A single intraoperative sub–Tenon's capsule triamcinolone acetonide injection for the treatment of post–cataract surgery inflammation

Abstract

Purpose To compare a single intraoperative sub–Tenon's capsule triamcinolone acetonide injection with steroid drops in the treatment of ocular inflammation after cataract surgery. Design Randomized, double-masked controlled trial. Participants A total of 100 patients were randomized prospectively into 2 groups: 50 patients treated with 1% prednisolone eyedrops (control group A) and 50 patients treated with sub–Tenon's capsule triamcinolone (treatment group B). Methods All patients underwent phacoemulsification and intraocular posterior lens implantation. After surgery, patients were randomized to receive either (group B) an intraoperative 40 mg triamcinolone acetonide sub–Tenon's capsule injection or (group A) 1% prednisolone acetate eyedrops, according to the following schedule: 1 drop 4 times daily (week 1), 3 times daily (week 2), 2 times daily (week 3), once daily (week 4). To mask the study, group B received vehicle drops administered on a similar schedule, and group A received an intraoperative sub–Tenon's capsule injection of a 1 ml balanced salt solution. Main outcome measures The main outcome measures included inflammation (cell, flare, ciliary flush), intraocular pressure, and lack of response. Results Triamcinolone was shown to have anti-inflammatory efficacy clinically equivalent to conventional 1% prednisolone eyedrops in reducing intraocular inflammation, as measured by clinical methods. Triamcinolone was found to be as safe as the prednisolone in terms of adverse effects, changes in visual acuity, intraocular pressure, and biomicroscopic and ophthalmoscopic variables. On the third, seventh, fourteenth, and twenty-eighth postoperative days, a significantly lower intraocular pressure ( P<0.01) was noted in the triamcinolone group than in the prednisolone group. Conclusions A single intraoperative 40-mg triamcinolone acetonide sub–Tenon's capsule injection demonstrated a clinically equivalent therapeutic response and ocular tolerance compared with 1% prednisolone drops in controlling postoperative inflammation after uncomplicated cataract surgery and merits further investigation.