Subconjunctival Triamcinolone Acetonide Injection as Prophylactic Therapy for Pseudophakic Macular Edema

A study published in Ophthalmology suggests that subconjunctival triamcinolone acetonide injection is a useful prophylactic therapy for pseudophakic macular edema.

Study Overview

A study was conducted to compare the effectiveness and safety of a single injection of subconjunctival triamcinolone acetonide (TA) with postoperative topical prednisolone acetate (PA), with and without nonsteroidal anti-inflammatory drugs (NSAIDs), for cataract surgery prophylaxis. The study included patients at Kaiser Permanente Northern California from 2018 through 2021.

Exposure Groups

• Topical PA with or without NSAID
• Subconjunctival injection of TA (Kenalog; Bristol-Myers-Squibb) 10 mg/ml or 40 mg/ml in a low dose (1.0-3.0 mg) or high dose (3.1-5.0 mg)

Effectiveness and Safety Measures

The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated for the association of postoperative macular edema (ME) and iritis diagnoses 15 to 120 days after surgery (effectiveness measures) and a glaucoma-related event (safety measure) between 15 days and 1 year after surgery.

Results

Of 69,832 eligible patient-eyes, postoperative ME, iritis, and a glaucoma-related event occurred on average in 1.3%, 0.8%, and 3.4% of eyes in the topical groups and 0.8%, 0.5%, and 2.8% of eyes in the injection groups, respectively.

In multivariable analysis, compared with the PA reference group:

• The PA plus NSAID group had a lower OR of ME (OR, 0.88; 95% CI, 0.74-1.04; P = 0.135).
• All injection groups had even lower odds, with the high-dose TA 10-mg/ml group reaching statistical significance (OR, 0.64; 95% CI, 0.43-0.97; P = 0.033).

A trend of lower odds of a postoperative iritis diagnosis was noted in the high-strength (40 mg/ml) groups.

For postoperative glaucoma-related events, compared with PA:

• The TA 10-mg/ml low-dose group showed lower odds (OR, 0.69; 95% CI, 0.55-0.86; P = 0.001).
• The TA 10-mg/ml high-dose group showed similar odds (OR, 0.90; 95% CI, 0.70-1.15; P = 0.40).
• The TA 40-mg/ml low-dose and high-dose groups showed higher odds of an event occurring (OR, 1.46 [95% CI, 0.98-2.18; P = 0.062] and OR, 2.14 [95% CI, 1.36-3.37; P = 0.001], respectively).

The TA 10-mg/ml high-dose (4 mg) group was associated with a lower risk of postoperative ME and a similar risk of glaucoma-related events compared with the topical groups.

Reference

Shorstein NH, McCabe SE, Alavi M, Kwan ML, Chandra NS. Triamcinolone Acetonide Subconjunctival Injection as Stand-alone Inflammation Prophylaxis after Phacoemulsification Cataract Surgery. Ophthalmology. 2024 Oct;131(10):1145-1156. doi: 10.1016/j.ophtha.2024.03.025. Epub 2024 Apr 4. PMID: 38582155; PMCID: PMC11416342.

Keywords

• Subconjunctival
• Triamcinolone
• Acetonide
• Injection
• Prophylactic therapy
• Pseudophakic
• Macular edema
• Study
• Shorstein NH
• McCabe SE
• Alavi M
• Kwan ML
• Chandra NS
• Triamcinolone Acetonide Subconjunctival Injection
• Ophthalmology
• Dropless cataract surgery
• Macular edema prophylaxis
• Subconjunctival triamcinolone injection