Abstract
Purpose :
Dexamethasone intraocular suspension 9% (DEXYCU®) offers a sustained-release, FDA-approved alternative to anti-inflammatory drops. However, there is a paucity of post-market data on its safety and outcomes, especially with glaucoma patients. We performed a retrospective chart review to assess the results of the drug following cataract surgery and concomitant cataract-MIGS.
Methods :
Approval for a retrospective study of surgical outcomes was obtained from Sterling IRB. 29 eyes (n=29) that received dexamethasone intraocular suspension at a single New York City surgery center were included. 17 eyes underwent only cataract surgery, and 12 received cataract-MIGS. 13 eyes had glaucoma, with 9 taking glaucoma drops preoperatively. For all procedures, the surgeon placed drug aliquots within the ciliary sulcus, but some escaped to the anterior chamber (AC) intraoperatively or postoperatively. Average age was 67.9 years, with 15 female eyes. Changes in IOP were analyzed with two-tailed t-tests. Iris atrophy complications and rescue with anti-inflammatory drops were each correlated to aliquot location using Fisher’s exact test.
Results :
18 aliquots remained in the sulcus at follow-up, while 11 were visualized in the AC. 5 eyes (17%) experienced iris atrophy, and all atrophy cases occurred only when the drug was in the AC (Fisher’s p = 0.0039). From preop to 1 month postop, average IOP changed by -1.19 ± 2.03 mmHg (p = 0.24). For glaucomatous eyes, average IOP changed by -2.36 ± 4.35 mmHg (p = 0.26). 12 eyes (41%) were rescued with anti-inflammatory drops. There was no significant correlation between aliquot location and anti-inflammatory rescue (Fisher’s p = 0.72). No eyes had new glaucoma drops added by 1 or 3 months. There were no cases of visible damage to MIGS stents or the corneal endothelium.
Conclusions :
Dexamethasone intraocular suspension was used in cataract and cataract-MIGS patients without increasing average IOP or glaucoma drugs, and without corneal or stent complications. 17% of eyes had iris atrophy, and 41% required anti-inflammatory rescue. Given that atrophy was location-specific, occurring with 45% of AC aliquots, it may be mitigated by confining the aliquot to the ciliary sulcus. Further research should be pursued to determine how surgical technique, eye features, and drug properties affect sulcus escape.
This is a 2020 ARVO Annual Meeting abstract.