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Mian OT, Asif H, Sandhu U, Multani K, Farooq AV, Ding K, Riaz KM. Noninfectious Outcomes of Intravitreal Antibiotic Steroid Injection and Topical Nonsteroidal Antiinflammatory Drugs Versus Triple Drop Therapy After Cataract Surgery. Am J Ophthalmol 2024; 260:37-48. [PMID: 37944685 DOI: 10.1016/j.ajo.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To compare noninfectious outcomes of intravitreal antibiotic steroid (IVAS) injection (moxifloxacin-triamcinolone) and postoperative topical nonsteroidal antiinflammatory drugs (NSAID) with a standard 3-drop therapy (TDT) regimen (topical antibiotic, steroid, and NSAID) in patients after cataract surgery. DESIGN Retrospective comparative clinical cohort study. METHODS In 3 study centers in the United States, a total of 2143 eyes (N = 2143 patients) underwent cataract surgery with IVAS-NSAID or TDT between 2017 and 2022. Preoperative data were included, including patients' age, iris color, medical history, and ocular history. Postoperative data, including best-corrected visual acuity, intraocular pressure (IOP), and the need for IOP-lowering medications, were recorded at 1-week, 1-month, and 6-month time points. The primary outcome measures were postoperative complications, defined as persistent anterior chamber inflammation, persistent corneal edema (PCE), rebound inflammation, and cystoid macular edema, were compared between the 2 groups. RESULTS There were 1079 eyes in the IVAS-NSAID group and 1064 eyes in the TDT group. Best-corrected visual acuity and IOP were similar between IVAS-NSAID and TDT eyes at all time points. A portion (11.6%) of TDT eyes experienced postoperative complications compared with 6.5% in IVAS-NSAID eyes (P < .001). Femtosecond laser-assisted cataract surgery was associated with increased rates of PCE in IVAS-NSAID eyes, and eyes with dark irides had a higher incidence of cystoid macular edema, PCE, and rebound inflammation in the IVAS-NSAID group. CONCLUSION The IVAS-NSAID regimen overall had similar postoperative outcomes and fewer complications compared with the TDT regimen. IVAS-NSAID may be considered a safe alternative to topical regimens in non-femtosecond laser-assisted cataract surgery and patients with light irides.
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Affiliation(s)
- Osamah T Mian
- From the Department of Ophthalmology (O.T.M., K.M.R.), Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Hassaan Asif
- Department of Ophthalmology (H.A., A.V.F.), University of Chicago, Chicago, Illinois
| | - Umar Sandhu
- College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Karan Multani
- College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma
| | - Asim V Farooq
- Department of Ophthalmology (H.A., A.V.F.), University of Chicago, Chicago, Illinois
| | - Kai Ding
- Department of Biostatistics and Epidemiology (K.D.), University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Kamran M Riaz
- From the Department of Ophthalmology (O.T.M., K.M.R.), Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; College of Medicine (O.T.M., U.S., K.M., K.M.R.), University of Oklahoma, Oklahoma City, Oklahoma.
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Haddad JE, Sabbakh NA, Macaron MM, Shaaban H, Bourdakos NE, Shi A, Saad B, Nakanishi H, Than CA, Daoud YJ. NSAIDs and Corticosteroids for the Postoperative Management of Age-Related Cataract Surgery: A Systematic Review and Meta-analysis. Am J Ophthalmol 2024; 260:1-13. [PMID: 37797866 DOI: 10.1016/j.ajo.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/10/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids in the postoperative management of cataract surgery for age-related cataract in adults. DESIGN Meta-analysis. METHODS Cochrane, Embase, PubMed, Scopus, Web of Science and CINAHL were searched for articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42022364733). Randomized controlled trials of patients undergoing age-related cataract surgery treated with corticosteroids, NSAIDs, or a combination were included. RESULTS A total of 19 studies were included, with 3473 patients (3638 eyes) treated following cataract surgery with NSAIDs (n = 1479), corticosteroids (n = 1307), or a combination (n = 687). Combination treatment demonstrated favorable best-corrected visual acuity compared to corticosteroids 4 to 6 weeks postoperatively (MD = -0.01 logMAR, 95% CI: -0.02, -0.01, I2 = 0%). NSAIDs had more favorable flare values than corticosteroids on day 7 (MD = -9.17 photons/ms, 95% CI = -16.52, -1.82, I2 = 94%), day 14 (MD = -5.23 photons/ms, 95% CI = -8.35, -2.11, I2 = 94%), and 4 to 6 weeks (MD = -1.62 photons/ms, 95% CI = -3.03, -0.20, I2 = 93%) postoperatively. Furthermore, 4 to 8 weeks postoperatively, patients treated with NSAIDs showed lower central macular thickness (MD = -13.26 µm, 95% CI = -18.66, -7.86, I2 = 81%) compared to those treated with corticosteroids. NSAIDs and combination treatment were associated with a lower incidence of central macular edema (OR = 0.16, 95% CI = 0.07, 0.35, I2 = 61%; OR = 0.21, 95% CI = 0.10, 0.45, I2 = 31%) than corticosteroids 4 to 8 weeks postoperatively. CONCLUSIONS NSAIDs and combination treatments could be regarded as more effective and safer alternatives to corticosteroids alone in the postoperative management of cataract surgery. Further studies should be conducted to determine why this evidence has not been reflected in practice patterns, and to further compare the effectiveness of NSAIDs and combination treatments.
