Clinical outcomes of triamcinolone acetonide in pediatric cataract surgery with intraocular lens implantation: A systematic review and meta-analysis

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Purpose Children are prone to several complications following cataract surgery. Therefore, we aimed to evaluate the efficacy and safety of intracameral triamcinolone acetonide (TA) on inflammatory postoperative complications and intraocular pressure (IOP) in pediatric cataract surgery with intraocular lens (IOL) implantation. Design We conducted a systematic review and meta-analysis according to the PRISMA guidelines. Methods The search was performed in MEDLINE, Embase, and Cochrane Library databases. We included studies that compared the incidence of complications in patients who received TA during cataract surgery with IOL implant versus cataract surgery with IOL alone. We also performed a trial sequential analysis (TSA) to address the required sample size for each outcome. Prospective registration was made under the protocol CRD42023495272. Results The total dataset included 292 eyes, 126 (43.1 %) of which received TA. We found a significant reduction in the incidence of visual axis obscuration (VAO) (OR: 0.13; CI: 0.02 - 0.71; I² = 0 %; p = 0.019) and posterior synechiae (OR: 0.43; CI: 0.21 - 0.88; I² = 0 %; p = 0.021). There was no effect of the intervention in IOP at 6 months and beyond (SMD: 0.02; CI: -0.66 - 0.70; I² = 0 %; p = 0.85). TSA demonstrated the need for additional studies to reach reliable conclusions regarding cell deposits and IOP before 1 month. Conclusion Intracameral injection of TA was superior to surgery without TA in reducing VAO and posterior synechiae in pediatric cataract surgery with IOL implantation and has apparent safety regarding IOP.