Zirgan™(Ganciclovir Ophthalmic Gel) 0.15% "" Product Background!

8/10/12!2009 ARMOR Surveillance#All Coagulase-Negative Staphlylococci (n= 144) #!Antibiotic!MIC!Range!MIC 50! MIC 90!Vancomycin! 0.12 – 2! 1! 2!Besifloxacin! %0.015 – 8! 0.06! 2!Moxifloxacin! %0.015 – 64! 0.12! 16!Ciprofloxacin! %0.06 – >512! 0.5! 64!Tobramycin! %0.06 – >256! 0.12! 32!Azithromycin! %0.25 – >512! 64! >512!"!53% of ocular CoNS isolates were MRSA!"!43% of ocular CoNS isolates were FQ-resistant!Haas et al. Presented at ARVO, Fort Lauderdale, FL, May 2-6, 2010. Abstract #D965, % resistance based on oxacillin and ciprofloxacinbreakpoints.!55!ZYMAXID Pivotal Trials!•!Two identical, multicenter, double-masked, randomized, phase 3studies!–!1—United States only!–!1—United States and India!•!Patients at least 1 year of age who were#clinically diagnosed with acute bacterial #conjunctivitis in 1 or both eyes with:!–!Moderate to severe (grade 2-3)conjunctival hyperemia !•! and !–!Mild to severe (grade 1-3) discharge!•!Patients were excluded if they:!–!Had used antibiotics or corticosteroids during past 1 or 2 weeks,respectively, prior to the study enrollment!–!Had positive adeno-detector at baseline!Data on file, Allergan, Inc., 2009.!Viability (Log CFU/mL)!Eradication Rates for Individual#S aureus and CNS Isolates!S aureus!(n = 13)!Viability (Log CFU/mL)!CNS!(n = 5)!Viability (Log 10 CFU/mL)!Eradication Rates for Hinfluenzae #and S pneumoniae Isolates!H influenzae!Viability (Log 10 CFU/mL)!S pneumoniae!Time (minutes)!Time (minutes)!Time (min)!Time (min)!In vitro data. Clinical significance notknown.!Hyon et al. J Cataract Refract Surg. 2009.!In vitro data. Clinical significance notknown.!Callegan et al. Adv Ther. 2009.!Ethidium Bromide Staining of CornealEpithelial Cells (%)!Comparative in Vitro Cytotoxicity ofGatifloxacin 0.5%, Gatifloxacin 0.3%, andMoxifloxacin 0.5%!Adverse Events in % 1% of PatientsParticipated in Two ZYMAXID Trials (PooledSafety Population) !Vehicle (n = 716)! ZYMAXID (n = 717)!All adverse events a n (%)! 95 (13.3)! 83 (11.6)!Bacterial conjunctivitis! 32 (4.5)! 19 (2.6)!Eye irritation! 8 (1.1)! 15 (2.1)!Dysgeusia! 1 (0.1) b! 8 (1.1)!Eye pain! 9 (1.3)! 7 (1.0)!Conjunctivitis! 9 (1.3) c! 2 (0.3)!a According to the preferred terms by MedDRA 10.0.!b P < .05, Fisher exact test.!c P < .05, Pearson chi-square test.!EBSS = Earles Balanced Salt Solution.!15 minutes exposure!30 minutes exposure!Data on file, Allergan, Inc., 2009.!•! No burning and/or stinging was reported during study!•! ZYMAXID was well tolerated for up to 8 instillations onday 1!Data on file, Allergan, Inc., 2009.!10!

