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

To compare sub-Tenon's ("dropless") and topical steroid regimens for inflammation prophylaxis following cataract surgery.

This retrospective cohort study was conducted using the electronic health record (EHR) of a single academic medical centre in Philadelphia, Pennsylvania, USA. All patients who underwent phacoemulsification cataract surgeries from January 1, 2023, to August 31, 2024 were analysed. Eyes in the dropless group received an intraoperative sub-Tenon's triamcinolone acetonide (TA) injection. Eyes in the topical group followed a routine postoperative topical steroid taper (prednisolone acetate 1% drops). Baseline characteristics included age, race, and relevant comorbidities. Key outcomes assessed were incidence of intraocular pressure (IOP) spikes greater than 35 mmHg, cystoid macular oedema (CMO), and rebound iritis. Differences were analysed with Fisher's exact tests and linear regressions.

A total of 3307 eyes were included (291 treated with the dropless protocol and 3016 with topical drops). Baseline patient characteristics were similar between groups in terms of age, sex, and comorbidities, with the exception that the dropless cohort had a higher proportion of Black patients (46.0% vs 34.4%, p < 0.01) and diabetic patients (40.5% vs. 30.9%, p < 0.01). There were no significant differences between dropless and topical groups in the incidence of IOP spikes >35 mmHg, CMO, or rebound iritis (all p > 0.05).

Sub-Tenon's TA was noninferior to topical steroids in terms of incidence of IOP spikes, CMO, and rebound iritis following cataract surgery. However, further research is needed to identify risk factors for adverse outcomes and determine ideal use cases for a dropless protocol.