Dexycu Intravitreal Implantation

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3 min read

In this installment of Interventional Mindset, Dr. Radcliffe presents a case of intravitreal implantation of Dexycu.

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.

Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.

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.

Nathan Radcliffe, MD
About Nathan Radcliffe, MD

Nathan M. Radcliffe, M.D. is a highly-experienced glaucoma and cataract surgeon.

Dr. Radcliffe graduated Alpha Omega Alpha from the Temple University School of Medicine and was named transitional resident of the year at the University of Hawaii in Honolulu. He was Chief Resident at New York University for his ophthalmology residency and Chief Glaucoma Fellow at the New York Eye and Ear Infirmary.

He was the Director of the Glaucoma Services at NYU and Bellevue hospital and currently, is part of the advanced Microincisional Glaucoma Surgery Center at New York Eye and Ear Infirmary. Dr. Radcliffe is unique because he is active in both academic and private practice settings. He is a microincisional glaucoma surgery (MIGS) innovator and instructor and has given lectures all over the United States.

Dr. Radcliffe was the first surgeon in New York to offer patients the CyPass Supraciliary Microstent, the Kahook Dual Blade Goniotomy, Visco 360 and Trab 360, the G6 micropulse laser, and Allergan’s Xen subconjunctival implant.

Dr. Radcliffe has managed some of the most difficult glaucoma and cataract cases from all over the world and is truly able to offer a tailored glaucoma and cataract surgery to his patients, being able to perform all of the available glaucoma surgeries that are currently FDA approved, and knowing the procedures and the efficacy and safety data well enough to correlate the optimal procedure with the patient’s disease.

Nathan Radcliffe, MD
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