Simplifying surgical medication regimens
In 2016, Imprimis Pharmaceuticals also introduced a sublingual product for conscious sedation (IV Free MKO Melt). Containing midazolam, ketamine, and ondansetron, it offers an alternative to the use of intravenous medications and could open the door to in-office cataract surgery, said Dr. Packer.
In addition, Imprimis Pharmaceuticals announced plans to expand its LessDrops topical formulation line with a new product combining prednisolone acetate, moxifloxacin hydrocholoride, and nepafenac.
On the topic of minimizing the medication burden for cataract surgery patients, Dr. Donnenfeld said that he is looking forward to the eventual availability of the dexamethasone intracanalicular insert (Dextenza, Ocular Therapeutix). It was developed as a treatment for ocular pain after surgery, and in July, 2016, Ocular Therapeutix announced that it received a Complete Response Letter from the FDA regarding its NDA. The letter identified issues pertaining to manufacturing and controls but no efficacy or safety concerns.
“This punctal plug delivery system is designed to release dexamethasone for up to 30 days and would eliminate the need for using a topical corticosteroid drop after cataract surgery,” said Dr. Donnenfeld.
Ocular surface optimization
Another issue in cataract surgery that has been receiving increasing attention is the importance of optimizing the ocular surface preoperatively and avoiding dry eye postoperatively. Oral supplementation with omega-3 fatty acids is one strategy for improving and maintaining ocular surface health, and Dr. Donnenfeld noted he was involved in a multicenter, randomized, placebo-controlled, double-masked trial that demonstrated re-esterified omega-3 fatty acids (Physician Recommended Nutriceuticals) effectively improved the signs and symptoms of dry eye in patients with meibomian gland dysfunction. The paper reporting on the study was published in September 2016 [Epitropoulos AT, et al. Cornea. 2016;35(9):1185-1191].
“Nutritional supplementation with omega-3 fatty acids is an important way to improve the quality of the tear film. We are now including the re-esterified omega-3 product in our protocol for all patients having cataract surgery,” said Dr. Donnenfeld.
He added that he continues to be proactive in identifying dry eye preoperatively and is aggressive about treating it with anti-inflammatory medications as appropriate.
“I continue to use topical cyclosporine emulsion (Restasis, Allergan) and have begun to prescribe topical lifitegrast (Xiidra, Shire) to improve the ocular surface before cataract surgery in patients with dry eye,” Dr. Donnenfeld said.