Dextenza Implant Comparable to Topical Drops After Cataract Surgery

Glaucoma was equally common in treated and untreated cohorts, suggesting a practice pattern that doesn’t exclude dexamethasone implant use in eyes with preexisting glaucoma. Observed IOP increases in the study were more likely related to the surgery itself rather than steroid response, since pressure elevation occurred within a very short timeframe. Photo: Derek N. Cunningham, OD, and Walter O. Whitley, OD. Click image to enlarge. Topical corticosteroids such as loteprednol and prednisolone are the mainstay for treating postoperative inflammation and pain after cataract surgery, but as clinicians know, steroid drops aren’t without side effects. Intraocular pressure elevation may occur, and preservatives in some formulations may irritate the ocular surface, exacerbating preexisting or postsurgical dry eye. Patients may also find the dosing regimen arduous.One innovation that may address these concerns is Dextenza (Ocular Therapeutix), an intracanalicular hydrogel that delivers a tapered course of preservative-free steroid for up to one month. The insert is FDA-approved for treating ocular pain and inflammation after surgery, as well as for ocular itching associated with allergic conjunctivitis. As with any new drug, its performance in real-world settings may differ from that of clinical trials. In a company-supported study, researchers assessed IRIS Registry data to report patient profiles and safety-related diagnoses of the dexamethasone implant. They shared in their recent Journal of Cataract and Refractive Surgery paper that the insert was effective and comparable to control eyes.In the retrospective analysis, treated eyes were defined as those that received the dexamethasone insert two days before or up to seven days after cataract surgery. A total of 10,313 treated eyes and a control group of 425,098 eyes from the same practices were analyzed of the 3.7 million eyes undergoing cataract procedures in the index period. The researchers assumed that the majority of eyes that didn’t receive the insert were administered topical corticosteroids.The researchers found that eyes with a history of ocular surface disease-related conditions received the dexamethasone insert at a higher rate than those without. They also reported that 25% of eyes in both cohorts had preexisting glaucoma.Postoperative inflammation, corneal edema and lacrimal disorders were uncommon in both cohorts and had similar incidences. The researchers also reported low incidences of cystoid macular edema and epiphora in both cohorts, as well as comparable incidences of IOP changes and pressure elevations ≥10 mmHg through one month.“This real-world analysis demonstrates that the DEX insert provides comparable safety with alternate perioperative therapy after cataract surgery and that real-world safety outcomes are at least favorable, or in some cases more numerically favorable, than those observed in prior DEX clinical trials,” the researchers wrote in their paper. They concluded that the intracanalicular dexamethasone insert is a “potential alternative treatment option to topical steroids” for cataract surgery patients.Click here for the journal source. Vantipalli S, Mbagwu M, Chang RT, et al. Real-world characteristics and safety outcomes of 10 000 eyes treated with intracanalicular dexamethasone insert: IRIS registry analysis 2019 to 2021. J Cataract Refract Surg 2026;52:366-372.  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.