Prafulla K Maharana1, Jay K Chhablani2, Taraprasad Das2, Atul Kumar1, Namrata Sharma1. 1. Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. 2. Srimati Kanuri Santhamma Centre for Vitreoretinal Disease, L V Prasad Eye Institute, Hyderabad, Telangana, India.
Sir,We thank the authors for their keen interest in our article.[1] The authors have provided a concise update on the pros and cons of “Transzonular injection of antibiotics and steroids (dropless cataract surgery) technique”.[2] At first look, the technique appears potentially useful especially in the setting of large-volume surgeries and poor understanding of the patient about the treatment regimen, which is quite common in India. Several early reports have proven its efficacy too.[34] However, it is not fair to make any conclusive statement regarding this unique method of drug delivery as clinical trials are still going on.There are several issues that need to be addressed especially in relevance to Indian setup. First, the drug is still not available in India. Second, it is not possible to say it will be cost-effective compared with the topical drugs as it is still not launched in India. Moreover, with the recommendation of use of generic medications by the state, the cost of topical drugs has come down significantly. Third, injection of triamcinolone acetonide can lead to persistent vitreous haze. This may mask an early sign of endophthalmitis and this aspect needs to be studied in future trials. Inserting the cannula through the zonules and injecting the drug may not be that easy for general practitioners in developing countries like India. Inadvertent zonular damage is definitely a potential complication. Finally, in cases of steroid responders, topical drugs are definitely better as steroids can be withdrawn which is simply not possible with transzonular injection.To conclude, the technique of “Transzonular injection of antibiotics and steroids (dropless cataract surgery)” appears to be a safe and effective technique. It may be extremely useful in Indian setup. Although the initial results are quite encouraging, the results of ongoing trial may further bring more clarity.