Alternative to pre-operative steroid drops for cataract surgery

[SharonRD]

My mother recently had an adverse reaction to the preoperative drops given to prep her for her cataract surgery.
She is allergic to cortisone and very soon after I put the first compounded drop (which contains predisolone sodium phosphate, gatifloxacin, and bromfenac) she became weak, trembling, heart and blood pressure increased dramatically and she said she thought she was going to pass out.  Her surgeon's nurse said there is no alternative, that one must take a steroid drop to have the cataract removed.  She is almost blind in that eye and I read on this site where another person had the same issue...does anyone know if there is an alternative prep or method for someone with sensitivity to this compounded drop or the combined drops?  Thanks!

[JohnHaganMD]

You cannot say she had a reaction to cortisone as the drop you put in had 3 drugs in it plus likely preservatives and it was compounded which often means not manufactured to the same specifications as manufactured drugs.  The solution should be simple:   prescribe the drops individually.  She could try a different cortisone like dexamethasone.  A different antibiotic again by itself and a different NSAIDS .     Mixing 3 drugs in a compounding lab is not a good thing to do, especially in a developed country with access to branded medicines.

[SharonRD]

Thank you for your prompt and courteous reply.  I understand what you are saying that it might not be the cortisone, and I was concerned about the compounded product.  My mother has had allergic reaction in the past to cortisone and been advised by more than one physician in the past not to take it.  When the reaction to the compounded drops occurred,   I called the surgeon, and asked his nurse if we could use different and individual drops but she said no,  we had to use a steroid. She asked if I wanted to cancel the surgery and I said yes, of course, she cannot use these drops.
This is our second attempt to prep her for cataract surgery.  A year ago when she had her pre op exam, the surgeon's assistant placed multiple numbing drops in her eyes (one drop in each first when we arrived, then on our way out of the office, the assistant told us she had to do another measurement, and gave my mother more numbing solution in the right eye.)  About 5 minutes later, as we got the to elevator to leave the office,  my mother complained her neck was cramping, and she said she felt like she was going to have a stroke.  I do not know if it was due to the drops or excessive neck manipulation to get the measurements, but her symptoms did not improve for several hours, and took a few days to go away completely.  I am worried as her sight is almost gone in her right eye.  We are both apprehensive as we don't want another reaction with her heart rate elevating and becoming erratic and blood pressure spiking.  
Is there any alternative to the cortisone related drug?  Is it absolutely necessary to have the cortisone related drug?  Are there older, more established antibiotics and NSAIDS to use as well, so there would not be a concern if those were the issue?
Again, thank you so much for being so kind to offer your opinion on this.  I have been asking questions but not getting anywhere and now I have hope that something can be done.   Thank you!

[JohnHaganMD]

I have done over 12,000 cataract/IOL patients and not have anyone where we could not use cortisone eye drops. I have heard the story you are telling many time.   Rarely has this person gone into the Eye MD office and had ONLY a drop of steroid used.  Other drops used virtually every visit: topical anesthetics, dilating drops, fluoriscene drops.    Many people have adverse effects to dilating drops  especially 10% ephnephrine even 2.5% ephnephrine,  1% cyclogel,  1% tropicamide and some anesthetics.  Whenever someone told me that I would have them come in the office. We would put one drop ONLY of the steroid we were going to use NOTHING ELSE and  wait 30 minutes.  Never a problem.  Oral steroids different issue as many people can't take them.   Your eye doctor office seems pretty 'dug in'   If they would agree you might try that. ONLY use the steroid drop.  The doctor office should be set up so that if there is an allergic reaction that an antihistamine, or epinephrine is present.  Or you could take a single bottle of the drops the surge HAS to use (not compounded) and go to an allergiest and have the allergist test her.  Note I have had a patient have elevated blood pressure and a stroke in my office but it was from the dilating eye drops and before we switched from 10% neosynephrine to 2.5%