ROUTINE ADMINISTRATION OF SUB-TENON TRIAMCINOLONE AT THE TIME OF UNCOMPLICATED PHACOEMULSIFICATION AND IOL INSERTION FOR PATIENTS WITH DIABETES – CAN IT REDUCE POST-OPERATIVE CENTRAL RETINAL THICKNESS?

Routine administration of sub-tenon triamcinolone at the time of uncomplicated phacoemulsification and IOL insertion for patients with diabetes – can it reduce post-operative central retinal thickness and therefore diabetic macular oedema and cystoid macular oedema? Our aim is to compare the pre- and post-operative central retinal thickness (CRT) of diabetic patients who underwent routine phacoemulsification and IOL surgery, comparing those who did and did not receive a sub-tenon triamcinolone (Kenelog) injection at the end of the case.

Ophthalmology tertiary referral centre in Ireland

Patients selected had a diagnosis of diabetes mellitus and underwent elective, routine phacoemulsification and IOL surgery. 30 patients received a sub-tenon triamcinolone injection at the end of the case and 30 patients did not receive a sub-tenon triamcinolone injection. All patients had a sub-tenon anaesthetic block for the surgery and all had Rayone Aspheric IOLs inserted into the capsular bag. Patients were excluded if they required an anterior vitrectomy or different lens position or received any additional intravitreal injection at the time of surgery. Central retinal thickness (CRT) was measured using Heidelberg Optical coherence tomography (OCT) and values taken from a pre- and post-operative image. Post-operative review OCT was typically 4 weeks post-operative. All patients received the same post-operative drops – g. chloramphenicol QDS x 4 weeks and g.PredForte QDS x 2 weeks.

In those who received sub-tenon triamcinolone with their cataract surgery, their average pre-operative CRT was 258µm (range 141-750µm) and post-operative CRT was 246.2µm (range 113-423µm) In those patients who did not receive a sub-tenon triamcinolone injection their pre-op CRT was 209.2µm (141-374 µm) and their post-op CRT was 227.5µm (range 137-510µm). The mean post-operative change in CRT from pre-operative was an increase in CRT of 13µm and an increase in CRT of 24µm in those who did and did not receive sub-tenon triamcinolone injection.

Giving a sub-tenon triamcinolone injection at the time of phacoemulsification surgery is an option to decrease any post-operative central retinal thickening which diabetic patients may be prone to. Patients all received a sub-tenon anaesthetic ‘block’ for these surgeries anyway which means it is a minimal extra-step at the end of surgery. Average CRT increased for both groups but less so for those who received sub-tenon triamcinolone.