Steroid Response Following Dropless Cataract Surgery Using Subconjunctival Triamcinolone

Figures & data

Table 1 Demographic, Preoperative, and Postoperative Information for Dropless vs Conventional Cataract Surgery Groups

	Dropless	Conventional	P-value
	N = 150 Eyes	N = 218 Eyes
Demographics
Age at time of surgery, years	69.9±10.4	66.5±12.7	0.004*
Sex			0.92
Male	70 (0.47)	100 (0.46)
Race			>0.99
White	131 (0.87)	197 (0.90)
Non-white	19 (0.13)	21 (0.10)
Preoperative data
Operated eye			0.46
N of right eyes	81 (0.54)	109 (0.5)
Axial length of operated eye, mm	25.0±2.2	24.8±2.2	0.30
Baseline CDVA of operated eye, logMAR	0.4±0.4	0.5±0.5	0.18
Baseline IOP of operated eye, mmHg	16.6±3.2	16.4±3.6	0.54
Glaucoma or glaucoma suspect diagnosis	31 (0.21)	55 (0.25)	0.32
Glaucoma	12 (0.08)	26 (0.12)	0.87
Glaucoma suspect	19 (0.13)	29 (0.13)	0.33
Postoperative data
POM1 CDVA of operated eye, logMAR	0.1±0.2	0.2±0.4	0.005*
Additional or prolonged steroid use post op	17 (0.11)	17 (0.08)	0.27
Use of IOP lowering drops POD1-POM3^a	20 (0.13)	26 (0.12)	0.52
POD1 IOP of operated eye, mmHg	20.6±6.2	19.2±5.8	0.03*
POW1 IOP of operated eye, mmHg	16.4±3.5	15.5±3.7	0.03*
POM1 IOP of operated eye, mmHg	16.8±4.0	15.4±3.4	0.0008*
Steroid response^b	15 (0.10)	11 (0.05)	0.096

Notes: Data are reported as mean±standard deviation for continuous variables and frequency count (fraction of total) for categorical variables. *Statistically significant P-value <0.05. ^aRefers to additional IOP-lowering drops above pre-op baseline. ^bDefined as IOP >24 mmHg or IOP >50% above baseline.

Abbreviations: CDVA, corrected distance visual acuity; IOP, intraocular pressure; logMAR, logarithm of the minimum angle of resolution; POD1, postoperative day 1; POM1, postoperative month 1; POW1, postoperative week 1.

Figure 1 (A) Mean intraocular pressure (IOP) of all subjects at baseline, day 1, week 1, and week 4 after cataract surgery. (B) Mean IOP at baseline and postoperative weeks 1–24 in dropless vs conventional cataract surgery eyes with steroid response. The number of subjects in each group and at each timepoint is indicated below the diagram; “D” stands for dropless, “C” for conventional cataract surgery. *P<0.05, ***P<0.001. Error bars show standard error of the mean.

Table 2 Predictors of Steroid Response in All Eyes Undergoing Cataract Surgery (Univariate and Multivariate Analysis)

Predictor of Steroid Response	Univariate Analysis		Multivariate Analysis
	OR (95% CI) of Steroid Response	P-value	OR (95% CI) of Steroid Response	P-value
Age: Per 1 Year Increase	1.01 (0.98–1.05)	0.56
Sex: Male (vs Female)	1.21 (0.52–2.81)	0.65
Axial Length: Per 1 mm Increase	1.05 (0.87–1.24)	0.56
Baseline IOP: Per 1 mmHg Increase	0.95 (0.83–1.08)	0.48
Baseline Visual Acuity: per 0.1 Increase in logMAR	1.54 (0.68–3.01)	0.25
Glaucoma Suspect Diagnosis	1.65 (0.46–4.66)	0.39	2.85 (0.75–9.02)	0.09
Glaucoma Diagnosis	5.65 (2.21–13.82)	0.0002*	7.18 (2.66–19.22)	<0.001*
Dropless Surgery	2.22 (0.96–5.29)	0.06	2.43 (1.03–6.02)	0.046*
Additional Post-Op Steroid Use	2.03 (0.56–5.81)	0.22

Notes: *Statistically significant P-value <0.05 (shown in bold font). Statistically significant confidence intervals shown in bold font.

Abbreviations: CI, confidence interval; IOP, intraocular pressure; logMAR, logarithm of the minimum angle of resolution; OR, odds ratio.

Table 3 Characteristics of Dropless vs Conventional Cataract Surgery Eyes That Developed Steroid Response

	Dropless with Steroid Response	Conventional with Steroid Response	P-value
	N = 15 Eyes	N = 11 Eyes
Demographics
Age at time of surgery, years	74.1±7.2	62.7±17.6	0.07
Sex			>0.99
Male	7 (0.47)	6 (0.55)
Race			0.41
White	14 (0.93)	10 (0.91)
Non-White	1 (0.07)	1 (0.09)
Preoperative data
Operated eye			>0.99
Right	8 (0.53)	5 (0.45)
Axial length of operated eye, mm	24.9±1.9	25.6±2.3	0.38
Baseline CDVA of operated eye, logMAR	0.4±0.2	0.6±0.7	0.38
Baseline IOP of operated eye, mmHg	16.3±4.5	15.0±4.7	0.47
Glaucoma or glaucoma suspect diagnosis	7 (0.47)	7 (0.64)	0.45
Glaucoma	2 (0.13)	4 (0.36)	0.68
Glaucoma suspect	5 (0.33)	3 (0.27)	0.13
Postoperative data
POM1 CDVA of operated eye, logMAR	0.2 ± 0.2	0.2 ± 0.3	0.51
Additional or prolonged steroid use post op	2 (0.13)	2 (0.18)	>0.99
Use of IOP-lowering drops POD1-POM3	7 (0.47)	7 (0.64)	0.45
POD1 IOP of operated eye, mmHg	24.1±10.5	24.4±10.4	0.94
POW1 IOP of operated eye, mmHg	19.9±5.9	21.0±5.4	0.62
POM1 IOP of operated eye, mmHg	23.9±5.7	21.1±3.6	0.15
Duration of steroid response			0.008*
<30 days	6 (0.40)	10 (0.91)
≥30 days	9 (0.60)	1 (0.09)
Duration of steroid response, days	60.0±63.5	23.2±4.0	0.74

Notes: Data are reported as mean±standard deviation for continuous variables and frequency count (fraction of total) for categorical variables. *Statistically significant P-value <0.05.

Abbreviations: CDVA, corrected distance visual acuity; IOP, intraocular pressure; logMAR, logarithm of the minimum angle of resolution; POD1, postoperative day 1; POM1, postoperative month 1; POW1, postoperative week 1.

Figure 2 Optical Coherence Tomography and Humphrey Visual Field findings of a patient who developed severe glaucoma in the setting of prolonged steroid response following dropless cataract surgery. (A) Cirrus retinal nerve fiber layer (RNFL) Deviation Map for both eyes showing optic disc cupping and thinning of the peripapillary RNFL in both eyes. (B) RNFL thickness by quadrant showing superior and inferior thinning in the right eye and diffuse thinning in the left eye with mean RNFL thickness of 47 and 41 µm in the right and left eyes, respectively. (C) 24–2 SITA-Fast of right and left eyes showing significant arcuate defects in both eyes.