Effect Of Subconjunctival Dexamethasone Injection On Post-operative Inflammation After Cataract Surgery (sics); A Randomized Controlled Trial

Abstract

Background: Inflammation after cataract surgery remains an undesirable consequence despite many advances in surgical techniques. It can be rather persistent as well. Although corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have traditionally been used to treat inflammation after cataract surgery, there are no universal established guidelines for the treatment of inflammation induced by cataractsurgery.A subconjunctival dexamethasone injection at the end of cataract surgery has been widely used as a part of the treatment regimen of post cataract surgery inflammation, in the belief that it will reduce the postoperative inflammation. Purpose: To prospectively evaluate the usefulness of a subconjunctival steroid injection given at the completion of uneventful (STCS) cataract surgery. Setting: Lions Sight First Eye Hospital, Nairobi, Kenya Design: Randomized controlled trial Methods: One hundred six (106) eyes of healthy patients underwent routine small incision cataract surgery. They werethen randomized into 2 groups. The intervention group received a subconjunctival injection of dexamethasone-gentamicin and the control group received a subconjunctival injection of normal saline-gentamicin (placebo). Both groups commenced on topical steroids-antibiotic immediately on the first postoperative day, after the slit lamp examination. Anterior chamber cells & flare intensity was measured as a primary outcomewith a slit lamp on the first and second postoperative days (POD). Results: On the first POD, patients in the intervention group had a mean inflammation score in relation to cells of 3.2±0.8 and in the control group of 3.3±0.8. In relation to flare, the intervention group and the control group had a similar mean inflammation score of 3.4±0.7 and of 3.4±0.8 respectively. The same result was obtained on the second POD, the mean score difference between both groups was insignificant. No significant difference was observed between the two groups in aqueous cells & flare values at the first and the second postoperative days. Conclusion: A subconjunctival dexamethasone injection given at the completion of cataract surgery {SICS} had no beneficial effectson inflammation after cataract surgery.