Trabeculectomy Outcomes With Standard Postoperative Topical Steroids Versus Intraoperative Depot Corticosteroid

Intraoperative triamcinolone injection plus a reduced topical steroid schedule was compared with the standard topical steroid regimen post-trabeculectomy. Overall success was similar between the groups, although complete success was more likely with the standard, intensive topical steroid schedule.

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

Patients receiving one of the 2 steroid regimens were reviewed retrospectively for 2 years postoperatively. Primary outcome was surgical success defined as (1) intraocular pressure (IOP) ≤18 mm Hg with >20% reduction without or with glaucoma medication (complete or qualified success); and (2) 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 by logistic regression). 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 between the 2 groups at 24 months (Drop: 10.26±3.75 mm Hg; TAC: 11.08±3.69 mm Hg; P >0.20). No differences were observed in surgical complications.

Complete success is more likely in the Drop group, but overall success was high and similar between the 2 groups. These results suggest that TAC and an abbreviated steroid schedule are a viable alternative to the more intense traditional drop regimen, particularly in patients who might not be able to follow an intense postoperative drop schedule due to dexterity issues, inconvenience, or poor compliance.