EyeWorld India March 2021 Issue

FEATURE 14 EWAP MAR C H 2021 for corneal edema are less than 2% in the NSAID alone arm. My experience has been it doesn’t make any difference.” Overall, when it comes to cataract anti-inflammatory regimens, Dr. Saidel said doctors need to consider several factors: cost, outcome, and patient ease and compliance. “Cost reductions can be achieved using compounded drops. That is also something that will increase patient compliance. … In terms of administering the medication, whether in drop form or intraocular, you get fantastic patient compliance with intraocular injection of drugs. Because we know that patient compliance is so closely related to outcomes, that should be a strong motivator for any surgeon to consider providing that in their regimen.” EWAP References 1. Modjtahedi BS, et al. Perioperative topical nonsteroidal anti-inflammatory drugs for macular edema prophylaxis following cataract surgery. Am J Ophthalmol. 2017;176:174–182. 2. Hoffman RS, et al. Cataract surgery and nonsteroidal antiinflammatory drugs. J Cataract Refract Surg. 2016;42:1368–1379. Editors’ note: Dr. Saidel is in practice with North Bay Eye Associates, Petaluma, California, and has interests with EyePoint Pharmaceuticals, Sun Pharma, and Bausch + Lomb. Dr. Savetsky is in practice at SightMD New York, New York, and has interests with EyePoint Pharmaceuticals, Novartis, and Allergan. Dr. Walter practices at Wake Forest Baptist Health, Winston-Salem, North Carolina, and has interests with Omeros and Sun Pharma. Dr. Whitman practices at Key-Whitman Eye Center, Dallas, Texas, and declared no relevant financial interests. Keratoconus Progression at a Glance! The newly integrated post-CXL function and database allow for evaluation of the cornea after crosslinking, based on the full complement of parameters including posterior corneal surface and corneal thickness at its thinnest spot. Monitor your keratoconus treatment with ease and improve your surgery outcomes! Retrospective use Free update User-friendly OCULUS Asia Ltd. www.oculus.de • info@oculus.hk KLB Instruments Co. Pvt. Ltd KLB The Belin ABCD Progression Display now includes post-CXL data ASCRS Eyeworld Pentacm ABCD new - nur Screen 123.4x247.7 ind 02.21.indd 1 25.02.2021 13:39:50 “I think we have seen that steroids alone aren’t the best answer to prevent CME. We need to have an NSAID on board to help prevent CME and lessen pain and inflammation,” Dr. Walter said. When Omidria (phenylephrine and ketorolac intraocular solution 1%/0.3%, Omeros) became available, Dr. Walter said he began using this combined with topical bromfenac. He found this combination allows him to achieve a “near zero CME rate.” Dr. Walter said that bromfenac specifically is the most potent at preventing CME when used properly for 30 days. Why his push for reduced steroid use? Dr. Walter pointed out that ophthalmology is the only surgical specialty that puts steroids on a postop wound. “Steroids delay wound healing, increase risk of infection, and, in our case, can cause a drastic rise in IOP,” he said. “Most studies comparing steroids and NSAIDs have concluded that the two together are ‘synergistic’ and should both be used, but they only include two arms in the study. One arm is steroids alone and the other is steroids plus an NSAIDs. What about the NSAID alone arm? It’s typically not there. So those studies are invalid, as I think that the ‘synergy’ is all from the NSAID. “Some have claimed a steroid is needed for prevention of corneal edema,” Dr. Walter continued. “I find the data on this to be weak. When you look at all FDA studies where NSAIDs gain approval for postop cataract pain, the adverse events