Managing patient noncompliance with eye drops is a daily struggle for the eye care professional. In fact, researchers found that 92% of cataract patients who had no previous experience with eye drops improperly administered their prescribed postoperative medications.1 Fortunately, several novel approaches to drug delivery are aimed at increasing treatment effectiveness and at reducing the drop burden for patients.
MAKING THE POSTOP PLAN EASY
The dexamethasone intraocular suspension 9% (Dexycu, EyePoint Pharmaceuticals) is an FDA-approved, single-dose, sustained-release intracameral steroid indicated for the treatment of postoperative inflammation (hereafter referred to as the intraocular suspension).
The intraocular suspension reduces the number of postoperative drops the patient is responsible for, partially mitigating noncompliance issues. According to the drug’s labeling, administration is directed into the posterior chamber inferiorly behind the iris at the end of ocular surgery. Recently, however, placement of the intraocular suspension into the capsular bag has been gaining favor because this positioning reduces the risk of migration into the anterior chamber and improves visualization of the drug depot.2 Should migration to the anterior chamber occur, the medication appears as a white sphere. Although this does not seem to have any deleterious effects to the eye, it does place the medication further from the target tissue (ciliary body and iris).
CLINICAL EFFICACY
In clinical trials, efficacy was evaluated in patients who received either the intraocular suspension or vehicle administered at the conclusion of intraocular surgery. The primary endpoint was complete clearance of anterior chamber cells by day 8. Sixty percent of patients receiving the intraocular suspension experienced complete cell clearance, compared to 20% of those in the placebo arm. Patients receiving the treatment also experienced less eye pain and corneal edema in the postoperative period.3 Recruitment is ongoing for a comparison of the intraocular suspension and topical steroids after cataract surgery.3
Elevation of IOP is a concern with any steroid used in an ophthalmic setting. The intraocular suspension demonstrated a statistically significant increase in IOP compared to placebo at day 1, but the rise was transient; IOP returned to baseline by day 3 and throughout the 90-day duration of the study.3 Caution should be exercised for patients with glaucoma and known steroid responders.
BREAKING DOWN BARRIERS
Novel drug delivery approaches that are not reliant on patient compliance improve the chances of achieving desired treatment outcomes. The intraocular suspension described here safely and effectively controls postoperative inflammation and reduces the treatment burden—a win-win scenario for doctor and patient.
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