Subconjunctival triamcinolone acetate versus topical steroid for control of inflammation after phacoemulsification surgery – A randomized control trial

PURPOSE: To compare the efficacy of subconjunctival triamcinolone versus topical prednisolone in controlling postoperative inflammation after phacoemulsification. METHODS: In this randomized control study, a total of 100 eyes were enrolled. Patients with age-related cataract undergoing phacoemulsification under peribulbar anesthesia were randomly allocated into two groups using a computer-generated random table. Group A received single-dose subconjunctival triamcinolone acetonide (20 mg/0.5 ml) at the end of surgery; Group B received topical prednisolone 1% eyedrops in tapering doses for 1.5 months. Patients were followed up on postoperative days 1, 7, 21, and 42 for anterior chamber (AC) cells, flare, intraocular pressure (IOP), subconjunctival hemorrhage, and cystoid macular edema using optical coherence tomography (OCT). SPSS version 20.0, Chi-square, and t-tests were applied for statistical analysis. A P value < 0.05 was considered statistically significant. RESULTS: There was no significant difference in AC cells, flare, and mean IOP between both groups on any postoperative day. Three patients had extensive AC inflammation for 5-7 days. Pressure spikes >25 mmHg were noted in four patients in Group A and three patients in Group B ( P value = 0.69). Subconjunctival hemorrhage was significantly more in Group A (P 0.001) on days 1 and 7, which resolved in all patients by 21 days. There was no significant difference in central subfoveal thickness on OCT in both groups on day 42. All the patients had good postoperative gain in visual acuity. A few patients complained of mild cosmetic blemish from steroid deposit. CONCLUSION: Subconjunctival triamcinolone is noninferior to topical steroids in controlling post-phacoemulsification intraocular inflammation.