Comparison of orbital floor triamcinolone acetonide and oral prednisolone for cataract surgery management in patients with non-infectious uveitis

Abstract

Purpose: To compare orbital floor triamcinolone acetonide and oral prednisolone in cataract surgery in patients with chronic non-infectious uveitis with regard to visual outcome, postoperative inflammation and macular edema.

Methods: Monocentric prospective randomized clinical trial with 40 eyes included. Patients underwent phacoemulsification with intraocular acrylic foldable lens (IOL) implantation. Patients were randomized either to intraoperative orbital floor triamcinolone acetonide (TA) (1 ml = 40 mg) (group 1, n = 20), or to 4-week postoperative oral prednisolone (group 2, n = 20). Laser flare photometry (LFM), cells in the anterior chamber (AC), best-corrected visual acuity (BCVA), IOL cell deposits, cystoid macular edema (CME) by means of fluorescein angiography, and central foveal thickness (OCT), posterior capsule opacification (PCO), and intraocular pressure (IOP) were analysed during a 6-months period.

Results: Mean BCVA postoperatively improved (p < 0.01) from logMAR 0.74 and 0.86 to 0.23 and 0.35 in groups 1 and 2 respectively.The number of AC cells, LFM and IOL cell deposits did not differ. Macular edema stayed unchanged in most cases in both groups, and mean foveal thickness (OCT) initially increased postoperatively, but after 6 months it nearly returned to baseline thickness. Differences between the groups were not significant. Up to 12% in group 1 and 28% of group 2 developed IOP elevation over 21 mmHg.

Conclusions: A single intraoperative orbital floor injection of triamcinolone acetonide is as effective on postoperative inflammation, macular edema, and visual outcome as a 4-week course of postoperative oral prednisolone in cataract surgery with IOL implantation in uveitis patients.

Trial registration: ClinicalTrials.gov NCT00403832.