COMPARISON OF INTRA-OPERATIVE SUBTENON TRIAMCENOLONE ACETONIDE INJECTION WITH POST-OPERATIVE TOPICAL STEROID IN PHACOEMULSIFICATION

Background: Postoperative inflammation remains a common and potentially vision-threatening complication after phacoemulsification. Conventional topical corticosteroid regimens, while effective, are often hindered by poor patient compliance, especially in low-resource settings. Depot steroid delivery systems such as sub-Tenon’s triamcinolone acetonide offer a promising alternative by ensuring sustained anti-inflammatory effects with reduced dosing frequency. Objective: To compare the effectiveness of intraoperative sub-Tenon’s triamcinolone acetonide injection with postoperative topical steroids in preventing inflammation after uncomplicated phacoemulsification. Methods: A randomized controlled trial was conducted at the Department of Ophthalmology, Khyber Teaching Hospital, involving 74 patients (aged 40–80 years) undergoing phacoemulsification. Patients were randomly allocated into two equal groups: Group A received a single intraoperative sub-Tenon’s injection of triamcinolone acetonide (40 mg/ml), while Group B was treated with 0.1% dexamethasone eye drops postoperatively. The primary outcome was the absence of inflammation, defined by anterior chamber cells ≤3 per high power field or absence of posterior synechiae, assessed at 4 weeks post-surgery. Results: At 4 weeks follow-up, 83.8% of patients in Group A exhibited no signs of inflammation compared to 59.5% in Group B. The difference was statistically significant. Stratification analysis further revealed higher effectiveness among educated participants and urban residents. No significant adverse effects were noted in either group. Conclusion: Intraoperative sub-Tenon’s triamcinolone acetonide was more effective than postoperative topical steroids in controlling inflammation after phacoemulsification. Its ease of administration and reduced reliance on patient compliance support its integration into routine cataract surgery protocols, particularly in populations where adherence to postoperative regimens is limited.