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

Abstract

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.

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].…”