EyeWorld India September 2019 Issue

68 EWAP SEPTEMBER 2019 PHARMACEUTICALS safe,” Dr. Lindstrom said. “But if you’re using the full-strength 5,000 mg per ml, you have to appreciate that this can be toxic to the corneal endothelium.” Dr. Lindstrom currently relies on the intracameral injection after cataract surgery without use of supplemental antibiotic drops. “I’m also dropless with regard to the steroid because I inject a small amount of dexamethasone solution intracamerally,” he said, adding that he does use a topical -Ƃ ̜ Ài`ÕVi ˆ˜y>““>̈œ˜] pain, and the potential risk of Vˆ˜ˆV>Þ È}˜ˆwV>˜Ì ° i surgery when the lens must be prolapsed out of the capsular bag and into the anterior chamber. º/…ˆÃ ˆÃ ÛiÀÞ `ˆvwVÕÌ Ìœ do with any type of pupillary dilation device in place,” Dr. Henderson said. “Therefore, in these cases, I recommend using a dilation device (either hooks or rings) to dilate the pupil in order to perform the capsule opening Pupil dilating devices - from page 65 The future According to Dr. Miller, the FDA approval letter came with strings attached. “The company ˆÃ ÀiµÕˆÀi` ̜ `œ > «œÃ̇“>ÀŽiÌ study that is almost as involved as, if not even more involved Incorporating the light - from page 66 puts patients on nepafenac (Nevanac, Novartis) once a day or if that’s not available, bromfenac (Prolensa, Bausch + Lomb) also once a day or in some cases BromSite (Sun Pharmaceuticals) twice a day. If cost is a factor, he will turn to generic ketorolac. Although it is labeled as a four-times-a-day agent, he has patients use it twice a day for 2 weeks, then once a day until the bottle is gone. In some cases, he may use a single bottle of compounded drops that can contain an antibiotic, a steroid, and an NSAID. À° œ˜˜i˜vi` Ã̈ vÀiµÕi˜ÌÞ prescribes postoperative drops, predominantly in cases involving corneal incisions. i }i˜iÀ>Þ ˆŽià LiÈyœÝ>Vˆ˜ because it has the best activity against methicillin-resistant Staphylococcus aureus of all œv ̅i y՜ÀœµÕˆ˜œœ˜ið º ÕÃi that twice a day, and if a patient wants a generic, I tend to use œyœÝ>Vˆ˜]»…i Ã>ˆ`° The use of intracameral antibiotics in the U.S. is not yet the standard of care as it is in Europe, Dr. Donnenfeld said, adding that the real difference is its approval in Europe. “An ASCRS study looked at the reason ophthalmologists don’t use intracameral, and it’s because it is not FDA approved,” he said. “I think this will become the standard of care in the future once it is FDA approved.” EWAP Editors’ note: Dr. Donnenfeld practices at Ophthalmic Consultants of Long Island, Garden City, New York, CPF JCU ƂPCPEKCN KPVGTGUVU KP #NEQP Allergan, Bausch + Lomb, and Novartis. Dr. Lindstrom practices at Minnesota Eye Consultants, Minneapolis, and has ƂPCPEKCN KPVGTGUVU KP #NEQP #NNGTICP Bausch + Lomb, Novartis, and Sun Pharmaceuticals. and remove the device before prolapsing the nucleus.” Another situation where a surgeon should take caution with pupillary dilation is in cases of patients with uveitis. “In some patients, the iris can become damaged or remain dilated if the iris is stretched with a dilation device,” Dr. Henderson said. “The device may be necessary to perform the surgery safely so it is still prudent to use one, but the surgeon should be aware that the pupil may not constrict back ̜ ̅i Ã>“i «Àiœ«iÀ>̈Ûi Èâi°» Dr. Tipperman also has tried multiple devices, but he prefers the Malyugin ring for dilation due to its ease of insertion, placement, and removal. However, Dr. Tipperman avoids the use of the ring in ÛiÀÞ Ã“> «Õ«ˆÃ œÀ wLÀœÌˆV pupils, where it can still produce sphincter tears. “Especially if I’m using a multifocal IOL in these cases, I try to avoid mechanical pupillary dilation,” Dr. Tipperman said. EWAP Editors’ note: Dr. Henderson is clinical professor, Tufts University School of Medicine, Boston. Dr. Tipperman is attending surgeon at Wills Eye Hospital, Philadelphia. Neither have TGNGXCPV ƂPCPEKCN KPVGTGUVU than, the premarket approval clinical trial,” he said. Dr. Maloney thinks the LAL will be the lens of choice for the next 10 to 15 years. “After that, we will have electro- optical lenses with adjustable sphere and cylinder that also accommodate,” he said. EWAP Editors’ note: Dr. Berdahl practices at Vance Thompson Vision, Sioux Falls, South Dakota. Dr. Lindstrom practices at Minnesota Eye Consultants, Minneapolis. Dr. Maloney is director, Maloney-Shamie Vision Institute, Los Angeles. Dr. Miller is the Kolokotrones Chair in Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles. Dr. Waltz practices at Eye Surgeons of Indiana, Indianapolis. Drs. Berdahl, Lindstrom, CPF /CNQPG[ JCXG ƂPCPEKCN KPVGTGUVU KP RxSight. Drs. Miller and Waltz have no TGNGXCPV ƂPCPEKCN KPVGTGUVU