Study of Effects of Topical Fluorometholone on Tear MCP-1 in Eyes Undergoing Trabeculectomy: Effect on Early Trabeculectomy Outcomes in Asian Glaucoma Patients

<b>Objectives:</b> We aimed to determine if a 2-week pre-operative course of fluorometholone (FML) eyedrops in chronically medicated glaucoma patients reduces the levels of the pro-inflammatory cytokine Monocyte Chemoattractant Protein 1 (MCP-1) and improves early post-operative outcomes after trabeculectomy or phaco-trabeculectomy. <b>Methods:</b> We conducted a single-center, unmasked, prospective pilot interventional case series of 36 patients with glaucoma who received a 2-week course of FML eyedrops prior to undergoing trabeculectomy. A multiplex bead assay was used to quantify the presence of MCP-1 levels in tear samples before and after the use of FML eyedrops, and 307 eyes without treatment with topical FML served as historical controls. Clinical outcome measures of early post-operative outcomes included IOP and additional post-operative interventions (i.e., needling, glaucoma medications, and surgery) required to achieve the desired IOP at 6 months. <b>Results:</b> Out of 36 patients who received FML, 19 patients had a low MCP-1 level (<250 pg/mL/mg) at baseline, which did not significantly change after using FML, and were excluded from analysis. Of the 17 remaining patients, propensity score-matched analysis was conducted to compare them with 17 patients who did not receive FML, matching for the variables of age, gender, ethnicity, diagnosis, longest glaucoma medication duration, and surgery type. Patients with FML treatment had lower odds of requiring any post-operative intervention (including needling, surgery, or IOP-lowering medications) (OR 0.22, CI 0.049-0.95, <i>p</i> = 0.042) compared to patients who did not have pre-operative FML treatment. <b>Conclusions:</b> In patients with higher levels of MCP-1 pre-operatively, the use of FML for 2 weeks pre-operatively improved their early post-operative outcomes following trabeculectomy or phaco-trabeculectomy.