Dropless cataract surgery: comparing sub-Tenon's and topical steroids for postoperative inflammation prophylaxis

Area of Science:

• Ophthalmology
• Surgical Innovation
• Pharmacology

Background:

• Cataract surgery commonly requires postoperative anti-inflammatory treatment.
• Topical steroid eye drops are the standard for inflammation prophylaxis.
• Alternative "dropless" methods aim to simplify treatment and improve compliance.

Purpose of the Study:

• To compare the efficacy of sub-Tenon's triamcinolone acetonide (TA) injection versus topical steroid regimens for inflammation control after cataract surgery.
• To assess key postoperative complications including intraocular pressure (IOP) spikes, cystoid macular edema (CMO), and rebound iritis.

Main Methods:

• Retrospective cohort study analyzing electronic health records of 3307 patients undergoing phacoemulsification cataract surgery.
• Patients received either intraoperative sub-Tenon's TA injection (dropless group) or a standard topical steroid taper (topical group).
• Outcomes including IOP spikes (>35 mmHg), CMO, and rebound iritis were compared between groups using statistical analyses.

Main Results:

• No significant differences were observed in the incidence of IOP spikes, CMO, or rebound iritis between the dropless (291 eyes) and topical (3016 eyes) groups.
• Baseline characteristics were similar, though the dropless cohort had a higher proportion of Black and diabetic patients.
• Statistical analysis confirmed non-inferiority of the dropless approach for the studied inflammatory markers.

Conclusions:

• Sub-Tenon's TA injection is non-inferior to topical steroids for preventing inflammation and related complications post-cataract surgery.
• The "dropless" approach offers a viable alternative to traditional topical steroid regimens.
• Further research is warranted to identify optimal patient selection and risk factors for adverse events with dropless protocols.