JCRS Highlights

THOMAS KOHNEN European Editor of JCRS

NANOTECHNOLOGY—GOOD THINGS IN SMALL PACKAGES

A nanoemulsion of difluprednate twice a day proved equal to traditional treatment with prednisolone acetate four times a day, a recent study shows. The prospective, multicentre, double-blind study enrolled 259 patients in a randomised, parallel-group protocol. The primary endpoint was central corneal thickness. There was no difference in endothelial cell loss rates between the treatment groups. Both groups experienced transient IOP elevations. The main advantage of difluprednate nanoemulsion use is the possibility of reducing dosing frequency in the perioperative period, which could improve patients’ compliance, the researchers note. G Valvecchia et al., “Difluprednate 0.05% twice a day vs prednisolone acetate 1% 4 times a day for cataract postsurgical inflammation treatment: noninferiority trial”, 48(7): 753–758.

REDUCING INTRAOPERATIVE OPIOID USE

At a time of increasing concern about opioid abuse in communities around the world, the prescription rate for opioids after ophthalmic procedures, including cataract surgery, has been paradoxically increasing. Phenylephrine/ketorolac (P/K) could be a viable nonopioid alternative for managing both intraoperative and early postoperative pain. A study enrolled 112 eyes of 56 patients—mean age, 70 years—undergoing bilateral cataract surgery. Half of the patients received epinephrine for the first eye, followed two weeks later by P/K in the second eye; the other half received P/K in the first eye, followed by epinephrine in the second.

Patients treated with P/K had a statistically significant lower use of the opioid fentanyl intraoperatively while also experiencing significantly less pain than those treated with epinephrine. Pain reduction was significantly greater with P/K administration versus epinephrine at all evaluated timepoints: intraoperatively, immediately postoperatively, and one-day postoperatively. The researchers concluded that this finding could lead to decreased use of intraoperative opioids. E Donnenfeld et al. “Pain control and reduction of opioid use associated with intracameral phenylephrine1.0%–ketorolac 0.3% administered during cataract surgery”, 48(7): 759–764.

SLOW DRIP OF WASTED RESOURCES

Unnecessary waste of perioperative topical ophthalmic medications is an important component of clinical ophthalmology’s carbon footprint. A task force comprised of representatives of several ophthalmic societies released a position paper on this issue. The task force noted that discarded topical eyedrops and ointments from unused or partially used containers account for considerable costs locally and significant additions to global CO2 emissions. Citing clinical studies, the group suggests surgical facilities should be able to use topical drugs in multidose containers on multiple patients until the drugs expire, with proper guidelines. They also propose surgical patients be allowed to bring partially used medication home for postoperative use. DJ Palmer et al. “Reducing Topical Drug Waste in Ophthalmic Surgery: Multi-society Position Paper”, online, jcrs.org, May 2022.