The burden of eye drops is a leading cause of post-surgical noncompliance and compromised results. Dexycu (dexamethasone, 9% intracameral suspension, EyePoint Pharmaceuticals) offers surgeons an alternative that can release patients from a portion (and potentially all) of their drop responsibility.
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What is Dexycu?
Injected at the time of surgery, Dexycu is indicated for post-operative inflammation and delivers a continuous dose of dexamethasone directly to the site of inflammation for as long as 30 days. Once the Dexycu insertion technique has been mastered by the surgeon, it typically does not impact the safety of the surgery.
Surgical pearls for Dexycu implantation
To ensure Dexycu is placed in the proper position, which is critical, Dr. Radcliffe chose to make a capsulotomy with a landing space for the Dexycu bubble. He then placed the Dexycu either in the capsular bag or on the intraocular lens (IOL) in a peripheral location out of the visual axis, but towards the edge of the capsule.
Increased intraocular pressure (IOP), corneal edema, and iritis can be the most common side effects. In Dr. Radcliffe’s surgical experience, he has not encountered issues with clogged stents or IOP spikes when adding Dexycu to cataract surgery and microinvasive glaucoma surgery (MIGS). On the contrary, he has observed impressive IOP control after the procedure in the vast majority of my glaucoma patients.
Patient education on Dexycu
In Dr. Radcliffe’s practice, he found that with the proper education, patients can be very amenable to Dexycu. They have already committed to either cataract surgery, a MIGS procedure, or both, so being given the option of complementary therapy to reduce their eye drop regimen might be very appealing.
In his professional opinion, this has been the primary selling point. Dexycu can reduce or eliminate the need for an anti-inflammatory topical steroid post-cataract surgery. In addition, depending on the surgeon's practice pattern, it can also limit the need for off-label intracameral or intravitreal antibiotics.
To garner further confidence, Dr. Radcliffe pointed out that Dexycu has been through rigorous trials and has been one of the very few injectable FDA-approved therapies for treating post-operative inflammation after cataract surgery. He stressed that patients will be receiving a therapy that has likely undergone more study and research than even many of the standard-of-care medications (e.g., prednisolone acetate).
Dr. Radcliffe always makes the patient aware that there is an off chance a portion of the drug spherule, which some say resembles a small pearl, may be visible to either them or a friend/family member after the surgery. Explain this “pearl” will be supplying the continuous release of medication and assure them it will dissolve and thus no longer be visible over time.
Dexycu during the time of COVID-19
During the early stages and peak of COVID-19, Dr. Radcliffe witnessed the value of Dexycu firsthand when his office was forced to close at the beginning of the pandemic. Knowing that a dose of Dexycu was keeping their inflammation under control, he did not have to worry about cataract surgery patients being unable to come in for follow-up or having them take the risk of going to a pharmacy to pick up eye drops.
With Dexycu, he was able to prepare for the unexpected and allow for the opportunity to potentially improve his patients’ surgical outcomes.
In closing
In summary, for individuals undergoing cataract surgery, MIGS, or a combination thereof, Dexycu has proven incredibly valuable in the hands of Dr. Radcliffe. By reducing the drop burden and, by extension, improving compliance, he has seen better overall results and happier, more satisfied patients.
Disclaimer: Dexycu (dexamethasone ophthalmic suspension) 9% from EyePoint Pharmaceuticals, is an injectable, single-dose sustained-release medication indicated for the treatment of post-operative inflammation. The medical opinions and views expressed in this article are those of Nathan Radcliffe, MD.
