Dropless cataract surgery: modernizing perioperative medical therapy to improve outcomes and patient satisfaction

Abstract

Purpose of review Advances in pharmacology offer freedom from topical medical therapy without compromise of anti-inflammatory and antimicrobial coverage in the perioperative period. In this review, we describe the basis for dropless cataract surgery with the goal of improving outcomes and the patient experience. Recent findings Phacoemulsification outcomes depend largely on surgeon skill but also on adherence to a complex multidrug regimen of perioperative anti-inflammatory and antimicrobial therapy to prevent sight-threatening complications such as cystoid macular edema or endophthalmitis. Successful administration of this regimen can be limited by noncompliance, difficulty administering eye drops, bioavailability, and side effects, among others. The recent development of sustained-release formulations of dexamethasone – one an intracanalicular insert and the other an intraocular suspension – can provide sustained tapering doses of dexamethasone while reducing or eliminating the need for anti-inflammatory eye drop therapy. Similarly, mounting evidence compellingly demonstrates that intracameral antibiotic use intraoperatively is at least as effective as topical antibiotics in preventing endophthalmitis. Summary Sustained-release dexamethasone coupled with intracameral antibiotics at the time of phacoemulsification can provide antimicrobial and anti-inflammatory prophylaxis without the need for topical eye drop medications. This approach has the potential to improve compliance with therapy, visual acuity outcomes, and the overall patient experience.

Same-Day versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

“…This approach-utilizing intracameral antibiotics and sustained-release steroid products-has been advocated by multiple surgeons as an important step forward in optimizing therapeutic efficacy and postoperative quality of life in patients undergoing the most commonly performed outpatient surgery in adults in the United States. [10][11][12][13] Replacing self-administered topical therapy with surgeonadministered therapy reduces risks associated with improper instillation technique and eliminates nonadherence, resulting in better efficacy, safety, and quality of life outcomes. These attributes of sustained dexamethasone delivery with the intracanalicular insert are valued by both physicians and patients.…”

“…9 Multiple large-scale studies of intracameral antibiotics at the end of surgery have challenged the necessity of postoperative topical antibiotics, and the recent commercialization of 2 sustained-release formulations of dexamethasone-an intracanalicular insert containing dexamethasone (Dextenza (Dextenza, Ocular Therapeutix, Bedford, MA) and an intraocular dexamethasone suspension (Dexycu, dexamethasone 517 µg, EyePoint Pharmaceuticals, Watertown, MA)-has similarly challenged the need for topical dosing of corticosteroids postoperatively, leading many surgeons to propose a paradigm shift to dropless cataract surgery. [10][11][12][13] The intracanalicular insert is a polyethylene glycol hydrogel rod impregnated with 0.4 mg of preservativefree dexamethasone, conjugated with fluorescein for visualization, that is inserted through the punctum into the inferior or superior canaliculus. Upon hydration, the insert swells and self-anchors, dissolving over time with sustained and tapered delivery of dexamethasone for up to 30 days.…”

Same-Day Versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

“…This approach-utilizing intracameral antibiotics and sustained release steroid products-has been advocated by multiple surgeons as an important step forward in optimizing therapeutic e cacy and postoperative quality of life in patients undergoing the most commonly performed outpatient surgery in adults in the United States. [10][11][12][13] Replacing self-administered topical therapy with surgeon-administered therapy reduces risks associated with improper instillation technique and eliminates nonadherence, resulting in better e cacy, safety, and quality of life outcomes.…”

“…9 Multiple large-scale studies of intracameral antibiotics at the end of surgery have challenged the necessity of postoperative topical antibiotics, and the recent commercialization of 2 sustained-release formulations of dexamethasone-an intracanalicular insert containing dexamethasone (Dextenza, (Dextenza, Ocular Therapeutix, Bedford, MA) and an intraocular dexamethasone suspension (Dexycu, dexamethasone 517 µg, EyePoint Pharmaceuticals, Watertown, MA)-has similarly challenged the need for topical dosing of corticosteroids postoperatively, leading many surgeons to propose a paradigm shift to dropless cataract surgery. [10][11][12][13] The intracanalicular insert is a polyethylene glycol hydrogel rod impregnated with 0.4 mg of preservativefree dexamethasone, conjugated with uorescein for visualization, that is inserted through the punctum into the inferior or superior canaliculus. Upon hydration, the insert swells and self-anchors, dissolving over time with sustained and tapered delivery of dexamethasone for up to 30 days.…”

Classification Tree to Analyze Factors Connected with Post Operative Complications of Cataract Surgery in a Teaching Hospital

“…Phacoemulsification, with concomitant intraocular lens (IOL) implant, is the current standard technique for cataract surgery and represents one of the most commonly performed surgical acts in the world [1]. Thanks to the continuous improvement of IOL design and materials this technique allows vision restoration with or without spectacle aid [2,3].…”