- Design
- Systematic review and meta-analysis (9 RCTs, 3 prospective studies)
- Population
- 2,003 adults undergoing phacoemulsification
- Primary outcome
- Intraocular pressure, anterior chamber inflammation and visual acuity
- Effect
- No significant differences in IOP, cells or flare up to 3 months; low certainty
A systematic review and meta-analysis pooled 12 studies, nine of them randomised, comparing dexamethasone with triamcinolone acetonide for inflammation after phacoemulsification in 2,003 adults.
There were no significant differences in intraocular pressure at any time up to three months, nor in anterior chamber cells or flare. Triamcinolone gave a modest visual advantage at about one and four weeks, but this was not robust on sensitivity analysis. Dexamethasone showed a non-significant trend towards more endothelial cell loss. Overall certainty of evidence was low.
The practical relevance is in high-volume and low-resource settings, where patients may struggle with a weeks-long drop regimen. Triamcinolone, with its longer action, appears to control inflammation as well as dexamethasone, which supports choosing between them on adherence, access and cost rather than efficacy. Pressure checks after steroid exposure remain necessary either way.
- Consider triamcinolone acetonide as an alternative to dexamethasone after phacoemulsification when drop adherence is a concern.
- Inflammation and intraocular pressure were similar with the two steroids up to three months.
- Check intraocular pressure after surgery whichever steroid is used.
- Base the choice on adherence, access and cost, as efficacy appeared similar on low-certainty evidence.
- Endothelial cell loss trended higher with dexamethasone but not significantly; monitor at-risk corneas either way.
Why it matters
A longer-acting steroid may ease the burden of weeks of drops without giving up inflammation control.
Don't overread it
Certainty was low and three studies were non-randomised; this does not establish that the two are equivalent.
The statistics, in plain English
No significant difference means the studies could not separate the two drugs, not that they are proven identical. Low certainty means further studies could change the conclusion.
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