sulfi te that may cause allergic type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfi te sensitivity in the general population is unknown and probably low. Sulfi te sensitivity is seen more frequently in asthmatic than in non-asthmatic people. • All topical nonsteroidal anti-infl ammatory drugs (NSAIDs), including bromfenac, may slow or delay healing. Concomitant use of topical NSAIDs and topical steroids may increase the potential for healing problems. • There is the potential for cross-sensitivity to acetylsalicylic acid, phenylacetic acid derivatives, and other NSAIDs, including bromfenac. Use with caution in patients who have previously exhibited sensitivities to these drugs. • There have been reports that ocularly applied NSAIDs may cause increased bleeding of ocular tissues (including hyphemas) in conjunction with ocular surgery. Use with caution in patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time. • Use of topical NSAIDs may result in keratitis. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs, including bromfenac, and should be closely monitored for corneal health. 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. Post-marketing experience with topical NSAIDs suggests that use more than 24 hours prior to surgery or use beyond 14 days post-surgery may increase patient risk for the occurrence and severity of corneal adverse events. • PROLENSA ® should not be instilled while wearing contact lenses. The preservative in PROLENSA ® , benzalkonium chloride, may be absorbed by soft contact lenses. Lenses may be reinserted after 10 minutes following administration of PROLENSA ® . • The most commonly reported adverse reactions in 3%-8% of patients were anterior chamber infl ammation, foreign body sensation, eye pain, photophobia, and blurred vision. Please see brief summary of full Prescribing Information for PROLENSA ® on adjacent page. References: 1. PROLENSA Prescribing Information, April 2013. 2. Data on fi le, Bausch & Lomb Incorporated. 3. Baklayan GA, Patterson HM, Song CK, Gow JA, McNamara TR. 24-hour evaluation of the ocular distribution of (14)C-labeled bromfenac following topical instillation into the eyes of New Zealand white rabbits. J Ocul Pharmacol Ther. 2008;24(4):392-398. PROLENSA is a registered trademark of Bausch & Lomb Incorporated or its affi liates. © Bausch & Lomb Incorporated. All rights reserved. Printed in USA. PRA.0188.USA.15 The PROLENSA ® Effect POWERED FOR PENETRATION Advanced Formulation to Facilitate Corneal Penetration 1-3 pH e ffect Hal og en a ti on e ffect PROLENSA ® delivers potency and corneal penetration with QD dosing at a low concentration 1-3 continued on page 112

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