A Dose Response Study of a Single Intraoperative Sub–Tenon’s Capsule Triamcinolone Acetonide Injection for the Treatment of Post–Cataract Surgery Inflammation

Abstract

Abstract: : Purpose: To compare the dose response of different concentrations of a single intraoperative sub–Tenon’s capsule triamcinolone acetonide injection with steroid drops in the treatment of ocular inflammation after cataract surgery. Methods: A randomized, double masked controlled trial. After phacoemulsification and intraocular posterior lens implantation, 100 patients were randomized to receive either (B) a posterior 40 mg triamcinolone acetonide sub–Tenon’s capsule injection, (C) a posterior 20 mg triamcinolone acetonide sub–Tenon’s capsule injection, (D) a posterior 15 mg triamcinolone acetonide sub–Tenon’s capsule injection, (E) a posterior 10 mg triamcinolone acetonide sub–Tenon’s capsule injection, (A) 1% prednisolone acetate eye drops self–instilled into the treated eye, according to the following schedule: 1 drop 4 times daily (week 1); 3 times daily (week 2); 2 times daily (week 3); once daily (week 4). The main outcome measures included inflammation (cell, flare, ciliary flush), intraocular pressure and lack of response. Results: Triamcinolone in the dose of 40 and 20 mg was shown to have antiinflammatory efficacy clinically equivalent to conventional 1% prednisolone eye drops in reducing intraocular inflammation, as measured by clinical methods. Two out of twenty (10%) in group D and four out of twenty (20%) in group E required rescue medication and were dropped from the study for lack of response. Twenty milligram of triamcinolone was found to be as safe as the prednisolone in terms of adverse effects, changes in visual acuity, intraocular pressure, and biomicroscopic and ophthalmoscopic variables. On the third and seventh postoperative days a significant lower intraocular pressure (P<0.01) was noticed in the triamcinolone groups than in the prednisolone group. Conclusions: A single intraoperative 40 and 20 mg triamcinolone acetonide sub–Tenon’s capsule injection demonstrated a clinically equivalent therapeutic response and ocular tolerance to 1% prednisolone drops in controlling postoperative inflammation following uncomplicated cataract surgery. Therefore, in performing this approach, the lower dose of 20 mg is suggested.

Keywords: cataract • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled • pharmacology