EyeWorld Today is the official daily of the ASCRS Symposium & Congress. Each issue provides comprehensive coverage editorial coverage of meeting presentations, events, and breaking news
Issue link: https://daily.eyeworld.org/i/124056
42 EW SHOW DAILY Monday, April 22, 2013 Meeting Reporter "Hammer inflammation hard" by Chiles Aedam R. Samaniego EyeWorld AP Senior Staff Writer Francis S. Mah, MD, speaks at "Knocking Down Inflammatory Barriers to Success in Refractive Cataract Surgery." "I nflammation is a significant variable in refractive cataract procedures," said Terry Kim, MD, Durham, N.C. He and other experts at Saturday night's EyeWorld Education symposium recommend "Knocking Down Inflammatory Barriers to Success in Refractive Cataract Surgery." The goal, said Dr. Kim, is to eliminate post-cataract inflammation. He said that significant recent advances include the availability of a myriad of choices for both steroids and NSAIDs. In 2013 alone, he said, three new anti-inflammatory agents have become available after having received approval from the FDA within the last year: bromfenac ophthalmic solution 0.07% (Prolensa, Bausch + Lomb, Rochester, N.Y.), which features a lower concentration than the previous 0.09% solution (Bromday, Bausch + Lomb) that he said is designed to facilitate ocular penetration; nepafenac ophthalmic suspension 0.3% (Ilevro, Alcon Fort Worth, Texas), which increases the previous formulation's 0.1% (Nevanac, Alcon); and loteprednol etabonate ophthalmic gel (Lotemax, Bausch + Lomb). "I'm the person who brings a gun to a knife fight," said Keith A. Warren, MD, Overland Park, Kan., describing his personal approach to postop inflammation. Refractive cataract surgery patients, he said, "have little or no tolerance for inflammation" and "inflammatory control is tantamount to success." Multifocal IOLs in particular "will not work" in the presence of inflammation, so it is "critical to suppress all inflammation." Postop CME occurs in up to 12% of eyes following uncomplicated cataract surgery—that's an unacceptable one in eight patients, he said. Given their broad and nonspecific mechanism of action, he said, corticosteroids remain the treatment of choice for ocular inflammatory diseases including CME. Newer topical formulations such as loteprednol offer improved penetration and potency, potentially lowering morbidity and improving compliance, though in persistent or recalcitrant CME, combination therapy may be of benefit. One approach newer topical anti-inflammatory agents have taken to improve performance is to modify medication vehicles, according to Francis S. Mah, MD, La Jolla, Calif. These advanced formulations, he said, are safer for the ocular surface, enhance efficacy through increased penetration and tissue concentration, and allow less dosing for better patient compliance. Dr. Mah described three strategies concerning medication vehicles: 1) increasing the effective dose, which may involve adjusting the concentration of the active drug (as with both Prolensa and Ilevro) or increasing dose frequency; 2) using a molecular to increase lipophilicity and solubility; 3) using formulation science to increase viscosity, corneal penetration and residence time, as with the use of guar gum, mucoadhesive technology, and lipid emulsion technology. He also touched on the much maligned issue of preservatives. He called preservatives a "necessary evil," which may assist with penetration. Drs. Kim, Mah, and Warren, along with co-faculty members David F. Chang, MD, Los Altos, Calif., and Uday Devgan, MD, Los Angeles, all agree that NSAIDs should be started prior to surgery and continued based on inflammation and risk criteria, saying surgeons should "hammer inflammation hard," taking advantage of the myriad topical formulations now available. EW Editors' note: This event was supported by an unrestricted grant from Bausch + Lomb. Free Yourself Unlock the profit in your practice by puting your dispensary in our hands. visassoc.com ç 800.346.7486 Visit Booth #2536 for a FREE Assessment!