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Oral prednisone in guarded filtration procedures supplemented with antimetabolites
A Azuara-Blanco1, G L Spaeth, J J Augsburger
1Glaucoma Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, PA, USA.
Background And Objective:
To evaluate whether a three-day course of oral prednisone perioperatively improves the surgical outcome of guarded filtering procedures supplemented with antifibrosis agents.
Design, Materials And Methods:
A prospective, randomized, double-masked, placebo-controlled, clinical trial was designed. Adult patients with non-inflammatory glaucoma undergoing a guarded filtration procedure supplemented with antimetabolite were enrolled. Patients received a three-day course of prednisone (50 mg BID) or placebo perioperatively. The main outcome measures were intraocular pressure (IOP) and number of antiglaucoma medications. Surgical success was defined before data collection according to two different criteria: "success-I": IOP level < or = 15 mmHg with no more than one anti-glaucoma medication, and "success-II": IOP reduction of at least 20% of baseline level with no more than one antiglaucoma medication.
Results:
Thirty-five subjects were enrolled. Seventeen patients were treated with prednisone and eighteen with placebo. Mean follow-up was 9.2 months +/-6.2 months. The probability of success-I at 9 months was 63.0% in the study group and 65.6% in the control groups (p>0.05). The probability of success-II at 9 months was 60.2% in the study group and 55.0% in the control groups, (p>0.05). The difference in frequency of postoperative complications between groups was not statistically significant. The most common complication was choroidal detachment (n=2) in the prednisone-treated group and bleb leak (n=2) in the control group.
Conclusion:
The perioperative use of oral prednisone did not alter the surgical outcome of filtering procedures associated with antifibrosis agents in this population of glaucoma patients.