Dados do Trabalho

Título

A NEW POSTOPERATIVE APPROACH FOR IMPROVING THE EFFICACY OF TRABECULECTOMY AND PHACOTRABECULECTOMY IN GLAUCOMA

Objetivo

Most type of POAG are treated with topical medications. However, many patients might need surgery for IOP control and many surgical procedures are now available. However, despite all advances, the surgical treatment is not always successful.
This prospective cohort study aims to present the results of a novel postoperative approach for improving the efficacy of trabeculectomy (TRAB) and phacoemulsification associated to TRAB (PhacoTRAB).

Método

We included two groups of 18 patients who underwent TRAB or PhacoTRAB with MMC for uncontrolled primary open-angle glaucoma despite using two or more antiglaucoma medications. All patients used postoperatively topical gatifloxacin 3mg/ml and dexamethasone 1mg 4 times tapering overtime for four weeks. As a novel approach, patients of the first group used cylocortTM (ciprofloxacin hydrochloride 3.5 mg plus dexamethasone 1mg ointment) at night before bedtime for 30 days beginning the ointment at the first postoperative day. We compared IOP and the number of antiglaucoma eyedrops before and after the use of cylocortTM (ointment group, OG) with 18 patients who also underwent the same surgical procedures by the same surgeon but without using postoperatively the ointment (Non-ointment, NOG). We also compared central corneal thickness (CCT), C/D ratio and visual field indexes. One eye of each patient with a minimum follow-up of six months was included. Mann Whitney U was used to compare independent samples and Fisher exact test to evaluate dependency between variables.

Resultados

The median and interquartile range (IQR) for age were 71.5 (66.5-78.0) in OG and 69.0 (64.0-74.5) in NOG (P=0.355). No statistically significant difference between patients using OG and NOG was found in pre-operative and postoperative IOP: 14.0 (10.0-17.5)/15.0 (10.0-20.0) (P=0.858); 10.0 (8.0-12.0)/10.0 (10.0-11.0) (P=0.406); CCT 522.5 (491.5-551.0)/515.0 (502.2-520.0) (P=0.606); C/D ratio: 0.8 (0.75-0.9)/0.85 (0.8-0.9) (P=0.503); MD: 7.8 (4.02-11.07)/4.5 (3.12-15.8) (P=0.478). and PSD: 5.8 (2.95-7.97)/7.7 (3.55-9.50) (P=0.211). A statistically significant difference in pre-operative eyedrop use was observed between groups: 3.0 (3.0-3.0) in OG and 2.5 (2.0-3.0) in NOG (P=0.007). Postoperatively, only 2 eyes (11.0%) in OG required antiglaucoma eyedrops, compared to 10 eyes (55.5%) in NOG (P=0.012).

Conclusões

The use of cylocortTM ointment improved significantly the efficacy of TRAB and PhacoTREC providing excellent IOP control.

Palavras Chave

Glaucoma, Surgery, Trabeculectomy, Ointment