Published: 26 August 2020

Eye drops can be hard for some patients to put into their eyes. After cataract surgery, there are two main issues we are trying to control: Preventing infection and controlling inflammation. Traditionally, we prescribed antibiotic eye drops to prevent infection, as well as steroid eye drops to control post-operative inflammation. Now we have some alternatives to using eye drops after surgery. There are some antibiotic solutions we can place inside the eye at the end of the cataract surgery that have been shown in most studies to do as good or better a job preventing infection as using antibiotic eye drops before and after surgery. Just recently, the FDA approved two new steroid delivery methods to reduce post-operative inflammation that have the potential to eliminate post-op steroid eye drops in most (but not all) patients who are undergoing cataract surgery. Those two products are called Dexycu and Dextenza. Dexycu is a white bolus of steroid medication that is injected inside the eye after cataract surgery. It will not be visible in most patients because it is injected behind the iris, or the colored part of the eye. It sometimes doesn’t stay behind the iris and you might see a small white dot in the eye initially after surgery. It is a sustained-released medication, is resorbed over a couple of weeks and replaces the need for post-operative steroid drops. Dextenza is a white pellet that is inserted into the lower punctum of the lid, which is the small opening for the drainage of tears. This insert is designed to deliver medication for up to 30 days. It is slowly resorbed and doesn't need to be removed. Similarly, it is usually not visible and does not cause any discomfort. If you have either a Dexycu or Dextenza implant placed and an antibiotic medication is injected inside the eye after surgery, then you may be drop free after surgery. The main difference between the two steroid injections is that Dexycu is injected inside the eye while Dextenza is deposited outside the eye. For each of these new options there is a chance that in your particular case there may still be too much inflammation and you might need to take eye drops for a while, but the majority of the time you would not need drops. If you are going to have cataract surgery and would like to be drop free after the procedure, then ask your surgeon if you would be a candidate for either the Dexycu or Dextenza implant. Article contributed by Dr. Jane Pan.

Published: 18 August 2020

The majority of cataract surgeries performed in the U.S. are done with a local anesthetic and IV sedation. The local anesthesia may be accomplished in one of two ways: either an injection of anesthetic around the eye or anesthetic eye drops placed on the eye, often combined with an injection of a small amount of anesthetic into the front of the eye at the very beginning of surgery. The injection of anesthetic around the eye generally produces a deeper anesthesia for the surgery than the topical method but it also comes with increased risk. There is a very small chance of potentially serious bleeding behind the eye and a rare chance of inadvertent penetration of the back of the eye with the injection needle. The topical anesthesia has lower risk but does not provide quite as deep of an anesthesia, although the overwhelming majority of people having cataract surgery with a topical anesthetic do not experience any significant pain during the procedure. The other difference between the two anesthesias is with that topical anesthesia you maintain your ability to move your eye around whereas with injection anesthesia the eye muscles are temporarily paralyzed so your eye doesn’t move during the surgery. When you have topical anesthesia it is important for you to try to stare straight ahead at the light in the microscope above you. Most people accomplish this quite easily. Along with the anesthetic to the eye, in most cataract surgeries an anesthetist will also give you some mild sedative medication through an IV. This relaxes you but does not put you “out,” although some people do fall asleep during the procedure from the effects of the sedation. Many people who have cataract surgery with IV sedation don’t remember some of the surgery because of the amnesiac effect that occurs from the sedative. This often doesn’t happen when you return for surgery on your second eye. Despite often getting the exact same dose of sedative on the second surgery you have significant less amnesia the second time. This is caused by a quick buildup in tolerance to the medication. When they have their second surgery, many patients feel that the surgery was significantly different than the first time even though it was done exactly the same. The reason is just that you remember more the second time. On rare occasions people need to have general anesthesia to have their cataracts removed. Today, that is mostly done for people who are incapable of cooperating and staying still for the surgery. For everyone who can cooperate it is generally not worth the risks, which include death, to put people to sleep for a surgery that is easily done under a local anesthetic. Article contributed by Dr. Brian Wnorowski, M.D.