Intraocular Pressure Elevation Following Intracameral Steroid In Dropless Cataract Surgery: A Systematic Review

To evaluate the incidence, magnitude, and timing of intraocular pressure (IOP) elevation following intracameral or periocular steroid administration in dropless cataract surgery compared with conventional topical steroid regimens.

Systematic review conducted according to predefined inclusion criteria using electronic databases and reference screening.

A systematic search of PubMed, Embase, and Cochrane Library identified comparative and non-comparative studies evaluating intracameral or periocular steroid use in routine phacoemulsification. Primary outcome was incidence of IOP elevation ≥25 mmHg within 30 days postoperatively. Secondary outcomes included mean IOP change and requirement for pressure-lowering treatment. Randomised controlled trials were assessed using RoB 2 and observational studies using Newcastle–Ottawa Scale. Data were synthesised descriptively due to heterogeneity.

Fourteen studies (6 randomised, 8 observational) comprising 4,862 eyes met inclusion criteria. Reported incidence of IOP elevation ≥25 mmHg ranged from 1.8% to 9.6% in intracameral steroid arms compared with 0.9% to 4.2% in topical regimens. Transient IOP spikes typically occurred within 7–14 days and were medically controlled in most cases. Higher rates were noted in depot steroid preparations. Risk of bias was moderate in observational studies and low-to-moderate in RCTs.

Intracameral steroid–based dropless cataract surgery demonstrates generally acceptable safety profiles; however, a modestly increased rate of early postoperative IOP elevation is consistently reported, particularly with depot preparations. Careful patient selection and early postoperative IOP monitoring are advisable. Standardised definitions and longer follow-up are needed in future trials.