Trabeculectomy with Intraoperative Peribulbar Triamcinolone Acetonide

1
Trabeculectomy with Intraoperative Peribulbar
Triamcinolone Acetonide Larissa Camejo, MD,
Malik Y. Kahook, MD, Robert J. Noecker, MD
UPMC Eye Center Department of Ophthalmology Unive
rsity of Pittsburgh School of Medicine
Pittsburgh PA
Introduction
Conclusions
Purpose

Trabeculectomy success improved after the
introduction of antimetabolites, first of
5-fluorouracil and later mitomycin C.
Nevertheless, along with the improved success,
came an increasing number of complications such
as bleb leaks, hypotony, hypotony maculopathy and
endophthalmitis. The use of antimetabolites to
decrease wound healing seems justified in cases
where the benefits outweigh the risks.
Corticosteroids have also been proved to inhibit
fibroblast proliferation.1 Postoperative use of
topical prednisolone acetate plays a very
important role in halting fibrosis and
consequent bleb failure but some blebs still
fail.2-3 As with any medication, prednisolone
delivery will depend on the patients compliance
and dexterity, among other factors. We evaluate
the use of intraoperative peribulbar application
of triamcinolone acetonide

• High success rate (76) with statistically
  significant decrease in IOP at POW1, POM1 and
  POM6 in patients undergoing trabeculectomy with
  MMC and peribulbar triamcinolone acetonide
  injection.
• The use of triamcinolone acetonide as explained
  appears safe in cases of trabeculectomy with
  mitomycin C for patients at high risk for
  failure. Further prospective randomized studies
  are needed to compare success and complication
  rates of this method to trabeculectomy with
  mitomycin C alone.

We investigate the use of intra-operative
peribulbar triamcinolone acetonide in
trabeculectomy surgery.
Results

• Mean age was 67.8/-12.9 years
• IOP decreased from 22.44/- 8.09 mmHg
  pre-operatively to 9.32/-4.69 mmHg, 11.92/-8.20
  mmHg and 12.47/- 3.19 mmHg at postoperative week
  1(POW1), month 1 (POM1) and month 6 (POM6),
  respectively.
• The difference between preoperative and
  postoperative pressures was statistically
  significant at all 3 points in time POW1
  (p1.59x10-8), POM1 (p 7.46x10-7) and POM6 (p
  0.001). Three cases required a glaucoma drainage
  device and were counted as failures. Other three
  patients were lost to follow up before the 6
  months reading. These 6 cases were included in
  the 1week and 1 month analysis but not in the 6
  month analysis.
• Success rate was 76 at 6 months.
• Pre-operatively, patients used an average of
  3.05 drops compared to 0.16 postoperatively at 6
  months.
• LSL was done in 40of patients.
• Needling was done in 12 of patients.

References
1) Blumenkranz MS, Claflin A, Hajek AS. Selection
of therapeutic agents for intraocular
proliferative disease. Cell culture evaluation.
Arch Ophthalmol 1984 1025998-604. 2) Araujo SV,
Spaeth GL, Roth SM, Roth SM, Starita RJ. A
ten-year follow-up on a prospective, randomized
trial of postoperative corticosteroids after
trabeculectomy. Ophthalmology 19951021753-1759 3
) Roth SM, Spaeth GL, Starita RJ, Birbillis EM,
Steinman WC. The effects of postoperative
corticosteroids on trabeculectomy and the
clinical course of glaucoma five year follow up
study. Ophthalmol Surg 199122724-729.
Methods

• This is a retrospective review of trabeculectomy
  procedures performed with mitomycin C (0.4mg/ml
  for 2 minutes) and peribulbar triamcinolone
  acetonide (0.3 ml of 10mg/ml) in 25 consecutive
  cases.
• We delivered the triamcinolone after suturing
  the scleral flap. We used a 19 G curved canula
  hooked to a 1ml syringe and slid it over sclera,
  below the conjunctival flap to deliver the drug
  as posteriorly as possible.
• Preoperative intraocular pressures were compared
  to postoperative pressures at 1 week, 1 month and
  6 months.
• Prevalence of laser suturelysis (LSL) and
  needling procedures was recorded.
• Pre and postoperative use of drops were also
  compared.
• Statistical significance was determined using a
  2-tailed paired T-test.

Support
Core Grant for Vision Research EY080908