8/10/12!Dosing!•!In patients 1 year of age or older: !•!Instill 1 drop every 2 hours in the #a&ected eye(s) while awake, up to #8 times on day 1!•!Instill 1 drop 2 to 4 times daily in #the a&ected eye(s) while awake on #days 2 through 7!•!ZYMAXID (gatifloxacin ophthalmic #solution) 0.5% performed well in #clinical trials when dosed BID.' !•!Dosing ZYMAXID 4 times a day delivers more drug tothe eye, taking full advantage of the higherconcentration of gatifloxacin.!ZYMAXID [package insert]. 2010.!ZYMAXID "(gatifloxacin ophthalmic solution) 0.5%!Indications/Usage!ZYMAXID ophthalmic solution is a topical fluoroquinoloneanti-infective indicated for the treatment of bacterialconjunctivitis caused by susceptible strains of the followingorganisms:!Aerobic Gram-Positive Bacteria!Staphylococcus aureus!Staphylococcus epidermidis!Streptococcus mitis group*!Streptococcus oralis*!Streptococcus pneumoniae !Aerobic Gram-Negative Bacteria!Haemophilus influenzae!*E"cacy for this organism was studied in fewer than 10infections.!!ZYMAXID [package insert]. 2010.!MOXEZA #!•! Moxifloxacin hydrochloride ophthalmicsolution 0.5% as base!Moxeza!•! Xantham gum allows for better residence time onthe surface. More penetration into conjunctiva. "•! Moxi is very lipophilic. "•! 1.8x the penetration into the conjunctiva thanvigamox!•! BID dosing!•! Down to 4 months of age indication!Case MEB!•! 5 year old patient!•! Significant mucopurulent discharge and red eye!•! Began 2 days ago not improving!Childhood ConjunctivitisManagement?!•! Antibiotic drops TID x 5 – 7 days!•! Besivance TID every 4-12 hours!•! Are you done?!11!

8/10/12!Most common cause of bacterial keratitis/conjunctivitis in children?Childhood Conjunctivitis!•!A. Pseudomonas•!C. Strep PneumoB. StaphylococcusD. Haemophilusinfluenza•! Most common eye disorder in young children!•! Adult conjunctivitis is typically caused bygram-positive organisms•! Staphylococcus aureus and Staphylococcusepidermidis. 5•! Conjunctivitis in children is caused by:•! nontypeable forms of Haemophilusinfluenzae, Streptococcus pneumoniae,Moraxella catarrhalis and adenovirusWhats your diagnosis?!•! One of the most common complications associated withacute bacterial conjunctivitis is preseptal cellulitis•! Examine skin and adnexa around the orbit for a discretereddish sheen!•! Patients with a preseptal cellulitis often have ethmoidal ormaxillary sinus involvement, which results in orbitaltenderness. 9!How to effectively managechildhood conjunctivitis:!When to Refer to a Pediatrician!•! Fever or general malaise!•! Purchase a tympanic or forehead thermometer!•! Acute earache or ear infection!•! Approximately one-third of all childhood cases are otitisconjunctivitissyndrome!•! A notable red sheen around the eyelids!•! Preseptal cellulitis or cellulitis!•! Significant purulent rhinorrhea or an upper respiratoryinfection associated with any fussiness or sleeplessness!Difluprednate: Durezol!!! Developed by Mitsubishi as a dermatological preparation!!! Categorized as a very strong steroid in dermatology!!! Developed by Senju as an ophthalmic emulsion!!! Approval on June 23, 2008!12!

8/10/12!Difluprednate Molecule!To increasepenetration To increaseanti-inflammatoryactivity!!Developed as an emulsion!!!No shaking required!!!BAK-free !!!Uses sorbic acid as a preservative!!!Available in 5 mL bottle!To increase potencyDifluprednate Formulation!DUREZOL Emulsion Package Insert!DUREZOL Emulsion Package Insert!!! Studied extensively in Japan for ophthalmic use!!! In one preclinical pharmacokinetic study, the emulsionformulation was shown to have better ocular bioavailability thanthe suspension formulation 1!!! In several preclinical studies, it was found to be!!! Safe and well tolerated after repeated doses!!! Effective at reducing inflammation in animal models of postoperativeinflammation 2,3!1. Inoue, J., et al. Preclinical pharmocokinetics of difluprednate ophthalmic emulsion. ARVO Annual Meeting, May 6–10, 2007, Ft Lauderdale, FL, poster B741, program2651.!2. Okumura A, et al. Efficacy of difluprednate ophthalmic emulsion in preclinical studies of uveitis. ARVO Annual Meeting, May 6–10, 2007, Ft Lauderdale, FL, posterB742, program 2652.!3. Kida T, et al. Difluprednate emulsion inhibits postoperative inflammation in rabbit paracentesis model. ARVO Annual Meeting, May 6–10, 2007, Ft Lauderdale, FL,poster B745, program 2655!Six Rules of Iritis Management!1.! Rule out keratouveitis!2.! Check IOP!3.! Rule out previous ocular surgery!4.! Gauge severity – need for systemic work-up !5.! Treat AGGRESSIVELY!6.! Go beyond AC cell and flare (Restore the Blood-AqueousBarrier!Masking Scheme!•! Patients were each given twobottles: Bottle A and Bottle B!•! Each patient received 8 dropsevery day !•! In the Durezol group Bottle Acontained Durezol and Bottle Bcontained vehicle!•! In the Pred Forte group, Bottle Acontained Pred Forte and BottleB contained Pred Forte!Mean Change from Baseline in !Anterior Chamber Cell Grade!*Mean Score atBaseline!Durezol=2.5!Pred Forte=2.4!*At Day 14, the non-inferiority hypothesis wasmet, demonstrating that Durezol QID was notinferior to Pred Forte dosed eight times a dayi h C fid I l f 95%!!13!

