Dexamethasone versus triamcinolone acetonide for the management of postoperative inflammation following cataract surgery

Abstract

Background: Cataract remains the leading cause of reversible blindness worldwide, particularly in low-resource settings. Effective control of postoperative inflammation is essential to prevent complications such as cystoid macular edema and raised intraocular pressure. Dexamethasone and Triamcinolone acetonide (TCA) are widely used corticosteroids; however, their comparative efficacy remains uncertain. This updated systematic review and meta-analysis aimed to compare their effectiveness following cataract surgery. Methods: A systematic search of 4 databases (PubMed, Google Scholar, Cochrane Central Library and Scopus) was conducted up to June 2026 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews: CRD420261435380). Randomized controlled trials and prospective studies comparing dexamethasone and TCA in adults undergoing phacoemulsification were included. Risk of bias was assessed using cochrane risk of bias 2 and the Newcastle–Ottawa Scale. Certainty of evidence was evaluated using grading of recommendations assessment, development and evaluation. A random-effects model was used, with heterogeneity assessed by I2. Results: Twelve studies (nine randomized controlled trials and 3 non-randomized prospective studies; n = 2003) were included. No significant differences were observed in intraocular pressure (Mean Difference, mm Hg) at any time point up to 3 months. Visual acuity showed modest improvement with TCA at 7 and 28/30 days, though results were inconsistent on sensitivity analysis. No significant differences were found in anterior chamber flare or cells across all time points. A nonsignificant trend toward greater endothelial cell loss was observed with dexamethasone. Overall, evidence certainty was low. Conclusion: Dexamethasone and TCA demonstrate comparable efficacy and safety in controlling postoperative inflammation after cataract surgery. TCA may offer short-term visual benefits and prolonged action, whereas dexamethasone allows flexible dosing. Clinical decisions should be individualized, considering patient compliance and clinical context.