The safety and efficacy of intra-canalicular dexamethasone insert for ocular pain and inflammation management post-cataract surgery: a systematic review and meta-analysis of randomized controlled trials.

Cataract surgery is often associated with postoperative inflammation and pain, which, if inadequately managed, can lead to complications such as macular edema, increased intraocular pressure, and delayed recovery. Topical corticosteroids are the standard treatment but are limited by poor patient adherence and administration challenges. The intracanalicular dexamethasone insert (DEXTENZA) offers a sustained, automated drug delivery platform that addresses these limitations. This systematic review and meta-analysis evaluated the efficacy and safety of DEXTENZA for managing postoperative pain and inflammation following cataract surgery. A comprehensive search of PubMed, Embase, Cochrane Library, Directory of Open Access Journals (DOAJ), and ClinicalTrials.gov-without date restrictions-identified four randomized controlled trials (RCTs) involving 985 participants The protocol was registered with PROSPERO (CRD42023457981). This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Meta-analysis demonstrated that DEXTENZA significantly reduced anterior chamber cell clearance (RR = 1.63, 95% CI = 1.27-2.08, P = 0.0001) by day 14 and improved pain resolution (RR = 1.59, 95% CI = 1.24-2.03, P = 0.0002) by day 8 compared to placebo. Adverse events, including non-serious and serious ocular incidents, were lower in the DEXTENZA group (RR = 0.57, 95% CI = 0.42-0.78, P = 0.0005). The sustained-release mechanism of DEXTENZA improves adherence and may offer practical advantages in postoperative management, particularly in patients with challenges using topical drops these findings support the use of intracanalicular corticosteroids as a promising alternative for managing postoperative pain and inflammation in cataract surgery patients.