Evaluation of Same-Day versus Next-Day Implantation of Intracanalicular Dexamethasone for the Control of Postoperative Inflammation and Pain Following Cataract Surgery

Abstract

Purpose: To evaluate the safety and efficacy of a sustained-release intracanalicular dexamethasone insert for postoperative inflammation and pain implanted in a clinical setting preoperatively or on postoperative day 1. Methods: Single-site, retrospective, contralateral eye study of patients undergoing cataract surgery. Included were subjects with a dexamethasone intracanalicular insert implanted in the clinic immediately prior to surgery in one eye (same-day) and on postoperative day 1 (POD1) in the contralateral eye. The primary outcome measure was the resolution of anterior chamber inflammation at 1 week postoperative. Secondary outcome measures included proportion of eyes requiring additional therapy for pain and inflammation through 1 month as well as the number of eyes with IOP spikes above baseline. Safety measures included adverse events through 1 month postoperative. Results: Sixty-two eyes of 31 subjects were included in the case series. At 1 week postoperative, 52% of the eyes (n = 16) achieved complete resolution of inflammation in the same-day group and 58% (n = 18) met this endpoint at 1 week in the POD1 group. One subject in the same-day group required additional therapy for rebound inflammation and no eyes required additional therapy in the POD1 group. There were no reports of pain at 1 week or 1 month in either group. There were no implant-related adverse events in either group. Conclusion:The favorable results of this study indicate that the sustained-release dexamethasone insert can be safely implanted in the clinic either preoperatively on the day of surgery or on postoperative day 1 for the control of pain and inflammation following cataract surgery.

Intracanalicular Dexamethasone Insert for Post-Corneal Cross-Linking Inflammation and Pain - The LINK Study

“…[17][18][19][20]25 The tear film is an integral component in corneal epithelial healing; the fewer disturbances it experiences portend potentially easier re-epithelialization for post-CXL eyes. 9,[13][14][15][16][17][18][19][25][26][27][28][29] It is also worthwhile to note that all CXL patients in this study had a bandage contact lens placed at the time of CXL completion. As the ocular surface is a dynamic environment, and factors such as reflex tearing, blinking, tear film quality, and surface characteristics all play a role in topically administered medications, it may be hypothesized that in terms of re-epithelialization and maintenance of the ocular surface milieu, the topical prednisolone may not have completely penetrated to the ocular surface after CXL because of the application of a BCL, whereas the dexamethasone insert was not necessarily impeded in this manner.…”

“…This was interesting to the authors in that instillation of drops could potentially disturb the ocular surface and tear film. 9,[13][14][15][16][17][18][19][25][26][27][28][29] However, perhaps the direct application of steroids to the ocular surface allowed for less inflammation/pain compared with intracanalicular steroids. Of interest, in a study by Ibach et al, in patients who had PRK with an intracanalicular dexamethasone insert in one eye and standard steroid drops in the other eye, 70% of patients preferred the dexamethasone insert; there was no difference in postoperative pain control between groups (based on patient responses to a validated questionnaire).…”

Management of inflammation after the cataract surgery

“…The most common adverse event was raised IOP but none of the patients with IOP increases in either arm (dexamethasone insert arm, n ¼ 16; placebo arm, n ¼ 6) were judged by the investigators to be related to treatment [109]. Moreover, this implant can be inserted at first postoperative day -some studies showed that there was no significant difference when comparing implantation during the surgery and 1 day after [110,111]. Also, in Larsen and others' study, patients preferred dexamethasone implant when compared with topical steroid drops after undergoing bilateral refractive lens exchange [112].…”

Early Real-World Patient and Staff Experience with an Intracanalicular Dexamethasone Insert

“…DEX can be administered by optometrists and ophthalmologists, and can be inserted in the outpatient setting. [13][14][15] The timing of DEX administration is flexible with administration being feasible preoperatively, during surgery, or postoperatively without compromising efficacy or safety. 13,15 DEX has been approved by the US Food and Drug Administration for the treatment of ocular inflammation and pain following ophthalmic surgery and also for the treatment of ocular itching associated with allergic conjunctivitis 16 on the basis of results from multiple Phase 3 clinical trials.…”

“…13,15 DEX has been approved by the US Food and Drug Administration for the treatment of ocular inflammation and pain following ophthalmic surgery and also for the treatment of ocular itching associated with allergic conjunctivitis 16 on the basis of results from multiple Phase 3 clinical trials. [17][18][19] Real-world studies have further demonstrated the role of DEX in the management of postoperative cataract surgery, 13,14 ocular surface disease, 20 refractive surgery, 21,22 minimally invasive glaucoma surgery, 23 and posterior segment surgery. 24 We administered quantitative survey in this study to assess patient and health care provider attitudes toward DEX and its impact on clinical practice.…”