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Nikoly Tigani Tigani, Renata Portela, Lilian Machado, Augusto Paranhos, Denise Freitas, Carolina Pelegrini Gracitelli; Effect of Preoperative Use of Steroid Eyedrops in Glaucoma Patient and its Outcomes after Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5890. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Numerous studies in the literature have shown that the presence of ocular surface disease (OSD) in patients with glaucoma affects patients' quality of life (QoL) and may influence therapeutic adherence. The aim of this study was to investigate the benefit of preoperative treatment with steroid eyedrops in OSD before trabeculectomy.
A prospective study was carried out in which 30 glaucoma patients using at least 3 topical IOP-lowering medications were included. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% qid for 1 week before trabeculectomy. Baseline (day of surgery) and follow-up visit (2 weeks after surgery). A detailed ophthalmological examination was performed in all patients. OSD was evaluated using Ocular Surface Disease Index (OSDI) questionnaire and clinical measures: tear break-up time (TBUT), corneal fluorescein staining (conjunctival hyperemia) and biomicroscopy showing presence or absence of keratitis. OSDI scores higher than 13 indicated a clinically relevant presence of OSD. All patients underwent to keratograph analysis: non-invasive keratograph BUT, meibography quantification, tear meniscus height, and redness scale. The comparison of OSD before and after trabeculectomy was assessed using paired test.
Mean age in glaucoma subjects was 74.00±11.23 years. Average visual acuity of the better and worse eye of glaucoma subjects were 0.61±0.39 and 0.68±0.30 LogMAR, respectively. Average conjunctival hyperemia of glaucoma subjects before and after treatment were 0.69±0.75 crosses and 1.46±0.88 crosses, respectively (P=0.002). Average keratitis of glaucoma subjects before and after treatment were 72.8±8.5 units and 74.2±8.4 units, respectively (P=0.668). There is no significant difference in TBUT of glaucoma subjects before and after treatment (P=0.096). For the keratograph analysis, the only parameter that was significant different before and after trabeculectomy was the redness scale. Patients after the trabeculectomy presented more conjunctival hyperemia compared before the surgery (P=0.002).
Although loteprednol etabonate ophthalmic suspension 0.5% may improve OSD in glaucoma patients, this sample presented more conjunctival hyperemia measured by clinical approach and by keratograph analysis. Due to recent trabeculectomy surgery, these patients might present worse OSD.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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