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Affiliation(s)
- Joe El Haddad
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Nader Al Sabbakh
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Marie Michele Macaron
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Hashim Shaaban
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Natalie E Bourdakos
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Ao Shi
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Baraa Saad
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Hayato Nakanishi
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus
| | - Christian A Than
- From the St George's University of London (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), London, UK; University of Nicosia Medical School (J.E.H., N.A.S., M.M.M., H.S., N.E.B., A.S., B.S., H.N., C.A.T.), University of Nicosia, Nicosia, Cyprus; School of Biomedical Sciences (C.A.T.), The University of Queensland, St Lucia, Australia
| | - Yassine J Daoud
- The Wilmer Eye Institute (Y.J.D.), The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Awidi AA, Chang DF, Riaz KM, Li X, LaBorwit S, Zebardast N, Srikumaran D, Prescott CR, Daoud YJ, Woreta FA. Anti-inflammatory medication use after cataract surgery: online survey of practice patterns. J Cataract Refract Surg 2024; 50:224-229. [PMID: 38381616 PMCID: PMC10878440 DOI: 10.1097/j.jcrs.0000000000001341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE To determine current prescribing patterns for topical or intraocular/periocular anti-inflammatory medications (AIMs) after routine cataract surgery. SETTING kera-net online members. DESIGN Cross-sectional survey. METHODS An online survey was distributed to subscribers of kera-net, a global online platform sponsored by the Cornea Society. Questions were asked regarding the use of topical or intraocular/periocular AIM after cataract surgery and types of medications prescribed. RESULTS Of 217 surgeon respondents (23% response rate), 171 (79%) practiced in the United States and 171 (79%) were cornea subspecialists. Most of the respondents (n = 196, 97%) prescribed topical corticosteroids after routine cataract surgery. The most frequently prescribed were prednisolone acetate (n = 162, 83%), followed by dexamethasone (n = 26, 13%), difluprednate (n = 24, 12%), and loteprednol etabonate (n = 13, 7%). Corticosteroids comprised (n = 40, 32%) of total intraocular/periocular injections, with triamcinolone acetonide 10 or 40 mg (n = 19, 47.5%) most commonly used. 23 surgeons (58%) who utilized intraocular/periocular corticosteroids also prescribed topical corticosteroids. Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 148 surgeons (73%). CONCLUSIONS Most surgeons prescribed topical AIM after routine cataract surgery. Many surgeons injected intraocular or periocular AIM while prescribing topical AIM. The diversity of practice patterns may reflect the lack of clear evidence-based guidelines.
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Affiliation(s)
- Abdelhalim A. Awidi
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - David F. Chang
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Kamran M. Riaz
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Ximin Li
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Scott LaBorwit
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Nazlee Zebardast
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Divya Srikumaran
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Christina R. Prescott
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Yassine J. Daoud
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
| | - Fasika A. Woreta
- From the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland (Awidi, Srikumaran, Daoud, Woreta); University of California, San Francisco, San Francisco, California (Chang); Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Riaz); Department of Biostatistics, Johns Hopkins University School of Public Health Biostatistics Center, Baltimore, Maryland (Li); Select Eye Care, Towson, Maryland (LaBorwit); Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (Zebardast); Department of Ophthalmology, Grossman School of Medicine, New York University Langone Health, New York, New York (Prescott)
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Nishihara TW, Hu JQ, Buchholz RD, Murphy JD, Afshari NA. Cost-Effectiveness Analysis of Light Adjustable Lens Compared to Monofocal Intraocular Lens in Cataract Surgery. J Refract Surg 2023; 39:777-782. [PMID: 37937762 DOI: 10.3928/1081597x-20231016-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE To analyze the cost-effectiveness of the Light Adjustable Lens (LAL; RxSight) in comparison to a monofocal intraocular lens (IOL) for individuals undergoing cataract surgery in both eyes. METHODS A cost-effectiveness analysis was performed using a Markov model that simulated the patient outcomes and costs associated with undergoing cataract surgery with the LAL or monofocal IOL. Cost-effectiveness was determined using the incremental cost-effectiveness ratio (ICER), a measure that quantifies the incremental cost in dollars per quality-adjusted life year (QALY) gained. Treatments with the ICER below the willingness-to-pay threshold (WTP) of $50,000/QALY were considered cost-effective. The model was also evaluated for the impact of uncertainties in parameters using one-way sensitivity and probabilistic sensitivity analyses. RESULTS The cost-effectiveness analysis showed that the LAL is cost-effective compared to monofocal IOLs in patients undergoing cataract surgery, with ICERs of $9,792/QALY (health care perspective) and $10,072/QALY (societal perspective) both significantly below the WTP. The model was most sensitive to patient age, market cost of the LAL, and proportion of patients with residual astigmatism following cataract surgery. The probabilistic sensitivity analysis showed that cataract surgeries in patients starting at age 65 years were cost-effective in 94% of the simulations at a WTP of $50,000/QALY. CONCLUSIONS From both health care and societal perspectives, the study shows cataract surgeries performed with the LAL are cost-effective when compared to those performed with a monofocal IOL. More studies are needed to compare the LAL to other premium lenses that also provide patients with excellent visual outcomes at a higher cost. [J Refract Surg. 2023;39(11):777-782.].
