William B. Trattler
SAN FRANCISCO — Surgeons have many options for controlling pain and inflammation following refractive surgery, William B. Trattler, MD, said in a presentation at Refractive Subspecialty Day at the American Academy of Ophthalmology annual meeting.
“In an ideal world we’re going to perform lens surgery, we’re all fantastic surgeons...we’ll all get fantastic visual results, and we don’t even need any postoperative meds,” he said. “But as we know, we all need postoperative meds in some way to help our patients.”
Compliance and cost can be challenges to using eye drops, and some generic agents can cause toxicity to the ocular surface, but there are safe and effective pharmaceutical options, he said.
Intracameral antibiotics have been shown to work well in multiple studies, but in the U.S. there are no commercially available options, he said.
Trattler orders intracameral antibiotics from a 503B compounding pharmacy, but there is risk of compounding error, so he recommends using a patient consent form to explain the risks.
Intracameral steroids such as triamcinolone can also be used, but that, too, carries a risk for snow globe effect and increased IOP, he said.
Two dexamethasone options, Dexycu (dexamethasone intraocular suspension 9%, Eyepoint) and Dextenza (dexamethasone ophthalmic insert 0.4 mg, Ocular Therapeutix), are both good, effective options, he said.
“Some surgeons are also using intracameral moxifloxacin along with Kenalog, Trattler said.
In addition, Omidria (phenylephrine 1% and ketorolac 0.3% intraocular solution, Omeros) inhibits intraocular prostaglandin release, reducing postoperative pain while maintaining pupil size.
“We have so many great options. We’re all using something different, but the good news is we are doing a great job for our patients. We’re controlling inflammation and doing our best to prevent infection,” Trattler said. – by Rebecca L. Forand
Trattler W. Optimizing pharmaceutical agents for refractive lens surgery. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosure: Trattler reports he is a consultant for Omeros, Ocular Therapeutix, EyePoint, Imprimis and Ocular Science.