Eyeworld

98 | EYEWORLD | MARCH 2021 G UCOMA Reference 1. Robin A, Covert D. Does adjunctive glaucoma therapy affect adherence to the initial primary therapy? Ophthalmolo- gy. 2005;112:863–868. Relevant disclosures Herndon: Ocular Therapeutix Radcliffe: Alcon, EyePoint Pharmaceuticals, Glaukos, Ocular Therapeutix Intravitreal Dexycu being delivered via pars plana injection in a patient receiving a PanOptix IOL (Alcon) Source: Nathan Radcliffe, MD of dexamethasone. When using an intracameral antibiotic, Dr. Radcliffe said the wounds need to be especially tight and well-sealed because the volume injected into the vitreous can cause a high positive pressure situation. There can also be temporary visual issues with the opaque solution. Dr. Radcliffe said some surgeons have had trouble with the placement of Dexycu, the sphere getting into the anterior chamber. As such, he said he's placed it into the periphery of the capsular bag or in the vitreous. He has also injected a little under the conjunctiva for ad- ditional surface anti-inflammatory therapy. He noted that these injection approaches are con- sidered off-label, though the drug is approved for after eye surgery. Dr. Radcliffe said he's found Dextenza and Dexycu helpful in cataract surgery plus MIGS cases, but he's also found it useful in traditional glaucoma surgeries. Dr. Herndon also said he has used Dextenza with trabeculectomy proce- dures but still prescribes a prednisolone acetate drop. "I'm hesitant to make [trabeculectomies] dropless because the inflammatory reaction is so much more potent in those patients," Dr. Herndon said. From an ocular surface standpoint, Dr. Herndon said taking away steroid and nonste- roidal drops that have preservatives in them is beneficial to glaucoma patients who could be particularly sensitive on the ocular surface. Reimbursement for these is a regional issue. Dr. Herndon said his staff preoperatively confirms patients who would be approved for Dextenza. He's found good coverage for Medi- care patients coming to Duke University for surgery. Dr. Radcliffe said if done on-label, the reimbursement landscape works for Dextenza and Dexycu. An intracameral antibiotic is out of pocket, but he said it is usually around $20. Dr. Radcliffe and Dr. Herndon said they haven't seen contraindications for patients receiving Dextenza or Dexycu. Even the concern of a steroid response in glaucoma patients with these options is minimal. Dr. Herndon said most steroid responses occur after 4–5 weeks. Both Dextenza and Dexycu last up to 30 days and taper over time, and neither have had steroid response issues with the products they use. "I find with Tri-Moxi [triamcinolone ace- tonide/moxifloxacin, ImprimisRx], Dexycu, and Dextenza, I can get most of my patients to have surgery without any eye drops, and that is a huge relief for my colleagues who are seeing them postoperatively and for my office staff who don't have to put in many prescriptions the day after a big surgery day," Dr. Radcliffe said. Dr. Radcliffe said that any surgeons who would like to discuss "in-the-bag" or intravitreal Dexycu techniques can contact him. Contact Herndon: leon.herndon@duke.edu Radcliffe: drradcliffe@gmail.com continued from page 97

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