EyeWorld Asia-Pacific September 2020 Issue

EWAP SEPTEMBER 2020 53 DEVICES in patients treated with the compounded combination. In a randomized, double-masked prospective U.S. multicenter study by Fram et al., OMNI demonstrated 50% reduction in summed ocular inflammation score over the 23% reduction seen with the control of Pred Forte (prednisolone, Allergan), Vigamox (moxifloxacin, Novartis), and Ilevro (nepafenac, Novartis). 1 “I’m sure some of the success of OMNI is from the simplified patient use to one bottle a couple of times a day instead of three different bottles on three different dosing schedules,” Dr. Goldberg said. Dr. Chu, who has experience with many intracameral and combination therapies, uses intracameral drugs for patients who may have difficulty using topical drops or who have medical conditions, such as diabetes and inflammatory conditions, which may increase their risk of CME or prolonged postop healing. “We have had good experience with intracameral and subconjunctival medications, but some patients had slower visual recovery, and some had more postop inflammation than others,” Dr. Chu said. Dr. Goldberg has experienced good results from the use of intracameral injections, although use among his patients has been limited by health plan payment. “If I could do it, I would,” Dr. Goldberg said. “There’s good data that supports the use of intracameral moxifloxacin.” Dr. Goldberg expects intracameral medications, including those inserted into the cannula, to gain traction among cataract surgeons. Dr. Chu, who has participated in FDA clinical trials using punctal plugs to deliver drugs, said such therapies are promising and attractive because plugs can be removed and, theoretically, titrated based upon how many plugs are placed. Dr. Goldberg, who participated in clinical trials for Dextenza, said it has provided clinical benefits to patients, but wider use of it awaits Medicare payment approval. An intracameral option for dilation is Omidria (phenylephrine and ketorolac injection, Omeros). Dr. Chu, who uses a standard drop dilation regimen, participated in the clinical trials for Omidria and found it effective. His practice is now conducting some post- market evaluations of the product. Although some practices have had good results with Omidria, Dr. Goldberg said payment issues continues to limit his use of that treatment. Dexycu (dexamethasone, EyePoint Pharmaceuticals) is another promising intracameral option to treat postoperative inflammation. EWAP Reference 1. Fram N, et al. Prospective U.S. multicenter study of safety and efficacy of combination drop prednisolone phosphate, moxifloxacin, and ketorolac in treating postop inflammation and pain after cataract surgery. 2017 ASCRS•ASOA Symposium & Congress. Editors’ note: Dr. Goldberg is a partner at Wolstan & Goldberg Eye Associates, Torrance, California, and has relevant interests with Ocular Science and Ocular Therapeutix. Dr. Chu is founder and medical director of Chu Vision Institute, Bloomington, Minnesota, and declared no conflicts of interest. Untitled-3 1 25/08/2020 4:44 PM