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Dai X, Chang DF, Chen A, Dun C, Saeed S, Repka MX, Woreta FA. Use and Cost of Sustained-Release Corticosteroids for Cataract Surgery Under the Medicare Pass-Through Program. JAMA Ophthalmol 2023; 141:844-851. [PMID: 37535374 PMCID: PMC10401390 DOI: 10.1001/jamaophthalmol.2023.3389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 08/04/2023]
Abstract
Importance Sustained-release corticosteroids offer the potential of improved compliance and greater patient convenience for anti-inflammatory treatment after cataract surgery. However, they are substantially more expensive than postoperative corticosteroid eye drops, which have historically been standard care. Objective To examine the use and cost of sustained-release corticosteroids in patients with Medicare who underwent cataract surgery in the US during the temporary pass-through reimbursement program period. Design, Setting, and Participants This cross-sectional study examined Medicare fee-for-service (FFS) claims from beneficiaries with at least 12 continuous months of Medicare enrollment who underwent at least 1 cataract surgery from March 2019 through December 2021. Patients younger than 65 years, those with missing demographic information, those who had more than 1 cataract surgery on each eye, and those who received more than 1 corticosteroid on the day of surgery were excluded. Cataract surgeries with concurrent use of dexamethasone intraocular suspension 9% or dexamethasone ophthalmic insert were identified. Information on surgeon demographic characteristics and costs of surgery and drugs were extracted. Data were analyzed from June 15 to December 4, 2022. Exposure Use of dexamethasone intraocular suspension 9% or dexamethasone ophthalmic insert during cataract surgery. Main Outcome Measures Utilization rate and cost of dexamethasone intraocular suspension 9% and dexamethasone ophthalmic insert among Medicare FFS beneficiaries who underwent cataract surgery. Results A total of 4 252 532 cataract surgeries in Medicare FFS beneficiaries (mean [SD] age, 74.8 [5.8] years; 1 730 811 male [40.7%] and 2 521 721 female [59.3%]) were performed by 12 284 ophthalmologists (8876 male [72.3%], 2877 female [23.4%], and 531 sex unknown [4.3%]). In all, 34 627 beneficiaries (0.8%) received dexamethasone intraocular suspension 9% and 73 430 (1.7%) received a dexamethasone ophthalmic insert; the use of both drugs increased over the study period. The mean (SD) Medicare allowed charges for dexamethasone intraocular suspension 9% and dexamethasone ophthalmic insert were $531.47 ($141.52) and $538.49 ($63.79), respectively. Conclusions and Relevance Despite offering the potential of improved compliance and greater patient convenience, findings of this study suggest that sustained-release corticosteroid use during cataract surgery was low and associated with cost increases to the health care system vs conventional postoperative eye drops. As these new products must be priced high enough to qualify for the Medicare pass-through program, unreasonable cost may have been a deterrent to their use, suggesting that the current Medicare reimbursement rules may not be appropriate for sustained-release postoperative corticosteroids in cataract surgery.
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Affiliation(s)
- Xi Dai
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David F. Chang
- Department of Ophthalmology, University of California, San Francisco, San Francisco
- Altos Eye Physicians, Los Altos, California
| | - Ariel Chen
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Safa Saeed
- School of Medicine, Aga Khan University, Karachi, Pakistan
| | - Michael X. Repka
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika Ambachew Woreta
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Heath M, McDonald MC, Murphy DA, Shah SV, Shah S, Ding K, Riaz KM. Fill levels, cost comparisons, and expulsion force requirements of commonly used topical ophthalmic nonsteroidal anti-inflammatory drugs. J Cataract Refract Surg 2023; 49:747-753. [PMID: 36853852 DOI: 10.1097/j.jcrs.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/21/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To determine volume fill levels, estimated costs, and force expulsion requirements per bottle of topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) commonly perioperatively in the United States. SETTING Tertiary care academic medical center. DESIGN Prospective laboratory investigation. METHODS 8 commercially available NSAIDs (3 branded, 5 generic) were tested: branded bromfenac 0.07%, generic bromfenac 0.09%, diclofenac 0.1%, flurbiprofen 0.03%, generic ketorolac 0.5%, branded ketorolac 0.5%, ketorolac 0.47%, and branded nepafenac 0.3%. 10 bottles of each medication were tested, with an additional bottle tested for expulsion force requirements. A double-blinded method was used to measure the actual bottle fill volume and number of drops per bottle. The total cost per drop was calculated using published cash prices. Force requirements were measured using a customized force gauge apparatus. Formulations were compared using the Kruskal-Wallis test, followed by pairwise comparisons with the Dwass, Steel, Critchlow-Fligner Method. RESULTS 2 branded NSAIDs (bromfenac and nepafenac) had slightly lower-than-sticker volumes while generics other than ketorolac had higher-than-sticker volumes. Diclofenac and branded bromfenac had the highest and lowest adjusted number of drops respectively. Generic bromfenac and generic ketorolac had the highest and lowest adjusted volume compared with sticker volume respectively. Branded bromfenac was the most expensive medication, while generic diclofenac was the least expensive. Force expulsion requirements varied significantly among generic and branded NSAIDs. CONCLUSIONS Volume fill levels, patient-incurred costs, and expulsion force requirements per bottle of topical NSAID medications vary significantly. Surgeons may wish to consider these factors when deciding how best to use these medications perioperatively.
