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  • Triamcinolone Injections Could Be Useful for Reducing Post-Phaco Inflammation

    Cataract/Anterior Segment

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    Review of: Triamcinolone acetonide subconjunctival injection as stand-alone inflammation prophylaxis after phacoemulsification cataract surgery

    Shorstein N, McCabe S, Alavi M, et al. Ophthalmology, in press 2024

    A retrospective cohort study compared the effectiveness of a single injection of subconjunctival triamcinolone with a topical steroid (with or without additional nonsteroidal anti-inflammatory drug drops) for inflammation prophylaxis following phacoemulsification cataract surgery.

    Study Design

    Data from 69,382 patients operated on at Kaiser Permanente Northern California facilities between 2018 and 2021 were included in the study. Patients given triamcinolone received either the 10 or 40 mg/mL concentration, with total dosages of 1−3 mg (“low”) or 3.1−5 mg (“high”). Outcomes were the incidence rates of iritis and macular edema in the 120 days after surgery and glaucoma-related events in the year after surgery.

    Outcomes

    The group that received the high dose of the 10 mg/mL triamcinolone concentration (mean of 4 mg of total drug) had the lowest odds of macular edema development than the other triamcinolone groups or the topical steroid ± NSAID group. The high-dose 40 mg/mL triamcinolone group had the lowest odds of developing iritis. Intraocular pressure and glaucoma-related event rates were similar between those given triamcinolone injections and those given topical steroids ± NSAID drops.

    Limitations

    As this was a retrospective review, the results could have been biased by the surgeons' various techniques. The study was also performed in one general geographic location. Finally, there was no documentation of pre-existing risk factors, such as diabetes or underlying autoimmune conditions, that may have predisposed the patients to developing postoperative macular edema.

    Clinical Significance

    Triamcinolone injections may be a good postoperative inflammation prophylaxis option for patients who are unable or unwilling to use topical drops. Injections could also potentially be more cost-effective than topical drops or currently available “dropless” treatments. Finally, a depot steroid may eliminate the need to rely on patient adherence to a precise drop regimen.

    Financial Disclosures: Dr. Stella Luo discloses no financial relationships.