Clinical Outcomes of Phacoemulsification using Dropless Cataract Surgery Compared to Traditional Protocol using Preoperative and Post-operative Eye Drops

Maan Omar Albarry1, Sara Samir Howldar2, *, Mohammed Ghazi Alsaedi3, 4
1 Department of Ophthalmology, College of Medicine, Tibah University, Madinah, Saudi Arabia
2 Department of Ophthalmology, King Abdullah Medical Complex, Jeddah, Saudi Arabia
3 Department of Ophthalmology, King Salman bin Abdulaziz Medical City, Madinah, Saudi Arabia
4 Department of Ophthalmology, Ohud General Hospital, Madinah, Saudi Arabia

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© 2023 Howldar et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Ophthalmology, King Abdullah medical complex, Jeddah, Saudi Arabia; Tel: +966566559980; E-mail:



This study compared the clinical outcomes of phacoemulsification performed with two different protocols, including dropless cataract surgery using intraoperative intraocular injections, versus the traditional protocol using preoperative and post-operative topical corticosteroids and antibiotics.


This was a retrospective cohort that was conducted at the Ophthalmology Department of Maghrabi Hospital, Al-Madinah, Saudi Arabia, between date 2015 and date 2020. All consecutive eyes that underwent phacoemulsification cataract surgery using either dropless (Group 1) or traditional (Group 2) protocol were included. Preoperative and early postoperative (<1 month) measurements of visual acuity and intraocular pressure were analyzed as the primary study outcomes.


A total of 577 eyes were included: 207 (51.1%) in the dropless and 198 (48.9%) in the traditional protocol groups. Postoperative assessments showed no difference in visual acuity or IOP between the two groups. Pre-to-postoperative analysis showed an increase in mean IOP by 0.72 mmHg (p=0.002) and an increase in median VA by 0.47 decimal (p<0.001), with no difference between the two groups (p>0.05). Similarly, factorial repeated-measure ANOVA analysis showed no effect for the protocol type on IOP change (between-subject analysis, p=0.742), while time had a small effect (partial eta squared =0.018, p=0.002). Regarding visual acuity, the protocol type showed a small effect (between-subject effect: partial eta squared = 0.017, p=0.002), while time had a large effect (partial eta squared = 0.635, p<0.001).


In summary, our study compared dropless cataract surgery with traditional methods and found no significant differences in postoperative outcomes. Dropless surgery simplifies care, reduces the risk of non-compliance, and is potentially cost-effective. However, it highlighted the need for optimized follow-up schedules. Future research should explore long-term effects, conduct cost-effectiveness analyses, and assess patient satisfaction to comprehensively evaluate the impact of these surgical approaches on both healthcare efficiency and patient well-being.

Keywords: Phacoemulsification, Cataract, Surgery, Dropless, Intraocular pressure, Postoperative, Topical, Corticosteroids.