Efficacy of the efficacy between dexamethasone versus triamcinolone acetonide after cataract surgery

Author: Zhou T, Yang M, Zhang J, Zhang G, Kang L, Guan H.

Geographical coverage: Pakistan, China, Thailand, Turkey, Iraq, and Finland.

Sector: Cataract surgery

Sub-sector: Treatment efficacy

Equity focus: Not reported

Study population: Patients with cataract

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background:

Cataract, a major cause of reversible blindness, is primarily treated through surgery and often leads to postoperative inflammation. Dexamethasone eye drops are widely used to control this inflammation but require frequent dosing, making patient compliance challenging. Triamcinolone acetonide (TA), a longer-acting corticosteroid, offers an alternative that does not require daily eye drops; it can be administered by injection, potentially improving adherence. TA has demonstrated effectiveness in reducing ocular inflammation and macular oedema. Previous studies comparing dexamethasone and TA reported mixed results, highlighting the need for a pooled analysis to better understand their comparative efficacy after cataract surgery.

Objectives:

This meta-analysis aimed to compare the effectiveness of dexamethasone versus TA in controlling intraocular inflammation after phacoemulsification cataract surgery with intraocular lens implantation in patients with cataract.

Main findings:

In total, seven studies (n = 1535 patients) were included in the meta-analysis. Of these, five were randomised controlled trials (RCTs) and two were retrospective cohort studies. The overall methodological quality of the included studies was rated as moderate to high. The trials were conducted in Pakistan (2 studies), China (1), Thailand (1), Turkey (1), Iraq (1), and Finland (1).

– Intraocular pressure (IOP): No significant difference was found between the TA injection group and the dexamethasone group on the first postoperative day or at the final follow-up (Day 1: standardised mean difference [SMD] 0.22, 95% confidence interval [CI] –0.29 to 0.73; P = 0.408. Last follow-up: SMD 0.04, 95% CI –0.18 to 0.26; P = 0.737).
– Visual acuity (LogMAR): There was no significant difference in visual acuity between the TA and dexamethasone groups on the first day after treatment or at the last recorded follow-up.
– Anterior chamber flare: No significant difference in anterior chamber flare was observed between the two groups on the first postoperative day (SMD 0.08, 95% CI –0.01 to 0.18; P = 0.087) or at the last follow-up (SMD –0.02; P = 0.656).
– Anterior chamber cells: On the first postoperative day, the TA group had a significantly higher anterior chamber cell count than the dexamethasone group (SMD –0.21, 95% CI –0.42 to –0.01; P = 0.044). However, by the final follow-up there was no significant difference in cell counts between the groups (P = 0.534).

Methodology:

The authors systematically searched PubMed, Embase, and the Cochrane Library for relevant studies published in English up to December 2022. The search included patients who underwent phacoemulsification with intraocular lens implantation, comparing TA injection to dexamethasone (with no restriction on study design, though language was limited to English). Two reviewers independently screened the search results for eligible studies, and full-text articles were assessed against inclusion criteria. Data from the included studies were extracted using a standardised form, and the original investigators were contacted for missing information. The risk of bias in RCTs was assessed with the Cochrane Collaboration’s tool, while the quality of observational studies was evaluated using the Newcastle–Ottawa Scale. Results from individual studies were pooled using a random-effects meta-analysis model, given the anticipated heterogeneity in steroid dose and follow-up duration. Statistical heterogeneity was evaluated with Cochran’s Q-test and the I² statistic. Because fewer than 10 studies were included, the authors did not perform a formal publication bias assessment (as funnel plots and Egger’s test would be unreliable in this context).

Applicability/external validity:

The review did not explicitly discuss the generalisability of its findings. It noted considerable heterogeneity in corticosteroid dosages, delivery methods, and follow-up durations across the included studies. Moreover, most studies excluded patients with pre-existing glaucoma or ocular hypertension, which limits the applicability of the results to those patient groups. These factors suggest that the findings should be applied with caution to broader patient populations or different clinical settings.

Geographic focus:

The seven included studies were conducted across six countries: Pakistan (2 studies), China (1), Thailand (1), Turkey (1), Iraq (1), and Finland (1).

Summary of quality assessment:

Overall, there is low confidence in the review’s conclusions about the treatment effects. Key limitations include the restriction of the search to English-language publications and a lack of clarity on whether data extraction was performed independently by more than one reviewer. These methodological limitations reduce confidence in the evidence and suggest that the results should be interpreted with care.