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Ha, Lee, Sung, and Park: Comparison of the Efficacy of Topical Steroids after Trabeculectomy in Patients with Primary Open-angle Glaucoma
Original Article

J Korean Ophthalmol Soc 2018;59(4):362-368.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.362

Comparison of the Efficacy of Topical Steroids after Trabeculectomy in Patients with Primary Open-angle Glaucoma

Jun Young Ha, MD1, Tae Hee Lee, MD1, Mi Sun Sung, MD1, Sang Woo Park, MD, PhD1, 2,

1Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

2Center 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

Received 2 November 2017       Revised 23 January 2018       Accepted 2 April 2018

Copyright © 2018 Korean Ophthalmological Society

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.

Keywords: Primary open-angle glaucoma, Topical steroid, Trabeculectomy

REFERENCES

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Figure 1.
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.
jkos-59-362f1.tif
Figure 2.
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).
jkos-59-362f2.tif
Table 1.
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.

Table 2.
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.

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