The Advantages of Dropless Cataract Surgery

Evidence appears to support dropless prophylaxis after cataract surgery, noted Stewart Galloway, MD, an eye surgeon with Cookeville Eye Specialists in Cookeville, TN, during OSN New York 2018. 

Most clinical experience shows low rates of postop inflammation (just 2%) with the dropless approach. Additionally, rates of cystoid macular edema are very low vs traditional drop usage. Why? The traditional approach tends to lead to improper drop administration, including missing the eye, instilling the incorrect amount, contaminating the bottle tip, and failing to wash hands. There are also issues with dexterity, blink reflex, eye trauma, and the need for numerous medications and changed dosages. What’s more, drops are becoming cost-prohibitive for some patients. 

Meanwhile, dropless cataract surgery offerings the following advantages, said Dr. Galloway: 

• Minimal preoperative counseling required. 
• Less staff time reviewing drop regimen.
• No formulary restrictions.
• No pharmacy call-backs for substitutions or to verify dosage. 

Current approaches for dropless include: 

• Intracameral antibiotic combined with separate subconjunctival triamcinolone.
• Combination antibiotic and steroid into one intravitreal injection.

In the future, noted Dr. Galloway, these combinations will likely be available:

• Dexamethasone suspension and intracameral antibiotics.
• Dexamethasone punctal plug and intracameral antibiotics. 
• Additional sustained-release devices.

He concluded by debunking certain misconceptions about the dropless approach:

• Many think that drops will ultimately be required anyway, yet less than 5% of patients do. 
• Others note that cost can be excessive, but the average cost per patient is $20. 
• Compounded medications are thought to be risky, but this should not be an issue if you are working with a compounding pharmacy that is 503b FDA registered. 
• There is potential to damage the zonules, which could create new and significant problems. But such risk is minimal, noted Dr. Galloway. 

Galloway S . Dropless cataract surgery: Rationale, evidence, and technique. Talk presented at: OSN New York 2018; September 28-30, 2018; New York.