Intracanalicular Insert Can Alleviate Pain, Inflammation After Corneal Crosslinking

Using an intracanalicular insert that gradually releases dexamethasone for up to 30 days is safe and effective for managing post-corneal crosslinking (CXL) pain and inflammation, according to a prospective, randomized study published in the Journal of Cataract & Refractive Surgery.

This study (ClinicalTrials.gov Identifier: NCT04168112) included 40 eyes from 20 patients who were undergoing bilateral corneal crosslinking for progressive keratoconus. In total, 10 patients (mean age, 36.3 years; age range, 25-47 years; 60% women) were randomly assigned to receive dexamethasone intracanalicular inserts at the time of CXL, and 10 patients (mean age, 26 years; age range, 19-27 years; 60% men) were randomly assigned to receive prednisolone eye drops on a tapering schedule post-CXL.

All study participants were evaluated for pain scores, rate of re-epithelialization, ease of post-CXL regimen and need for rescue pain medication after standard bilateral epithelium-off CXL on postoperative day 1, postoperative day 3, postoperative days 4 to 7, postoperative week 1, postoperative week 2, postoperative week 3 and postoperative week 4.

The researchers found no significant difference in rate of re-epithelialization or use of rescue pain medication between groups, irrespective of postoperative steroid regimen. Though nominal, the research team found a statistical difference in pain scores between groups, favoring prednisolone eye drops. 

Both groups reported no difficulty in following postoperative regimens. 

No adverse events were noted in relation to treatment or CXL procedure.

“Utilizing a dexamethasone insert to alleviate pain and inflammation can be considered as a safe and efficacious part of a post-CXL regimen,” according to the researchers. “As patient compliance with topical medication regimens can sometimes prove difficult, the convenience of the dexamethasone intracanalicular insert makes it a favorable option for the treatment of post-CXL inflammation and pain.”

Study limitations include the small sample size and 2 patients in the control group dropped out of the study early. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.