Drop-free approaches for cataract surgery

Shorstein, Neal H.; Myers, William G.

doi:10.1097/icu.0000000000000625

Cited by 28 publications

(36 citation statements)

References 74 publications

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“…This approach-utilizing intracameral antibiotics and sustained-release steroid products-has been advocated by multiple surgeons as an important step forward in optimizing therapeutic efficacy and postoperative quality of life in patients undergoing the most commonly performed outpatient surgery in adults in the United States. [10][11][12][13] Replacing self-administered topical therapy with surgeonadministered therapy reduces risks associated with improper instillation technique and eliminates nonadherence, resulting in better efficacy, safety, and quality of life outcomes. These attributes of sustained dexamethasone delivery with the intracanalicular insert are valued by both physicians and patients.…”

Section: Discussionmentioning

confidence: 99%

“…9 Multiple large-scale studies of intracameral antibiotics at the end of surgery have challenged the necessity of postoperative topical antibiotics, and the recent commercialization of 2 sustained-release formulations of dexamethasone-an intracanalicular insert containing dexamethasone (Dextenza (Dextenza, Ocular Therapeutix, Bedford, MA) and an intraocular dexamethasone suspension (Dexycu, dexamethasone 517 µg, EyePoint Pharmaceuticals, Watertown, MA)-has similarly challenged the need for topical dosing of corticosteroids postoperatively, leading many surgeons to propose a paradigm shift to dropless cataract surgery. [10][11][12][13] The intracanalicular insert is a polyethylene glycol hydrogel rod impregnated with 0.4 mg of preservativefree dexamethasone, conjugated with fluorescein for visualization, that is inserted through the punctum into the inferior or superior canaliculus. Upon hydration, the insert swells and self-anchors, dissolving over time with sustained and tapered delivery of dexamethasone for up to 30 days.…”

Section: Introductionmentioning

confidence: 99%

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Same-Day versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

Foster¹

2021

OPTH

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Background: The dexamethasone 0.4mg intracanalicular insert (Dextenza, Ocular Therapeutix, Bedford, MA) is approved for control of postoperative pain and inflammation following ocular surgery. This study compared pain and inflammation resolution following phacoemulsification in eyes that received the insert immediately postoperatively versus the next day. Methods: This was a retrospective analysis of existing electronic health records. Consecutive qualifying eyes were included for analysis. All patients received perioperative antibiotics and nonsteroidal anti-inflammatory drugs. Pain and inflammation were assessed at baseline and on postoperative days 1, 7, and 30. Pain was assessed by dichotomous patient report (present/absent). Anterior chamber cell (0, 0.5+, 1-4+) and flare (0-4+) were graded using the Standardization of Uveitis Nomenclature rubric. Results: Data from 17 eyes of 17 subjects were analyzed; 8 received the insert immediately postoperative and 9 in the office the next day. In both groups, trace cell was present in all eyes at day 1 and had resolved in all but 1 eye in each group at days 7 and 30. Flare was absent in all eyes at every time point, and transient pain was reported in a single same-day eye on day 7. No insert-related adverse events were observed, and no eyes required rescue corticosteroid therapy or insert removal. Conclusion: Similar rates of inflammation and pain resolution after phacoemulsification were observed with the dexamethasone intracanalicular insert placed either immediately postoperatively or the next day.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Same-Day versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

Foster¹

2021

OPTH

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“…This approach-utilizing intracameral antibiotics and sustained release steroid products-has been advocated by multiple surgeons as an important step forward in optimizing therapeutic e cacy and postoperative quality of life in patients undergoing the most commonly performed outpatient surgery in adults in the United States. [10][11][12][13] Replacing self-administered topical therapy with surgeon-administered therapy reduces risks associated with improper instillation technique and eliminates nonadherence, resulting in better e cacy, safety, and quality of life outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…9 Multiple large-scale studies of intracameral antibiotics at the end of surgery have challenged the necessity of postoperative topical antibiotics, and the recent commercialization of 2 sustained-release formulations of dexamethasone-an intracanalicular insert containing dexamethasone (Dextenza, (Dextenza, Ocular Therapeutix, Bedford, MA) and an intraocular dexamethasone suspension (Dexycu, dexamethasone 517 µg, EyePoint Pharmaceuticals, Watertown, MA)-has similarly challenged the need for topical dosing of corticosteroids postoperatively, leading many surgeons to propose a paradigm shift to dropless cataract surgery. [10][11][12][13] The intracanalicular insert is a polyethylene glycol hydrogel rod impregnated with 0.4 mg of preservativefree dexamethasone, conjugated with uorescein for visualization, that is inserted through the punctum into the inferior or superior canaliculus. Upon hydration, the insert swells and self-anchors, dissolving over time with sustained and tapered delivery of dexamethasone for up to 30 days.…”

