17/8/2017 Senile Cataract (Age-Related Cataract) Medication: Mydriatics, Nonsteroidal anti-inflammatory ophthalmics, Combination Ophthalmics, Cor

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Senile Cataract (Age-Related

Cataract) Medication
Updated: May 09, 2017
Author: Vicente Victor D Ocampo, Jr, MD; Chief Editor: Andrew A Dahl, MD, FACS more...

MEDICATION

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]

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)

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

Nonsteroidal anti-inflammatory ophthalmics

Class Summary

Used for pain and inflammation associated with cataract surgery.

Nepafenac ophthalmic (Nevanac, Ilevro)

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17/8/2017 Senile Cataract (Age-Related Cataract) Medication: Mydriatics, Nonsteroidal anti-inflammatory ophthalmics, Combination Ophthalmics, Cor

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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)

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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.

Combination Ophthalmics
Class Summary

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

Ketorolac/phenylephrine ophthalmic (Omidria)

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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.

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)

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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)

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17/8/2017 Senile Cataract (Age-Related Cataract) Medication: Mydriatics, Nonsteroidal anti-inflammatory ophthalmics, Combination Ophthalmics, Cor

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Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing

capillary permeability.

Difluprednate ophthalmic (Durezol)

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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)

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

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)

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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)

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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)

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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)

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

Gatifloxacin ophthalmic (Zymaxid)

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

Erythromycin ophthalmic (Ilotycin)

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

Dexamethasone/tobramycin (TobraDex, TobraDex ST)

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

Tobramycin/loteprednol ophthalmic (Zylet)

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

Follow-up

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