Abstract / Summary
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.
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.
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.
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.