Presentations

Abstract

Introduction: Cataract surgery is one of the most common surgical procedures in the United States. Although outcomes are typically positive, there are several well described complications that may arise following surgery. Cystoid macular edema (CME) is one of the most common causes of poor visual outcome following cataract surgery. To ward against this, prophylactic treatment with anti-inflammatory ophthalmic medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and/or corticosteroids is administered in postoperative cataract patients. This standard drop therapy can last up to six weeks and requires a diligent daily schedule to stay on top of medication intervals. While this has been the standard for years, many patients struggle to instill eye drops for one reason or another. Because of this burden, new "drop-less" regimes have offered alternatives to surgeons and their patients. One dropless option, Dextenza®, releases dexamethasone after the insert is placed in the intracanalicular space of the patient at the time of cataract surgery. This alternative can at least eliminate one of the more burdensome ophthalmic drops patients typically have to use. Dextenza® stays active over the course of 30 days following surgery and then dissolves without requiring further intervention. The purpose of this report is to examine the rates of cystoid macular edema in patients treated with Dextenza® over the calendar year of 2023.

Methods: We performed a nonrandomized, nonblinded retrospective chart review of patients with visually significant cystoid macular edema from January 1, 2023 to December 31, 2023. All surgeries were performed by the same surgeon with standard technique. Data included patients between the ages of 18 and 89 years old who underwent phacoemulsification and posterior chamber intraocular lens placement and were subsequently treated with Dextenza®. All patients under the age of 18 and over the age of 89 as well as anyone who received corticosteroid or NSAID ophthalmic eye drops in place of or in conjunction with Dextenza® treatment were excluded. Patients who received their postoperative care at any other facility or those with incomplete documentation due to reasons such as non-adherence of at least one month of follow-up appointments were also excluded. The diagnosis of cystoid macular edema was made by one of six providers including ophthalmologists and optometrists. A positive diagnosis was suspected based on poor visual acuity in relation to the expected outcome. CME was then confirmed via fundoscopic exam and/or macular optical coherence tomography between the 2-8-week postoperative interval following cataract surgery of the affected eye.

Results: After screening for eligibility as stated, a total of 151 individuals and 245 eyes were included in our study and analyzed. 14 eyes (5.7%) from 10 different patients were diagnosed with cystoid macular edema during the postoperative interval. 11.2% of males in the study developed CME while only 2.8% of females did. The majority of eyes included in this study were of White patients, while Black and Hispanic patients were represented at lower rates. Of these patients, CME was diagnosed in 6.6% of eyes in White patients and 4.4% of eyes of Black patients. No Hispanic patients developed CME. In addition, eyes of previously diagnosed diabetic patients with no history of diabetic retinopathy developed CME at a rate of 4.5%. In eyes with a past history of diabetic retinopathy, 12.5% were diagnosed with CME. Non-diabetic patients' eyes had a rate of 6.1%. The mean intraocular pressure was 16.0 mm Hg for individuals with CME and 14.9 mm Hg for those who were not diagnosed. Of the eyes diagnosed with CME, the average visual acuity change between expected outcome and actual outcome was 0.2 using the LogMAR scale. This correlates to a change in two lines of letters on the Snellen chart.

Conclusion: This is a multi-part project reviewing patients from a single institution who underwent cataract surgery. Future projects will look to examine CME rates in patient populations treated with standard drop therapy and/or a combination of therapies. With the examination of other therapies, we will be able to more effectively conclude whether or not Dextenza® is on par with standard treatment options. Results to date demonstrate that Dextenza® is an effective treatment option that provides prophylactic treatment in addition to decreasing the burden of instilling eye drops.