Surgeons debate postop inflammation management in cataract patients
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KOLOA, Hawaii — Surgeons can ease the burden of managing inflammation in their postoperative cataract patients by using FDA-approved sustained release steroids, Cynthia A. Matossian, MD, FACS, said at Hawaiian Eye 2020.
Dexycu (dexamethasone intraocular suspension 9%, EyePoint Pharmaceuticals) and Dextenza (dexamethasone ophthalmic insert 0.4 mg, Ocular Therapeutix) do not carry the safety concerns associated with non-FDA-approved compounded intracameral products used in cataract surgery, she said in a debate with John P. Berdahl, MD.
Matossian cited the FDA’s position that compounded medication should only be used when “an alternative to meet the needs of patients whose medical needs cannot be met by an FDA-approved drug.”
Outcomes are driven by patient compliance with postoperative medications, so reducing the medication burden is a benefit to the patient, Matossian said. Furthermore, compounding medications is outdated and unnecessary, while FDA-approved therapies limit risk, she said.
“We have two FDA-approved steroids to be used at the end of cataract surgery, so why not choose a 21st century approach?” she asked.
Berdahl countered, saying, “There is a need for compounded medications. A lot of innovation comes out of compounded medications.”
Both Avastin (bevacizumab, Genentech) and Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) were innovations starting with compounded medicines, he said.
Regarding outcomes, Berdahl said, “There is no doubt, of millions of patients studied, that intracameral antibiotics help prevent endophthalmitis, but there’s no mechanism to get a drug like that to market.”
Compounded postoperative drops can be convenient for patients and cheaper, he said.
“A few years ago, when we went to combo medications that were compounded for cataract surgery, we did so because the cost of all the recommended medications was $600 to $700 total. So, now for $75, a patient can get an intracameral injection inside their eye and they can get a bottle that has all the drops in it.” – by Patricia Nale, ELS
Reference:
Berdahl JP, Matossian CA. Debate 1. Improving medication compliance after cataract surgery: The case for FDA-approved products. Presented at: Hawaiian Eye 2020; Jan. 18-24, 2020; Koloa, Hawaii.
Disclosures: Berdahl reports financial disclosures with Imprimis/Harrow Health and Ocular Therapeutix. Matossian reports financial disclosures with Ocular Therapeutix and EyePoint.
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