- Design
- Systematic review and meta-analysis (9 randomised trials, 3 non-randomised prospective studies)
- Population
- 12 studies, 2,003 adults having phacoemulsification
- Primary outcome
- Intraocular pressure, visual acuity and anterior chamber inflammation after cataract surgery
- Effect
- No significant difference in IOP up to 3 months or in flare and cells; modest early visual advantage with triamcinolone, not robust
A meta-analysis of 12 studies with 2,003 adults having phacoemulsification, nine randomised and three non-randomised prospective, compared dexamethasone with triamcinolone acetonide for postoperative inflammation.
Intraocular pressure did not differ at any time point up to 3 months. Visual acuity improved modestly more with triamcinolone at 7 and 28 to 30 days, but not consistently on sensitivity analysis. Anterior chamber flare and cells did not differ. A non-significant trend towards more endothelial cell loss appeared with dexamethasone. Overall certainty of evidence was low.
The authors suggest triamcinolone may give short-term visual benefit and longer action, while dexamethasone allows flexible dosing, and advise individualising choice by compliance and context. In a patient who may not manage drops reliably, a longer-acting depot may be attractive; where costs matter, dexamethasone drops remain a reasonable option.
- Either steroid controlled postoperative inflammation similarly in pooled data.
- Pressure was not different up to 3 months, but monitor both as usual.
- Consider depot triamcinolone where adherence to drops is doubtful.
- Evidence certainty was low; local cost and availability can reasonably decide.
Why it matters
It shifts the choice from efficacy, where evidence is thin, to practical questions such as adherence and cost.
Don't overread it
Low-certainty evidence from mixed designs; the endothelial cell trend was not significant.
The statistics, in plain English
No significant difference does not prove the drugs are equal; it means the studies could not separate them. A modest visual advantage that disappears on sensitivity testing should not drive the choice.
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