EyeWorld Weekly Update, March 30, 2018

March 30, 2018
Volume 24 , Number 11

pSivida acquires Icon Bioscience, rebrands to EyePoint Pharmaceuticals

pSivida (Watertown, Massachusetts) announced the acquisition of Icon Bioscience (Newark, California) and its intention to rebrand and change its name to EyePoint Pharmaceuticals beginning on April 2. Icon Bioscience makes the product Dexycu (dexamethasone intraocular suspension), which was approved by the U.S. Food and Drug Administration (FDA) in February for postop inflammation and is given as a single dose at the end of eye surgery. pSivida has also entered into a financial relationship with growth equity firm Essex Woodlands Healthcare Partners. With funding from Essex Woodlands Healthcare Partners and SKW Holdings Corporation, the company can fund the Icon acquisition and the commercial launches of Dexycu and possibly Durasert, a pSivida microinsert designed to treat noninfectious posterior segment uveitis. Durasert is not yet approved by the FDA. Dexycu is expected to be released in the U.S. in the first half of 2019, according to the company.

Patent issued for non-opioid conscious sedation formulation

A patent has been secured for MKO Melt (midazolam, ketamine, and ondansetron, Imprimis Pharmaceuticals, San Diego). The melt has been available since 2015 and is used primarily before and during cataract surgery. It has unique benefits for patients who may not be well suited for traditional IV sedation, according to a company press release. Imprimis thinks it could be used with other medical procedures, including dental, OB/GYN, medical imaging, vasectomies, and other surgeries that could benefit from an IV-free and opioid-free formulation. The MKO Melt is currently the subject of two Institutional Review Board-approved clinical studies, according to Imprimis.

Racial and ethnic minorities are up to 90% more likely to require complex cataract surgery

Racial and ethnic minorities were 42% to 90% more likely to have complex cataract surgery compared with white patients in a retrospective case series, led by Michael Mahr, MD. Researchers used information from the 2014 U.S. Medicare 5% Limited Data Set, which according to the study authors represents a 5% sample of claims for approximately 28 million fee-for-service Medicare beneficiaries and included more than 1 million beneficiaries who had cataract surgery (n=1,087,680). The likelihood of complex cataract surgery was significantly higher in African Americans, Asians, and Hispanics. It was also more likely in men and in patients older than 84 years old. The research appears in the Journal of Cataract & Refractive Surgery.

Study compares outcomes in manual versus femtosecond laser-assisted cataract surgery

Similar results were found between eyes having manual cataract surgery versus eyes having femtosecond laser-assisted cataract surgery (FLACS), according to Thomas Berk, MD, and coresearchers. The main outcome measure was the percentage of eyes achieving an absolute error of 0.5 D or less. In their single center, comparative, retrospective cohort analysis of 883 eyes having manual surgery and 955 having FLACS, 82.6% of FLACS eyes and 78.8% of manual eyes had a 0.5 D or less absolute error at 3 weeks postop. About 97% of FLACS and 97.2% of manual eyes had an absolute error of 1.0 D or less. Factors that were more likely to lead to a favorable outcome included an axial length between 22 mm and 24.8 mm, use of a toric IOL, less preoperative cylinder, and greater preop mean keratometry. The study is published in Ophthalmology.


  • A study looking at factors associated with intraoperative floppy iris syndrome (IFIS) in patients who had phacoemulsification cataract surgery found aging, tamsulosin use, and finasteride use had a greater association with IFIS. Led by Ilona Kaczmarek, the study included 319 eyes from 319 patients having cataract surgery and IOL implantation into the posterior chamber. Injection of epinephrine into the anterior chamber was performed in all eyes. Information about patient sex, age, axial length, presence of pseudoexfoliation, glaucoma, diabetes, hypertension, current medication use, and surgery length were all recorded. The overall IFIS incidence was 9.09%. Tamsulosin use (P=0.004), finasteride use (P=0.014), and increasing age (P=0.06) were significantly associated with IFIS, according to the authors. Although male sex and benzodiazepine use were significantly associated with IFIS in a univariate analysis, they were not associated with it in the multivariate analysis. The study is published in International Ophthalmology.
  • As an adjunct to steroids, topical tacrolimus 0.05% can help resolve endothelial rejection of a penetrating keratoplasty graft more quickly and potentially lower rejection recurrence, reported Mohammad Nasser Hashemian, MD, and coauthors. However, topical tacrolimus may not improve rejection reversal success. Patients were randomized into a group receiving topical tacrolimus 0.05% as adjuvant therapy to corticosteroid treatment (group 1, n=17) or a group receiving only corticosteroid treatment (group 2, n=14). Rejection reversal, time to rejection reversal, and recurrence of rejection were the main outcome measures. Of the 31 eyes included, rejection episodes completely resolved in 88.2% of patients in group 1 and 85.7% of patients in group 2. The recurrence rate of rejection was markedly higher in group 2 than in group 1. After adjustments for preop factors, the time to resolution of rejection was significantly shorter in group 1. The research appears in Cornea.
  • There were fewer visual concerns for users of cryolite glass prosthetic eye wearers compared with (poly)methyl methacrylate (PMMA) prosthetic eye wearers, according to Alexander Rokohl and coauthors. Their study included 106 cryolite glass and 63 PMMA prosthetic eye wearers. Subjects completed a questionnaire about their general and specific prosthetic eye concerns. Concerns about loss of balance, phantom sight vision, pain, comfort of the prosthetic, and other factors were significantly less for cryolite glass wearers. There was not a significant difference for concerns related to watering, crusting, discharge, and visual perception. An examination of the visual differences between the two prosthetic eye types should be further explored in a prospective, comparison, multicenter trial, the researchers concluded. The study is published in Graefe's Archive for Clinical and Experimental Ophthalmology.
  • In a prospective case series, 52% of patients presenting for cataract surgery had meibomian gland dysfunction (MGD), reported Beatrice Cochener, MD, and coauthors. The research included 342 eyes of 180 patients who had cataract surgery between November 2015 and June 2016. Respondents completed the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and had lipid layer thickness and partial blink rate measurements performed, among other factors. The mean lipid layer thickness was 72.5 nm, but in patients with a SPEED score of less than 8, the mean lipid layer thickness was 77.5 nm. In those with a SPEED score of 8 or higher, the mean lipid layer thickness was 58.5 nm. Fifty-six percent of patients had meibomian gland atrophy equal to or more than Arita grade 1. There was a significant correlation between meibomian gland function and lipid layer thickness, symptoms, age, and gland atrophy (P<.05). Comprehensive preop testing should routinely evaluate meibomian function, the authors concluded. The study appears in the Journal of Cataract & Refractive Surgery.
  • Bausch + Lomb (Bridgewater, New Jersey) introduced 25- and 27-gauge Bi-Blade dual port vitrectomy cutters for the Stellaris Elite vision enhancement system.

This issue of EyeWorld Weekly Update was edited by Amy Goldenberg and Vanessa Caceres.

EyeWorld Weekly Update (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrators, is published every Friday, distributed by email, and posted live on Friday.

Medical Editors: Eric Donnenfeld, MD, chief medical editor; Rosa Braga-Mele, MD, cataract editor; Clara Chan, MD, cornea editor; Nathan Radcliffe, MD, glaucoma editor; and Vance Thompson, MD, refractive editor.

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