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A sustained-release intracanalicular dexamethasone insert for treating ocular inflammation after intraocular surgery
Nallely R Morales-Mancillas1, Rupal H Trivedi1, M Edward Wilson1
1Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina.
Insights
The intracanalicular dexamethasone insert effectively reduces inflammation after pediatric intraocular surgery, minimizing the need for eye drops and improving patient compliance.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative intraocular surgery management in children typically requires steroid eye drops.
- Pediatric patients often exhibit poor compliance with topical eye drop regimens.
- This can lead to suboptimal drug delivery and increased inflammation.
Purpose of the Study:
- To evaluate the clinical utility of a 0.4 mg intracanalicular dexamethasone insert.
- To assess its efficacy in managing inflammation after pediatric intraocular surgery.
Main Methods:
- Retrospective chart review of pediatric patients (≤21 years) receiving the dexamethasone insert.
- Exclusion criteria included loss to follow-up, prior FDA multicenter study participation, and uveitic cataract.
- Data collected on inflammation, need for rescue drops, and complications.
Main Results:
- 97 eyes received the insert across various procedures (cataract, secondary IOL, membrane removal).
- 77% of cataract eyes and 92% of secondary IOL eyes showed no inflammation at 1 month.
- Low rates of rescue anti-inflammatory drops (22% and 20%) and intraocular pressure-lowering drops (12%) were noted; one insert dislodgement occurred.
Conclusions:
- The intracanalicular dexamethasone insert provides a reliable, low-burden method for reducing pediatric intraocular surgery inflammation.
- It significantly reduces reliance on parental compliance for administering eye drops.
- When combined with intracameral antibiotics, it facilitates dropless cataract surgery in most pediatric anterior segment procedures.
Background:
Postoperative management in children after intraocular surgery involves steroid eye drops. However, children may be uncooperative, leading to more washout than in adults. We aimed to evaluate the clinical utility of a 0.4 mg intracanalicular dexamethasone insert after pediatric intraocular surgery.
Methods:
A retrospective chart review was conducted on all pediatric patients (≤21 years) who received a dexamethasone intracanalicular insert following intraocular surgery. The exclusion criteria included loss to follow-up, prior participation in an FDA multicenter study, and uveitic cataract.
Results:
A total of 97 eyes received the insert (cataract, n = 68; secondary IOL, n = 27; secondary membrane removal, n = 2). The median age at surgery in the cataract subgroup was 7.2 years (range, 0.19-21.4). No inflammation was observed in 77% at 1 month. Rescue anti-inflammatory drops were used twice per day in 22%. The only complication noted was an insert that fell out at 12 days postoperatively. The median age in the secondary IOL subgroup was 6.05 years (range, 2.77-21.44). No inflammation was seen in 92% at 1 month. Rescue anti-inflammatory drops were used in 20%. Topical intraocular pressure-lowering drops were required in 12% of eyes.
Conclusions:
The intracanalicular dexamethasone insert offers a reliable, minimally burdensome way to reduce inflammation after pediatric intraocular surgery. It minimizes dependence on parental compliance, needing only one application by the physician instead of multiple drops daily. Combined with intracameral antibiotics, it enables dropless cataract surgery for most children undergoing intraocular anterior segment procedures.
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