Comparative Analysis of Cystoid Macular Edema Incidence Following Cataract Surgery: Dextenza® vs. Topical Prednisolone Acetate
Poster #: 081
Session/Time: B
Author:
Zachary Goodrich, BS
Mentor:
Jennifer Schneider, MD
Research Type: Clinical Research
Abstract
INTRODUCTION:
Cataract surgery is one of the most common procedures in the United States, and while outcomes are generally favorable, cystoid macular edema (CME) remains a leading cause of suboptimal vision. To reduce CME risk, patients are often prescribed postoperative anti-inflammatory drops, typically corticosteroids and/or NSAIDs, for up to six weeks. However, adherence can be difficult for older patients due to drop frequency and instillation challenges. Sustained-release alternatives, such as the dexamethasone intracanalicular insert (Dextenza®), provide a "dropless" option by delivering medication over 30 days and dissolving without need for removal. The purpose of this study is to compare CME incidence following cataract surgery between patients treated with Dextenza® versus prednisolone acetate drops, and evaluate risk factors for CME.
METHODS:
A retrospective chart review was performed for all cataract surgeries at a single institution between January 4, 2022, and November 19, 2024. All surgeries were performed by one surgeon using standard technique. CME was diagnosed between weeks 2-8 postoperatively by fundoscopic exam or macular optical coherence tomography (OCT). Variables collected included treatment type, CME diagnosis, age, sex, race, intraocular pressure, diabetes status (with or without retinopathy), prostaglandin analog use, and visual acuity change. Chi-square tests were used for categorical variables and t-tests for continuous variables, with significance set at p<0.05. Inclusion criteria: Patients aged 18-89 undergoing phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation, treated with either Dextenza® or prednisolone as monotherapy. Exclusion criteria: Patients <18 or >89 years, those using additional anti-inflammatory drops, crossover between treatment groups, or incomplete/non-institutional follow-up.
RESULTS:
A total of 1,931 eye surgeries met inclusion criteria, with 716 (37.1%) treated with Dextenza® and 1,215 (62.9%) with prednisolone. The incidence of CME was 5.92% in the Dextenza® group and 4.47% in the prednisolone group, a difference not statistically significant (p=0.192). Within the prednisolone group, CME-positive patients were significantly older on average (p=0.038). Significant racial differences in CME incidence were observed between White and Black individuals in the prednisolone group (p<0.0001) and across both groups combined (p<0.0001). Among Dextenza®-treated patients with diabetes, those with retinopathy were more likely to develop CME (p=0.01). Prostaglandin analog use was associated with increased CME rates across both groups (p=0.01). Patients with prior CME in the fellow eye were significantly more likely to develop CME in both the Dextenza® (p=0.01) and prednisolone (p<0.0001) groups, as well as the combined cohort (p<0.0001). Mean intraocular pressure was higher in CME-positive patients in the Dextenza® group (p=0.029) and combined cohort (p=0.037). A history of CME was the strongest predictor of postoperative CME (OR 60.5, 95% CI 29.0-130.8, p<0.0001). Prostaglandin use at surgery was also associated with increased risk (OR 2.1, 95% CI 1.2-3.9, p=0.012). In CME-positive cases, the mean deviation in visual acuity from expected outcome was 0.21 LogMAR, equivalent to two Snellen chart lines.
CONCLUSION:
Dextenza® demonstrated comparable efficacy to prednisolone drops in CME prevention. Several demographic and clinical risk factors-including age, race, history of diabetic retinopathy, prostaglandin use, prior CME, and higher IOP-were associated with increased CME risk and warrant further investigation.
Cataract surgery is one of the most common procedures in the United States, and while outcomes are generally favorable, cystoid macular edema (CME) remains a leading cause of suboptimal vision. To reduce CME risk, patients are often prescribed postoperative anti-inflammatory drops, typically corticosteroids and/or NSAIDs, for up to six weeks. However, adherence can be difficult for older patients due to drop frequency and instillation challenges. Sustained-release alternatives, such as the dexamethasone intracanalicular insert (Dextenza®), provide a "dropless" option by delivering medication over 30 days and dissolving without need for removal. The purpose of this study is to compare CME incidence following cataract surgery between patients treated with Dextenza® versus prednisolone acetate drops, and evaluate risk factors for CME.
METHODS:
A retrospective chart review was performed for all cataract surgeries at a single institution between January 4, 2022, and November 19, 2024. All surgeries were performed by one surgeon using standard technique. CME was diagnosed between weeks 2-8 postoperatively by fundoscopic exam or macular optical coherence tomography (OCT). Variables collected included treatment type, CME diagnosis, age, sex, race, intraocular pressure, diabetes status (with or without retinopathy), prostaglandin analog use, and visual acuity change. Chi-square tests were used for categorical variables and t-tests for continuous variables, with significance set at p<0.05. Inclusion criteria: Patients aged 18-89 undergoing phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation, treated with either Dextenza® or prednisolone as monotherapy. Exclusion criteria: Patients <18 or >89 years, those using additional anti-inflammatory drops, crossover between treatment groups, or incomplete/non-institutional follow-up.
RESULTS:
A total of 1,931 eye surgeries met inclusion criteria, with 716 (37.1%) treated with Dextenza® and 1,215 (62.9%) with prednisolone. The incidence of CME was 5.92% in the Dextenza® group and 4.47% in the prednisolone group, a difference not statistically significant (p=0.192). Within the prednisolone group, CME-positive patients were significantly older on average (p=0.038). Significant racial differences in CME incidence were observed between White and Black individuals in the prednisolone group (p<0.0001) and across both groups combined (p<0.0001). Among Dextenza®-treated patients with diabetes, those with retinopathy were more likely to develop CME (p=0.01). Prostaglandin analog use was associated with increased CME rates across both groups (p=0.01). Patients with prior CME in the fellow eye were significantly more likely to develop CME in both the Dextenza® (p=0.01) and prednisolone (p<0.0001) groups, as well as the combined cohort (p<0.0001). Mean intraocular pressure was higher in CME-positive patients in the Dextenza® group (p=0.029) and combined cohort (p=0.037). A history of CME was the strongest predictor of postoperative CME (OR 60.5, 95% CI 29.0-130.8, p<0.0001). Prostaglandin use at surgery was also associated with increased risk (OR 2.1, 95% CI 1.2-3.9, p=0.012). In CME-positive cases, the mean deviation in visual acuity from expected outcome was 0.21 LogMAR, equivalent to two Snellen chart lines.
CONCLUSION:
Dextenza® demonstrated comparable efficacy to prednisolone drops in CME prevention. Several demographic and clinical risk factors-including age, race, history of diabetic retinopathy, prostaglandin use, prior CME, and higher IOP-were associated with increased CME risk and warrant further investigation.