Comparative Safety Of Subconjunctival Triamcinolone Dropless Therapy Versus Topical Drops Following Cataract Surgery: A Large Multi-Site Cohort Study
Published 2026 - 44th Congress of the ESCRS
Reference: FP09.01 | Type: Free paper | DOI: 10.82333/5tb6-6064
Authors: Mr Alastair Stuart* 1 , Mr Amir Hamid 2 , Prof. Clare ODonnell 3 , Dr Nabila Jones 1
1Eye Sciences,Optegra Eye Health Care,Manchester ,United Kingdom, 2Eye Sciences,Optegra Eye Health Care,Manchester ,United Kingdom;Faculty of Biology, Medicine and Health,University of Manchester ,Manchester ,United Kingdom, 3Eye Sciences,Optegra Eye Health Care,Manchester ,United Kingdom;Faculty of Biology, Medicine and Health,University of Manchester ,Manchester,United Kingdom;College Health and Life Sciences ,Aston University,Birmingham,United Kingdom
Purpose
To compare clinical outcomes of dropless therapy and conventional topical drop regimens following cataract surgery across a multi-site hospital group.
Setting
Optegra Eye Health Care, United Kingdom
Methods
This cohort study analysed 23,613 cataract surgeries across 17 sites between January 2025-December 2025. The drops cohort (n=11,101) received standard postoperative topical antibiotic and corticosteroid therapy. The dropless cohort (n=12,512) received intracameral antibiotic and subconjunctival triamcinolone at surgery conclusion, eliminating postoperative topical medications. Primary outcomes included cystoid macular oedema (CMO), steroid-related intraocular pressure (IOP) elevation, and postoperative uveitis. CMO was assessed in all eyes and in a subgroup without diabetes or pre-existing retinal pathology. Visual and refractive outcomes were also evaluated. Risk ratios (RR) with 95% confidence intervals (CI) were calculated.
Results
CMO occurred less frequently with dropless compared with the drops cohort (2.84% vs.3.55%, p=0.004; RR=0.80, 95% CI=0.69–0.92), representing a 20% relative risk reduction. After excluding eyes with diabetes/preexisting retinal pathology, the protective effect strengthened (2.23% vs.3.04%, p=0.002; RR=0.73, 95% CI=0.61–0.88). Eyes with diabetes/retinal pathology demonstrated ~two-fold higher CMO risk irrespective of treatment modality (dropless 4.60% vs.2.23% without pathology; drops 4.89% vs.3.04%). IOP elevation was reduced with dropless (0.44% vs. 0.68%, p=0.02; RR=0.65, 95% CI=0.46–0.92). Postoperative uveitis rates were comparable (2.13% vs. 2.34%, p=0.31; RR 0.91, 95% CI 0.77–1.08). Visual and refractive outcomes were also equivalent.
Conclusions
In this large multi-site cohort, dropless therapy was associated with significantly reduced rates of CMO and steroid response compared with conventional topical drops, particularly in eyes without pre-existing risk factors. Uveitis, visual and refractive outcomes were comparable between treatment modalities. These findings support the safety profile of dropless protocols in routine cataract surgery while eliminating the burden of postoperative drop administration.