Eyeworld

EW CATARACT 47 The ketorolac in Omidria can help with inflammation in the eye during cataract surgery. If Omidria is added to the irrigating solution, this should help decrease the likelihood of bleb scarring. "This is why Omidria helps in glaucoma patients, especially those who have had prior glaucoma surgery," Dr. Teymoorian said. In cases where the practitioner wants to do a MIGS procedure, it may behoove him or her to use Omidria for cataract surgery as well, Dr. Teymoorian said. "The difficulty with doing MIGS is having a good view of the angle, which requires a gonioprism," he said. "But that requires a clear cornea; if the cornea isn't clear, you'll never see the angle." If the cataract surgery takes too long, the cornea will cloud up. "One thing you can do is make sure you have a good pupil size," he said. "Omidria helps the dilation and makes the surgery more efficient, keeps the cornea clear, and allows for a good view of the angle when you're doing a MIGS procedure." These days, there is a growing trend with the different types of glaucoma to do cataract surgery as a first-line therapy, Dr. Teymoorian noted. "The use of Omidria in glau- coma patients should be considered because these are patients who have a lot to lose if the surgery does not go well. Any type of addition- al dilation that you can get will significantly help out," he said. "If a patient has glaucoma and is having cataract surgery, I think physicians should consider putting Omidria in the eye regardless of what type of glaucoma it is." Dr. Matossian views the use of Omidria in such complex patients as a safety net. "If you know it's going to be a complex case from the his- tory and the existing comorbidities, why not try to control one thing to make [the case] a little smoother, in order to help the final outcome for patients." EW Editors' note: Dr. Matossian and Dr. Teymoorian have financial interests with Omeros. Contact information Matossian: cmatossian@matossianeye.com Teymoorian: savakteymoorian@hotmail.com postoperatively," she said. In a patient with lax zonules or zonular dialysis, the better the visibility, the more likely you are to avoid unnec- essary manipulation and potential complications. In addition, Omidria may help to minimize discom- fort. "In patients with exfoliation syndrome or glaucoma, you might have to use a Malyugin Ring [Mi- croSurgical Technology, Redmond, Washington] or another pupil-dilat- ing device," Dr. Matossian said. "If we don't have to do that because the Omidria is adequately dilating the pupil, that's less manipulation." Keeping the eye as quiet as possible can take on particular im- portance for glaucoma patients who may already have a compromise in their eye pressures and whose trabecular meshwork may have already been stressed, Dr. Matossian said. With a lot of manipulation during cataract surgery, pushing or pulling the iris, you're generating cell and flare and therefore increas- ing the risk of intraocular pressure rise. "By using Omidria, creating less inflammation, you're going to have a much quieter eye," Dr. Matossian said. For those with floppy iris syndrome, Dr. Teymoorian finds Omidria can make the surgery easier. "In patients with a floppy iris, where the iris has a tendency to blow up and down, with Omidria in the eye, it doesn't move," he said. "It's like putting cement on the iris." This reduces issues that may occur, such as having the iris go up toward the wound because the iris naturally wants to go toward the incision site, he explained. Keeping all options open Using Omidria can be helpful for keeping glaucoma options open. One issue that practitioners have with glaucoma patients who had a trabeculectomy with a functional bleb is contending with any kind of inflammation. "In the process of addressing the cataract, there will be inflammation in the eye, and that inflammation has a tendency to scar the bleb," Dr. Teymoorian said, adding that this is why there is a high rate of bleb scarring 1 or 2 years after cataract surgery. This rate is somewhere between 50 and 75%.

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