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EW SHOW DAILY 52 Meeting Reporter Tuesday, May 9, 2017 Dr. Berdahl uses a pars plana ap- proach to his injections of Tri-Moxi and also uses a topical NSAID. "Our corneas were clearer than ever because that intraocular steroid does help," Dr. Berdahl said. He avoids the injections in patients at a high risk for retinal detachment. Many ophthalmologists are interested in using an intracameral antibiotic as long as it is commer- cially produced, according to an ASCRS member survey. Some manufacturers are focus- ing on combining drops so at least patients can reduce the number they need to take, which can improve compliance. Another approach, called Dex- tenza (Ocular Therapeutix, Bedford, Massachusetts), offers dexametha- sone in a punctal plug released over 4 weeks. However, the approach would still require NSAID drops. "What's in the best interest of the patient? 'Do you want to go buy that drop and take the drop, or here is something I can put in at the time of surgery and it's absolutely free,'" Dr. Lindstrom said. "From a patient perspective, that's a no-brainer." Dr. Lindstrom would likely use the plug along with an anterior chamber injection of anti-inflamma- tories. Results from a third clinical trial—expected soon—show the plug delivery, which tapers down over a month, is effective for pain and inflammation. Dr. Lindstrom expects Food and Drug Administration ap- proval of the self-dissolving hydro- gel plug by the end of the year. EW Editors' note: Dr. Lindstrom has finan- cial interests with Imprimis, Ocular Therapeutix, and other companies. Dr. Kim has financial interests with Ocular Therapeutix and other companies. Dr. Holland has financial interests with TearLab (San Diego) and other compa- nies. Dr. Berdahl has financial interests with Ocular Therapeutix and other companies. by Rich Daly EyeWorld Contributing Writer "We already have a way to tran- sition to significantly reduced drops, but we don't have a way to deliver a non-steroidal in extended release," Dr. Lindstrom said. Rather than delivery into the vitreous, Dr. Lindstrom injects cataract patients transzonularly after the IOL and viscoelastic are placed in the eye. "You see this cloud of triamcin- olone and you'd think the patient would be blind but after they sit in the recovery room for 30 minutes, by the time they are ready to go home they are seeing about 20/40," Dr. Lindstrom said. "I would rather have patients see well from day 1 so I've been looking for other alterna- tives to that." Some surgeons have reported transzonular injection problems, including torn zonules and hemor- rhage. "Effective medications that people don't take, don't work," Dr. Lindstrom said. "So we doctors have to take control of the therapy." Edward Holland, MD, Cin- cinnati, noted that research going back to the 1970s showed 50% of glaucoma patient don't comply with their drug treatment regimens. John Berdahl, MD, Sioux Falls, South Da- kota, noted recent research indicated even higher non-adherence rates— up to 80%. Dr. Lindstrom was an early believer in replacing antibiotics with something in the eye and switched to intracameral injections 8 years ago. He has since transitioned to intravitreal Tri-Moxi (triamcinolone/ moxifloxacin, Imprimis Pharmaceu- ticals, San Diego). That has allowed him to move down to one drop a day with an NSAID. I nterest remains strong in ways to reduce the need for patient action in medication use. Terry Kim, MD, Durham, North Car- olina, consistently hears from cataract surgeons about challenges around cost, compliance, and call- backs at practices. "All of which equates to more time, more staff devoted to this issue," Dr. Kim said. "A lot of provid- ers, and patients as well, are looking for an alternative to address all of these issues." Richard Lindstrom, MD, Minneapolis, cited one study where patients were instructed on shaking the bottle 20 times before admin- istering a drop, then they tried to administer the drop in themselves 5 minutes later; only one of 20 did what they were instructed to do. Compliance problems drive emerging drug delivery vehicle interest Research has consistently noted that at least half of glaucoma patients do not follow their drug treatment regimens, says Dr. Holland.

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