A prospective study comparing topical corticosteroids versus NSAIDs on IOP & the hypertensive phase following Ahmed GV surgery (Dr Darana Yuen)

Notes and comments regarding 26Jun2010 1355hrs presentation at the COS Annual Meeting in Quebec City by Dr Darana Yuen of University of Toronto Dept of Ophthalmology & Visual Sciences

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Rising

Dr Yuen begins by describing the early hypotensive then later hypertensive phases that follow implantation of the Ahmed Glaucoma Valve. Post-op NSAIDs have a potential advantage of not effecting IOP therefore hypothesized that their use could reduce the hypertensive phase if part of this phase is due to the so-called ‘steroid-responder’ phenomenon.

This study involved two surgeons with anterior tube placement with patients randomized to receive either Ketorolac vs dexamethasone eye drops. Glaucoma medications and patient digital massage were prescribed as needed in the post-operative period. The study size was rather small with 13 ketorolac patients compared with 15 dexamethasone patients. The primary outcome being measured was mean IOP.

Pre-op IOP readings were near 30 for both groups. Post-op at all time points. the dexamethasone group had higher IOP but this only reached statistical significance at one time point.

The hypertensive phase was a secondary measure for this study. Here too there was no statistically significant difference in the incidence and duration of the hypertensive phase between the dexamethasone and the ketorolac group.

In terms of post-op complications, conjunctival dehiscence and wound leak was significantly higher in the NSAID group! In fact, all 3 wound leaks were patients using the NSAID.

Conclusion

The mean IOP was greater at all time points in the dexamethasone group but this was only statistically significant at the 4 week visit. However, due to the high incidence of wound leak with the NSAID, the use of Ketorolac instead of dexamethasone drops is not advisable for the control of inflammation following Ahmed Glaucoma Valve surgery.

Q: Why would we see wound leaks with ketorolac?

A: NSAIDs can enhance neutrophil migration, affect MMP, and act as a topical analgesic