Options for prolonging the hypotensive effect of trabeculectomy

Petrov, S. Yu.; Антонов, А.; Макарова, А. С.; Vostrukhin, S. V.; Сафонова, Д. М.

doi:10.17116/oftalma2015131175-81

Cited by 10 publications

(6 citation statements)

References 25 publications

(20 reference statements)

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“…Patients undergoing trabeculectomy, tube shunt surgery or triple procedure were not reported individually, and hence, it was not possible to extract the data for patients undergoing trabeculectomy only Farooq & Ali (2003) An RCT combining multiple surgical methods in same analysis. We could not distinguish between extracapsular cataract extraction (ECCE), ECCE with intraocular lens implantation, phacoemulsification and trabeculectomy Breusegem et al (2010) An RCT with focus on preoperative steroid therapy before trabeculectomy Petrov et al (2015) Written in Russian Roth et al (1991) The 5-year follow-up of patients enrolled in RCT by Starita 1985(Starita et al 1985. Excluded since the follow-up time was not comparable with any other study, and the same patient group as Starita 1985study Araujo et al (1995 The 10-year follow-up of patients enrolled in RCT by Starita 1985(Starita et al 1985.…”

Section: Referencesmentioning

confidence: 99%

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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Section: Referencesmentioning

confidence: 99%

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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“…Our findings are consistent with early trials of Molteno and Dempster 11 implants, which showed that the addition of an oral NSAID (diclofenac) on top of oral prednisone, prescribed for a duration of about 6 weeks to all patients regardless of the risk of bleb failure, produced a synergistic anti-inflammatory effect that greatly reduced bleb inflammation and provided better postoperative IOP control than using oral steroids alone. Similarly, an RCT by Petrov et al 12 showed that patients who have prescribed a combination of topical nepafenac and dexamethasone for 2 weeks before trabeculectomy had a less frequent need for postoperative needling, remedial hypotensive therapy, and a greater likelihood of complete trabeculectomy success in the first postoperative year, compared with patients on topical dexamethasone only. In contrast, Cantor et al 13 did not find any additional benefit to using topical flurbiprofen on top of topical prednisolone after trabeculectomy in terms of postoperative IOP and visual acuity.…”

Section: Discussionmentioning

confidence: 99%

“…Early Molteno implant trials were one of the first studies to demonstrate the efficacy of a 6-week adjunctive dose of postoperative oral diclofenac in controlling IOP, a finding that was later replicated in a randomized controlled trial (RCT) by Petrov and colleagues, who administered a 2-week regime of topical nepafenac as an adjunct to topical dexamethasone pretrabeculectomy. 11,12 In contrast, an RCT by Cantor et al 13 observed no significant difference in postoperative outcomes despite the administration of adjunctive topical flurbiprofen posttrabeculectomy. To address this knowledge gap, we evaluated the independent associations of the early adjunctive use of oral ibuprofen in posttrabeculectomy patients with IOP reduction and bleb failure over 1 year in a retrospective clinical cohort.…”

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confidence: 97%

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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“…Eine 2-wöchige Vorbehandlung mit einer topischen Kombination von Steroiden und nicht steroidalen Antiphlogistika erreichte in einer randomisierten russischen Studie den stärksten Effekt auf die postoperative Augendrucksenkung, gefolgt von der alleinigen topischen Steroidvorbehandlung, dann von der alleinigen nicht steroidalen Antiphlogistikatherapie und dem Placebo als Schlusslicht [8].…”

Section: Perioperative Antientzündliche Therapie Im Rahmen Der Glaukounclassified

Perioperative antientzündliche Therapie im Rahmen der Glaukomchirurgie

Dietlein

Erb²

2019

Klin Monatsbl Augenheilkd

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ZusammenfassungViele klinische Studien belegen, dass der funktionelle Ausgang der Glaukomchirurgie, insbesondere der Filtrationschirurgie, durch eine topische antientzündliche Vor- und Nachbehandlung signifikant beeinflusst werden kann. Die topischen Steroide erweisen sich sowohl in der Vor- als auch in der Nachbehandlung nach Trabekulektomie als günstig, wobei die Dauer der postoperativen Behandlung vom individuellen Befund abhängig gemacht werden soll. Eine systemische Steroidtherapie oder Immunmodulation ist beim uveitischen Sekundärglaukom für den Erfolg der Glaukomchirurgie signifikant von Bedeutung, bei anderen Glaukomformen ist ein Nutzen der systemischen Therapie nicht belegt. Eine zusätzliche topische Therapie mit nicht steroidalen Antiphlogistika ist bei einer kombinierten Katarakt-Glaukom-Chirurgie zu erwägen. Eine topische antientzündliche Therapie nach selektiver Lasertrabekuloplastik ist nicht notwendig, bei Argonlasertrabekuloplastik und Zyklophotokoagulation wirkt diese sich schmerzlindernd aus. Die intravitreale Gabe von Steroiden im Rahmen der Glaukomchirurgie muss aufgrund der Induktion von Augendruckspitzen immer kritisch abgewogen werden.

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Options for prolonging the hypotensive effect of trabeculectomy

Cited by 10 publications

References 25 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

Perioperative antientzündliche Therapie im Rahmen der Glaukomchirurgie

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