What eye drops are recommended for post-cataract operation care?

Post-Cataract Surgery Eye Drop Regimen

The standard post-cataract surgery regimen consists of a topical antibiotic (moxifloxacin 0.5% three times daily for 7 days) combined with a topical corticosteroid (prednisolone acetate 1% or loteprednol four times daily, tapered over 3-5 weeks), with preservative-free formulations strongly preferred to minimize ocular surface toxicity. 1, 2, 3, 4

Core Medication Regimen

Antibiotic Coverage

• Moxifloxacin 0.5%: Instill one drop in the affected eye 3 times daily for 7 days 3
• This provides prophylaxis against postoperative endophthalmitis 3
• Preservative-free formulations should be prioritized when available to reduce ocular surface irritation 1

Anti-Inflammatory Coverage

• Prednisolone acetate 1%: Instill one to two drops into the conjunctival sac two to four times daily 4

  • During the initial 24-48 hours, dosing frequency may be increased if necessary 4
  • Typical taper: 4 times daily for 1 week, then 2-4 times daily for 1-2 weeks, then 2 times daily for 2-3 weeks 1

• Alternative: Loteprednol: One drop four times daily if prednisolone is contraindicated 5

NSAID Addition for High-Risk Patients

• Ketorolac 0.45% (preservative-free): Recommended within the first post-surgical month, particularly for patients at risk of dry eye disease or cystoid macular edema 2
• The American Academy of Ophthalmology specifically recommends preservative-free NSAIDs like ketorolac for the first postoperative month 2

Preservative-Free Formulations: Critical Consideration

Preservative-free eye drops should be strongly prioritized, especially in high-risk patients, as preservatives (particularly benzalkonium chloride) are a major source of ocular surface irritation and can exacerbate dry eye disease. 1

High-risk patients include those with:

• History of dry eye disease 1
• Current use of multiple topical medications 1
• History of cataract surgery-induced dry eye 1
• Contact lens use 1
• Diabetes or peripheral nerve disorders 1

Alternative: Dropless Strategy

For appropriate candidates, consider intraoperative drug delivery to reduce postoperative burden 1:

• Intracameral moxifloxacin (150-250 μg) can be administered at surgery conclusion 6, 7, 8
• Transzonular or intracameral dexamethasone/triamcinolone can provide anti-inflammatory coverage 9

Important caveat: While dropless strategies reduce patient burden, recent evidence suggests transzonular triamcinolone-moxifloxacin may be associated with increased breakthrough inflammation (11.1% vs 3%) compared to topical drops, requiring careful patient selection and monitoring 10. The safety profile for intracameral moxifloxacin alone appears favorable with no increased endophthalmitis risk 6, 7, 8.

Postoperative Follow-Up Schedule

Critical monitoring points 1:

• Day 1: Check for infection or inflammation, assess intraocular pressure
• Weeks 1-2: Evaluate for infection, dry eye occurrence, ocular surface damage; assess visual acuity and intraocular pressure
• 1 month: Evaluate treatment effectiveness, visual acuity, intraocular pressure
• 2 months: Assess refraction and continued healing
• 3-6 months: Regular consultation as needed

Common Pitfalls to Avoid

• Premature discontinuation of steroids: Care should be taken not to discontinue therapy prematurely; if signs and symptoms fail to improve after 2 days, re-evaluate the patient 4
• Using preserved drops in high-risk patients: This significantly increases risk of ocular surface toxicity and dry eye exacerbation 1
• Inadequate aggressive management: Cataract surgery causes or exacerbates dry eye disease; therapy should be more frequent and aggressive than preoperative management 1
• Ignoring breakthrough inflammation: If breakthrough inflammation occurs (more common with dropless strategies), promptly initiate topical steroid therapy 10