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Patients who receive intraocular dexamethasone (DXM) suspension after undergoing cataract surgery achieve favorable inflammatory outcomes without unanticipated safety problems, according to real-world evidence published in Clinical Ophthalmology.
Patients (N=527 mean age 71.5±8.35 years, 58.4% women, 73.6% White) who underwent cataract surgery and received 9% intraocular DXM in 2019 at 22 eye surgery centers in the United States were retrospectively reviewed for safety and efficacy. The primary outcomes were anterior chamber cell and flare grades, visual acuity, intraocular pressure (IOP), and adverse events up to day 30 after surgery. Of the 641 eyes included in the research, 80 had glaucoma, according to the study.
Most eyes (88.1%) received femtosecond laser-assisted cataract surgery. Few procedures (2.1%) were considered complex with use of Malyugin ring (0.9%), trypan blue staining (0.9%), or iris hooks (0.3%). Complications included intra-operative floppy iris (0.8%), bleed (0.2%), or other complications (1.8%).
At postoperative day 1, 14.4% of eyes were given topical nonsteroidal anti-inflammatory drugs (NSAIDs). Few eyes (3.6%) received topical steroids at days 8, 14, and 30.
Anterior chamber cell (ACC) clearing was observed among 40.0% at day 1, 65.0% at day eight, 85.0% at day 14, and 89.7% at day 30. The rates of ACC clearing among the eyes with a history of glaucoma were 51.6%, 68.0%, 82.3%, and 90.2%, respectively. Eyes that received DXM alone had poorer ACC clearance on day one compared with eyes that received NSAIDs (23.8% vs 58.6%) by day 30 clearance rates were similar (94.1% vs 92.5%), respectively.
Anterior chamber flare (ACF) clearance increased from 78.4% at day 1 to 97.1% at day 30. Stratified by concomitant drug use, clearance was lower in eyes that received DXM alone at day 1, but clearance rates were similar by day 8.
At day 30, corrected visual acuity was 20/25 or better in 33.9% and not recorded in 48.7% and uncorrected visual acuity was 20/25 or better in 21.8% and not recorded in 42.3%. Target visual acuity was not reached among 2.3%.
Among all eyes, IOP was 18.6 mm Hg at day 1, decreasing to 15.2 mm Hg at day 8 and 14.1 mm Hg at day 30. Among the eyes with glaucoma, similar trends were observed, in which IOP was 18.5 mm Hg at day 1 and 14.4 mm Hg at day 30.
Adverse events (n=22) occurred among 20 patients. The most common events were IOP increase (n=7), corneal edema (n=6), and iritis (n=4). Events were mild (n=11) or moderate (n=10). Three events were definitely related and two probably related with treatment.
The surgeons reported that DXM was not tolerated in 1 eye. Most (92%) surgeons were ‘very satisfied’ or ‘satisfied’ with DXM.
The major limitations were the proportion of missing data about visual acuity outcomes and lack of a comparator cohort.
This study found real-world evidence to support the use of DXM after cataract surgery to manage postoperative ocular inflammation.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Reference
Bacharach J, McCabe C, Jackson M, et al. First real-world, multicenter, post-marketing, retrospective study of dexamethasone intraocular suspension for inflammation after cataract surgery.Clin Ophthalmol. 2022;16:1783-1794. doi:10.2147/OPTH.S357267
