In this installment of Interventional Mindset, Dr. Nathan Radcliffe reviews intra-operative surgical pearls for placing Dexycu during glaucoma and cataract surgery.
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 can Dexycu offer cataract and glaucoma surgeons?
As a glaucoma and cataract surgeon, Dr. Radcliffe noted that many of his glaucoma patients are on multiple eye drops. To reduce their medication burden, he began to adopt early on Dexycu (dexamethasone intraocular suspension 9%, EyePoint Pharmaceuticals) at the time of cataract surgery (and oftentimes cataract surgery with microinvasive glaucoma surgery [MIGS]).
Anecdotally, he found that following the implantation of Dexycu, there was a reduced need to employ steroid drops following cataract surgery for many of his patients. Further, he observed in certain patients a reduction in intraocular pressure (IOP). Most importantly, Dr. Radcliffe also found enhanced outcomes in his MIGS procedures allowing him to taper down glaucoma medications which potentially helped to improve his patients’ compliance and in extension quality of life.
Intra-operative pearls for Dexycu implantation
Dr. Radcliffe highlighted that although Dexycu is a medication, it is also a surgical technique, in which you place a small “bubble” of dexamethasone into the eye. To maintain quality control within his cataract outcomes, it is imperative to place Dexycu in the appropriate position. Through discussions with colleagues and shadowing other surgeons, Dr. Radcliffe evolved his Dexycu implantation skill set to what it is today.
His technique involves placing 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. The goal of the procedure is to make a capsulotomy with a landing space for the Dexycu bubble.
While performing the cataract extraction, Dr. Radcliffe would make a slightly large rhexis to ensure space for where the Dexycu can be placed on the anterior optic in a location where the capsulorhexis will not be close by. Similarly, he noted that you can place Dexycu peripheral to the optic in the bag.
Attaching Dexycu to the IOL during cataract surgery
He remarked that he hasn’t encountered issues with clogged stents or IOP spikes when adding Dexycu to cataract surgery and MIGS, and, instead, he has observed impressive pressure control after the procedure in patients without a need to prescribe additional topical steroids, which can be a relief if they are already on multiple glaucoma medications.
After completing the MIGS portion of the cataract surgery, Dr. Radcliffe likes to keep the anterior chamber well-formed to prevent any bleeding. Once the stents have been placed, he starts to seal the wounds and also uses a small amount of MIOSTAT (carbachol intraocular solution 0.01%, Alcon), as well as intracameral moxifloxacin to again reduce the necessity for patients to be prescribed additional topical treatments including antibiotics post-operatively.
Dr. Radcliffe highlighted that the goal is for the chamber to be firm so that when the Dexycu is inserted with the cannula, he doesn’t have to worry about the anterior chamber losing shape or having aqueous escape through any of the wounds. Then, the Dexycu is delivered onto the IOL in the periphery of the capsular bag.
Conclusion
When the surgical technique becomes consistent, the ideal placement for Dexycu would be to adhere to the IOL optic, positioned in the peripheral optic, or in the capsular bag adjacent to the optic. By landing Dexycu in these particular spaces, the surgeon can maintain superior control over positioning and potentially minimize complications at the end of the cataract surgery.
Additionally, patients will likely have improved surgical outcomes with these preferred locations for Dexycu as it releases the dexamethasone to reduce pain and inflammation following ocular surgery.
