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Database study of 20,066 cataract operations: do intraoperative subconjunctival steroids reduce the rate of macular oedema following cataract surgery?

Poster Details

First Author: M.Teo UK

Co Author(s):    P. Ursell   R. Muniraju                 

Abstract Details


To assess if intra-operative subconjunctival steroids have an effect on incidence of post-operative macular oedema in (a) normal (non-diabetic) patients, (b) diabetics without retinopathy and (c) diabetics with diabetic retinopathy.


Retrospective, single-centre (Epsom and St Helier NHS Hospitals, London), database study analysing 20,066 cataract surgeries extracted from electronic patient record (EPR) ‘medisoft’ from October 2007 to November 2017.


Data collected by EPR were extracted for each eye undergoing cataract surgery for occurrence of macular oedema within 3 months of cataract surgery, use of intraoperative subconjunctival steroids, diabetic status, intraoperative complications, post-operative complications, post-operative use of NSAIDs, co-pathologies, and concurrent anti-VEGF injection. Patients with factors that may affect rate of post-operative macular oedema were excluded. This comprised of patients with complicated surgery (PC rupture, vitreous loss, lens fragment into vitreous, iris trauma, hyphema, choroidal haemorrhage, zonular dialysis); known risk factors for macular oedema (uveitis, vitrectomy, retinal vein occlusion, and/or epiretinal membrane); concurrent anti-VEGF injection and post-operative NSAID use.


In all 3 groups, there was a relative risk reduction of post-operative macular oedema of between 30 - 40% in patients who received subconjunctival steroids.16% of group(b) and 42% of group(c) were on NSAIDs post-operatively, therefore were excluded from the study. Consequently, in these groups, the reduction in incidence of macular oedema did not reach statistical significance of p <0.05, but all groups reached a significance of p≤ 0.1. There was no increase in rate of raised IOP. (a) Non-diabetics n= 13000 (0.55%vs0.84% ,RRR=0.34,p=0.034) (b)Diabetics without retinopathy n= 2862 (0.91%vs1.52%,RRR=0.40,p=0.100) (c)Diabetics with retinopathy n= 644 (8.19%vs11.62%,RRR=0.30,p=0.098)


There appeared to be a trend towards a lower incidence of post-operative macular oedema with the use of subconjunctival steroids, which reached statistical significance of P<0.05 in group (a). A large proportion of diabetic patients had to be excluded from the study due to post-operative NSAID use. This study supports further evaluation of the use of subconjunctival steroids in cataract surgery, controlling for NSAID use.

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