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Safety and Efficacy of Topical versus Intracanalicular Corticosteroids for the Prevention of Postoperative Inflammation after Cataract Surgery

Amy Q. Lu, Monica Rizk, Tara O’Rourke, Kristin Goodling, Erik Lehman, Ingrid U. Scott,

Abstract: Purpose: To compare the safety and efficacy of topical prednisolone and intra-canalicular dexamethasone ophthalmic insert for the prevention of post-operative inflammation after cataract surgery. Setting: Penn State College of Medicine, Hershey, PA. Design: Retrospective consecutive case series. Methods: Patients scheduled for elective phacoemulsification cataract surgery with a plan to receive inflammation prophylaxis with topical prednisolone (prednisolone acetate 1mg/1mL) between January 2018 and November 2019 or intracanalicular dexamethasone (Dextenza, 0.4mg, Ocular Therapeutix) between December 2019 and March 2021 were screened. Patients were seen 1 day, 1 week, and 4-16 weeks postoperatively. Medical records were also reviewed for any urgent messages between visits. Primary endpoints were proportion of eyes with 1) breakthrough inflammation requiring escalation of anti-inflammatory therapy and 2) intraocular pressure (IOP) increase ≥ 10mmHg at 4-16 weeks follow-up. Secondary endpoints included incidence of intra-operative complications, cystoid macular edema, and infectious sequelae. Results: Three-hundred and fifty-eight patient charts (358 eyes) were screened. Of these, 262 eyes of 262 patients met criteria for inclusion in the study; 131 eyes received topical drops and 131 eyes received the intracanalicular insert. Amongst eyes that completed follow-up, 9 eyes (6.9%) in the drops group and 12 eyes (9.2%) in the insert group experienced breakthrough inflammation necessitating treatment (P = .50). Two eyes in the drops group and 1 eye in the insert group had elevated IOP. Conclusions: Postoperative inflammation prophylaxis with the intracanalicular insert may be associated with similar rates of breakthrough inflammation and IOP elevation as topical drops.
Keywords: inflammation prophylaxis / Efficacy / cataract / surgery / prednisolone / Postoperative inflammation / topical drops / intra / safety

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