Scientific evidence mounting for superior outcomes with dropless cataract surgery
Approach shown to provide improved infection, inflammation prevention than previous methods
Deland, FL—When a certain practice pattern has persisted over decades, it can be difficult to convince physicians to change.
However, this desire to cling to traditional techniques has more to do with habit than a basis in scientific data and literature. This struggle is currently occurring with medication following cataract surgery.
Traditionally, patients must endure weeks of a strict multi-drop regimen pre- and postoperatively. This confusing and often costly requirement typically results in dissatisfied patients, office staff, and physicians alike. Continually rising costs can at times reach up to $650 per eye,1 an amount few patients can manage. Even those who can obtain the correct drops often struggle with compliance.2,3
The drops are administered to prevent infection and inflammation, most notably endophthalmitis.
However, there is no solid scientific evidence that these drops actually aid in prevention. Conversely, studies have shown that while there is a statistically insignificant drop in the rate of endophthalmitis using topical therapies, occurrences of this condition are five times less likely to occur when medications are injected intracamerally.4,5
Injecting medications has also been shown to decrease the development of antibiotic resistance, which is a common occurrence in topical antibiotic applications.6-8
If injecting these medications intracamerally produces such exceptional results, it stands to reason that injecting intravitreally will work even better. Studies have shown intravitreal injections of triamcinolone acetonide and moxifloxacin hydrochloride (Tri-Moxi, Imprimis Pharmaceuticals) and triamcinolone-moxifloxacin-vancomycin (Tri-Moxi-Vanc, Imprimis) not only reduce rates of infection and inflammation, and nearly eliminate endophthalmitis, but significantly reduce occurrences of cystoid macular edema (CME) as well.9,10
Yet, the ophthalmic surgical community as a whole continues to cling to traditional methods, despite science pointing to a superior technique. It is time for a paradigm shift.