Routine Uncomplicated Cataract Surgery Is Safe Without Post Operative Topical Antibiotics

Dropless cataract surgery is becoming more prevalent and there is a growing evidence base of its' safety and efficacy.  However, one barrier to the uptake of dropless cataract surgery is the perceived requirement for topical antibiotics following cataract surgery.There is little evidence that topical antibiotics prevent endophthalmitis, however, they are still commonly used in the United Kingdom.  Antibiotic resistance remains a significant risk and antibiotic stewardship is required to reduce the overuse of inappropriate antibiotics.  This is a large, multi-site retrospective study, to demonstrate the safety of removing topical antibiotics from post operative regimens following uncomplicated cataract surgery. 

A retrospective review of 848,160 uncomplicated cataract operations performed between 01/01/2019 to 01/12/2025 at 60 cataract surgery centres in the United Kingdom, without post operative topical antibiotics.   

Retrospective review of the electronic medical records (Medisight) of all uncomplicated cataract operations performed at 60 cataract centres between January 2019 and December 2025.  No patients received topical antibiotics following their cataract surgery.  Patients who had an operative complication were excluded.  

The primary outcome was endophthalmitis rate.

Endophthalmitis was defined as per the Royal College of Ophthalmologists' National Ophthalmology Database audit and included both confirmed and presumed cases. 

Patients had follow up 4-6 weeks following cataract surgery either performed by a community optometrist or by the hospital provider.    

848,160 cataract operations were performed in the time period, for 531,767 patients aged 20 - 100 years, mean age 74.6 years, 58.5% female.

The endophthalmitis rate was 0.008%.

This is the largest retrospective review demonstrating that topical antbiotics are not required following uncomplicated cataract surgery.  

The endophthalmitis rate was significantly less than national benchmarks.  The overuse of inappropriate antibiotics is associated with increased antibiotic resistance, particularly amongst elderly patients with co-morbidities.  Cataract surgeons should consider removing topical antibiotics from their routine post operative regimen following uncomplicated cataract surgery.  This should remove the potential barrier to wider adoption of dropless cataract surgery.