Eyeworld Supplements

August 2012 1 I nflammation remains a significant challenge to modern cataract surgery. Left untreated, inflamma- tion can ruin even the most consummately performed surgery utilizing the most advanced techniques and technology. Experts gathered to discuss "Ocular Anti-Inflammation: Prevention, Diagnosis, and Curative Treatment Options" at an EyeWorld Educational Symposium held at the 2012 ASCRS•ASOA Symposium & Congress. The event was supported by an educational grant from ISTA Pharmaceuticals (Irvine, Calif.). NSAID issues 2012 "Cataract surgery is evolving," said Dr. Katsev. According to Dr. Katsev, patients' standards have been increasing in the last decade in part thanks to the increasing role of premium IOLs in cataract surgery. In that time, the use of premium IOLs has increased dramatically, he said, but the promise of great vision these IOLs make does not necessarily mean happy patients; surgeons need to give them more. Surgeons need to take the extra step and give their patients great vision that is also free of complications such as cystoid macular edema (CME). More than 20 years ago, Dr. Katsev started using Ocufen (flurbiprofen sodium 0.3%, Allergan, Irvine, Calif.) based on studies that showed that the drug prevented miosis in all cases. More importantly, he said, the prevention of miosis was most effective in patients with small pupils. www.eyeworld.org Anti-inflammation: Perfecting cataract surgery Supplement to EyeWorld August 2012 The News Magazine of the American Society of Cataract & Refractive Surgery Uday Devgan, M.D., in private practice, Devgan Eye Surgery, Los Angeles and Beverly Hills, Calif., and chief of ophthalmology, Olive View UCLA Medical Center, Los Angeles, performs the full spectrum of corneal and lenticular refractive surgery Johnny L. Gayton, M.D., adjunct professor of ophthalmology, Mercer Medical School, and chief executive officer and chief surgeon, Eye Associates of Middle Georgia, Warner Robins, Ga., has practiced ophthalmology for over 25 years Douglas A. Katsev, M.D., chairman of ophthalmology, Sansum Clinic, Santa Barbara, Calif., is the lead ophthalmologist in a large group performing over 2,500 cataract/refractive cases a year Terry Kim, M.D., professor of ophthalmology, Duke University School of Medicine, Durham, N.C., has published over 200 journal articles, textbook chapters, and scientific abstracts in peer- reviewed literature and has delivered over 200 national and international invited lectures Keith A. Walter, M.D., associate professor of ophthalmology, Wake Forest University, Winston-Salem, N.C., has published several landmark articles on the effects of humidity on LASIK, IOL calculations after LASIK, and small incision DSAEK A study he co-authored with Robert C. Drews, M.D., showed as much as a 30% decrease in pupil surface area in small pupils when the non-steroidal anti- inflammatory drug (NSAID) was not used. 1 The benefits of using NSAIDs during cataract surgery have long been estab- lished. Inflammation as indicated by increased anterior chamber cells and flare is known to slow visual recovery. 2,3 Topical NSAIDs have been shown to reduce post- op inflammation and pain after surgery and have typically been used in place of or in addition to topical corticosteroids. Other suspected benefits in peer review include decreasing CME and maintaining pupil dilation during surgery. There are many reasons to use NSAIDs, but CME prevention is the biggest "stay out of trouble" factor, said Dr. Katsev, adding that it only takes a few loud patients suffering from this complication to negatively influence a practice. A large-scale study comparing ketoro- lac 0.4% and steroid with steroid alone after cataract surgery found that anywhere from 2.4-6.1% of healthy eyes develop CME without NSAIDs. 4 This percentage, while small, is not insignificant. In practice terms, said Dr. Katsev, these patients provide "the best advertisement." Supported by an educational grant from ISTA Pharmaceuticals Moderator The increasing utilization of premium IOLs is indicative of an increasing standard for post-op outcomes in cataract surgery ISTA supplement_EW August 2012-DL_Layout 1 6/3/14 2:36 PM Page 2

• Cover