8/10/12!Percent of Subjects with Clearing of AnteriorChamber Cells!(Grade 0 defined as 1 cell)!Mean Change from Baseline in !Total Symptom Score*!Mean Score at Baseline!Durezol=187.6!Pred Forte=165.1!*The total symptom score was the sum of pain/oculardiscomfort, photophobia, blurred vision, and lacrimation.Each symptom was graded using a visual analogue scalethat ranged from 0-100. Patients were asked to assessthese symptoms by using a mark on a 100 mm line!Photophobia, Mean change from baseline!Mean Score at Baseline!Durezol=48.7!Pred Forte=44.5!Mean score !at baseline!Durezol 60.1!Pred Forte 50.9 !Percent Reduction in Mean Pain Score from Baseline!Treatment: Iridocyclitis!•! Pred Acetate 1% q1 or q2h!•! Durezol (Difluprednate) 0.05% QID!•! 1/2 the dosing for 2-3 weeks!•! Lotemax ung QHS!•! Lotemax Longer term!•! Cycloplegia!•! Homatropine 5% bid!•! Cyclopentolate 1% bid!Back-up Option!•!Prednisolone acetate!•!SHAKE WELL!!•!Generic prednisolone?!14!

8/10/12!The Importance of Cycloplegia!A New Approach: Ester Steroids!1.! Re-establish vascular permeability!2.! Prevent synechiae!3.! Pain Management!•! Dr. Nicholas Bodor studied ketonesteroid metabolism !•! Challenge: reduce adverse effectswithout compromising efficacy !•! Discovery: naturally occurring esteraseswill metabolize a corticosteroid with anester group at C-20 rather than aketone group !•! Retro-metabolic design !•! Inactive metabolites!Loteprednol etabonateDruzgala P, et al. J Steroid Biochem Molec Biol. 1991;38(2):149-154.Bodor N. Pharmazie. 2001;56(suppl 1):S67-S74.Howes J, Novack GD. J Ocul Pharmacol Ther. 1998;14:153-158.Prednisolone•! First ester topical steroid!–!Retrometabolic drug design 1-3!Loteprednol Etabonate:"A Unique Ester Corticosteroid!CH•! 2OHModification of an existing molecule to reduce unwanted adverse events !C = O•! Prednisolone derivative!HOOH•! Unique position CH20 ester group replaces the ketone group!3OCH 2CI Position 20 EsterOOCH 3CH 3CH 3HO1. Bodor N. Pharmazie. 2001;56(suppl 1):S67-S74.2. Novack GD et al. J Glaucoma. 1998;7:266-269.3. Howes J, Novack GD. J Ocul Pharmacol Ther. 1998;14:153-158.\C = OOCO 2 C 2 H 5LoteprednolEtabonateLoteprednol Etabonate: The First EsterCorticosteroid for Ophthalmic Use!•!Ester 1,2!C-20 Ester vs C-20 Ketone Corticosteroids !•!Loteprednol!Ketone 1,2•! Prednisolone•! Fluorometholone•! Dexamethasone•! Medrysone•! Rimexolone1. Lotemax [package insert]. Tampa, Fla: Bausch & Lomb Incorporated; 2006.2.! Howes J, Novack GD. J Ocul Pharmacol Ther. 1998;14:153-158.3.! Durezol (difluprednate ophthalmic emulsion) 0.05% [package insert]. Tampa, Fla: SirionTherapeutics, Inc.; 2008.•! Difluprednate 3"Loteprednol Etabonate !"Lotemax Ointment 0.5% !•! High lipophilicity may lead to better penetration 1,2–!Lipophilic index 10 times higher than dexamethasone (asdemonstrated in animal models) 1,2•! Receptor binding affinity is 4.3 times that of dexamethasone(as demonstrated in animal models) 3•! Preservative free ointment preparation•! No preservatives because of no water concentration•! Fills a significant need1.! Alberth M, et al. J Biopharm Sci. 1991;2:115-125.2.! Howes JF. Pharmazie. 2000;55:178-183.3.! Druzgala P, et al. J Steroid Biochem Molec Biol. 1991;38(2):149-154.1.! Alberth M, et al. J Biopharm Sci. 1991;2:115-125.2.! Howes JF. Pharmazie. 2000;55:178-183.3.! Druzgala P, et al. J Steroid Biochem Molec Biol. 1991;38(2):149-154.15!

