Dropless regimen after cataract surgery relieves patient treatment burden

A dropless regimen, moxifloxacin is a safe and effective alternative to topical medications to reduce pain, inflammation, and infection following cataract surgery.

This article was reviewed by Eric Donnenfeld, MD

Patients expressed a strong preference for a dropless medication regimen after cataract surgery compared with a conventional regimen of topical medications. In addition to the obvious convenience of not instilling eye drops multiple times a day for up to four weeks postoperatively, there was no significant difference in pain or inflammation when the two regimens were compared and the dropless regimen was less expensive, according to Eric Donnenfeld, MD, John Hovanesian, MD, and Chad Hummel, MD.

The dropless regimen is comprised of dexamethasone ophthalmic insert, 0.4 mg (Dextenza, Ocular Therapeutix), ketorolac and phenylephrine (Omidria, Omeros Corp.), and intracameral moxifloxacin 500 mcg, all of which are in a punctal plug that is inserted at the end of surgery.

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The conventional regimen included the standard topical regimen of prednisolone acetate 1% administered four times daily for two weeks and then twice daily for two weeks, moxifloxacin 0.5% administered four times daily for 10 days, and ketorolac administered four times daily for four weeks.
 

The study
The investigators conducted a randomized, self-controlled, prospective clinical study to compare the standard (control) and dropless regimens (experimental) for safety and ocular efficacy for controlling postoperative ocular pain, inflammation, and infection associated with cataract surgery.

A total of 56 patients (25 men, 31 women) were included in the study. Each patient underwent sequential bilateral cataract surgery two weeks apart and were randomly treated with the dropless regimen in one eye and the standard topical regimen in the fellow eye.

Dr. Donnenfeld reported that no significant differences were seen at any postoperative time points in the two groups in cell and flare, postoperative pain, best-corrected visual acuity, or macular thickness at two weeks, one month, and two months after cataract surgery.

No cases of endophthalmitis or cystoid macular edema developed in either group. Two patients in the dropless group required rescue topical prednisolone acetate 1% for inflammation and one patient in the standard drop treatment had rebound iritis requiring additional prednisolone acetate 1%. Six patients in the topical medication study developed significant superficial punctate keratitis (SPK). No endophthalmitis or cystoid macular edema developed in the topical group.

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When patients were questioned about which eye regimen they preferred, 96% (P<0.0001) of patients chose the eye randomized to the dropless regimen. Two of 56 patients preferred the standard topical regimen.

The investigators reached the following conclusions. Compared with a traditional eyedrop regimen, patients receiving Dextenza/Omidria + intracameral moxifloxacin expressed a strong preference for the dropless regimen.

No significant differences were seen in pain and the summed ocular inflammation score. No endophthalmitis developed in either group.

The dropless group significantly reduced the out-of-pocket expenses for the patients. Because the dropless regimen contains a preservative-free corticosteroid, there was less SPK and no medication toxicity,

“Dropless intracameral and punctal plug delivery medications following cataract surgery are a safe, preservative free and efficacious alternative to traditional topical medications increasing compliance, improving the ocular surface, and benefiting social distancing,” Dr. Donnenfeld concluded.

Eric Donnenfeld, MD
E: ericdonnenfeld@gmail.com
Eric Donnenfeld is founding partner, Ophthalmic Consultants of Long Island and Connecticut, Clinical Professor of Ophthalmology at New York University, and a Trustee of Dartmouth Medical School, Hanover, NH. John A. Hovanesian, MD, is clinical assistant professor at the University of California Los Angeles, Jules Stein Eye Institute. Chad Hummel, MD, is in private practice in Massapequa, NY. All authors reported being consultants to Ocular Therapeutix, which funded the study.