Patients Prefer Insert to Conventional Anti-Inflammatory Drops

Patients overwhelmingly prefer an intracanalicular insert to a topical steroid drop regimen after undergoing cataract surgery, according to research presented at the American Academy of Optometry 2022 conference, held October 26 to 29 in San Diego, CA. The presentation reviewed the work published in Clinical Ophthalmology. 

The investigators — based in the Sioux Falls, SD, location of Vance Thompson Vision — included Mitch Ibach, OD, Larae Zimprich, OD, and Douglas Wallin, OD. The researchers included 60 eyes of 30 patients who underwent routine, uncomplicated bilateral cataract surgery. In 1 eye (considered the control eye), each patient was given topical prednisolone acetate 1% dosed 4 times a day for 1 week, 3 times a day for the next week, twice a day for the next week, and once a day for 1 more week. In the other eye (the experimental eye), they received a dexamethasone ophthalmic insert 0.4 mg, placed in-office by an optometrist, prior to cataract surgery. 

The researchers evaluated the effect of the insert through week 4 using mean anterior chamber cell flare score as measured by slit lamp biomicroscopy. As secondary endpoints, they considered the patients’ responses to the Comparison of Ophthalmic Medications and Tolerability (COMToL) questionnaire

In the first day after the surgery, clinicians noted no significant differences in either mean anterior chamber cell score (P =.70) or pain (P =.92) and no anterior chamber cell flare in either group. A single patient experienced elevated intraocular pressure that resolved without cystoid macular edema.

However, the patient experience shows a notable difference. Of the 30 patients, 29 said they preferred the dexamethasone inserts to the topical prednisolone acetate. 

The investigators speculate that relative ocular surface comfort was at least partially responsible for this patient preference. “In addition to the sustained dexamethasone release, another hypothesized benefit of a punctal plug is the benefits for the tear film. Preservatives found in eyedrops and ocular surgery can cause disruption to tear film which leads to vision and ocular symptoms. Dexamethasone intracanalicular inserts do not contain preservatives and this eliminates one source of ocular surface toxicity,” according to the researchers.

The study’s small sample size is a recognized limitation.