8/10/12!"Loteprednol Etabonate !•! High lipophilicity may lead to better penetration 1,2–!Lipophilic index 10 times higher than dexamethasone (asdemonstrated in animal models) 1,2•! Receptor binding affinity is 4.3 times that of dexamethasone(as demonstrated in animal models) 3AzaSite ®"Multiple-Dose Rabbit Study!1.! Alberth M, et al. J Biopharm Sci. 1991;2:115-125.2.! Howes JF. Pharmazie. 2000;55:178-183.3.! Druzgala P, et al. J Steroid Biochem Molec Biol. 1991;38(2):149-154.Multiple-Dose Rabbit: Study Design 1!•! AzaSite ® administered according to package insert "(BID days 1-2, QD days 3-7); total=9 drops!•! Pigmented rabbits (N=156; 4 per timepoint)!•! Tissue samples collected: !•! Cornea, conjunctiva, and eyelids !•! Days 1-6: predose, 0.5 and 1 hr post-dose !•! Day 7: predose, 5, 15 and 30 min; 1, 2, 8, 12, 24, 48, 72,96, 120 and 144 hr after last dose!•! LC/MS/MS was used to determine the tissueconcentrations!Multiple-Dose Rabbit: AzithromycinConcentrations in Rabbit Conjunctiva 1 !1. Data on file. Inspire Pharmaceuticals Inc, Study report I 04U02072. Data on file. Inspire Pharmaceuticals Inc, NDA Study Report 01-401-0033. Data on file. Inspire Pharmaceuticals Inc, NDA Study Report 01-401-004Multiple-Dose Rabbit: AzithromycinConcentrations in Rabbit Eyelid 1 !Physicochemical Differences in Normal 60! vs MGD Patients! 40!50!MGDMGDLipid order at 34°C(% trans rotamers)40!NormalPhase transitiontemperature (°C)30!Normal30!20!20!The thickened and turbid MG secretions in patients withMGD can be attributed to a more ordered lipid structure. !Increased phase transition temperature noted withMGD correlates with the more ordered lipid structureseen in the graph on the left.!1. Data on file. Inspire Pharmaceuticals Inc, Study report I 04U02072. Data on file. Inspire Pharmaceuticals Inc, NDA Study Report 01-401-0033. Data on file. Inspire Pharmaceuticals Inc, NDA Study Report 01-401-004!Foulks GN, Bron AJ. Ocul Surf. 2003;1:107-126; Foulks GN et al. Modification of meibomian gland lipids by topical azithromycin. Poster presentedat: ARVO 2009 Annual Meeting; May 3-7, 2009; Fort Lauderdale, FL.!20!16!

Baseline8/10/12!Quickly and SignificantlyImproves the Quality of MGSecretions!Enrolled in AzaSite ® StudyEnrolled in AzaSite ® StudyShort Term!6036Hydrocarbon chain orderat 33.4ºC (% trans)Stopped Stopped MGD55*MGDTreatment *P

