Reasons Why Dropless Cataract Surgery or TriMoxi Intravitreal Injections May Truly Help Our Patients Who Have Cataract Surgery: Benefits of Dropless Cataract Surgery

Reasons Why Dropless Cataract Surgery or TriMoxi Intravitreal Injections May Truly Help Our Patients Who Have Cataract Surgery: 
Benefits of Dropless Cataract Surgery

Here are the top 5 reasons why Dropless Cataract Surgery or TriMoxi Intravitreal Injections may be an excellent innovation in cataract surgery.

1. Injecting antibiotics into the eye instead of using them on the eye as drops have been shown in multiple studies to be more effective in preventing endophthalmitis, a potentially devastating eye infection, than just using eye drops. The referenced Dec 2015 study below, published in the most respected eye journal in the world, is a large study of 480,000 showing that injection of an antibiotic into the eye after cataract surgery was 100% protective of a serious eye infection.  Their conclusion, “intracameral cefuroxime was 100% effective in preventing endophthalmitis in this series.” This is another reason why Dropless Cataract Surgery may hopefully prove to be a better option than topical drops which has been published to not enter the eye effectively enough to kill dangerous bacteria: see study at end by a well known eye surgeon, Dr. Eric Donnenfeld.

2. All surgeons have had patients who forgot to use their  drops after cataract surgery due to early dementia or other reasons. Dropless Cataract surgery is better than nothing at all.

3. Most eyeMDs have had patients who have had an accident on their way to a routine post op visit. Recently I had a patient who fell and broke her arm after cataract surgery on her way to her post op visit because the ground was slippery.She was thrilled with her 20/20 vision, but was in pain from a broken arm for months. Avoiding potentially unnecessary visits for our patients would benefit our patients tremendously.

4. Confusion about drops. Every doctor’s office get multiple phone calls per day from patients who are confused about their eye drops, even though the surgeon, the surgical coordinator, the scribe, and a video may have been shown. Multiple drops can be very frustrating! We hope Dropless Cataract Surgery will hopefully help our patients not need multiple drops for weeks after cataract surgery.

5. Decrease cost to the patient and to the insurance. The 3 most commonly used eye drops for cataract surgery cost about $300 to patients whose insurances do not cover these “best practices” drops. Dropless Cataract Surgery has the potential to cost less than half of that.

A patient recently came in complaining of the outrageous cost of the drops for cataract surgery.

For the “Best” Brand Name: “Best” here meaning that these drops have been published as superior to their generic versions. As noted in previous posts, many of these famous publications by famous eyeMDs were funded by the drug company (often because it is so expensive to do a good study without their help). Thus the vast
Besivance: $150
Durezol:  $169
Illevro: $232
Total: $551!

This is outrageous. What are MDs to do for their patients? Doctors too are at the mercy of the drug companies and their peer-reviewed publications. If a journal notes that a drug is superior to another drug, even in the slightest issue, ESPECIALLY when it comes to someone’s eyes, doctors want to give the best to their patients. 

I hope patients will know that I and the vast majority of surgeons and physicians are trying to provide the best care for their patients. We are trying to think about the cost as well, but we have been trained to save the eye and vision and patient as best as we can.

Durezol $169

Sandra Lora Cremers, MD, FACS
 2015 Dec 15. pii: S0161-6420(15)00844-1. doi: 10.1016/j.ophtha.2015.08.023. [Epub ahead of print]

Endophthalmitis Occurring after Cataract Surgery: Outcomes of More Than 480 000 Cataract Surgeries, Epidemiologic Features, and Risk Factors.

Author information

  • 1Department of Ophthalmology, Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • 2Department of Ophthalmology, Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:
  • 3Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.



To report the incidence of endophthalmitis after senile cataract surgery and to describe the epidemiology and main risk factors.


Retrospective, single-center, cross-sectional descriptive study.


Patients who underwent cataract surgery in Farabi Eye Hospital from 2006 through 2014.


All patients were evaluated retrospectively to compare risk factors, epidemiologic factors, and prophylaxis methods related to endophthalmitis. Patient records were used to gather the data.


Epidemiologic factors, systemic diseases, other ocular pathologic characteristics, complications during the surgery, technique of cataract surgery, intraocular lens type, method of antibiotic prophylaxis, surgeon experience, vitreous culture, and vision outcome were evaluated in these patients.


One hundred twelve endophthalmitis cases among 480 104 operations reported, equaling an incidence of 0.023%. Patients with diabetes mellitus (14.3%) and of older age (mean age, 81 years), perioperative communication with the vitreous (17.9%), extracapsular cataract surgery procedure (11%), and surgery on the left eye (58.9% vs. 41.1% for right eye; P = 0.03) showed a statistically significant association with endophthalmitis. Short-term treatment with topical or systemic preoperative antibiotics or postoperative subconjunctival injection was associated with a 40% to 50% reduced odds of endophthalmitis compared with no prophylaxis (P = 0.2). No cases of endophthalmitis were observed among the 25 920 patients who received intracameral cefuroxime, suggesting that this approach to antibiotic prophylaxis may be far more effective than traditional topical or subconjunctival approaches.


The incidence of endophthalmitis after cataract surgery in our center was 0.023%, comparable with that of other previously published international studies. Older rural patients with immune suppressive diseases, such as diabetes mellitus, are particularly more prone to endophthalmitis. Vitreous loss at the time of surgery was associated with a significantly increased risk. Whereas antibiotic prophylaxis overall showed a 40% to 50% reduction in risk, intracameral cefuroxime was 100% effective in preventing endophthalmitis in this series.
Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

 2011 Jun;37(6):1082-9. doi: 10.1016/j.jcrs.2010.12.046.

Human aqueous humor concentrations of besifloxacinmoxifloxacin, and gatifloxacin after topical ocular application.



To determine the concentrations of besifloxacinmoxifloxacin, and gatifloxacin in human aqueous humor after topical instillation of commercially available besifloxacin ophthalmic suspension 0.6%, moxifloxacin ophthalmic solution 0.5%, and gatifloxacin ophthalmic solution 0.3%, and to assess these concentrations relative to the minimum inhibitory concentration for 90% of strains (MIC(90)) for each drug against bacterial pathogens identified in recent cases of postoperative endophthalmitis.


Six clinical sites, United States.


Randomized open-label controlled clinical trial.


The aqueous humor drug concentrations were compared 60 minutes ± 5 minutes after instillation of 1 topical drop to patients aged 18 years or older having uncomplicated cataract surgery. Concentrations of besifloxacinmoxifloxacin, and gatifloxacin were determined using a validated liquid chromatography with tandem mass spectrometry method.


A total of 105 patients were randomized, and aqueous humor samples were analyzed for 103 patients. Mean aqueous humor concentrations were 0.13 μg/mL ± 0.58 (SD), 0.67 ± 0.50 μg/mL, and 0.13 ± 0.08 μg/mL for besifloxacinmoxifloxacin, and gatifloxacin, respectively. Both besifloxacin and moxifloxacin achieved aqueous humor concentrations equal to or slightly higher than their respective MIC(90) for methicillin-resistant and methicillin-susceptible Staphylococcus aureus and Staphylococcus epidermidis; none of the fluoroquinolones achieved concentrations above their MIC(90) for ciprofloxacin-resistant strains of S aureus and S epidermidis.


Based on the aqueous humor drug concentrations measured in this study, it is unlikely that any of the fluoroquinolones tested would be therapeutically effective in the aqueous humor against the most frequently identified drug-resistant staphylococcal isolates from recent cases of postoperative endophthalmitis.


No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.

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