- Design
- Randomised controlled trial
- Population
- 100 eyes having phacoemulsification for age-related cataract, India
- Primary outcome
- Postoperative anterior chamber inflammation
- Effect
- No difference in cells, flare or IOP; IOP spikes >25 mmHg 4 vs 3 eyes; more subconjunctival haemorrhage with injection
In this Indian randomised trial, 100 eyes having phacoemulsification under peribulbar anaesthesia received either subconjunctival triamcinolone acetonide 20 mg at the end of surgery or prednisolone 1% drops tapered over six weeks.
Anterior chamber cells, flare, mean pressure and central macular thickness at six weeks did not differ. Pressure spikes above 25 mmHg occurred in four eyes with triamcinolone and three with drops. Subconjunctival haemorrhage was more common after the injection in the first week, and some patients noticed a visible steroid deposit. The authors conclude that the injection was non-inferior.
Adherence to a six-week taper is a real problem, especially for elderly patients who struggle to instil drops, and in high-volume outreach surgery. A single injection removes that step. The trial is small, so pressure monitoring still matters, particularly because depot steroid cannot be stopped if pressure rises.
- Consider subconjunctival triamcinolone at the end of routine phaco for patients unlikely to manage a drop taper.
- Warn patients about subconjunctival haemorrhage and a possible visible deposit.
- Check pressure at follow-up, since a depot steroid cannot be withdrawn if pressure rises.
- Avoid it in known steroid responders and eyes with glaucoma until there is more evidence.
Why it matters
It removes a six-week drop regimen that many older patients find hard to follow.
Don't overread it
With 100 eyes, the trial could miss uncommon pressure rises; it does not establish safety in glaucoma or steroid responders.
The statistics, in plain English
Pressure spikes in 4 versus 3 eyes (P = 0.69) are too few to compare reliably. Non-inferiority here means inflammation scores were not worse with the injection.
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