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Annie M Wu,1,2 Kristen M Pitts,1,3 Roberto Pineda,1 Sherleen H Chen,1 Mengyu Wang,3 Grace Johnson,1 Lucy Q Shen,1,* Milica A Margeta1,3,* 1Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; 2Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA; 3Harvard Ophthalmology AI Lab, Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Annie M Wu, Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI, 48108, USA, Tel +1 408 628 8420, Email wuann@med.umich.eduPurpose: To assess the rates of postoperative steroid response following dropless cataract surgery using a subconjunctival depot of triamcinolone versus conventional cataract surgery using topical prednisolone.Patients and Methods: We reviewed consecutive cataract surgery cases performed by a single surgeon to determine the likelihood of steroid response, defined as intraocular pressure (IOP) 50% above baseline or IOP > 24 mmHg postoperatively, excluding the first 72 hours. Logistic regression models were performed including baseline characteristics as exposures in the model and steroid response as the outcome. Main outcome measures were the proportion of eyes developing steroid response, risk factors for developing steroid response, and duration of steroid response.Results: Of the 150 dropless and 218 conventional cases, 26 eyes developed steroid response (15 dropless and 11 conventional cases [10% vs 5%, P=0.096]). Risk factors for steroid response included dropless surgery (OR=2.43, 95% CI=1.03– 6.02], P=0.046) and prior diagnosis of glaucoma (OR=7.18, 95% CI=2.66– 19.22], P< 0.001). Baseline IOP, age, sex, race, and axial length did not increase risk for steroid response. Of the eyes with steroid response, more dropless cases had an IOP elevation ≥ 30 days (9/15 eyes vs 1/11 eyes; P=0.008), including one patient with refractory IOP elevation in the dropless group who required urgent bilateral trabeculectomy for IOP control.Conclusion: Dropless cataract surgery increases the risk of prolonged steroid response postoperatively. Patients with glaucoma have an increased risk of steroid response and may not be good candidates for dropless cataract surgery with subconjunctival triamcinolone.Keywords: ocular hypertension, glaucoma, intraocular pressure, triamcinolone depot, postoperative |