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Affiliation(s)
- Michael Heath
- From the Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma (Heath, McDonald, Murphy, Riaz); Oklahoma School of Science and Mathematics, Oklahoma City, Oklahoma (S.V. Shah, S. Shah); Hudson College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma (Ding)
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Management of inflammation after the cataract surgery. Curr Opin Ophthalmol 2023; 34:9-20. [PMID: 36305352 DOI: 10.1097/icu.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To review most recent studies and clinical trials regarding pathogenesis, treatment, and prevention of inflammation after the cataract surgery. RECENT FINDINGS FLACS gave opportunity to evaluate inflammatory cytokines in the aqueous humour right after the laser procedure, which led to acknowledging the inflammation pathogenesis during the phacoemulsification. Although there is still a lack of evidence, which would prove the long-term benefit of NSAIDs, they are indicated and effective when risk factors for PCME are present. PREMED studies showed that combination of NSAID and steroids after the surgery for healthy subjects is cost-effective. The triamcinolone injection together with topical steroids and NSAIDs for diabetic patients after the cataract surgery was the most cost-effective in preventing PCME according to the PREMED. Dropless cataract surgery is another emerging topic: dexamethasone implants and suspensions look promising as we await more clinical trials with drug-loaded IOLs. SUMMARY Inflammation after the cataract surgery can be prevented, and these methods are one of the most essential topics with growing phacoemulsification rate. Topical NSAIDs are cost-effective not only for patients with risk factors for PCME but also for healthy subjects. New dropless techniques are being successfully introduced in the clinical practice.
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Parametric Drug Release Optimization of Anti-Inflammatory Drugs by Gold Nanoparticles for Topically Applied Ocular Therapy. Int J Mol Sci 2022; 23:ijms232416191. [PMID: 36555830 PMCID: PMC9786640 DOI: 10.3390/ijms232416191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Eye drops represent 90% of all currently used ophthalmic treatments. Only 0.02% of therapeutic molecules contained in eye drops reach the eye anterior chamber despite their high concentration. The tear film efficiently protects the cornea, reducing access to the target. Thereby, the increase in the drug bioavailability and efficiency must come from the mucoadhesion optimization of the drug delivery system. The gold nanoparticles, used as a drug delivery system in this study, already showcased ultrastable and mucoadhesive properties. The goal was to study the gold nanoparticles' ability to release two specific ophthalmic drugs, flurbiprofen and ketorolac. The parameters of interest were those involving the loading conditions, the gold nanoparticles properties, and the release experimental conditions. The drug release was measured using an in vitro model based on dialysis bags coupled with UV-visible spectroscopy. Gold nanoparticles showed an ability to release different molecules, whether hydrophobic or hydrophilic, in passive or active drug release environments. Based on these preliminary results, gold nanoparticles could represent a promising drug delivery system for ketorolac and flurbiprofen when topically applied through eye drops.
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9
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Saenz B, Ferguson TJ, Abraham N, Mueller BH, Parkhurst GD. Evaluation of Same-Day versus Next-Day Implantation of Intracanalicular Dexamethasone for the Control of Postoperative Inflammation and Pain Following Cataract Surgery. Clin Ophthalmol 2021; 15:4615-4620. [PMID: 34916773 PMCID: PMC8669496 DOI: 10.2147/opth.s334297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of a sustained-release intracanalicular dexamethasone insert for postoperative inflammation and pain implanted in a clinical setting preoperatively or on postoperative day 1. Methods Single-site, retrospective, contralateral eye study of patients undergoing cataract surgery. Included were subjects with a dexamethasone intracanalicular insert implanted in the clinic immediately prior to surgery in one eye (same-day) and on postoperative day 1 (POD1) in the contralateral eye. The primary outcome measure was the resolution of anterior chamber inflammation at 1 week postoperative. Secondary outcome measures included proportion of eyes requiring additional therapy for pain and inflammation through 1 month as well as the number of eyes with IOP spikes above baseline. Safety measures included adverse events through 1 month postoperative. Results Sixty-two eyes of 31 subjects were included in the case series. At 1 week postoperative, 52% of the eyes (n = 16) achieved complete resolution of inflammation in the same-day group and 58% (n = 18) met this endpoint at 1 week in the POD1 group. One subject in the same-day group required additional therapy for rebound inflammation and no eyes required additional therapy in the POD1 group. There were no reports of pain at 1 week or 1 month in either group. There were no implant-related adverse events in either group. Conclusion The favorable results of this study indicate that the sustained-release dexamethasone insert can be safely implanted in the clinic either preoperatively on the day of surgery or on postoperative day 1 for the control of pain and inflammation following cataract surgery.
