Eyeworld

42 | EYEWORLD | OCTOBER 2019 R EFRACTIVE PHARMACEUTICAL FOCUS Contact information Berdahl: john.berdahl@vancethompsonvi- sion.com Stephens: david.stephens@tysoneye.com by Maxine Lipner EyeWorld Senior Contributing Writer surgery. It also helps circumvent dependence on patient compliance. David Stephens, MD, views Dextenza as particularly helpful for patients who are at risk for more inflammation than normal, 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 it dry. Dextenza swells imme- diately when it comes in contact with water, which would make it difficult to insert. T he FDA-approved drug-eluting punc- tal plug Dextenza (dexamethasone, Ocular Therapeutix) is now being used by cataract practitioners hoping to alleviate some of the postoperative drop burden for patients, accord- ing 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 lower pain and inflammation as- sociated 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 surgery or in the office, and it 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 itself so patients get the benefits of a punctal plug and better lubrication of the eye after cataract Plugging cataract patients into Dextenza use The Dextenza plug is placed into the tear duct, usually at the time of cataract surgery. Source: John Berdahl, MD About the doctors John Berdahl, MD Vance Thompson Vison Sioux Falls, South Dakota David Stephens, MD Tyson Eye Fort Myers, Florida Reference 1.Tyson SL, et al. Multicenter randomized phase 3 study of a sustained-release intracanalic- ular dexamethasone insert for treatment of ocular inflamma- tion and pain after cataract surgery. J Cataract Refract Surg. 2019;45:204–212. Relevant financial interests Berdahl: None Stephens: Ocular Therapeutix

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