Effect of postoperative corticosteroids on surgical outcome and aqueous autotaxin following combined cataract and microhook ab interno trabeculotomy

Abstract

To evaluate the effect of postoperative corticosteroids on surgical outcome and autotaxin (ATX) levels after microhook ab interno trabeculotomy combined with cataract surgery (μLOT-CS), prospective, consecutive non-randomized case series comparing outcomes of 30 eyes with primary open angle glaucoma was performed. The aqueous ATX, intraocular pressure (IOP) and glaucoma medications were monitored for 3 months postoperatively. An in-vivo mouse μLOT model was generated. In vitro, ATX and fibrotic changes induced by dexamethasone (Dex) treatment following scratch (S) in cultured human trabecular meshwork (hTM) cells were assessed by immunofluorescence, immunoenzymatic assay, and RT-qPCR. Postoperative ATX at 1 week and the number of antiglaucoma medications at 3 months were significantly lower in non-steroid group, and steroid use was the only variable significantly associated with postoperative medications at 3 months in multiregression analyses. In vitro, ATX activity was significantly upregulated in the Dex + S group, and αSMA was significantly upregulated in the Dex and Dex + S groups. Fibronectin and COL1A1 were significantly upregulated in the S group. μLOT-CS decreased IOP and medications in the overall cohort, and non-use of postoperative steroids resulted in a smaller number of postoperative medications. Limiting postoperative steroids in μLOT may minimize IOP elevation and postoperative fibrosis.

Comparison of postcataract surgery anti-inflammatory regimens on the incidence of cystoid macular edema, iritis, pain, and photophobia

“…Excessive prostaglandin release that is a potent mediator of the inflammatory cascade causes breakdown of the bloodaqueous barrier, resulting in clinical symptoms such as pain, hyperemia, light sensitivity, and vision-threatening CME. 12,13 Prolonged inflammation leads to patient discomfort and delayed recovery and increases the risk of complications including increased IOP, posterior synechia, uveitis, secondary glaucoma, and posterior capsular opacification. 14 Prophylactic anti-inflammatory regimens vary widely among clinicians but mainly involve the perioperative use of corticosteroids and NSAIDs.…”

“…15,16 NSAIDs have been found to with steroids. 5,12,[17][18][19] In addition to blocking the inflammatory cascade, NSAIDs play an important role in preventing miosis during surgery, improving visualization, reducing intraoperative manipulation, and decreasing the risk of complications that may occur due to poor dilation. 20,21 Several prospective and retrospective clinical studies demonstrated that the combined use of postoperative NSAIDs and steroids is superior to either topical treatment alone in controlling pain and inflammation and reducing the risk for postoperative CME.…”

The lysophosphatidic acid axis in fibrosis: Implications for glaucoma

“…ATX levels in the AH have been positively correlated to postoperative corticosteroid use after microhook ab interno trabeculotomy for POAG. 136 Trabeculotomy is a procedure which involves cleaving the TM and inner wall of SC to reduce resistance to AH outflow in glaucoma patients. 136 Post-operative corticosteroids are associated with IOP spikes, 137 and therefore their use post microinvasive glaucoma surgery is controversial.…”

“…136 Trabeculotomy is a procedure which involves cleaving the TM and inner wall of SC to reduce resistance to AH outflow in glaucoma patients. 136 Post-operative corticosteroids are associated with IOP spikes, 137 and therefore their use post microinvasive glaucoma surgery is controversial. Patients who did not receive post-operative corticosteroids demonstrated significantly lower ATX levels in the AH 1 week post-operatively and required significantly less IOP-lowering medications at 3 months versus those who did received steroids.…”

“…Patients who did not receive post-operative corticosteroids demonstrated significantly lower ATX levels in the AH 1 week post-operatively and required significantly less IOP-lowering medications at 3 months versus those who did received steroids. 136 Post-operative topical corticosteroids are, therefore, associated with reduced success of microhook ab interno trabeculotomy, likely due to ATX-mediated fibrosis in the TM. and ATX in TM cells was significantly increased.…”