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Patients undergoing pars plana vitrectomy (PPV) with gas tamponade often need to position their upper body specifically after surgery, and this factor may make the task of self-instilling eye drops more complex. Alternatives to topicals include sustained-release delivery methods; sub-Tenon’s steroid injection, intravitreal implant, intraocular suspension, and a new option — an intracanalicular insert.
A drawback of subTenon’s delivery is that injections may not last a predictable amount of time, and intravitreal implants have risks associated with close retinal contact, or endophthalmitis. Also, anterior chamber intraocular suspensions may raise intraocular pressure (IOP). Intracanalicular inserts are currently in use after cataract removal, although until now, they have not been analyzed in PPV recovery. A novel study evaluates how well dexamethasone sustained-release intracanalicular implants (DII) compare with standard steroid eye drop therapy for inflammation and pain control after PPV — the retrospective investigation is published in Clinical Ophthalmology.
Forty-six patients of a retina clinic in Tampa, Florida underwent PPV surgery with air or gas tamponade for epiretinal membrane, macular hole, rhegmatogenous retinal detachment, vitreous hemorrhage, and other indications, as well as combined phaco-vitrectomy. This case-matched study included 23 consecutive patients who underwent PPV with standard postoperative prednisolone eye drop therapy between January 2019 and July 2019, and 23 consecutive patients who received vitrectomy with a DII between August 2019 and October 2019.
The primary outcome examined was anterior chamber cell clearance (ACCC). At day 7 after surgery, 35% of patients in the topical steroid control group displayed complete ACCC, and 65% in the DII cohort achieved complete ACCC (P =.01), a significant difference.
No implant migrated in the 30-day postoperative period. One eye in the DII group developed cystoid macular edema (CME) by day 30, as well as 3 eyes in the eye drop cohort. Two participants had an IOP increase >25 mm Hg, both patients taking topical steroids. Mean central foveal thickness (CFT) decreased from baseline 390.0 µm to 292.5 µm by postoperative day 30 in the DII set, and from 356.0 µm to 296.8 µm in the control group (P =.30). All patients received antibiotic prophylaxis, and no additional adverse events occurred.
DII was well tolerated by all 23 participants, and 7 patients who previously experienced steroid drop therapy in the contralateral eye stated they preferred DII for “convenience and comfort.”
The mean age for DII recipients was 69 years, and for those instilling eye drops, 66 years. One eye per patient was used for analysis. DII, a rod-shaped hydrogel was inserted into the canaliculus after inferior punctum dilation. Limitations of this study include a relatively small sample, retrospective design, and diverse indications for PPV. Conversely, this report is first to examine DII in a cohort of consecutive patients after vitrectomy.
“This regimen should be considered for patients undergoing PPV to safely and effectively control postoperative inflammation, to ensure patient compliance, and to improve patient satisfaction,” the investigation suggests, adding sustained-release delivery may also simplify treatment and reduce patient calls to the clinic with questions about postoperative therapy.
Disclosures: The study authors have declared affiliations with the pharmaceutical and biotech industries. This research was supported by an unrestricted research grant from Ocular Therapeutix, Inc. Please see the original reference for a full list of disclosures.
Reference
Suñer IJ, Peden MC. Dexamethasone sustained-release intracanalicular insert for control of postoperative inflammation after pars plana vitrectomy. Clin Ophthalmol. 2021;15(9):3859–3864 . doi:10.2147/OPTH.S330255
