Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery

Neal H Shorstein; Shannon E McCabe; Mubarika Alavi; Marilyn L Kwan; Naveen S Chandra

doi:10.1016/j.ophtha.2024.03.025

Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery

Ophthalmology. 2024 Apr 4:S0161-6420(24)00206-9. doi: 10.1016/j.ophtha.2024.03.025. Online ahead of print.

Authors

Neal H Shorstein¹, Shannon E McCabe², Mubarika Alavi³, Marilyn L Kwan³, Naveen S Chandra⁴

Affiliations

¹ Seva Foundation, Berkeley, California.
² Department of Ophthalmology, Kaiser Permanente, Walnut Creek, California.
³ Division of Research, Kaiser Permanente Northern California, Oakland, California.
⁴ Department of Ophthalmology, Kaiser Permanente, Walnut Creek, California. Electronic address: naveen.chandra@kp.org.

PMID: 38582155
DOI: 10.1016/j.ophtha.2024.03.025

Abstract

Purpose: To compare the effectiveness and safety of a single injection of subconjunctival triamcinolone acetonide (TA) with that of postoperative topical prednisolone acetate (PA) with and without nonsteroidal anti-inflammatory drugs (NSAIDs) for cataract surgery prophylaxis.

Design: Retrospective, comparative effectiveness cohort study.

Participants: Patients at Kaiser Permanente Northern California from 2018 through 2021.

Intervention: Exposure groups included topical PA with or without NSAID and subconjunctival injection of TA (Kenalog; Bristol-Myers-Squibb) 10 mg/ml or 40 mg/ml in a low dose (1.0-3.0 mg) or high dose (3.1-5.0 mg).

Main outcome measures: The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of postoperative macular edema (ME) and iritis diagnoses 15 to 120 days after surgery (effectiveness measures) and a glaucoma-related event (safety measure) between 15 days and 1 year after surgery.

Results: Of 69 832 eligible patient-eyes, postoperative ME, iritis, and a glaucoma-related event occurred on average in 1.3%, 0.8%, and 3.4% of eyes in the topical groups and 0.8%, 0.5%, and 2.8% of eyes in the injection groups, respectively. In multivariable analysis, compared with the PA reference group, the PA plus NSAID group had a lower OR of ME (OR, 0.88; 95% CI, 0.74-1.04; P = 0.135). and all injection groups had even lower odds, with the high-dose TA 10-mg/ml group reaching statistical significance (OR, 0.64; 95% CI, 0.43-0.97; P = 0.033). A trend of lower odds of a postoperative iritis diagnosis was noted in the high-strength (40 mg/ml) groups. For postoperative glaucoma-related events, compared with PA, the TA 10-mg/ml low-dose group showed lower odds (OR, 0.69; 95% CI, 0.55-0.86; P = 0.001), the TA 10-mg/ml high-dose group showed similar odds (OR, 0.90; 95% CI, 0.70-1.15; P = 0.40), and the TA 40-mg/ml low-dose and high-dose groups showed higher odds of an event occurring (OR, 1.46 [95% CI, 0.98-2.18; P = 0.062] and OR, 2.14 [95% CI, 1.36-3.37; P = 0.001], respectively).

Conclusions: The TA 10-mg/ml high-dose (4 mg) group was associated with a lower risk of postoperative ME and a similar risk of glaucoma-related events compared with the topical groups.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Keywords: Dropless cataract surgery; Macular edema prophylaxis; Subconjunctival triamcinolone injection.