JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2018.59.4.362 jkos-59-362 Original Article Comparison of the Efficacy of Topical Steroids after Trabeculectomy in Patients with Primary Open-angle Glaucoma HaJun YoungMD1 LeeTae HeeMD1 SungMi SunMD1 ParkSang WooMD, PhD12 Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea Center for Creative Biomedical Scientists, Chonnam National University, Gwangju, Korea Address reprint requests to Sang Woo Park, MD, PhD Department of Ophthalmology, Chonnam National University Hospital, #42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: exo70@naver.com 92018 792018 59 4 362 368 2112017 23012018 2042018 Copyright © 2018 Korean Ophthalmological Society 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose

To compare the surgical outcomes and intraocular pressure (IOP) reduction after trabeculectomy in patients with primary open-angle glaucoma (POAG) according to treatment with three different postoperative topical steroids.

 Methods

A total of 84 eyes of 84 patients who had undergone trabeculectomy for POAG and were followed-up at least 1 year were included in this study. According to the postoperative topical steroid treatment, the patients were divided into three groups involving 0.5% loteprednol etabonate (LE), 1% rimexolone (RMX), and 1% prednisolone acetate (PDA). The mean IOP change, mean number of topical anti-glaucoma medication changes, 1-year success rate, and complication percentage were compared among the three groups.

 Results

There were significant reductions in the IOP and number of anti-glaucoma medications during the postoperative 1-year follow-up in all of the groups (all, p < 0.05), but there were no differences among the three groups. Postoperative 1-year success rates (68.2% in the LE group, 67.0% in the RMX group, and 65.9% in the PDA group; p = 0.88) and complication percentages of trabeculectomy were not significantly different among the three groups.

 Conclusions

There were no statistical differences in the 1-year success rate, complication percentage, visual acuity, IOP, and number of anti-glaucoma medications among treatment regimens. LE and RMX were as effective and safe as PDA after trabeculectomy in patients with POAG.

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The changes in best corrected visual acuity (BCVA), intraocular pressure (IOP), and mean number of anti-glaucoma medication in the three groups during the 1-year follow-up. (A) BCVA was remained stable during the follow-up in the three groups. (B, C) IOP and mean number of glaucoma medication were significantly reduced after trabeculectomy through the 1-year follow up. There were no significant differences in BCVA, IOP, or mean number of glaucoma medication among the three groups. mon = month(s); LE = loteprednol etabonate; RMX = rimexolone; PDA = prednisolone acetate.

Cumulative probabilities of success of trabeculectomy in the three groups. The success rates at 1 year was 68.2% in loteprednol etabonate (LE) group, 67.0% in rimexolone (RMX) group, and 65.9% in prednisolone acetate (PDA) Group, which was not significantly different among the three groups (p = 0.877, log-rank test). mon = month(s).

Demographic and baseline characteristics of the three groups

LE RMX PDA p-value
Number of patients/eyes 22/22 28/28 34/34 -
Age (years)* 60.25 ± 11.51 58.91 ± 17.01 61.26 ± 14.97 0.721
Sex (male:female)† 11:11 19:9 20:14 0.438
BCVA (logMAR)* 0.58 ± 0.89 0.60 ± 0.98 0.64 ± 1.05 0.744
IOP (mmHg)* 30.94 ± 8.95 (20–41) 29.52 ± 7.75 (18–37) 27.07 ± 7.23 (19–36) 0.272
Glaucoma medication (n)* 2.94 ± 0.44 3.04 ± 0.37 2.85 ± 0.46 0.312
Visual field
   MD (dB)* −18.58 ± 8.64 −24.83 ± 7.08 −18.84 ± 8.96 0.605
   PSD (dB)* 8.92 ± 3.24 8.32 ± 4.22 8.15 ± 4.67 0.879
Cup-to-disc ratio* 0.81 ± 0.07 0.85 ± 0.11 0.86 ± 0.07 0.818
Corneal ECC (cells/mm2)* 2,355.88 ± 353.41 2,250.70 ± 581.57 2,087.08 ± 616.03 0.316

Values are presented as mean ± SD (range) or n (%) unless otherwise indicated.

LE = loteprednol etabonate; RMX = rimexolone; PDA = prednisolone acetate; BCVA = best corrected visual acuity; logMAR = logarthim of the minimum angle of resolution; IOP = intraocular pressure; MD = mean deivation; PSD = pattern standard deviation; ECC = endothelial cell count.

Kruskall-wallis test;

Chi-square test.

Postoperative interventions and complications in the three groups

LE (n = 22) RMX (n = 28) PDA (n = 34) p-value*
Interventions (eyes, [n, %])
   Releasable suture removal 22 (100) 28 (100) 34 (100) 0.99
   5-FU augmented needling 4(18.2) 4 (14.3) 5 (14.7) 0.21
Complications (eyes, [n, %])
   Hypotony 4(18.2) 4 (14.3) 4 (11.8) 0.16
   Bleb leakage 2 (0.09) 2 (0.07) 1 (0.03) 0.34
   Bleb infection 0 (0) 0 (0) 0 (0) 0.99
   Choroidal effusion 1 (4.5) 1 (3.5) 2 (5.9) 0.67

Values are presented as n (%) unless otherwise indicated.

LE = loteprednol etabonate; RMX = rimexolone; PDA = prednisolone acetate; 5-FU = 5-fluorouracil.

Chi-square test.