NO DROPS AFTER CATARACT SURGERY, IS IT POSSBILE?

Premium Vision Surgical Centres (PVSC) introduces a new option to improve the patients’ cataract and refractive surgery experience. “No Drops” Cataract Surgery is now available to significantly decrease the after cataract eye drop regimen. The goal with “No Drops” Cataract Surgery is to improve the surgical outcome and provide the patient with least impact in their post surgical lifestyle.  Cataract patients have been prescribed 3-4 different eye drops for up to 5 weeks.

 

Depending on coverage, it might cost a lot of money, up to $150/eye. Patients 65 and over, can have their Standard/regular drops covered by Medicare, apart from the filling fees or copay.

But, are there other ways to do it? The answer is yes. We have introduced “No Drops” Cataract Surgery in an effort to address compliance and convenience for our patients.

 

At PVSC, we use a new medication which is a compound mixture of steroid (Triamcinolone) with an antibiotic (4th generation quinolones) which is administered inside (Moxifloxacin) and around the eye (Triamcinolone and Gatifloxacin) at the time of surgery.  This way, you just might need to use lubricating drops if the eyes feel dry. A small number of patients may have some inflammation that requires eye drops to be started or if the pressure goes up, we might need to use drops to control it.
The advantage of using this is that medication is administered into the eye at time of surgery, thus ensuring compliance. The postoperative course removes the inconvenience of obtaining and placing drops in the surgical eye. “No Drops” Cataract Surgery is especially beneficial for patients with arthritis or who have difficulty administering drops.
Known side effects of this method includes possible rise of the eye pressure which might need treatment. You can als see the white Triamcinolone below the lower lids with trace of blood sometimes.  We avoid the foggy vision that was caused by the white Triamcinolone by giving it with Gatifloxacin in the subconjunctival space just outside the eye and give only the Moxifloxacin part into the cavities of the eye and into the wound. This way, you get the benefits without the foggy of the vision caused by the white Triamcinolone being in the cavity of the eye.

It is very important to avoid rubbing the eyes after cataract surgery and specially with “No-Drops” surgery. If you rub your eyes early after surgery, you can open the wound and introduce bugs that can lead to serious infection inside the eye which can be blinding if not treated. The vision should be getting always better and better after surgery. If the vision start to get worse or the eyes start to feel worse please let us know ASAP as these can be signs of serious side effects.

Other options to control inflammation and infection after cataract surgery are:

1. “Standard drops” Use the Medicare covered drops if you are 65 and over. Tobradex and Acuvail. Two drops for 2 weeks and one drop for 5 weeks total. This option is okay with some precautions.
   1. Possible side effects are
      1. increased eye pressure with Tobradex due to the strong steroids, and
      2. eye burning sensation for a minute after putting the Acuvail.
   2. The penetration of the Tobramycin antibiotic into the inside of the eye is not as good as the penetration of the 4th generation quinolones in the other options below.
2. LessDrops“: This option adds convenience. These have better penetration and effect than the standard drops with less side effects. One dropper is used three time per day for a week then another dropped is used once a day for 3 weeks. This option is the best option for patients with glaucoma.
3. No-Drops” Cataract surgery or “Dropless”. In which the Moxifloxacin is injected inside the eye and the Triamcinolone and Gatifloxacin is injected outside the eye under the conjunctiva. This is the main method used at PVSC. This option is not available to patients with glaucoma due to increased risk of IOP rise due to the Triamcinolone steroid. This is the most convenient and effective way. Love it!

It’s very common to get some eye irritation after cataract surgery. You can use any artificial tears that you like. If you use them more than 4 times per day, its preferred to use some that are preservative free.

Note: We do not use Vancomycin. Recently, there have been several cases of postoperative Hemorrhagic Occlusive Retinal Vasculitis (HORV) that have emerged both in Canada and the US following uncomplicated cataract surgery following intracameral vancomycin injection.  These cases represent eyes that appear normal during the early postoperative period (up to 14 days) and subsequently develop a progressive painless loss of vision (Witkin J. et al. Ophthalmology. 2015 Jul;122(7):1438-51).  Diffuse ischemia, significant retinal hemorrhaging and retinal vasculitis are the hallmarks of this condition.  Several bilateral cases have been also reported.