Comparison of peroperative subconjunctival injection of methylprednisolone and standard postoperative steroid drops after uneventful cataract surgery.

PURPOSE: To compare the safety and efficacy of a single subconjunctival injection of methylprednisolone and a standard postoperative steroid regimen in terms of intraocular inflammation and intraocular pressure (IOP) after uncomplicated phacoemulsification surgery.

METHODS: Two groups of 25 patients each were included in this prospective randomized controlled trial. Patients in the injection group were given a subconjunctival injection of 20 mg methylprednisolone and the topical group received the conventional postoperative care with steroid eye drops (dexamethasone 1 mg/ml). The patients were examined 1 week and 1 month after surgery. Slit-lamp evaluation of anterior chamber inflammation and IOP were performed. Changes in IOP of ≥2.4 mmHg were considered clinically relevant.

RESULTS: In the injection group, mean IOP decreased from 15.4 ± 2.2 mmHg (baseline) to 14.1 ± 3.2 mmHg at 1 week (p = 0.03). The topical group had a stable IOP at 1 week (16.3 ± 2.6 mmHg) compared to baseline (16.1 ± 2.7 mmHg; p = 0.74). At 1 month, mean IOP was 14.3 ± 2.6 mmHg (p = 0.03) in the injection group and 15.6 ± 2.3 mmHg (p = 0.2) in the topical group. The intragroup changes were neither statistically significant nor clinically relevant at any postoperative visit. Both groups had the highest values of intraocular inflammation at the 1-week postoperative visit, followed by a decline to barely traceable levels at 1 month. The difference was not clinically relevant at any postoperative visit.

CONCLUSIONS: The subconjunctival injection of methylprednisolone appears to be as safe and effective as the conventional treatment, and it might therefore be considered for treatment of individuals with compliance issues.