#  Postoperative care  

 



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 After a successful cataract surgery, infection prophylaxis and postoperative ocular inflammation control are critical for healing. Today, surgeons are starting to adopt newer strategies beyond the traditional three-bottle (topical antibiotic, NSAID and steroid) postoperative eye drop regimen.

 This includes:

 **Intracameral antibiotics:** Following the landmark prospective, randomized 2007 ESCRS endophthalmitis prophylaxis study that showed a reduction in endophthalmitis with the use of intracameral cefuroxime, there has been growing interest in the use of intracameral antibiotics. Two metaanalyses found no clear benefit to topical antibiotics when an intracameral antibiotic was used. Of note, there currently is no FDA-approved antibiotic for intracameral injection, so cefuroxime and moxifloxacin must be compounded for intracameral injection.

 **Topical NSAIDs** reduce the risk of postoperative cystoid macular edema (CME), but the cost of treatment is being weighed against the potential benefit for treatment. Some surgeons now reserve topical NSAID prophylaxis for patients at high risk of developing CME, such as those with diabetic retinopathy, retinitis pigmentosa, epiretinal membrane, or history of CME after previous cataract surgery.

 **Subconjunctival steroids** depots or steroid-eluting punctal plugs (DEXTENZA, Ocular Therapeutix) offer an alternative for patients who cannot reliably follow or administer topical postoperative drops.Such approaches potentially decrease the patient challenges of postoperative eyedrops, including compliance, self-injury, bottle contamination, and dexterity issues. “Dropless” cataract surgery via transzonular delivery of antibiotics and steroid (TriMoxi or TriMoxiVanc, Imprimis Pharmaceuticals) raises concerns for zonular damage, risk of steroid-induced ocular hypertension, and causing blurred vision, thus this approach has not been as widely adopted.

###  Referral guidelines

 When patients experience difficulties such as progressive blurring of vision, glare with night driving, difficulty reading, struggles with activities of daily living, and updated refractive correction does not alleviate the problem, a consultation for cataract surgery may be considered.