A dropless regimen after cataract surgery is preferred by 96% of patients and is a safe and effective alternative to reduce pain, inflammation and infection following cataract surgery, concluded a study into a punctal plug alternative. 

“In addition to the obvious convenience of not instilling eye drops multiple times a day for up to four weeks postoperatively, there was no significant difference in pain or inflammation when the two regimens were compared and the dropless regimen was less expensive,” study author New York University Professor Eric Donnenfeld, a consultant to Ocular Therapeutix, told Ophthalmology Times.  

The dropless regimen comprised of dexamethasone ophthalmic insert (Dextenza, Ocular Therapeutix), ketorolac and phenylephrine (Omidria, Omeros Corp) and intracameral moxifloxacin in a punctal plug, inserted at the end of surgery. 

The Ocular Therapeutix-funded randomised, self-controlled, prospective clinical study compared standard and dropless regimens in 56 patients who all underwent sequential bilateral cataract surgery two weeks apart. Participants were randomly treated with the dropless regimen in one eye and the standard topical regimen in the fellow eye.  

No cases of endophthalmitis or cystoid macular oedema developed in either group. Two patients in the dropless group required rescue topical prednisolone acetate 1% for inflammation and one patient in the standard drop treatment had rebound iritis, requiring additional prednisolone acetate 1%. Six patients in the topical medication study developed significant superficial punctate keratitis (SPK). No endophthalmitis or cystoid macular oedema developed in the topical group. 

“Dropless intracameral and punctal plug delivery medications following cataract surgery are a safe, preservative free and efficacious alternative to traditional topical medications increasing compliance, improving the ocular surface and benefiting social distancing,” said Prof Donnenfeld.