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Taubenslag KJ, Kim SJ, Grzybowski A. Anti-inflammatory Pharmacotherapy for the Prevention of Cystoid Macular Edema After Cataract Surgery. Am J Ophthalmol 2021; 232:1-8. [PMID: 34157275 DOI: 10.1016/j.ajo.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE To elucidate strategies for and controversies surrounding the use of anti-inflammatory medications after uneventful cataract surgery, with a focus on the prevention of irreversible vision loss due to cystoid macular edema (CME). DESIGN Perspective. METHODS Expert commentary on the management of inflammation after cataract surgery. Discussion includes combination therapy with corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), dosing strategies, and emerging therapies. RESULTS While prescribing both NSAIDs and corticosteroids for cataract surgery is common, these classes have overlapping mechanisms. Combination therapy may speed visual recovery, but there remains little evidence for improved long-term visual outcomes from NSAIDs. The last 2 decades have seen increasing data on potential benefits of pretreatment with NSAIDs 1-3 days prior to cataract surgery. Simultaneously, newly approved "dropless" delivery systems hold promise, and clinical trials are ongoing to assess outcomes of such formulations. CONCLUSIONS Optimal pharmacologic treatment for inflammation after cataract surgery remains controversial. A consensus definition for clinically significant CME may facilitate the comparison of anti-inflammatory drugs. And there remains a need for well-designed trials examining both topical and extended-release drug-delivery systems to refine the treatment paradigm.
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Dığın F, Özkan ZK, Şahin A. Effect of Sending SMS, Which Reminds About the Intake of Medication, on Reducing Postoperative Anxiety in Patients Undergoing Cataract Surgery: A Randomized Controlled Study. J Perianesth Nurs 2021; 37:75-79. [PMID: 34815165 DOI: 10.1016/j.jopan.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Patients undergoing cataract surgery find postoperative medication management difficult and are anxious about this issue. Differences in the number of medications and frequency of administration can lead to confusion in patients. The aim of this randomized-controlled study was to evaluate the effect of sending short message service (SMS) texts, to reminds patients about need to take postoperative medications, on reducing postoperative anxiety in patients undergoing cataract surgery. DESIGN The randomized, controlled study. METHODS The patients in the experimental group received short message service reminders on the first to the seventh days postoperatively. FINDINGS The SMS group was found to have significantly lower State Anxiety Inventory mean scores than the control group on the seventh postoperative day (P = .001). The majority (82.9%) of patients were satisfied with receiving an SMS reminder. CONCLUSIONS In this study, SMS reminders may be effective in decreasing postoperative anxiety for patients undergoing cataract surgery and this intervention was welcomed by patients.
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Affiliation(s)
- Figen Dığın
- Department of Nursing, Faculty of Health Sciences, Kırklareli University, Kırklareli, Turkey.
| | - Zeynep Kızılcık Özkan
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
| | - Ayşe Şahin
- Martyr Professor Dr İlhan Varank Education and Research Hospital, Istanbul, Turkey
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Foster B. Same-Day versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis. Clin Ophthalmol 2021; 15:4091-4096. [PMID: 34703199 PMCID: PMC8541700 DOI: 10.2147/opth.s335764] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background The dexamethasone 0.4mg intracanalicular insert (Dextenza, Ocular Therapeutix, Bedford, MA) is approved for control of postoperative pain and inflammation following ocular surgery. This study compared pain and inflammation resolution following phacoemulsification in eyes that received the insert immediately postoperatively versus the next day. Methods This was a retrospective analysis of existing electronic health records. Consecutive qualifying eyes were included for analysis. All patients received perioperative antibiotics and nonsteroidal anti-inflammatory drugs. Pain and inflammation were assessed at baseline and on postoperative days 1, 7, and 30. Pain was assessed by dichotomous patient report (present/absent). Anterior chamber cell (0, 0.5+, 1–4+) and flare (0–4+) were graded using the Standardization of Uveitis Nomenclature rubric. Results Data from 17 eyes of 17 subjects were analyzed; 8 received the insert immediately postoperative and 9 in the office the next day. In both groups, trace cell was present in all eyes at day 1 and had resolved in all but 1 eye in each group at days 7 and 30. Flare was absent in all eyes at every time point, and transient pain was reported in a single same-day eye on day 7. No insert-related adverse events were observed, and no eyes required rescue corticosteroid therapy or insert removal. Conclusion Similar rates of inflammation and pain resolution after phacoemulsification were observed with the dexamethasone intracanalicular insert placed either immediately postoperatively or the next day. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/u7wchyuX-MA
