ESCRS - FP20.11 - Two Years Of Dropless Cataract Surgery Cases Using A Low-Cost Subtenons Injection Of Triamcinolone Acetonide

Two Years Of Dropless Cataract Surgery Cases Using A Low-Cost Subtenons Injection Of Triamcinolone Acetonide

Published 2026 - 44th Congress of the ESCRS

Reference: FP20.11 | Type: Free paper | DOI: 10.82333/zbw4-0s02

Authors: Dr Harry Rosen* 1 , Dr Tolga Guven 2

1Hampshire Hospitals NHS Trust,Winchester,United Kingdom;Ophthalmology,University of Utrecht,Utrecht,Netherlands, 2Isle of Wight NHS trust,Isle of Wight,United Kingdom

Purpose

 

There is growing interest in Dropless Cataract Surgery (DCS) due to its practical benefits to patients and healthcare providers, and its increasing evidence of non-inferiority over standard non-dropless regimes. This study aimed to compare the rates of post-op inflammatory and glaucomatous complications between DCS patients receiving a subtenons injection of Triamcinolone Acetate (TA) vs a standard regime of topical drops.

 

Secondary objectives included:

  1. To perform a cost-benefit analysis
  2. The development of a guidance protocol for wider implementation of DCS
  3. To compare the accuracy of an AI Large Language Model (LLM) in performing basic statistical tests (Claude Sonnet 4.5), when compared to gold-standard statistical Software (SPSS).

 

 

Setting

 

Three Public sector Hospitals in Hampshire, southern England (Basingstoke and North Hampshire Hospital, Royal Hampshire County Hospital and Andover War Memorial Hospital). 

 

 

Methods

 

  • This was a retrospective cohort study comparing post-op complications in DCS vs Non-DCS cases.
  • Electronic Medical Records were searched from January 2023 to November 2025 for all cataract cases performed. A manual review of a sample of cases was performed, to rule out any systematic confounding factors such as differing follow-up practices between groups.
  • Statistical analysis was performed in tandem with both Claude Sonnet v.4.5 (an artificial Intelligence Large Language Model) and SPSS (IBM) for comparison.

 

 

Results

 

  • 5003 non-dropless cases and 671 DCS cases were performed in the study timeframe with no major demographic differences.
  • DCS cases showed reduced rates of iritis (Χ2 = 6.27, p= 0.012, RR 0.24), cystoid macular oedema (Χ2 = 7.53, p= 0.006, RR 0.22) and no difference in rates of raised IOP (OR=2.42 [reduced in DCS], p= 0.311). Results were similar when controlling for resident performed cases.
  • Cost-benefit analysis revealed a potential saving of £10.70 saved per patient, amounting to potential savings of £22,500 per year + a reduction of 14 metric tonnes of CO2 in carbon equivalents based on UK DEFRA (Department for Environment Food and Rural Affairs) carbon calculators.
  • No difference was found between AI LLM and SPSS statistical outputs. 

 

 

Conclusions

 

  • These results are similar to those found in the wider literature, e.g. the ESCRS EPICAT trial and the work of Neal Shorstein’s group in California, indicating DCS is non-inferior, if not superior to non-dropless cataract surgery.
  • DCS also possesses numerous practical benefits for patients + cost savings for the provider, which are very difficult to overlook.
  • Using these data we have developed a regional protocol for conducting DCS for high volume cataract surgery. Availability of a low-cost triamcinolone remains the largest limiting factor for implementing cost-effective DCS to a European population.
  • With judicious use of prompts, AI LLMs are equivalent to gold-standard statistical software in performing common statistical tests.