Intracanalicular Dexamethasone Insert for Post-Corneal Cross-Linking Inflammation and Pain - The LINK Study.

Abstract

There is no standard-of-care treatment regimen for post-corneal crosslinking (CXL) inflammation & pain. This study compared efficacy of intracanalicular dexamethasone insert to tapered topical steroid over 28 days post-CXL. Single-private practice, outpatient setting. Prospective, observational, randomized study. This prospective, randomized study investigated the efficacy of a dexamethasone intracanalicular insert on post-CXL pain and inflammation in progressive keratoconus patients. Twenty patients (40 eyes) were enrolled; half were randomized to the dexamethasone intracanalicular insert group; half were prescribed a 28-day topical tapering steroid regimen. All patients were evaluated for pain scores, rate of re-epithelialization, ease of post-CXL regimen & need for rescue pain medication following standard bilateral epithelium-off CXL on postoperative day (POD) 1, POD-3, POD4-7, postoperative week (POW)-1, POW2, POW3 and POW4. Twenty patients (40 eyes) underwent standard-of-care epithelium-off bilateral CXL for progressive keratoconus. Ten patients were randomized to receive prednisolone eye drops on a tapering schedule post-CXL; 10 patients received dexamethasone intracanalicular inserts at the time of CXL. Regardless of postoperative steroid regimen, there was no significant difference in rate of re-epithelialization or use of rescue pain medication between groups. There was a nominal, however statistical difference in pain scores between groups, favoring prednisolone eye drops. Both groups stated no difficulty in following postoperative regimens. There were no adverse events noted in relation to treatment or CXL procedure. Utilizing a dexamethasone insert to alleviate pain and inflammation can be considered as a safe and efficacious part of a post-CXL regimen.