Effect of steroid eyedrops after trabeculectomy in glaucoma patients: a keratograph analysis

ABSTRACT Purpose: To investigate the use of preoperative steroid eyedrops in glaucoma patients undergoing trabeculectomy for ocular surface disease. Methods: A total of 31 eyes of 31 glaucoma patients were included. Only glaucoma patients who had been using at least three topical intraocular pressure-lowering medications for longer than 6 months were included. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% four times per day for 1 week before trabeculectomy. Data from baseline (day of surgery) and the follow-up visit (2 weeks after surgery) were included. All patients underwent a detailed ophthalmologic examination. Ocular surface disease was evaluated using the Ocular Surface Disease Index questionnaire and clinical measures, including tear breakup time, conjunctival hyperemia, and biomicroscopy to detect the presence or absence of keratitis. Ocular Surface Disease Index scores greater than 13 indicated a clinically relevant presence of ocular surface disease. In addition, all patients underwent keratograph analysis. The comparison of ocular surface disease before and after trabeculectomy was assessed using a paired test. Results: The mean age of the glaucoma patients was 69.90 ± 10.77 years. The average visual acuity was 0.40 ± 0.34 logMAR. The overall Ocular Surface Disease Index prevalence rate was 27.20 ± 17.56 units. Clinical assessment revealed no significant difference in bulbar redness, breakup time, or keratitis before and after surgery (p>0.05 for all comparisons). Keratograph analysis showed that the only two parameters that were significantly different before and after trabeculectomy ewere the bulbar redness by keratograph (BR-K) and the average noninvasive tear breakup time. Patients presented more conjunctival hyperemia and shorter noninvasive tear breakup time after trabeculectomy as compared with before surgery (p=0.013 and p=0.041, respectively). Conclusions: The present study not only confirms the high prevalence of clinical findings of ocular surface disease in glaucoma patients but also reveals new objective parameters measured by keratograph analysis. Apart from using loteprednol etabonate ophthalmic suspension 0.5% 1 week before the surgery, our sample presented a worsening of conjunctival hyperemia (bulbar redness by keratograph) and also a shorter noninvasive tear breakup time postoperatively.

摘要：
研究目的：探讨接受小梁切除术的青光眼患者术前应用类固醇滴眼液对眼表疾病的影响。
研究方法：共纳入31例（31眼）青光眼患者，纳入标准为至少使用3种局部降眼压药物超过6个月的患者。所有患者于小梁切除术术前1周给予0.5%氯替泼诺混悬滴眼液，每日4次。收集基线（手术当日）及术后2周随访时的临床资料。所有患者均接受详细的眼科检查。眼表疾病采用眼表疾病指数（Ocular Surface Disease Index, OSDI）问卷及临床指标进行评估，包括泪膜破裂时间、结膜充血、裂隙灯生物显微镜检查以检测角膜炎的存在与否。眼表疾病指数评分＞13分提示存在临床意义明确的眼表疾病。此外，所有患者均接受角膜地形图仪（keratograph）分析。采用配对检验比较小梁切除术前后的眼表疾病情况。
研究结果：青光眼患者的平均年龄为69.90±10.77岁，平均视力为0.40±0.34 logMAR。整体眼表疾病指数评分为27.20±17.56分。临床评估显示，手术前后的球结膜发红、泪膜破裂时间及角膜炎情况均无显著差异（所有比较项p＞0.05）。角膜地形图仪分析显示，仅两项参数在小梁切除术前后存在显著差异：角膜地形图仪测得的球结膜发红（bulbar redness by keratograph, BR-K）及平均无创泪膜破裂时间。与术前相比，术后患者的结膜充血程度更显著，无创泪膜破裂时间更短（分别为p=0.013和p=0.041）。
研究结论：本研究不仅证实了青光眼患者临床眼表疾病的高患病率，还揭示了角膜地形图仪分析可测得的新型客观参数。除术前1周应用0.5%氯替泼诺混悬滴眼液外，本研究纳入的样本术后出现了结膜充血（角膜地形图仪测得的球结膜发红）加重及无创泪膜破裂时间缩短的情况。