EyeWorld Asia-Pacific June 2021 Issue

GLAUCOMA 50 EWAP JUNE 2021 Dextenza. Source: Leon Herndon, MD Options to reduce postop cataract surgery drops for glaucoma patients by Liz Hillman Editorial Co-Director Contact information Herndon: leon.herndon@duke.edu Radcliffe: drradcliffe@gmail.com This article originally appeared in the March 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. S tudies have shown that the addition of a second glaucoma medication reduces adherence. 1 With that in mind, it makes sense that adding postop cataract surgery drops to a patient’s existing glaucoma drop regimen could have the same effect. Newer steroid and NSAID options (and some off-label administration of antibiotics) that are delivered either via injection or intracanalicular insert can help avoid complicating a patient’s drop regimen that is already subject to non-compliance, instillation issues, potential for ocular surface agitation, and more. When EyeWorld spoke with Leon Herndon, MD, he said he had a patient who came in recently for her cataract postop visit with a moxifloxacin bottle capped with a green Lumigan (bimatoprost, Allergan) top. “This happens,” he said. Nathan Radcliffe, MD, said “things fall apart” when you add a steroid, antibiotic, and NSAID onto a complicated glaucoma drop regimen. “We see a lot of errors where instead of taking prednisolone four times a day, patients will take their glaucoma drop that’s usually once a day four times a day. This creates problems with healing, more inflammation on the eye,” he said. In addition to the confusion adding new drops (even short-term ones) causes, Dr. Radcliffe pointed out that they can negate, for a time, the glaucoma-related procedures that are often performed with cataract surgery to get patients off drops. “It’s nice to be able to deliver on the promise to reduce drops by actually doing so, not just trading their glaucoma drops for anti-inflammatory drops,” he said. Dr. Herndon said he has used Dextenza (dexamethasone ophthalmic insert, Ocular Therapeutix) for more than a year for combined cataract surgery/MIGS patients. He said he injects intracameral moxifloxacin and inserts the Dextenza intracanalicular implant, finding it has worked well with MIGS like iStent (Glaukos), Hydrus (Ivantis), and Kahook Dual Blade (New World Medical). Dr. Radcliffe also said he’ll use intracameral moxifloxacin, off-label obtained by a compounding pharmacy, putting it in the anterior chamber. Dextenza, he said, is put into the lacrimal puncta;