Optimizing cataract care in high-volume and low-resource setting: Drop-less surgery versus conventional topical therapy

Background: Modern cataract surgery, utilizing phacoemulsification and femtosecond laser techniques, achieves excellent visual outcomes but relies on topical steroids and antibiotics postoperatively. These pose challenges such as noncompliance, contamination risks, and ocular surface damage. Drop-less (DL) cataract surgery, using intraoperative drug delivery, offers a promising alternative to optimize care in high-volume, low-resource settings. Aims: This study aimed to compare the efficacy and safety of DL cataract surgery using 0.1 mL intracameral moxifloxacin (0.5%) and 0.5 mL subtenon Triamcinolone acetonide (40 mg/mL) with conventional postoperative eye drops. Setting and Design: A prospective observational clinical study in a tertiary care teaching hospital. Materials and Methods: Patients undergoing cataract surgery, by phacoemulsification or manual small incision, were divided into two groups: DL surgery ( n = 56) and topical eye drops ( n = 55). Outcomes included anterior chamber (AC) reaction, intraocular pressure (IOP), and best-corrected visual acuity (BCVA). Statistical Analysis: Inflammation resolution rate, IOP changes, and visual outcomes between groups over 30 days postoperatively were analyzed. Results: The DL group demonstrated faster inflammation resolution, with a 75% reduction in the AC reaction by day 15 ( P < 0.001). The IOP changes were minor and comparable between the groups, with no significant spikes observed ( P > 0.05). No inter-group statistically significant difference in BCVA at 1 month ( P > 0.05) was observed. Conclusion: The DL approach simplifies postoperative care by offering comparable visual outcomes and inflammation control, while addressing patient compliance and logistical challenges.