Eyeworld

FALL 2026 | EYEWORLD | 47 C References 1. Barry P, et al. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a Europe- an multicenter study. J Cataract Refract Surg. 2006;32:407–410. 2. Sharma N, et al. Efficacy of intracameral moxifloxacin in pre- vention of postcataract surgery endophthalmitis: randomized control trial. J Cataract Refract Surg. 2026;52:67–73. 3. Donnenfeld E, Holland E. Dexamethasone intracameral drug-delivery suspension for inflammation associated with cataract surgery: a random- ized, placebo-controlled, Phase III trial. Ophthalmology. 2018;125:799–806. 4. Tyson SL, et al. Multicenter randomized phase 3 study of a sustained-release intracanalic- ular dexamethasone insert for treatment of ocular inflamma- tion and pain after cataract surgery. J Cataract Refract Surg. 2019;45:204–212. 5. Huang AY, et al. Dropless cataract surgery: comparing sub-Tenon's and topical steroids for postoperative inflamma- tion prophylaxis. Eye (Lond). 2026;40:848–853. 6. Cyrino LG, et al. Perioperative subconjunctival steroid injection in dropless cataract surgery: a systematic review and meta- analysis. Arq Bras Oftalmol. 2025;88:e20240394. and inflammation. … Over 25 years, we've been doing what's right but not what's labeled for on-label FDA use. To that end, since it was not FDA approved and also not within the standard in my community, I had a separate consent form that I still have patients sign. … Out of 1,500 surgeries a year, maybe 10 people opt out." Dr. LaBorwit said another barrier could be fear of compounding errors. "There are some nightmare stories. So, we specifically prefer 503B pharmacies that are held to the same stan- dards as large-scale manufacturing facilities," he said. At this point, Dr. LaBorwit said he uses a 503B compounding pharmacy to obtain his intraocular products. He uses 0.3 cc of antibi- otic and triamcinolone in the anterior chamber, preferably supranasally, 8 mm posterior to the limbus. He said he doesn't use an NSAID and noted that when you look at large datasets, the CME rates without a non-steroidal were not any higher than cases that used an NSAID. "How do you treat swelling of the macula, CME? It's with sub-Tenon triamcinolone. The treatment is what we're giving for the cataract surgery," Dr. LaBorwit said. How surgeons are implementing dropless regimens Marissa Larochelle, MD, began using a dropless approach, which for her includes intracameral moxifloxacin and 0.1 mL subconjunctival triam- cinolone, in her routine cataract cases about 5 years ago. She said these patients love not hav- ing to follow postop drop plans, and it has made her time in clinic more efficient. "There's a big advantage of being able to do dropless, if you can, as far as patient convenience and cost," she said, adding that she's found triamcinolone to be inexpensive and effective as a postop steroid. Dr. Larochelle said she tried other intraca- meral and implantable options for steroid and pain mitigation—Dexycu and Dextenza—but ultimately gave these up due to efficiency issues. "It ended up being so much extra work trying to keep track of insurance coverage, so I said, 'I'm just going to go with [triamcinolone].' It's cheap, no one has to pay extra for it. I don't have to worry about insurance status," Dr. Larochelle said. John D. Bartlett, MD, began using intraca- meral antibiotics several years ago and switched to a fully dropless regimen—no antibiotic, no steroid drops—earlier in 2026. He said he has had to use a topical steroid for one patient with persistent inflammation out of more than 200 that he has treated with a dropless approach so far. He said dropless cataract surgery is not common among cataract surgeons in his region. What pushed him to go completely dropless was one patient's experience. "She was prescribed steroid drops after sur- gery but somehow didn't get the correct drop. She thought she was using the steroids, but since she wasn't, her inflammation kept getting worse, leading to a suspicion of endophthal- mitis," he said. "Once she was on steroids, the inflammation resolved, and she ended up with a great outcome. The major issue with prescrip- tion eye drops is getting people to actually use them. Giving the medications at the time of surgery avoids that whole problem—you know the patient got the drugs you wanted them to have. And it's easier for them." Dr. Bartlett is currently using intracameral moxifloxacin supplied by a 503B compounding pharmacy. "With the diluted concentration, I aim to fill the entire anterior chamber at the end of the case. For those with fluoroquinolone allergies, we have cefuroxime compounded by our hospital pharmacy. I'm using 2 mg of subconjunctival triamcinolone for anti-inflam- matory action," he said, adding that he won't use a dropless approach on patients who have glaucoma or high myopia (an axial length over 26 mm) due to the higher risk of a steroid re- sponsive IOP rise. Benefits and remaining considerations Switching to a dropless cataract regimen has exceeded Dr. LaBorwit's expectations. Patients aren't burdened with costs and can focus on other things postop rather than remembering drops, which is also a benefit to family mem- bers/caregivers who may have had to assist them, he said. Dr. LaBorwit also found it, in some cases, to be a practice builder, with some continued on page 48

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