Management of Post-Operative Inflammation After Cataract Surgery with Intracanalicular Dexamethasone Implant and...

To determine the safety of an intracanalicular dexamethasone ophthalmic insert (IDOI) and topical Ketorolac tromethamine 0.5% (ketorolac) versus ketorolac and topical prednisolone acetate 1% (PA) over the first month after cataract surgery (POM1).

Retrospective study of uncomplicated cataract surgeries between June 2020 and March 2023 at the University of Michigan. Patients received either IDOI and ketorolac or PA and ketorolac (control) during POM1. Outcomes included breakthrough inflammation necessitating additional anti-inflammatory drops, cystoid macular edema, and increased intraocular pressure at POM1.

100 eyes of 78 patients were included in the IDOI/ketorolac group, and 102 eyes of 83 individuals in the control group. Demographics, ocular comorbidities, and baseline IOP were comparable between groups. There were no differences between groups in the distribution of race (p = 0.137), the preoperative presence of epiretinal membrane (43.5% vs 57.83%; p = 0.88), or history of diabetic retinopathy (19.23% vs 15.6%; p = 0.59) in the surgical eyes. There were no differences in the rates of postoperative rebound inflammation in the IDOI/ketorolac compared to the PA/ketorolac group (2.0% vs 2.0%; p = 1.00) or in the development of cystoid macular edema (2.0% vs 2.9%; p = 1.00). There were no cases of increased IOP > 10 mmHg at POM1 compared with baseline in either group.

There was no difference in the rate of rebound inflammation or CME in the IDOI/ketorolac regimen compared to the PA/ketorolac regimen. IDOI can be a safe and effective dropless alternative to PA/ketorolac therapy after cataract surgery in patients susceptible to inflammation.