Drop-Less Cataract Surgery Using Intraoperative Triamcinolone: Re-Audit Of Safety, Unplanned Reviews, And Cost Versus A Traditional Drop-Based Regimen.
Published 2026 - 44th Congress of the ESCRS
Reference: FP20.13 | Type: Free paper | DOI: 10.82333/6ftm-1066
Authors: Ms Norhan Alaaeldin Hussein Mohamed Khamis* 1 , Ms Sarah Maling 2 , Mr Christopher King 3 , Ms Lin Lu 4
1Ophthalmology-Cataract,Buckinghamshire healthcare NHS trust,Buckinghamshire,United Kingdom, 2Buckinghamshire healthcare NHS trust.,Buckinghamshire,United Kingdom, 3Ophthalmology-Cataract,Buckinghamshire healthcare NHS trust,Buckinghamshire ,United Kingdom, 4Ophthalmology-Cornea ,Buckinghamshire healthcare NHS trust,Buckinghamshire,United Kingdom
Purpose
To evaluate the safety and service impact of a drop-less cataract surgery protocol using intracameral cefuroxime and intraoperative triamcinolone, compared with a recent audit of a traditional post-operative drop-based regimen in a high-volume NHS cataract service.
Setting
Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, a high-volume NHS cataract service.
Methods
Pilot service implementation with retrospective re-audit of consecutive uncomplicated phacoemulsification cases (July–September 2025) receiving intracameral cefuroxime and intraoperative triamcinolone (subconjunctival or sub-Tenon) without routine post-operative drops. Adults without glaucoma, steroid response, ocular inflammation, high myopia or combined procedures were included. Primary outcomes were IOP elevation, endophthalmitis and unplanned emergency eye clinic attendance. Secondary outcomes included additional topical therapy and medication cost. Outcomes were compared descriptively with a June 2025 audit of 300 eyes receiving chloramphenicol and dexamethasone.
Results
Three hundred eyes of 245 patients were included (median age 77 years; 54% female). IOP was recorded in 55%; one bilateral patient developed elevated IOP (RE 27–LE34 mmHg), managed medically. No cases of post-operative endophthalmitis occurred. Twenty-seven patients (11%) attended emergency clinic, most commonly for reassurance or transient visual symptoms. Ten eyes (3.3%) required additional topical therapy (7 cystoid macular oedema, 3 anterior chamber inflammation). Medication costs were markedly lower than the prior drop-based regimen, and most patients preferred the drop-less approach.
Conclusions
In appropriately selected cataract-only patients, drop-less surgery using intraoperative triamcinolone demonstrated low complication rates, minimal additional treatment requirement and substantial cost reduction. These findings support wider adoption of drop-less protocols in high-volume cataract services.