Dexamethasone Intracanalicular Insert: A Review in Treating Post-Surgical Ocular Pain and Inflammation

Arnold Lee, Hannah A Blair, Arnold Lee, Hannah A Blair

Abstract

Dextenza®, an intracanalicular insert that is placed into the lower punctal opening of the eye, gradually releases dexamethasone for up to 30 days to alleviate pain and inflammation associated with ophthalmic surgery. A significantly higher proportion of patients treated with the dexamethasone intracanalicular insert than with the placebo insert had no pain at day 8 (co-primary endpoint, 7 days post-operation) across three pivotal phase III trials, and the inflammation co-primary endpoint (absence of anterior chamber cells) at day 14 (13 days post-operation) was met in two of three trials. Overall, the dexamethasone intracanalicular insert was effective and generally well tolerated for the treatment of post-surgical ocular pain and inflammation following cataract surgery. As low patient adherence is an issue for topical ophthalmic anti-inflammatory medications, the convenience (ease of insertion, single application with no patient input and typically no removal required) of the dexamethasone intracanalicular insert makes it a promising emerging option for the treatment of ocular inflammation and pain following ophthalmic surgery.

Conflict of interest statement

Arnold Lee and Hannah Blair are salaried employees of Adis International Ltd/Springer Nature, are responsible for the article content and declare no relevant conflicts of interest.

Figures

Fig. 1
Fig. 1
Design of phase III trials (OTX-13-002 [12], OTX-14-003 [12] and OTX-15-003 [13]) evaluating the efficacy of the dexamethasone intracanalicular insert in post-surgical ocular pain and inflammation as assessed by the absence of AC cells, with the proportion of patients achieving an absence of pain or AC cells reported in the animated figure (available online). Dotted outlines indicate follow-up visits if the insert is detected on day 60. *p ≤ 0.05 vs placebo in the respective trial. AC anterior chamber
Fig. 2
Fig. 2
Placement of the dexamethasone intracanalicular insert through the lacrimal punctum and into the lower canaliculus. Reproduced with permission from Ocular Therapeutix, Inc

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