Preoperative Nonsteroidal Anti-inflammatory Drug or Steroid and Outcomes after Trabeculectomy A Randomized Controlled Trial

Abstract

Purpose: To investigate the benefit of preoperative treatment with either topical nonsteroidal anti-inflammatory drug (NSAID) or steroid in terms of clinical outcomes following trabeculectomy. Design: Prospective, randomized placebo-controlled trial. Participants: 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. Main Outcome Measures: 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. Financial Disclosure( s): The author( s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2010; 117: 1324-1330 (C) 2010 by the American Academy of Ophthalmology.