Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: a randomized controlled trial.
OBJECTIVE
To investigate the benefit of preoperative treatment with either topical nonsteroidal anti-inflammatory drug (NSAID) or steroid in terms of clinical outcomes following trabeculectomy.


METHODS
Prospective, randomized placebo-controlled trial.


METHODS
Sixty-one patients.


METHODS
Between July 2005 and October 2007, 61 consecutive medically uncontrolled glaucoma patients scheduled for first-time trabeculectomy were randomized to 1 of 3 study topical medication groups: nonsteroidal anti-inflammatory drugs (ketorolac), steroids (fluorometholone), or placebo (artificial tears). Patients instilled 1 drop 4 times daily for 1 month before the procedure and were examined on days 1 and 2, at weeks 1, 2, and 4, and at months 3, 6, 12, 18, and 24 after trabeculectomy.


METHODS
Incidence of postoperative surgical or medical interventions (needling, laser suture lysis, needling revision, and intraocular pressure [IOP]-lowering medication).


RESULTS
Fifty-four patients (54 eyes) were entered for analysis. The mean number of preoperative medications was 2.3+/-0.9. The mean baseline IOP was 21.0+/-6.0 mmHg. The mean postoperative target IOP was 16.5+/-1.8 mmHg. The mean follow-up was 23.6+/-4.0 months. The percentage of patients requiring needling within the first year was 41% in the placebo group, 6% in the NSAID, and 5% in the steroid group (P = 0.006). The percentage of patients requiring IOP-lowering medication to reach the target IOP at 1 year was 24% in the placebo group, 18% in the NSAID group, and 0% in the steroid group (P = 0.054 overall; P = 0.038 for steroids vs. others). The log-rank test showed a significant (P = 0.019) difference in medication-free survival curves between the different groups. More specifically, patients in the steroid group needed significantly less medication over the total follow-up (P = 0.007).


CONCLUSIONS
Topical ketorolac or fluorometholone for 1 month before surgery was associated with improved trabeculectomy outcomes in terms of likelihood of postoperative needling. In the steroid group, there was a significantly reduced need for additional postoperative IOP-lowering medication compared with the other groups.


BACKGROUND
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Breusegem
Christophe
C
Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
Spielberg
Leigh
L
Van Ginderdeuren
Rita
R
Vandewalle
Evelien
E
Renier
Charlotte
C
Van de Veire
Sara
S
Fieuws
Steffen
S
Zeyen
Thierry
T
Stalmans
Ingeborg
I
D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage; D003228:Conjunctiva / Q000187:drug effects / Q000473:pathology; D004311:Double-Blind Method; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D005469:Fluorometholone / Q000008:administration & dosage; D005901:Glaucoma / Q000188:drug therapy / Q000601:surgery*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007429:Intraocular Pressure; D020910:Ketorolac / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011446:Prospective Studies; D014130:Trabeculectomy; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000959:Antihypertensive Agents; D005938:Glucocorticoids; D016685:Mitomycin; D005469:Fluorometholone; D020910:Ketorolac