Safety and Functional Outcome of Dropless Surgery Versus Topical Medication Following Phacoemulsification

Purpose: To evaluate the efficacy and safety of dropless cataract surgery compared to conventional topical therapy in patients undergoing phacoemulsification, focusing on intraocular pressure (IOP), best corrected visual acuity (BCVA), anterior chamber (AC) inflammation, endothelial cell count, and patient satisfaction. Methods: This prospective interventional trial was conducted at a tertiary care centre in South India from June 2023 to December 2024, with 700 eyes from 433 patients assigned to two groups: Group A (dropless) and Group B (topical). Group A received intracameral moxifloxacin and subconjunctival triamcinolone at the end of surgery, whereas Group B was treated with postoperative topical antibiotics and steroids. The outcome measures were analysed at Days 1, 7, 30, and 60. Data were analyzed using independent t-tests, Chi-square tests, and Fisher’s Exact Test. Results: Group A exhibited transiently higher IOP on day 1, with 41.1% of patients having an IOP ≥21 mmHg, and a mean IOP of 25.39 mmHg. However, all patients in both groups achieved an IOP <21 mmHg by Day 60. BCVA improved significantly in both groups, with no significant differences in all visits. AC inflammation and Endothelial cell count changes were minimal and comparable between groups. Patient satisfaction was significantly higher in Group A (96% vs. 56% in Group B). The dropless approach also demonstrated potential cost savings by reducing the need for multiple postoperative medications. Conclusions: The dropless approach offers the added benefits of simplified postoperative care, improved patient satisfaction, and reduced costs, making it a viable alternative, especially in settings with challenges in patient compliance.