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Senile Cataract Medication

  • Author: Vicente Victor D Ocampo, Jr, MD; Chief Editor: John D Sheppard, Jr, MD, MMSc  more...
 
Updated: Mar 01, 2016
 

Medication Summary

No drug is available that has been proven to prevent the progression of senile cataracts. Medical therapy is used preoperatively and postoperatively to ensure a successful operation and subsequent visual rehabilitation.[37]

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Mydriatics

Class Summary

Autonomic drugs used to ensure maximal pupillary dilation preoperatively, which is essential for a successful lens extraction. Short-acting mydriatics often are used. Most commonly used mydriatics are phenylephrine hydrochloride and tropicamide.

Phenylephrine ophthalmic (Altafrin)

 

Direct-acting adrenergic agent available in 2.5% and 10% concentrations. Acts locally as potent vasoconstrictor and mydriatic by constricting ophthalmic blood vessels and radial muscles of the iris. Favorably used by many ophthalmologists because of rapid onset and moderately prolonged action, as well as the fact that it does not produce compensatory vasodilation. Most ophthalmologists prefer 2.5% to 10% concentration because of fewer risks of severe adverse systemic effects. Onset of action is within 30-60 min lasting for 3-5 h.

Tropicamide (Mydriacyl)

 

Tropicamide blocks the response of the sphincter muscle of the iris and the muscle of the ciliary body to cholinergic stimulation.

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Nonsteroidal anti-inflammatory ophthalmics

Class Summary

Used for pain and inflammation associated with cataract surgery.

Nepafenac ophthalmic (Nevanac, Ilevro)

 

Nonsteroidal anti-inflammatory prodrug for ophthalmic use. Following administration, converted by ocular tissue hydrolases to amfenac, an NSAID. Inhibits prostaglandin H synthase (cyclooxygenase), an enzyme required for prostaglandin production. Indicated for treatment of pain and inflammation associated with cataract surgery.

Bromfenac ophthalmic (Bromday, Prolensa)

 

Nonsteroidal anti-inflammatory prodrug for ophthalmic use. Following topical administration, this NSAID achieves high therapeutic intraocular levels. Inhibits prostaglandin H synthase (cyclooxygenase), an enzyme required for prostaglandin production. Indicated for treatment of pain and inflammation associated with cataract surgery. 

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Combination Ophthalmics

Class Summary

Combination allows for maintenance of intraoperative mydriasis and reduces postoperative pain.

Ketorolac/phenylephrine ophthalmic (Omidria)

 

Ketorolac/phenylephrine ophthalmic is a proprietary FDA-approved combination agent that is added to the standard irrigating solution used during cataract surgery and other intraocular lens replacement procedures, including refractive lens exchange. Phenylephrine is an alpha1-agonist that prevents intraoperative miosis and ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) that facilitates mydriasis and reduces postoperative pain.

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Corticosteroids

Class Summary

Help decrease and control the inflammatory response following cataract surgery especially in the immediate postoperative period. The most commonly used ophthalmic steroid is prednisolone acetate 1%. Dexamethasone 0.1% ophthalmic solution sometimes is used as a generic alternative. 

Prednisolone acetate 1% (Pred Forte, Omnipred, Pred Mild)

 

Topical anti-inflammatory agent for ophthalmic use. A good glucocorticoid that, on the basis of weight, has 3-5 times anti-inflammatory potency of hydrocortisone. Glucocorticoids act at the nuclear level by down-regulating transcription of inflammatory mediators. Thus, they reduce prostaglandin synthesis, block arachidonic acid activity, and inhibit edema, fibrin deposition, capillary dilation, and phagocytic migration of acute inflammatory response, as well as capillary proliferation, deposition of collagen, and scar formation. Indicated for treatment of steroid-responsive inflammation of palpebral and bulbar conjunctiva, cornea, and anterior segment of the globe.

Dexamethasone ophthalmic (Ozurdex, Maxidex)

 

Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability.

Difluprednate ophthalmic (Durezol)

 

A potent corticosteroid approved for a wide variety of anterior segment surgical procedures, including cataract surgery, as well as acute noninfectious anterior uveitis. Provides powerful control of postoperative pain and inflammation in the cornea, anterior chamber, and, possibly, the retina.