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Fill levels, cost comparisons and expulsion force requirements of commonly used topical ophthalmic steroids. J Cataract Refract Surg 2021; 48:475-480. [PMID: 34653089 DOI: 10.1097/j.jcrs.0000000000000833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine volume fill levels, estimated costs, and force expulsion requirements per bottle of topical ophthalmic steroids commonly used in the United States. SETTING Tertiary care academic referral center. DESIGN Prospective laboratory investigation. METHODS Eight commercially available medications were tested: loteprednol 0.5%, loteprednol gel 0.5%, loteprednol gel 0.38%, difluprednate 0.05%, generic fluorometholone 0.1%, branded fluorometholone 0.1%, generic prednisolone 1.0%, and branded prednisolone 1.0%. Ten bottles of each medication were tested. A double-blinded method was used to measure actual bottle-fill volume and number of drops dispensed per bottle. The total perioperative cost per drop was calculated for each medication using average cash price. Force requirements were measured using a customized force gauge apparatus. Formulations were compared using Kruskal-Wallis one-way ANOVAs. RESULTS All formulations were able to cover postoperative periods commensurate with commonly used dosing regimens for cataract surgery. All medications had greater than sticker volume. Loteprednol 0.5% suspension and branded fluorometholone had the highest and lowest number of drops among the medications tested, respectively. Loteprednol 0.38% gel was the most expensive medication, while generic prednisolone 1.0% was the least expensive. Gel and branded formulations of ophthalmic steroids required less expulsion force compared to other tested formulations. CONCLUSIONS Volume fill levels, patient-incurred costs and expulsion force requirements per bottle of topical steroid medications vary widely. Clinicians may wish to consider these findings when determining their perioperative prescribing regimens.
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Berkowitz ST, Liu Y, Chen Q, Patel S. Correlation Between Ophthalmology Market Saturation and Medicare Utilization Rates. Am J Ophthalmol 2021; 229:137-144. [PMID: 33910054 DOI: 10.1016/j.ajo.2021.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize usage of ophthalmologic services by Medicare Fee-For-Service (FFS) beneficiaries relative to geography-specific market saturation, demographics, and contextual factors DESIGN: Cross-sectional study METHODS: Data sets from Centers for Medicare & Medicaid Services, US Census Bureau, US Department of Agriculture, and Housing and Urban Development, were used to calculate county- and state-level ophthalmologic service usage, market saturation, and demographic characteristics. Negative binomial regression models were used to evaluate the association between results and demographic or population-specific variables. RESULTS Ophthalmologic service usage ranged from 58.2% to 15.2%, whereas saturation ranged from 21,763 to 91.4 FFS beneficiaries per registered ophthalmologist. Usage was significantly associated with demographic characteristics in each geography: lower proportion of African American (P = .009), Hispanic (P < .001), and other race beneficiaries (P < .001), relative to white beneficiaries; a higher proportion of female (P < .001) relative to male; a higher proportion of adults having completed an associate degree or some college (P = .001), or holding a bachelor's degree or higher (P < .001), relative to a high school diploma; a lower proportion of adults in each geography experiencing poverty (P = .009), geographies with lower Multidimensional Deprivation Index (P < .001); a higher urban-influence code (P < .001). There was no significant correlation between the usage of ophthalmologic services and the geographic market saturation of ophthalmologists (Spearman rho, -0.030, P = .227). CONCLUSIONS AND RELEVANCE Ophthalmologic service usage is significantly influenced by population demographics; however, increased provider density alone appears insufficient to promote the usage of eye care services.
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Affiliation(s)
| | - Yuhan Liu
- Department of Biostatistics, Vanderbilt University
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University; Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University Medical Center, Nashville, Tennessee, USA..
