Initial results on safety and efficacy of sub-tenon triamcinolone injection versus a conventional steroid drops post-operative regimen following glaucoma surgery

Theme: Glaucoma
What: Glaucoma
Part of: Glaucoma III: Old is New / Glaucome III: Faire du neuf avec du vieux
When: 5/31/2024, 04:15 PM - 05:45 PM
Where: Room | Salle 801

Abstract

Purpose: Our study aims to: (i) compare surgical results between use of either sub-tenon triamcinolone acetonide (TAC) injection or prednisolone acetate drops following trabeculectomy and PreserFlo MicroShunt® surgery, and (ii) determine the safety of sub-tenon TAC after these procedures. This novel approach could reduce the burden of drops required after surgery, while achieving non-inferior intraocular pressure (IOP) reduction compared to the traditional post-operative drop regime.

Study design: Patients undergoing trabeculectomy or PreserFlo MicroShunt® surgery were randomized to two distinct steroid regimens: (i) a one-time TAC injection (16 mg) at the conclusion of their surgical case or (ii) a 10 week course of topical steroid drops. Data collected at each post-operative visit included IOP, number of glaucoma medications, need for additional rescue steroid, need for additional surgical procedures and complications.

Methods: Data analysis consisted of a two-sided t-test, with a p-value < 0.05 considered statistically significant.

Results: Thirteen patients undergoing trabeculectomy and nine patients undergoing PreserFlo MicroShunt® surgery were included in the current analysis, for a total of 22 participants.  Twelve out of 22 patients (54.5%) were randomized to TAC injection. Mean IOP at the last post-operative visit thus far, ranging from 2 weeks to 3 months postoperatively, was not found to be significantly different between patients randomized to TAC injection versus steroid drops (10.8 ± 3.2 vs 14.6 ± 7.4, p= 0.12). At their most recent follow up visit, patients who received TAC injection across both surgical groups required an average of 0.1 classes of glaucoma medications, compared to 1.2 in those randomized to drops.  One patient initially given TAC injection required rescue topical steroid to control anterior chamber inflammation at post-operative week two.  Regarding complication rate, one patient who underwent trabeculectomy and TAC injection required reformation of the anterior chamber with viscoelastic for early hypotony, while another who was randomized to conventional drops following their trabeculectomy surgery required bleb needling.  Two patients who were randomized to steroid drops following their PreserFlo MicroShunt® surgeries required revision of the shunt due to elevated IOP.

Conclusions: Patients randomized to TAC injection demonstrated similar IOP post-operatively compared to the conventional drops groups, while requiring fewer topical glaucoma medications. These early results suggests that TAC injection may be a safe and effective alternative to conventional post operative steroid drops following bleb forming glaucoma surgery.

Presenter(s)

Presenting Author: Devin Betsch

Additional Author(s):

Kevin Hodgson, Dalhousie University

Rodolfo Bonatti, Dalhousie University

Lesya Shuba, Dalhousie University

Brennan Eadie, Dalhousie University

Paul Rafuse, Dalhousie University

Mathew Palakkamanil, University of Alberta

Marcelo Nicolela, Dalhousie University

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