Retrospective Study Of Intraocular Pressure And Complication Outcomes With Use Of Intraoperative Intracameral Versus Subconjunctival Dexamethasone For Combined Phacoemulsification And Endoscopic Cyclophotocoagulation

Perioperative subconjunctival dexamethasone during combined phacoemulsification and endoscopic cyclophotocoagulation had been the standard practice previously. However, this has transitioned to intracameral administration at the end of surgery followed by intensive postoperative topical steroid drops. The aim of this study was to determine the safety and effectiveness of this change in practice.

Retrospective data for eyes undergoing phacoemulsification combined with endoscopic cyclophotocoagulation at a single-centre between 1^st October 2019 and 22^nd October 2024 was used. 

126 underwent the combined procedure during this time period. Data for 106 consecutive eyes with a minimum of 6 months follow up were included in this study. 29 had an intraoperative steroid subconjunctival injection (SC) and 77 had an intraoperative intracameral (IC) steroid injection. Intraocular pressure (IOP) was recorded pre-operatively, at 1 month, 6 months, 12 months, 24 months, 36 months and 48 months where available. Number of glaucoma medications and postoperative complications were recorded.

The pre-operative IOP for the SC steroid group was 23±9.2mmHg, while the IOP at 1, 6, 12, 24, 36 and 48 months were 15.5±3.3 (p<0.01),16.0±7.4 (p<0.01),14.1±3.3 (p<0.01), 14.4±3.0 (p<0.01) and 15.7±6.7mmHg (p<0.01) respectively. The pre-operative IOP for the IC steroid group was 20.2±7.2mmHg, while the IOP at 1, 6, 12, 24, 36 and 48 months were 14.9±6.2 (p<0.01), 14.5±4.2 (p<0.01), 13.8±4.0 (p<0.01), 14.2±3.8 (p<0.01) and 13.3±4.1mmHg (p<0.01) respectively. 27.6% (8 out of 29) of patients in the SC group compared to 19.5% (15 out of 77) of patients in the IC group had prolonged AU (p=0.37). 13.8% (4 out of 29) of patients in the SC group compared to 7.8% (6 out of 77) of patients in the IC group had CMO (p=0.35).

The IOP was significantly lower at the measured time points post operatively in the two groups. There were proportionally less patients developing clinically significant inflammation in the IC compared to the SC group.