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Speaker prefers lifitegrast, punctal plugs for controlling dry eye
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WAIKOLOA, Hawaii — Douglas A. Katsev, MD, said that cataract patients should be aware of dry eye, as it is the most common cornea issue, at Hawaiian Eye 2019.
“Sometimes there are fires to put out in cataract surgery,” Katsev said. “The initial screening should detect dry eye whether it’s through a questionnaire or staining.”
He said dry eye needs to be on the radar of surgeons and their staff.
“To achieve the best IOL scores you need a good calculation, good data, have the best cornea and have it sustained for vision after surgery,” he added.
Katsev stressed the need to protect the cornea.
The results are judged long-term but are produced both preoperatively and intraoperatively, he said.
In cataract patients with dry eye, Katsev advised controlling the inflammation, blocking drainage and producing better tears.
“Certainly punctal plugs are really easy, 3-month plugs can get you through the postop period very well, but I personally like permanent plugs,” Katsev said.
Identifying the right plug size is essential, he said. “They do come out all the time and you’ve got to get it in there so that it stays.”
Meibomian gland dysfunction is a major problem after cataract surgery that is often missed, especially in women.
Some medications will improve symptoms of dry eye, but improving the signs, is paramount.
That’s one reason he starts with lifitegrast, he said.
Loteprednol will address inflammation quickly, he added.
Katsev completed a small retrospective study of nine patients in which his technicians identified issues with topography and delayed surgery for 2 weeks. Patients were placed on loteprednol and lifitegrast twice daily for 2 weeks. He then repeated the IOL calculations, performed the surgery and implanted IOLs. At 4 weeks postoperatively, target refraction was improved in six patients and equivocal in three.
Lifitegrast is his go-to for long-term dry eye, he said. – by Abigail Sutton
Reference: Katsev DA. My choices for the management of dry eye in the cataract patient. Presented at: Hawaiian Eye; Jan. 19-25, 2019; Waikoloa, Hawaii.
Disclosures: Katsev reports consulting with and is on the speakers bureau for Bausch + Lomb, Omeros, Shire and Sun.