Dropless after cataract surgery (DACS): concepts, evidence and clinical potential

Cataract surgery is one of the most commonly performed surgeries worldwide, and is traditionally followed by a postoperative regimen of eyedrops to reduce the risk of infection and inflammation. However, variable adherence to treatment and the burden of administering drops pose significant challenges. "Dropless after cataract surgery" (DACS) has emerged as an approach where intraoperative delivery may eliminate the need for postoperative drops. DACS offers a simplified alternative to eyedrop therapy, with the potential to improve patient-related quality of life, lower healthcare costs, and promote sustainable practices by reducing medical waste. Multiple studies over the past few decades have demonstrated the effectiveness of intraoperative intracameral antibiotics alone in reducing endophthalmitis rates, thus eliminating the need for topical antibiotic drops. Sustained-release steroid formulations have demonstrated reliable control of postoperative inflammation, similar to those achieved with standard topical regimens, but their adoption remains limited. Realising the full benefits of DACS will require systemic barriers to be addressed, and dropless regimens should be considered within a holistic value-based healthcare approach. As the global burden of cataract surgery continues to grow, embracing dropless techniques may represent a forward-looking step in modernising postoperative management to optimise patient-centred care.