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Updated: Jun 18, 2025
Author Spotlight: A Novel Protocol for Intracameral Injections to Enhance Precision in Rodent Ophthalmology
Published on: May 31, 2024
Dexamethasone Intracanalicular Insert versus Standard Topical Steroids for the Prophylaxis of Inflammation after
Jeremy N Shapiro1, Stephen T Armenti2, Harry Levine1
1Kellogg Eye Center and Department of Ophthalmology and Visual Sciences (J.N.S., H.L., C.T.H., S.I.M.), University of Michigan, Ann Arbor, Michigan, USA.
Insights
The intracanalicular dexamethasone insert (DII) showed a higher rate of breakthrough inflammation after cataract surgery compared to topical steroids. However, both treatments resulted in low complication rates and similar cystoid macular edema outcomes.
Area of Science:
- Ophthalmology
- Ophthalmic surgery
- Inflammation control
Background:
- Post-cataract surgery inflammation requires effective management.
- Topical corticosteroids are standard, but adherence can be an issue.
- Intracanalicular inserts offer an alternative drug delivery method.
Purpose of the Study:
- To compare the efficacy of an intracanalicular dexamethasone insert (DII) versus topical prednisolone acetate 1% for preventing breakthrough inflammation.
- To assess rates of iritis and cystoid macular edema (CME) in the first postoperative month.
- To evaluate intraocular pressure (IOP) changes post-surgery.
Main Methods:
- Retrospective, nonrandomized comparative study.
- Patients received either DII or topical prednisolone acetate 1% eyedrops.
- Exclusion criteria ensured a homogenous study population; outcomes monitored for 1 month.
Main Results:
- Breakthrough inflammation occurred more frequently with DII (9.0%) than topical steroids (3.1%).
- Cystoid macular edema (CME) rates were similar between groups (4.9% vs 4.3%).
- No significant increase in intraocular pressure (IOP) was observed in either group.
Conclusions:
- Intracanalicular dexamethasone inserts showed a higher breakthrough inflammation rate than topical steroids post-cataract surgery.
- DII is a safe alternative with comparable CME and IOP outcomes.
- Overall postoperative complication rates were low for both treatment methods.
Purpose:
To compare the efficacy of an intracanalicular dexamethasone intracanalicular insert (DII) to a topical prednisolone acetate 1% taper for preventing breakthrough inflammation (iritis or cystoid macular edema [CME]) during the first postoperative month (POM1) after cataract surgery.
Design:
Retrospective, nonrandomized comparative interventional study.
Methods:
Patients received either DII or topical prednisolone acetate 1% eyedrops (control) during POM1. Exclusion criteria included history of iritis, glaucoma, intraoperative posterior capsular rupture or vitreous prolapse, immediate postoperative anterior chamber inflammation requiring treatment, or less than 1 month follow-up postoperatively. Outcomes included development of breakthrough inflammation after >3 days postoperatively necessitating additional antiinflammatory drops, CME, and increased intraocular pressure (IOP) at POM1.
Results:
A total of 266 eyes of 174 patients were included in the DII group and 258 eyes of 167 patients in the control group. Demographics, comorbidities, and baseline IOP were comparable between groups. The breakthrough inflammation rate was significantly higher in the DII group compared to control (9.0% vs 3.1%; P < .01); CME rates were similar between groups (4.9% vs 4.3%; P = .75). There were no cases of increased IOP >10 mm Hg at POM1 compared to baseline in either group.
Conclusions:
After cataract surgery, DII demonstrated a higher rate of breakthrough inflammation than a standard topical steroid regimen with no significant differences in CME rate or IOP increase; however, overall, the rate of postoperative complications was low. DII can be a safe and effective alternative to topical corticosteroid therapy after cataract surgery.
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