Effect of Topical Hypotensive Medications for Preventing Intraocular Pressure Increase after Cataract Surgery in Eyes with Glaucoma

Dropless Cataract Surgery: A Review of the Literature

Cataract surgery is one of the most performed surgeries worldwide, often necessitating postoperative eye drops to manage infection, inflammation, and pain. However, complex regimens, patient adherence challenges, and environmental concerns have led to growing interest in "dropless" cataract surgery, which eliminates or reduces the need for postoperative drops by delivering medications intraoperatively through injections or drug-eluting implants. This review provides an overview of dropless cataract surgery, focusing on common medications used including antibiotics, steroids, nonsteroidal anti-inflammatory drugs, and intraocular pressure medications. Intracameral antibiotic use has become widespread, with strong evidence showing that it effectively reduces the risk of postoperative endophthalmitis without the need for additional topical antibiotics. Steroids, typically delivered through subconjunctival injections or sustained-release implants, show promise in safely and effectively controlling inflammation, though further research is needed to validate fully dropless approaches. Nonsteroidal anti-inflammatory drugs and intraocular pressure medications are less frequently included in dropless regimens, with mixed evidence regarding their impact on long-term outcomes. For patients, dropless cataract surgery can help simplify postoperative care and potentially lower out-of-pocket costs. For health systems, recent analyses suggest dropless surgery could reduce overall costs and decrease environmental waste by reducing consumption of eye drop bottles. Future research should focus on assessing true dropless approaches and optimizing medication delivery. Overall, dropless cataract surgery offers many potential benefits for patients, health systems, and the environment. Additional high-quality evidence substantiating these benefits would help advance its adoption globally.

Advantages of eliminating the cataract surgery post-operative day 1 appointment in a rural practice

INTRODUCTION

We sought to streamline cataract surgery post-operative care when COVID-19 hit by discontinuing the 1-day post-operative visit. We wanted to know if this change was safe and beneficial to our patients by reducing patients' time and transportation burden, opening appointment slots allowing providers to see more patients and reducing greenhouse gas emissions. By minimising intraoperative use of dispersive viscoelastic, increasing irrigation/aspiration time at the end of the surgery and using intraocular pressure (IOP) lowering medications such as carbachol, brimonidine and acetazolamide routinely, we posit that post-operative day 1 IOP spikes can be avoided, thereby eliminating the need for the 1st post-operative day visit. We also sought to show the positive environmental impact of eliminating that 1st day.

METHODS

We retrospectively reviewed cataract surgeries performed before COVID-19 to determine the incidence of serious pathology discovered at the post-operative day 1 visit. Subsequently, we examined all the cataract surgeries performed in 2023 by our practice.

RESULTS

One hundred and ninety-three cataract surgeries performed before COVID-19 and 832 performed in 2023 were reviewed. We found that the post-operative day 1 visit after cataract surgery is unnecessary in most routine uncomplicated cases.

CONCLUSION

By eliminating hundreds of post-operative day 1 visits for a busy rural practice annually, patients, their friends and relatives are spared an extra trip to the office (that can be 100 km each way), the office schedule is open to accommodate more patients, and the patients' carbon footprint of travel to the office is reduced.

INTRODUCTION

Nous avons cherché à rationaliser les soins postopératoires de la chirurgie de la cataracte lors de l'arrivée de la Covid en supprimant la visite postopératoire d'un jour. Nous voulions savoir si ce changement était sécuritaire et bénéfique pour nos patients en réduisant le temps et la charge de transport des patients, en ouvrant des créneaux de rendez-vous permettant aux prestataires de voir plus de patients et en réduisant les émissions de gaz à effet de serre. En minimisant l'utilisation peropératoire de viscoélastique dispersif, en augmentant le temps d'irrigation/aspiration à la fin de l'opération et en utilisant systématiquement des médicaments abaissant la PIO, tels que le carbachol, la brimonidine et l'acétazolamide, nous pensons que les PIO postopératoire du premier jour peuvent être évitées, éliminant ainsi la nécessité d'une première visite de jour postopératoire. Nous avons également cherché à démontrer l'impact environnemental positif de l'élimination de ce premier jour.

MTHODES

Nous avons examiné rétrospectivement opérations de la cataracte réalisées avant la Covid afin de déterminer l'incidence des pathologies graves découvertes lors de la visite postopératoire du premier jour. Par la suite, nous avons examiné toutes les opérations de la cataracte réalisées en 2023 par notre cabinet.

RSULTATS

193 opérations de la cataracte réalisées avant la Covid et 832 réalisées en 2023 ont été examinées. Nous avons constaté que la visite postopératoire du premier jour après la chirurgie de la cataracte n'est pas nécessaire dans la plupart des cas de routine sans complications.

CONCLUSION

En éliminant des centaines de visites postopératoires du premier jour dans une région rural, les patients, leurs amis et leurs proches n'ont pas à SE rendre au cabinet (ce qui peut représenter des centaines de kilomètres aller-retour). L'emploi du temps du cabinet est libéré pour accueillir davantage de patients et l'empreinte carbone des patients liée à leur déplacement au cabinet est réduite.