Real-World Outcomes of Intraoperative Intravitreal Triamcinolone at Phacoemulsification Cataract Surgery in Eyes with a History of Diabetic Macular Edema
TL;DR
The findings suggest that intraoperative IVTA may contribute to maintaining CSMT stability during the first three postoperative months in eyes with a history of DME.
Abstract
Objective Postoperative macular edema is a major cause of suboptimal visual acuity in diabetics who have undergone cataract surgery. Intravitreal Triamcinolone Acetonide (IVTA) may be used at the time of cataract surgery with the aim of limiting postoperative macular edema. This study evaluates the real‑world anatomical, visual and safety outcomes of combined intraoperative IVTA and phacoemulsification cataract surgery in eyes with a history of Diabetic Macular Edema (DME). Methods This single-centre retrospective observational study analysed the records of 73 eyes, all with a history of DME, which underwent combined phacoemulsification surgery with intraocular lens implantation and IVTA injection between January 2023 and December 2024. Analyses used available paired observations. Results The mean preoperative central subfield macular thickness (CSMT) was 265.0 ± 98.42 µm and 20/73 eyes (27%) had a baseline CSMT of >300 μm preoperatively. OCT scans were available for 51 eyes at 1 month (mean CSMT 313.2 ± 124.04 µm), 52 eyes at 3 months (299.3 ± 112.34 µm), 42 eyes at 6 months (336.2 ± 119.81µm) and 34 eyes at 1 year (310.5 ± 102.11 µm). A significant increase in CSMT was seen at 6 months and 1 year (p<0.01) but not at 1 month and 3 months (p>0.05). 17 eyes received rescue intravitreal therapy within 12 months (10 IVTA, 7 anti-VEGF). Mean visual acuity was 0.988 ± 0.688 logMAR preoperatively with significant improvement at all postoperative visits to 0.414 ± 0.340, 0.436 ± 0.411, 0.464 ± 0.454 and 0.501 ± 0.571 logMAR at 1 month, 3 months, 6 months and 1 year respectively (p<0.001). The mean IOP was not significantly increased at any of the postoperative visits. 3 eyes required the commencement, and 4 eyes required an increased usage of topical ocular anti-hypertensives within 1-year post-surgery. No patient required surgery for uncontrolled postoperative intraocular pressure. There were no cases of endophthalmitis. Conclusion In this real-world cohort, the findings suggest that intraoperative IVTA may contribute to maintaining CSMT stability during the first three postoperative months in eyes with a history of DME.