Eyeworld

APRIL 2020 | EYEWORLD | 89 G D exycu (dexamethasone intraocular suspension, EyePoint Pharmaceuti- cals) and Dextenza (dexamethasone ophthalmic insert, Ocular Therapeu- tix) both received FDA approval in 2019. While they are both approved for the treatment of postoperative inflammation, they are most thought of in association with cataract surgery. Of note, both products are not contraindicated in glaucoma but contain a label warning that prolonged use of steroids can be associated with elevated IOP and that IOP should be monitored in patients using steroids. Inder Paul Singh, MD, and Nathan Radcliffe, MD, shared how they've been using these products to calm inflammation in a variety of procedures. "A very simplistic way to look at it is wherever you use a steroid, you could use these products," Dr. Singh said. Dexycu and Dextenza can reduce or elim- inate the need for topical steroid drops, Dr. Singh said. Because Dexycu is an injection, Dr. Singh and Dr. Radcliffe said they use it for intraocu- lar surgeries, such as tube shunt surgery, IOL exchange, standalone and combined MIGS procedures, and pupilloplasty, to name a few. "One thing people worry about is does Dexycu clog the stent; it does not," Dr. Rad- cliffe said, referencing stenting procedures for glaucoma. "I would say you could think of Dexycu for any intraocular surgery you're doing." Dr. Singh said Dexycu is advantageous because you don't have to worry about absorp- tion into the eye. He said people with significant risk factors for inflammation, such as epiretinal membrane, CME, diabetic retinopathy, rheu- matoid arthritis, autoimmune conditions, or past uveitis, could benefit. One of the negatives of Dexycu is you can't remove it if a negative response occurs. Removability, however, is one of Dexten- za's advantages. Dr. Singh said he uses Dexten- za for canaloplasty, goniotomy, subconjunctival surgery with the XEN Gel Stent (Allergan) or tube shunts, and pterygium surgery. He has found a significant benefit for the ocular surface preoperatively before taking measurements for cataract surgery and for optimizing the ocular surface before subconjunctival surgery. Dr. Radcliffe also said Dextenza makes sense for conjunctival surgeries, pterygium, and glaucoma tube shunt surgeries. Dr. Singh mentioned a study that looked at use of Dextenza before XEN surgery; there is a J code that allows Dextenza to be placed in the office. Anecdotally, he said the outcomes thus far are no different than those on topical Using Dextenza and Dexycu outside of cataract surgery Dexycu placement Source (all): Inder Paul Singh, MD Dextenza placement by Liz Hillman Editorial Co-Director About the doctors Nathan Radcliffe, MD Associate clinical professor New York Eye and Ear Infirmary New York, New York Inder Paul Singh, MD The Eye Centers of Racine & Kenosha Racine and Kenosha, Wisconsin Relevant disclosures Radcliffe: EyePoint Pharmaceuti- cals, Ocular Therapeutix Singh: Allergan, Bausch + Lomb, Kala Pharmaceuticals, EyePoint Pharmaceuticals continued on page 90

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