Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, California.
Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Ophthalmology. 2019 Nov;126(11):1511-1516. doi: 10.1016/j.ophtha.2019.05.032. Epub 2019 Jun 6.
This study examined whether short-term use of topical nonsteroidal anti-inflammatory drug (NSAID) or steroid therapy affected the efficacy of selective laser trabeculoplasty (SLT).
Double-masked, randomized, placebo-controlled, dual-center, multisurgeon trial.
Patients older than 18 years with intraocular pressure (IOP) of more than 18 mmHg for whom the clinician decided SLT was the appropriately indicated therapy were randomized to 1 of 3 groups in a ratio of 1:1:1 as follows: ketorolac 0.5%, prednisolone 1%, or saline tears.
After SLT, patients randomized into each group were instructed to use an unmarked drop 4 times daily starting the day of SLT and continuing for 4 additional days. The Kruskal-Wallis test and Wilcoxon rank-sum test were used for continuous variables when comparing 2 or 3 treatment groups, respectively. The Fisher exact test was used for categorical variables.
The primary outcome of this study was IOP at 12 weeks. Secondary outcome measures included IOP at 1 and 6 weeks, patient-reported pain, and detectable anterior chamber inflammation.
Ninety-six eyes of 85 patients fit inclusion criteria and were enrolled between the 2 sites. The NSAID, steroid, and placebo groups were similar in baseline demographics and baseline IOP (mean, 23.3±3.9 mmHg; P = 0.57). There was no statistically significant difference in IOP decrease among groups at week 6. Both the NSAID and steroid groups showed a statistically significantly greater decrease in IOP at week 12 compared with the placebo group (mean, -6.2±3.1 mmHg, -5.2±2.7 mmHg, and -3±4.3 mmHg, respectively; P = 0.02 [analysis of variance] and P = 0.002 [t test] for NSAID vs. placebo groups; P = 0.02 for steroid vs. placebo groups).
Significantly better IOP reduction at 12 weeks was measured in eyes treated with steroid or NSAID drops after SLT. Short-term postoperative use of NSAID or steroid drops may improve IOP reduction after SLT. Longer-term follow-up studies are indicated.
本研究旨在探讨短期局部使用非甾体类抗炎药（NSAID）或皮质类固醇治疗是否会影响选择性激光小梁成形术（SLT）的疗效。
双盲、随机、安慰剂对照、双中心、多外科医生试验。
年龄大于 18 岁、眼压（IOP）超过 18mmHg 的患者，临床医生决定 SLT 是适当的治疗方法，这些患者被随机分为 3 组，比例为 1:1:1，如下所示：酮咯酸 0.5%、泼尼松龙 1%或生理盐水泪液。
在 SLT 后，随机分为每组的患者被指示从 SLT 当天开始每天使用 4 次未标记的滴眼剂，持续 4 天。当比较 2 个或 3 个治疗组时，分别使用 Kruskal-Wallis 检验和 Wilcoxon 秩和检验进行连续变量比较。Fisher 确切检验用于分类变量。
本研究的主要结局是 12 周时的 IOP。次要结局指标包括 1 周和 6 周时的 IOP、患者报告的疼痛和可检测到的前房炎症。
96 只眼的 85 名患者符合纳入标准，并在两个地点入组。NSAID、皮质类固醇和安慰剂组在基线人口统计学和基线 IOP（平均值，23.3±3.9mmHg；P=0.57）方面相似。在第 6 周时，各组之间的 IOP 降低没有统计学上的显著差异。与安慰剂组相比，NSAID 和皮质类固醇组在第 12 周时 IOP 降低均有统计学显著差异（平均分别为-6.2±3.1mmHg、-5.2±2.7mmHg 和-3±4.3mmHg；P=0.02[方差分析]和 P=0.002[t 检验]，NSAID 与安慰剂组；P=0.02，皮质类固醇与安慰剂组）。
在 SLT 后使用皮质类固醇或 NSAID 滴眼剂治疗的眼睛，12 周时的 IOP 降低显著更好。SLT 后短期使用 NSAID 或皮质类固醇滴眼剂可能会改善 IOP 降低。需要进行更长时间的随访研究。