8/10/12!Suspension Technology!•!Viscosity!•! TOBRADEX® STSuspension: increased7-fold from bottle totears in-vitro!7x!Scoper SV, Kabat AG, Owen GR, et al. Ocular distribution, bactericidal activity and settling characteristics ofTOBRADEX ® ST Ophthalmic Suspension compared with TOBRADEX® Ophthalmic Suspension. Adv Ther.2008;25:77-88. !TOBRADEX® ST Suspension!•!Indication and Usage:!•!TOBRADEX® ST ophthalmic suspension is indicated for steroidresponsiveinflammatory ocular conditions for which acorticosteroid is indicated and where superficial bacterial ocularinfection or a risk of bacterial ocular infection exists. !•!Ocular steroids are indicated in inflammatory conditions of thepalpebral and bulbar conjunctiva, cornea and anterior segment ofthe globe where the inherent risk of steroid use in certain infectiveconjunctivitides is accepted to obtain a diminution in edema andinflammation. !•!They are also indicated in chronic anterior uveitis and cornealinjury from chemical, radiation or thermal burns, or penetration offoreign bodies. The use of a combination drug with an antiinfectivecomponent is indicated where the risk of superficial ocularinfection is high or where there is an expectation that potentiallydangerous numbers of bacteria will be present in the eye.!Important SafetyInformation!•!Dosing and Administration:!•!Instill one drop into the conjunctival sac(s) every 4 to 6 hours. !•!During the initial 24-48 hours, dosage may be increased to onedrop every 2 hours. !•!Frequency should be decreased gradually as warranted byimprovement in clinical signs, but care should be taken not todiscontinue therapy prematurely.!•!Contraindications:!•!TOBRADEX® ST Suspension, as with other ophthalmiccorticosteroids, is contraindicated in most viral diseases of thecornea and conjunctiva including epithelial herpes simplexkeratitis (dendritic keratitis), vaccinia, and varicella, and also inmycobacterial infection of the eye and fungal diseases of ocularstructures. !•!Hypersensitivity to any components of the medication.!Important SafetyInformation Cont.!•!Warnings and Precautions:!•!Intraocular pressure (IOP) increase-Prolonged use ofcorticosteroids may result in glaucoma with damage to theoptic nerve, defects in visual acuity and fields of vision. If thisproduct is used for 10 days or longer, IOP should be monitored. !•!Sensitivity to topically applied aminoglycosides may occur. !•!Cataracts – Use of corticosteroids may result in posteriorsubcapsular cataract formation. !•!Delayed healing – The use of steroids after cataract surgerymay delay healing and increase the incidence of bleb formation.In those diseases causing thinning of the cornea or sclera,perforations have been known to occur with the use of topicalsteroids. The initial prescription and renewal of the medicationorder should be made by a physician only after examination ofthe patient with the aid of magnification such as slit lampbiomicroscopy and, where appropriate, fluorescein staining. !•!ZYLET ®Tobramycin Is Effective Against "Common Ocular Pathogens !•! Tobramycin is bactericidal against a wide range of grampositiveand gram-negative pathogens!LOTEPREDNOL ETABONATE 0.5% ANDTOBRAMYCIN 0.3% OPHTHALMICSUSPENSION–!Staphylococci species !– Morganella morganii–!Streptococci species !– Proteus vulgaris (most strains)!–!Pseudomonas aeruginosa !– Haemophilus influenzae–!Escherichia coli !–!Klebsiella pneumoniae!– Haemophilus aegyptius!– Moraxella lacunata–!Enterobacter aerogenes !– Acinetobacter calcoaceticus–!Proteus mirabilis!!– Neisseria (some species)!Zylet (loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension) [package insert]. Tampa,Fla: Bausch & Lomb Incorporated; January 2006.Tobramycin ophthalmic solution, 0.3% [package insert]. Forth Worth, Tex: Falcon Pharmaceuticals; November2003.18!

