EyeWorld Asia-Pacific December 2019 Issue

EWAP DECEMBER 2019 63 PHARMACEUTICALS by Maxine Lipner EyeWorld Senior Contributing Writer Plugging cataract patients into Dextenza use Contact information Berdahl: john.berdahl@vancethompsonvision.com Stephens: david.stephens@tysoneye.com This article originally appeared in the October 2019 issue of EyeWorld . It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp. T he U.S. FDA-approved drug-eluting punctal plug Dextenza (dexamethasone, Ocular Therapeutix) is now being used by cataract practitioners hoping to alleviate some of the postoperative drop burden for patients, according to John Berdahl, MD. What can physicians expect when including this in their patients’ cataract regimens? Implanting Dextenza Dr. Berdahl said that the FDA indication for Dextenza is to œÜiÀ «>ˆ˜ >˜` ˆ˜y>““>̈œ˜ associated with cataract surgery. There are several advantages to using it over postoperative drops alone, he pointed out. The plug itself works in a straightforward manner. “It’s a hydrogel polymer implant that goes into the canaliculus either at the time of cataract ÃÕÀ}iÀÞ œÀ ˆ˜ ̅i œvwVi] >˜` ˆÌ elutes dexamethasone over the following 4 to 6 weeks,” he said. “It delivers dexamethasone and patients don’t have to take steroid eye drops,” Dr. Berdahl said, adding that it auto-tapers ˆÌÃiv Ü «>̈i˜Ìà }iÌ Ì…i Li˜iwÌà of a punctal plug and better lubrication of the eye after cataract surgery. It also helps circumvent dependence on patient compliance. David Stephens, MD, views Dextenza as particularly helpful for patients who are at risk for “œÀi ˆ˜y>““>̈œ˜ ̅>˜ ˜œÀ“>] such as someone with uveitis or ocular surface disease for whom the physician would like to alleviate the drop burden. Dr. Stephens implants Dextenza in the operating room at the time of cataract surgery, just as he would with a normal punctal plug. “Following the surgery, we take the drape down and I evert the eyelid with a cotton tip and we perform punctal dilation,” Dr. Stephens said. Then the surface of the eye and the punctum is dried thoroughly and the plug inserted with forceps into the lower punctum. He explains to patients beforehand that he will be putting a medicated plug into the tear duct at the time of the cataract procedure. He alerts them that they might feel a little pressure because the eye is numb but the eyelids are not. When inserting the plug, Dr. Stephens stressed the need to keep this dry since Dextenza swells immediately when it comes in contact with water, “>Žˆ˜} ˆÌ `ˆvwVÕÌ Ìœ ˆ˜ÃiÀÌ° Postoperative expectations i w˜`à ̅>Ì «>̈i˜Ì Ài뜘Ãià have been promising. “We do an injection of antibiotic and steroid at the time of cataract surgery and we have them on a combination drop of «Ài`˜ˆÃœœ˜i] }>̈yœÝ>Vˆ˜] >˜` bromfenac once a day for 2 weeks,” he said, adding that so far results have been good. Dr. Berdahl agreed that those already on a steroid antibiotic combination in conjunction with Dextenza won’t need much else. The FDA study 1 showed that at day 14 approximately 52% of patients had the absence of >˜ÌiÀˆœÀ Vi y>Ài Vœ“«>Ài` ܈̅ 31% in the placebo group. While there can be some complications, these are limited. With the plug in the eye, patients’ tears don’t drain as rapidly as they would otherwise. “In an older population, we like those extra tears around in the healing period with cataract surgery,” Dr. Berdahl said. One possibility to watch out for is `ˆvwVՏÌÞ }iÌ̈˜} ̅i «Õ} ˆ˜ > œv the way, in which case you might have to trim this postoperatively, Dr. Berdahl noted. Dr. Stephens pointed out ̅>Ì ÀiLœÕ˜` ˆ˜y>““>̈œ˜ The Dextenza plug is placed into the tear duct, usually at the time of cataract surgery. Source: John Berdahl, MD