ESCRS - FP01.07 - MACULAR EDEMA AND IOP OUTCOMES WITH PERIOCULAR VERSUS TOPICAL CORTICOSTEROIDS IN PHACOEMULSIFICATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

MACULAR EDEMA AND IOP OUTCOMES WITH PERIOCULAR VERSUS TOPICAL CORTICOSTEROIDS IN PHACOEMULSIFICATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Published 2026 - 30th ESCRS Winter Meeting

Reference: FP01.07 | Type: Free Paper | DOI: 10.82333/nvna-m339

Authors: Nuno Rodrigues Alves* 1 , Pedro Sperotto 2 , Carolina Carvalho Soares Valentim 3 , Guilherme Lopes 4 , Eduardo Mazzocato 5 , Neeran Narainswami 6 , Catarina Barão 1 , Lívio Costa 1 , Pedro Gil 1 , João Feijão 1 , Nuno Filipe Alves 1

1Ophthalmology,Unidade Local de Saúde de São José,Lisbon,Portugal, 2Universidade do Sul de Santa Catarina,Santa Catarina,Brazil, 3University of Louisville,Kentucky,United States, 4Centro Universitário FMABC,São Paulo,Brazil, 5Hospital de Olhos de Blumenau,Santa Catarina,Brazil, 6Red Cross War Memorial Children's Hospital,Cape Town,South Africa

Purpose

To determine whether periocular corticosteroid injections provide comparable protection against pseudophakic macular edema and postoperative intraocular pressure (IOP) elevation as standard topical therapy following uncomplicated phacoemulsification.

Setting

Department of Ophthalmology, Unidade Local de Saúde de São José, Lisbon, Portugal

Methods

Following PRISMA 2020 guidelines and PROSPERO registration, PubMed, Embase, and the Cochrane Library were systematically searched for studies comparing intraoperative periocular injections (subconjunctival or subtenon) versus standard topical corticosteroids in adults undergoing uncomplicated phacoemulsification. Main outcomes were postoperative cystoid macular edema incidence and IOP. Data were pooled using random-effects models; heterogeneity was assessed with I².

Results

Ten studies (six randomized controlled trials) involving 57,545 patients (86,178 eyes) were analyzed: 14,833 received periocular steroids, and 42,712 received topical steroids. No statistically significant differences were observed in macular edema (1.22% periocular vs 1.26% topical; RR 0.89, 95% CI 0.67–1.19; p = 0.44; I² = 39%) or IOP (MD 0.91 mmHg; 95% CI -0.12 to 1.93; p = 0.07; I² = 90%).

Conclusion

Periocular and topical corticosteroids demonstrate comparable effects on postoperative macular edema and IOP. A single periocular injection may therefore serve as a practical alternative to standard topical therapy. Further high-quality, standardized RCTs are warranted to determine the optimal regimen and dosage.