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Erichsen JH, Holm LM, Forslund Jacobsen M, Forman JL, Kessel L. Prednisolone and Ketorolac vs Ketorolac Monotherapy or Sub-Tenon Prophylaxis for Macular Thickening in Cataract Surgery: A Randomized Clinical Trial. JAMA Ophthalmol 2021; 139:1062-1070. [PMID: 34383010 PMCID: PMC8529413 DOI: 10.1001/jamaophthalmol.2021.2976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Question Is a combination of corticosteroid and nonsteroidal anti-inflammatory drug (NSAID) eye drops superior to NSAID eye drops alone or dropless surgery with a sub-Tenon dexamethasone depot in controlling postoperative central macular thickening after uncomplicated cataract surgery? Findings In this randomized clinical trial with 470 participants, no differences in central subfield thickness or visual acuity across treatment arms were identified, although approximately half of the group given the sub-Tenon depot received additional anti-inflammatory treatment. Meaning Therapy with NSAID plus corticosteroid eye drops was not superior to NSAID monotherapy or sub-Tenon depot for postoperative central macular thickening after uncomplicated cataract surgery. Importance The choice of anti-inflammatory prophylaxis parallel to cataract surgery is important for patient safety and successful outcome of surgery, but which regimen to choose is contested. Objectives To determine whether a combination of prednisolone and nonsteroidal anti-inflammatory drug (NSAID) eye drops was superior in preventing increased central macular thickness (central subfield thickness [CST]) after uncomplicated cataract surgery compared with NSAID monotherapy and sub-Tenon capsule depot (dropless surgery), and to test whether preoperative initiation of eye drop treatment was superior to initiation on the day of surgery. Design, Setting, and Participants This investigator-driven, single-center, randomized clinical trial with masked statistical analyses enrolled patients at the Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark, from February 1, 2018, to August 15, 2019. Follow-up was completed December 18, 2019. Participants included low-risk patients undergoing phacoemulsification for age-related cataract by an experienced surgeon (1 eye per participant). Data were analyzed from February 17 to June 15, 2020. Interventions Participants scheduled for cataract removal were randomized to 1 of 5 anti-inflammatory prophylactic regimens: eye drops with a combination of prednisolone, 1%, and ketorolac tromethamine, 0.5%, with or without preoperative initiation (preoperative prednisolone plus NSAID [control] and postoperative prednisolone plus NSAID groups), ketorolac monotherapy with or without preoperative initiation (preoperative and postoperative NSAID groups), or sub-Tenon depot of dexamethasone phosphate (sub-Tenon group). Eye drops were administered 3 times per day until 3 weeks postoperatively. Main Outcomes and Measures CST 3 months postoperatively. Results A total of 470 participants (mean [SD] age, 72.2 [7.0] years; 290 women [61.7%]) with 94 participants in each group were included in the analysis. Three months after surgery, the mean CST was 250.7 (95% CI, 247.6-253.7) μm in the preoperative prednisolone plus NSAID group, 250.7 (95% CI, 247.8-253.7) μm in the postoperative prednisolone plus NSAID group, 251.3 (95% CI, 248.2-254.4) μm in the preoperative NSAID group, 249.2 (95% CI, 246.2-252.3) μm in the postoperative NSAID group, and 255.2 (95% CI, 252.0-258.3) μm in the sub-Tenon group. There were no significant differences in CST or visual acuity compared with control and no differences between preoperative and postoperative groups, but 47 of 83 participants (56.6%) in the sub-Tenon group needed additional anti-inflammatory treatment. Conclusions and Relevance No differences in CST or visual acuity were detected between the combination of prednisolone and NSAID eye drops vs NSAID monotherapy or sub-Tenon dexamethasone depot, although more than one-half of patients in the sub-Tenon arm received additional anti-inflammatory treatment. Initiating prophylaxis 3 days preoperatively was not superior to initiation on the day of surgery. Monotherapy with NSAIDs may be preferred in uncomplicated cataract surgery. Trial Registration ClinicalTrials.gov Identifier: NCT03383328
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Affiliation(s)
| | - Lars M Holm
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Yu Z, Zhu J, Jin J, Yu L, Han G. Trends in Outpatient Prescribing Patterns for Ocular Topical Anti-Infectives in Six Major Areas of China, 2013-2019. Antibiotics (Basel) 2021; 10:916. [PMID: 34438966 PMCID: PMC8388675 DOI: 10.3390/antibiotics10080916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
Topical anti-infectives are important in the management of ocular infections, but little is known about their current status and trends in their use in China. Thus, we carried out a prescription-based, cross-sectional study using the database of Hospital Prescription Analysis Projection of China, and aimed to analyze the trend in the use of ocular topical anti-infectives for outpatients of the ophthalmology department from 2013 to 2019. A total of 2,341,719 prescriptions from 61 hospitals located in six major areas written by ophthalmologists for outpatients were identified, and 1,002,254 of the prescriptions contained at least one anti-infective. The yearly anti-infective prescriptions increased continuously from 126,828 prescriptions in 2013 to 163,434 prescriptions in 2019. The cost also increased from 4,503,711 Chinese Yuan (CNY) in 2013 to CNY 5,860,945 in 2019. However, the use rate of anti-infectives decreased slightly from 46.5% in 2013 to 41.1% in 2019. Patients aged between 19 and 45 years old had the highest anti-infective use rate. Levofloxacin was the most frequently used anti-infective and kept on increasing among all age groups, occupying 67.1% of the total cost at the end of the study. Tobramycin was more frequently used in pediatric patients than in adults, but the use still decreased. Ganciclovir was the preferred anti-viral drug over acyclovir. In conclusion, the prescriptions and cost of ocular topical anti-infectives for outpatients both increased progressively. The increasingly widespread use of levofloxacin raised concerns regarding safety in pediatrics and resistance development. The observed trends can lead to the more efficient management of ocular anti-topical anti-infectives in China.
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Affiliation(s)
- Zhenwei Yu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
| | - Jianping Zhu
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
| | - Jiayi Jin
- Biomedical Research Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;
| | - Lingyan Yu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Gang Han
- Department of Pharmacy, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; (Z.Y.); (J.Z.)
