One subconjunctival triamcinolone injection controlled post-phaco inflammation as well as six weeks of drops

Design

Randomised controlled trial

Population

100 eyes having phacoemulsification for age-related cataract in India

Primary outcome

Anterior chamber cells and flare to day 42

Effect

No significant difference; IOP spikes >25 mmHg 4 vs 3 (p = 0.69)

This randomised trial from India enrolled 100 eyes having phacoemulsification for age-related cataract under peribulbar anaesthesia. Half received subconjunctival triamcinolone acetonide 20 mg at the end of surgery; half received tapering topical prednisolone 1% for six weeks.

Anterior chamber cells, flare and mean intraocular pressure did not differ at any visit through day 42. Pressure spikes above 25 mmHg occurred in four eyes with triamcinolone and three with drops (p = 0.69). Central subfoveal thickness on OCT at day 42 was similar. Subconjunctival haemorrhage was more common with the injection at days 1 and 7, resolving by day 21, and a few patients noticed a visible steroid deposit.

For elderly patients who struggle with drop schedules, and for high-volume and outreach cataract services where follow-up is uncertain, a single depot removes an adherence problem. The trial was small and not powered to detect differences in rare events such as steroid-induced pressure rise or cystoid macular oedema.

• Consider depot subconjunctival triamcinolone for patients unlikely to manage a drop taper
• Warn patients about subconjunctival haemorrhage and a visible deposit
• Check intraocular pressure at follow-up, particularly in known steroid responders or glaucoma
• Avoid in patients with a history of steroid-induced pressure rise

Why it matters

Adherence to postoperative drops is poor in elderly and rural patients, and a single depot takes that out of the equation.

Don't overread it

A 100-eye single-centre trial — too small to establish safety for pressure rise or macular oedema.

The statistics, in plain English

With 50 eyes per group, the trial could show that inflammation scores were similar but could not reliably compare uncommon complications — the pressure spike counts (4 vs 3) are too small to draw conclusions. 'Non-inferior' here reflects no significant difference rather than a formally prespecified margin in the abstract.

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