Clinical outcomes after injection of a compounded pharmaceutical for prophylaxis after cataract surgery: a large-scale review

Abstract

Purpose of review: To evaluate relevant clinical outcomes following a transzonular intravitreal injection of a compounded triamcinolone-moxifloxacin-vancomycin (TMV) formulation for postoperative prophylaxis after cataract surgery in a retrospective review of medical records from a private practice, single-specialty ambulatory center in New Jersey, USA.

Recent findings: The analysis included 1541 cases from 922 patients who underwent cataract surgery with an intravitreal injection of TMV from November 2013 to December 2014. Cataract surgery was performed by a standard clear corneal phacoemulsification technique. Transzonular injection was used to deliver TMV directly into the anterior vitreous after implantation of an intraocular lens.

Summary: There were no major intraoperative complications associated with the transzonular injection technique. There were no cases of postoperative endophthalmitis. Nearly 92% of cases (n = 1413/1541) did not require supplemental medication after surgery. The rate of breakthrough inflammation at Days 14-21 was 9.2% (n = 132/1429). The rate of visually significant postoperative cystoid macular edema was 2.0% (n = 28/1429). The rate of clinically significant postoperative intraocular pressure increase was low: 0.9% (n = 13/1425) of cases had an at least 10 mmHg increase at Days 14-21 or 90. Four of these cases had intraocular pressure at least 30 mmHg. The rates of infection and inflammation reported in this retrospective review of a transzonular injection of TMV for prophylaxis after cataract surgery appear similar to reported rates with alternative prophylactic therapies such as topical drops. The transzonular injection of TMV may have advantages in terms of patient compliance.

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FIGURE 1

Surgical view of a transzonular intravitreal injection of a compounded triamcinolone–moxifloxacin–vancomycin formulation. A transzonular intravitreal injection of 0.2 ml triamcinolone–moxifloxacin–vancomycin was administered into the anterior vitreous after implantation of a multifocal toric intraocular lens. The triamcinolone–moxifloxacin–vancomycin formulation was injected through the zonules via the ciliary sulcus inferonasally with a 30-ga Rycroft cannula. Intravitreal triamcinolone–moxifloxacin–vancomycin placement was visually confirmed by the appearance of a white plume in the vitreous.