Surgeons can also opt for a preservative-free corticosteroid intra-
canalicular hydrogel insert that's placed through the punctum in the
lower eyelid at the end of surgery, where it dissolves to deliver dex-
amethasone across the eye's surface for a month.
Topical antibiotics have never been proven to prevent post-op infec-
tion, but several studies have shown intracameral antibiotics are the
most effective way to prevent endophthalmitis, according to Dr.
Hovanesian.
He says it costs between $8 and $10 to buy a compounded moxi-
floxacin suspension that can be injected into the eye at the end of sur-
gery. Surgeons can combine the suspension with one of the sustained-
release steroids or a phenylephrine and ketorolac intraocular solution,
which delivers a high dose of a nonsteroidal.
"The anti-inflammatory and anti-microbial regimen avoids eyedrops
altogether for most patients who are not at high risk for cystoid macu-
lar edema," says Dr. Hovanesian. "In fact, I'm doing this in my practice
with good outcomes. It's exciting."
Some surgeons are interested in eliminating or at least reducing the
use of post-op steroids. Dr. Hovanesian injects a combination antibiot-
ic and steroid behind the lens implant and into the anterior vitreous
cavity, either through the zonules or through a pars plana. The injec-
tions essentially eliminate the need for patients to apply post-op
drops. They aren't very expensive — $20 to $25 per case — and are a
good option for patients who are unlikely to comply with a post-op
drop regimen.
Ocular surface toxicity is often caused by topical medications,
including steroids, because of the varying amounts of preservatives
contained in generic preparations. "When we see patients three or
four weeks after surgery, they're often frustrated that their vision is
blurrier than it was a few days after surgery," says Dr. Hovanesian.
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