EyeWorld Asia-Pacific December 2015 Issue

42 EWAP CATARACT/IOL December 2015 by EyeWorld staff A new dawn in postop cataract anti-inflammatory treatment Going beyond topical postop regimens W hen it comes to cataract surgery, there’s no doubt ophthalmology has come a long way across all platforms and all spectrums of the procedure in achieving better outcomes, said Jai G. Parekh, MD , MBA , chief eye surgeon and managing partner, Brar-Parekh Eye Associates, Woodland Park/ Edison, NJ, and chief of cornea and external diseases/director of the Research Institute, St. Joseph’s Healthcare System, NJ. However, by the mere fact that any form of cataract surgery involves making a cut in the eye and removing the cataract, we still have the release of inflammatory mediators requiring the use of anti- inflammatory medication, not only to mitigate cell, flare, and pain, but also to reduce corneal edema, he said. Dr. Parekh noted that topical therapy remains the most attractive way for getting drugs into the eye. While generics dominate topical therapy overall because of the rise in healthcare costs over the last couple of years, a lot of companies have come out with innovative postoperative medications, Dr. Parekh said. These include steroids and nonsteroidals that are geared toward “being kinder” to the ocular surface while getting drugs into the eye in a much better fashion and reducing the actual regimen. There have been big strides in reducing medication regimens, Dr. Parekh said. Where before patients had to administer drops 4 times a day, now some of the more common branded ones are dosed at 2 times a day or even once a day. These improvements mean today’s anti-inflammatories are better for the ocular surface overall, and good efficacy and better compliance can be achieved, he said. “Those are very important parameters in figuring out what kind of medications you should give postop,” Dr. Parekh said. Beyond topical tools Topical treatments aside, there has been a lot of buzz recently about different ways of delivering drugs to the eye, including intracameral and transzonular delivery of intraocular medication, Dr. Parekh said. “While that is a small minority, it’s gaining more traction across the country and across the world, but it has not cannibalized the use of topical postop medication,” he said. To add to these drug delivery system options, Dr. Parekh said, “We’re all excited to look at a postop regimen including punctal plugs that may deliver steroids and other anti-inflammatories to the eye in postop patients. “While there are none yet in the market, Ocular Therapeutix [Bedford, Mass.] should be completing their studies later on this year, and we look forward to the data coming out of that and finding ways to adopt that technology in our current practices,” he said. The jury may still be out on some of these new delivery systems, but “there’s definitely