Corticosteroids versus NSAIDs on intraocular pressure and the hypertensive phase after Ahmed glaucoma valve surgery.
OBJECTIVE
To compare the effect of topical steroids versus nonsteroidal anti-inflammatory drugs on intraocular pressure (IOP) and the hypertensive phase (HP) after Ahmed glaucoma valve surgery.


METHODS
Prospective, randomized, double-masked controlled trial. Twenty-eight consecutive consenting patients scheduled for Ahmed glaucoma valve surgery were randomized to receive either postoperative topical dexamethasone or ketorolac. The main outcome measure was IOP. Secondary outcomes included incidence of HP, visual acuity, number of glaucoma medications, postoperative complications, and subsequent procedures.


RESULTS
The mean postoperative IOP (in mm Hg) in the ketorolac versus dexamethasone arms respectively was as follows: 8.8±4.7 versus 10.0±4.5 at week 1 (P=0.500); 10.7±6.7 versus 17.5±10.4 at week 2 (P=0.053); 11.0±6.5 versus 18.0±7.3 at week 4 (P=0.013); 14.8±8.6 versus 17.5±5.2 at week 6 to 8 (P=0.323); and 14.8±9.6 versus 17.8±7.5 at week 10 to 12 (P=0.374). Four patients (31%) in the ketorolac arm versus 8 patients (53%) in the dexamethasone arm exhibited the HP (P=0.276). Wound leak was the most severe complication and there were 3 cases (23%) in the ketorolac group versus nil in the steroid group (P=0.087). Conjunctival retraction was observed in 8 patients (62%) in the ketorolac arm versus 2 patients (13%) in the dexamethasone arm (P=0.016).


CONCLUSIONS
Mean IOP was greater at all time points postoperatively in the steroid group with the difference between groups statistically significant at week 4. The nonsteroidal anti-inflammatory drug group showed greater wound-healing problems.
Yuen
Darana
D
Department of Ophthalmology and Visual Sciences, Toronto Western Hospital, Ontario, Canada.
Buys
Yvonne
Y
Jin
Ya-Ping
YP
Alasbali
Tariq
T
Smith
Michael
M
Trope
Graham E
GE
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D020327:Glaucoma Drainage Implants / Q000009:adverse effects*; D005902:Glaucoma, Open-Angle / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D020911:Ketorolac Tromethamine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000009:adverse effects; D013529:Surgical Wound Dehiscence / Q000209:etiology; D014792:Visual Acuity
D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D020911:Ketorolac Tromethamine; D003907:Dexamethasone