Intracameral dexamethasone during infantile cataract surgery appears safe

This retrospective study examined the use of intracameral preservative-free dexamethasone during infantile cataract surgery and found that it did not seem to cause an increased risk of glaucoma and appeared to protect against anterior membrane formation.

The pediatric eye being the canary in the coal mine, so to speak, this article is reassuring that when we use Triessence (and we shouldn't be using Kenalog) in uveitis patients or diabetics, there is no evidence of increasing their potential risk of glaucoma. I have used triamcinolone for a long time in my pediatric cataract cases, and it makes quite a difference.

The authors reviewed the cases of all infants who had cataract surgery with IOL implantation in 2007 and 2008 at one hospital in London and were given preservative-free intracameral dexamethasone intraoperatively. Eighteen patients (24 eyes) were included. The median age at surgery was three months (range 1 to 11 months). The median follow-up was 38 months (range 20 to 48 months).

Transient postoperative antihypertensive medication was used in four eyes; however, no eye developed glaucoma during the follow-up period. Fifteen eyes had a second procedure to clear the visual axis due to posterior visual axis opacification a mean of 6.4 months postoperatively (range 3.5 to 14.5 months); however, no eye developed anterior membranes.

The authors conclude that in this cohort, preservative-free intracameral dexamethasone was a safe adjunct in the infant eye (i.e., corneal clarity was maintained). These results indicate that the endothelium was not affected to a clinically significant degree and that the rate of early-onset glaucoma was not increased.