Short- and Long-Term Effects of Postoperative Corticosteroids on Trabeculectomy RICHARD J. STARITA, MD, RONALD L. FELLMAN, MD, GEORGE L. SPAETH, MD, EFFIE M. PORYZEES, BA, KEVIN C. GREENIDGE, MD, CARLO E. TRAVERSO, MD Abstract: All patients with primary open-angle or primary angle-closure glaucoma requiring trabeculectomy between January 1982 and January 1983 were entered into a randomized prospective study to evaluate the effect of postoperative corticosteroids. Twenty-three eyes in Group 1 received a cycloplegic and topical antibiotic. Twenty-nine eyes in Group 2 received the same treatment, with the addition of topical 1 "'o prednisolone acetate. Twenty- three eyes in Group 3 received the same treatment as Group 2, with the addition of systemic prednisone. Success rate was significantly improved with the use of topical corticosteroids. Systemic steroids did not prove to be of any added benefit over topical use alone. [Key words: corticosteroids, filtering, bleb, glaucoma, trabeculectomy.] Ophthalmology 92:938-946, 1985 The long-term results of surgical trabeculectomy for the lowering of intraocular pressure (lOP) in glaucom- atous patients are well established. t-It Modifications of these surgical techniques are constantly being sought in an effort to maximize success and to lower morbid- ity.11-19 This approach has added little towards improving the stabilization of visual function in uncontrolled glaucomatous eyes since Caims' 20 and Watson's 21 original description. The possibility of enhancing the final result by drug therapy in the early postoperative period seems to be an intriguing alternative for research. 22 - 26 Clinical observation that systemic corticosteroids may cause thinning 27 and perforation 28 of a preexisting filter- ing bleb supplies stimulating evidence of possible drug- induced alterations in bleb morphology. Early experi- From the William A. and Anna V. Goldberg Glaucoma Service and Research Laboratories of the Wills Eye Hospital and Thomas Jefferson University, Philadelphia. Presented at the Eighty-ninth Annual Meeting of the American Academy of Ophthalmology, Atlanta, Georgia, November 11-15, 1984. Reprint requests to Richard J. Starita, MD, Co-Director, Glaucoma Service, Montefiore Medical Center, 111 East 210th Street, New York NY 10467. 938 mental studies demonstrated the inhibitory effects of steroids on neovascularization, 29 inflammation, 30 and cellular wound healing. 31 It has been speculated that fibroblastic proliferation and cellular inflammation are etiologic factors in the mechanism of filtration fail- ure. 32 - 35 These points lead to the hypothesis that steroid therapy may alter the outcome of trabeculectomy. This hypothesis remains unproven. High success rates for trabeculectomy have been reported with 1 · 6 • 18 · 36 - 41 and without postoperative corticosteroids. 6.4 2 - 44 The problems of transient lOP rise 11 · 18 · 37 · 38 · 45 and cataract formation 5 - 9 are well-known to the ophthalmic surgeon performing trabeculectomy. The ability of cor- ticosteroids to precipitate the same problems in eyes not undergoing surgery is well documented. 46 - 49 Whether corticosteroids increase or decrease the incidence of such complications is not clear. The complex and varied responses of biologic tissues to corticosteroid action are not fully understood. 50 The mechanism by which trabeculectomy stabilizes lOP defies simple explanation. 32 · 33 In light of our ignorance, what result should be expected. This prospective, randomized, clinical trial was designed to establish the possible benefits and risks of postoperative corticosteroid therapy to the patient undergoing trabeculectomy.