Preoperative Topical Steroid Use and Trabeculectomy Outcomes

PRCIS: Preoperative topical steroid use was associated with greater surgical success and thicker, less reflective bleb walls on anterior segment optical coherence tomography 1 year after trabeculectomy. PURPOSE: To assess the association of preoperative topical steroid administration with surgical outcomes and filtering bleb morphology 1 year after trabeculectomy. PATIENTS AND METHODS: This study included 304 eyes of 272 patients who underwent primary trabeculectomy with mitomycin C. Eyes were classified into steroid and non-steroid groups based on the administration of topical steroids for 7 days preoperatively. The primary outcome was surgical success at 1 year, defined by either criterion A (intraocular pressure [IOP] ≤15 mmHg and a ≥20% reduction from preoperative IOP) or criterion B (IOP ≤12 mmHg and a ≥30% reduction from preoperative IOP), achieved without glaucoma medication or additional glaucoma surgery. Bleb morphology was evaluated using anterior segment optical coherence tomography. Multivariable Cox regression was used to adjust for potential confounders. RESULTS: At 1 year, surgical success rates were significantly higher in the steroid group than in the non-steroid group for both criterion A (85.5% vs. 71.1%, P=0.005) and criterion B (76.4% vs. 65.4%, P=0.040). Preoperative steroid use was significantly associated with a lower hazard of surgical failure (criterion A: adjusted hazard ratio, 0.47; 95% confidence interval, 0.27-0.82; P=0.008). Compared with the non-steroid group, the steroid group exhibited greater bleb wall thickness (0.812 vs. 0.723 mm, P=0.038) and lower bleb wall reflectivity (130.3 vs. 141.9 arbitrary units, P=0.011). CONCLUSIONS: Preoperative administration of topical steroids, compared to no steroids, was associated with higher surgical success rates, thicker bleb walls, and lower bleb wall reflectivity on AS-OCT at 1 year.