Dropless cataract surgery using intraoperative subconjunctival triamcinolone: a multicentre comparative analysis of 22,000 eyes

Purpose: To compare postoperative inflammatory and visual outcomes between dropless cataract surgery using intraoperative subconjunctival triamcinolone and conventional postoperative topical steroid therapy. Setting: Optegra UK, a private eye hospital providing NHS-funded cataract surgery across 17 centres. Design: Non-randomised retrospective multicentre audit Methods: Two postoperative regimens were compared: a dropless pathway incorporating intraoperative subconjunctival triamcinolone acetonide (Kenalog®) 40 mg administered as a visible subconjunctival depot using a 30-gauge needle, and conventional postoperative topical steroid therapy. Patients with glaucoma and young high myopes (<50 years of age with axial length ≥27 mm) were excluded. Primary outcomes assessed were cystoid macular oedema (CMO), postoperative uveitis, and intraocular pressure (IOP) elevation. Eyes with a minimum of 12 weeks (84 days) of follow-up were included. IOP analysis was restricted to eyes with ≥14 days of postoperative follow-up. Results: A total of 34,846 eyes were included (17,423 per group). Statistical significance was defined p value <0.05. CMO occurred in 3.3% of the topical group and 3.1% of the dropless group (RR 0.95, p=0.411). Postoperative uveitis occurred in 2.5% and 2.4% of eyes, respectively (RR 0.95, p=0.508). Steroid-related IOP elevation occurred in 0.6% in both groups (RR 1.00, p=1.00). Visual acuity and refractive outcomes were similar between groups. Conclusions: Dropless cataract surgery was associated with comparable rates of CMO, uveitis, and steroid-related IOP elevation compared with topical steroid regimens, with similar visual outcomes and no increase in adverse safety events. These findings support dropless pathways as an effective and safe alternative to conventional postoperative drop regimens.