Safety And Efficacy Of Intracameral Steroids In Controlling Post-Operative Inflammation In Phacoemulsification: A Meta-Analysis

Cataract is the leading cause of blindness worldwide, and surgery is its primary treatment. Although cataract surgery generally has high success rate, post-operative complications, such as inflammation, are common. Traditional methods like topical corticosteroid application are used to prevent these issues. This study aimed to compare intracameral steroid use, a recent innovation, with traditional topical corticosteroid application to understand their efficacy and safety.

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The meta-analysis design and method were reported in line with Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. We included all randomized control clinical trials (RCT) with completed manuscripts or abstracts published online regardless of publication date or publication status. To obtain the articles for review, the following search terms were used: “intracameral” “steroids”, “dexamethasone”, “triamcinolone”, “cataract surgery”, “post-operative inflammation”, and “phacoemulsification”. The primary outcome was decrease in AC reaction (cells and flare) by SUN Classification. Secondary outcomes included IOP and adverse events.

Four studies were included in this meta-analysis. The pooled mean difference showed no significant difference in the reduction of inflammation scores in anterior chamber cells (MD=-0.11, 95%CI=-0.22 to 0.01, p=0.07), anterior chamber flare between (MD=0.04, 95%CI=-0.04 to 0.13, p=0.29), and in IOP (MD=-0.06, 95%CI=-0.54 to 0.42, p=0.81) between the two groups. Two studies reported on adverse events which observed the absence of serious adverse events in the topic group and one case in intracameral group.

There is evidence that supports the equivalence of intracameral steroid injections and topical steroids in reducing postoperative inflammation after phacoemulsification. There are also minimal adverse events, including ocular surface toxicity, in both intracameral steroid injections and topical steroids. Postoperative intraocular pressure is also comparative in both treatments. It is recommended that intracameral steroid injections be used as a safe and effective alternative to topical steroids for managing postoperative inflammation after phacoemulsification. Additionally, intracameral steroid injections may offer the added benefit of improved patient compliance due to their convenience and reduced frequency of administration.