Postoperative Inflammation and Pain Management with Intracanalicular Dexamethasone Insert: Real-World Applications

Transient pain and ocular inflammation may occur with ophthalmic surgery. Pain is an important determinant of patient satisfaction, and inflammation can increase the risk for suboptimal visual outcomes. Topical anti-inflammatory therapies can reduce the incidence of postoperative pain and inflammation but have many limitations, including nonadherence and significant potential side effects such as cataract formation and intraocular pressure elevation. There is unmet need for a therapy that provides anti-inflammatory and analgesic activity while overcoming the limitations of topical therapy. The intracanalicular dexamethasone insert (DEX) overcomes many of the limitations of topical therapy. DEX is a fluorescent yellow cylindrical-shaped polyethylene glycol-based hydrogel insert incorporating 0.4 mg preservative-free dexamethasone. The insert was designed based on human anatomy and measurements of the canalicular system and continuously releases a tapered dose of dexamethasone over approximately 30 days onto the surface of the eye. The insert is completely resorbable and does not require removal. DEX was approved by the US Food and Drug Administration for the treatment of pain (in 2018) and inflammation (in 2019) following ocular surgery; in 2021, the treatment of ocular itching associated with allergic conjunctivitis was added as an indication.

We present a comprehensive review of the current therapeutic landscape for management of postoperative pain and inflammation following cataract surgery, including the limitations of topical eye drop medications. We review data from the key phase 2 and 3 clinical trials that supported the approval and label expansion for DEX. We also summarize the broader literature of smaller studies evaluating the role of DEX in controlling postoperative pain and inflammation for a variety of ophthalmic surgery beyond cataract surgery as well as in management of ocular itching associated with allergic conjunctivitis.