In Clinic Optometrist Insertion of Dextenza (Dexamethasone Ophthalmic Insert 0.4mg) Prior to Cataract Surgery: The PREPARE Study.

Purpose: To evaluate the clinical outcomes with optometrist pre-surgical insertion of dexamethasone ophthalmic insert 0.4mg in the clinical office setting in patients undergoing same-day cataract surgery compared to standard of care steroid therapy. Methods: In this prospective, contralateral eye trial, one eye received a dexamethasone ophthalmic insert 0.4mg and the other received topical prednisolone acetate 1% four times per day for one week, then three times per day for one week, then two times per day for one week, and then one time per day for one week. At one day, seven days, and four weeks postoperatively mean anterior chamber cell score and mean anterior chamber flare score was assessed by Slit Lamp Biomicroscopy and pain score was assessed by Visual Analog Scale from 0-10. Incidence of increased intraocular pressure and cystoid macular edema were also assessed. Results: Thirty patients (60 eyes) participated. At one day postoperative there was no significant difference in mean anterior chamber cell score (p= 0.70) or pain score (p= 0.92). There was no anterior chamber cell flare observed in the study or control group. Of the 30 patients, 29 expressed a preference for dexamethasone inserts compared to topical prednisolone acetate. One patient in the study group had elevated intraocular pressure that resolved and there was no cystoid macular edema measured. Conclusion: In patients undergoing routine cataract surgery, there was an overwhelming preference for a dexamethasone insert compared to topical steroid drops. The dexamethasone insert produced similar ocular comfort and inflammation prevention compared to prednisolone acetate eyedrops. Dexamethasone inserts are a safe and effective treatment option for reducing pain and inflammation when inserted by an optometrist prior to routine cataract surgery.