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Niccolo Dosto, Thomas Vincent Johnson, Elyse McGlumphy, Harry A Quigley; Electronically Monitored Steroid Eye Drop Adherence After Trabeculectomy Compared to Short-Term Surgical Success. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3427.
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To measure adherence with steroid eye drops after trabeculectomy with an electronic monitoring device compared to short-term achievement of target IOP.
Open angle glaucoma patients who underwent trabeculectomy were instructed on use of an electronic monitor attached to a topical steroid drop bottle that recorded drop use in real time through wireless technology. Patients were prescribed only 1% prednisolone acetate every 2 hours while awake for 1 week, then 4 times a day for 1 week tapered by 1 drop/week until week 6. Postop visits were at 1, 3 and 6 weeks, 3 and 6 months, and 1 year. Primary outcome was percent adherence compared to achievement of IOP target. Secondary outcomes were comparison of adherence to a questionnaire estimating adherence to daily glaucoma drops, grading of bleb morphology, reported pain, and anterior chamber inflammation grade.
Data were available for 60 subjects at 6 weeks, 24 at 6 months and 10 at 1 year postop. Devices recorded drop use in 82 of 85 subjects. Total adherence was 90±14% with q2h frequency at 79±18%. Total adherence did not significantly differ by age, race or sex, nor was it related to inflammation or pain for 6 weeks. 82% achieved target IOP at 6 weeks (49/57, 3 incomplete). Adherence was 78±18% for eyes ≤ target IOP at 6 weeks and 86±16% for those > target (p=0.27). 15/49 subjects ≤ target and 7/8 > target at 6 weeks were women (p=0.0043). Eyes with 6-week IOP <6 mm Hg had lower adherence than those ≥ 6 mmHg (ratio taken/ideal drop adherence: 84% vs 0.92%, p=0.07). Predicted adherence from a daily glaucoma drop questionnaire did not correlate with steroid drop adherence. At 6 months, 16/24 reached IOP target, while 10/10 eyes were below target at 1 year. Those achieving target IOP without further glaucoma surgery were not more adherent than those who were over target (74% vs. 80%, p=0.50).
Detailed eye drop adherence data can be obtained electronically in real time, showing substantial adherence with postop steroid drops after glaucoma surgery. With the protocol of steroid drops used here, the observed adherence was not related to success of IOP control at 6 weeks or 6 months after surgery. Low postop IOP at 6 weeks was potentially related to poorer adherence.
This is a 2021 ARVO Annual Meeting abstract.
Ratio of drops taken for 6 postop weeks to ideal prescribed (x axis) versus IOP at 6 weeks post-trabeculectomy (r2 for linear regression = 0.04).
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