Intracameral triamcinolone appears to improve outcomes in pediatric cataract surgery

The authors of this retrospective study found that children who underwent cataract surgery and IOL implantation combined with intracameral triamcinolone have significantly less anterior segment inflammation and no visual axis obscuration.

They enrolled 41 consecutive children (41 eyes) in the study group and 83 children (83 eyes) in the control group. Their mean age was similar, at 9.15 months in the study group and 9.34 months in the control group. Both groups underwent phacoaspiration, posterior capsulectomy, vitrectomy and IOL implantation. The study group eyes received a standardized application of an intracameral preservative-free triamcinolone acetonide suspension intraoperatively while the control group did not. Both groups received systemic steroidal agents in tapering doses over one month and topical steroidal agents in tapering doses over two to three months postoperatively. All patients were evaluated after one and 12 months.

Postoperatively, the visual axis was not obscured in any eye in the study group, while nine eyes (10.8 percent) in the control group had an obscured axis (P < 0.029). There was a statistically significant difference between the groups in posterior synechias and cell deposits (both P < 0.033). Posterior synechias were observed in four eyes (9.8 percent) in the study group and 21 eyes (25.3 percent) in the control group at one month and at the last follow-up. Cell deposits were observed in four eyes (9.8 percent) in the study group and 21 eyes (25.3 percent) in the control group at one month and at the last follow-up. Preoperative and postoperative IOP measurements were similar between the groups.

Even though this study includes only pediatric cases, I believe it is very important because there is a big trend toward the use of intracameral triamcinolone in complex and even routine adult phacoemulsification. This study shows a significant difference in inflammation even in the face of systemic steroids in the control group. The safety of intracameral triamcinolone demonstrated from the point of view of IOP and endophthalmitis is also important.