Dropless Vitreoretinal Surgery: A Review and Pooled Analysis

The aim of this review is to provide an overview of the literature on dropless vitreoretinal surgery. A comprehensive search was conducted using the PubMed database from August 2004 to August 2024 using the following keywords: "dropless" and "vitrectomy" or "retinal surgery" or "detachment surgery". Relevant studies included randomized controlled trials (RCTs) and observational studies. Data on protocols, patient characteristics, clinical and visual outcomes and adverse events were collected. Seven studies met the inclusion criteria. Protocols included a range of alternative antimicrobial and anti-inflammatory prophylaxis including intravitreal, intracameral, subconjunctival or sub-Tenon's injection of single-use, compounded medication. The current literature demonstrated no increased rates of endophthalmitis and no increase in intraocular pressure during the post-operative period. In summary, this review pools the current dropless protocols and outcomes for vitreoretinal surgery. There is moderate certainty suggesting non-inferiority, yet there is a need for higher quality supporting evidence and prospective RCTs.