Eyeworld

EW FEATURE 58 finding that both were effective at controlling intraocular inflamma- tion after cataract surgery. 3 Ozur- dex (Allergan), a dexamethasone implant for macula edema following branch retinal vein occlusion or central retinal vein occlusion, in one study was implanted in the capsular bag after phacoemulsification and IOL implantation and resulted in effective inflammation control with no significant side effects. 4 "One of the things that's fas- cinating is how quickly our post- operative medication regimens are evolving," Dr. Berdahl said. "Just a few years ago we used nothing inside the eye and all topical drops. Now we use a hybrid of most of the medication at the time of surgery and a little bit of topical adjunctive therapy once a day. As we move forward with other drug delivery mechanisms, I think the paradigm is going to continue to evolve. If we can have a depot that allows the right medication to get to the right place at the right time and favorable economics for the patient, the payer, and doctors, we have the ability to affect all 3.5 million cataracts that are removed every year. I think surgeons will make decisions based on the available safety and efficacy data, the economics, and patient convenience." EW References 1. Olson RJ, et al. Cataract in the Adult Eye Preferred Practice Pattern. Ophthalmology. 2017;124:1–119. 2. Henderson BA, et al. Clinical pseudopha- kic cystoid macular edema. Risk factors for development and duration after treatment. J Cataract Refract Surg. 2007;33:1550–8. 3. Wadood AC, et al. Safety and efficacy of a dexamethasone anterior segment drug deliv- ery system in patients after phacoemulsifica- tion. J Cataract Refract Surg. 2004;30:761–8. 4. Vianna LM, et al. Intracapsular dexa- methasone implant in patients undergoing phacoemulsification and intraocular lens im- plantation. Arg Bras Oftalmol. 2013;74:226–8. Editors' note: Dr. Hovanesian has financial interests with Ocular Ther- apeutix, Bausch + Lomb, Alcon (Fort Worth, Texas), and Sun Pharmaceuti- cals (Mumbai, India). Dr. Berdahl has financial interests with Alcon, Allergan, Bausch + Lomb, Imprimis Pharmaceu- ticals, Ocular Therapeutix, and Envisia Therapeutics (Durham, North Caro- lina). Dr. Newsom has no financial interests related to his comments. Contact information Berdahl: johnberdahl@gmail.com Hovanesian: DrHovanesian@harvardeye.com Newsom: hunter@newsomeye.net Dr. Newsom said, however, there are certain conditions in which he will inject antibiotics and steroids, such as in patients with uveitis and patients who have trou- ble instilling drops. "On a random basis, this is a great option, but for us to use this 100 times this week, our practice can't deal with 10 rebounds this week, 10 next week, 10 the week after. … That was too much of a burden for us," he said. Dr. Hovanesian said he tries to avoid routine use of compounded medications. "Compounded medications are not FDA approved. They're combi- nations of drugs that may individu- ally be approved in different formu- lations by different manufacturers, but we're mixing them in ways that the FDA has never investigated or approved and, in doing so, we're assuming a risk on behalf of the patient and on behalf of the sur- geon, which we don't have if we use an FDA-approved product," he said, also noting the higher likelihood of rebound inflammation. What's next? The ideal situation for an anti-in- flammatory drug would be one that has a high dose initially that slowly tapers and discontinues on its own, Dr. Hovanesian said. The dose would be low enough to avoid pressure spikes, and it wouldn't require any compliance from the patient's standpoint, he continued. This is what the punctal plug depot deliv- ery method Dextenza (dexametha- sone, Ocular Therapeutix, Bedford, Massachusetts) aims to accomplish, he said. In clinical trials, Dextenza resulted in no significant inflamma- tion, it had no complications, and pressure spikes were similar to that of the placebo, Dr. Hovanesian said. With FDA approval expected later this year, Dr. Hovanesian thinks patients could someday receive an injected antibiotic and this punctal plug steroid depot, eliminating the need for drops. Intravitreal, slow-release steroid implants are mostly designed for treatment of conditions like macular edema and uveitis. A rod-shaped biodegradable implant inserted into the anterior chamber to reduce inflammation post-cataract surgery, Surodex (dexamethasone, Allergan, Dublin, Ireland), was in develop- ment several years ago and approved for use in some countries outside the U.S. A study published in 2004 compared the dexamethasone im- plant to dexamethasone eye drops, The who continued from page 57

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