Loteprednol ophthalmic (Alrex, Lotemax)

 

An ester rather than a ketone steroid, provides FDA-approved control of pain and inflammation following cataract surgery, as well as anterior uveitis, contact lens–induced giant papillary conjunctivitis, and perennial and seasonal allergic conjunctivitis. Newer ointment and gel drop formulations are approved for cataract surgery pain and inflammation.

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Antibiotics

Class Summary

Broad-spectrum antibiotic ophthalmic solutions often are used prophylactically off-label in the immediate postoperative period. A number of topical antibiotics are used depending on the surgeon's preference, but, generally, medications are active against both gram-positive and gram-negative organisms.

Ciprofloxacin ophthalmic (Ciloxan)

 

Active against a broad spectrum of gram-positive and gram-negative organisms. Bactericidal action results from interference with enzyme DNA gyrase needed for bacterial DNA synthesis. In vitro and clinical studies have shown it to be active against following organisms: gram-positive (ie, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus viridans) and gram-negative (ie, Haemophilus influenzae, Pseudomonas aeruginosa, Serratia marcescens). Other organisms have been found to be susceptible in vitro but have yet to be firmly established by clinical studies.

Moxifloxacin ophthalmic (Moxeza, Vigamox)

 

A self-preserved topical fluoroquinolone approved for conjunctivitis. Prescribed frequently for cataract and other intraocular surgical procedures as infection prophylaxis. By virtue of its broad spectrum and preservative-free status, many surgeons also inject 0.1 mL directly into the anterior chamber at the conclusion of cataract surgery to prevent endophthalmitis.

Besifloxacin ophthalmic (Besivance)

 

A uniquely formulated fluoro-chloro fluoroquinolone that is bihalogenated for increased spectrum and potency. Highly effective against multiply drug-resistant strains of Staphylococcus aureus and Staphylococcus epidermidis. Not available for animal, farm, or systemic human use, presumably reducing resistance profiles. Excellent pharmacokinetics due to highly viscous Insite® vehicle.

Levofloxacin ophthalmic (Quixin)

 

An increased spectrum L-isomer of ofloxacin provides antibiotic coverage for all types of intraocular surgery.

Gatifloxacin ophthalmic (Zymaxid)

 

A potent fluoroquinolone approved for bacterial conjunctivitis, like all the other listed fluoroquinolones herein, but used frequently for surgical prophylaxis.

Erythromycin ophthalmic (Ilotycin)

 

Indicated for infections caused by susceptible strains of microorganisms and for prevention of corneal and conjunctival infections.

Dexamethasone/tobramycin (TobraDex, TobraDex ST)

 

A commonly prescribed topical combination agent used for conjunctivitis and surgical prophylaxis. Available as a generic.

Tobramycin/loteprednol ophthalmic (Zylet)

 

A commonly prescribed topical combination agent used for conjunctivitis and surgical prophylaxis. Much less likely to produce IOP elevations than dexamethasone-based combination agents.

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Contributor Information and Disclosures
Author

Vicente Victor D Ocampo, Jr, MD Head, Uveitis and Ocular Immunology Service, Veterans Memorial Medical Center, Philippines; Head, Uveitis and Ocular Immunology Service, Ospital ng Makati Medical Center, Philippines; Consulting Staff, Department of Ophthalmology, Asian Hospital and Medical Center, Philippines

Vicente Victor D Ocampo, Jr, MD is a member of the following medical societies: American Academy of Ophthalmology, Philippine Ocular Inflammation Society, Philippine Academy of Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

C Stephen Foster, MD, FACS, FACR, FAAO, FARVO Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution

C Stephen Foster, MD, FACS, FACR, FAAO, FARVO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

J James Rowsey, MD Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Sigma Xi, Southern Medical Association, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Chief Editor

John D Sheppard, Jr, MD, MMSc Professor of Ophthalmology, Microbiology and Molecular Biology, Clinical Director, Thomas R Lee Center for Ocular Pharmacology, Ophthalmology Residency Research Program Director, Eastern Virginia Medical School; President, Virginia Eye Consultants

John D Sheppard, Jr, MD, MMSc is a member of the following medical societies: American Academy of Ophthalmology, American Society for Microbiology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, American Uveitis Society

Disclosure: Nothing to disclose.

Additional Contributors

Richard W Allinson, MD Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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