Retrospective Study of a Sustained-Release Intracanalicular Dexamethasone Insert for Treatment of Ocular Inflammation After Cataract and Corneal Surgery

Abstract

Purpose To evaluate the effectiveness and safety of a sustained-release intracanalicular dexamethasone insert (Dextenza, Ocular Therapeutix, Inc.) as an adjunctive therapy in patients undergoing cataract and corneal surgery. Patients and Methods This retrospective case series contains 18 patients undergoing cataract surgery and 6 patients undergoing corneal surgery. All patients received the Dextenza intracanalicular insert. 6/18 of the patients in the cataract surgery arm were on the standard of care post-surgery topical steroid drop regimen, whereas 11/18 of the patients were on a reduced regimen. 1/18 of the patients was on a drop regimen that deviated from the aforementioned regimens. 2/6 of the patients in the corneal surgery arm were on the standard of care post-surgery topical steroid drop regimen, whereas 3/6 of the patients were on a reduced regimen. 1/6 of the patients were on a drop regimen that deviated from the aforementioned regimens. Results The primary outcome measures are intraocular pressure (IOP) levels and anterior chamber inflammation levels across the post-operative recovery period. 1/18 of the patients in the cataract surgery arm and 1/6 of the patients in the corneal surgery arm experienced a clinically significant IOP spike greater than 10 millimeters of mercury (mmHg) above baseline IOP. No patient in either of the study groups had significant inflammation after 1 week post-surgery. 1/18 of the patients in the cataract surgery arm and 1/6 of the patients in the corneal surgery arm experienced a canalicular obstruction. Conclusion Dextenza with the lower drop protocol showed non-inferiority in terms of inflammation management and safety. As with any steroid delivery mechanism, monitoring IOP is paramount when using Dextenza. One of the patients with a canalicular obstruction had a history of punctal plug implantation, so care should be taken when choosing to implant Dextenza in such a patient.

Evaluating a Sustained-Release Dexamethasone Insert as Adjunctive Therapy for Inflammation and Pain Post-Corneal Transplantation

“… 13 Our recent publication exploring Dextenza as an adjunct to therapy, following corneal transplantation in 6 patients found Dextenza to be safe and comparable to the standard of care, as long as IOPs were monitored, and patients were screened for a past ocular history of punctal plug insertions. 14 Due to the small sample size and retrospective nature of that study, as well as a scarcity of the literature exploring applications of Dextenza for corneal transplantation, we evaluated the safety and compatibility of Dextenza as an adjunct to therapy, following PKP, DSEK and DMEK in a randomized, controlled, prospective study.…”

“…The Dextenza insert was found to be safe if intraocular pressure (IOP) was appropriately monitored, and patients were screened for past histories of punctal plug insertions prior to selection as Dextenza candidates. 14 Due to the small sample size of that study and its retrospective nature, we felt the potential of Dextenza as a means to safely mitigate the burdens of high-dose topical steroid regimens could be further elucidated in the setting of corneal transplantation.…”

0.2% Betamethasone Sodium Phosphate: A Multicenter, Randomized, Double-Masked Study to Compare Its Ocular Safety, Tolerability, and Efficacy to Vehicle in Cataract Surgery Subjects

“…To the authors' knowledge, this is the first study to report on 0.2% BSP in a proprietary vehicle for the treatment of postoperative inflammation and prevention of pain after cataract surgery. There is a multitude of studies in the literature on the use of corticosteroids (dropless, submicron suspension, or topical) and NSAIDs post-cataract surgery, 7,8,10,11,13,16,19,25,[49][50][51][52][53][54][55][56] with topical corticosteroid use much more common than other forms. Topical corticosteroid therapy in the postoperative period remains the standard of care, despite concerns about patient adherence/compliance and potential bottle tip contamination.…”

Comparing Intracanalicular and Topical Steroid Use in Patients Undergoing Pterygium Surgery

“…The insert has been successfully used in many ocular diseases and surgeries, including photorefractive keratectomy, refractive lens exchange, microinvasive glaucoma surgery, allergic conjunctivitis, pars plana vitrectomy, corneal transplants, dry eye syndrome, and cataract surgery. [9][10][11][12][13][14] We undertook this study to compare the safety and efficacy of DEXTENZA with topical prednisolone acetate (PA) 1% in controlling postoperative pain and inflammation in patients undergoing pterygium surgery because pterygium surgery requires a longer and more frequent steroid course. To the best of our knowledge, this is the first study to describe the use of DEXTENZA insert in pterygium surgery.…”

“…The insert has been successfully used in many ocular diseases and surgeries, including photorefractive keratectomy, refractive lens exchange, microinvasive glaucoma surgery, allergic conjunctivitis, pars plana vitrectomy, corneal transplants, dry eye syndrome, and cataract surgery. 9–14…”