The effect of preoperative topical anti-inflammatory treatment on anterior segment and trabeculectomy outcomes assessed by venous oxygen saturation

PURPOSE: To study the effect of local preoperative therapy with steroid and non-steroid anti-inflammatory drugs (NSAIDs) (on the level of the oxygen saturation in anterior segment tissues and prolonging the hypotensive effect of trabeculectomy. METHODS: 80 patients with primary open-angle glaucoma were randomized into 4 groups of 20 people according to the study drug: Nepafenac, Dexasone, their non-fixed combination and the control group with no preoperative therapy. All patients underwent trabeculectomy. The patients administered 1 drop of study drug b.i.d. for 2 weeks before the operation and were examined each day for the first week, on weeks 1, 2 and 4, and on months 3, 6 and 12. Oxygen saturation (SO2) was measured in supralimbal and sublimbal deep conjunctival veins before and after 2 weeks of anti-inflammatory therapy. Main outcome measure was the incidence of postoperative surgical or medical interventions (needling, needling revision, hypotensive therapy). RESULTS: In combined anti-inflammatory treatment group, SO2 increased by 5.2% (from 53.6 to 56.4%), in steroid treatment group - by 4.7% (from 52.7 to 55.2%), in nonsteroidal treatment group - by 2.6% (from 53.4 to 54.8%). In controls, no significant changes in SO2 were observed. 50% of patients in the control group needed postoperative needling, 35% in the NSAIDs, 30% - in the steroid drug group and 20% - in the combined therapy group. 10% of the control group and 5% of the NSAIDs required a needling-revision in the postoperative period. Patients from the steroid and combined therapy groups had no need of a needling procedure. 50% of patients in the control group, 35% in the NSAIDs group, 25% in the steroid drug group and 20% in the combined therapy group required further hypotensive therapy. Complete surgery success in the course of the first year amounted to 50% in patients in the control group, 65% in the NSAIDs group, 75% of the steroid drug group and 80% in the combined therapy group. Qualified success during the first year after surgery totaled 100% in all the groups. CONCLUSION: Pre-op topical anti-inflammatory treatment significantly increased venous oxygen saturation in anterior segment tissues which correlated with 1-year rate of absolute success of trabeculectomy as compared with controls. Local preoperative administration of anti-inflammatory drugs helped increase the complete surgery success throughout a year after trabeculectomy as compared to the control group. The best hypotensive effect was noted in the combined therapy group (80%), then - in the steroid and non-steroid monotherapy groups (75% and 65%).

оксигемоглобин, дезоксигемоглобин, окси гемометрия, сатурация, глаукома, синустрабекулэктомия, противовоспалительная терапия, нидлинг, oxyhemoglobin, deoxyhemoglobin, oxygen saturation, glaucoma, trabeculectomy, anti-inflammatory therapy, needling

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