Dropless Pars Plana Vitrectomy Using Intravitreal Decanted Triamcinolone and Moxifloxacin: Safety and Efficacy.

Abstract

To evaluate the safety and efficacy of a dropless regimen using intravitreal decanted triamcinolone acetonide and moxifloxacin at the conclusion of pars plana vitrectomy (PPV), compared with standard postoperative topical therapy. This retrospective study included consecutive patients undergoing PPV at a tertiary retina center. The dropless cohort (May-October 2025) received intravitreal decanted triamcinolone (5 mg) and moxifloxacin (500 μg). The control cohort, operated during the preceding 6 months, received topical moxifloxacin 0.5% and prednisolone acetate 1%. Outcomes included intraocular inflammation, intraocular pressure (IOP), central subfield thickness (CST), cystoid macular edema (CME), and best-corrected visual acuity (BCVA). A prespecified subgroup analysis was performed for epiretinal membrane (ERM). 172 eyes were included (87 dropless, 85 topical). The dropless group demonstrated significantly less anterior chamber inflammation at week 2 (P = 0.0008) and at month 3 (P = 0.0223). Mean CST was lower at week 2 (P = 0.001), month 3 (P = 0.0009), and month 6 (P = 0.012). CME incidence was reduced (P < 0.001). BCVA improvement was greater in the dropless group at week 2 (+15 vs -2.5 ETDRS letters; P = 0.0003), month 3 (+25 vs +9.5 letters; P = 0.002), and month 6 (+20 vs +8 letters; P = 0.01). IOP was similar between groups, and no endophthalmitis occurred. Findings were consistent in the ERM subgroup. A dropless intravitreal regimen at the conclusion of PPV can be a safe and effective alternative to topical therapy, with reduced postoperative inflammation and CME and improved visual outcomes.