[Options for prolonging the hypotensive effect of trabeculectomy].

Objective: To assess potential of preoperative therapy with local steroid and non-steroid anti-inflammatory drugs (SAIDs and NSAIDs) for prolonging the hypotensive effect of trabeculectomy.

Material And Methods: A total of 80 patients with primary open-angle glaucoma planed for trabeculectomy were randomized into 4 groups of 20 each: 3 groups that differed in the studied drug (nepafenac, dexamethasone, or their non-fixed combination) and a control group with no preoperative therapy. The patients instilled 1 drop of either drug b.i.d. for 2 weeks before the surgery and were examined each day of the first week and then at weeks 1, 2, 4 and months 3, 6, and 12. The rate of postoperative surgical and medical interventions (needling, needling revision, hypotensive therapy) was used for outcome evaluation.

Results: Postoperative needling was required in 50% of the controls, 35% of the NSAIDs and 30% of the SAIDs patients as well as 20% the combination-therapy patients. Needling revision had to be performed in 10% of patients from the control group and 5% of patients from the NSAIDs group. Patients from the steroid and combination-therapy groups had no need in needling procedure. Further hypotensive therapy was required in 50% of the control group, 35% of the NSAIDs group, 25% of the SAIDs group and 20% of the combination-therapy group. During the first postoperative year complete success of the treatment was achieved in 50% of the controls, 65% of the NSAIDs patients, 75% of the SAIDs patients, and 80% of those under combination therapy. Qualified success during the same period was achieved in 100% of cases.

Conclusion: Preoperative local anti-inflammatory therapy helped to increase the one-year complete success rate after trabeculectomy as compared with the controls. The most significant hypotensive effect was noted in the combination-therapy group (80%), less significant--in the steroid and non-steroid monotherapy groups (75% and 65% correspondingly). A negative correlation was noted between the use of nepafenac and dexamethasone and other measures aimed at increasing the hypotensive effect of glaucoma surgery.