Triamcinolone acetonide injection helps prevent macular edema after cataract surgery

Treatment with subconjunctival triamcinolone acetonide (TA) results in a reduced risk of postoperative macular edema (ME), particularly the 10-mg/ml high-dose (4 mg) group, reports a study. Additionally, the risk of glaucoma-related events is similar to that of topical groups.

Patients at the Kaiser Permanente Northern California, US, from 2018 through 2021 were included in this retrospective, comparative effectiveness cohort study. Participants received topical prednisolone acetate (PA) with or without NSAID or subconjunctival injection of TA 10 or 40 mg/ml in a low (1.0–3.0 mg) or high dose (3.1–5.0 mg).

The investigators calculated the adjusted odds ratio (OR) and 95 percent confidence interval (CI) for the association of postoperative ME and iritis diagnoses 15 to 120 days after surgery. They also examined any glaucoma-related event between 15 days and 1 year after surgery.

A total of 69,832 patient-eyes met the eligibility criteria. On average, postoperative ME, iritis, and a glaucoma-related event occurred in 1.3 percent, 0.8 percent, and 3.4 percent of eyes in the topical groups and 0.8 percent, 0.5 percent, and 2.8 percent of eyes in the injection groups, respectively.

Multivariate analysis revealed that the PA plus NSAID group had a lower likelihood of ME (OR, 0.88, 95 percent CI, 0.74–1.04; p=0.135) than the PA reference group. Additionally, all injection groups had much lower odds, with the high-dose TA 10-mg/ml group achieving statistical significance (OR, 0.64, 95 percent CI, 0.43–0.97; p=0.033).

There was also a trend towards a reduced likelihood of a postoperative iritis diagnosis in the high-dose group (40 mg/ml).

In terms of safety, the TA 10-mg/ml low-dose group had fewer postoperative glaucoma-related events (OR, 0.69, 95 percent CI, 0.55–0.86; p=0.001) compared with PA, while the TA 10-mg/ml high-dose group had similar odds (OR, 0.90, 95 percent CI, 0.70–1.15; p=0.4). 

On the other hand, the TA 40-mg/ml low-dose (OR, 1.46, 95 percent CI, 0.98–2.18; p=0.062) and high-dose (OR, 2.14, 95 percent CI, 1.36–3.37; p=0.001) groups had a higher chance of experiencing an event.