March 2013

 

NEWS & OPINION

 

Medication alert for LASIK and PRK


   

A joint statement by the ASCRS Cornea and Refractive Surgery Clinical Committees

The ASCRS Cornea and Refractive Surgery Clinical Committees issued a joint alert regarding the use of topical medications immediately prior to or intraoperatively during LASIK and PRK. Several new topical ophthalmic medications have become available that contain advanced vehicles designed to deliver consistent dosage of medication, increase contact time on the eye, stabilize the ocular surface, and reduce dosing frequency. These medications are not FDA approved specifically for LASIK or PRK but are commonly used by clinicians in the practice of medicine. These medications alphabetically include: Azithromycin 1% ophthalmic solution with a vehicle of polycarbophil, edetate disodium, sodium chloride (Azasite, Merck, Whitehouse Station, N.J.) Besifloxacin 0.6% ophthalmic suspension with a vehicle of polycarbophil, edetate disodium, sodium chloride (Besivance, Bausch + Lomb, Rochester, N.Y.) Cyclosporine ophthalmic emulsion 0.05% with a vehicle that includes castor oil (Restasis, Allergan, Irvine, Calif.) Difluprednate ophthalmic emulsion 0.05% with a vehicle that includes castor oil (Durezol, Alcon, Fort Worth, Texas) Ketorolac 0.45% ophthalmic solution with a vehicle of carboxymethylcellulose sodium (Acuvail, Allergan) Loteprednol 0.5% ophthalmic gel with a vehicle that includes glycerin, polycarbophil, propylene glycol, tyloxapol (Lotemax Gel drop, Bausch + Lomb) Moxifloxacin 0.5% ophthalmic solution with a vehicle that includes xanthan gum and tyloxapol (Moxeza, Alcon) Nepafanac 0.3% ophthalmic suspension with a vehicle that includes mannitol, carbomer 974P, sodium chloride, tyloxapol, edetate disodium (Nevanac, Alcon) Nepafanac 0.3% ophthalmic suspension with a vehicle that includes propylene glycol, carbomer 974P, guar gum, and carboxymethylcellulose sodium (Ilevro, Alcon) Additionally, there are a number of highly viscous artificial tears and lubricating drops that contain these inactive ingredients and may pose similar hazards when used intraoperatively in LASIK and PRK.

These medications contain vehicles that have the potential to be sequestered beneath a LASIK flap or a bandage contact lens following PRK and not absorbed. The ASCRS Cornea and Refractive Surgery Clinical Committees have become aware of several cases of flap slippage and/or diffuse lamellar keratitis (DLK) following LASIK when topical ophthalmic medications with these advanced vehicles have been instilled immediately prior to LASIK or intraoperatively while the flap has been elevated. There have been no problems documented with the use of these medications after the flap has been properly positioned. There have also been documented cases of poor epithelial healing when topical ophthalmic medications with these advanced vehicles have been instilled on the stromal bed following PRK prior to placement of a bandage contact lens. The ASCRS Cornea and Refractive Surgery Clinical Committees suggest that these medications not be used immediately prior to or intraoperatively during LASIK or PRK while the stromal bed is exposed until the medications have been studied for these indications. The use of these medications with advanced vehicles following routine LASIK and PRK has not been associated with increased adverse events and may provide benefits in the postop period. We would note that ketorolac, loteprednol, moxifloxacin, and nepafanac are also FDA approved in solution or suspension formulations without these advanced vehicles.

Contact information

Sebrell: csebrell@ascrs.org

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Medication alert for LASIK and PRK Medication alert for LASIK and PRK
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