Adjunctive sub-tenon triamcinolone with Susanna glaucoma drainage device: a randomized clinical trial

To evaluate the efficacy and safety of Adjunct Triamcinolone (TA) with the Susanna drainage device for refractory primary open-angle glaucoma, to our knowledge, the first such evaluation with a non-valved glaucoma drainage device.

This prospective, multicenter, randomized, double-blind (patient and outcome assessor) trial included 39 eyes with refractory primary open-angle glaucoma, divided into a control (n = 20) and a triamcinolone group (n = 19). Primary outcome was mean Intraocular Pressure (IOP) at six months. Secondary outcomes included success rates and postoperative complications.

Baseline characteristics and mean preoperative IOP were similar (24.45±8.03 mmHg control vs. 24.95±6.80 mmHg TA, p = 0.83). At six months, both groups showed similar mean IOP reduction (14.05±3.99 mmHg control vs. 14.33±4.70 mmHg TA, p > 0.99), with percentage reductions of 42.53% and 42.56%, respectively. Hypotensive eyedrop use also decreased similarly (1.57 control vs. 1.16 TA, p = 0.95). Qualified success (IOP 5‒21 mmHg) was 90% (control) and 89.47% (TA) (p > 0.05). However, the triamcinolone group had a significantly higher incidence of late-onset hypotony (52.6%vs. 0%, p < 0.001). Clinically significant hypotony requiring surgical re-intervention occurred in 36.8% of the TA group versus 0% in the control group (p = 0.003).

In patients undergoing Susanna GDD implantation, adjunctive sub-Tenon triamcinolone provided no additional IOP-lowering benefit but was associated with a significantly increased risk of serious hypotony-related complications. Our findings do not support the use of sub-Tenon triamcinolone (20 mg) as an adjunct to non-valved GDDs in this setting.