Drop-Free Approaches for Cataract Surgery

Neal H. Shorstein; William G. Myers


Curr Opin Ophthalmol. 2020;31(1):67-73. 

In This Article


Intraoperative injections offer the patient and surgeon assured drug delivery and hold promise to avoid the pitfalls of patient adherence, incorrect topical instillation, and topical drop-associated corneal issues. The authors currently inject a lidocaine–phenylephrine combination at the beginning of surgery for iris dilation. One of the authors (N.S.) prescribes cyclopentolate drops for instillation in the preoperative holding area of the surgery center.

In the penultimate step, moxifloxacin 0.1% is injected into the wound for stromal hydration and then 0.5 to 0.6 mL into the AC to flush and essentially replace the aqueous contents. Finally, 0.4 ml of triamcinolone acetate 10 mg/ml (4 mg) is injected in the subconjunctival space 5–6 mm posterior to the limbus. Tunneling the needle for 1–2 mm and injecting slowly avoids reflux of drug; avoiding piercing conjunctival vessels generally prevents subconjunctival hemorrhage.