Purpose
To evaluate if there is significant risk when post-operative drops are eliminated after cataract surgery when using intra-cameral and sub-tenons medication at the time of cataract surgery.

Methods
Retrospective review of patients who had cataract surgery over a 4-year period. Patients determined during initial consultation to need drops post-operative were not included. Included patients received intra-cameral moxifloxacin and sub-tenons Kenalog at the time of cataract surgery along with peri-operative antibiotic drops and Betadine 5%. Significant risk post operatively would include patients with endophthalmitis, allergic reaction to medication, persistent elevation of eye pressure and any other long-term vision-threatening outcome related to inflammation or infection.

Results
Between 2015 and 2019 there were 6,150 cataract surgeries performed. There were no intra-operative complications related to placement of medication. There were no cases of endophthalmitis. There was a peripheral corneal ulcer in a 2 patients(0.033%) each at 2 weeks post operatively. As a result of elevated IOP after 3 months on medication, 10 patients(0.16%) required needling of the sub-tenons Kenalog (STK) in the office and 2 patients(0.0033%) had complete excision of the STK. This treatment resulted in normalization of IOP off all medication and no glaucoma damage. There were no other significant long-term vision-threatening outcomes related to inflammation or infection.

Conclusion
Elimination of post-operative drops for cataract surgery by utilizing intra-operative medication at the time of surgery is a safe alternative with minimal risk. Ophthalmologists may consider this cost-effective alternative by implementing a similar strategy to decrease unnecessary healthcare costs, patient compliance and side effects of drops.