Eyeworld

Supported by an unrestricted educational grant from EyePoint Pharmaceuticals, ImprimisRx, Ocular Therapeutix, and Omeros DECEMBER 2019 | SUPPLEMENT TO EYEWORLD | 3 Intracameral dexamethasone helps overcome adherence obstacles By Eric Donnenfeld, MD P atient adherence issues to drop regimens after cataract surgery decrease postop medication effi- cacy and can adversely impact patients' surgical outcomes. A newly approved prod- uct—a novel, bioabsorbable, intracameral dexamethasone drug delivery suspension—can clear this stumbling block. Delivery system I gained experience with this new treatment option through FDA clinical trials. In the trials and in prac- tice, we found that when you enter at 180 degrees and pull back slowly, the dexamethasone suspension often ends up in the anterior chamber. This is common and not a problem, but it is preferable to place it behind the iris. We developed a simple technique that is performed after the cataract procedure is completed. It's critical to hydrate the main wound so it does not leak. Wound leaks are a significant problem; when the wound leaks, it draws the dexa- methasone suspension out of the eye. It is also important to remove all of the viscoelastic. As the second-to-last step in the procedure, we inject intracameral moxifloxacin through the side port incision, filling the anterior chamber. As the final step, we use a 25-gauge cannula, taking a small volume of dexamethasone (0.005 ml), entering through the incision or paracentesis, 120 degrees across, directly behind the iris. It forms a surface ten- sion-based sphere. We rotate it to the side, allowing the bubble of dexamethasone to scrape against the posterior iris, where it is captured and usually stays. Another successful tech- nique is to place the cannula under the iris as close to the iris root as possible. Then, pull back quickly, leaving the dexa- methasone behind. Whichever technique you choose, place the cannula paral- lel to the iris and don't gape the corneal wound. Therapeutic levels are maintained for as long as 21 days with one administration. In the first clinical trial, we examined two different doses compared with placebo. 1 Both doses showed significant improvement of inflammation. There was not a significant difference between treatment groups in anterior chamber postop complications can occur as a result of nonadherence with a topical regimen. Intra- cameral dexamethasone allows us to administer a precise dose, avoid systemic absorption and topical toxicity, and overcome obstacles to adherence. n References 1. Donnenfeld ED, et al. Dexameth- asone intracameral drug-delivery suspension for inflammation associat- ed with cataract surgery: a random- ized, placebo-controlled, phase III trial. Ophthalmology. 2018;125:799–806. 2. Donnenfeld ED, et al. Safety of IBI-10090 for inflammation associ- ated with cataract surgery: phase 3 multicenter study. J Cataract Refract Surg. 2018;44:1236–46. Dr. Donnenfeld practices with Ophthalmic Consultants of Long Island and Connecticut and is a clinical professor of ophthalmology at New York University and a trustee at Dartmouth Medical School. He can be contacted at ericdonnenfeld@ gmail.com. Eric Donnenfeld, MD cell and flare, corneal clarity, or endothelial cell counts. A subsequent clinical trial compared intracameral dexa- methasone with topical pred- nisolone acetate administered 4 times per day. 2 At day 8, there was no difference in anterior chamber cell clearing between prednisolone acetate 4 times a day vs. intracameral dexameth- asone used without corticoste- roids. Patient response New drug delivery systems are meeting a major unmet need. I estimate that 20% of patients physically cannot use drops. In the intracameral dexamethasone group, 69% of patients agreed that not having eye drops was very convenient. 2 I am pleased with the dexamethasone intraocular suspension because it guaran- tees compliance and gives the surgeon control. A surgeon may perform a perfect surgery, but Dexamethasone suspension in the anterior chamber

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