Back to Search
Start Over
Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery.
- Source :
-
Ophthalmology [Ophthalmology] 2024 Oct; Vol. 131 (10), pp. 1145-1156. Date of Electronic Publication: 2024 Apr 04. - Publication Year :
- 2024
-
Abstract
- Purpose: To compare the effectiveness and safety of a single injection of subconjunctival triamcinolone acetonide (TA) with that of postoperative topical prednisolone acetate (PA) with and without nonsteroidal anti-inflammatory drugs (NSAIDs) for cataract surgery prophylaxis.<br />Design: Retrospective, comparative effectiveness cohort study.<br />Participants: Patients at Kaiser Permanente Northern California from 2018 through 2021.<br />Intervention: Exposure groups included topical PA with or without NSAID and subconjunctival injection of TA (Kenalog; Bristol-Myers-Squibb) 10 mg/ml or 40 mg/ml in a low dose (1.0-3.0 mg) or high dose (3.1-5.0 mg).<br />Main Outcome Measures: The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of postoperative macular edema (ME) and iritis diagnoses 15 to 120 days after surgery (effectiveness measures) and a glaucoma-related event (safety measure) between 15 days and 1 year after surgery.<br />Results: Of 69 832 eligible patient-eyes, postoperative ME, iritis, and a glaucoma-related event occurred on average in 1.3%, 0.8%, and 3.4% of eyes in the topical groups and 0.8%, 0.5%, and 2.8% of eyes in the injection groups, respectively. In multivariable analysis, compared with the PA reference group, the PA plus NSAID group had a lower OR of ME (OR, 0.88; 95% CI, 0.74-1.04; P = 0.135). and all injection groups had even lower odds, with the high-dose TA 10-mg/ml group reaching statistical significance (OR, 0.64; 95% CI, 0.43-0.97; P = 0.033). A trend of lower odds of a postoperative iritis diagnosis was noted in the high-strength (40 mg/ml) groups. For postoperative glaucoma-related events, compared with PA, the TA 10-mg/ml low-dose group showed lower odds (OR, 0.69; 95% CI, 0.55-0.86; P = 0.001), the TA 10-mg/ml high-dose group showed similar odds (OR, 0.90; 95% CI, 0.70-1.15; P = 0.40), and the TA 40-mg/ml low-dose and high-dose groups showed higher odds of an event occurring (OR, 1.46 [95% CI, 0.98-2.18; P = 0.062] and OR, 2.14 [95% CI, 1.36-3.37; P = 0.001], respectively).<br />Conclusions: The TA 10-mg/ml high-dose (4 mg) group was associated with a lower risk of postoperative ME and a similar risk of glaucoma-related events compared with the topical groups.<br />Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.<br /> (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Retrospective Studies
Male
Female
Aged
Injections, Intraocular
Middle Aged
Aged, 80 and over
Prednisolone analogs & derivatives
Prednisolone administration & dosage
Prednisolone therapeutic use
Iritis
Anti-Inflammatory Agents, Non-Steroidal administration & dosage
Visual Acuity
Triamcinolone Acetonide administration & dosage
Phacoemulsification adverse effects
Glucocorticoids administration & dosage
Conjunctiva
Postoperative Complications prevention & control
Macular Edema prevention & control
Macular Edema etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1549-4713
- Volume :
- 131
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Ophthalmology
- Publication Type :
- Academic Journal
- Accession number :
- 38582155
- Full Text :
- https://doi.org/10.1016/j.ophtha.2024.03.025