| Preoperative nonsteroidal anti-inflammatory drug or steroid and outcomes after trabeculectomy: a randomized controlled trial. | |
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MedLine Citation:
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PMID: 20382428 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To investigate the benefit of preoperative treatment with either topical nonsteroidal anti-inflammatory drug (NSAID) or steroid in terms of clinical outcomes following trabeculectomy. DESIGN: Prospective, randomized placebo-controlled trial. PARTICIPANTS: Sixty-one patients. METHODS: 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. MAIN OUTCOME MEASURES: Incidence of postoperative surgical or medical interventions (needling, laser suture lysis, needling revision, and intraocular pressure [IOP]-lowering medication). RESULTS: 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). CONCLUSIONS: 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. |
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Authors:
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Christophe Breusegem; Leigh Spielberg; Rita Van Ginderdeuren; Evelien Vandewalle; Charlotte Renier; Sara Van de Veire; Steffen Fieuws; Thierry Zeyen; Ingeborg Stalmans |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2010-04-10 |
Journal Detail:
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Title: Ophthalmology Volume: 117 ISSN: 1549-4713 ISO Abbreviation: Ophthalmology Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-08 Completed Date: 2010-07-21 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802443 Medline TA: Ophthalmology Country: United States |
Other Details:
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Languages: eng Pagination: 1324-30 Citation Subset: IM |
Copyright Information:
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Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Topical Aged Aged, 80 and over Anti-Inflammatory Agents, Non-Steroidal / administration & dosage* Antihypertensive Agents / administration & dosage Conjunctiva / drug effects, pathology Double-Blind Method Female Fibrosis / prevention & control Fluorometholone / administration & dosage Glaucoma / drug therapy, surgery* Glucocorticoids / administration & dosage* Humans Intraocular Pressure Ketorolac / administration & dosage Male Middle Aged Mitomycin / administration & dosage Postoperative Complications / prevention & control Preoperative Care Prospective Studies Trabeculectomy* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anti-Inflammatory Agents, Non-Steroidal; 0/Antihypertensive Agents; 0/Glucocorticoids; 426-13-1/Fluorometholone; 50-07-7/Mitomycin; 66635-83-4/Ketorolac |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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