Efficacy of intracameral preservative-free triamcinolone acetonide in pediatric cataract surgery: a meta-analysis

Purpose The aim of this study is to evaluate the efficacy of intracameral preservative-free triamcinolone acetonide (TA) on reducing inflammatory reactions after pediatric cataract surgery. Methods Researches were comprehensively searched in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to 30 November, 2019. Data of interest were extracted and analyzed by Review Manager 5.2. The primary outcome was cell deposits. The secondary outcomes included posterior synechias, fibrinous anterior chamber reaction, visual axis obscuration, and posterior capsule opacification. The odds ratio (OR), weight mean difference (WMD), and their 95% confidence intervals (95% CI) were used to assess the strength of the association. Results In total, 45 articles were obtained. Finally, 5 studies with a total of 308 eyes were enrolled in this meta-analysis. Among these, 134 eyes underwent intracameral TA treatment and 174 eyes did not. In intracameral TA treatment group, the incidence of cell deposits (OR = 0.35, 95% CI 0.16-0.76,P= 0.008), posterior synechias (OR = 0.44, 95% CI 0.23-0.86,P= 0.02), and fibrinous anterior chamber reaction (OR = 0.12, 95% CI 0.01-1.05,P= 0.05) were lower compared to those in patients without intracameral TA treatment. Meanwhile, the incidence of visual axis obscuration (OR = 0.10, 95% CI 0.01-0.85,P= 0.04) and posterior capsule opacification (OR = 0.09, 95% CI 0.02-0.55,P= 0.009) were also reduced significantly. The intraocular pressure (IOP) was evaluated at the first month postoperatively (WMD = 0.84 mmHg, 95% CI 0.14-1.53,P= 0.02), but within the normal range. There was no difference of IOP between two groups at 6 months or above after operation (P= 0.93). Conclusions The intracameral preservative-free TA in pediatric cataract surgery contributed to much less inflammatory reaction with the normal IOP range.