Reducing drop burden after cataract surgery can improve patient compliance, reduce costs
Dropless or reduced drop cataract surgery can improve patient compliance, reduce costs, reduce ocular surface damage, and increase patient satisfaction and convenience, according to a speaker.
“The advantages of dropless over traditional drops can be summarized by the three Cs: compliance, cost and complications,” Kendall E. Donaldson, MD, MS, said at the virtual OSN New York meeting.
Evidence in the literature shows patients who underwent cataract surgery and were inexperienced with eye drops had poor compliance, poor technique using the drops and an inability to correctly place the drops in the eye postoperatively. However, there are commercially and non-commercially available options to replace the traditional postoperative antibiotics, steroids and NSAIDs, she said.
Intracameral antibiotic options, such as moxifloxacin, cefuroxime and vancomycin, can be used to prevent endophthalmitis. These can be self-prepared or prepared with several different formulations by a 503A compounding pharmacy, she said.
“There are also steroid-alone options that are available that can be administered in a sub-Tenon’s, intravitreal or transzonular administration,” she said.
Omidria (phenylephrine 1%/ketorolac 0.3%, Omeros) can be used throughout the surgery to maintain pupillary dilation. It has been shown to reduce the incidence of cystoid macular edema, postoperative breakthrough iritis and postoperative pain compared with eye drops alone.
Dextenza (dexamethasone ophthalmic insert 0.4 mg, Ocular Therapeutix) can reduce pain and inflammation for up to 30 days postoperatively. Dexycu (dexamethasone intraocular suspension 9%, EyePoint Pharmaceuticals) has also been shown to reduce anterior segment inflammation after cataract surgery, she said.
The pros of dropless cataract surgery include enhanced preoperative and postoperative ease for patients, lower cost and fewer follow-up calls for staff pertaining to drop questions, concerns or insurance coverage.
“However, some of the barriers include liabilities. Is this a deviation from the standard of care? We have to take into account the emerging resistance of staphylococci, the chance of compounding errors, the risk of steroid-induced glaucoma and possible lens subluxation if we’re injecting something transzonular,” Donaldson said.
Physicians should also be wary of the potential for breakthrough inflammation and blurred vision a week postoperatively.
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Donaldson KE. Options to decrease the drop burden post cataract surgery. Presented at: OSN New York and OSN New York Retina; Oct. 17-18, 2020 (virtual meeting).
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