Intraoperative Intraocular Dexamethasone After Cataract Surgery: A Systematic Review and Meta-Analysis of Drop-Replacement and Add-On Strategies.

Purpose: Postoperative corticosteroid regimens after cataract surgery rely on correct drop use and completion of a taper. We evaluated whether one intraoperative dose of dexamethasone could replace topical corticosteroids or improve outcomes when added. Methods: PubMed, CENTRAL, ClinicalTrials.gov, and WHO ICTRP were searched through 25 July 2026; citation searching was updated on 3 August 2026. Reports from each trial were linked, replacement and add-on strategies were analyzed separately, and random-effects models were used for comparable outcomes. Results: Thirteen reports represented 11 study families and 1,079 participants or eyes. Across two Surodex studies, steroid augmentation was less frequent than with topical dexamethasone (risk ratio 0.20, 95% confidence interval 0.08–0.53; I2=0%). A 2026 quasi-experimental study favored intracameral dexamethasone for minimal or absent day-3 inflammation (risk ratio 3.14, 95% confidence interval 1.59–6.23). Add-on intracameral dexamethasone reduced day-1 inflammation (Hedges g=-0.58, 95% confidence interval -1.03 to -0.13; I2=64.5%) and day-7 inflammation (g=-0.76, 95% confidence interval -1.11 to -0.42; I2=0%). Overall safety appeared comparable, although one study reported device migration in three of seven eyes. Conclusion: Intraoperative dexamethasone can control postoperative inflammation and may reduce reliance on topical corticosteroids, but heterogeneous formulations, nonrandomized evidence, incomplete reporting, and imprecise safety estimates preclude universal replacement.