To compare the effectiveness and safety of a single injection of subconjunctival triamcinolone acetonide (TA) with that of postoperative topical prednisolone acetate (PA) with and without nonsteroidal anti-inflammatory drugs (NSAIDs) for cataract surgery prophylaxis. Retrospective, comparative effectiveness cohort study. Patients at Kaiser Permanente Northern California from 2018 through 2021. Exposure groups included topical PA with or without NSAID and subconjunctival injection of TA (Kenalog; Bristol-Myers-Squibb) 10 mg/ml or 40 mg/ml in a low dose (1.0–3.0 mg) or high dose (3.1–5.0 mg). The adjusted odds ratio (OR) and 95% confidence interval (CI) for the association of postoperative macular edema (ME) and iritis diagnoses 15 to 120 days after surgery (effectiveness measures) and a glaucoma-related event (safety measure) between 15 days and 1 year after surgery. Of 69 832 eligible patient-eyes, postoperative ME, iritis, and a glaucoma-related event occurred on average in 1.3%, 0.8%, and 3.4% of eyes in the topical groups and 0.8%, 0.5%, and 2.8% of eyes in the injection groups, respectively. In multivariable analysis, compared with the PA reference group, the PA plus NSAID group had a lower OR of ME (OR, 0.88; 95% CI, 0.74–1.04; = 0.135). and all injection groups had even lower odds, with the high-dose TA 10-mg/ml group reaching statistical significance (OR, 0.64; 95% CI, 0.43–0.97; = 0.033). A trend of lower odds of a postoperative iritis diagnosis was noted in the high-strength (40 mg/ml) groups. For postoperative glaucoma-related events, compared with PA, the TA 10-mg/ml low-dose group showed lower odds (OR, 0.69; 95% CI, 0.55–0.86; = 0.001), the TA 10-mg/ml high-dose group showed similar odds (OR, 0.90; 95% CI, 0.70–1.15; = 0.40), and the TA 40-mg/ml low-dose and high-dose groups showed higher odds of an event occurring (OR, 1.46 [95% CI, 0.98–2.18; = 0.062] and OR, 2.14 [95% CI, 1.36–3.37; = 0.001], respectively). The TA 10-mg/ml high-dose (4 mg) group was associated with a lower risk of postoperative ME and a similar risk of glaucoma-related events compared with the topical groups. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

中文翻译：

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曲安奈德结膜下注射作为超声乳化白内障手术后独立的炎症预防


比较单次结膜下注射曲安奈德（TA）与术后局部注射醋酸泼尼松龙（PA）联合或不联合非甾体抗炎药（NSAID）预防白内障手术的有效性和安全性。回顾性、比较有效性队列研究。 2018 年至 2021 年北加州 Kaiser Permanente 的患者。暴露组包括局部 PA 联合或不联合 NSAID 以及结膜下注射 TA（Kenalog；百时美施贵宝）10 mg/ml 或 40 mg/ml 低剂量（1.0– 3.0 毫克）或高剂量（3.1–5.0 毫克）。术后黄斑水肿 (ME) 与手术后 15 至 120 天虹膜炎诊断（有效性测量）以及青光眼相关事件（安全测量）之间关系的调整比值比 (OR) 和 95% 置信区间 (CI) 介于 15术后几天和一年。在 69 832 名符合条件的患者眼睛中，局部用药组中平均有 1.3%、0.8% 和 3.4% 的眼睛发生术后 ME、虹膜炎和青光眼相关事件，而在局部组中，平均有 0.8%、0.5% 和 2.8% 的眼睛发生术后 ME、虹膜炎和青光眼相关事件。分别在注射组中。在多变量分析中，与 PA 参考组相比，PA 加 NSAID 组 ME 的 OR 较低（OR，0.88；95% CI，0.74–1.04；= 0.135）。所有注射组的几率甚至更低，其中高剂量 TA 10 mg/ml 组达到统计学显着性（OR，0.64；95% CI，0.43–0.97；= 0.033）。在高强度（40 mg/ml）组中注意到术后虹膜炎诊断几率较低的趋势。对于术后青光眼相关事件，与 PA 相比，TA 10 mg/ml 低剂量组的发生率较低（OR，0.69；95% CI，0.55–0.86；= 0.001），TA 10 mg/ml 高剂量组的发生率较低- 剂量组显示相似的赔率（OR，0.90；95% CI，0.70–1.15；= 0。40），TA 40 mg/ml 低剂量组和高剂量组表现出较高的事件发生几率（OR，1.46 [95% CI，0.98–2.18；= 0.062] 和 OR，2.14 [95% CI ，1.36–3.37；= 0.001]，分别）。与外用组相比，TA 10 mg/ml 高剂量（4 mg）组术后 ME 风险较低，青光眼相关事件风险相似。作者对本文讨论的任何材料没有专有或商业利益。