Subconjunctival betamethasone is of benefit after cataract surgery

Following cataract extraction, the intraocular inflammatory response is particularly marked in some patients, who then require more intensive post-operative care. This prospective randomised double-masked controlled trial of 246 patients undergoing cataract extraction assessed the efficacy and safety of a prophylactic subconjunctival injection of betamethasone (Betnesol, Glaxo) in improving the post-operative course. Betamethasone injected subconjunctivally at the end of cataract extraction significantly reduces anterior segment inflammation (p < 0.05) on the first post-operative day. It also reduces the need for additional steroid treatment and in-patient stay (p < 0.05). The benefits are most marked in those patients prone to a greater inflammatory response: especially those with previous intraocular inflammation (p < 0.01), but also those with racial pigmentation or difficult surgery. There was no evidence of adverse effects following betamethasone; in particular there was no endophthalmitis or steroid-induced elevation of intraocular pressure. We therefore conclude that subconjunctival injection of betamethasone is a practical, safe and effective means of improving the quality and efficiency of patient care.