Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
Ophthalmology. 2010 Jul;117(7):1324-30. doi: 10.1016/j.ophtha.2009.11.038. Epub 2010 Apr 10.
To investigate the benefit of preoperative treatment with either topical nonsteroidal anti-inflammatory drug (NSAID) or steroid in terms of clinical outcomes following trabeculectomy.
Prospective, randomized placebo-controlled trial.
Sixty-one patients.
Between July 2005 and October 2007, 61 consecutive medically uncontrolled glaucoma patients scheduled for first-time trabeculectomy were randomized to 1 of 3 study topical medication groups: nonsteroidal anti-inflammatory drugs (ketorolac), steroids (fluorometholone), or placebo (artificial tears). Patients instilled 1 drop 4 times daily for 1 month before the procedure and were examined on days 1 and 2, at weeks 1, 2, and 4, and at months 3, 6, 12, 18, and 24 after trabeculectomy.
Incidence of postoperative surgical or medical interventions (needling, laser suture lysis, needling revision, and intraocular pressure [IOP]-lowering medication).
Fifty-four patients (54 eyes) were entered for analysis. The mean number of preoperative medications was 2.3+/-0.9. The mean baseline IOP was 21.0+/-6.0 mmHg. The mean postoperative target IOP was 16.5+/-1.8 mmHg. The mean follow-up was 23.6+/-4.0 months. The percentage of patients requiring needling within the first year was 41% in the placebo group, 6% in the NSAID, and 5% in the steroid group (P = 0.006). The percentage of patients requiring IOP-lowering medication to reach the target IOP at 1 year was 24% in the placebo group, 18% in the NSAID group, and 0% in the steroid group (P = 0.054 overall; P = 0.038 for steroids vs. others). The log-rank test showed a significant (P = 0.019) difference in medication-free survival curves between the different groups. More specifically, patients in the steroid group needed significantly less medication over the total follow-up (P = 0.007).
Topical ketorolac or fluorometholone for 1 month before surgery was associated with improved trabeculectomy outcomes in terms of likelihood of postoperative needling. In the steroid group, there was a significantly reduced need for additional postoperative IOP-lowering medication compared with the other groups.
FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
探讨术前局部使用非甾体类抗炎药（NSAID）或皮质类固醇治疗对小梁切除术临床效果的影响。
前瞻性、随机、安慰剂对照临床试验。
61 名患者。
2005 年 7 月至 2007 年 10 月，61 例经药物治疗但眼压仍未控制的青光眼患者，随机分为 3 组：非甾体抗炎药（酮咯酸）、皮质类固醇（氟米龙）或安慰剂（人工泪液）。术前 1 个月每天滴 4 次，共 1 个月，术后第 1、2 天，第 1、2、4 周，第 3、6、12、18、24 个月进行检查。
术后手术或药物干预（针刺、激光缝线松解、针刺后松解、眼压降低药物）的发生率。
54 例（54 只眼）患者纳入分析。术前平均用药数为 2.3+/-0.9。基线眼压为 21.0+/-6.0mmHg。术后目标眼压为 16.5+/-1.8mmHg。平均随访时间为 23.6+/-4.0 个月。术后第 1 年，安慰剂组、非甾体抗炎药组和皮质类固醇组需行针刺治疗的患者比例分别为 41%、6%和 5%（P = 0.006）。术后第 1 年，需要应用降眼压药物以达到目标眼压的患者比例，安慰剂组为 24%，非甾体抗炎药组为 18%，皮质类固醇组为 0%（P = 0.054；皮质类固醇与其他组比较 P = 0.038）。对数秩检验显示，不同组别之间的药物无失败生存曲线差异有统计学意义（P = 0.019）。具体而言，皮质类固醇组患者在整个随访过程中需要的药物明显较少（P = 0.007）。
术前局部使用酮咯酸或氟米龙 1 个月，小梁切除术的效果改善，术后需要针刺治疗的可能性降低。与其他组相比，皮质类固醇组患者术后需要应用额外的降眼压药物的可能性显著降低。
作者在本文讨论的材料中没有任何专有或商业利益。
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