This episode of Interventional Mindset features a surgical video with narration from Nathan Radcliffe, MD, discussing his technique for intravitreal
Dexycu implantation.
Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.
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What is Dexycu?
Dexycu (dexamethasone intraocular suspension 9%, EyePoint Pharmaceuticals) is the only FDA-approved single-dose, sustained-release intracameral steroid currently available on the market. Using patented Verisome Technology, Dexycu forms a dexamethasone “bubble” (spherule) when injected into the aqueous media, which tends to shrink in size as dexamethasone is released.
The indication for Dexycu is for the
treatment of post-operative inflammation; consequently, it can be a useful option for surgeons interested in providing patients with a temporary hiatus from eye drops while reducing inflammation following ocular surgery.
Surgical pearls for intravitreal Dexycu implantation
Following cataract extraction, Dr. Radcliffe hydrates the main wounds and asks an ophthalmic technician to have Dexycu drawn up into a 1cc syringe with a 30 gauge needle. He highlighted that reasonable wound firmness is required for intravitreal implantation. Once the syringe is ready, Dr. Radcliffe will move 3mm posterior to the limbus, as is necessary for any intravitreal injection, and then will place the Dexycu inferiorly.
Dr. Radcliffe explained that because dexamethasone tends to settle inferiorly, if he leaves the implanted spherule in the inferior vitreous, it will stay
further out of view for the patient. Anecdotally, as of yet, none of Dr. Radcliffe’s patients have reported floaters from Dexycu after placing the spherule. While injecting, he adds a slightly larger amount of Dexycu than would typically be inserted into the sulcus since the vitreous is a larger cavity.
Subconjunctival Dexycu implantation
Switching anatomical injection sites, Dr. Radcliffe will use 0.12 forceps for a subconjunctival or subtenon Dexycu placement, which he places superiorly, where the patient will not notice it. Due to the superior placement and the white coloration of Dexycu, the patient will likely not be able to visualize the medication. Further, Dexycu tends to resorb in approximately 1 week. In his professional experience, the patient might only notice slight blanching at the injection site after surgery.
Final protocol thoughts
Antibiotic prophylaxis following cataract extraction is a cornerstone of his surgical protocol, where Dr. Radcliffe builds in an injection of intracameral moxifloxacin along with subconjunctival Solu-Medrol (methylprednisone, Pfizer) and ANCEF (cefazolin, GlaxoSmithKline). This marks the completion of cataract surgery and
Dexycu implantation per Dr. Radcliffe’s personalized protocol.
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.
