Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: a randomized controlled trial.

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.

Comparison of ocular response analyzer, dynamic contour tonometer and Goldmann applanation tonometer.

The aim of this study was to compare the intra-ocular pressure (IOP) obtained by ocular response analyzer (ORA), dynamic contour tonometer (DCT) and Goldmann applanation tonometer (GAT). In 102 patients (47 with primary open-angle glaucoma and 55 healthy controls) IOP was measured with GAT, ORA and DCT in one eye. The agreement between GAT, DCT and ORA values was assessed using Bland-Altman plots. The discrepancy between the methods was related to central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF) using linear regression models. Significant differences were observed amongst DCT, corneal compensated ORA (ORAcc) and GAT (P < 0.01). Only the ORAcc and DCT were comparable. ORAcc and DCT significantly over-estimated IOP compared to GAT and for ORAcc this difference depended on the height of IOP. A significant correlation was found between CCT and the deviation of DCT and ORAcc from corrected GAT (both P < 0.0001). Our study showed a low degree of agreement between IOP measured by ORA, DCT and GAT. DCT and ORAcc over-estimated the IOP compared to GAT.

Trabeculectomy with or without anterior chamber maintainer and adjustable sutures.

PURPOSE: To assess the long-term outcomes of trabeculectomy using an anterior chamber maintainer and a combination of adjustable and releasable sutures compared with trabeculectomy using a viscoelastic and solely releasable sutures. METHODS: In a prospective, randomized, single-center study, 2 different trabeculectomy techniques were compared. One eye of each patient was randomly assigned to trabeculectomy with an anterior chamber maintainer and a combination of 2 adjustable and 2 releasable flap sutures (technique 1), whereas the other eye had trabeculectomy with viscoelastic and 2 releasable flap sutures (technique 2). The postoperative management was comparable in both groups except for the manipulation of the adjustable sutures. The main outcome measures were the postoperative intraocular pressure (IOP), the frequency of early postoperative complications and interventions, and the number of glaucoma medications. RESULTS: Thirty-two patients were included and had a follow-up of at least 18 months. The preoperative and postoperative IOP at 18 months was 22.1±8 and 13.3±2 mm Hg in the group using technique 1 and 22.7±7 and 13.3±3 mm Hg in the group using technique 2, respectively (mean±SD; P=0.18 for IOP reduction between both techniques). Early postoperative complications and interventions were infrequent and comparable in both techniques. The reduction in number of medications was not significantly different between the 2 groups (mean±SD from 2.4±1.0 to 0.4±0.8 in the group using technique 1 and from 2.3±1.0 to 0.2±0.5 in the group using technique 2; P=0.50). CONCLUSIONS: There is no significant difference in IOP reduction, in frequency of postoperative complications and interventions, or in reduction of medications between the 2 techniques.

Influences of atmospheric pressure and temperature on intraocular pressure.

PURPOSE: To determine whether the atmospheric pressure (ATM) change experienced during diving can induce changes in the intraocular pressure (IOP) of eyes in a normal population. METHODS: The IOP of 27 healthy volunteers (ages, 23.8 +/- 4.9 years; range, 18-44) was measured with a Perkins applanation tonometer by two independent investigators who were masked to the previous measurements. Measurements were taken at baseline (normal ATM, 1 Bar and 24 degrees C), at 28 degrees C and 24 degrees C after the ATM was increased to 2 Bar in a hyperbaric chamber, at baseline again, and finally at the normal ATM of 1 Bar but a temperature of 28 degrees C. Multivariate regression analysis was used to evaluate the RESULTS: results. The mean IOP decreased significantly from 11.8 mm Hg in the right eye (RE) and 11.7 mm Hg in the left eye (LE) at 1 Bar to 10.7 mm Hg (RE) and 10.3 mm Hg (LE) at 2 Bar (P = 0.024, RE; P = 0.0006, LE). The IOP decrease remained constant during the ATM increase period (40 minutes) and was independent of the temperature change. The temperature increase alone did not significantly influence the IOP. CONCLUSIONS: An increase of the ATM to 2 Bar (equal to conditions experienced during underwater diving at 10 meters) modestly but significantly decreased the IOP independently of the temperature change. During the period of increased ATM (60 minutes), the IOP decrease remained stable and was independent of blood pressure change or corneal thickness.