A review of some of the most significant advances in medications for cataract surgery during the past year revealed a mix of the expected with a few surprises. For instance, though phenylephrine and ketorolac injection 1%/0.3% (Omidria, Omeros Corp.) received FDA approval for marketing in 2014, this intracameral product still earned top mention by Ophthalmology Times' Editorial Advisory Board members.
Eric D. Donnenfeld, MD, noted that use of the combination product grew substantially in 2016 and with good reason.
“There is strong and convincing evidence from clinical trials showing that adding phenylephrine/ketorolac injection to the irrigating solution is effective for preventing intraoperative miosis and reducing pain after cataract surgery. My real-world experience has been that its use reduces problems with intraoperative pupil constriction, and as a result, cataract surgery is much less traumatic,” said Dr. Donnenfeld, Clinical Professor of Ophthalmology, New York University, New York, and Founding Partner, Ophthalmic Consultants of Long Island and Connecticut, Garden City, NY.
Robert H. Osher, MD, professor of ophthalmology, University of Cincinnati School of Medicine, and Medical Director Emeritus, Cincinnati Eye Institute, Cincinnati, OH noted that phenylephrine/ketorolac is an important drug because it fulfills the need for an approved intracameral medication for preventing intraoperative miosis.
“With a commercially available intracameral product that is indicated for preventing intraoperative miosis, surgeons using medications in an off-label manner may be putting themselves at risk medicolegally, even if a complication occurs and is completely unrelated to the pupil,” he said.
Because intracameral phenylephrine/ketorolac was granted pass-through reimbursement status, there is no reason why surgeons should not be using it routinely, said Mark Packer, MD, Clinical Associate Professor of Ophthalmology, Oregon Health & Science University, Portland.
“The decision to grant pass-through reimbursement status to Omidria indicates that the reviewers at the Centers for Medicare and Medicaid Services were convinced it provides significant benefit, and it is certainly a better option than using some extemporaneously compounded formulation,” he said.