Subconjunctival injection of triamcinolone acetonide may prevent complications after phacoemulsification: Study

In recent research conducted by Kaiser Permanente Northern California, a single injection of triamcinolone acetonide (TA) was identified to be more effective and safer than traditional topical prednisolone acetate (PA) in preventing complications following cataract surgery. The findings were published in the Ophthalmology journal.

This retrospective study spanned from 2018 to 2021 and included 69,832 patient-eyes which underwent phacoemulsification to remove cataract. The patients were categorized into groups receiving either topical PA with or without a nonsteroidal anti-inflammatory drug (NSAID) or a subconjunctival injection of TA, at varying doses and concentrations. The effectiveness of these treatments was evaluated based on the incidence of postoperative macular edema (ME) and iritis and the safety was assessed via the occurrence of glaucoma-related events within a year following the surgery.

The results highlighted that the high-dose TA (10 mg/mL) group showed a statistically significant reduction in the risk of developing postoperative ME when compared to the group treated with topical PA. The odds ratio (OR) was 0.64 which suggests a 36% lower risk and provides promising insight into the potential benefits of opting for an injection over topical solutions. Further, the combination of PA and NSAID did not show a statistically significant benefit in reducing ME.

This study observed trends in the reduction of postoperative iritis in patients who were treated with high concentration TA (40 mg/mL), although these findings did not reach statistical significance. The low dose TA (10 mg/mL) group experienced markedly lower odds of encountering glaucoma-related events when compared to the topical PA group by indicating a safer profile for this particular injection dosage.

Higher doses of TA at 40 mg/mL were associated with an elevated risk of glaucoma-related events which suggesting that while effective, the higher concentrations of the drug might increase the risk of adverse effects. This underlines the importance of dose management in the use of injectable steroids to balance efficacy and safety.

This findings are significant as they could influence future protocols in the management of inflammation and prevention of complications post-cataract surgery. The subconjunctival injections of TA with optimized dosages lower risks of ME and iritis and might become a preferred strategy over the conventional topical treatments. This offers a simpler and potentially more effective prophylactic option for the patients who undergo cataract surgery every year.

Reference:

Shorstein, N. H., McCabe, S. E., Alavi, M., Kwan, M. L., & Chandra, N. S. (2024). Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery. In Ophthalmology. Elsevier BV. https://doi.org/10.1016/j.ophtha.2024.03.025