Intraocular corticosteroid a step forward for postop inflammation

July 12, 2019

Sustained-release option overcomes limitations of topically administered drops

Dexamethasone intraocular suspension 9% (Dexycu, EyePoint Pharmaceuticals) was launched in March 2019. Its advantages make it a natural choice to routinely replace topical corticosteroid drops in all Medicare cataract surgery patients.

Reviewed by Eric D. Donnenfeld, MD

Approved by the FDA last year, dexamethasone intraocular suspension 9% (Dexycu, EyePoint Pharmaceuticals) was officially launched in March. As an investigator in premarketing clinical trials, Eric D. Donnenfeld, MD, began using the novel sustained-release corticosteroid three years ago.

Based on his experience and the advantages of the intraocular product, Dr. Donnenfeld said he is now using it routinely in all cataract surgery cases involving Medicare patients.

“Drug delivery for medications used in cataract surgery is changing dramatically, and dexamethasone intraocular suspension is an exciting advance that overcomes the limitations of topically administered drops,” said Dr. Donnenfeld, clinical professor of ophthalmology, New York University Langone Medical Center, New York, NY, and founding partner, Ophthalmic Consultants of Long Island and Connecticut, Garden City, NY.

“It puts the surgeon in charge and takes the responsibility of the corticosteroid out of the hands of patients who may be unreliable or unable to administer their medication,” he said. “Furthermore, it avoids the potential ocular surface toxicity of topical medications and their cost.”

Pass-through status

The dexamethasone intraocular suspension has been granted pass-through status and reimbursement by the Centers for Medicare and Medicaid Services, Dr. Donnenfeld noted. As a result, dexamethasone intraocular suspension is provided at no cost to the surgery center, the surgeon, or Medicare patients with coinsurance, who represent about 90% of the Medicare population.

In the few months since the intraocular corticosteroid became commercially available, Dr. Donnenfeld said that he has used it with excellent safety and efficacy in about 100 eyes that underwent cataract surgery, including some complex cases.

RELATED: Novel compound shows promise for dry eye in proof-of-concept study“The intraocular product immediately delivers and maintains a therapeutic concentration of the corticosteroid at the target site,” he explained. That can be a key driver for physicians to consider ensuring positive results for patients.

“For that reason, I particularly like it in situations where there is likely to be an increased inflammatory response, such as in a case involving a sutured IOL or planned pars plana vitrectomy,” he added.

Use in glaucoma surgery

For the same reasons, Dr. Donnenfeld said his partners are using it in glaucoma surgery. “I am considering its use for keratoplasty cases,” he added.

Dr. Donnenfeld said that he has seen a single patient who required rescue topical corticosteroid treatment to control inflammation, despite the routine use of a topical nonsteroidal anti-inflammatory drug (NSAID) in all cases.

Although there is a risk for IOP elevation with any corticosteroid, and IOP monitoring is necessary when using the dexamethasone intraocular suspension, the incidence of increased IOP in clinical trials was low, and Dr. Donnenfeld said that he has not encountered any patients who developed a postoperative IOP spike.

The intraocular corticosteroid is administered as an 0.005 mL injection behind the iris at the end of the case and following delivery of any intracameral antibiotic.

Dr. Donnenfeld offered the following tips to optimize retention of the material behind the iris:

  • Hydrate the surgical incision so that it is sealed-incision leak will draw the product into the anterior chamber.

  • Place the tip of the delivery cannula behind the iris at 120° and move it inferiorly while rubbing tangentially along the back of the iris.

According to Dr. Donnenfeld, migration of the medication into the anterior chamber does not seem to compromise efficacy nor interfere with vision. Patients should be informed that they may notice the material and that it is not a cause for concern.

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Disclosures:

Eric D. Donnenfeld, MD
E: ericdonnenfeld@gmail.com
Dr. Donnenfeld is a consultant to EyePoint Pharmaceuticals and other companies marketing and developing products for treating inflammation after ophthalmic surgery.