Cataract Drug Delivery Systems (Dropless vs. Nondropless Cataract Surgery)
Cataract surgery is the most commonly performed procedure in the world, estimated at >20 to 25 million in number annually. With the aging population growing, the volume will continue to rise. Although there have been advancements in technology, techniques, and training to increase the safety and efficacy of cataract surgery, there has not been a commensurate evolution in the prophylaxis against infectious postoperative endophthalmitis (IPOE) and inflammation. Although the incidence of IPOE is small and ranges from 0.04% to 0.36% its devastating, sight threatening potential requires constant vigilance and motivation to further minimize its occurrence. In addition, postoperative cystoid macular edema (CME) persists as a significant cause of suboptimal visual recovery, which is particularly important given the expanding population of diabetic patients. More recently, there has been growing interest and acceptance of 'dropless' (eg, intracameral, transzonular, pars plana) alternatives to topical drops in the treatment of postoperative cataract patients. This interest has been enhanced by the development of a commercially available intracameral preparation of cefuroxime, as well as off label, compounded use of moxifloxacin with or without dexamethasone, in addition to compounded transzonular and/ or pars plana triamcinolone acetonide, moxifloxacin, and vancomycin. We will review the published literature on prophylaxis against IPOE and inflammation in cataract surgery, and discuss the different drug delivery methods.
International ophthalmology clinics