Eyeworld

EW CATARACT 47 November 2017 combination drop LessDrops (Im- primis Pharmaceuticals), which is comprised of prednisolone, gatiflox- acin, and bromfenac. "The biggest reason why we still do a drop a day is for the anti-in- flammatory component. We found that a lot of patients with either intravitreal or sub-Tenon's steroid injection would get a little rebound iritis or inflammation … around 3 weeks as the steroid started to wear off," Dr. Swan said. Michael Greenwood, MD, Vance Thompson Vision, Fargo, North Dakota, had a topical post- op regimen while in residency but switched to intracameral antibiotics during fellowship. He also uses dexa- methasone/moxifloxacin/ketorolac, injecting into the vitreous and into the subconjunctival space. These locations, he said, allow the drugs to stay in the system longer. He added later, however, that he plans on switching to an injection into the anterior chamber and subconjuncti- va. Dr. Greenwood said he is making this change because evidence is showing anterior chamber injection seems just as effective. "For me the transition from a topical to intracameral was easy because it made sense to me, putting the medication inside the eye where it's needed, it decreases the cost to patients, it increases the rate of com- pliance, and the data is out there internationally and now in the U.S. that it decreases the risk of infec- tion," Dr. Greenwood said. "It was an easy switch, and I would have switched earlier if I had access while I was a resident." In terms of a postop regimen, Dr. Greenwood said he still includes either a branded NSAID or LessDrops once a day for 1 month. Patients who are at a high risk for cystoid macular edema, however, will be prescribed a topical NSAID for 3 months. Advice to those new to intracameral antibiotics First and foremost with intracameral antibiotics, Dr. Mamalis said, is be- ing aware of what you're injecting. "We found that the more com- plicated the steps that have to be done to reconstitute medications, the more chance there is for the concentration to be done incorrect- ly," he said. "An example of that is cefuroxime, which is the antibiotic used in the ESCRS endophthalmitis study. Outside the U.S. there is a single-use vial of this, so you just constitute it and inject it. But inside the U.S., we don't have that. If you're going to be using cefuroxime in the U.S., there's a multiple-step procedure that must be done to mix it up and dilute it, and if that's done improperly, you could end up with an inordinately high concentration, which could cause toxicity." When the world demands the best, it looks to Wills Eye. With the nation's highest clinical volume of annually referred patients, we've always been at the forefront of eye disease treatment. Our expertise and advanced capabilities are what defined the field in 1832, and continue to redefine it today. 840 Walnut Street Philadelphia, PA 19107 willseye.org 1-877-289-4557 A doctor doesn't give a hospital its reputation. A team of doctors do. continued on page 48

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