Novel therapeutic approaches and drug-delivery technologies are improving control of pain and inflammation after cataract and other ocular surgeries.
Steroid drops and gel
Other steroid treatments have been engineered to be a step above standard drop therapy with enhanced penetration, which can improve efficacy and help prevent ocular surface disease from corneal toxicity.
The first, loteprednol etabonate ophthalmic suspension 1% (Inveltys, Kala Pharmaceuticals), makes use of nanoparticle technology to provide better penetration into the eye following ocular surgeries. The FDA approved this formulation for use after ocular surgery in 2018. The drug achieves improved intraocular penetration as the result of nanoparticle sized particles that range from 200 to 400 nanomolars.
Dr. Epitropoulos explained that when dosed twice daily, the drug is designed to efficiently penetrate through the mucus barrier on the ocular surface and into the target tissue of the cornea and anterior chamber.
Another novel steroid, loteprednol etabonate ophthalmic gel 0.38% (Lotemax SM, Bausch + Lomb), received FDA approval in early 2019. This formulation provides two times greater penetration to the aqueous humor as a result of its submicron particle size. The particles are 80% smaller than those in the Lotemax gel formulation, which allows for more efficient penetration into the target tissues, Dr. Epitropoulos explained.
Lastly, fluorometholone acetate ophthalmic suspension 0.1% (Flarex, Eyevance Pharmaceuticals LLC) is being reinvigorated after having been acquired recently by Eyevance Pharmaceuticals.
“This topical steroid has the broadest indication of any current branded steroid. It is indicated for conditions of the bulbar and palpebral conjunctiva, the cornea, and anterior segment of the eye with a low incidence of increase in the intraocular pressure. It can be used for induction treatment for dry eye disease or other ocular surface inflammatory conditions, corneal procedures such as LASIK, PRK, keratectomy, corneal-crosslinking, Descemet stripping endothelial keratoplasty, Descemet’s membrane endothelial keratoplasty, and pterygium removal,” she pointed out.
Alice Epitropoulos, MD
E: [email protected]
Dr. Epitropoulos is a speaker and/or consultant for Bausch + Lomb, EyePoint Pharmaceuticals, Kala Pharmaceuticals, Ocular Therapeutix, and Omeros.