Subconjunctival Triamcinolone Acetonide Injection Compared with Dexamethasone Ophthalmic Insert for Inflammation Prophylaxis After Cataract Surgery: A Comparative Clinical Study.

PURPOSE: To determine differences in efficacy and outcomes during the first post-operative month (POM1) between intracanicular dexamethasone implant (DII) and subconjunctival triamcinolone injection (STAI) for prophylaxis of rebound iritis or cystoid macular edema (CME) in patients undergoing cataract surgery.

DESIGN

This was a retrospective, comparative cohort study of standard phacoemulsification with posterior-chamber intraocular lens placement between January 2020 and July 2023.

METHODS

Patients in the DII group received a 0.4 mg insert intraoperatively, whereas those in the STAI group received 4-6 mg of triamcinolone. Patients were excluded if they received additional anti-inflammatory treatment or a history of iritis, ocular infection, glaucoma, intraoperative posterior capsular rupture, vitreous prolapse, or retained lens fragments. Post-operative visits during POM1 were reviewed to determine the characteristics and timing of rebound iritis, CME, and changes in intraocular pressures (IOP).

RESULTS

In total, 266 eyes from 174 patients were included in the DII group, while 103 eyes from 62 patients were included in the STAI group. Demographics, comorbidities, and pre-operative IOPs were similar between groups. Neither group experienced an increase in IOP elevation of >10 mmHg from baseline or preoperative measurements compared to POM1. The DII group had mean time (days) to iritis that occurred sooner compared to the STAI group [DII group (12.8 days, SD: 8.3) vs STAI group (22.3 days, SD: 5.7), p < 0.05]. Overall, there was a trend toward higher rates of rebound iritis among the DII (9.0%) than among the STAI (3.9%) groups (p = 0.12).

CONCLUSION

In this retrospective cohort study, participants who received STAI appeared to have iritis at a later onset than those who received DII. However, post-operative complications were low, with no significant differences in the rates of rebound iritis or CME between the two groups. STAI and DII have similar clinical utility in the prophylaxis of inflammation after cataract surgery.