Section: Introductionmentioning

confidence: 99%

Same-Day Versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

Foster¹

2021

Preprint

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Background: The dexamethasone 0.4mg intracanalicular insert (Dextenza, Ocular Therapeutix, Bedford, MA) is approved for control of postoperative pain and inflammation following ocular surgery. This study compared pain and inflammation resolution following phacoemulsification in eyes that received the insert immediately postoperatively versus the next day.Methods: This was a retrospective analysis of existing electronic health records. Consecutive qualifying eyes were included for analysis. All patients received perioperative antibiotics and nonsteroidal anti-inflammatory drugs. Pain and inflammation were assessed at baseline and on postoperative days 1, 7, and 30. Pain was assessed by dichotomous patient report (present/absent). Anterior chamber cell (0, 0.5+, 1-4+) and flare (0-4+) were graded using the Standardization of Uveitis Nomenclature rubric. Results: Data from 17 eyes of 17 subjects were analyzed; 8 received the insert immediately postoperative and 9 in the office the next day. In both groups, trace cell was present in all eyes at day 1 and had resolved in all but 1 eye in each group at days 7 and 30. Flare was absent in all eyes at every time point, and transient pain was reported in a single same-day eye on day 7. No insert-related adverse events were observed, and no eyes required rescue corticosteroid therapy or insert removal.Conclusion: Similar rates of inflammation and pain resolution after phacoemulsification were achieved with the dexamethasone intracanalicular insert placed either immediately postoperatively or the next day. These findings expand options for insert use to offer surgeons and patients greater flexibility in developing perioperative pain and inflammation control strategies.

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“…4 Shorstein and Myers recently described the growing trend towards the use of postoperative ophthalmic treatments following cataract surgery, including anti-inflammatory treatments, intended to replace the need for topical eyedrops. 5 One such treatment is an intracameral injection of a dexamethasone suspension formulated to form a drug encapsulating sphere in the anterior chamber that degrades and releases the drug, treating postoperative inflammation, over the course of 30 days. The FDA approved this drug (Dexycu; Eyepoint Pharmaceuticals, Watertown, Massachusetts, USA) in 2018.…”

Section: Introductionmentioning

confidence: 99%

Dexamethasone intracameral drug-delivery suspension for inflammation associated with vitreoretinal surgery

Kiernan

2020

BMJ Open Ophth

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ObjectiveTo evaluate the efficacy of an anterior chamber intracameral dexamethasone (ICD) drug-delivery suspension (Dexycu; EyePoint Pharmaceuticals, Watertown, Massachusetts, USA) providing sustained release of medication following a single application for the treatment of postoperative inflammation in patients undergoing vitreoretinal surgery compared to daily postoperative treatment with topical corticosteroids for up to 1 month.Methods and analysisRetrospective case-matched comparison of patients undergoing initial vitreoretinal surgery by a single surgeon. Patients had a preoperative best-corrected visual acuity of 20/20 to light perception and a variety of vitreoretinal pathologies. 27 eyes of 27 patients received ICD at the time of surgery and were compared with 27 eyes of 27 patients who received daily postoperative corticosteroid eye drops over 4 weeks. The primary efficacy outcome was anterior chamber cell (ACC) clearing (0 cells) in the study eye at postoperative day (POD) 7. Ocular adverse events were assessed through POD 90.ResultsACC clearing at POD 7 was achieved in 67% of eyes in the ICD treatment group and 37% of eyes in the control group treated with topical corticosteroids (p=0.029). No serious ocular adverse events were noted up to POD 90 in either group.ConclusionThe ICD drug-delivery suspension placed in the anterior chamber after vitreoretinal surgery was more effective than topical corticosteroids in treating inflammation occurring 1 week following vitreoretinal surgery and thus may be an alternative to daily corticosteroid drop installation in this patient population.

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Drop-free approaches for cataract surgery

Abstract: Intraoperative injections offer the patient and surgeon assured drug delivery and hold promise to avoid the pitfalls of patient adherence, incorrect topical instillation and topical drop-associated corneal issues.

Cited by 28 publications

References 74 publications

Same-Day versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

Same-Day versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

Same-Day Versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

Dexamethasone intracameral drug-delivery suspension for inflammation associated with vitreoretinal surgery

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