Effect of Topical Flurbiprofen on Trabeculectomy

Cantor, Louis B.; Phillips, Carolyn; Kramer, David A.; Boeglin, Robert J.; Manatunga, Amita K.; Holleman, Eleanor

doi:10.1097/00061198-199504000-00006

Cited by 2 publications

(9 citation statements)

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“…Number of complications was also reported by the majority of studies except two (Cantor et al. ; Wang et al. ).…”

Section: Level Of Evidencementioning

confidence: 80%

“…VA in the intervention groups was reported by four studies (Cantor et al. ; Kent et al. ; Azuara‐Blanco et al.…”

Section: Level Of Evidencementioning

confidence: 86%

“…The total number of patients in the included studies was 342, and these patients underwent a large range of interventions with very few comparable outcomes. Generally, postoperative IOP was the best reported outcome and it was reported by all included studies (Starita et al 1985;Cantor et al 1995;Kent et al 1998;Azuara-Blanco et al 1999;Yuki et al 2009;Levkovitch-Verbin et al 2013;Wang et al 2013). All studies but one reported on the number of postoperative antiglaucomatous medications (Starita et al 1985).…”

Section: Level Of Evidencementioning

confidence: 90%

“…Titles and abstracts were reviewed, and 15 references were judged to be of potential interest and read in full text. Seven RCTs met our inclusion criteria (Starita et al 1985;Cantor et al 1995;Kent et al 1998;Azuara-Blanco et al 1999;Yuki et al 2009;Levkovitch-Verbin et al 2013;Wang et al 2013). An overview of included studies for each intervention is provided in Table 2.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…We identified one study comparing postoperative topical steroids (n = 25 patients) to topical steroids plus NSAID (n = 24 patients) (Cantor et al 1995). The study included patients with mixed types of glaucomas, who had trabeculectomy without antimetabolites.…”

Section: Referencesmentioning

confidence: 99%

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Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Almatlouh

Bach‐Holm

Kessel

2018

Acta Ophthalmologica

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Surgical outcome after trabeculectomy depends on maintaining a functional bleb which requires a delicate balance between incomplete wound healing to prevent fibrosis and enough wound healing to prevent hyperfiltration. Thus, controlling the inflammatory response is essential. We conducted a systematic review and meta-analysis to compare the effectiveness of different formulations of steroids (topical, systemic and depot) and nonsteroidal anti-inflammatory drugs (NSAIDs) in achieving long-term pressure control with fewer antiglaucomatous medications, preserving visual acuity and visual fields while considering surgical and postoperative complications. We used the PubMed, EMBASE and Cochrane Libraries to identify randomized controlled trials (RCTs) comparing the effect of different formulations of steroids (topical, systemic or depot) to NSAIDs. Data on prespecified outcomes from eligible references were entered into a meta-analysis using the Review Manager 5.3 program. We identified seven RCTs with a total of 342 included patients. Topical steroids were superior to placebo in controlling intraocular pressure (IOP) and reducing the risk of complications. Supplementing topical steroids with a perioperative steroid depot (subtenon or intracamerally) or systemic steroids in the early postoperative period did not provide better outcome or a change in the risk of complications. Addition of topical NSAIDs to topical steroids in patients undergoing trabeculectomy did not change the outcome or risk profile. For patients undergoing phacotrabeculectomy and topical NSAID, there was a nonsignificant trend towards better intermediate IOP control and a reduced need for antiglaucomatous medications compared to topical steroids but there was no difference in effect for patients undergoing trabeculectomy. In conclusion, there is a low level of evidence to support the clinician in deciding which postoperative regime provides a more favourable outcome because of inconsistency in the reported outcomes between studies and a low number of patients for each comparable intervention and outcome. It does seem that topical steroids are better than no antiinflammatory treatment after glaucoma surgery, but further research is recommended.The authors are grateful for the help of information specialist Karine Korsgaard with the literature search.

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“…Number of complications was also reported by the majority of studies except two (Cantor et al. ; Wang et al. ).…”

Section: Level Of Evidencementioning

confidence: 80%

“…VA in the intervention groups was reported by four studies (Cantor et al. ; Kent et al. ; Azuara‐Blanco et al.…”

Section: Level Of Evidencementioning

confidence: 86%

Section: Level Of Evidencementioning

confidence: 90%

Section: Summary Of Evidencementioning

confidence: 99%

Section: Referencesmentioning

confidence: 99%

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Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Almatlouh

Bach‐Holm

Kessel

2018

Acta Ophthalmologica

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Oral Ibuprofen is Associated With Reduced Likelihood of Early Bleb Failure After Trabeculectomy in High-Risk Glaucoma Patients

Sim

Foo

Huang

et al. 2023

Journal of Glaucoma

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Précis: Individuals prescribed ibuprofen after trabeculectomy have better postoperative intraocular pressure (IOP) control and a higher chance of bleb survival despite being at a higher risk of scarring. Purpose: To investigate the effects of early adjunctive oral ibuprofen treatment on IOP and bleb failure in eyes at high risk of scarring. Methods: In these retrospective analyses, 288 eyes of 273 patients (mean ± SD age: 68.56 ± 10.47 y; 32.60% females) with primary glaucoma who underwent trabeculectomy/phacotrabeculectomy at the Singapore National Eye Centre between April 2020 and April 2021 with a follow-up duration ≥1 year were included. Of these, 77 (26.7%) eyes deemed to be at high risk of scarring were administered oral ibuprofen ≥3 months postoperatively (mean ± SD ibuprofen administration duration: 4.08 ± 2.28 wk). Participant’s IOPs at baseline and at postoperative weeks 1, 2–3; and months 1, 2, 3, 6, and 12 were recorded. Bleb failure was defined as 2 consecutive IOP readings of >21, >18, and >15 mm Hg, and/or requiring remedial postoperative laser or surgery. Results: The ibuprofen group experienced significantly greater postoperative IOP reductions at week 1 [mean difference, 95%CI: −2.89 (−5.22, −0.56) mm Hg] and month 1 [−2.29 (−4.53, −0.05) mm Hg]; and substantially lower odds of bleb failure at the >18 mm Hg [odds ratio, 95% CI: 0.39 (0.20–0.79)] and >15 mm Hg [0.52 (0.29–0.94)] thresholds, compared with the non-ibuprofen group. No differences in adverse ocular hypotony events were observed. Conclusion: Early adjunctive oral ibuprofen administered to individuals at high risk of posttrabeculectomy scarring is associated with greater IOP reductions and reduced likelihood of bleb failure. Our results suggest that oral nonsteroidal anti-inflammatory drugs may be a safe way of improving trabeculectomy survival in high-risk eyes.

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Effect of Topical Flurbiprofen on Trabeculectomy

Cited by 2 publications

References 0 publications

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Oral Ibuprofen is Associated With Reduced Likelihood of Early Bleb Failure After Trabeculectomy in High-Risk Glaucoma Patients

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