What eye drops are recommended for cataract surgery?

Eye Drops for Cataract Surgery

For cataract surgery, a single intracameral injection of cefuroxime (1 mg in 0.1 mL) at the end of the procedure is recommended as antibiotic prophylaxis, with postoperative topical anti-inflammatory medications including NSAIDs like ketorolac and corticosteroids for inflammation control. 1

Antibiotic Prophylaxis

Intraoperative

• Intracameral cefuroxime: 1 mg in 0.1 mL administered at the end of the procedure 1
  • This is the standard approved antibiotic prophylaxis for cataract surgery since 2014
  • For patients with beta-lactam allergies, alternatives include:
    • Intracameral moxifloxacin (250 μg/0.05 mL) 2
    • Studies have confirmed the safety of intracameral moxifloxacin with no significant adverse effects on corneal endothelial cell density, corneal thickness, or anterior chamber inflammation 2, 3

Postoperative

• Traditional approach includes topical antibiotic drops (e.g., moxifloxacin 0.5%) 5 times daily for 1 week 4
• Some surgeons are moving toward "dropless" approaches using only the intracameral antibiotic without postoperative topical antibiotics 5

Anti-inflammatory Medications

Postoperative Regimen

1. Topical NSAIDs:

   • Ketorolac tromethamine ophthalmic solution: One drop four times daily beginning 24 hours after surgery and continuing through the first 2 weeks 6
   • Mechanism: Reduces prostaglandin E2 levels in aqueous humor, controlling inflammation and potentially reducing miosis during surgery 6

2. Topical Corticosteroids:

   • Prednisolone acetate 1%: Typically 5 times daily for 1 week, then tapered to 4 times daily for 1 week, then 2 times daily for 3 weeks 4
   • Alternative: Difluprednate combined with moxifloxacin as a fixed combination, 4 times daily 7

Modern "Dropless" Approaches

Recent evidence supports alternative approaches that may improve patient compliance:

1. Complete Dropless Regimen 5:

   • Intracanalicular dexamethasone insert
   • Intracameral ketorolac 0.3%
   • Intracameral moxifloxacin 50 μg
   • Benefits: 94.7% of patients preferred this approach over conventional eye drops 5
   • Equally effective for pain control and inflammation management

2. Reduced Drop Regimen:

   • Intracameral antibiotics with reduced topical medications
   • Preservative-free formulations are recommended, especially for patients with dry eye disease 1

Special Considerations

Dry Eye Management

• Dry eye should be diagnosed and treated before cataract surgery to optimize outcomes 8
• Preservative-free eye drops are recommended for patients with pre-existing dry eye disease 1
• Postoperative follow-up should include tear break-up time examination to monitor for dry eye development 1

Postoperative Follow-up Schedule

1. Day 1: Check for signs of infection or inflammation, assess intraocular pressure
2. Weeks 1-2: Evaluate for infection, dry eye occurrence, visual acuity
3. Month 1: Evaluate treatment effect, visual acuity, intraocular pressure
4. Month 2: Evaluate visual acuity, refraction, intraocular pressure 1

Common Pitfalls to Avoid

1. Intraocular Pressure Elevation:

   • Monitor IOP, especially with steroid use
   • In studies, approximately 1.2% of patients using difluprednate/moxifloxacin combination developed significant IOP elevation requiring anti-glaucoma treatment 7

2. Medication Compliance Issues:

   • Consider patient factors when selecting between traditional drop regimens versus dropless approaches
   • Elderly patients may have difficulty with drop administration

3. Preservative Toxicity:

   • Minimize use of preservative-containing drops, especially in patients with ocular surface disease 1
   • Consider preservative-free formulations for patients with pre-existing dry eye

By following these evidence-based recommendations, the risk of postoperative endophthalmitis can be minimized while effectively controlling inflammation and ensuring optimal visual outcomes after cataract surgery.