Dropless Cataract Surgery: A Review of the Literature.

Abstract

Cataract surgery is one of the most performed surgeries worldwide, often necessitating postoperative eye drops to manage infection, inflammation, and pain. However, complex regimens, patient adherence challenges, and environmental concerns have led to growing interest in "dropless" cataract surgery, which eliminates or reduces the need for postoperative drops by delivering medications intraoperatively through injections or drug-eluting implants. This review provides an overview of dropless cataract surgery, focusing on common medications used including antibiotics, steroids, nonsteroidal anti-inflammatory drugs, and intraocular pressure medications. Intracameral antibiotic use has become widespread, with strong evidence showing that it effectively reduces the risk of postoperative endophthalmitis without the need for additional topical antibiotics. Steroids, typically delivered through subconjunctival injections or sustained-release implants, show promise in safely and effectively controlling inflammation, though further research is needed to validate fully dropless approaches. Nonsteroidal anti-inflammatory drugs and intraocular pressure medications are less frequently included in dropless regimens, with mixed evidence regarding their impact on long-term outcomes. For patients, dropless cataract surgery can help simplify postoperative care and potentially lower out-of-pocket costs. For health systems, recent analyses suggest dropless surgery could reduce overall costs and decrease environmental waste by reducing consumption of eye drop bottles. Future research should focus on assessing true dropless approaches and optimizing medication delivery. Overall, dropless cataract surgery offers many potential benefits for patients, health systems, and the environment. Additional high-quality evidence substantiating these benefits would help advance its adoption globally.