Abstract
Purpose :
Anti-inflammatory medications are used to prevent inflammatory complications such as cystoid macular edema (CME) after cataract surgery. However, elevated intraocular pressure (IOP) due to corticosteroids may damage the eye. Therefore, the purpose of this study is to determine how varying doses of intraoperative triamcinolone influence the rates of postoperative CME, IOP rise, and need for supplemental steroid. Analysis of these factors lends insight into optimal dosing.
Methods :
We reviewed clinical records of uncomplicated cataract surgery patients (n=1705) at Nuvance Health from 2008-2022. Patients were routinely injected with subconjunctival triamcinolone by one surgeon (PEL) at the time of surgery. The dosage gradually decreased from 12 mg to 1 mg as IOP rise was more frequently problematic than CME incidence. All patients received a topical NSAID once daily for 5 weeks post-op. Data collected includes triamcinolone dose, pre and post-op IOP, pre and post-op best corrected visual acuity (BCVA), CME incidence within 90 days post-op, and need for supplemental steroid within 90 days post-op. Since there were insufficient numbers to analyze every dosage level separately, K-means clustering was used to determine that the dosage should be grouped as: 1-3mg, 4mg, and 6-12mg.
Results :
The average IOP change at 4 weeks post-op significantly decreased with 1-3mg intraoperative triamcinolone when compared with the 6-12mg dose (p=0.0000071). The incidence of IOP spikes were significantly increased in the: 6-12mg over the 1-3mg group (p<0.05 at IOP>4,6,8,10mmHg), the 6-12mg over the 4mg group (p=0.07 at IOP>4mmHg) and the 4mg over the 1-3mg group (p<0.05 at IOP> 4,6,8,10mmHg). The trend of BCVA improved with increased intraoperative triamcinolone, however this difference was not statistically significant. Patients who required additional post-operative steroid were significantly higher in the 1-3mg vs 4mg groups (p=0.0033) and the 1-3mg vs 6mg groups (p=0.0107). CME percentage increased with decreased triamcinolone dose, but there was no significant difference.
Conclusions :
Patients who are at a long-term vision risk from higher IOP would benefit from a lower triamcinolone dose-around 2mg. The study suggests that patients who are at risk for CME, such as patients with diabetes or epiretinal membrane, may benefit from a 4mg dose of triamcinolone but further investigation is needed.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.