The American Society of Cataract and Refractive Surgery (ASCRS) issued an alert concerning anecdotal reports of complications, such as flap slippage and diffuse lamellar keratitis, associated with the use of topical medications immediately prior to and during LASIK and PRK. 

The problem seemingly stems from the drugs’ vehicles. These topical meds—including antibiotics, NSAIDs, steroids and artificial tears—are known to contain vehicles that, in isolated cases, may get sequestered beneath the LASIK flap or a bandage contact lens following PRK, and may remain unabsorbed, according to ASCRS. Anecdotal reports of complications cite delayed epithelial healing and inflammation.

“The ASCRS Medication Alert was issued to remind eye care professionals to not use these next-generation medications on the refractive bed immediately prior to or during LASIK or PRK,” says Eric Donnenfeld, MD, ASCRS’s president-elect.

But don’t call off a patient’s procedure just yet. “Refractive surgery has never been safer or more effective,” Dr. Donnenfeld says. While these meds should not be used just before or during surgery, they can still be used afterward, he says.

There have been no problems documented with the use of these medications after the LASIK flap has been properly positioned, ASCRS reports.

“I have used these advanced formulations on all of my LASIK and PRK cases, and have never had a single medication problem when they are used according to the guidelines in the ASCRS alert,” Dr. Donnenfeld says.

Don’t Use These Meds Right Before or During LASIK or PRK
  • Acuvail (ketorolac 0.45%, Allergan), vehicle includes carboxymethylcellulose sodium.
  • AzaSite (azithromycin 1%, Merck), vehicle includes polycarbophil, edetate disodium, sodium chloride.
  • Besivance (besifloxacin 0.6%, Bausch + Lomb), vehicle includes polycarbophil, edetate disodium, sodium chloride.
  • Durezol (difluprednate 0.05%, Alcon), vehicle incudes castor oil.
  • Ilevro (nepafenac 0.3%, Alcon), vehicle includes propylene glycol, carbomer 974P, guar gum and carboxymethylcellulose sodium. 
  • Lotemax Gel (loteprednol 0.5%, Bausch + Lomb), vehicle includes glycerin, polycarbophil, propylene glycol and tyloxapol.
  • Moxeza (moxifloxacin 0.5%, Alcon), vehicle includes xanthan gum and tyloxapol.
  • Nevanac (nepafenac 0.3%, Alcon), vehicle includes mannitol, carbomer 974P, sodium chloride, tyloxapol and edeate disodium.
  • Restasis (cyclosporine 0.05%, Allergan), vehicle includes castor oil.

ASCRS also advises against the use of highly viscous artificial tears and lubricating drops that contain these inactive ingredients. ASCRS also notes that ketorolac, loteprednol, moxifloxacin and nepafanac are available in formulations without these vehicles.