Single perioperative triamcinolone injection versus standard postoperative steroid drops after uneventful phacoemulsification surgery - Randomized controlled trial

PURPOSE: To evaluate the safety and efficacy of a single perioperative sub-Tenon's injection of triamcinolone following cataract surgery and its effect on the incidence of early pseudophakic cystoid macular edema (CME). SETTING: Ophthalmology Department, Queen's Medical Centre University Hospital, Nottingham. United Kingdom. METHODS: This prospective randomized controlled trial included 54 eyes (54 patients) having routine cataract surgery. Twenty-seven eyes received the conventional postoperative care with steroid drops (drops group), whereas the other 27 were given a perioperative sub-Tenon's injection of triamcinolone (injection group); 10 of these received 20 mg, and the remaining 17 eyes had 30 mg triamcinolone. All patients were evaluated preoperatively and at days 1, 8, 30, and 90. The outcome measures evaluated were logMAR best corrected visual acuity (BCVA), anterior chamber flare (Kowa-500 flare meter), intraocular pressure, and slitlamp biomicroscopy. Oral fluorescein angiograms were performed at 30 and 90 days to detect angiographic CME. RESULTS: The mean logMAR BCVA improved from a baseline of 0.38 +/- 0.38 (SD) and 0.44 +/- 0.26 to 0.02 +/- 0.14 and 0.0 +/- 0.07 at 90 days in the steroid drops and injection groups, respectively. (P =.59). The mean flare increased from a baseline of 8.9 +/- 3.2 photons/ms and 8.3 +/- 3.7 photons/ms in the steroid drops and injection groups, respectively, to a maximum of +/-14.1 photons/ms and 25.8 +/- 7.5 photons/ms at day 8. Mean flare decreased to 15.8 +/- 9.7 photons/ms and 13.8 +/- 10.1 photons/ms at 30 days (P =.48, difference between groups) and 10.4 +/- 3.6 photons/ms and 9.8 +/- 3.1 photons/ms at 90 days, respectively, in the 2 groups. Subanalysis revealed lowest peak flare (17.9 +/- 7.9 photons/ms) at 8 days in the group that received 30 mg triamcinolone. CONCLUSIONS: A single sub-Tenon's injection of 30 mg triamcinolone seem to be safe and effective as a route of steroid delivery after uneventful phacoemulsification surgery. Larger numbers in patients at high risk are required to assess its effectiveness in reducing the risk for pseudophakic CME.