Eyeworld

93 EW CORNEA September 2017 serum it's going to clear in a week." In the bloodstream the virus clears rapidly, and patients begin to devel- op antibodies, although the virus is found in the saliva for a bit longer. means that there's the potential for the virus to remain in those sites for longer time periods than it does in serum. "Zika has been shown to spread from male to male or from male to female via semen," she said. "It has been shown to hang around in the testes up to 6 months, whereas in "We had a patient who had some virus in the vitreous," Dr. Robertson said, adding that there's no telling if this was active virus or residual RNA that was still there because the eye is an immune privileged site. "We need more samples to be able to test that and answer that question." Heightening research A lot more research in general is needed on the Zika, Dengue, and Chikungunya viruses, which are all emerging infectious diseases in the U.S., Dr. Robertson stressed. "I think a lot more research is warranted to make sure that these aren't things we can pass along," she said. "Zika has the heightened risk because of the risk of microcephaly, and if a woman is infected during the first trimester, there is a frequency of 5% of babies who are going to be born microcephalic." She said there are also cases where the babies are nor- mal cephalic when they're born but go on to develop neurologic deficits over time due to the virus. Currently, the FDA recom- mends that if there is a possible history of Zika infection or a known case of Zika that the tissue not be transplanted within 6 months, Dr. Robertson said. Dr. Robertson hopes that prac- titioners come away from the case with the understanding that a lot more research needs to be conducted on Zika to determine what it's doing in the eye and if there is going to be long-term sequelae. "At the same time, I think our eye banks here in the U.S. do an excellent job in screening tissue and are on the alert, which is why we maintain such a high safety profile with corneal transplants," Dr. Robertson said. "It's something to be concerned about, it's something to be aware of, but it's not something to be scared of." EW Reference 1. Heck E, et al. Zika virus RNA in an asymp- tomatic donor's vitreous: Risk of transmission? Am J Transplant. 2017;17:2227–2228. Editors' note: Dr. Robertson has no financial interests related to her comments. Contact information Robertson: Danielle.robertson@utsouthwestern.edu 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

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