Dropless Cataract Surgery

Eye drops can be hard for some patients to instill into their eyes.   After cataract surgery, there are two main issues we are trying to control: preventing infection and controlling inflammation.  Traditionally we prescribed antibiotic eye drops to prevent infection as well as steroid eye drops to control post-operative inflammation. Now we have some alternatives to using eye drops after surgery.   

There are some antibiotic solutions we can place inside the eye at the end of the cataract surgery that have been shown in most studies to do as good or better of a job preventing infection as using antibiotic eye drops before and after surgery. 

How to care for your eye after cataract surgery 

Just recently the FDA has approved two new delivery methods for steroid to reduce post-operative inflammation that have the potential to eliminate post-op steroid eye drops in most (but not all) patients who are undergoing cataract surgery.  Those two products are called Dexycu and Dextenza. 

Dexycu is a white bolus of steroid medication that is injected inside the eye after cataract surgery.  It will not be visible in most patients because it is injected behind the iris or the colored part of the eye.   Sometimes it doesn’t stay behind the iris and you might see a small white dot in the eye initially after surgery.  It is a sustained-released medication, is resorbed over a couple of weeks and replaces the need for post-operative steroid drops.  

Dextenza is a white pellet that is inserted into the lower punctum of the lid, which is the small opening for the drainage of tears.  This insert is designed to deliver medication for up to 30 days.  It is slowly resorbed and doesn't need to be removed.  Similarly, it is usually not visible and does not cause any discomfort.

Should I pay out of pocket for cataract surgery?

If you have either a Dexycu or Dextenza implant placed and an antibiotic medication is injected inside the eye after surgery, then you may be drop free after surgery.   The main difference between the two steroid injections is that Dexycu is injected inside the eye while Dextenza is deposited outside the eye.  For each of these new options there is a chance that in your particular case there may still be too much inflammation and you might need to take eye drops for a while but in the majority of surgeries using these devices you will be drop free.

If you are going to have cataract surgery and would like to be drop free after surgery, then discuss with your surgeon if you would be a candidate for either the Dexycu or Dextenza implant.