Raised intraocular pressure with topical steroids after trabeculectomy

Area of Science:

• Ophthalmology
• Glaucoma Research
• Pharmacology

Background:

• Primary open-angle glaucoma (POAG) management often involves surgery like trabeculectomy.
• Post-operative intraocular pressure (IOP) control is critical for surgical success.
• Topical steroids are commonly used post-operatively but can elevate IOP.

Purpose of the Study:

• To evaluate the incidence and characteristics of steroid-induced intraocular pressure (IOP) rise after trabeculectomy in POAG patients.
• To compare steroid response rates based on prior medical therapy.
• To assess the persistence of steroid responsiveness in the late post-operative period.

Main Methods:

• Prospective study of 87 eyes from 52 patients with POAG undergoing trabeculectomy.
• Monitoring IOP and visual field status post-surgery.
• Assessing steroid response based on IOP elevation after topical steroid administration.
• Re-challenge with topical steroids in a subset of patients.

Main Results:

• A significant steroid-induced IOP rise occurred in 23% of eyes within 4 weeks post-trabeculectomy.
• Steroid response rate was lower in eyes without prior medical therapy (17%) versus those with prior medical failure (36%), though not statistically significant.
• Responders and non-responders did not differ significantly in baseline IOP or visual field loss severity.
• Steroid responsiveness decreased in the late post-operative period, with only 3 of 8 re-challenged eyes showing persistent response.

Conclusions:

• Topical steroids are a frequent cause of elevated IOP in the early post-trabeculectomy period.
• Delayed initiation of long-term medical therapy is advisable until the influence of post-operative steroids on IOP is determined.