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Samadi B, Lundstrom M, Zetterberg M, Nilsson I, Montan P, Behndig A, Kugelberg M. Anti-inflammatory treatment after cataract surgery in Sweden: changes in prescribing patterns from 2010 to 2017. BMJ Open Ophthalmol 2021; 6:e000635. [PMID: 33880412 PMCID: PMC7993195 DOI: 10.1136/bmjophth-2020-000635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022] Open
Abstract
Aims To investigate changes in the prescribing patterns of postoperative eye drops following cataract surgery in Sweden from 2010 to 2017. Methods Data from cataract procedures registered in the National Cataract Register during the month of March from 2010 to 2017 were record linked and sent to the Swedish Prescribed Drug Register, which allowed us to determine which eye drops the patients had obtained from 3 months presurgery to 2 weeks post surgery. Results During the 8-year study period, 54 889 surgeries were registered. Combination treatment with steroid and non-steroidal anti-inflammatory drug (NSAID) eye drops increased from 12% in 2010 to 60% in 2017 (p<0.001) while monotherapy with steroids decreased from 71% in 2010 to 26% in 2017 (p<0.001). Monotherapy with NSAIDs after surgery was fairly stable, at 17% in 2010 and 13% in 2017 (p<0.001). Combination treatment was more frequent in patients with diabetic retinopathy (p<0.001) or age-related macular degeneration (p<0.001), while monotherapy with steroids was more frequent in patients with glaucoma (p<0.001). The proportion of monotherapy or combination therapy varied widely between ophthalmic clinics. The prescription of antibiotic eye drops after surgery also varied greatly between clinics, from 0% to 63%, with a national average of 4.9%. Conclusion There is a change in the prescription pattern of anti-inflammatory eye drops after cataract surgery in Sweden, with less monotherapy and an increasing proportion of patients receiving a combination of steroid and NSAID eye drops.
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Affiliation(s)
- Behrad Samadi
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Mats Lundstrom
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Karlskrona, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, University of Gothenburg, Mölndal, Sweden.,Ophthalmology, Sahlgrenska University Hospital, Goteborg, Sweden
| | | | - Per Montan
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, St Erik Eye Hospital, Stockholm, Sweden
| | - Anders Behndig
- RC Syd, Blekinge Hospital Karlskrona, Karlskrona, Sweden
| | - Maria Kugelberg
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, St Erik Eye Hospital, Stockholm, Sweden
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Assil KK, Greenwood MD, Gibson A, Vantipalli S, Metzinger JL, Goldstein MH. Dropless cataract surgery: modernizing perioperative medical therapy to improve outcomes and patient satisfaction. Curr Opin Ophthalmol 2021; 32 Suppl 1:S1-S12. [PMID: 33273209 DOI: 10.1097/icu.0000000000000708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Advances in pharmacology offer freedom from topical medical therapy without compromise of anti-inflammatory and antimicrobial coverage in the perioperative period. In this review, we describe the basis for dropless cataract surgery with the goal of improving outcomes and the patient experience. RECENT FINDINGS Phacoemulsification outcomes depend largely on surgeon skill but also on adherence to a complex multidrug regimen of perioperative anti-inflammatory and antimicrobial therapy to prevent sight-threatening complications such as cystoid macular edema or endophthalmitis. Successful administration of this regimen can be limited by noncompliance, difficulty administering eye drops, bioavailability, and side effects, among others. The recent development of sustained-release formulations of dexamethasone - one an intracanalicular insert and the other an intraocular suspension - can provide sustained tapering doses of dexamethasone while reducing or eliminating the need for anti-inflammatory eye drop therapy. Similarly, mounting evidence compellingly demonstrates that intracameral antibiotic use intraoperatively is at least as effective as topical antibiotics in preventing endophthalmitis. SUMMARY Sustained-release dexamethasone coupled with intracameral antibiotics at the time of phacoemulsification can provide antimicrobial and anti-inflammatory prophylaxis without the need for topical eye drop medications. This approach has the potential to improve compliance with therapy, visual acuity outcomes, and the overall patient experience.
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Affiliation(s)
| | | | - Andrea Gibson
- Ocular Therapeutix, Inc., Bedford, Massachusetts, USA
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Hecht I, Tuuminen R. Re: Zafar et al.: Prescribing patterns and costs associated with postoperative eye drop use in Medicare beneficiaries undergoing cataract surgery (Ophthalmology 2020;127;573-581). Ophthalmology 2020; 127:e109-e110. [PMID: 32739186 DOI: 10.1016/j.ophtha.2020.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Idan Hecht
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland; Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.
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Rudnisky CJ. Re: Zafar et al.: Prescribing patterns and costs associated with postoperative eye drop use in Medicare beneficiaries undergoing cataract surgery (Ophthalmology. 2020:127:573-581). Ophthalmology 2020; 127:e110-e111. [PMID: 32739187 DOI: 10.1016/j.ophtha.2020.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022] Open
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Zafar S, Schein OD, Woreta FA. Reply. Ophthalmology 2020; 127:e111. [PMID: 32739195 DOI: 10.1016/j.ophtha.2020.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022] Open
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Reply. Ophthalmology 2020; 127:e110. [PMID: 32739183 DOI: 10.1016/j.ophtha.2020.06.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/22/2022] Open
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