Postoperative Treatment With Topical Diclofenac Versus Topical Dexamethasone After Combined Phacotrabeculectomy With Mitomycin C

Levkovitch-Verbin, Hani; Katz, Gabriel; Kalev-Landoi, Maia; Goldenfeld, Modi

doi:10.1097/ijg.0b013e318237bf9e

Cited by 16 publications

(21 citation statements)

References 15 publications

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“…; Levkovitch‐Verbin et al. ). One study included patients with mixed glaucoma types undergoing phacotrabeculectomy with MMC (Levkovitch‐Verbin et al.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…One study included patients with mixed glaucoma types undergoing phacotrabeculectomy with MMC (Levkovitch‐Verbin et al. ), the other study included patients with chronic POAG undergoing trabeculectomy with MMC (Kent et al. ).…”

Section: Summary Of Evidencementioning

confidence: 99%

“…For patients undergoing phacotrabeculectomy, there was a trend towards a greater IOP reduction for the NSAID group compared to the steroid group (p = 0.1) and a trend towards higher mean IOP in the steroid group in the intermediate period after surgery (p = 0.08 and 0.07 at 6 weeks and 5 months, respectively) but the difference disappeared after 8 months (Levkovitch‐Verbin et al. ) but data were only presented graphically and means (SD) were not reported. In the trabeculectomy study, IOP was 12.4 (6.5) (mean (SD)) in the diclofenac group versus 12.8 (0.6) in the prednisolone group at 6 months after surgery (Kent et al.…”

Section: Summary Of Evidencementioning

confidence: 99%

See 2 more Smart Citations

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Almatlouh

Bach‐Holm

Kessel

2018

Acta Ophthalmologica

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Surgical outcome after trabeculectomy depends on maintaining a functional bleb which requires a delicate balance between incomplete wound healing to prevent fibrosis and enough wound healing to prevent hyperfiltration. Thus, controlling the inflammatory response is essential. We conducted a systematic review and meta-analysis to compare the effectiveness of different formulations of steroids (topical, systemic and depot) and nonsteroidal anti-inflammatory drugs (NSAIDs) in achieving long-term pressure control with fewer antiglaucomatous medications, preserving visual acuity and visual fields while considering surgical and postoperative complications. We used the PubMed, EMBASE and Cochrane Libraries to identify randomized controlled trials (RCTs) comparing the effect of different formulations of steroids (topical, systemic or depot) to NSAIDs. Data on prespecified outcomes from eligible references were entered into a meta-analysis using the Review Manager 5.3 program. We identified seven RCTs with a total of 342 included patients. Topical steroids were superior to placebo in controlling intraocular pressure (IOP) and reducing the risk of complications. Supplementing topical steroids with a perioperative steroid depot (subtenon or intracamerally) or systemic steroids in the early postoperative period did not provide better outcome or a change in the risk of complications. Addition of topical NSAIDs to topical steroids in patients undergoing trabeculectomy did not change the outcome or risk profile. For patients undergoing phacotrabeculectomy and topical NSAID, there was a nonsignificant trend towards better intermediate IOP control and a reduced need for antiglaucomatous medications compared to topical steroids but there was no difference in effect for patients undergoing trabeculectomy. In conclusion, there is a low level of evidence to support the clinician in deciding which postoperative regime provides a more favourable outcome because of inconsistency in the reported outcomes between studies and a low number of patients for each comparable intervention and outcome. It does seem that topical steroids are better than no antiinflammatory treatment after glaucoma surgery, but further research is recommended.The authors are grateful for the help of information specialist Karine Korsgaard with the literature search.

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“…; Levkovitch‐Verbin et al. ). One study included patients with mixed glaucoma types undergoing phacotrabeculectomy with MMC (Levkovitch‐Verbin et al.…”

Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

See 1 more Smart Citation

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Almatlouh

Bach‐Holm

Kessel

2018

Acta Ophthalmologica

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“…A single small study 65 compared diclofenac and dexamethasone following combined cataract and trabeculectomy procedures, reporting higher and broader blebs and a trend toward lower IOP in the NSAID group than in the steroid group. Given the paucity of data to guide the use of NSAIDs following cataract surgery combined with trabeculectomy, tube shunt implantation, or minimally invasive glaucoma procedures, NSAID use should be based on the nature of surgery planned, individual patient characteristics, and the anticipated risks and benefits of their use.…”

Section: Special Considerations For Glaucoma Patients Having Cataractmentioning

confidence: 99%

Cataract surgery and nonsteroidal antiinflammatory drugs

Hoffman¹,

Braga-Mele²,

Donaldson

et al. 2016

Journal of Cataract and Refractive Surgery

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Nonsteroidal antiinflammatory drugs (NSAIDs) have become an important adjunctive tool for surgeons performing routine and complicated cataract surgery. These medications have been found to reduce pain, prevent intraoperative miosis, modulate postoperative inflammation, and reduce the incidence of cystoid macular edema (CME). Whether used alone, synergistically with steroids, or for specific high-risk eyes prone to the development of CME, the effectiveness of these medications is compelling. This review describes the potential preoperative, intraoperative, and postoperative uses of NSAIDs, including the potency, indications and treatment paradigms and adverse effects and contraindications. A thorough understanding of these issues will help surgeons maximize the therapeutic benefits of these agents and improve surgical outcomes.

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“…56 Some authors have proposed that 0.1% topical diclofenac is at least equally effective as topical corticoid treatment with 0.1% dexamethasone and even better in some series in what concerns number of medications for glaucoma after surgery, IOP value or bleb morphology. 57 Similarly, there is no general agreement on the range of suspension possibilities: avoiding drugs with conservatives, suspending all activeprinciples or only some, substituting by other less damaging topical drugs, substituting by oral hypotensor medication or directly call off any hypotensor treatment.…”

Section: Issues To Be Clarified About Presurgery Treatment Suspensionmentioning

confidence: 98%

Perioperative pharmacological management in patients with glaucoma

Uña

Martínez-de-la-Casa

Júlvez

et al. 2015

Archivos de la Sociedad Española de Oftalmología (English Editi

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Postoperative Treatment With Topical Diclofenac Versus Topical Dexamethasone After Combined Phacotrabeculectomy With Mitomycin C

Abstract: In this preliminary study, diclofenac sodium is at least as good as topical dexamethasone phosphate for glaucoma patients undergoing two-site combined phacotrabeculectomy with mitomycin C.

Cited by 16 publications

References 15 publications

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Steroids and nonsteroidal anti‐inflammatory drugs in the postoperative regime after trabeculectomy – which provides the better outcome? A systematic review and meta‐analysis

Cataract surgery and nonsteroidal antiinflammatory drugs

Perioperative pharmacological management in patients with glaucoma

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