Efficacy and safety of intracameral betamethasone versus dexamethasone at the end of phacoemulsification

Purpose The current study aimed to determine the safety and efficacy of intracameral injection of betamethasone or dexamethasone at the end of phacoemulsification in decreasing postoperative inflammation. Patients and methods This is a comparative, prospective, interventional, randomized study that was carried out at Cairo University Hospital, Cairo, Egypt. It included 90 patients with age-related cataracts for whom phacoemulsification was performed. They were randomized into three equal groups: the betamethasone group had an intracameral injection of 0.2 mg/0.1 ml betamethasone at the surgery end, the dexamethasone group received an intracameral injection of 0.4 mg/0.1 ml dexamethasone at the surgery end, and the control group who did not receive either drug. All patients were evaluated for anterior chamber inflammation (cells and flare), LogMAR best-corrected visual acuity, corneal endothelial cell count, pachymetry, and intraocular pressure (IOP) 14 days after surgery. Results On the 14th postoperative day, all patients of the betamethasone and dexamethasone groups had grade 0 cells and flare, while in the control group, 20% had grade 1 cells and 16.6% grade 1 flare, with a statistically significant difference (betamethasone vs. control: P =0.02 and dexamethasone vs. control: P =0.02). The mean LogMAR best-corrected visual acuity was 0.4±0.2, 0.3±0.1, and 0.5±0.2 in the betamethasone, dexamethasone, and control groups, respectively (betamethasone vs. control: P =0.005 and dexamethasone vs. control: P =0.003). The mean endothelial cell count was 2160.2±336.3, 2185.3±381.7, and 1892.3±352.3 cells/mm 2 , respectively (betamethasone vs. control: P =0.005 and dexamethasone vs. control: P =0.002). The mean corneal pachymetry was 563.9±37.1, 565.4±26.9, and 585.5±26.4 μm, respectively (betamethasone vs. control: P =0.03 and dexamethasone vs. control: P =0.01). According to the post-hoc analysis, the betamethasone versus the dexamethasone groups exhibited no significant differences. The mean IOP was 12.8±1.1, 12.2±1.07, and 13.0±1.7 mmHg, respectively, without significant difference ( P =0.06). Conclusion At the end of uneventful phacoemulsification, intracameral dexamethasone or betamethasone significantly minimized the postoperative ocular inflammation and corneal endothelial cell loss and did not increase the IOP. Thus, injecting either intracameral dexamethasone or betamethasone at the end of cataract surgery is recommended.