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    Transzonular intravitreal injection eases treatment burden after cataract surgery

    Compounded formulation prevents infection, inflammation, cystoid macular edema


    Retrospective study

    Dr. Tyson, who is attending surgeon, Cataract and Primary Eye Care Service, Wills Eye Hospital, Philadelphia, and colleagues, conducted a retrospective review of the medical records of patients who underwent cataract surgery and were treated with a preservative-free 0.2 ml intravitreal injection containing triamcinolone acetonide (15 mg/ml), moxifloxacin (1 mg/ml), and vancomycin (10 mg/ml) (TMV, Imprimis Pharmaceuticals) between November 2012 and December 2014.

    A total of 923 patients (1,541 eyes) were included and received the transzonular injection of TMV into the anterior vitreous after an IOL was implanted following phacoemulsification and before the viscoelastic was removed. All patients underwent the standard phacoemulsification and IOL implantation at one ambulatory center in Vineland, NJ.

    Dr. Tyson explained that the TMV formulation was injected slowly using a 30-gauge cannula through the zonules via the ciliary sulcus inferonasally and the correct placement was confirmed by the observing the presence of a white plume in the vitreous after injection. If the injection was inadequate, second and third injections were allowed.

    Patients also were treated with one drop of prednisolone acetate (Pred Forte 1%, Allergan), one drop of a fluoroquinolone, and one drop of an ophthalmic antihypertensive drug after surgery. Patients were followed on day 1, between days 14 to 21, and day 90 postoperatively.

    Investigators analyzed the changes in the best-corrected and uncorrected visual acuities over time; the development of CME, inflammation, and endophthalmitis; changes in the IOP over time, and any postoperative medications used.


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