Intraoperative Intraocular Dexamethasone After Cataract Surgery: A Systematic Review and Meta-Analysis of Drop-Replacement and Add-On Strategies

Purpose Postoperative corticosteroid regimens after cataract surgery rely on correct drop use and completion of a taper. We evaluated whether one intraoperative dose of dexamethasone could replace topical corticosteroids or improve outcomes when added.Methods PubMed, CENTRAL, ClinicalTrials.gov, and WHO ICTRP were searched through 25 July 2026; citation searching was updated on 3 August 2026. Reports from each trial were linked, replacement and add-on strategies were analyzed separately, and random-effects models were used for comparable outcomes.Results Thirteen reports represented 11 study families and 1,079 participants or eyes. Across two Surodex studies, steroid augmentation was less frequent than with topical dexamethasone (risk ratio 0.20, 95% confidence interval 0.08–0.53; I2=0%). A 2026 quasi-experimental study favored intracameral dexamethasone for minimal or absent day-3 inflammation (risk ratio 3.14, 95% confidence interval 1.59–6.23). Add-on intracameral dexamethasone reduced day-1 inflammation (Hedges g=-0.58, 95% confidence interval -1.03 to -0.13; I2=64.5%) and day-7 inflammation (g=-0.76, 95% confidence interval -1.11 to -0.42; I2=0%). Overall safety appeared comparable, although one study reported device migration in three of seven eyes.Conclusion Intraoperative dexamethasone can control postoperative inflammation and may reduce reliance on topical corticosteroids, but heterogeneous formulations, nonrandomized evidence, incomplete reporting, and imprecise safety estimates preclude universal replacement.