A retrospective study from Trinidad and Tobago suggests that intraoperative triamcinolone may temporarily reduce postoperative macular thickening in diabetic patients undergoing cataract surgery, but benefits diminish over time, highlighting the need for further research and vigilant follow-up.
Diabetic cataract patients who receive intraoperative triamcinolone at the time of lens replacement may see short-term stability in macular thickness, but that benefit appears to fade over time, according to a retrospective study from Trinidad and Tobago published in the journal Clinical Ophthalmology.
Researchers at Trinidad Eye Hospital reviewed 73 eyes in 73 patients with a history of diabetic macular oedema who underwent phacoemulsification with intraocular lens implantation and an intravitreal triamcinolone acetonide injection at the end of surgery. The study found that central subfield macular thickness did not change significantly at one or three months after surgery, but it rose significantly at six months and one year. Visual acuity improved at every postoperative visit, while eye pressure stayed broadly stable and no cases of endophthalmitis were reported.
The findings fit with earlier evidence that cataract surgery in diabetes carries a higher risk of postoperative macular oedema, especially in people with diabetic retinopathy or existing macular disease. A review on diabetic cataract surgery risks in the National Library of Medicine noted that adjunctive treatments, including intravitreal anti-VEGF therapy, are often considered for patients at greatest risk. Separate OCT-based research has shown that macular oedema tends to peak around one month after surgery and often improves spontaneously over subsequent months, although prior laser treatment may reduce the risk in the short term.
In the Trinidad and Tobago cohort, 76.7% of eyes had previously received bevacizumab and nearly a quarter had also had earlier triamcinolone. The authors reported that eyes with foveal exudates and those whose fellow eye had postoperative macular oedema were more likely to develop oedema again, although the estimates did not reach statistical significance. Eyes with lower baseline macular thickness seemed to show the clearest later rise, while eyes starting above 300 microns remained broadly unchanged. Some patients still needed rescue injections during follow-up, mostly anti-VEGF treatment or additional triamcinolone.
The study’s main appeal is practical: triamcinolone is cheaper than many alternatives, and cost remains a major barrier in Trinidad and Tobago. The authors argue that the treatment may help hold macular thickness steady for roughly the period when the steroid is expected to be active, but they also stress that the benefit looks temporary and that stronger evidence is still needed. Their bottom line is cautious rather than definitive: patients with a history of diabetic macular oedema should be watched closely after cataract surgery, and intraoperative triamcinolone may be a reasonable low-cost option in resource-limited settings, but only a controlled prospective trial can show whether it truly prevents postoperative macular oedema.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
