Comparison of peroperative subconjunctival injection of methylprednisolone and standard postoperative steroid drops after uneventful cataract surgery.
OBJECTIVE
To compare the safety and efficacy of a single subconjunctival injection of methylprednisolone and a standard postoperative steroid regimen in terms of intraocular inflammation and intraocular pressure (IOP) after uncomplicated phacoemulsification surgery.


METHODS
Two groups of 25 patients each were included in this prospective randomized controlled trial. Patients in the injection group were given a subconjunctival injection of 20 mg methylprednisolone and the topical group received the conventional postoperative care with steroid eye drops (dexamethasone 1 mg/ml). The patients were examined 1 week and 1 month after surgery. Slit-lamp evaluation of anterior chamber inflammation and IOP were performed. Changes in IOP of ≥2.4 mmHg were considered clinically relevant.


RESULTS
In the injection group, mean IOP decreased from 15.4 ± 2.2 mmHg (baseline) to 14.1 ± 3.2 mmHg at 1 week (p = 0.03). The topical group had a stable IOP at 1 week (16.3 ± 2.6 mmHg) compared to baseline (16.1 ± 2.7 mmHg; p = 0.74). At 1 month, mean IOP was 14.3 ± 2.6 mmHg (p = 0.03) in the injection group and 15.6 ± 2.3 mmHg (p = 0.2) in the topical group. The intragroup changes were neither statistically significant nor clinically relevant at any postoperative visit. Both groups had the highest values of intraocular inflammation at the 1-week postoperative visit, followed by a decline to barely traceable levels at 1 month. The difference was not clinically relevant at any postoperative visit.


CONCLUSIONS
The subconjunctival injection of methylprednisolone appears to be as safe and effective as the conventional treatment, and it might therefore be considered for treatment of individuals with compliance issues.
Department of Neuroscience/Ophthalmology, Uppsala University Hospital, Uppsala, Sweden.
Nikolaos
N
Merkoudis
Anna
A
Wikberg Matsson
Elisabet
E
Granstam
D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D003228:Conjunctiva / Q000187:drug effects*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D056965:Injections, Intraocular; D007429:Intraocular Pressure / Q000187:drug effects; D019654:Lens Implantation, Intraocular; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D009798:Ocular Hypertension / Q000503:physiopathology / Q000517:prevention & control; D009883:Ophthalmic Solutions; D018918:Phacoemulsification; D011300:Preoperative Care; D011446:Prospective Studies; D014606:Uveitis, Anterior / Q000503:physiopathology / Q000517:prevention & control
D005938:Glucocorticoids; D009883:Ophthalmic Solutions; D003907:Dexamethasone; D008775:Methylprednisolone
cataract; intraocular pressure; methylprednisolone; phacoemulsification