RESUMO
Purpose: To assess the efficiency and safety of an intracanalicular dexamethasone insert (Dextenza, Ocular Therapeutix, Inc) supplemented with a reduced-frequency topical drop regimen in mitigating pain and inflammation post-penetrating keratoplasty (PKP), Descemet stripping endothelial keratoplasty (DSEK), and Descemet membrane endothelial keratoplasty (DMEK), compared to standard topical corticosteroid therapy. Patients and Methods: Eyes were categorized within the DSEK, DMEK, or PKP groups based on ocular characteristics and surgical indications. Randomized in a 1:1 ratio, the intervention group received Dextenza alongside a lowered drop frequency, while the control group followed a conventional drop protocol with no Dextenza. Primary outcomes included average pain scores and absence of anterior chamber cell and flare. Secondary outcomes included delayed re-epithelialization, corneal rejection episodes, instances of intraocular pressure (IOP) elevation >10mmHg above baseline, cystoid macular edema (CME) occurrence, and the necessity for steroid rescue. Results: The study included 30 eyes (10 PKP, 10 DSEK, 10 DMEK). Mean pain scores (0-100 scale; (0-39 = mild pain, 40-69 = moderate pain, 70-100 = severe pain) in the Dextenza group were 3.6 (PKP), 12 (DSEK), 8 (DMEK), compared to 1.2 (PKP), 0 (DSEK), and 4 (DMEK) in controls. PKP control (n=5): 1 delayed re-epithelialization, 1 IOP elevation, 2 CME. DSEK control (n=5): 1 corneal rejection, 1 IOP elevation, 1 CME. DMEK control (n=5): 1 IOP elevation, 1 CME. DMEK Dextenza (n=5): 1 delayed re-epithelialization, 1 CME. No cases required steroid rescue, and no cell or flare was observed one-week post-surgery. There were no statistically significant differences in pain, delayed re-epithelialization, IOP elevation, corneal rejection, or CME between the Dextenza and control groups regardless of the type of corneal transplantation performed. Conclusion: Dextenza, when combined with a lower-frequency drop regimen, demonstrates a safety profile comparable to that of a traditional higher-frequency drop protocol in terms of pain management and the adverse events explored in this study, potentially enhancing postoperative drop adherence.
RESUMO
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.
