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43 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, Los Angeles 2017 by Ellen Stodola EyeWorld Senior Staff Writer laxis? Dr. Chang said there con- tinues to be some concern about evidence, though that has dropped. Others are concerned about mixing T he symposium sponsored by the ASCRS FDA Commit- tee took place on Sunday afternoon, focusing on the topic of off-label drugs for anterior segment surgery. David Chang, MD, Los Al- tos, California, discussed surgical antibiotic prophylaxis. "Intracam- eral antibiotic prophylaxis remains controversial, but [there is] a lot of focus on this," he said. The only prospective randomized trial of any size to date was from ESCRS in 2006 showing a 5-fold reduction with the use of routine intracameral cefurox- ime, he said. In 2007, the ASCRS Cataract Clinical Committee con- ducted a survey of membership to look at practice patterns for antibiot- ic prophylaxis in general to exam- ine the impact of the ESCRS study. The survey featured close to 1,300 respondents, with 30% indicating they were using intracamerals at that time. Dr. Chang noted that half of respondents were putting it in the bottle, and vancomycin was most common. Only about 16% were injecting it directly intracamerally. He noted that four out of five said they would if it was commercially available and reasonable. Dr. Chang also noted that there were nine studies in 7 years looking at intracameral prophylaxis. The strongest recommendation is from the ESCRS, he said, which was influenced by the availability in Europe of the first commercial intracameral, Aprokam, from Thea Pharmaceuticals (Newcastle, U.K.). Dr. Chang noted that the company said it has sold 5.7 million units with no reported adverse events. It's hard to get exactly 1 mg per 0.1 mL dilution, and that's the advantage of the way they've been able to manu- facture, he said. After 7 years, Dr. Chang said the ASCRS membership was resurveyed in summer 2014, with a similar response rate to the initial survey. Nine of 10 were using some type of topical antibiotic at the time of surgery, he said, with fluoroquinolo- nes favored overwhelmingly. There was a bit of a shift away from the latest generation to a more generic version, he said. Preoperatively, 85% were using some type of antibiotic, Dr. Chang said. Most people were starting about 3 days prior. Others may start at the time of surgery or a day before. Additionally, most people were using some type of topical postoper- ative antibiotic. Dr. Chang said that about 50% were using intracameral antibiotics, and of those using it, only 16% put it in the bottle; most are injecting it directly. So why aren't people using some type of intracameral prophy- Looking at off-label drugs for anterior segment surgery Dr. Chambers discusses off-label communi- cation from a regulatory perspective. continued on page 44

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