8/10/12!"Zylet ® : Indications, Clinical Use "(loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension)!•! Zylet ® is indicated for steroid-responsive inflammatory ocular conditions forwhich a corticosteroid is indicated and where superficial bacterial ocularinfection or a risk of bacterial ocular infection exists !•! The use of a combination drug with an anti-infective component is indicatedwhere the risk of superficial ocular infection is high or where there is anexpectation that potentially dangerous numbers of bacteria will be presentin the eye!•! Conditions may include:!–!Conjunctivitis!•!Non-specific conjunctivitis!•!Blepharokeratoconjunctivitis!•!Contact lens-induced acute red eye (CLARE) !Zylet (loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension) [package insert].Tampa, Fla: Bausch & Lomb Incorporated; 2006.Clinical Efficacy and Safety of "Zylet ® vs TobraDex ® in BKC !•!Randomized, investigator-masked, parallel-group, prospective !–!276 adult subjects in 17 centers !•!Subjects were randomized to Zylet (n=138) or TobraDex (n=138)administered 4 times/day for 14 days !•!Primary efficacy end point !–!Change from baseline to Day 15 (±1 day) in composite score (signs andsymptoms) !–!Non-inferiority paradigm !BKC = BlepharokeratoconjunctivitisWhite EM, et al. Curr Med Res Opin. 2008;24:287-296.Clinical Efficacy: "Zylet ® vs TobraDex ® in BKC !•!78% reduction in signs andsymptoms in both groups atDay 15!•!At all time points therewere no statisticallysignificant difference in signsand symptoms betweenZylet and TobraDex !BKC = BlepharokeratoconjunctivitisMean Change From Baseline inSigns and Symptoms CompositeScore50-5-10-15-20Day 3(n=135)!(n=136)!Intent-to-Treat PopulationDay 7(n=134)!(n=133)!Day 15(n=133)!(n=132)!TobraDex ®Zylet ®•! Patients treated withTobraDexdemonstrated smallbut statisticallysignificant increasesin IOP on Days 7and 15, and overall,vs Zylet !BKC = BlepharokeratoconjunctivitisClinical Safety:Zylet ® vs TobraDex ® in BKCChanges From Baselinein IOP (mm Hg)1.51.00.50.0-0.5ZyletTobraDexVisit 2 Visit 3 Visit 4White EM, et al. Curr Med Res Opin. 2008;24:287-296.White EM, et al. Curr Med Res Opin. 2008;24:287-296.Clinical Safety: Effects on IOPZylet ® vs TobraDex ® in Healthy Adults•!Randomized, double-masked, parallel group,prospective study!–!306 healthy adult volunteers at 19 centers!•!Randomized to Zylet ® (n=156) or TobraDex ®(n=150) administered QID for 28 days !•!Primary ocular safety end point!–!Proportion of subjects with an elevation inintraocular pressure %10 mm Hg over baseline inHolland EJ, et either al. Cornea. 2008;27(1):50-55. eye at any visit !% of SubjectsPercentage of Subjects in Each Treatment Group With IOPChanges !10 mm Hg Over Baseline86420Clinical Safety: Effects on IOPZylet ® vs TobraDex ® in Healthy AdultsZylet QID(n=156)Holland EJ, et al. Cornea. 2008;27:50-55.(P=0.0280)TobraDex QID(n=150)Zylet was nearly 4times less likelythan TobraDex toproduce a rise inIOP 10 mm Hgafter 4 weeks!19!

8/10/12!Long Term!•!Pulse dose periodically!•!Restasis bid!•!Omega-3s!•!EPA!•!DHA!•!GLA!Initial Treatments:!Treatment:!!!Hyperosmotic agents!!!Muro 128 ung & gtts!!!Bandage contact lens!!!Non-Ionic vs. silicone hydrogel!!!Daytime meds?!!!What about hyperosmotic drops?!!!FreshKote gtts up to QID (Rx only)!FreshKote ® Lubricant Eye Drop!•!Oncotic pressuredrop!The POWER that healsdamaged !epithelium and assists in !re-establishing a stable tear film"!FreshKote has a high oncotic pressure of 65 mmHgwhich helps to…"!!Re-establish the integrity of epithelium!!!Reduce microcystic edema!!!Prevent recurrent damage!20!

8/10/12!Significance of FreshKotes High OncoticPressure (65 mmHg)(The hydrostatic pressure capable of stoppingosmotic flow across a semi-permeable membrane)!!The imbibition pressure of the stroma is –40 mm Hg. Negativesign indicates that it is attempting to move water from the tears,so it has to be overcome by the oncotic pressure of the eye drop.!!The intraocular pressure of the eye is contained by the sclera andthe cornea while most of the tension change occurs in thestroma. This adds another –15 mm Hg.!!Excess water is present in the loose and often damagedepithelium in form of microcystic edema.FutureMedications!Gel Formulation Gives Opportunity To Change Efficacy Perception!Lifitegrast!SAFETY!Lotemax!fluorometholone!dexamethasone! prednisolone!GfK; Lotemax Gel Positioning Research Feb 2012!Source: May 2010 Post-Op Lotemax ATU Study!EFFICACY!Durezol!•! Small molecule integrin antagonist!•! Inhibits T-cell inflammation by blocking twokey proteins!•! LFA-1!•! ICAM-1!•! For the treatment of dry eye disease!Conclusions!•! Many exciting advances in medications!•! Important as gatekeepers to be aware how tobest use these medications!•! Having a good grasp of these medications willenhance you ability to practice and provide foryour patients!THANK YOU!!Paul@Karpecki.com!21!