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After cataract surgery, there are two main issues we try to control: preventing infection and controlling inflammation. Traditionally, we prescribed antibiotic eye drops to prevent infection, as well as steroid eye drops to control post-operative inflammation. But eye drops can be hard for some patients to put into their eyes. Now we have some alternatives to using drops after surgery.
There are some antibiotic solutions we can place inside the eye at the end of the cataract surgery that have been shown in most studies to do as good or better a job preventing infection as using antibiotic eye drops before and after surgery.
The FDA approved steroid delivery methods to reduce post-operative inflammation that have the potential to eliminate post-op steroid eye drops in most (but not all) patients who are undergoing cataract surgery. Two of these products are called Dexycu and Dextenza.
Dexycu is a white bolus of steroid medication that is injected inside the eye after cataract surgery. It will not be visible in most patients because it is injected behind the iris, or the colored part of the eye. It sometimes doesn’t stay behind the iris and you might see a small white dot in the eye initially after surgery. It is a sustained-released medication, which is absorbed over a couple of weeks and replaces the need for post-operative steroid drops.
Dextenza is a white pellet that is inserted into the lower punctum of the lid, which is the small opening for the drainage of tears. This insert is designed to deliver medication for up to 30 days. It is slowly absorbed and doesn't need to be removed. Similarly, it is usually not visible and does not cause any discomfort.
If you have either a Dexycu or Dextenza implant placed and an antibiotic medication is injected inside the eye after surgery, then you may be drop free after surgery. The main difference between the two steroid injections is that Dexycu is injected inside the eye while Dextenza is deposited outside the eye. For each of these newer options there is a chance that in your particular case there may still be too much inflammation and you might need to take eye drops for a while, but the majority of the time you would not need drops.
If you are going to have cataract surgery and would like to be drop free after the procedure, then ask your surgeon if you would be a candidate for a steroid implant.
Article contributed by Dr. Jane Pan.
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