Clinical context
Cataract surgery outcomes are not defined by best-corrected visual acuity alone. Refractive accuracy, vision at different distances, spectacle dependence, contrast sensitivity, dysphotopsia and procedural safety all matter. Corneal and macular status, capsular support, cataract density and IOL calculation also shape the final result. A statistically convincing average therefore still has to be interpreted against the characteristics of an individual eye.
What was studied
Inflammation after uncomplicated phacoemulsification is usually treated with steroid drops, but repeated dosing can challenge adherence. A periocular injection may provide sustained treatment in one dose. This PRISMA 2020 review compared both routes in adults after uncomplicated surgery. Its protocol was registered in PROSPERO, and PubMed, Embase and CENTRAL were searched through December 1, 2025. Ten studies with 57,564 eyes entered random-effects meta-analysis.
How the evidence was produced
A meta-analysis combines several studies and can increase the precision of an overall estimate. Its conclusion still depends on the quality of the component studies, comparability of interventions and endpoints, statistical heterogeneity and publication bias. The pooled effect should be read with its confidence interval, sensitivity analyses and the reasons results differed across studies.
How to interpret the result
Current evidence does not establish superiority for either route. Injection may reduce dependence on drop technique and adherence; drops can be changed after an adverse response. Nonsignificance does not prove equivalence because confidence intervals and heterogeneity still allow important effects. Choice should account for drug, dose, injection site, steroid-response risk and monitoring access.
The result should be understood as an estimate for the population studied, not a promise of an individual outcome. Statistical and clinical significance, absolute and relative effects, and prespecified and exploratory analyses should be distinguished. When several endpoints or subgroups are reported, the prespecified primary endpoint for which the study was designed usually provides the most reliable inference.
Clinical applicability
This evidence is most useful as a basis for preoperative discussion and surgical planning. It helps identify which outcomes should be measured and which trade-offs should be explained to patients. The average effect should not be generalized to every IOL, technique or patient without checking eligibility criteria, surgeon experience, biometry, ocular comorbidity and duration of follow-up.
Limitations
Evidence certainty was low, with variation in design, steroid, dose and periocular route. A large administrative dataset dominated the rare edema outcome, while IOP and vision samples were much smaller. I² of 65% showed heterogeneity for two primary outcomes. Follow-up to 120 days may miss later pressure elevation. Verify bias assessments, edema definitions, diabetes and uveitis mix, NSAID use, influence of large studies and drug-specific analyses in the source.
Beyond the limitations acknowledged by the authors, confidence is affected by sample size, follow-up duration, missing data, choice of comparator and relevance of the outcomes to routine care. Uncommon complications may remain undetected even in a well-conducted study. External validity is reduced when participants, equipment or investigator expertise differ substantially from everyday settings.
What to verify in the source
In the full paper, verify the protocol, eligibility criteria, baseline group characteristics, primary endpoint definition, confidence intervals, adverse events and losses to follow-up. Funding, conflicts of interest, trial registration and consistency between the published analysis and the original plan deserve separate attention. The DOI or source link below provides access to the primary publication for this check.