Intravitreal dexamethasone an effective alternative to systemic steroids for uveitic cataract surgery

This study compares the prophylactic effects of a dexamethasone implant versus systemic steroids in patients with intermediate or posterior uveitis who were scheduled for cataract surgery.

Study design

This randomized, comparative clinical trial randomized patients into 2 groups. Group 1 (20 patients) received intravitreal dexamethasone concurrently with cataract surgery, while Group 2 (23 patients) received systemic steroids 2 days prior to surgery, with subsequent tapering over 3 to 4 weeks. The authors primarily assessed the incidence of postoperative cystoid macular edema (CME); the study also examined changes in BCVA, central subfield thickness and complications.

Outcomes

The groups showed similar changes in central macular thickness. In the intravitreal group, 1 patient developed CME requiring a second dexamethasone implant, and 4 patients developed ocular hypertension. All patients were managed with topical medications and returned to baseline by the end of the study period.

In the systemic steroid group, 3 patients required a rapid taper of prednisone due to uncontrolled blood glucose and 2 patients developed CME. Both patients were treated with a dexamethasone implant in the postoperative period with successful resolution.

Limitations

This is a small study with a demographically homogenous population; it may be difficult to extrapolate the findings to more diverse populations. The study did not include patients with anterior uveitis.

Clinical significance

It may be very useful to add intravitreal dexamethasone to the armamentarium of perioperative medications in cataract surgery, especially in patients who have contraindications to systemic steroids.