Eyeworld

46 | EYEWORLD | FALL 2026 ATARACT C REWIND. REFRESH. REFINE. by Liz Hillman Editorial Co-Director About the physicians John D. Bartlett, MD Clinical Professor of Ophthalmology Stein Eye Institute University of California, Los Angeles Los Angeles, California Scott LaBorwit, MD Associate Professor Wilmer Eye Institute Johns Hopkins Hospital Baltimore, Maryland Marissa Larochelle, MD Associate Professor John A. Moran Eye Center University of Utah Salt Lake City, Utah endophthalmitis went from 1 in 3,000 to 1 in 8,000, which was consistent in all the studies," he said. Studies—such as the ESCRS randomized controlled trial that involved intracameral cefu- roxime published in 2006 and the more recent 2026 randomized control trial looking at the safety and efficacy of intracameral moxifloxacin —have found that intracameral antibiotics are not only effective, but they outperform drops in endophthalmitis prophylaxis. 1,2 Other prod- ucts that are being injected intraoperatively, namely steroids, have been researched as well. Dexycu (dexamethasone intraocular suspension, EyePoint Pharmaceuticals), which received FDA approval in 2018, and Dextenza (dexametha- sone ophthalmic insert, Ocular Therapeutix), which received FDA approval in 2018, and sub-Tenon or subconjunctival triamcinolone, for example, have been researched and deemed effective and safe replacements (under most circumstances) to topical corticosteroid drops for treatment of inflammation after cataract surgery. 3-6 "If we truly are going to practice evidence- based medicine, then you look at the data, and everyone should at a minimum be using an AC antibiotic," Dr. LaBorwit said, adding later that he thinks it's a "convenient excuse" to cite a lack of FDA approval as a reason for not doing so. "None of the drops we've used up until now have been FDA approved for cataract surgery. They're approved for bacterial conjunctivitis Where does dropless cataract surgery stand in 2026? A lthough published data do not yet establish a firm percentage of U.S. cataract surgeons who routinely employ a dropless cataract surgery regimen, available evidence suggests that cataract surgery without pre- or postop top- ical drops is increasing as a practice in the U.S. In 2021, the ASCRS Cataract Clinical Com- mittee issued a membership survey inquiring about topical and anterior chamber antibiotic use. The survey, which was completed by 1,205 respondents, 76% of whom were from the U.S., found that two-thirds were using intracameral antibiotics, an increase from 50% reporting to use this approach in 2014. The survey found that most (95%) injected the antibiotic directly into the anterior chamber. But as David F. Chang, MD, pointed out in his Lindstrom Lecture at the 2026 ASCRS Annual Meeting, while there has been an uptick in dropless cataract surgery, especially in intra- cameral antibiotics, the work to make it more mainstream in the U.S. has been stymied for various reasons. For more from Dr. Chang, read "Lindstrom Lecture highlights endophthalmitis" at www.EyeWorldOnsite.org. There is currently not an FDA-approved intracameral antibiotic in the U.S., but there are FDA-approved options for dropless pain and in- flammation treatment after cataract surgery, and some surgeons, based on available safety and efficacy data, have chosen to employ a dropless approach off-label. "I would expect one in 15 of my patients a week may need a steroid drop for rebound inflammation, but that's 14 patients who don't have the burden of drops, who on postop day 1 didn't have to be overwhelmed with instruc- tions, inundated with costs—this is a benefit for staff and patients," Scott LaBorwit, MD, said of his dropless cataract practice. The case for going dropless Dr. LaBorwit began a dropless approach about 10 years ago after he became concerned that the cost of drops and the burden to staff and patients was ruining the patient experience. "There was overwhelming data with tens of thousands of patients in many countries that showed that with drop-free, the risk of Dr. LaBorwit with a postoperative day 1 patient and her daughter. "Mom sees a month's worth of eye drops. Daughter sees a month's worth of phone calls. I see a problem already solved. Dropless cataract surgery lets everyone breathe easier," Dr. LaBorwit said. Source: Scott LaBorwit, MD

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