Trabeculectomy Outcomes With Standard Postoperative Topical Steroids Versus Intraoperative Depot Corticosteroid

Compare trabeculectomy surgical outcomes between patients receiving standard prednisolone acetate schedule postoperatively (Drop group) and those receiving intraoperative periocular injection of triamcinolone (16 mg) combined with reduced steroid regimen (TAC group).

Patients receiving one of the two steroid regimens were reviewed retrospectively for 2 years postoperatively. Primary outcome was surgical success defined as intraocular pressure (IOP) ≤18 mmHg with >20% reduction without or with glaucoma medication (complete or qualified success); (b) no clinical hypotony, further glaucoma surgery or loss of visual acuity.

Complete success at 24 months was 51.8% in the Drop group (56 eyes) and 37.5% in the TAC group (26 eyes; P=0.02 with logistic regression analysis). Overall success (complete plus qualified) at 24 months was 88.8% in the Drop group and 87.5% in the TAC group, comparable in the 2 groups (P=0.13). Postoperative IOP was similar in the two groups at 24 months (Drop: 10.26±3.75 mmHg; TAC: 11.08±3.69 mmHg; P>0.20). No differences were observed in surgical complications.

Complete success is more likely to be obtained in the Drop group but overall success was high and similar in the two groups. These results suggest that TAC and an abbreviated steroid schedule is a viable alternative to the more intense traditional drop regimen, particularly in patients who might not be able to follow an intense post-operatory drop schedule due to dexterity issues, inconvenience or poor compliance.

Intraoperative triamcinolone injection plus reduced topical steroid schedule was compared with standard topical steroid regimen post trabeculectomy. Overall success was similar between the groups, although complete success was more likely to be obtained with standard, intense topical steroid schedule.