Intracameral dexamethasone injection in the treatment of cataract surgery induced inflammation: design, development, and place in therapy

Abstract

Cataract surgery is one of the most commonly performed surgeries worldwide, with nearly 20 million cases annually. Appropriate prophylaxis after cataract surgery can contribute to a safe and quick visual recovery with high patient satisfaction. Despite being the current standard of care, the use of multiple postoperative eye drops can create a significant burden on these patients, contributing to documented and significant non-adherence to the postoperative regimen. Over the past 25 years, there have been a few studies analyzing the use of intracameral dexamethasone (DXM) in controlling inflammation following cataract surgery. This review explores various drug delivery approaches for managing intraocular inflammation after cataract surgery, documenting the strengths and weaknesses of these options and examining the role of intracameral DXM (among these other strategies) in controlling postoperative intraocular inflammation. Intracameral DXM has a particular advantage over topical steroids in possibly decreasing postoperative inflammatory symptoms and objective anterior cell and flare scores. Compared to topical steroids, there may be a slightly less theoretical risk of significant intraocular pressure spikes and systemic absorption. In addition, surveys indicate patients prefer an intraoperative intracameral injection over a self-administered postoperative eye drop regimen. However, there are several adverse effects associated with intracameral DXM delivery that are not seen with the noninvasive topical approach. Although it is unlikely that intracameral DXM will replace topical medications as the standard management for postoperative inflammation, it is seemingly another safe and effective strategy for controlling postoperative inflammation after routine cataract surgery.

Preparation and Evaluation of Eudragit® L100 Nanoparticles LoadedImpregnated with KT Tromethamine Loaded PVA -HEC Insertions forOphthalmic Drug Delivery

“…Drug delivery systems decrease the side effects of drugs such as postoperative inflammation of the eyes, postoperative pain and the conjunctivitis with no alteration of corneal opacity. 3,4 Despite eye drops cause a little blurring, they are popular due to low cost, great simplicity of formulation, development and production and better acceptance by patients. According to the physiology and anatomy of the eye, the prescription drug was absorbed in a very small percentage due to the protection mechanisms, such as tearing and blinking reflex.…”

Impact of dexamethasone intraocular suspension 9% on intraocular pressure after routine cataract surgery: post hoc analysis

“…Long-acting antiinflammatory therapy formulated for intraocular administration has the potential to relieve patients of the need for topical antiinflammatory medications after cataract surgery, potentially reducing patient nonadherence and dosing errors. 6 Patients who received intraocular corticosteroids and antibiotics at the end of the procedure could be discharged on fewer, or potentially no, drops. Furthermore, delivery of antiinflammatory medication intraocularly, directly to the site of inflammation, should result in improved bioavailability and lower overall corticosteroid exposure to the eye, which could reduce corticosteroid-related side effects and ocular surface toxicity.…”

“…Furthermore, delivery of antiinflammatory medication intraocularly, directly to the site of inflammation, should result in improved bioavailability and lower overall corticosteroid exposure to the eye, which could reduce corticosteroid-related side effects and ocular surface toxicity. 6 …”

Dexamethasone Intracanalicular Insert: A Review in Treating Post-Surgical Ocular Pain and Inflammation

“…Although the intraocular dexamethasone suspension has a similar dosing frequency as the dexamethasone intracanalicular insert (one injection during surgery), the dexamethasone suspension is not currently indicated for post-surgical pain [25]. Furthermore, removal of the intraocular dexamethasone suspension was reported to be difficult [29], whereas the dexamethasone intracanalicular insert was easy or moderately easy to remove (when required) during phase III trials. In most cases, manual expression of the dexamethasone intracanalicular insert was not required as the insert is resorbed (Sect.…”