Eyeworld

World view Sea of steroid selections T opical steroids are a mainstay in oph- thalmology for a multitude of ocular conditions. It can certainly be over- whelming to keep up with the various potencies, delivery options, and dosing schedules that are available. Knowing when steroids are needed for the treatment of inflam- matory conditions and balancing their use with potential side effects can also be challenging. In this issue of EyeWorld, we have some great articles highlighting everything you want to know about using steroids in ophthalmology. Edward Holland, MD, Henry Perry, MD, John Sheppard, MD, Christopher Starr, MD, and David Verdier, MD, begin by reviewing their go-to topical steroids and how to balance potency, side effects, and cost issues. Common ocular conditions that require topical steroids include graft rejection, dry eye, and corneal neovascularization. In these scenarios, among others, chronic topical steroid use may be required for disease control. Given the potential for intraocular pressure elevation, the off-label use of steroid-sparing agents such as cyclosporine, lifitegrast, and bevacizumab are described. Loteprednol as an ester steroid has the advantage that it has a significantly less IOP-raising effect than ketone steroids. Difluprednate has also revolutionized how clinicians can manage diseases requiring a powerful anti-inflammatory agent. Edward Holland, MD, Barry Lee, MD, and Henry Perry, MD, discuss how they optimize the use of off-label anti-inflammatory agents and alternative drug delivery options. Herpes simplex keratitis is one of the most common corneal infections managed by ophthalmologists. While most clinicians can recognize the typ- ical dendrite requiring anti-viral therapy, diagnosing and managing immune manifestations of HSV can be more challenging. Steroids play a role espe- cially if there is an immune-mediated stromal keratitis, iritis, or endotheliitis present. Vincent de Luise, MD, Bennie Jeng, MD, and Francis Mah, MD, review the role of steroids in HSV, when anti-viral treatment is also needed, and their tapering process if steroids are used. The most common situation for the use of topical steroids is in the perioperative management of cataract surgery. Drop regimens and delivery vary among surgeons and depending on whether the case is routine or com- plex. John Berdahl, MD, John Hovanesian, MD, and T. Hunter Newsom, review their preferred perioperative routine as well as new drug delivery options that aim to reduce or eliminate the need for eye drops. I hope you enjoy this issue of EyeWorld, and thank you to all the physi- cians for taking the time to share their expertise. EW Clara Chan, MD, Cornea editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S August 2017 Vol. 22 • No. 8 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Michelle Stephenson Roanoke, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 Fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Paul Zelin paul@eyeworld.org Jaclyn Talon jaclyn@eyeworld.org Classified Sales Cathy Stern cathy@eyeworld.org EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org Anne Le anne@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. 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