Topical Steroids and Glaucoma Filtration Surgery Outcomes: An In Vivo Confocal Study of the Conjunctiva

Abstract

(1) Background: The purpose of this study is to investigate the effects of topical steroids on conjunctiva in patients undergoing filtration surgery (FS) for glaucoma by using confocal microscopy (CM); (2) Methods: One hundred and four glaucomatous patients were randomized to fluorometholone or lubricants four weeks before FS. CM was performed before treatments and pre-operatively. Dendritic and goblet cell densities (DCD, GCD), stromal meshwork reflectivity (SMR), vascular tortuosity (VT), and intra-ocular pressure (IOP) were the main outcomes. By evaluating treatments and outcomes (12-month success/failure) as categorical variables, patients were grouped into Group 1, 2, 3, or 4 (success/failure with fluorometholone, or lubricants); (3) Results: Twelve-month IOP was reduced in Groups 1 and 3 (p < 0.001). After treatments, DCD and SMR were reduced in Groups 1 and 2 (p < 0.01), and 1 and 3 (p < 0.05), respectively. Pre-operative DCD was lower in the steroid compared to lubricant group (p < 0.001), whereas SMR was lower in successful (1 and 3) compared to failed groups (2 and 4) (p = 0.004). There were no significant differences between the fluorometholone and lubricant groups for success percentages. The number of bleb management procedures and IOP lowering medications were lower in Group 1 compared to Groups 2–4 (p < 0.05); (4) Conclusions: Topical steroids mitigate conjunctival inflammation and lower the stromal density in patients undergoing FS. These modifications lead to less intensive post-operative management.

A machine learning approach to predict the glaucoma filtration surgery outcome

“…Among the numerous aspects gravitating around the field of glaucoma surgery, the need to predict the risk of failure before the procedure still represents one of the most relevant. As known, besides demographic and disease-related variables, the ocular surface impairment represents the most important determinant for the outcome 1 – 4 . In the present study, we utilized an ML algorithm (CART) to predict the risk of failure in patients undergoing filtration surgery taking into consideration: (i) demographic, (ii) glaucoma-, and (iii) ocular surface-related features.…”

“…Thus, the pre-operative risk assessment, especially focused on the ocular surface evaluation, represents the most crucial step to define the risk profile for failure as it may supplement the decision-making processes of clinicians. The risk assessment may in fact guide surgeons in adopting the most appropriate surgical procedure, and implementing personalized pre-, intra-, and post-operative treatment plans to improve the outcomes 4 .…”

Analysis of the impact of different schemes of preparation to trabeculectomy on the healing markers on the Tenon fibroblasts cultures

“…The final long-term success of trabeculectomy is related to sufficient management of healing processes. The rate of clinical failures is higher in patients chronically treated with antiglaucoma drops 13 , because of induced prolonged conjunctival inflammation as the response for toxic and allergic actions of both active substances and preservatives 14 – 16 . In patients before trabeculectomy to diminish chronic inflammation of the ocular surface preoperatively, most of the surgeons withdraw antiglaucoma drops and introduce local steroid application.…”

“…In this study, we used dexamethasone as a potent steroid which is used in our typical practice in trabeculectomy patients and which at the time of study design was the only preservative-free steroid medicament in drops commercially available in Poland. Although, some previous research 15 , 16 used fluorometholone as the one with the smaller potential to cause IOP spikes.…”