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8 | EYEWORLD DAILY NEWS | MAY 7, 2019 ASCRS NEWS by Liz Hillman EyeWorld Senior Staff Writer tors. It was also shown to improve brow ache and tearing, Dr. Mc- Cafferty said, however, there was no significant effect on capsular phimosis, endothelial cell loss, and YAG capsulotomy incidence. Editors' note: Dr. Tyson has financial interests with Ocular Therapeutix. Dr. Matossian has financial interests related to her comments. Dr. McCafferty does not have financial interests related to his comments. of added cost for topical NSAIDS and it's yet another drop to take, he said. It is touted as preventing pseudophakic cystoid macular edema (PCME), decreasing in- flammation and pain, and poten- tially other benefits. A randomized, double-blind, placebo-controlled study of 1,000 patients showed that topical nepafenac did improve incidence of PCME, however, Dr. McCaf- ferty noted, if you stratify patients with risk factors or not, it was only significant in those with risk fac- The main concern with a steroid in the eye is steroid response, Dr. Matossian said, explaining that 40% of patients in the general population are steroid responders, presenting with an IOP rise 3 to 6 weeks on topical corti- costeroids. The theory is that these people have altered trabecular mesh- work cell morphology and function. According to the research presented by Dr. Matossian, there was no dif- ference in IOP between the two groups on day 1 and IOP between the two arms remained identical through the study's 90-day period. The proportion of patients with an IOP increase of more than 10 mm Hg was also comparable in the dexametha- sone and prednisolone groups at each time point. In cases where IOP-lowering medications were needed, the issue was resolved by the next measurement. In conclusion, the effect on IOP of a single dose of an intra- ocular dexamethasone suspension is comparable to short-term top- ically administered prednisolone acetate, Dr. Matossian said. A member of the panel asked Dr. Matossian whether the spherical bolus of dexamethasone was visualized by the patient. Dr. Matossian said "the pearl" of dexamethasone gets smaller as it eludes over a 30-day period. It can be seen immediately after injection and postop day 2, but it will usually sink down into the angle. Dr. Matossian said she lets patients know it's OK if they see something white and round. Sean McCafferty, MD, Tucson, Arizona, discussed the use of topical nepafenac after phacoemulsification. There is a lot R esearch on strategies to treat pain, inflamma- tion, and infection were the focus of a Monday morning paper session. Sydney Tyson, MD, Vineland, New Jer- sey, led the session with research that compared Dextenza (dexa- methasone, Ocular Therapeutix) to placebo for control of inflam- mation and pain after cataract surgery. Primary endpoints of the double-masked, parallel-arm, vehi- cle-control study were ocular pain and anterior chamber cells. Dr. Tyson said these end points were met by day 8 with clinical significance between the Dextenza arm and placebo. Early pain relief started at day 2, and a consistent, statistically significant difference was observed at each time point of the study out to 30 days. A clinically significant difference in clearance of inflam- mation was observed in favor of Dextenza as early as day 4, Dr. Tyson said. Adverse events were similar between the treatment groups and there were no significant, treat- ment-related adverse events, Dr. Tyson said. A steroid was adminis- tered when patients needed rescue, but there was a significant differ- ence in rescue incidence between the two groups. Cynthia Matossian, MD, Doylestown, Pennsylvania, spoke about two studies that evaluated IOP after cataract surgery with intraocular dexamethasone intra- ocular suspension 9% (Dexycu, EyePoint Pharmaceuticals). One study was placebo controlled and the other was a head-to-head com- parison with topical prednisolone acetate. Dr. Matossian presents at a paper session on Monday. Papers on pain, inflammation, and infection

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