ATARACT INTRACANALICULAR INSERT
Ophthalmic Inserts
Promising Alternatives to Eye Drops? by Konstantin Yakimchuk
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n ophthalmology, corticosteroids are widely used for postoperative control of pain and inflammation. While steroid-based supportive therapy aims to diminish ocular inflammation, it is potentially followed by a plethora of secondary complications including elevated intraocular pressure, glaucoma, slow tissue regeneration, pain and impaired vision.1 However, traditional eye drops may no longer satisfy ophthalmologists, since only a very small volume is actually delivered to the internal eye tissues — even if application recommendations are precisely followed.2 Moreover, liquid drainage through the nasolacrimal channel, reduced corneal permeability and blinking are natural barriers which diminish the efficiency of standard eye drops.3 Besides, eye drops are directly diluted by the tear film. Thus, novel methods of drug delivery to the intraocular tissues are, indeed, needed. One such technique has been described by Brooks et. al., from the Duke University Eye Center in Durham, North Carolina and University of Illinois at Chicago, Illinois, U.S., in the recent issue of Clinical Ophthalmology.4
Application of Intracanalicular SustainedRelease Dexamethasone A comprehensive review by Brooks et. al. described the applications of
For some patients, eye drops aren’t an option.
intracanalicular sustained-release dexamethasone (Dextenza, Ocular Therapeutix, Bedford, Maine, U.S.) to reduce postoperative ocular inflammation and pain. The review strongly advocates punctal plugs as an effective method to deliver therapeutic agents; while the dexamethasone intracanalicular insert might replace eye drops in near future due to clear advantages, such as continuous drug administration into the eyes.5 This method has been already approved by the Federal Drug Administration (FDA), especially for the suppression of postoperative inflammation. Dexamethasone has been efficiently used to inhibit postoperative inflammation and pain after ocular surgery.6 Moreover, it is well tolerated by ocular tissues.
To obtain an expert’s opinion on Dr. Brooks’ review, Dr. Harvey Uy, clinical associate professor of ophthalmology, University of the Philippines and medical director at Peregrine Eye and Laser Institute in Makati, the Philippines, was invited to comment on the study. According to Dr. Uy, therapeutic management after cataract surgery is primarily based on the proper control of postoperative surgery. Currently, the standard care approach implements the installation of topical drops with antibiotics and corticosteroids. Although this approach proved to be highly effective, poor compliance may cause complications and insufficient outcomes.
| May 2020
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